Novel quinazolinone MJ­33 induces AKT/mTOR­mediated autophagy­associated apoptosis in 5FU­resistant colorectal cancer cells.

Novel quinazolinone compounds have been studied in the field of drug discovery for a long time. Among their broad range of pharmacological effects, certain compounds effectively inhibit cancer cell proliferation. MJ­33 is a quinazolinone derivative with proposed anticancer activities that was synthesized in our laboratory. The present study aimed to evaluate the anticancer activity of MJ­33 in fluorouracil (5FU)­resistant colorectal cancer cells (HT­29/5FUR) and to investigate the underlying molecular mechanisms. The cell viability assay results indicated that HT­29/5FUR cell viability was inhibited by MJ­33 treatment in a concentration­dependent manner compared with the control group. The cellular morphological alterations observed following MJ­33 treatment indicated the occurrence of apoptosis and autophagy, as well as inhibition of cell proliferation in a time­dependent manner compared with the control group. The acridine orange, LysoTracker Red and LC3­green fluorescent protein staining results indicated that MJ­33 treatment significantly induced autophagy compared with the control group. The DAPI/TUNEL dual staining results demonstrated increased nuclear fragmentation and condensation following MJ­33 treatment compared with the control group. The Annexin V apoptosis assay and image cytometry analysis results demonstrated a significant increase in apoptotic cells following MJ­33 treatment compared with the control group. The western blotting results demonstrated markedly decreased Bcl­2, phosphorylated (p)­BAD, pro­caspase­9 and pro­caspase­3 expression levels, and notably increased cytochrome c and apoptotic peptidase activating factor 1 expression levels following MJ­33 treatment compared with the control group. Moreover, the expression levels of autophagy­related proteins, including autophagy related (ATG)­5, ATG­7, ATG­12, ATG­16, p62 and LC3­II, were increased following MJ­33 treatment compared with the control group. Furthermore, MJ­33­treated HT­29/5FUR cells displayed decreased expression levels of p­AKT and p­mTOR compared with control cells. The results suggested that MJ­33­induced apoptosis was mediated by AKT signaling, and subsequently modulated via the mitochondria­dependent signaling pathway. Therefore, the results suggested that suppression of AKT/mTOR activity triggered autophagy in the HT­29/5FUR cell line. In summary, the results indicated that MJ­33 inhibited HT­29/5FUR cell viability, and induced apoptosis and autophagy via the AKT/mTOR signaling pathway. The present study may provide novel insight into the anticancer effects and mechanisms underlying MJ­33 in 5FU­resistant colorectal cancer cells.

Biocompatibilidade do gel de quitosana associado ao glicerol fosfato na reparação de defeitos ósseos induzidos experimentalmente no rádio de coelhos (Oryctolagus cuniculus) / [Biocompatibility of chitosan gel associated with glycerol phosphate for the healing of experimentally induced radial defects in rabbits (Oryctolagus cuniculus)]

A engenharia de tecidos caracteriza-se como ciência interdisciplinar, a qual vem desenvolvendo biomateriais para a regeneração do tecido ósseo no âmbito das medicinas humana e veterinária. O objetivo desta pesquisa foi avaliar a regeneração óssea obtida da aplicação do hidrogel de quitosana associado ao glicerol fosfato em falha óssea experimentalmente induzida no rádio de coelhos. Foram utilizados 15 coelhos adultos, distribuídos aleatoriamente em dois grupos, representados por cada um dos rádios de cada animal, sendo um grupo tratado com hidrogel de quitosana associado ao glicerol fosfato (grupo biomaterial - GB) e um grupo que não recebeu tratamento com o biomaterial (grupo controle - GC). Os animais foram avaliados radiograficamente, por densitometria óptica e análise histológica, nos períodos 30, 60 e 90 dias pós-operatórios. Houve superioridade estatística na média geral das avaliações radiográficas do GB (2,33±0,48) sobre o GC (1,77±0,06). As médias gerais de avaliação densitométrica do GB foram superiores às do GC, sendo 6,207±1,374 e 5,71±1,512, respectivamente. A avaliação histopatológica do GB foi superior à do GC nos períodos de 30, 60 e 90 dias. Assim, é possível afirmar que o hidrogel de quitosana constitui biomaterial de características desejáveis, promovendo consolidação óssea mais rápida e eficiente, sem causar reações adversas.(AU)

Tissue engineering is an interdisciplinary science that has been developing biomaterials for bone regeneration in medicine and veterinary medicine, following an imminent need. The aim of this study was to evaluate bone regeneration after use of chitosan hydrogel associated with glycerol phosphate in experimentally induced bone gap in the radius of rabbits. Fifteen adult rabbits were randomly distributed in two experimental groups, represented by each radius of every single animal. The animals in the Biomaterial Group (GB) were treated with a glycerol phosphate-associated chitosan hydrogel and in the Control Group (GC) they received no treatment with the biomaterial. The animals were evaluated clinically, radiographically, histologically and by optic densitometry at 30, 60 and 90 days postoperatively. There was statistical superiority in the general average of the radiographic estimates of GB (2.33 ± 0.48) over the CG (1.77 ± 0.06). The general averages of GB densitometric evaluation were higher than the CG, being 6.207 ± 1.374 and 5.71 ± 1.512, respectively. Histopathological evaluation of GB was superior to CG in periods of 30, 60 and 90 days. Chitosan hydrogel constitutes a biomaterial of desired characteristics, promoting faster and more efficient bone repair when compared to GC.(AU)

Severe euglycemic diabetic ketoacidosis of multifactorial etiology in a type 2 diabetic patient treated with empagliflozin: case report and literature review.

BACKGROUND: Sodium-glucose co-transporter-2 (SGLT-2) inhibitors are a relatively novel class of oral medications for the treatment of Type 2 DM with a generally acceptable safety profile. However, these agents have been associated with rare events of a serious and potentially life-threatening complication named euglycemic diabetic ketoacidosis (euDKA). euDKA is not identical with the typical diabetic ketoacidosis, as it often presents with serious metabolic acidosis but only mild to moderate glucose and anion gap elevation. CASE PRESENTATION: We report a case of a 51-year old female with Type 2 DM treated with an SGLT-2 inhibitor, developing severe metabolic acidosis with only mild blood glucose elevation after a routine surgery. A careful evaluation of involved factors led to the diagnosis of euDKA, followed by cautious application of simple therapeutic measures that resulted in complete restoration of acidosis and glycemic control in less than 48-h. CONCLUSIONS: Euglycemic ketoacidosis is a rare but rather serious complication of SGLT-2 inhibitors use, often with a multifactorial etiology. Its atypical presentation requires a high level of awareness by physicians as early recognition of this complication can quickly and safely restore acid-base balance.

Early Hypophosphatemia in High-Risk Preterm Infants: Efficacy and Safety of Sodium Glycerophosphate From First Day on Parenteral Nutrition.

BACKGROUND: Early hypophosphatemia is common in premature infants ≤1250 g. The aim of this study was to assess the frequency and severity of hypophosphatemia after sodium glycerophosphate supplementation from first day of life in parenteral nutrition and to address the safety of this practice. METHODS: Prospective cohort study of infants ≤1250 g birth weight born in a tertiary-care level neonatal intensive care unit and supplied with sodium glycerophosphate from the first day of life. Primary outcome was the presence of hypophosphatemia (<4 mg/dL) on the first week. Data were compared with our 2014 prospective subcohort of infants ≤1250 g receiving phosphate after 48 hours of life and morbidity with that of our 2016 retrospective cohort of ≤1250 g. RESULTS: Fifty-four neonates were included. The frequency of hypophosphatemia was 29.6%. Only 1 patient presented hypophosphatemia <2 mg/dL. Mild hypokalemia was found in 8 patients (50%). No cases of hypernatremia were observed. Patients with hypophosphatemia had significantly lower gestational age (27.4 vs 28.8 weeks, P = .032) and lower z-score birth weight (-1.68 vs -0.47; P = .001). When compared with the 2014 subcohort, we found a lower frequency of hypophosphatemia (29.6% vs 69.2%; P = .008) and a lower rate of samples with hypophosphatemia (20.4% vs 51.4%; P = .0002) and critical hypophosphatemia (0.68% vs 11.4%, P = .0005). No differences were found in morbidity or mortality. CONCLUSIONS: Sodium glycerophosphate supplementation in parenteral nutrition from the first day of life significantly decreased the frequency of hypophosphatemia. No adverse events were reported.

In situ evaluation of low-fluoride toothpastes associated to calcium glycerophosphate on enamel remineralization.

OBJECTIVES: This study aimed to evaluate the effect of low-fluoride toothpastes with calcium glycerophosphate (CaGP) on enamel remineralization in situ. METHODS: Volunteers (n=10) wore palatal devices holding four bovine enamel blocks. The treatments involved 5 experimental phases of 3 days each according to the following toothpastes: placebo, 500 ppm F (500 NaF), 500 ppm F with 0.25% CaGP (500 NaF CaGP), 500 ppm F with 0.25% CaGP (500 MFP CaGP) and 1100 ppm F (1100; positive control). After this experimental period, the fluoride, calcium, and phosphorus ion concentrations from enamel were determined. Surface and cross-sectional hardness were also performed. Data were analysed by 1-way ANOVA, Student-Newman-Keuls' test and by Pearson's correlation. RESULTS: The addition of 0.25% CaGP improved the remineralization potential of low-fluoride toothpastes and the NaF as source of fluoride yielded the best results (p<0.001) as evidenced by the hardness analysis. The 1100 ppm F toothpaste provided higher presence of fluoride in the enamel after remineralization (p<0.001). The addition of CaGP to the NaF and MFP toothpastes led to similar calcium concentration in the enamel as the observed with the positive control (p=0.054). CONCLUSIONS: Toothpastes with 500 ppm F (NaF or MFP) and CaGP showed similar remineralization potential than 1100 ppm F toothpaste. CLINICAL SIGNIFICANCE: Toothpastes containing 500 ppm F associated to CaGP, with both fluoride source (NaF or MFP), showed a potential of remineralization similar to commercial toothpaste. Although there is a need for confirmation in the clinical setting, these results point to an alternative for improving the risk-benefit relationship between fluorosis and dental caries in small children.

Complementary and alternative medications for chronic pelvic pain.

Chronic pelvic pain is common, but rarely cured, thus patients seek both second opinions and alternative means of controlling their pain. Complementary and alternative medicine accounts for 11.2% of out-of-pocket medical expenditures for adults for all conditions in the United States. Although there are many treatments, rigorous testing and well-done randomized studies are lacking. Dietary changes and physical modalities such as physical therapy have often been included in the category of alternative medicine, but their use is now considered mainstream. This article concentrates on other sources of alternative and complementary medicine, such as dietary supplementation and acupuncture.

Effect of low-fluoride dentifrices supplemented with calcium glycerophosphate on enamel demineralization in situ.

PURPOSE: To evaluate whether a low-fluoride dentifrice with calcium glycerophosphate (CaGP) reduced the demineralization process in situ. METHODS: A cross-over design with four treatment phases of 7 days each was used. Ten volunteers wore palatal devices containing four blocks of bovine dental enamel. The enamel was treated (ex-vivo) with a placebo, 500 microg-F/g (500), 500 microg-F/g with 0.25%CaGP (500 CaGP), and 1,100 microg-F/g (1,100) dentifrices (twice a day/1 minute) under cariogenic challenge from sucrose solution. To evaluate mineral loss, surface and cross-sectional hardness were performed. The fluoride, calcium, and phosphorus ion concentrations from enamel and dental plaque were determined. The insoluble extracellular polysaccharide (EPS) concentrations were also analyzed. The data were submitted to ANOVA (1-way) followed by the Student-Newman-Keuls test (P < 0.05). RESULTS: The mineral loss and EPS concentration were lowest in the 500 CaGP and 1,100 dentifrice groups. The use of the 500 CaGP and 1,100 dentifrices resulted in similar fluoride, calcium, and phosphorus concentrations in the enamel and in dental plaque (P > 0.05). The ionic activities of calcium phosphate phases for the 500 CaGP and 1,100 dentifrices were similar (P > or = 0.492). The low-fluoride dentifrice with 0.25%CaGP demonstrated efficacy similar to that of the positive control (1,100 dentifrice) with respect to in situ demineralization.

Grape seed extract as a potential remineralizing agent: a comparative in vitro study.

OBJECTIVE: Remineralization is an effective treatment that may stop or reverse early tooth decay. Grape seed extract (GSE) is the potential remineralizing agent under investigation. MATERIALS AND METHODS: Sound human tooth sections were obtained from the cervical portion of the root and stored in demineralizing solution at 37°C for 96 hours to induce artificial root caries lesions. The sections were divided into four treatment groups including 6.5% grape seed extract, sodium monofluorophosphate (220 ppm) with 0.05% calcium glycerophosphate, 0.5% calcium glycerophosphate and control (no treatment). An in vitro pH cycling model was used to cycle the demineralized specimens through treatment solutions, acidic buffer and neutral buffer for 8 days at 6 cycles per day. Subsequently, they were evaluated using confocal laser scanning microscope. Data were analyzed using analysis of variance (p < 0.05). RESULTS: GSE revealed less demineralization and more remineralization compared with other groups. CONCLUSION: GSE promotes remineralization of artificial root caries lesions. CLINICAL SIGNIFICANCE: The search for the perfect remineralizing agent continues to this day. GSE could be a welcome addition to the remineralization armamentarium.

Efficacy of a novel hydroquinone-free skin-brightening cream in patients with melasma.

BACKGROUND: For treating irregular skin pigmentation, a hallmark of premature skin aging, safe and effective alternatives to hydroquinone and kojic acid are being researched. AIMS: Four skin-brightening actives targeting melanin formation at multiple levels, namely disodium glycerophosphate, L-leucine, phenylethyl resorcinol, and undecylenoyl phenylalanine, in an oil-in-water emulsion cream were evaluated. PATIENTS/METHODS: Twenty female patients with mild-to-moderate epidermal melasma were included. After a washout period of 1 month with a sunscreen, they continued using the sunscreen and added the novel skin-brightening cream for 12 weeks twice daily to entire face. RESULTS: Whereas there was no significant change in skin pigmentation during the washout, signs for uneven skin tone including melasma area and severity and appearance of lentigines significantly decreased by up to 43% after the 12-week treatment period with the skin-brightening cream. The skin-brightening complex is well tolerated, which should allow its continued use over a prolonged period of time, in particular, when comparing skin-brightening approaches with exfoliating or peeling agents. CONCLUSIONS: When used with a daily sunscreen, the skin-brightening complex represents a valuable alternative to hydroquinone products and can be used for maintenance or adjunct skin care with lightening therapies.

Lysophosphatidic acid-induced arterial wall remodeling: requirement of PPARgamma but not LPA1 or LPA2 GPCR.

Lysophosphatidic acid (LPA) and its ether analog alkyl-glycerophosphate (AGP) elicit arterial wall remodeling when applied intralumenally into the uninjured carotid artery. LPA is the ligand of eight GPCRs and the peroxisome proliferator-activated receptor gamma (PPARgamma). We pursued a gene knockout strategy to identify the LPA receptor subtypes necessary for the neointimal response in a non-injury model of carotid remodeling and also compared the effects of AGP and the PPARgamma agonist rosiglitazone (ROSI) on balloon injury-elicited neointima development. In the balloon injury model AGP significantly increased neointima; however, rosiglitazone application attenuated it. AGP and ROSI were also applied intralumenally for 1h without injury into the carotid arteries of LPA(1), LPA(2), LPA(1&2) double knockout, and Mx1Cre-inducible conditional PPARgamma knockout mice targeted to vascular smooth muscle cells, macrophages, and endothelial cells. The neointima was quantified and also stained for CD31, CD68, CD11b, and alpha-smooth muscle actin markers. In LPA(1), LPA(2), LPA(1&2) GPCR knockout, Mx1Cre transgenic, PPARgamma(fl/-), and uninduced Mx1CrexPPARgamma(fl/-) mice AGP- and ROSI-elicited neointima was indistinguishable in its progression and cytological features from that of WT C57BL/6 mice. In PPARgamma(-/-) knockout mice, generated by activation of Mx1Cre-mediated recombination, AGP and ROSI failed to elicit neointima and vascular wall remodeling. Our findings point to a difference in the effects of AGP and ROSI between the balloon injury- and the non-injury chemically-induced neointima. The present data provide genetic evidence for the requirement of PPARgamma in AGP- and ROSI-elicited neointimal thickening in the non-injury model and reveal that the overwhelming majority of the cells in the neointimal layer express alpha-smooth muscle actin.

Injectable thermosensitive hydrogel based on chitosan and quaternized chitosan and the biomedical properties.

A novel injectable thermosensitive hydrogel (CS-HTCC/alpha beta-GP) was successfully designed and prepared using chitosan (CS), quaternized chitosan (HTCC) and alpha,beta-glycerophosphate (alpha,beta-GP) without any additional chemical stimulus. The gelation point of CS-HTCC/alpha beta-GP can be set at a temperature close to normal body temperature or other temperature above 25 degrees C. The transition process can be controlled by adjusting the weight ratio of CS to HTCC, or different final concentration of alpha,beta-GP. The optimum formulation is (CS + HTCC) (2% w/v), CS/HTCC (5/1 w/w) and alpha,beta-GP 8.33% or 9.09% (w/v), where the sol-gel transition time was 3 min at 37 degrees C. The drug released over 3 h from the CS-HTCC/alpha,beta-GP thermosensitive hydrogel in artificial saliva pH 6.8. In addition, CS-HTCC/alpha,beta-GP thermosensitive hydrogel exhibited stronger antibacterial activity towards two periodontal pathogens (Porphyromonas gingivalis, P.g and Prevotella intermedia, P.i). CS-HTCC/alpha, beta-GP thermosensitive hydrogel was a considerable candidate as a local drug delivery system for periodontal treatment.

Effect of a calcium glycerophosphate fluoride dentifrice formulation on enamel demineralization in situ.

PURPOSE: To evaluate in situ the effect and mechanisms involved in the anticariogenic effect of a calcium glycerophosphate fluoride dentifrice. METHODS: In a double-blind, crossover design, a non-F dentifrice (negative control), a F dentifrice and a F dentifrice containing 0.13% CaGP were compared regarding the inhibition of enamel demineralization. Both F dentifrices contained 1500 microg F/g (w/w) as sodium monofluorophosphate (MFP). Bovine enamel blocks were mounted in contact with a S. mutans test plaque, in palatal appliances worn by 10 volunteers. 30 minutes after treatment with the dentifrices, a sucrose rinse was performed and enamel demineralization was assessed after an additional 45 minutes. RESULTS: No significant difference was observed among groups in the calcium and inorganic phosphate concentrations in the fluid phase of the test plaque 30 minutes after the dentifrice use (P > 0.05), but F concentration was significantly higher for both F dentifrices (P < 0.05). Also, the dentifrices did not differ regarding the pH before or 5 minutes after the sugar challenge (P > 0.05). A higher mineral loss was observed for the non-F dentifrice group (P < 0.05), but no significant difference was observed between the F dentifrices containing CaGP or not (P > 0.05). Using this in situ model, the findings suggested that CaGP at the concentration tested did not enhance the inhibition of enamel demineralization promoted by F dentifrice.

Patient perceived outcomes of treatments used for interstitial cystitis.

OBJECTIVES: Interstitial cystitis (IC) is a challenging disease complex. Patients' perception of their outcomes after different treatment modalities may be the best measure of therapeutic efficacy. Our study focused on a large group of women with a diagnosis of IC who reported on perceived outcomes after undergoing invasive and pharmaceutical treatments for their disease. METHODS: Seven hundred fifty patients with a diagnosis of IC completed a computerized survey that queried each patient about their demographics, symptoms, concomitant diagnoses, treatments, and their perceived treatment outcomes. The patients were surveyed on therapies used to treat IC and whether they perceived their condition to be improved, not affected or having deteriorated at a mean follow-up of 6 months. Pearson chi-squared tests were used in the statistical analyses. RESULTS: Invasive and medical therapies were surveyed. The most commonly performed procedures were hydrodistention (61.9%), intravesical therapy (40.1%), and urethral dilatation (26.5%). Of these procedures, 24.4% to 45.3% of patients were improved by these procedures; whereas 27.0% to 49.8% felt no effect and 25.9% to 30.7% worsened. A comparison of the number of patients who improved with those who deteriorated while on medical therapy was found to be significant for all drugs (P <0.001). The majority of patients reported that medications improved their condition, perceptively. CONCLUSIONS: Medical therapy is perceived to be superior to invasive therapy in the treatment of IC. Medication should be considered the first line therapy for IC. Several medications showed a large percentage of patients with improvement in symptoms. These medications were calcium glycerophosphate (Prelief, AkPharma Inc, Pleasantville, NJ), phenazopyridine, and pentosan polysulfate sodium.

[Efficacy of the pharmacotherapy of secondary enuresis in children].

43 children, 8-16 years old, suffering from secondary nocturnal enuresis were treated using different schemes. The most effective treatment of patients with only nocturnal enuresis was using a complex of nootropic psychostimulant medications (Fesam, B vitamins, apilak, Ca Glycerophosphat) with xanthinol nicotinat and combined treatment with the help of day-light therapy (motivating and regimen measures).

A thermo- and pH-sensitive hydrogel composed of quaternized chitosan/glycerophosphate.

The quaternized chitosan was synthesized by the reaction of chitosan and glycidyltrimethylammonium chloride (GTMAC) and named as N-[(2-hydroxy-3-trimethylammonium) propyl] chitosan chloride (HTCC). A novel hydrogel system composed of HTCC/glycerophosphate (HTCC/GP) with thermo- and pH-sensitivity was synthesized and used as an intelligent drug carrier. The formulation was solution below or at room temperature, which allowed it injectable and to incorporate living cells, proteins, enzymes or other therapeutic drugs easily. Once the surrounding temperature was up to 37 degrees C, the system was transformed to a non-flowing hydrogel, and the formed hydrogel can release the trapped drug as a function of pH values. The swelling behavior of the system and the release profiles of doxorubicin hydrochloride (DX) as a model drug at different pH values were investigated. At acidic condition the hydrogel dissolved and released drug quickly, while it absorbed water and released drug slowly at neutral or basic conditions. Hydrogel composed of chitosan hydrochloride and glycerophosphate (CS/GP) was also prepared to compare with HTCC/GP hydrogel. The HTCC/GP hydrogel in this study was transparent which made it suitable for some specific uses such as ocular drug formulation.

Calcium glycerophosphate and caries: a review of the literature.

AIM: To review studies in the dental literature regarding the anti-caries mode of action of glycerophosphate with special reference to calcium glycerophosphate. The cariostatic properties of calcium glycerophosphate have been demonstrated during numerous in vivo and in vitro studies. Several mechanisms have been suggested and these include plaque-pH buffering, elevation of plaque calcium and phosphate levels and direct interaction with dental mineral. There is credible evidence that calcium glycerophosphate has the potential to reduce the progression of caries via all of these mechanisms if it is applied frequently and at a sufficiently high concentration. Reduction of plaque mass has also been proposed as a cariostatic mechanism but this seems less likely. Animal studies have shown that the calcium glycerophosphate/sodium monofluorophosphate system can have a greater anti-caries effect than sodium monofluorophosphate alone and this was subsequently confirmed in a caries clinical trial. We conclude that elevation of calcium levels in plaque is the most likely explanation and that any means of enhancing this effect has significant promise as a means to further increase in anti-caries potential of the calcium glycerophosphate/sodium monofluorophosphate system compared to sodium monofluorophosphate alone.

Structure and chemical composition of an experimentally formed apical barrier after the application of calcium-glycerophosphate.

Transformation in the structure and composition of calcium-glycerophosphate (Ca-GP) was investigated using a scanning electron microscope fitted with an energy dispersive X-ray microanalysis (EDX) system. Ca-GP was packed inside roots that were subsequently implanted into the mandibles of rats to stimulate the formation of an apical barrier. Scanning electron microscopic observations of packed Ca-GP revealed three types of structures: globular aggregates, plate or flake-like aggregates, and granular aggregates. The average Ca/P molar ratios of EDX by area mode--postoperatively obtained at days 1, 3, 5, and 7--were 1.300, 1.533, 1.472, and 1.495 (analytic area: 0.01 to 0.03 mm2) and those of EDX by point mode were 1.220, 1.451, 1.487, and 1.467 (analytic point: 0.05 micron 2). The magnesium (Mg) weight percentage was found to be approximately 1.9 at days 3, 5, and 7, similar to Mg-substituted whitlockite. These findings suggest that Ca-GP are transformed, over a period of 3 days into Mg-substituted whitlockite as a result of being hydrolyzed by tissue fluid.

The effect of magnesium oral therapy on spasticity in a patient with multiple sclerosis.

The effects of magnesium glycerophosphate oral therapy on spasticity was studied in a 35-year-old woman with severe spastic paraplegia resulting from multiple sclerosis (MS). We found a significant improvement in the spasticity after only 1 week from the onset of the treatment on the modified Ashworth scale, an improvement in the range of motion and in the measures of angles at resting position in lower limbs. No side-effects were reported and there was no weakness in the arms during the treatment.