Neuromuscular electrical stimulation changes glucose, but not its variability in type 2 diabetes: a randomized clinical trial.

Neuromuscular electrical stimulation (NMES) can be an alternative to conventional exercising. This randomized clinical trial evaluated the effect of NMES in type 2 diabetes patients. Twenty-eight individuals with type 2 diabetes were assigned to NMES (n=14) or NMES-placebo (n=14) applied to knee extensor muscles for 60 minutes. Glucose variability, microvascular function and endothelial function were evaluated through continuous glucose monitoring system, near infrared spectroscopy and flow-mediated dilatation, respectively. Glucose levels (mg/dl) decreased 2h (184 ± 11 vs 223 ±15), 3h (179 ± 12 vs 219 ±14) and 4h (177 ± 12 vs 212 ±12) after NMES, in comparison to NMES-placebo. No differences in glucose variability were found: coefficient of variation (%) at 0-6h (11.4±1.3 vs 11.4±1.2), 6-12h (9.8±1.0 vs 11.6±1.6), 12-18h (15.5±2.0 vs 11.4±2.1), 18-24h (12.8±2.3 vs 10.0±1.6); standard deviation (mg/dl) at 0-6h (21.6±2 vs 24.6±3.5), 6-12h (19.5±1.8 vs 20.3±2.8), 12-18h (29.9±3.5 vs 21.3±2.8),18-24h (22.8±4.1 vs 16.6±2.0) and mean amplitude of glycemic excursions (mg/dl) 54.9±25.0 vs 70.3±35.7. Endothelial and microvascular functions did not change. In conclusion, one acute NMES session was strong enough to trigger glucose reduction in individuals with type 2 DM, but it failed to induce any significant change in glucose variability, endothelial and microvascular functions.

Allogeneic mesenchymal stromal cells: Novel therapeutic option for mutated FLNA-associated respiratory failure in the pediatric setting.

BACKGROUND: Mesenchymal stromal cell (MSC)-mediated therapeutic effects have been observed in the treatment of lung diseases. For the first time, this treatment was used as rescue therapy in a pediatric patient with a life-threatening respiratory syndrome associated with the filamin A (FLNA) gene mutation. METHODS: A child with a new pathogenic variant of the FLNA gene c.7391_7403del (p.Val2464AlafsTer5), at the age of 18 months, due to serious and irreversible chronic respiratory failure, was treated with repeated intravenous infusions of allogeneic bone marrow (BM)-MSCs. The child's respiratory condition was monitored. Immunologic studies before each MSC treatment were performed. RESULTS: No acute adverse events related to the MSC infusions were observed. After the second infusion, the child's respiratory condition progressively improved, with reduced necessity for mechanical ventilation support. A thorax computed tomography (CT) scan showed bilateral recovery of the basal parenchyma, anatomical-functional alignment and aerial penetration improvement. After the first MSC administration, an increase in Th17 and FoxP3+ T percentages in the peripheral blood was observed. After the second MSC infusion, a significant rise in the Treg/Th17 ratio was noted, as well as an increased percentage of CD20+ /CD19+ B lymphocytes and augmented PHA-induced proliferation. DISCUSSION: MSC infusions are a promising therapeutic modality for patients in respiratory failure, as observed in this pediatric patient with an FLNA mutation. MSCs may have an immunomodulatory effect and thus mitigate lung injury; although in this case, MSC antimicrobial effects may have synergistically impacted the clinical improvements. Further investigations are planned to establish the safety and efficacy of this treatment option for interstitial lung diseases in children.

Topical application of cashew gum or chlorhexidine gel reduces overexpression of proinflammatory genes in experimental periodontitis.

This study aimed to explore the effect of topically administering an orabase gel containing cashew gum (CG), a complex polysaccharide from Anacardium occidentale L., on the transcription of important proinflammatory (COX-2, NOS-2, INF-γ, OSCAR, and MYD88) and anti-inflammatory genes (IL-10, IL-4, and TGFß1) in the gingival tissues of rats with ligature-induced periodontitis, compared to the effect observed upon topically applying a well-known antibiofilm agent (chlorhexidine) under the same experimental conditions. The gene expression profile in the gingival tissues of rats with periodontitis treated with CG did not statistically significantly differ from that observed in the group of animals treated with chlorhexidine. Results showed that CG is able to attenuate general inflammation in the periodontium by reducing the transcription of proinflammatory mediators in a MYD88-independent manner, and not by inducing the expression of anti-inflammatory factors. In conclusion, this study demonstrated that CG and chlorhexidine treatment reduced significantly the gene overexpression (COX-2, NOS-2, INF-γ, OSCAR, and TGFß1) in the model of ligature-induced periodontitis.

Boyd Amputation Using the Tension Band Technique.

BACKGROUND: Amputation at the level of the hindfoot results in an equinus deformity from an imbalance of muscle-tendons acting across the ankle. Boyd's reconstruction for hindfoot amputations is a well-known technique that retains the calcaneus and fuses it with the distal tibia at the ankle mortise. It provides an excellent weight-bearing stump and in most cases does not require an artificial limb but its use has been restricted because of the difficulty in obtaining high union rates in the tibiocalcaneal fusion. MATERIALS AND METHODS: Five patients (four unilateral and one bilateral) underwent leg amputations from January 2012 to November 2013 using the Boyd technique for reconstructing the stump and were stabilized with a tension band. The study sample consisted of adult patients who had traumatic reasons for the amputation. Patients under 18 years old with a hindfoot that was inadequate for Boyd reconstruction (i.e., insufficient soft tissue coverage or no posterior tibial artery pulse) were excluded. One (case #2) had systemic comorbidities (e.g., hypertension, diabetes, chronic vascular insufficiency) as well as being a smoker. Three men and two women (mean age 39 years; range 21-61 years) were included. Three patients underwent amputation on the right side, one on the left side, and one bilaterally (case #5). All patients presented with Gustillo and Anderson IIIC open fractures. The mean time from lesion to amputation was 2.25 weeks (range 1-4 weeks). The mean follow-up duration was 16 (range 12-24) months. The post-surgery examination included a clinical examination and radiography. A 6 minute walk test (6 MWT) was performed on week 32 after the amputation. This study was carried out with the approval of our institution's ethics committee. All patients provided a written informed consent form in accordance with the World Medical Association and the Declaration of Helsinki. RESULTS: All six stumps fused successfully. The 6 MWT results were comparable to those found in the literature for other lower limb amputees. CONCLUSION: The tension band technique used as part of the Boyd amputation to achieve tibiocalcaneal fusion was effective in all five trauma patients. Sound fusion was achieved in all cases with the 6 MWT scores comparable to that in the literature. This technique should be considered an osteosynthesis option for the Boyd procedure. LEVEL OF EVIDENCE: Level IV, retrospective study. HOW TO CITE THIS ARTICLE: Mongon MLD, Sposito AL, Nunes GMN, et al. Boyd Amputation Using the Tension Band Technique. Strategies Trauma Limb Reconstr 2019;14(2):102-105.

Periodontal therapy and endothelial function in coronary artery disease: A randomized controlled trial.

OBJECTIVE: To assess the effects of periodontal treatment on endothelial function in patients with coronary artery disease. MATERIALS AND METHODS: A randomized controlled trial was conducted with 69 patients with stable coronary disease and severe periodontitis. The test group received nonsurgical periodontal therapy consisting of personalized oral hygiene instructions, subgingival scaling, and root planing per quadrant, whereas the control group received equal treatment after the study period. Endothelial function was assessed by measurement of brachial artery flow-mediated dilation, concentrations of sVCAM-1, sICAM-1, and P-selectin in serum before and 3 months after periodontal therapy. RESULTS: The test group exhibited statistically better periodontal parameters-plaque, probing depth, periodontal attachment loss, and bleeding on probing. No significant improvements were observed in the control (1.37%) and test (1.39%) groups in flow-mediated dilation, with no significant between-group difference. sVCAM-1 concentration increased in the control group (997.6 ± 384.4-1201.8 ± 412.5; p = 0.03), whereas in the test group, no significant changes were observed (915.1 ± 303.8-1050.3 ± 492.3; p = 0.17), resulting in a significant difference between the two groups (p = 0.04). The same pattern was observed for concentrations of sICAM-1. CONCLUSION: Periodontal treatment did not provide better vasodilation in patients with coronary disease in a short-term follow-up period, although it maintained blood concentrations of markers of vascular inflammation.

Critical analyses when modeling tree biomass to ensure additivity of its components.

It is presented the theme additivity of biomass of tree components. To evaluate and discuss this context, experimental information collected in forests of Acacia mearnsii De Wild. was used. Equations for components (stem and crown) and total biomass were fitted by means of two procedures: 1) generalized nonlinear least squares and 2) weighted-nonlinear seemingly unrelated regressions. Analyzing the performance of the estimators, it can be concluded that the two tested procedures are equivalent. On the other hand, this conclusion differs when evaluated the consistency and efficiency of the estimators. Fitting equations for the components and for the total biomass by an independent way is not realistic, because from a biological point of view the estimates of biomass are inconsistent, i.e., are not additive. The biomass estimates of the components and of the total, resulting from equations adjusted by means of systems of equations, provided narrower confidence intervals in relation to the equations adjusted independently, and is therefore more efficient. The second procedure presents better biological properties and statistics to estimate allometric equations for biomass of the components and for the total when compared with the independent estimation, thus it should be the method to be used.

Supra-Nanoparticle Functional Assemblies through Programmable Stacking.

The quest for the by-design assembly of material and devices from nanoscale inorganic components is well recognized. Conventional self-assembly is often limited in its ability to control material morphology and structure simultaneously. Here, we report a general method of assembling nanoparticles in a linear "pillar" morphology with regulated internal configurations. Our approach is inspired by supramolecular systems, where intermolecular stacking guides the assembly process to form diverse linear morphologies. Programmable stacking interactions were realized through incorporation of DNA coded recognition between the designed planar nanoparticle clusters. This resulted in the formation of multilayered pillar architectures with a well-defined internal nanoparticle organization. By controlling the number, position, size, and composition of the nanoparticles in each layer, a broad range of nanoparticle pillars were assembled and characterized in detail. In addition, we demonstrated the utility of this stacking assembly strategy for investigating plasmonic and electrical transport properties.

Pedicled Sensate Composite Calcaneal Flap in Children With Congenital Tibial Pseudoarthrosis.

BACKGROUND: The preservation and functionality of a limb affected by a malformation (such as congenital pseudoarthrosis of the tibia) or a severely mangled lower limb in children, despite modern reconstructive techniques, remains challenging, often eventually requiring amputation to achieve a better outcome. The classical Syme and Boyd procedures are functionally better than transtibial (TT) amputation, but are not feasible for congenital tibial pseudoarthrosis. TT amputation delivers an excellent, effective, and functional stump that usually leads, after prosthetization, to a functional gait. Unfortunately, in some situations, particularly when amputation is performed conventionally, the stump is also associated with complications. Future surgical revisions are often needed, particularly in children, because of stump overgrowth. METHODS: Between 2008 and 2010, three patients diagnosed with congenital pseudoarthrosis of the tibia associated with neurofibromatosis who were indicated for TT amputation with calcaneal flap after failure of all previous surgical reconstructive procedures were selected. The chosen method for osteosynthesis was an external fixator of Ilizarov. RESULTS: At 12 weeks of follow-up, the stump had healed in all three patients, and tibiocalcaneal fusion was achieved without complications. All patients were prosthetized and had an asymptomatic gait. After a minimum follow-up of 6 years, all three cases with the pedicled sensate composite calcaneal flap still had a strong, full weight-bearing surface and have adapted easily to the conventional prosthesis, providing a painless stump with excellent functionality. CONCLUSION: With a 0 rate of needed revisions, all 3 cases with the pedicled sensate composite calcaneal flap preserving the hind foot still have a strong, full weight-bearing surface and have easily adapted to the conventional prosthesis, providing a painless and excellent functional stump that could last a lifetime. LEVEL OF EVIDENCE: Level IV.

Protein conformation by EPR spectroscopy using gadolinium tags clicked to genetically encoded p-azido-L-phenylalanine.

Quantitative cysteine-independent ligation of a Gd(3+) tag to genetically encoded p-azido-L-phenylalanine via Cu(I)-catalyzed click chemistry is shown to deliver an exceptionally powerful tool for Gd(3+)-Gd(3+) distance measurements by double electron-electron resonance (DEER) experiments, as the position of the Gd(3+) ion relative to the protein can be predicted with high accuracy.

Comparison of data mining and allometric model in estimation of tree biomass.

BACKGROUND: The traditional method used to estimate tree biomass is allometry. In this method, models are tested and equations fitted by regression usually applying ordinary least squares, though other analogous methods are also used for this purpose. Due to the nature of tree biomass data, the assumptions of regression are not always accomplished, bringing uncertainties to the inferences. This article demonstrates that the Data Mining (DM) technique can be used as an alternative to traditional regression approach to estimate tree biomass in the Atlantic Forest, providing better results than allometry, and demonstrating simplicity, versatility and flexibility to apply to a wide range of conditions. RESULTS: Various DM approaches were examined regarding distance, number of neighbors and weighting, by using 180 trees coming from environmental restoration plantations in the Atlantic Forest biome. The best results were attained using the Chebishev distance, 1/d weighting and 5 neighbors. Increasing number of neighbors did not improve estimates. We also analyze the effect of the size of data set and number of variables in the results. The complete data set and the maximum number of predicting variables provided the best fitting. We compare DM to Schumacher-Hall model and the results showed a gain of up to 16.5% in reduction of the standard error of estimate. CONCLUSION: It was concluded that Data Mining can provide accurate estimates of tree biomass and can be successfully used for this purpose in environmental restoration plantations in the Atlantic Forest. This technique provides lower standard error of estimate than the Schumacher-Hall model and has the advantage of not requiring some statistical assumptions as do the regression models. Flexibility, versatility and simplicity are attributes of DM that corroborates its great potential for similar applications.

Psychological factors are associated with changes in the health-related quality of life in inflammatory bowel disease.

BACKGROUND: The effect of different sociodemographic and clinical variables on the health-related quality of life (HRQOL) of patients with inflammatory bowel disease (IBD) is currently known, but the influence of psychological factors has not been sufficiently explored. The objective of this study was to identify psychological predictors of HRQOL in patients with IBD. METHODS: A cross-sectional prospective study was undertaken including 875 consecutive IBD patients. Independent variables were measured using a sociodemographic and clinical questionnaire, the Hospital Anxiety and Depression Scale (HADS) questionnaire, the Perceived Stress Scale (PSS) questionnaire, and the COPE questionnaire. Dependent variables were measured using the Short Form 36 Health Survey (SF-36) and the Inflammatory Bowel Disease Questionnaire (IBDQ-36). Logistic regression was performed to identify factors associated with HRQOL. RESULTS: The participation rate was 91.3%. Patients with IBD had a poorer HRQOL than the general population except on the Physical Function, Social Function, and Emotional Function Scale. Moreover, high levels of anxiety, depression, and stress were found to be associated with low levels in all quality of life measurements. No significant relationship was found between HRQOL and coping strategies. CONCLUSIONS: In patients with IBD, stress, anxiety and depression are important determinants of HRQOL and should therefore be considered in the management of this patient population.

Contribuição do Mismatch Negativity na avaliação cognitiva de indivíduos portadores de esclerose múltipla / Mismatch Negativity contribution in Multiple Sclerosis patients

O Mismatch Negativity (MMN) é um potencial evocado auditivo endógeno, gerado por mudanças no processo de discriminação que ocorrem no córtex auditivo que avalia a memória sensorial auditiva. OBJETIVOS: Avaliar se, quando presente, o MMN pode ser utilizado como um índice funcional do córtex auditivo supratemporal e correlacionar com comprometimento cognitivo, avaliado pelo Teste Auditivo Compassado de Adição Seriada (PASAT). MATERIAL E MÉTODOS: Um grupo controle e outro com diagnóstico definido de EM foram submetidos ao registro do MMN com estímulos auditivos com variação de duração e de freqüência. O grupo de EM foi submetido ao PASAT. As latências e as amplitudes negativas do MMN foram comparadas entre os grupos. Os escores do PASAT foram correlacionados com a presença ou ausência do MMN nos dois protocolos de estimulação auditiva. RESULTADOS: O MMN esteve presente em 60 por cento dos indivíduos no grupo de EM no protocolo de estimulação auditiva com variação de duração, e em 45 por cento no protocolo de estimulação auditiva com variação de freqüência. Encontrou-se uma correlação estatisticamente significante entre a ausência da onda do MMN com a presença de comprometimento cognitivo avaliado pelo PASAT. CONCLUSÕES: A ausência do MMN se correlaciona com comprometimento cognitivo avaliado pelo PASAT.

Mismatch Negativity is a functional index of the supratemporal auditory cortex. AIM: The aim of the present study on Mismatch Negativity (MMN) in multiple sclerosis (MS) patients was to evaluate if the MMN can be correlated with cognitive deficits assessed by the Paced Auditory Addition Task - PASAT. METHOD: a clinical study in forty females and 20 males separated in two groups: control individuals and those with a definite diagnosis of MS underwent a duration and frequncy MMN. The MMN latencies and negative amplitudes obtained from the MS group were compared to the ones from the control group. The scores from the Paced Auditory Addition Task were correlated either with the presence or the absence of MMN. RESULTS: MMN was found in 60 percent of the individuals with multiple sclerosis within the auditory stimulation protocol with varied durations, and in 45 percent within the auditory stimulation protocol with frequency variations. There were no statistically significant differences in latencies and amplitudes when compared to controls. We found a statistically significant correlation for the lack of MMN wave together with cognitive disorder asserted by the PASAT. CONCLUSIONS: The MMN correlated to the cognitive deficit assessed by the PASAT.

Mismatch negativity contribution in multiple sclerosis patients.

UNLABELLED: Mismatch Negativity is a functional index of the supratemporal auditory cortex. AIM: The aim of the present study on Mismatch Negativity (MMN) in multiple sclerosis (MS) patients was to evaluate if the MMN can be correlated with cognitive deficits assessed by the Paced Auditory Addition Task--PASAT. METHOD: a clinical study in forty females and 20 males separated in two groups: control individuals and those with a definite diagnosis of MS underwent a duration and frequency MMN. The MMN latencies and negative amplitudes obtained from the MS group were compared to the ones from the control group. The scores from the Paced Auditory Addition Task were correlated either with the presence or the absence of MMN. RESULTS: MMN was found in 60% of the individuals with multiple sclerosis within the auditory stimulation protocol with varied durations, and in 45 % within the auditory stimulation protocol with frequency variations. There were no statistically significant differences in latencies and amplitudes when compared to controls. We found a statistically significant correlation for the lack of MMN wave together with cognitive disorder asserted by the PASAT. CONCLUSIONS: The MMN correlated to the cognitive deficit assessed by the PASAT.

Hiperaldosteronismo primário revisitado / Revised primary hyperaldosteronism

Esta apresentação tem o objetivo de discutir o tema "hiperaldosteronismo primário" (HAP). Inicialmente, serão apresentados os dados clínicos, laboratoriais, radiológicos e o resultado do estudo anátomo-patológico do tumor de uma paciente portadora de "aldosteronoma", seguindo-se uma discussão centrada em três pontos principais: 1) a investigação de HAP em pacientes com hipertensão arterial; 2) o diagnóstico etiológico do HAP; e 3) o tratamento das várias formas de apresentação do HAP.

Carga viral en el manejo clínico de la infección por VIH / Viral load in the clinic management of HIV infection

Los marcadores clínicos (infecciones oportunistas), los marcadores inmunológicos (recuento de CD4) o los marcadores virales (beta 2 microglobulina, cultivo viral, antígeno p24, etc.) son poco eficientes como predictores de progresión en los pacientes con infección por VIH. Algunos son tardíos, como los clínicos, de costo elevado, de relativa lentitud en la obtención de resultados, los que a veces son paradójicos, como ocurre con los inmunológicos y vírológicos, todo lo cual los hace poco contables para predecir el progreso de la enfermedad y la eficacia de la terapia antirretroviral. En la actualidad, la cuantificación de Za carga viral aparece como una técnica más eficiente en cualquier etapa de la infección, tanto para establecer el pronóstico de progresión, como para el manejo de la terapia antiviral. Por ello, en este artículo revisamos los conceptos más actuales sobre ésta, los fundamentos en que se sustenta y su utilidad en el manejo clínico de los pacientes VIH positivos

Condiçöes do aleitamento materno em uma populaçäo assistida pela Unidade Básica de Saúde Säo Lourenço Regiäo Sul-Londrina-PR / Breath feeding's conditions in an assisted population by Säo Lourenço Health Basic Unit - Londrina-PR

O aleitamento materno é reconhecidamente um dos principais fatores de crescimento saudável, um indicador de saúde das crianças, especialmente nas populaçöes carentes. Este trabalho objetivou caracterizar a prática da amamentaçäo em um grupo de 143 mäes atendidas na Unidade Básica de Saúde Säo Lourenço (Regiäo Sul, Londrina), distribuídas em duas realidades socioeconômicas distintas. Investigou-se a frequência do aleitamento, incidência de doenças em crianças amamentadas ou näo, conhecimentos sobre o tipo ideal de leite, suplementaçäo e desmame e tabus alimentares. Observamos que a prática do aleitamento é maior entre mäes de família que ganham até um salário mínimo mensal (cerca de 64 por cento) e que receberam orientaçöes quando do parto (90 por cento); o aleitamento exclusivo até os seis meses de idade ocorre em apenas 50 por cento dos casos e o desmame é relativamente tardio, talvez devido à impossibilidade econômica em introduzir suplementaçäo adequada. Estes resultados apontam à necessidade de desencadear atividades educativas, de atençäo pré e perinatal nos serviços de saúde e lideranças comunitárias, visando a prevençäo de agravos à saúde das mäes e de seus filhos

Levels of cadmium, lead and zinc protoporphyrin absorption in different risk groups.

We studied groups of workers, of pregnant women and of neonates exposed and unexposed to cadmium and lead at their place of work or in the environment. A total of 118 exposed and 28 unexposed workers were studied, together with 90 exposed and 100 unexposed pregnant women and neonates. Concentrations of cadmium and lead in the blood were determined by atomic absorption spectrophotometry. There were significant differences in cadmium concentrations between workers and neonates, and significant differences in lead concentrations between workers and pregnant women. We believe these differences are due mainly to high levels of pollution in the area studied.