Bilateral Idiopathic Carpal Tunnel Syndrome: Clinical-Functional Characterization and Efficacy of Two Combined Postoperative Physiotherapeutic Treatments.

OBJECTIVE: To evaluate the efficacy of combined association instrument myofascial mobilization (IASTM) and stretching in patients with idiopathic bilateral carpal tunnel syndrome (CTS) operated on one hand and to analyze the response of the operated (OH) and non-operated (NH) hand according to the sequence of therapies. Research on these parameters has not yet been found in the literature. METHODS: Randomized controlled crossover study with 43 participants using the objective and subjective outcome variables. Patients were randomly assigned to two groups: starting with stretching followed by IASTM and starting with IASTM followed by stretching. Then patients underwent surgery on the hand with more severe involvement and physical therapy rehabilitation was started 30 days after for a period of 4 weeks. After the 1-week interval the participants who started with stretching were referred to IASTM and vice versa, following the same previous patterns. The outpatient reassessments took place at 3 to 6 months. Crossover ANOVA and effect sizes were used as analysis methods. RESULTS: Time was the most significant outcome for all variables both during therapies and at 6-month follow-up. Regarding response to the combined therapies between OH and NH, there were differences for both OH and NH, with the greatest impact on NH for the palmar grip and VAS variables. The treatment sequences were significant for pain on the NH and mental SF-12, suggesting that starting with IASTM followed by stretching had a superior outcome for these outcomes. CONCLUSION: The combination of IASTM with stretching, used in the postoperative period of bilateral idiopathic CTS, proved to be supplementary, with significant results and large effect sizes for most of the outcomes assessed, both during the time of application of the therapies and in the 6-month follow-up for both hands, and may constitute a viable therapeutic alternative for this population.

Towards the Objective Identification of the Presence of Pain Based on Electroencephalography Signals' Analysis: A Proof-of-Concept.

This proof-of-concept study explores the potential of developing objective pain identification based on the analysis of electroencephalography (EEG) signals. Data were collected from participants living with chronic fibromyalgia pain (n = 4) and from healthy volunteers (n = 7) submitted to experimental pain by the application of capsaicin cream (1%) on the right upper trapezius. This data collection was conducted in two parts: (1) baseline measures including pain intensity and EEG signals, with the participant at rest; (2) active measures collected under the execution of a visuo-motor task, including EEG signals and the task performance index. The main measure for the objective identification of the presence of pain was the coefficient of variation of the upper envelope (CVUE) of the EEG signal from left fronto-central (FC5) and left temporal (T7) electrodes, in alpha (8-12 Hz), beta (12-30 Hz) and gamma (30-43 Hz) frequency bands. The task performance index was also calculated. CVUE (%) was compared between groups: those with chronic fibromyalgia pain, healthy volunteers with "No pain" and healthy volunteers with experimentally-induced pain. The identification of the presence of pain was determined by an increased CVUE in beta (CVUEß) from the EEG signals captured at the left FC5 electrode. More specifically, CVUEß increased up to 20% in the pain condition at rest. In addition, no correlation was found between CVUEß and pain intensity or the task performance index. These results support the objective identification of the presence of pain based on the quantification of the coefficient of variation of the upper envelope of the EEG signal.

tDCS Task-Oriented Approach Improves Function in Individuals With Fibromyalgia Pain. A Pilot Study.

Fibromyalgia (FM) is a complex pain syndrome accompanied by physical disability and loss of daily life activities. Evidences suggest that modulation of the primary motor cortex (M1) by transcranial direct current stimulation (tDCS) improves functional physical capacity in chronic pain conditions. However, the gain on physical function in people living with FM receiving tDCS is still unclear. This study aimed to evaluate whether the tDCS task-oriented approach improves function and reduces pain in a single cohort of 10 FM. A total of 10 women with FM (60.4 ± 15.37 years old) were enrolled in an intervention including anodal tDCS delivered on M1 (2 mA from a constant stimulator for 20 min); simultaneously they performed a functional task. The anode was placed on the contralateral hemisphere of the dominant hand. Outcome assessments were done before the stimulation, immediately after stimulation and 30 min after the end of tDCS. The same protocol was applied in subsequent sessions. A total of five consecutive days of tDCS were completed. The main outcomes were the number of repetitions achieved and time in active practice to evaluate functional physical task performance such as intensity of the pain (visual analog scale) and level of fatigue (Borg scale). After 5 days of tDCS, the number of repetitions achieved significantly increased by 49% (p = 0.012). No change was observed in active practice time. No increase in pain was observed despite the mobility of the painful parts of the body. These results are encouraging since an increase in pain due to the mobilization of painful body parts could have been observed at the end of the 5th day of the experiment. These results support the use of tDCS in task-based rehabilitation.

Posturographic Analysis in the Elderly with and without sensorineural Hearing Loss

Abstract Introduction Sensorineural hearing loss (SNHL) is a serious public health problem. Some evidence suggests a significant relationship between SNHL and balance disorders. The inability to maintain balance associated with SNHL while standing further increases the risk of falls among older people. Objective To investigate the association between SNHL on the postural balance in elderly individuals of both genders. Methods The sample consisted of 247 (166 women) physically independent elderly individuals, (mean age = 68.4 ± 6.0). The instruments used were the anamnesis and the pure tone audiometry for hearing loss, and for balance a force platform based in measures of center of pressure area and of sway velocity in the anteroposterior and mediolateral directions. Results Presence of hearing loss (HL) was observed in 68% of the participants. We observed a significant association between SNHL and characteristics of balance between the groups with and without HL for center of pressure (COP) area (p = 0.010), anteroposterior velocity (p = 0.001) and mediolateral velocity (p = 0.020). There was a significant difference between the gender groups for center of pressure area (p = 0.004), anteroposterior velocity (p = 0.001) and mediolateral velocity (p = 0.001) with better performance in the female group. Amongst men, there was a difference between the ones with HL and those without it, for COP area (p = 0.049). Conclusion In the present study, elderly individuals with SNHL exhibited more instability on the postural balance, and elderly men presented worse results in the test.

Diagnostic Validity of an Isokinetic Testing to Identify Partial Anterior Cruciate Ligament Injuries.

OBJECTIVE: To assess the diagnostic validity of an isokinetic testing to detect partial injuries on the anterior cruciate ligament (ACL). DESIGN: Prospective diagnostic study. SETTINGS: Orthopedic clinic, physiotherapy clinic, orthopedic hospital, and diagnostic/image clinic. PARTICIPANTS: Consecutive patients (n = 29) with unilateral knee complaint submitted to physical examination, magnetic resonance images (MRIs), and isokinetic testing prior to surgery of ACL reconstruction. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The isokinetic torque curves data from extensor and flexor muscles were converted to frequency domain by fast Fourier transformation and compared with healthy contralateral limb. Differences were categorized as unstable knees and these conclusions were compared with patient's physical examinations (doctor's conclusion on ACL integrity) and MRIs (as the radiologist conclusions on ACL integrity). After surgery, all intraoperatively confirmed partial injured patient's data were collected. The diagnostic accuracy measures to compare the conclusions of all 3 professionals included sensitivity, specificity, positive predictive value, negative predictive value, disease prevalence, positive likelihood ratio, and accuracy-all using a confidence interval of 95%. RESULTS: Compared with MRI, the sensitivity of isokinetic test for an ACL partial injury was 90.00%, specificity 83.33%, positive predictive value 52.94%, negative predictive value 97.56%, and accuracy 84.48%. Compared with physical examination, the sensitivity of isokinetic test for an ACL partial injury was 85.71%, specificity 78.43%, positive predictive value 35.29%, negative predictive value 97.56%, and accuracy 79.31%. CONCLUSIONS: This method of isokinetic data analysis through fast Fourier transformation can be used to improve diagnostic accuracy of a difficult detection injury. Even present, a partial ACL injury can produce a stable knee during isokinetic testing and could be used to detect candidates for conservative treatment based on strengthening exercises, reducing surgery risks, and financial and social impact on patient's life.

Kinetics, Assembling, and Conformation Control of L-Cysteine Adsorption on Pt Investigated by in situ FTIR Spectroscopy and QCM-D.

A quartz crystal microbalance method with dissipation (QCM-D) and attenuated total reflection Fourier-transform infrared (ATR-FTIRS) spectroscopy were used to study the adsorption of L-cysteine (L-Cys) on Pt. Through QCM-D, it was possible to verify that the viscoelastic properties of the adsorbed species play an important role in the adsorption, rendering Sauerbrey's equation inapplicable. The modelling of QCM-D data exposed two different processes for the adsorption reaction. The first one had an activation time and is fast, whereas the second is slow. These processes were also resolved by ATR-FTIRS and identified to be water and anion adsorption preceded by L-Cys adsorption. Both techniques reveal that the degree of surface coverage is pH dependent. Spectroscopic data indicate that the conformation of L-Cys(ads) changes with pH and that the structures do not fully agree with those proposed in literature for other metallic surfaces. The assembling of the adsorbed monolayer appeared to be very fast, and it was not possible to determine or quantify this kinetics. The conformation is also controlled by applied potential, and the anion adsorption and interfacial water depends on the conformation of the adsorbed molecules.

Effects of training volume on lower-body muscle strength in untrained young men: a contralateral control study

The purpose of this study was to examine the effects of training volume (1 vs. 3 sets) on lower-body muscle strength in untrained young men. Methodsː Eighteen untrained young men were recruited and their legs were trained with 1 or 3 sets (in a contralateral design) for 6 weeks, using a knee extension machine. Isokinetic peak torque and one repetition maximum (1RM) were assessed at pre- and post-training. Resultsː There was a similar improvement in the 1RM strength (1SET: +14.8% vs. 3SET: 16.3%, P > 0.05) and peak torque (1SET: +8.1% vs. 3SET: 9.3%, P > 0.05) for both conditions from pre- to post-training. The effect size (ES) for the change in 1RM was moderate for both conditions (1SET: 1.39 vs. 3SET: 1.41), and peak torque was trivial and small for 1SET (0.47) and 3SET (0.55), respectively. Additionally, there were no significant (P > 0.05) differences in the dietary intakes from pre- to post-training. Conclusionsː Our results indicate that 1 set is as effective as 3 sets for increasing lower-body muscle strength after a short-term RT period (6 weeks) in untrained young men.(AU)

Effects of Holding an External Load on the Standing Balance of Older and Younger Adults With and Without Chronic Low Back Pain.

OBJECTIVE: The purpose of this study was to assess the effect of holding an external load on the standing balance of younger and older adults with and without chronic low back pain (CLBP). METHODS: Twenty participants with and 20 without CLBP participated in the study. Each group contained 10 younger (50% men) and 10 older adults (50% men). Participants were instructed to look straight ahead while standing on a force platform during two 120-second trials with and without holding an external load (10% of body mass). The center of pressure area, mean velocity, and mean frequency in the anteroposterior and mediolateral directions were measured. RESULTS: Older adults had worse standing balance than younger adults did (P < .001, d = 0.20). There were no significant balance differences between participants with and without CLBP within age groups during standing balance condition. However, holding the external load significantly increased postural instability for both age groups and CLBP status, with mean effect size across center of pressure variables of d = 0.82 for older participants without CLBP and d = 2.65 for younger participants without CLBP. These effects for people with CLBP were d = 1.65 for subgroup of older and d = 1.60 for subgroup of younger participants. CONCLUSION: Holding an external load of 10% of body mass increased postural instability of both younger and older adults with and without CLBP.

Prevalence of Trypanosoma cruzi infection among Bolivian immigrants in the city of São Paulo, Brazil

With the urbanisation of the population in developing countries and the process of globalisation, Chagas has become an emerging disease in the urban areas of endemic and non-endemic countries. In 2006, it was estimated that the prevalence of Chagas disease among the general Bolivian population was 6.8%. The aim of the present study was to determine the prevalence of Trypanosoma cruzi infection among Bolivian immigrants living in São Paulo, Brazil. This study had a sample of 633 volunteers who were randomly selected from the clientele of primary care units located in the central districts of São Paulo, Brazil. Infection was detected by two different ELISA assays with epimastigote antigens, followed by an immunoblot with trypomastigote antigens as a confirmatory test. The prevalence of the infection was 4.4%. Risk factors independently associated with the infection were: a history of rural jobs in Bolivia, knowledge of the vector involved in transmission, and having relatives with Chagas disease. Brazil has successfully eliminated household vector transmission of T. cruzi, as well as its transmission by blood transfusion. The arrival of infected immigrants represents an additional challenge to primary care clinics to manage chronic Chagas disease, its vertical transmission, and the blood derivatives and organ transplant programs.

Can functional exercise capacity discriminate older individuals with poor postural control? / A capacidade funcional de exercício pode discriminar idosos com pior controle postural? / La capacidad funcional de ejercicio puede discriminar ancianos con mal control postural?

Postural instability can be related to functional limitations as a result of the aging process. This study aimed to compare functional exercise capacity and postural control in older adults. Participants were allocated into three groups according to their functional exercise capacity based on the six minute walking test (6MWT): 1) Low performance group (LP: distance walked ≤ 80% of the predicted value n = 19), 2) Normal performance group (NP: distance walked 81-100% of the predicted value n = 21) and, 3) High performance group (HP: distance walked >100% of the predicted value n = 23). All groups performed three trials of a one-leg stance for 30s on a force platform. LP showed worse postural control in comparison to NP and HP, and significant differences (p < .05) were found between groups for area, velocity antero-posterior of center of pressure and time limit variables during the one-leg stance task. These results have implications for rehabilitation management with regard to exercise, balance assessment and intervention in older adults.

Instabilidade postural pode estar relacionada com as limitações funcionais, como um resultado do processo de envelhecimento. Este estudo teve como objetivo comparar a capacidade funcional de exercício e o controle postural em indivíduos idosos. Os participantes foram separados em três grupos de acordo com sua capacidade funcional de exercício baseada no teste de caminhada de seis minutos (TC6min): 1) grupo baixo desempenho (BD: distância caminhada ≤ 80% do valor predito n = 19), 2) grupo normal desempenho (ND : distância caminhada 81-100% do valor predito n = 21) e, 3) grupo alto desempenho (AD: distância caminhada >100% do valor predito n = 23). Todos os grupos realizaram três testes com apoio unipodal permanecendo por 30s sobre a plataforma de força. BD apresentou pior equilíbrio postural em comparação com ND e AD; com diferenças significativas (p < 0,05) encontradas entre os grupos para os parâmetros de área e velocidade antero-posterior do centro de pressão e a variável tempo-limite durante a posição unipodal. Estes resultados têm implicações para estratégias de reabilitação no que diz respeito ao exercício, avaliação do equilíbrio e intervenção em idosos.

Inestabilidad postural puede estar relacionada con las limitaciones funcionales como resultado del proceso de envejecimiento. Este estudio tuvo como objetivo evaluar la comparación entre la capacidad funcional del ejercicio en el control postural de las personas de edad avanzada. Los participantes fueron divididos en tres grupos de acuerdo a su capacidad de ejercicio funcional basado en la Prueba de Caminada de seis minutos (PC6M): 1) grupo Bajo Rendimiento (BR: distancia recorrida ≤ 80% del valor predijo, n = 19), 2) grupo Normal Rendimiento (NR: distancia recorrida 81-100% del valor predijo, n = 21) y 3) grupo Alto Rendimiento (AR: distancia recorrida >100% del valor predijo, n = 23). Todos los grupos realizaron tres pruebas sobre un solo pie por 30s en la plataforma de fuerza. BR presentó un mal equilibrio postural en comparación con NR y AR; con diferencias significativas (p < 0,05) encontrado entre los grupos de los parámetros área y velocidad antero-posterior del centro de presión y el límite de tiempo para la postura de una sola pierna. Estos resultados tienen implicaciones para las estrategias de rehabilitación en relación con el ejercicio, la evaluación del equilibrio y la intervención en los ancianos.

Hemostasis in raw peritoneal surfaces by combined use of sodium carboxymethylcellulose and papain for prevention of adhesions in the rat

A associacao de carboximetilcelulose sodica (CMC) e Papaina (PP), ja demonstrada como inibidora da formacao de aderencias peritoniais, e estudada em ratos quanto a seus possiveis efeitos sobre a hemostasia espontanea em areas cruentas do peritonio. A acao proteolitica da PP sobre a fibrina, que explica seu efeito anti-aderencia, nao se fez presente nem "in vivo", nem "in vitro" sobre coagulos pre-formados e ainda permitiu a formacao de coagulo "novo". Este comportamento e atribuido a outra acao da PP, semelhante a da trombina, de coagular fibrinogenio por cisao de seus fibrinopeptidios terminais. Concluiu-se que o emprego da associacao CMC-PP para previnir a formacao de aderencias peritoneais possa apresentar seguranca para uso em clinica humana, embora novos estudos devam ser ainda realizados.

Stryphnodendron barbadetiman (Vellozo) Martius: teor em Tannino na casca e sua propriedade cicatrizante / Stryphnodendron barbardetiman (Vellozo) Martius: Tannin content and cicatrisant properties of its bark

Com o nome de barbatimäo säo conhecidas várias plantas taníferas pertencentes às Leguminosas. Entre elas, destaca-se Stryphnodendron barbadetiman (Vellozo) Martius, espécie nativa do Brasil, que ocorre, principalmente, nos campos cerrados. Empregando-se o método de Linde e Teufer, modificado por WASICKI (18), verificam-se, na casca dessa espécie, cerca de 25 a 30 por cento de tanino. Em funçäo do alto teor desse princípio, constataram-se, experimentalmente, a atividade cicatrizante de decocto da casca referida espécie. Para a verificaçäo dessa propriedade, foram utilizados camundongos depilados no dorso em áreas delimitadas, onde se praticaram incisöes. Os animais foram separados, ao acaso, em dois grupos: I-controle; II-pincelados nas lesöes com o decocto da casca a 1 por cento. O processo cicatricial evoluiu mais rapidamente nos animais tratados com o decocto, acima mencionado