Ultrasound-Guided Percutaneous Needle Electrolysis in Dancers with Chronic Soleus Injury: A Randomized Clinical Trial.

Damage to intramuscular tendons is very common in sports injuries, specifically in soleus muscle injuries. This study sought to compare the effects of applying ultrasound- (US-) guided percutaneous needle electrolysis (PNE) in combination with an eccentric exercise program on pain and functionality in dancers with chronic soleus injury, located in the central tendon. Thirty dancers with injured central tendon of the soleus muscle were randomly allocated to a PNE group (n = 10), an eccentric exercise group (n = 10), or a combined group (n = 10). Pain, ankle dorsiflexion range of motion (DROM), endurance, the heel raise test, the DFOS questionnaire, and the minimal clinically important difference (MCID) were analyzed at baseline and after treatment (four weeks). Over half (52%) of the dancers had a chronic soleus muscle injury. Variables for pain, DROM, the heel rise test, ADL, technique, DFOS total, and DFOS-subjective variables showed significant differences (P < 0.05) in pretreatment and posttreatment in all groups, whereas no significant differences were observed between intervention groups. However, the combined group showed a higher percentage of changes compared to the other groups, and these dancers had greater perceived changes (MCID = 4.70 ± 1.42). The conclusion of the study was that dancers with chronic soleus injury, located in the central tendon, treated with a combination of US-guided PNE and an eccentric exercise program displayed improved outcomes compared to the application of PNE therapy or eccentric exercise alone. The US-guided PNE, combined with an eccentric exercise program, is a useful therapeutic tool for the treatment of chronic soleus injury, located in the central tendon. The trial is registered with NCT04042012.

Percutaneous Application of Galvanic Current in Rodents Reverses Signs of Myofascial Trigger Points.

An increase in the spontaneous release of acetylcholine (ACh) at the motor endplate is directly related to the generation of myofascial trigger points (MTrPs). In this study, percutaneous electric fields were applied to an animal model of MTrPs with high levels of spontaneous ACh release. All experiments were performed on Swiss mice and Sprague Dawley rats. For evaluating the spontaneous neurotransmission, intracellular recordings were performed, and the frequency of miniature endplate potentials was evaluated. Electromyographic recordings were also conducted to evaluate the endplate noise. Finally, the number and strength of local twitch responses (LTR) were evaluated using ultrasound recordings. The protocols used for the electric currents were 0.4 mA for five seconds and four repetitions (protocol 1), 1.5 mA for five seconds and three repetitions (protocol 2), and 3 mA for three seconds and three repetitions (protocol 3). After a subcutaneous injection of neostigmine (NTG), a great increase was observed in the frequency of mEPPs, together with an elevated endplate noise. Protocols 2 and 3 were the most effective. Protocol 3 could completely reverse the action of NTG at both three hours and 24 hours, respectively. The application of percutaneous currents produced both an increase in the number (144%) and in the speed (230% faster) of LTR compared with dry needling. In conclusion, higher doses of electrical current are more effective for decreasing MTrPs findings in an animal model.

Percutaneous Needle Electrolysis Reverses Neurographic Signs of Nerve Entrapment by Induced Fibrosis in Mice.

Nerve entrapments such as carpal tunnel syndrome are the most common mononeuropathies. The lesional mechanism includes a scarring reaction that causes a vascular compromise. The most effective treatment is surgery, which consists of removing the scarred area, thus reverting the vascular impairment. In the present study, a more conservative therapeutic approach has been undertaken to release the nerve by means of galvanic current (GC) applied with a needle: percutaneous needle electrolysis (PNE). For this purpose, a mouse model of sciatic nerve entrapment has been created using albumin coagulated by glutaraldehyde (albumin 35% and glutaraldehyde 2% volume applied, 10 µl). After two weeks, a fibrous reaction was obtained which entrapped the nerve to the extent of causing atrophy of the leg musculature (14.7%, P < 0.05 compared to the control leg). Ultrasound imaging confirmed that the model's image was compatible with that of nerve entrapment in patients. To quantify the degree of entrapment, nerve conduction recordings were made. The amplitude (peak-to-peak) of the compound muscle action potential (CMAPs) decreased by 32.2% (P < 0.05), and the proximal latency increases by 17.7% (P < 0.05, in both cases). In order to release the sciatic nerve, PNE was applied (1.5 mA for 3 seconds and 3 repetitions; 1.5/3/3) by means of a solid needle in the immediacy of perineural fibrosis before and 5 minutes after the application of GC, and the proximal latency shows a decrease of 16% (P < 0.05). The recovery of CMAPs amplitude was about 48.7% (P < 0.05). Three weeks later, the CMAPs amplitude was almost completely recovered (94.64%). Therefore, with the application of GC by means of a solid needle, the sciatic nerve was definitively released from its fibrous entrapment.

Acupuncture Points and Perforating Cutaneous Vessels Identified Using Infrared Thermography: A Cross-Sectional Pilot Study.

AIMS: To evaluate the presence of perforating cutaneous vessels (PCV) in different lower limb acupuncture points (AP) using thermography. MATERIAL AND METHODS: An analytical cross-sectional study was performed on the two lower limbs (n=6) of volunteer subjects. In total, 144 AP and 144 control points (CP) were analysed, one for each AP. First, the AP and CP were located on each individual. Subsequently, both the real and thermographic images were created. In the real images, the location of the AP and the established CP were highlighted with boxes. FLIR Tools Plus and Physio Thermal Imaging software were used to merge the real image with the AP and the CP and to merge the thermographic image with the PCV. By superimposing both images, we were able to verify the presence of PCV among the AP and CP. RESULTS: PCV were identified in 87.5% of the 144 AP examined and in 18.1% of the respective CP. All the AP had a higher percentage of PCV compared to their respective CP, with statistically significant differences in all points, except for ST33 and ST34. The probability of finding PCV in AP was 11 times higher than the probability of not finding it. DISCUSSION: Thermography may serve as a useful tool in the assessment and treatment of patients using acupuncture. The presence of PCV in the area of the acupuncture needle insertion could partially influence the effects generated by the acupuncture technique from the vascular autonomic point of view. CONCLUSIONS: There is a high proportion of PCV in the AP area located in the lower limb.

Fiabilidad interobservador del test de movilidad pasiva accesoria intervertebral lumbar y su correlación con la galvanopalpación en sujetos sanos / Inter-observer reliability of the passive accessory intervertebral motion test and its correlation with the galvanic palpation in healthy subjects

Introducción El diagnóstico de fisioterapia de las disfunciones vertebrales es fundamental para clasificar las alteraciones musculoesqueléticas. La evaluación pasiva de la cantidad y la calidad del movimiento en los diferentes segmentos vertebrales guía la toma de decisiones en relación con el tratamiento de fisioterapia. Los objetivos del presente estudio son determinar la fiabilidad interobservador del test de movilidad pasiva accesoria posteroanterior intervertebral unilateral lumbar como test indicado para identificar sujetos con disfunción articular y analizar la corriente galvánica como herramienta diagnóstica en la identificación de disfunción articular en la columna lumbar con dicho test ortopédico. Material y método Dos fisioterapeutas expertos en fisioterapia manual realizaron el test en una muestra de 30 sujetos asintomáticos en los niveles L1-L5 (lado derecho e izquierdo), realizándose un total de 300 pruebas. Se determinó que un nivel lumbar estaba en disfunción basándose en una sensación final anormal, la calidad de la resistencia anormal y la posible aparición de dolor asociado al movimiento. Para determinar la utilidad diagnóstica de la corriente galvánica, otros dos fisioterapeutas realizaron galvanopalpación consecutivamente al test de movilidad en las articulaciones interapofisarias lumbares de los mismos sujetos asintomáticos. Resultados En el test de movilidad, el porcentaje de acuerdo fue del 86,3%. El índice kappa (k) mostró un acuerdo moderado (k=0,5). El test fue más fiable en los niveles lumbares L3-L4 y L4-L5. En la galvanopalpación el porcentaje de acuerdo fue del 83%. El k mostró un acuerdo moderado en la identificación de disfunción articular (k=0,41). La sensibilidad fue alta en el nivel lumbar L3-L4 y L4-L5 y baja en L1-L2; la especificidad fue elevada (82,7–96,3%) en toda la columna lumbar. Conclusiones La fiabilidad interobservador del test de movilidad es moderada (k=0,5). La galvanopalpación identifica disfunciones articulares, pero en la columna lumbar alta la sensibilidad es baja (AU)

Introduction The physical therapy diagnosis of a vertebral dysfunction is essential in order to classify musculoskeletal diseases. Passive assessment of quantity and quality of movement on the different vertebral segments guides the decision-making process relative to manual therapy treatment. The aims of this present study have been to determine the interobserver reliability of passive accessory intervertebral postero-anterior unilateral lumbar motion test as a test to identify subjects with joint dysfunction, and to analyze galvanic current as a diagnostic tool to identify joint dysfunction in the lumbar spine with the motion test. Material and methods Two physiotherapists, experts in manual therapy, carried out the test in 30 asymptomatic subjects at L1 to L5 levels (right and left sides), performing a total of 300 tests. To determine the diagnostic value of galvanic current, two other physiotherapists performed galvanic palpation consecutively to the motion test in lumbar zygapophysial joints in the same asymptomatic subjects. Results Percentage agreement was 86.3% for the motion test. The Kappa index showed substantial agreement (according to Landis and Koch, 1977) (k=0.5). PA accessory motion test was more reliable to identify symptomatic spinal L4-L5 and L5-S1 level. Regarding galvanic palpation, the agreement percentage was 83%. Kappa coefficient (k) showed moderate agreement for identification of joint dysfunction (k=0.41). Sensitivity was high in the lumbar level L3-L4 and L4-L5 and was low in L1-L2 level; specificity was high (82.7–96.3%) throughout the lumbar spine. Conclusions Interobserver reliability of the passive motion test is moderate (k=0.5). Galvanic palpation identifies joint dysfunction, however sensitivity is low in the upper lumbar spine (AU)

Assessment of the use of industrial by-products for induced reduction of As, and Se potential leachability in an acid soil.

Four industrial by-products (phosphogypsum, PG; red gypsum, RG; sugar foam, SF and ashes from the combustion of biomass, ACB) were evaluated as possible amendments for reducing the leachability and bioavailability of As and Se in a metalloid-spiked acidic soil. The treatments were applied as single, double and triple amendments and at two different rates. The effectiveness of the treatments was evaluated after a series of leaching experiments using a chelating agent (DTPA solution) or a weak acidification (acetic acid at pH 4.93). The most effective treatments (ACB and RG, both applied at high rate) were identified by means of Cluster Analysis using the leachability indexes. Different sorption mechanisms involved in the overall reduction of metalloid leachability were identified using scanning electron microscopy (SEM-BSE and SEM-EDS). In the ACB-treated samples, Se was found associated to organic matter aggregates and to Fe compounds. In the RG-treated samples, EDS analyses showed that As and Se were associated to Fe/Ti (hydr)oxides phases which are present not only in the by-product as maghemite and rutile, but also in the soil as hematite and goethite. In addition, the application of RG induced the formation of non-crystalline Al-hydroxy polymers with As and Se in their composition.

Acute pseudoaneurysm of the femoral artery after repeated trauma in full-contact karate practice.

Traumatic pseudoaneurysms of the deep femoral artery are only encountered infrequently in sports medical literature. We present the case of a male who, after practising full-contact karate, experienced pain and oedema in the right thigh. The ultrasound results and the arteriography showed the presence of a pseudoaneurysm in a branch of the deep femoral artery. Traumatic pseudoaneurysms of the deep femoral artery are normally secondary to endovascular interventions or to mycotic infections in injecting drug users. The majority appear asymptomatically as a pulsatile mass, although on occasions clinical signs of compression (pain, neurological or venous symptoms) may occur or, if the aneurysm bursts, hypovolemic shock.

Prolapso de uretra / Urethral prolapse

El prolapso uretral en la mujer es infrecuente. Se define como la completa eversión de la mucosa uretral a través del meato. Ocurre frecuentemente en mujeres negras prepúperes y en mujeres blancas posmenopáusicas. El tratamiento recomendado incluye desde la terapia conservadora hasta múltiples intervenciones quirúrgicas (AU)

Prolapse of the urethra in female patients is a rare events. It is defined as the complete eversion of the urethral mucosa through the external meatus. It occurs most often in pre-puberal black girls and in postmenopausal white women. Recommended treatment ranges from conservative therapy to a diversity of operative techniques (AU)

ACTH and beta-endorphin in transcendental meditation.

We have evaluated the effect of Transcendental Meditation (TM) on the hypothalamo-hypophyseal-adrenal axis diurnal rhythms through the determination of hormone levels. Blood samples were taken at 0900 hours. and at 2000 hours. These samples were taken from 18 healthy volunteers who regularly practice TM and from nine healthy non-meditators. Cortisol, beta-endorphin, and adrenocorticotropic hormone (ACTH) were measured at both hours. TM practitioners showed no diurnal rhythm for ACTH and for beta-endorphin (ACTH, pg/mL, mean +/- SE; 13.8+/-1.2 - 12.1+/-1.5/beta-endorphin, pg/mL; 14.4+/-1.5 - 17.2+/-1.9, at 0900 hours and 2000 hours, respectively), in contrast to control subjects, who showed normal diurnal rhythm for these hormones and for cortisol (ACTH, pg/mL; 19.4+/-1.9 - 11.9+/-2.2/beta-endorphin, pg/mL; 25.4+/-1.7 - 17.7+/-1.1/Cortisol, ng/mL; 201.4+/-13.2 - 71.3+/-6.5, at 0900-2000 hours, respectively, p < 0.01 in the three cases). Practitioners of TM with similar anxiety levels to those of the control group showed a different pattern in the daytime secretion of pituitary hormones. TM thus appears to have a significant effect on the neuroendocrine axis. Because cortisol levels had a normal pattern in the TM group, these results may be due to a change in feedback sensitivity caused by this mental technique.

Ingestion of high doses of fish oil increases the susceptibility of cellular membranes to the induction of oxidative stress.

Feeding rats with 4 g/kg body weight of sardine oil during 7 or 14 days increases the content of eicosapentaenoic acid and docosahexaenoic acid in the erythrocyte and hepatic microsomal membranes by 2 to 6%. These membranes show increased susceptibility to the induction of oxidative stress, expressed as lipid peroxidation, when they are exposed to Fe2+-ascorbate and to NADPH-FE3+-ADP, respectively. The results indicate that in order to prevent the increased susceptibility to lipid peroxidation, supplementation with larger amounts of antioxidants may be needed than those required to stabilize the oil.