Isquemia de mão de pacientes em terapia renal substitutiva: avaliação por termografia / Isquemia de mano de pacientes en terapia de reemplazo renal: evaluación por termografía / Hand ischemia in patients undergoing renal replacement therapy: assessment by thermography

Resumo Objetivo Avaliar a presença de isquemia na porção distal das mãos dos membros superiores com Fistula Arteriovenosa (FAV) de pacientes em Terapia Renal Substitutiva (TRS) através da termografia por infravermelho. Método Amostra composta por 15 pacientes em TRS por hemodiálise por meio de FAV que responderam um questionário elaborado pelos próprios autores com as seguintes variáveis: dados sociodemográficos, diagnóstico, sinais vitais e dados sobre a FAV. Para obtenção dos termogramas das mãos com e sem FAV foi utilizado uma câmera termográfica por infravermelho C5, FLIR Systems, fixada a 50 cm das mãos dos participantes, privilegiando o enquadramento bilateral enquadrando ambas as mãos. Os dados obtidos foram organizados em planilha de Excel 2011® e comparados estatisticamente utilizando o programa Microcal Origin 6.0, para avaliar se existia diferença entre as médias de temperatura. Resultados Com relação as variáveis sociodemográficas, o gênero masculino foi o predominante, faixa etária com média de 45 anos, ensino fundamental (incompleto/completo), casados e provenientes de outros municípios. A termografia demonstrou que há diferença de temperatura entre as mãos com FAV e sem FAV, com variação na temperatura de 1,78°C (± DP 1,99°C), menor para as mãos com FAV. Conclusão A análise da distribuição do sangue das mãos por meio da termografia pode fornecer evidências sobre a microcirculação periférica e orientar o diagnóstico precoce e o tratamento da isquemia induzida por FAV em indivíduos em TRS, como ferramenta inovadora de diagnóstico auxiliar das complicações dos acessos venosos de pacientes em hemodiálise.

Resumen Objetivo Evaluar la presencia de isquemia en la parte distal de las manos de los miembros superiores con fístula arteriovenosa (FAV) de pacientes en terapia de reemplazo renal (TRR) a través de la termografía infrarroja. Métodos Muestra compuesta por 15 pacientes en TRR por hemodiálisis mediante FAV que respondieron un cuestionario elaborado por los propios autores con las siguientes variables: datos sociodemográficos, diagnóstico, signos vitales y datos sobre la FAV. Para obtener los termogramas de las manos con y sin FAV, se utilizó una cámara termográfica infrarroja C5, FLIR Systems, ubicada a 50 cm de las manos de los participantes, favoreciendo el encuadramiento bilateral y encuadrando ambas manos. Los datos obtenidos se organizaron en una planilla de Excel 2011® y se compararon estadísticamente con el programa Microcal Origin 6.0, para evaluar si había diferencia entre los promedios de temperatura. Resultados Con relación a las variables sociodemográficas, el género masculino fue predominante, grupo de edad promedio de 45 años, educación primaria (incompleta/completa), casados y provenientes de otros municipios. La termografía demostró que hay diferencia de temperatura entre las manos con FAV y sin FAV, con una variación de temperatura de 1,78°C (± DP 1,99°C), menor en las manos con FAV. Conclusión El análisis de la distribución de la sangre de las manos por medio de termografía puede ofrecer evidencias sobre la microcirculación periférica y guiar el diagnóstico temprano y el tratamiento de la isquemia inducida por FAV en individuos en TRR, como una herramienta innovadora de diagnóstico auxiliar de las complicaciones de los accesos vasculares de pacientes en hemodiálisis.

Abstract Objective To assess the presence of ischemia in the distal portion of the hands of the upper limbs with arteriovenous fistula (AVF) in patients undergoing renal replacement therapy (RRT) using infrared thermography. Method The sample consisted of 15 patients on RRT via hemodialysis using an AVF who answered a questionnaire prepared by the authors themselves with sociodemographic data, diagnosis, vital signs and data on AVF. To obtain thermograms of hands with and without AVF, a C5 infrared thermographic camera, FLIR Systems, was used, fixed 50 cm from participants' hands, favoring bilateral framing of both hands. The data obtained were organized in an Excel 2011® spreadsheet and statistically compared using the Microcal Origin 6.0 program to assess whether there was a difference between temperature averages. Results Regarding sociodemographic variables, males were predominant, with a mean age of 45 years, (incomplete/complete) elementary school, married and from other municipalities. Thermography demonstrated that there is a difference in temperature between hands with AVF and without AVF, with a temperature variation of 1.78°C (± SD 1.99°C), lower for hands with AVF. Conclusion The analysis of hand blood distribution using thermography can provide evidence on peripheral microcirculation and guide the early diagnosis and treatment of AVF-induced ischemia in individuals undergoing RRT as an innovative auxiliary diagnostic tool for complications of venous access in hemodialysis patients.

Autonomic nerve regulation in joint hypermobility patients with myofascial trigger points by Musculoskeletal Interfiber Counterirritant Stimulation (MICS).

Joint hypermobility (JH) conditions suggest dysfunction in the autonomic nervous system (ANS) (dysautonomia), associated with multifactor non-articular local musculoskeletal pain, and remains a complex treatment. This study aims to determine the effects of musculoskeletal interfiber counterirritant stimulation (MICS) as an innovative treatment of myofascial trigger points (MTrPs) on the upper trapezius muscle in JH patients. We evaluate the ANS activity by wavelet transform spectral analysis of heart rate variability (HRV) in sixty women, equally divided: MTrP, MTrP + general joint hypermobility (GJH), and MTrP + joint hypermobility syndrome (JHS). The protocol phases were rest, stimulation, and recovery, with clinical and home treatment for three-days. All groups show a significantly decreased in pain perception during and post-treatment, and an increased parasympathetic ANS activity under MICS in the GJH and JHS groups. The variables low-frequency (LF) vs. high-frequency (HF) showed significant differences during the protocol phases, and the LF/HF ratio maintained a predominance of sympathetic activity (SA) throughout the protocol. The new MICS technique reduces the pain perception and modulates the ANS activity by an increase in vagal tone, and a decrease in sympathetic tone. This modulation was followed by an increase in the HRV in JH patients after treatment with MICS. Clinical Trials: RBR-88z25c5.

Analysis of pain relief and functional recovery in patients with rotator cuff tendinopathy through therapeutic ultrasound and photobiomodulation therapy: a comparative study.

This study aimed to compare shoulder tendinopathy treatment with therapeutic ultrasound combined with LED photobiomodulation therapy using LED-infrared (850 nm) or LED-red (640 nm). The study assessed 75 patients, aged 45 to 70 years, distributed into five experimental groups (15 patients each): therapeutic ultrasound (US), infrared light irradiation (IR), visible red light irradiation (VR), infrared light and ultrasound combined (IR-US), and red light in conjunction with ultrasound (VR-US). The ultrasound parameters are 1 MHz, 0.5 W/cm2 (SATA), and 100 Hz repetition rate, applied for 4 min each session. LED irradiation protocols were as follows: 3 points, 7.5 J per point, IR-LED 750 mW, 10 s, VR-LED 250 mW, 30 s. LED irradiation is followed by ultrasound in the combined therapies. The efficiency of the five therapies was evaluated assessing 12 parameters: quality of life (Health Assessment Questionnaire, HAQ), pain intensity (Visual Analog Scale, VAS), articular amplitude of shoulder movement (flexion, extension, abduction, adduction, medial rotation, lateral rotation), muscle strength (abduction, lateral rotation), and electromyography (lateral rotation, abduction). Treatments comprised 12 sessions for 4 weeks. Intra-group analysis showed that the five therapies significantly improved the recovery of all parameters after treatment. Regarding the comparison of irradiated therapies and ultrasound, statistical analysis showed that IR-US was a better treatment than US for all 12 parameters. IR treatment exceeded US on 9 items, whereas that VR and VR-US therapies exceeded US in 7 and 10 parameters, respectively (p < 0.05). Because of that, IR-US shows to be the best treatment for rotator cuff tendinopathy. In conclusion, improvements in quality of life, pain intensity relief, shoulder amplitude motion, and muscle strength force obtained with ultrasound therapy are enhanced by adding infrared LED irradiation to ultrasound for patients suffering from rotator cuff tendinopathy. This study was registered with the Brazilian Registry of Clinical Trials (ReBEC) under Universal Trial Number (UTN) U1111-1219-3594 (2018/22/08).

Detecting active ingredients of insect repellents and sunscreens topically in skin by Raman spectroscopy.

We present the use of Raman spectroscopy for determination of functional characteristics of insect repellents and sunscreens by identifying the active ingredients of these products applied topically to the skin. Commercial formulations of insect repellents and sunscreens (SPF 15 and 30) were obtained, and Raman spectra were obtained from the formulations and from volunteers' skins with topical applications of such products compared to controls. The results indicated that, for insect repellents, the peaks at 527 and 1003 cm - 1 were markers of the presence of the active ingredient diethyl toluamide in the skin, while for sunscreens, the peaks at 1177, 1288, and 1611 cm - 1, associated to octinoxate, benzophenone-3, and avobenzone, were markers of the presence of solar filters in the skin. The results suggested reliability in the use of Raman spectroscopy to identify the active ingredients of insect repellents and sunscreens topically applied on the skin; the applied methodology can be used to determine the functional characteristics of topical products with similar characteristics.

LED phototherapy in full-thickness burns induced by CO2 laser in rats skin.

Many studies have been conducted on the treatment of burns because they are important in morbidity and mortality. These studies are mainly focused on improving care and quality of life of patients. The aim of this study was evaluate the LED phototherapy effects in rats skin full-thickness burns induced by CO2 laser. The animals were divided in NT group that did not received any treatment and LED group that received LED irradiation at 685 nm, 220 mW, and 4.5 J/cm2 during 40 s by burned area. Biopsies were obtained after 7, 14, and 21 days of treatment and submitted to histological and immunohistochemical analysis. The LED phototherapy shows anti-inflammatory effects, improves angiogenesis, and stimulates the migration and proliferation of fibroblasts. The T CD8+ lymphocytes were more common in burned areas compared to T CD4+ lymphocytes since statistically significant differences were observed in the LED group compared to the NT group after 7 days of treatment. These results showed that LED phototherapy performs positive influence in full-thickness burns repair from the healing process modulated by cellular immune response. The obtained results allowed inferring that burns exhibit a characteristic cell immune response and this cannot be extrapolated to other wounds such as incision and wounds induced by punch, among others.

Staining Beverages and Cigarette Smoke on Composite Resin and Human Tooth Fluorescence by Direct Spectrometry.

INTRODUCTION: This study evaluated the fluorescence intensity (FI) of different brands of composite resins (CRs) and compare those values with the FI of human tooth, under the action of cigarette smoke (CI), coffee (CA), and soft drink (CO), measured by direct spectrometry. MATERIALS AND METHODS: A total of 30 specimens of each brand (Filtek Z350, Esthet-X, Amelogen, Durafill) were made. Others 30 tooth specimens (3 mm/diameter) were obtained from human molars using a trephine bur. The specimens were randomly divided into three groups (n = 10), according to substances: CI, CA, CO. The FI was directly measured using an optic fiber associated with a spectrometer and was measured at baseline and after staining. Data were submitted to Kruskal-Wallis, Dunnett, and Dunn tests. RESULTS: Staining influenced FI mean values among CRs and between those with human tooth. Z showed the closest FI mean values of tooth after staining. CONCLUSION: Staining beverages and cigarette smoke negatively influenced on FI of CR and human tooth. CLINICAL SIGNIFICANCE: The study shows darkening treatments influenced on the fluorescent property of the dental tissues and restorative materials according to the direct spectrometry analysis.

Aloe vera extract reduces both growth and germ tube formation by Candida albicans.

Due to the increased number of immunocompromised patients, the infections associated with the pathogen of the genus Candida have significantly increased in recent years. To grow, Candida albicans may form a germ tube extension from the cells, which is essential for virulence. In this work, we studied the effect of crude glycolic extract of Aloe vera fresh leaves (20% w/v) on growth and germ tube formation by C. albicans. The C. albicans growth was determined in the presence of different concentrations of A. vera extracts in Sabouraud dextrose broth medium. In the presence of A. vera extract (10% v/v), the pronounced inhibition in the C. albicans growth (90-100%) was observed. This inhibition occurred parallel to the decrease in the germ tube formation induced by goat serum. Our results demonstrated that A. vera fresh leaves plant extract can inhibit both the growth and the germ tube formation by C. albicans. Our results suggest the possibility that A. vera extract may be used as a promising novel antifungal treatment.

Fourier transform-Raman and reflectance studies on dental enamel bleached with hydrogen peroxide activated using a light-emitting diode-laser system.

OBJECTIVE: To evaluate the effects of 35% hydrogen peroxide bleaching on bovine teeth using reflectance and Fourier transform (FT)-Raman spectroscopy. BACKGROUND DATA: Previous investigations have shown that hydrogen peroxide can modify dental components, but more studies are necessary to comprehend its effects. MATERIALS AND METHODS: Forty bovine enamel fragments (4.0x4.0x4.0 mm) were divided into four experimental groups according to the hydrogen peroxide gel manufacturer's application: G1-Whiteness HP Maxx, G2-Whiteness HP, G3-Whiteform- Perox Red Form, G4-Opalescence Xtra. All groups were activated using a light-emitting diode-laser system. The bleaching treatments were performed in two sessions with a 72-h interval between sessions. The reflectance and Raman analyses of the enamel samples were performed before and after bleaching. The analyses before treatments were used as control. RESULTS: Enamel reflectance was significantly greater after the bleaching in group G3 than in groups G1, G2, and G4 (p<0.01). FT-Raman spectroscopy data showed no significant chemical changes in the inorganic components for the tested groups (p>0.05). Hydrogen peroxide gel caused significant reduction of the dental organics associated with type I collagen vibration only in group G3 (p<0.05). CONCLUSION: Under the conditions of this study, 35% hydrogen peroxide Whiteform-Perox Red Form gel, exhibited great bleaching potential. This highly concentrated hydrogen peroxide gel significantly changed the reflectance of enamel and dental organics without significant chemical changes in enamel phosphate and carbonate content.

Photodynamic antimicrobial chemotherapy (PACT) with methylene blue increases membrane permeability in Candida albicans.

Photodynamic antimicrobial chemotherapy (PACT) is a potential antimicrobial therapy that combines light and a photosensitizing drug, promoting a phototoxic effect on the treated cells, in general via oxidative damage. In this work we studied the effect of PACT, using methylene blue (MB), on the permeability of Candida albicans membrane. Our results demonstrated that the combination of MB and laser (684 nm) promoted a decrease in Candida growth. The inhibition was more pronounced in the presence of 0.05 mg/ml MB and with an energy density of 28 J/cm(2). The decrease in Candida growth was associated with an increase in membrane permeabilization. Thus, we suggest that a PACT mechanism using MB can be related to damage in the plasma membranes of the cells.

Fluorescence and reflectance spectroscopy for identification of atherosclerosis in human carotid arteries using principal components analysis.

OBJECTIVES: The aim of this work was to verify the differentiation between normal and pathological human carotid artery tissues by using fluorescence and reflectance spectroscopy in the 400- to 700-nm range and the spectral characterization by means of principal components analysis. BACKGROUND DATA: Atherosclerosis is the most common and serious pathology of the cardiovascular system. Principal components represent the main spectral characteristics that occur within the spectral data and could be used for tissue classification. MATERIALS AND METHODS: Sixty postmortem carotid artery fragments (26 non-atherosclerotic and 34 atherosclerotic with non-calcified plaques) were studied. The excitation radiation consisted of a 488-nm argon laser. Two 600-microm core optical fibers were used, one for excitation and one to collect the fluorescence radiation from the samples. The reflectance system was composed of a halogen lamp coupled to an excitation fiber positioned in one of the ports of an integrating sphere that delivered 5 mW to the sample. The photo-reflectance signal was coupled to a (1/4)-m spectrograph via an optical fiber. Euclidean distance was then used to classify each principal component score into one of two classes, normal and atherosclerotic tissue, for both fluorescence and reflectance. RESULTS: The principal components analysis allowed classification of the samples with 81% sensitivity and 88% specificity for fluorescence, and 81% sensitivity and 91% specificity for reflectance. CONCLUSIONS: Our results showed that principal components analysis could be applied to differentiate between normal and atherosclerotic tissue with high sensitivity and specificity.

Study of germ tube formation by Candida albicans after photodynamic antimicrobial chemotherapy (PACT).

Due to the augmented number of immunocompromised patients, the infections associated to the pathogen of the genus Candida have increased dramatically in the recent years. In order to proliferate, Candida albicans can produce a germ tube formation extending from the cells. The germ tube formation is a transition state from budding to hyphal cells, and represents an essential stage for virulence. In this work we studied the effect of the photodynamic antimicrobial chemotherapy (PACT), a potential antimicrobial treatment on the germ tube formation by C. albicans. Germ tube formation was induced by goat serum after different treatments with Methylene blue (MB) and Laser (683nm). Our results demonstrated that photodynamic therapy using MB, as a photosensitizing drug; inhibits both the growth and the germ tube formation by C. albicans. Thus, our results suggest the possibility that Methylene blue, combined with light in a specific wavelength, can be used as a promising novel antifungal agent.

Low power laser radiation at 685 nm stimulates stem-cell proliferation rate in Dugesia tigrina during regeneration.

Today's scientific interest in tissue engineering for organ transplantations and regeneration from stem cells, allied with recent observations on biostimulation of tissues and cells by laser radiation, stands as a strong motivation for the present work, in which we examine the effects of the low power laser radiation onto planarians under regenerative process. To investigate those effects, a number of 60 amputated worms were divided in three study groups: a control group and two other groups submitted to daily 1 and 3 min long laser treatment sections at approximately 910 W/m2 power density. A 685 nm diode laser with 35 mW optical power was used. Samples were sent to histological analysis at the 4th, the 7th and the 15th days after amputation. A remarkable increase in stem cells counts for the fourth day of regeneration was observed when the regenerating worms was stimulated by the laser radiation. Our findings encourage further research works on the influence of optical radiation onto stem cells and tissue regeneration.