Outcomes of bilateral carpal tunnel syndrome treatment - A systematic review and meta-analysis.

Carpal tunnel syndrome (CTS) is the predominant compressive neuropathy among adults worldwide. However, evidence regarding treatment alternatives and their outcomes, especially with bilateral carpus involvement, is inconclusive. To analyze the clinical and surgical outcomes of bilateral CTS treatment using the visual analog scale (VAS) and Boston questionnaire, a systematic review was conducted according to PRISMA guidelines. After evaluating 129 articles from different databases, nine papers with low bias risk were included in the study. These studies were assessed for methodological quality, both in scale and degree, ensuring bias identification and independence of data extraction. Eligible articles were those in Portuguese, Spanish, and English, with no publication time limit. The outcomes assessed were the standardized mean differences (SMDs) on the symptom severity scale (SSS), functional state scale (FSS), and VAS. In the clinical treatment group, a positive effect was observed on the SSS (SMD: 0.53), FSS (SMD: 0.47), and VAS (SMD decrease: 2.52) at the one-month follow-up. In the surgical-treatment group, a positive effect was observed on the SSS (SMDs: 1.97 for endoscopic and 1.55 for open surgery), FSS (SMDs: 1.52 for endoscopic and 1.77 for open surgery), and VAS (SMDs: 2.19 for endoscopic and 2.59 for open surgery) at the one-month follow-up. Significant improvements in VAS, SSS, and FSS were observed at the three-month follow-up. Current evidence in both clinical and surgical treatments demonstrates their effectiveness, as they potentially improve symptom severity, functional status, and pain intensity in patients with bilateral CTS during one- and three-month follow-up periods.

Cariogenic microorganisms and oral conditions in asthmatic children.

This study evaluated the caries risk of asthmatic patients on the basis of mutans streptococci (MS) and lactobacilli levels in saliva samples as well as the index of oral hygiene and dental caries (DMFT index). The study population was composed of 80 asthmatic children, aged 3-15 years, who use specific medication, and 80 matched, healthy control children. The parents were interviewed about oral health-related factors. The World Health Organization criteria were used for dental examinations. The Köhler and Bratthal methodology was used to detect salivary MS levels and dilutions of saliva were done for lactobacilli counting. No differences between asthma and control groups were observed for caries prevalence in children aged 3-6 and 7-10 years, except in severe cases in the younger group. However, higher caries prevalence for permanent dentition was observed in 11- to 15-year-old asthmatic children. An increased dental biofilm was observed in the asthma group, as well as salivary levels of MS. No differences were observed in levels of lactobacilli. No statistical correlations were found between medication, frequency of treatment, method of consumption and caries experience, dental biofilm and salivary levels of MS or lactobacilli. However, there was a correlation between MS levels and treatment duration. The logistic regression revealed that MS level is an important risk factor for increased caries experience. Asthma should be evaluated as a risk factor for caries experience because it can increase the levels of MS and the dental biofilm.

Evaluation of food retention in occlusal surfaces of first primary molars / Evaluación de la retención de alimentos en las superficies oclusales de los primeros molares temporales

Some food characteristics, like stickiness and consistency, can modify the time for food removal from the mouth as well as favors the activity of cariogenic bacteria, increasing dental caries risk. This study aimed to observe food retention in contact with a cariogenic substrate in 24-30 months old children. Therefore, 27 children (54 teeth) were evaluated. They intake a chocolate cookie and the food retention area was documented by digital photography in two experimental times (to: 0 and t1: 30 minutes) and it was calculated using Image Tool 3.0 software. The food retention surface index (mm2) was statistically reduced (Wilcoxon’s test, p=0.001) after 30 minutes for both maxillary (to: 0.37 +/- 0.04 and t1:0.042 +/- 0.015) and mandibular (to: 0.30 +/- 0.03 and t1: 0.078 +/- 0.019) molars. No differences were observed between the groups in food retention surface index at the initial time. At the final time, the mandibular molars show a higher retention area than the maxillary ones (Mann-Whitney’s test, p=0.04). The prevalence of food retention at the mandibular molars is higher than the maxillary molars (Chi Square’s test, p=0.03). In conclusion, first primary mandibular molars retain more food than the maxillary molars, being in agreement with clinical results of dental caries’ prevalence.

Algunas características de los alimentos, como la viscosidad y consistencia, puede modificar el tiempo para el retiro de alimentos de la boca, así como favorecer la actividad de las bacterias cariogénicas, y el aumento de riesgo de caries dental. Este estudio tuvo como objetivos verificar la retención de alimentos en contacto con un sustrato cariogénico en niños de 24-30 meses de edad. 27 niños (54 dientes) fueron evaluados. Se realizo la ingesta de una galleta de chocolate, y la zona de retención del alimento fue documentada por la fotografía digital en dos tiempos de experimentación (to: 0 y t1: 30 minutos) y se calculó utilizando el software Image Tool 3.0. El índice de superficie (mm2) de retención de alimentos fue estadísticamente reducido (test de Wilcoxon, p = 0,001) después de 30 minutos para molares maxilares (to: 0,37 +/- 0,04 y t1: 0,042 +/- 0,015) y mandibulares (to:0,30 +/- 0,03 y t1: 0,078 +/- 0,019). No se observaron diferencias en El índice de superficie de retención de alimentos entre los grupos en el tiempo inicial. En el momento final, los molares inferiores muestran una zona de retención superiores a los maxilares (prueba de Mann-Whitney, p = 0,04). La prevalencia de la retención de alimentos en los molares inferiores fue más alta que los molares superiores (Chi cuadrado, p = 0,03). En conclusión, los primeros molares mandibulares primarios retienen más alimentos que los molares superiores, siendo concordante con los resultados clínicos de la prevalencia de caries.

The lateral septal area is involved in the pressor pathway activated by microinjection of norepinephrine into the rat brain cingulate cortex.

The cingulate cortex (CC) is involved in cardiovascular regulation. Microinjection of norepinephrine (NE) into the Cg3 area of the CC caused vasopressin release and pressor responses in unanesthetized rats. Microinjection of acetylcholine (ACh) into the lateral septal area (LSA) of unanesthetized rats caused similar vasopressin-related pressor responses. The LSA is anatomically connected to the CC and the paraventricular nucleus (PVN) of the hypothalamus, an important nucleus involved in vasopressin synthesis. Therefore, we attempted to verify if the cholinergic neurotransmission within the LSA is involved in the mediation of the pressor response to the microinjection of NE into the Cg3. Local pretreatment with lidocaine, muscimol, atropine or hemicholinium-3 microinjected into the LSA blocked the pressor response to the microinjection of NE injection into the Cg3. Conversely, pretreatment with physostigmine microinjected into the LSA potentiated the pressor response to NE injection into the Cg3. The present results indicate that the synapses in the LSA are part of the pressor pathway originating at the CC and that cholinergic neurotransmission within the LSA is involved in the mediation of the cardiovascular responses to the microinjection of NE into the Cg3.

alpha-Adrenergic and muscarinic cholinergic receptors are not involved in the modulation of the parasympathetic baroreflex by the medial prefrontal cortex in rats.

The medial prefrontal cortex (MPFC) is involved in cardiovascular control and baroreflex modulation. Recent studies indicated that stimulation of MPFC muscarinic receptors causes hypotensive responses whereas stimulation of alpha1- but not of alpha2-adrenoceptors causes pressor responses in unanesthetized rats. It has also been shown that the MPFC is involved in the modulation of the parasympathetic component of the baroreflex in rats. We report that bilateral injections of CoCl2 in the ventral portion of the MPFC (vMPFC) reduced the parasympathetic component of the baroreflex, thus confirming the involvement of local synapses. We further evaluated the effect of the pharmacologic block of vMPFC alpha1- or alpha2-adrenoceptors and muscarinic receptors on the vMPFC-related modulation of the parasympathetic component of the baroreflex in unanesthetized rats. Bilateral microinjections of 10 nmol of the selective alpha1-adrenoceptor antagonist WB4101 or 10 nmol of the selective alpha2-adrenoceptors antagonist RX821002 into the MPFC did not affect the baroreflex. Bilateral microinjections of 9 nmol of the muscarinic antagonist atropine also did not affect baroreflex activity. The present results indicate that although vMPFC alpha-adrenergic and muscarinic receptors are involved in cardiovascular regulation, they do not mediate the vMPFC-related modulation of the parasympathetic component of the baroreflex.

Medial prefrontal cortex modulation of the baroreflex parasympathetic component in the rat.

The ventral portion of the medial prefrontal cortex (vMPFC) that comprises the prelimbic and infralimbic cortex is involved in arterial blood pressure and heart rate control. In the present study, we attempted to verify the effect of an acute and reversible blockade of vMPFC activity by local bilateral microinjections of either lidocaine (a local anesthetic) or CoCl2 (a nonselective synapse blocker) on the baroreflex response of unanesthetized rats. Bilateral microinjection of lidocaine into the vMPFC did not affect the tachycardiac response to mean arterial pressure (MAP) decreases caused by i.v. infusion of sodium nitroprusside or the baroreflex gain in unanesthetized rats. However, lidocaine caused a reversible shift of the reflex threshold pressure toward higher (MAP) increases in response to i.v. infusion of phenylephrine, thus indicating an action on the parasympathetic component of the baroreflex. The effects of the blockade of local synapses in the vMPFC by CoCl2 were similar to those observed after the acute ablation of that area caused by lidocaine. Bilateral microinjection of CoCl2 into the vMPFC also caused a shift of the reflex threshold pressure bradycardiac responses to MAP increases toward higher MAP values, without affecting the baroreflex gain. In conclusion, our data indicate that the vMPFC is involved in baroreflex control, and more specifically in the modulation of the parasympathetic baroreflex component. The temporary ablation of this area by local microinjections of lidocaine caused a shift of the reflex threshold pressure toward higher MAP values, which is compatible with the idea that the vMPFC has a modulatory action on the baroreflex. The observation that CoCl2 and lidocaine microinjections had similar effects on the baroreflex also suggests that this modulation involves local synaptic neurotransmission within the vMPFC.

Mechanisms involved in the pressor response to noradrenaline injection into the cingulate cortex of unanesthetized rats.

The cingulate cortex (CC) is involved in cardiovascular modulation. CC electrical or chemical stimulation may evoke either pressor or depressor responses, depending on the stimulated site and experimental conditions such as anesthesia. Noradrenaline (NA) is involved in cardiovascular regulation and it is present throughout the cortex. However, there is no report on the cardiovascular effects of intracortical injections of NA. We attempted to verify the effect of NA injection into the CC and to identify possible receptor and peripheral mechanisms involved. NA injection caused pressor responses accompanied by bradycardia, in unanesthetized rats. These responses were markedly reduced under urethane anesthesia. The pressor response was blocked by intracortical pretreatment with phenoxybenzamine or the selective alpha(1)-antagonist WB4101, and it was not affected by pretreatment with the selective alpha(2)-antagonist RX821002, suggesting that alpha(1)-adrenoceptors mediate the response. The pressor response was potentiated by pretreatment with the ganglion blocker mecamylamine and it was abolished by pretreatment with the vasopressin antagonist, dTyr(CH(2)) (5)(Me)AVP or by hypophysectomy. Circulating vasopressin levels were increased after NA injection into the CC. The present results indicate that the pressor response to local injection of NA within the CC is independent of sympathetic nerve activation and is mediated by vasopressin release.