A Pyranoxanthone as a Potent Antimitotic and Sensitizer of Cancer Cells to Low Doses of Paclitaxel.

Microtubule-targeting agents (MTAs) remain a gold standard for the treatment of several cancer types. By interfering with microtubules dynamic, MTAs induce a mitotic arrest followed by cell death. This antimitotic activity of MTAs is dependent on the spindle assembly checkpoint (SAC), which monitors the integrity of the mitotic spindle and proper chromosome attachments to microtubules in order to ensure accurate chromosome segregation and timely anaphase onset. However, the cytotoxic activity of MTAs is restrained by drug resistance and/or toxicities, and had motivated the search for new compounds and/or alternative therapeutic strategies. Here, we describe the synthesis and mechanism of action of the xanthone derivative pyranoxanthone 2 that exhibits a potent anti-growth activity against cancer cells. We found that cancer cells treated with the pyranoxanthone 2 exhibited persistent defects in chromosome congression during mitosis that were not corrected over time, which induced a prolonged SAC-dependent mitotic arrest followed by massive apoptosis. Importantly, pyranoxanthone 2 was able to potentiate apoptosis of cancer cells treated with nanomolar concentrations of paclitaxel. Our data identified the potential of the pyranoxanthone 2 as a new potent antimitotic with promising antitumor potential, either alone or in combination regimens.

Motor Control Training Compared With Transcutaneous Electrical Nerve Stimulation in Patients With Disc Herniation With Associated Radiculopathy: A Randomized Controlled Trial.

OBJECTIVE: The aim of the study was to compare the effectiveness of motor control training and transcutaneous electrical nerve stimulation in relieving pain, reducing functional disability, and improving transversus abdominis activation in patients with lumbar disc herniation with associated radiculopathy. DESIGN: This is a randomized controlled trial. METHODS: Forty patients diagnosed with lumbar disc herniation were randomly divided into two groups: motor control training group (n = 20) and transcutaneous electrical nerve stimulation group (n = 20). INTERVENTIONS: The motor control training group and transcutaneous electrical nerve stimulation group attended 60 mini sessions twice a week for 8 wks, totaling to 16 sessions. MAIN OUTCOME MEASURES: The main outcome measures are pain, functional disability, and transversus abdominis activation capacity. RESULTS: Differences between both groups were observed after 8 wks, favoring the motor control training group. Motor control training was more effective than transcutaneous electrical nerve stimulation in relieving pain (mean difference = 3.3 points, 95% confidence interval = 2.12-4.48), reducing functional disability (mean difference = 8.4 points, 95% confidence interval = 5.44-11.36), improving the quality of pain (mean difference = 17 points, 95% confidence interval = 7.93-26.07), sensory quality of pain (mean difference = 10.3 points, 95% confidence interval = 5.55-15.05), and transversus abdominis activation (mean difference = 1.5 points, 95% confidence interval = 0.90-2.10). CONCLUSIONS: The results suggest that motor control training is more effective than transcutaneous electrical nerve stimulation with respect to relieving pain, reducing functional disability, and improving transversus abdominis activation in patients with lumbar disc herniation.

Comparison Between Transcutaneous Electrical Nerve Stimulation and Stabilization Exercises in Fatigue and Transversus Abdominis Activation in Patients With Lumbar Disk Herniation: A Randomized Study.

OBJECTIVE: The purpose of this study was to compare transcutaneous electrical nerve stimulation (TENS) and stabilization exercises in an attempt to prevent fatigue and improve muscle activation in patients with lumbar disk herniation associated with low back pain. METHODS: This study involved 29 patients (age range 25-58 years) randomized into 2 groups: the segmental stabilization group (n = 15), who received stabilization exercises on the transversus abdominis (TrA) and lumbar multifidus muscles; and the TENS group (n = 14), who received electrotherapy. Groups underwent 16 sessions, for 60 minutes, twice per week, and they were evaluated before and after intervention. Pain was measured using a visual analog scale, functional disability using the Oswestry Disability Index, muscle activation and fatigue with electromyography, and patients' ability to contract the TrA with a pressure biofeedback unit. Analyses within and between groups were performed. RESULTS: The stabilization group improved lumbar multifidus fatigue (median frequency [MF] initial [P = .002], MF final [P < .001], MF slope [P = .001], and resistance time [P < .001]), ability to contract the TrA (P < .001), pain (P < .001), and functional disability (P < .001). TENS only was effective for pain (P = .012). CONCLUSION: Although it relieved pain, TENS was not effective as a single treatment to prevent fatigue, increase TrA contraction, and reduce functional disability in herniated disk patients. Stabilization exercises alone improved all measured outcomes.

Cobertura do exame citopatológico em unidades de saúde no interior de Mato Grosso / Coverage of the cytopathological examination in health units in the interior of Mato Grosso / Cobertura del examen citopatológico en las unidades de salud en el interior de Mato Grosso

Objetivo: verificar a cobertura do exame Papanicolaou em um município no interior de Mato grosso na região Vale do Araguaia. Método: trata-se de um estudo quantitativo e comparativo de tendências temporais, realizado a partir nos cadernos de prevenção de câncer de colo uterino de três unidades de saúde, nos registros do período de 2010 e 2011. Os dados foram lançados em planilha do Microsoft Excel 2013 e analisados por meio de estatística descritiva simples, em números absolutos e relativos. Resultados: A pesquisa demonstrou um aumento na adesão ao exame, bem como encaminhamentos para colposcopia e amostras consideradas insatisfatórias. Enquanto que a cobertura de mulheres com menos de 35 anos decresceu, na comparação entre o período investigado. Conclusão: Apesar do aumento na adesão, faz-se necessária à implementação de estratégias frente ao cenário encontrado, como a capacitação dos profissionais, visto possíveis falhas na realização do procedimento, não deixando de intensificar de ações voltadas à a prevenção do câncer do colo do útero.

Objective: to verify the coverage of the Pap smear examination in a municipality in the interior of Mato Grosso in the Vale do Araguaia region. Method: this is a quantitative and comparative study of temporal trends, carried out from the cervical cancer prevention books of three health units, in the records of the period of 2010 and 2011. The data were published in a Microsoft Excel 2013 worksheet and analyzed using simple descriptive statistics, in absolute and relative numbers. Results: The study demonstrated an increase in adherence to the examination, as well as referrals for colposcopy and samples considered unsatisfactory. While the coverage of women under 35 years of age decreased in the comparison between the periods under investigation. Conclusion: In spite of the increase in adherence, it is necessary to implement strategies in the face of the scenario found, such as the qualification of the professionals, considering possible failures in the accomplishment of the procedure, while continuing to intensify actions aimed at the prevention of cervical cancer uterus.

Objetivo: verificar la cobertura del examen Papanicolaou en un municipio en el interior de Mato grueso en la región Vale do Araguaia. Método: se trata de un estudio cuantitativo y comparativo de tendencias temporales, realizado a partir de los cuadernos de prevención de cáncer de cuello uterino de tres unidades de salud, en los registros del período de 2010 y 2011. Los datos se contabilizaron en la hoja de cálculo de Microsoft Excel 2013 y se analizaron mediante una estadística descriptiva simple, en números absolutos y relativos. Resultados: La investigación demostró un aumento en la adhesión al examen, así como encaminamientos para colposcopia y muestras consideradas insatisfactorias. Mientras que la cobertura de mujeres menores de 35 años disminuyó, en la comparación entre el período investigado. Conclusión: A pesar del aumento en la adhesión, se hace necesaria la implementación de estrategias frente al escenario encontrado, como la capacitación de los profesionales, visto posibles fallas en la realización del procedimiento, no dejando de intensificar las acciones dirigidas a la prevención del cáncer del cuello del útero.

TNM-O: ontology support for staging of malignant tumours.

BACKGROUND: Objectives of this work are to (1) present an ontological framework for the TNM classification system, (2) exemplify this framework by an ontology for colon and rectum tumours, and (3) evaluate this ontology by assigning TNM classes to real world pathology data. METHODS: The TNM ontology uses the Foundational Model of Anatomy for anatomical entities and BioTopLite 2 as a domain top-level ontology. General rules for the TNM classification system and the specific TNM classification for colorectal tumours were axiomatised in description logic. Case-based information was collected from tumour documentation practice in the Comprehensive Cancer Centre of a large university hospital. Based on the ontology, a module was developed that classifies pathology data. RESULTS: TNM was represented as an information artefact, which consists of single representational units. Corresponding to every representational unit, tumours and tumour aggregates were defined. Tumour aggregates consist of the primary tumour and, if existing, of infiltrated regional lymph nodes and distant metastases. TNM codes depend on the location and certain qualities of the primary tumour (T), the infiltrated regional lymph nodes (N) and the existence of distant metastases (M). Tumour data from clinical and pathological documentation were successfully classified with the ontology. CONCLUSION: A first version of the TNM Ontology represents the TNM system for the description of the anatomical extent of malignant tumours. The present work demonstrates its representational power and completeness as well as its applicability for classification of instance data.

Dynamic postural stability and muscle strength in patellofemoral pain: Is there a correlation?

BACKGROUND: Although females with patellofemoral pain (PFP) show a decrease in hip and knee muscle strength, there is a lack of studies that associates this with postural stability. The purpose of this study was to assess the dynamic postural stability and muscle strength in the hips and knees of females with and without PFP, and to verify the association between the postural stability and the muscle strength in the PFP group. METHODS: Two groups were tested: one with 25 PFP and one with 25 asymptomatic. Postural stability was evaluated during stepping up down tasks using a force platform to determine the center of pressure (COP) excursion and velocity. A handheld dynamometer was used to assess the muscles strength. The correlation analysis was conducted between the COP variables and the muscle strength. RESULTS: The PFP group demonstrated greater total and medial-lateral COP displacement (8887.7±761.7 vs. 8129.4±691.9mm, P<0.001; 32.3±5.5 vs. 21.7±2.7mm, P<0.001) and a higher total of medial-lateral COP velocity (22.2±5.2 vs. 17.0±1.6 P=0.001). The PFP group showed weaknesses in all muscles (P<0.05), and there was a good positive correlation between the anterior-posterior displacement and the velocity of the extensor hip muscle (r=0.52, P<0.01; r=0.55, P<0.001). CONCLUSIONS: Subjects with PFP have frontal dynamic postural stability deficit and show an association between hip extensor and sagittal plane stability.

Q-angle in patellofemoral pain: relationship with dynamic knee valgus, hip abductor torque, pain and function.

OBJECTIVE: To investigate the relationship between the q-angle and anterior knee pain severity, functional capacity, dynamic knee valgus and hip abductor torque in women with patellofemoral pain syndrome (PFPS). METHODS: This study included 22 women with PFPS. The q-angle was assessed using goniometry: the participants were positioned in dorsal decubitus with the knee and hip extended, and the hip and foot in neutral rotation. Anterior knee pain severity was assessed using a visual analog scale, and functional capacity was assessed using the anterior knee pain scale. Dynamic valgus was evaluated using the frontal plane projection angle (FPPA) of the knee, which was recorded using a digital camera during step down, and hip abductor peak torque was recorded using a handheld dynamometer. RESULTS: The q-angle did not present any significant correlation with severity of knee pain (r = -0.29; p = 0.19), functional capacity (r = -0.08; p = 0.72), FPPA (r = -0.28; p = 0.19) or isometric peak torque of the abductor muscles (r = -0.21; p = 0.35). CONCLUSION: The q-angle did not present any relationship with pain intensity, functional capacity, FPPA, or hip abductor peak torque in the patients with PFPS.

OBJETIVO: Investigar a relação entre o ângulo-q e intensidade da dor anterior no joelho, capacidade funcional, valgo dinâmico de joelho e torque abdutor do quadril em mulheres com síndrome da dor patelofemoral (SDPF). MÉTODOS: Participaram do estudo 22 mulheres com SDPF. O ângulo-q foi avaliado pela goniometria, as participantes foram posicionadas em decúbito dorsal com joelho e quadril estendido e quadril e pé em rotação neutra. A intensidade da dor anterior do joelho foi avaliada pela escala visual analógica de dor e a capacidade funcional com a escala de dor anterior no joelho. O valgo dinâmico foi avaliado pelo ângulo de projeção no plano frontal do joelho (APPF), registrado com câmera digital durante step down, e o pico de torque dos abdutores do quadril com dinamômetro manual. RESULTADOS: O ângulo-q não apresentou correlação significativa com a intensidade da dor no joelho (r = −0,29; p = 0,19), capacidade funcional (r = −0,08; p = 0,72), ângulo de projeção no plano frontal do joelho (r = −0,28; p = 0,19) e pico de torque isométrico dos músculos abdutores (r = −0,21; p = 0,35). CONCLUSÃO: O ângulo-q não apresentou relação com a intensidade da dor, capacidade funcional, ângulo de projeção no plano frontal do joelho e pico de torque dos abdutores do quadril em pacientes com SDPF.

Q-angle in patellofemoral pain: relationship with dynamic knee valgus, hip abductor torque, pain and function / Ângulo-q na dor patelofemoral: relação com valgo dinâmico de joelho, torque abdutor do quadril, dor e função

OBJECTIVE: To investigate the relationship between the q-angle and anterior knee pain severity, functional capacity, dynamic knee valgus and hip abductor torque in women with patellofemoral pain syndrome (PFPS). METHODS: This study included 22 women with PFPS. The q-angle was assessed using goniometry: the participants were positioned in dorsal decubitus with the knee and hip extended, and the hip and foot in neutral rotation. Anterior knee pain severity was assessed using a visual analog scale, and functional capacity was assessed using the anterior knee pain scale. Dynamic valgus was evaluated using the frontal plane projection angle (FPPA) of the knee, which was recorded using a digital camera during step down, and hip abductor peak torque was recorded using a handheld dynamometer. RESULTS: The q-angle did not present any significant correlation with severity of knee pain (r = -0.29; p = 0.19), functional capacity (r = -0.08; p = 0.72), FPPA (r = -0.28; p = 0.19) or isometric peak torque of the abductor muscles (r = -0.21; p = 0.35). CONCLUSION: The q-angle did not present any relationship with pain intensity, functional capacity, FPPA, or hip abductor peak torque in the patients with PFPS.

OBJETIVO: Investigar a relação entre o ângulo-q e intensidade da dor anterior no joelho, capacidade funcional, valgo dinâmico de joelho e torque abdutor do quadril em mulheres com síndrome da dor patelofemoral (SDPF). MÉTODOS: Participaram do estudo 22 mulheres com SDPF. O ângulo-q foi avaliado pela goniometria, as participantes foram posicionadas em decúbito dorsal com joelho e quadril estendido e quadril e pé em rotação neutra. A intensidade da dor anterior do joelho foi avaliada pela escala visual analógica de dor e a capacidade funcional com a escala de dor anterior no joelho. O valgo dinâmico foi avaliado pelo ângulo de projeção no plano frontal do joelho (APPF), registrado com câmera digital durante step down, e o pico de torque dos abdutores do quadril com dinamômetro manual. RESULTADOS: O ângulo-q não apresentou correlação significativa com a intensidade da dor no joelho (r = -0,29; p = 0,19), capacidade funcional (r = -0,08; p = 0,72), ângulo de projeção no plano frontal do joelho (r = -0,28; p = 0,19) e pico de torque isométrico dos músculos abdutores (r = -0,21; p = 0,35). CONCLUSÃO: O ângulo-q não apresentou relação com a intensidade da dor, capacidade funcional, ângulo de projeção no plano frontal do joelho e pico de torque dos abdutores do quadril em pacientes com SDPF.

Are lumbar multifidus fatigue and transversus abdominis activation similar in patients with lumbar disc herniation and healthy controls? A case control study.

PURPOSE: The aims of this study were to assess lumbar multifidus fatigue (LM) and transversus abdominis activation (TrA) in individuals with lumbar disc herniation associated with low back pain. METHODS: Sixty individuals were divided into the lumbar herniation (LHG, n = 30) and control groups (CG, n = 30). Fatigue of the LM was assessed using surface electromyography during the Sorensen effort test, and activation of the TrA with a pressure biofeedback unit. Pain intensity was determined using a visual analog scale and the McGill pain questionnaire. The Oswestry disability questionnaire and the Borg scale for self-evaluating exertion were used to assess functional disability. RESULTS: Fatigue was significantly more intense and the TrA activation was insufficient (p < 0.01) in individuals with disc herniation relative to the control group. The LHG had mild functional disability and moderate pain. There were differences in the initial exertion self-evaluation between groups, which were not observed in the final exertion evaluation. CONCLUSION: Individuals with lumbar disc herniation associated with low back pain have increased fatigue of the LM and decreased activation of the TrA, when compared to the control group.

Relationship between frontal plane projection angle of the knee and hip and trunk strength in women with and without patellofemoral pain.

BACKGROUND: It is theorized that increased dynamic knee valgus relates to decreased hip posterolateral muscle strength. OBJECTIVE: The aim here was to assess the relationship between the frontal plane projection angle (FPPA) of the knee and hip and trunk muscle strength in women with and without patellofemoral pain (PFP). METHODS: The sample comprised 43 women: Patellofemoral Pain Group (PPG, n = 22) and Control Group (CG, n = 21). Muscle strength for hip abduction, extension, external rotation and lateral core were measured using a handheld dynamometer. The FPPA was recorded during step-down. RESULTS: The PPG showed a deficit for hip muscles torque and increased FPPA (P < 0.05). Negative correlation of the FPPA-Peak was found in the CG for the hip abductor (r = -0.31) and posterolateral complex (r = -0.32) (P < 0.05). In the PPG, the FPPA-Peak showed a moderate negative correlation to the torque of external rotators and posterolateral hip muscles, although this correlation did not reach statistical significance. CONCLUSIONS: These findings suggest that women with patellofemoral pain present greater dynamic knee valgus and hip muscle weakness. Abductor and posterolateral hip muscles strength are associated with increased FPPA only in the pain-free population.

Does anterior knee pain severity and function relate to the frontal plane projection angle and trunk and hip strength in women with patellofemoral pain?

The aim of the present study was to determine the relationship between knee pain severity and function with the frontal plane projection angle (FPPA) and trunk and hip peak torque (PT) in women with patellofemoral pain (PFPS). Twenty-two women with PFPS were assessed. Knee pain severity (KPS) was assessed with an 11-point visual analog scale and function with an Anterior Knee Pain Scale. The FPPA was recorded with a digital camera. PT of extensors, abductors, and the lateral rotators of hip and lateral core stability were measured with a handheld dynamometer. FPPA was the only predictor for the KPS. Regarding predictors of function, PT of lateral core stability and the extensor and abductor of the hip explained 41.4% of the function. Increase in FPPA was associated with greater KPS, and the lowest PT of lateral core stability, hip abductors, and extensors was associated with lower function in women with PFPS.

The short-term effects of graded activity versus physiotherapy in patients with chronic low back pain: A randomized controlled trial.

BACKGROUND: Chronic low back pain is one of the most common problematic health conditions worldwide and is highly associated with disability, quality of life, emotional changes, and work absenteeism. Graded activity programs, based on cognitive behavioral therapy, and exercises are common treatments for patients with low back pain. However, recent evidence has shown that there is no evidence to support graded activity for patients with chronic nonspecific low back pain. AIM: to compare the effectiveness of graded activity and physiotherapy in patients with chronic nonspecific low back pain. METHODS: A total of 66 patients with chronic nonspecific low back pain were randomized to perform either graded activity (moderate intensity treadmill walking, brief education and strength exercises) or physiotherapy (strengthening, stretching and motor control). These patients received individual sessions twice a week for six weeks. The primary measures were intensity of pain (Pain Numerical Rating Scale) and disability (Rolland Morris Disability Questionnaire). RESULTS: After six weeks, significant improvements have been observed in all outcome measures of both groups, with a non-significant difference between the groups. For intensity of pain (mean difference = 0.1 points, 95% confidence interval [CI] = -1.1-1.3) and disability (mean difference = 0.8 points, 95% confidence interval [CI] = -2.6-4.2). No differences were found in the remaining outcomes. CONCLUSION: The results of this study suggest that graded activity and physiotherapy showed to be effective and have similar effects for patients with chronic nonspecific low back pain.

Postural control in individuals with and without non-specific chronic low back pain: a preliminary case-control study.

STUDY DESIGN: A preliminary case-control study. OBJECTIVE: To assess postural control in individuals with and without non-specific chronic low back pain (cLBP) during quiet standing. cLBP affects 12-33 % of the adult population. Reasons for pain chronicity are yet poorly known. Change in postural control may be a risk factor for cLBP, although available studies are not conclusive. METHODS: Sample consisted of 21 individuals with cLBP and 23 controls without cLBP. Balance was assessed using a force plate (Balance Master, NeuroCom) by the modified clinical test of sensory interaction and balance, pain severity by the visual analogue scale, quality of life with the SF-36 Questionnaire, and functional disability with the Roland-Morris Questionnaire. RESULTS: Groups were homogeneous for age, weight, height and body mass index. Relative to controls, participants in the cLBP group had deficits in the postural control, with greater postural sway in the quiet standing condition with closed eyes closed on unstable surfaces (p < 0.05) for the following parameters: total COP oscillation [cLBP 1,432.82 (73.27) vs CG 1,187.77 (60.30)], root mean square sagittal plane [cLBP 1.21 (0.06) vs CG 1.04 (0.04)], COP area [cLBP 24.27 (2.47) vs CG 16.45 (1.79)] and mean speed of oscillation [cLBP 12.97 (0.84) vs CG 10.55 (0.70)]. CONCLUSION: Postural control, as evidenced by increased oscillation of COP, is impaired in individuals with cLBP relative to controls. Differences are magnified by visual deprivation and unstable surface conditions.

Efficacy of graded activity versus supervised exercises in patients with chronic non-specific low back pain: protocol of a randomised controlled trial.

BACKGROUND: Low back pain is a relevant public health problem, being an important cause of work absenteeism worldwide, as well as affecting the quality of life of sufferers and their individual functional performances. Supervised active physical routines and of cognitive-behavioral therapies are recommended for the treatment of chronic Low back pain, although evidence to support the effectiveness of different techniques is missing. Accordingly, the aim of this study is to contrast the effectiveness of two types of exercises, graded activity or supervised, in decreasing symptoms of chronic low back pain. METHODS/DESIGN: Sample will consist of 66 patients, blindly allocated into one of two groups: 1) Graded activity which, based on an operant approach, will use time-contingent methods aiming to increase participants' activity levels; 2) Supervised exercise, where participants will be trained for strengthening, stretching, and motor control targeting different muscle groups. Interventions will last one hour, and will happen twice a week for 6 weeks. Outcomes (pain, disability, quality of life, global perceived effect, return to work, physical activity, physical capacity, and kinesiophobia) will be assessed at baseline, at treatment end, and three and six months after treatment end. Data collection will be conducted by an investigator blinded to treatment allocation. DISCUSSION: This project describes the randomisation method that will be used to compare the effectiveness of two different treatments for chronic low back pain: graded activity and supervised exercises. Since optimal approach for patients with chronic back pain have yet not been defined based on evidence, good quality studies on the subject are necessary. TRIAL REGISTRATION: NCT01719276.

Estabilização segmentar lombar e TENS na hérnia discal lombar: um ensaio clínico randomizado / Lumbar segmental stabilization and TENS in lumbar disc herniation: a randomized controlled trial

INTRODUÇÃO: A hérnia de disco lombar (HDL) acomete cerca de 5% dos pacientes com de dor lombar e o tratamento cirúrgico nestes casos é cada vez menos indicado, optando-se, na maior parte dos casos, pelo conservador. Embora o método estabilização lombar (EL) e a estimulação elétrica nervosa transcutânea (TENS) tenham mostrado bons resultados em indivíduos portadores de dor lombar inespecífica, há escassa literatura que tenha verificado a eficácia destes tratamentos isoladamente em sujeitos acometidos por hérnia de disco lombar. OBJETIVO: Comparar a eficácia dos exercícios de estabilização lombar e da TENS na dor, incapacidade funcional, e capacidade de ativação do músculo transverso do abdome (TrA) de indivíduos com hérnia de disco lombar. METODOLOGIA: Participaram da pesquisa 40 indivíduos com idade variando de 25 a 58 anos com dor lombar e hérnia de disco, e foram randomizados em dois grupos: Grupo estabilização lombar (EL) (exercícios específicos para os músculos TrA e multífido lombar(ML)) (n=20) e Grupo TENS (GT) (n=20) que receberam atendimento com corrente de estimulação elétrica nervosa transcutânea. Foram avaliados quanto à dor (Escala Visual Analógica e Questionário McGill de Dor), incapacidade funcional (Índice de Incapacidade de Oswestry), e capacidade de recrutamento do TrA (Unidade de Biofeedback Pressórico-UBP). Os grupos foram tratados em duas sessões semanais com duração de 60 minutos por oito semanas. Cada indivíduo foi avaliado antes e após o tratamento. O nível de significância estabelecido foi de alfa=0,05. RESULTADOS: Após oito semanas, o grupo estabilização lombar mostrou melhora significativa na dor (p < 0,001), incapacidade funcional (p < 0,001), e capacidade de ativação do TrA (p < 0,001). O grupo TENS apresentou diferença estatisticamente significante apenas na dor (p < 0,012). A estabilização foi superior à TENS na melhora na dor (p < 0,001), incapacidade funcional (p < 0,001), e capacidade de ativação do TrA (p < 0,001). CONCLUSÃO:...

INTRODUCTION: Lumbar disc herniation (LDH) affects about 5% of low back pain (LBP) patients. Surgical treatment in these cases is increasingly less suitable, opting, in most cases, for the conservative. Although lumbar stabilization method and transcutaneous electric nerve stimulation (TENS) have shown good results in patients with nonspecific low back pain, there is scarce literature that has verified the effectiveness of these treatments alone in subjects suffering from lumbar disc herniation.OBJECTIVE: To compare the effectiveness of lumbar stabilization exercises and transcutaneous electrical nerve stimulation (TENS), on pain, functional disability and activation of the transversus abdominis muscle (TrA), in individuals with lumbar disc herniation (LDH). METHODS: This study involved 40 patients (age range 25-58 years) with lumbar disc herniation randomized into two groups: Stabilization group (SG: n=20); which received of stabilization exercises (transversus abdominis and lumbar multifidus muscles) and TENS group (TG: n=20), which received electrotherapy. The following instruments were used: visual analogue pain scale and McGill Pain Questionnaire for pain, Oswestry Disability Index for functional disability, and pressure biofeedback unit (PBU) for ability to contract the TrA. Analyses within and between groups were performed after treatment. Groups underwent 16 sessions, for 60 minutes, twice a week and they were evaluated before and after eight weeks. Significance level was set at alfa= 0.05. RESULTS: After eight weeks, lumbar stabilization group showed significant improvements in pain (p < 0.001), functional disability (p < 0.001), and the ability to contract the TrA (p < 0.001). There were no significant differences in TENS group in terms of disability (p < 0.264) or ability to contract the TrA muscle (p < 0.181), however, improvement in pain was demonstrated (p < 0.012). The stabilization was superior to TENS in terms of improvements in pain...

Effects of muscular stretching and segmental stabilization on functional disability and pain in patients with chronic low back pain: a randomized, controlled trial.

OBJECTIVE: The purpose of this study was to compare the effects of 2 exercise programs, segmental stabilization exercises (SSEs) and stretching of trunk and hamstrings muscles, on functional disability, pain, and activation of the transversus abdominis muscle (TrA), in individuals with chronic low back pain. METHODS: A total of 30 participants were enrolled in this study and randomly assigned to 1 of 2 groups as a function of intervention. In the segmental stabilization group (SS), exercises focused on the TrA and lumbar multifidus muscles, whereas in the stretching group (ST), exercises focused on stretching the erector spinae, hamstrings, and triceps surae. Severity of pain (visual analog scale and McGill pain questionnaire) and functional disability (Oswestry disability questionnaire) and TrA muscle activation capacity (Pressure Biofeedback Unit, or PBU) were compared as a function of intervention. Interventions lasted 6 weeks, and sessions happened twice a week (30 minutes each). Analysis of variance was used for intergroup and intragroup comparisons. RESULTS: As compared with baseline, both treatments were effective in relieving pain and improving disability (P < .001). Those in the SS group had significantly higher gains for all variables. The stretching group did not effectively activate the TrA (P = .94). CONCLUSION: Both techniques improved pain and reduced disability. In this study, SS was superior to muscular stretching for the measured variables associated with chronic low back pain.

Postural control in elderly women with osteoporosis: comparison of balance, strengthening and stretching exercises. A randomized controlled trial.

OBJECTIVE: To compare the efficacy of balance training associated with muscle strengthening or stretching, relative to no intervention, in the postural control of elderly women with osteoporosis. DESIGN: A randomized, controlled trial. SUBJECTS AND INTERVENTIONS: Sample consisted of 50 women aged 65 years or older, with osteoporosis, randomized into one of three groups: strengthening group (n = 17) performed balance training with muscle strengthening; stretching group (n = 17) performed balance training with stretching; and control group (n = 16), no activities. Interventions lasted eight weeks, twice a week, 60 minutes a day. MAIN MEASURES: Postural control was evaluated by the modified Clinical Test of Sensory Interaction for Balance (CTSIBm) and Limits of Stability Test. Strength was assessed by dynamometry and the shortening of the hamstrings by goniometry. RESULTS: Relative to controls, participants in the strengthening group displayed significantly increased dorsiflexion strength and knee flexion strength, as well as centre of pressure velocity, directional control, and oscillation velocity (CTSIBm test). The stretching group had significantly improvements in hamstring length, knee flexion strength, centre of pressure velocity, and amplitude of movements. Relative to the stretching group, the strengthening group yielded better knee extension strength and directional control. CONCLUSION: The results suggest that both interventions are effective in improving postural control when compared to the control group, and the strengthening group was superior to the stretching group in knee extension strength and in directional control.

Epidemiological, clinical, and operational aspects of leprosy patients assisted at a referral service in the state of Maranhão, Brazil.

INTRODUCTION: Leprosy is an infectious disease caused by Mycobacterium leprae. The aim of this study was to describe the epidemiological, clinical, and operational aspects of leprosy carriers. METHODS: A cross-sectional study leprosy patients assisted in São Luis, MA, was performed. RESULTS: Of the 85 cases analyzed, 51.7% were male participants, and 60% were brown. Concerning the age, 54.8% of women were between 35 and 49 years, and 57.6% of men were between 20 and 34 years. Lepromatous leprosy was found in 42.3% of cases, and the multibacillary form was found in 72.9%. The skin smear was positive in 42.3%. The occurrence of reaction was found in 43.5% of cases, and 83.5% had no Bacillus Calmette-Guérin scar. Leprosy in the family was reported by 44.7% of the patients. Most of the individuals (96.4%) lived in houses made of brick with more than three rooms (72.6%) and two persons per room (65.1%). Concerning the level of education, 41.4% of women and 34.1% of men had more than one to three years of education. The most evaluated age group in the beginning of the treatment was that of 35 to 49 years with a Grade 0 incapability (64.5%), and that in the end was the age group of 20 to 34 (29.9%) with Grade 0, 30.7% Grade 1, and 11.5% Grade 2. CONCLUSIONS: The frequency of multibacillary forms found in this study and the cases in family members point out delayed diagnoses. Thus, early diagnosis and appropriate treatment are important in decreasing the outcome of disabilities.

Epidemiological, clinical, and operational aspects of leprosy patients assisted at a referral service in the state of Maranhão, Brazil / Aspectos epidemiológicos, clínicos e operacionais de portadores de hanseníase atendidos em um serviço de referência no estado do Maranhão

INTRODUCTION: Leprosy is an infectious disease caused by Mycobacterium leprae. The aim of this study was to describe the epidemiological, clinical, and operational aspects of leprosy carriers. METHODS: A cross-sectional study leprosy patients assisted in São Luis, MA, was performed. RESULTS: Of the 85 cases analyzed, 51.7 percent were male participants, and 60 percent were brown. Concerning the age, 54.8 percent of women were between 35 and 49 years, and 57.6 percent of men were between 20 and 34 years. Lepromatous leprosy was found in 42.3 percent of cases, and the multibacillary form was found in 72.9 percent. The skin smear was positive in 42.3 percent. The occurrence of reaction was found in 43.5 percent of cases, and 83.5 percent had no Bacillus Calmette-Guérin scar. Leprosy in the family was reported by 44.7 percent of the patients. Most of the individuals (96.4 percent) lived in houses made of brick with more than three rooms (72.6 percent) and two persons per room (65.1 percent). Concerning the level of education, 41.4 percent of women and 34.1 percent of men had more than one to three years of education. The most evaluated age group in the beginning of the treatment was that of 35 to 49 years with a Grade 0 incapability (64.5 percent), and that in the end was the age group of 20 to 34 (29.9 percent) with Grade 0, 30.7 percent Grade 1, and 11.5 percent Grade 2. CONCLUSIONS: The frequency of multibacillary forms found in this study and the cases in family members point out delayed diagnoses. Thus, early diagnosis and appropriate treatment are important in decreasing the outcome of disabilities.

INTRODUÇÃO: A hanseníase é uma doença infecto-contagiosa causada pelo Mycobacterium leprae. Este estudo descreve os aspectos epidemiológicos, clínicos e operacionais de portadores de hanseníase. MÉTODOS: Estudo transversal, realizado no município de São Luis, MA. RESULTADOS: Foram analisados 85 casos, sendo 51,7 por cento, do sexo masculino e cor parda (60 por cento). As mulheres tinham entre 35 a 49 anos de idade (54,8 por cento) e os homens entre 20 a 34 (57,6 por cento). A forma virchowiana foi mais frequente (42,3 por cento), a classe operacional a multibacilar (72,9 por cento) e baciloscopia positiva em 42,3 por cento. Houve ocorrência de reação em 43,5 por cento, e ausência da cicatriz da Bacillus Calmette-Guérin (BCG) em 83,5 por cento. Hanseníase na família foi referida por 44,7 por cento. As casas eram de alvenaria (96,4 por cento), tinham mais de 3 cômodos (72,6 por cento), dormindo duas pessoas por cômodo (65,1 por cento). Quanto aos anos de estudo, 41,4 por cento de mulheres e 34 por cento de homens tinham de um a três anos. A faixa etária entre 35 e 49 anos foi a mais avaliada com Grau 0 de incapacidade, no início do tratamento (64,5 por cento) e no final, foi entre 20 e 34 e destes 29,9 por cento tinham Grau 0, 30,7 por cento Grau 1 e 11,5 por cento Grau 2. CONCLUSÕES: A frequência das formas multibacilares e casos em familiares indicam diagnósticos tardios, reforçando a importância do diagnóstico precoce e tratamento adequado, para a redução do aparecimento de incapacidades.

Segmental stabilization and muscular strengthening in chronic low back pain: a comparative study.

OBJECTIVE: To contrast the efficacy of two exercise programs, segmental stabilization and strengthening of abdominal and trunk muscles, on pain, functional disability, and activation of the transversus abdominis muscle (TrA), in individuals with chronic low back pain. DESIGN: Our sample consisted of 30 individuals, randomly assigned to one of two treatment groups: segmental stabilization, where exercises focused on the TrA and lumbar multifidus muscles, and superficial strengthening, where exercises focused on the rectus abdominis, abdominus obliquus internus, abdominus obliquus externus, and erector spinae. Groups were examined to discovere whether the exercises created contrasts regarding pain (visual analogical scale and McGill pain questionnaire), functional disability (Oswestry disability questionnaire), and TrA muscle activation capacity (Pressure Biofeedback Unit = PBU). The program lasted 6 weeks, and 30-minute sessions occurred twice a week. Analysis of variance was used for inter- and intra-group comparisons. The significance level was established at 5%. RESULTS: As compared to baseline, both treatments were effective in relieving pain and improving disability (p < 0.001). Those in the segmental stabilization group had significant gains for all variables when compared to the ST group (p < 0.001), including TrA activation, where relative gains were 48.3% and -5.1%, respectively. CONCLUSION: Both techniques lessened pain and reduced disability. Segmental stabilization is superior to superficial strengthening for all variables. Superficial strengthening does not improve TrA activation capacity.