The efficacy of transcranial direct current stimulation and transcranial magnetic stimulation for chronic orofacial pain: A systematic review.

BACKGROUND: Transcranial Direct Current Stimulation (tDCS) and Transcranial Magnetic Stimulation (TMS) have been described as promising alternatives to treat different pain syndromes. This study evaluated the effects of TMS and tDCS in the treatment of chronic orofacial pain, through a systematic review. METHODS: An electronic search was performed in major databases: MEDLINE, Scopus, Web of Science, Cochrane, Embase, LILACS, BBO, Open Gray and CINAHL. The eligibility criteria comprised randomized clinical trials (RCTs) that applied TMS or tDCS to treat chronic orofacial pain. The variables analyzed were pain, functional limitation, quality of life, tolerance to treatment, somatosensory changes, and adverse effects. The risk of bias was assessed through the Cochrane Collaboration tool, and the certainty of evidence was evaluated through GRADE. The protocol was registered in the PROSPERO database (CRD42018090774). RESULTS: The electronic search resulted in 636 studies. Thereafter, the eligibility criteria were applied and the duplicates removed, resulting in eight RCTs (four TMS and four tDCS). The findings of these studies suggest that rTMS applied to the Motor cortex (M1), the dorsolateral prefrontal cortex (DLPFC) and the secondary somatosensory cortex (S2) provide adequate orofacial pain relief. Two studies reported significant pain improvement with tDCS applied over M1 while the other two failed to demonstrate significant effects compared to placebo. CONCLUSIONS: rTMS, applied to M1, DLPFC or S2, is a promising approach for the treatment of chronic orofacial pain. Moreover, tDCS targeting M1 seems to be also effective in chronic orofacial pain treatment. The included studies used a wide variety of therapeutic protocols. In addition, most of them used small sample sizes, with a high risk of biases in their methodologies, thus producing a low quality of evidence. The results indicate that further research should be carried out with caution and with better-standardized therapeutic protocols.

Behavior analysis of electromyographic activity of the masseter muscle in sleep bruxers.

The effects of occlusal splint on the electric activity of masseter were studied in 15 women who presented sleep bruxism using surface electromyography. Sleep bruxism was defined by its clinical characteristics. The signal acquisition was done during mandible occlusion without clenching and maximum voluntary contraction in two situations. The first was after a workday without using the occlusal splint; and the second, after a sleeping night using occlusal splints. Evaluating masseter muscles during mandible occlusion without clenching, it could be observed that lower values were noticed after splint wearing in both sides. The same results were verified in maximum voluntary contraction (MVC). These results confirmed that the use of occlusal splints reduced the electromyographic activity of the right and left masseters, showing its myorelaxing effect.

Oral appliance treatment for obstructive sleep apnea in a partly edentulous patient.

INTRODUCTION: We report on the use of an oral appliance fitted to a few maxillary and mandibular teeth to treat obstructive sleep apnea syndrome. METHODS: We used a mandibular repositioning appliance, the adjustable PMPositioner. Polysomnograms were taken before and after use of the appliance. RESULTS: The apnea-hypopnea index decreased from 19.0 to 8.0. Minimum oxygen saturation increased from 80.0% to 86.0%, and rapid eye movement sleep increased from 6.0% to 20.0%, indicating that the device remained in position during sleep. A 2-year follow-up showed that periodontal and gingival health was maintained. CONCLUSIONS: Oral appliances such as the PMPositioner are an alternative for treating obstructive sleep apnea in partly edentulous patients.

Assessment of cytoskeleton and endoplasmic reticulum of fibroblast cells subjected to low-level laser therapy and low-intensity pulsed ultrasound.

OBJECTIVE: The aim of the present study was to compare the effect of low-level laser therapy (LLLT) and low-intensity pulsed ultrasound (LIPUS) on the cytoskeleton and endoplasmic reticulum of L929 cells. Thermal and non-thermal physical mechanisms such as LLLT and LIPUS induce clinically significant responses in cells, tissues, and organs. MATERIALS AND METHODS: L929 fibroblast cell cultures were irradiated with LLLT and subjected to LIPUS. Cultures irradiated with the laser (904 nm) were divided into three groups: group I, control (no irradiation); group II, irradiated at 6 J/cm(2); and group III, irradiated at 50 mJ/cm(2). Cultures subjected to ultrasound were divided into five groups: group I, control (no LIPUS); group II, LIPUS at 0.2 W/cm(2) in pulsed mode at 10% (1:9 duty cycle); group III, LIPUS at 0.6 W/cm(2) in pulsed mode at 10% (1:9 duty cycle); group IV, LIPUS at 0.2 W/cm(2) in pulsed mode at 20% (2:8 duty cycle); and group V, LIPUS at 0.6 W/cm(2) in pulsed mode at 20% (2:8 duty cycle). Each group was irradiated at 24-h intervals, with the following post-treatment incubation times: 24, 48, and 72 h. The effects of LLLT and LIPUS on the cytoskeleton and endoplasmic reticulum was evaluated by the use of fluorescent probes and with fluorescence microscopy analysis. RESULTS: The results following LLLT and LIPUS demonstrate that ultrasound was more effective than laser on fibroblast cell cultures when the endoplasmic reticulum was assessed, whereas there was a better distribution of the filaments of the cytoskeleton in the cells subjected to laser irradiation. CONCLUSION: The study demonstrated that both LLLT and LIPUS promote changes on the cellular level. However, LIPUS was more effective than LLLT at the doses used here, as assessed by fluorescence microscopy, which revealed increased reticulum activity and increased protein synthesis. However, when the organization of actin filaments was assessed, LLLT achieved a better result.

Laboratory gait analysis in patients with low back pain before and after a pilates intervention.

OBJECTIVE: To evaluate the influence of pain on vertical ground-reaction force (VGRF) in patients with low back problems and the effect of the Pilates method on the gait of these patients. DESIGN: A single-blind randomized controlled trial. PARTICIPANTS: 28 individuals assigned to a control group (n = 11) and a low-back group (n = 17), the latter of which was subdivided into a Pilates group (n = 8) and a no-Pilates group (n = 9). INTERVENTION: The Pilates group undertook 15 sessions of Pilates. MAIN OUTCOME MEASURES: The VGRF parameters were recorded during preferred and faster walking speeds. The data were collected before and after the intervention. RESULTS: The weight-acceptance rate and push-off rate were significantly less in the right lower limb of low-back group than of the control group at preferred speed. Improvements were seen in the Pilates group postintervention, with increased middle-support force for the left lower limb at faster walking speed and decreased pain; this did not occur in the no-Pilates group. CONCLUSIONS: These results suggest that patients with low back pain use strategies to attenuate the amount of force imposed on their body. The Pilates method can improve weight discharge in gait and reduce pain compared with no intervention.

Systematic assessment of the impact of oral appliance therapy on the temporomandibular joint during treatment of obstructive sleep apnea: long-term evaluation.

OBJECTIVE: The aim of the present study was to evaluate the symptoms of temporomandibular dysfunction (TMD) in patients with obstructive sleep apnea treated with long-term use of an oral appliance (OA) using a questionnaire based on the Helkimo Anamnestic Dysfunction Index. A further aim of the study was to evaluate the presence of daytime sleepiness using the Epworth Sleep Scale (ESS) and otologic symptoms. MATERIALS AND METHODS: Polysomnograms of 34 patients were performed at baseline and after 6 months of OA use. As follow-up, the patients were contacted by telephone interview to answer the same questionnaires after 36.0 +/- 17.0 months. RESULTS AND DISCUSSION: The intensity of TMD symptoms decreased significantly throughout treatment (p < 0.01). ESS values improved from 12.2 +/- 5.0 to 6.9 +/- 2.6 (p < or = 0.05). Tinnitus was present in nine patients at baseline and decreased in intensity in seven patients by the final assessment while remaining at the same level in two patients. CONCLUSIONS: We conclude that long-term usage of an OA does not cause impairment to the temporomandibular joint. The Helkimo and otologic indexes are simple and useful in long-term patient follow-up. There was a long-term improvement in the ESS values over the years analyzed. A follow-up program could increase compliance by motivating patients to use the device regularly.

Assessment of fibroblast cells submitted to ultrasonic irradiation.

Physiotherapists consider ultrasound an indispensable tool, which is commonly employed in clinical practice as a treatment aid for musculoskeletal dysfunctions. The aim of our study has been to analyze fibroblast cell structures following low-intensity pulsed ultrasonic irradiation. Fibroblast cell cultures irradiated with ultrasound were analyzed through electron microscopy to determine an ideal irradiation beam that preserved cell morphology and integrity. Analysis by fluorescence microscopy and transmission electron microscopy was used to follow morphological changes of the nucleus and cytoskeleton following different ultrasound irradiation intensities. According to the parameters used in the pulsed irradiation of fibroblast cultures, control over the intensity employed is fundamental to the optimal use of therapeutic ultrasound. Cell cultures submitted to low-intensity pulsed ultrasonic irradiation (0.2-0.6 W/cm2) at 10% (1:9 duty cycle) and 20% (2:8 duty cycle) maintained shape and cellular integrity, with little damage. In the group irradiated with an intensity of 0.8 W/cm2, a loss of adhesion was observed along with an alteration in the morphology of some cells at an intensity of 1.0 W/cm2, which resulted in the presence of cellular fragments and a decrease of adhering cells. In cells irradiated at 2.0 W/cm2, there was a complete loss of adhesion and aggregation of cellular fragments. The present study confirms that biophysical properties of pulsed ultrasound may accelerate proliferation processes in different biological tissues.

Adaptive wavelet EMG compression based on local optimization of filter banks.

This paper presents an adaptive wavelet technique for compression of surface electromyographic signals. The technique employs an optimization algorithm to adjust the wavelet filter bank in order to minimize the distortion of the compressed signal. Orthogonality of the transform is ensured by using a restriction-free parametrization described elsewhere. A case study involving real-life isotonic and isometric electromyographic signals is presented for illustration. The results show that the proposed approach outperforms the standard non-optimized wavelet technique in terms of the percent residual difference for a given compression factor.

Comparison of force, power, and striking efficiency for a Kung Fu strike performed by novice and experienced practitioners: preliminary analysis.

This paper presents a comparison of force, power, and efficiency values calculated from Kung Fu Yau-Man palm strikes, when performed by 7 experienced and 6 novice men. They performed 5 palm strikes to a freestanding basketball, recorded by high-speed camera at 1000 Hz. Nonparametric comparisons and correlations showed experienced practitioners presented larger values of mean muscle force, mean impact force, mean muscle power, mean impact power, and mean striking efficiency, as is noted in evidence obtained for other martial arts. Also, an interesting result was that for experienced Kung Fu practitioners, muscle power was linearly correlated with impact power (p = .98) but not for the novice practitioners (p = .46).

Comparison between the effect of low-level laser therapy and low-intensity pulsed ultrasonic irradiation in vitro.

OBJECTIVE: The objective of this study was to compare the effect of low-level laser therapy (LLLT) and low-intensity pulsed ultrasound (LIPUS) on fibroblast cell culture. Several methods, including ultrasound treatment and LLLT, are being used to facilitate tissue repair and healing processes. MATERIALS AND METHODS: L929 fibroblast cell cultures were irradiated with low-level laser energy and LIPUS. Cultures irradiated with ultrasound were divided into five groups: group 1: control (did not receive irradiation); group 2: 0.2 W/cm(2) in pulsed mode at 10% (1:9 duty cycle); group 3: 0.6 W/cm(2) in pulsed mode at 10% (1:9 duty cycle); group 4: 0.2 W/cm(2) in pulsed mode at 20% (2:8 duty cycle); and group 5: 0.6 W/cm(2) in pulsed mode at 20% (2:8 duty cycle). Cultures irradiated with laser energy were divided into three groups: group 1: control (did not receive irradiation); group 2: 6 J/cm(2); and group 3: 50 mJ/cm(2). Each group was irradiated at 24-h intervals, with the following incubation periods post-irradiation: 24, 48, and 72 h; after each irradiation cycle the cultures were analyzed using MTT [3-(4.5-dimethylthiazol-2-yl)-2.5 diphenyltetrazolium bromide]. RESULTS: Analysis of results after LLLT and LIPUS demonstrated that the effect of laser therapy on fibroblast cell culture was greater than that of LIPUS (p < 0.05). CONCLUSION: Results demonstrated that LLLT significantly increased fibroblastic activity more than LIPUS. Therefore, in the first and second phases of tissue repair, laser treatment may be more effective than ultrasound treatment.

Electromiographic and kinematic characteristics of Kung Fu Yau-Man palm strike.

A kinematic and electromyographic analysis of Kung Fu (KF) Yau-Man palm strikes without impact is presented. An empirical model applied to data obtained by a high-speed camera describes the kinematic characteristics of the movement. The electromyographic patterns of the biceps brachii, brachioradialis and triceps brachii muscles were studied during the strike in the time (root mean square) and frequency (wavelet transform) domains. Eight KF practitioners participated in the investigation. A wooden board was placed in front of the subjects, and they were asked to perform the strike imagining a target above the board. The results show that the Yau-Man KF palm strike has very similar kinematic characteristics to a simple moderate speed elbow extension movement. All practitioners positioned themselves in relation to the wooden board in a way to achieve their highest hand speeds in the instant their hands crossed the board. The analyses of the electromyography data shows a well developed muscle coordination of the practitioners in agreement with kinematic results. The results of this paper are important not only for improving the performance of practitioners but also to demonstrate the applicability of KF in the process of motor control development.

Treatment of obstructive sleep apnea using an adjustable mandibular repositioning appliance fitted to a total prosthesis in a maxillary edentulous patient.

This paper reports on the case of an oral appliance used in the treatment of obstructive sleep apnea syndrome (OSAS) fitted to a superior total prosthesis. In this case, the chosen device was the adjustable PMPositioner, a mandibular repositioning appliance. A polysomnogram (PSG) both prior and with the oral appliance "in situ" was applied to evaluate the effect of the adaptation of the adjustable PMPositioner fixed onto a maxillary full denture in decreasing the apnea-hypopnea index from 18.0 to 2.2 as well as increasing the minimum oxygen saturation (SaO2 nadir) from 83 to 92%, proving that the device remained in position during sleep.

The role of effective mass and hand speed in the performance of kung fu athletes compared with nonpractitioners.

The main goal of this article is to quantify the contribution of effective mass (me) and handspeed (shi) on the palm strike performance of kung fu athletes (kung fu group) compared with nonpractitioners (control group). All subjects were asked to strike a basketball. Hand and ball speed (sbf) were determined by high-speed video analysis. The value for me was determined by an equation that does not depend upon postimpact measurement of the hand speed. The results show that kung fu athletes had greater shi (6.67 [SD 1.42] m/s), p = 0.042), higher me (2.62 [SD 0.33] kg, p = 0.004), and greater sbf (9.00 [SD 1.89] m/s), p = 0.004) than the nonpractitioners (5.04 [SD 0.57] m/s, 1.33 [SD 0.19] kg, and 5.72 [SD 0.44] m/s, respectively). Comparing the average values obtained for me and hand and forearm mass (m), it was found that for the control group me is statistically equal to m (p = 0.917), whereas for the kung fu group me is significant greater than m (p = 0.003). It is suggested that for impacts against heavier objects, the effective mass would be the main factor to distinguish a martial arts-trained from an untrained subject.

Electromyographic Study of a Sequence of Yau-Man Kung Fu Palm Strikes with and without Impact.

IN MARTIAL ARTS AND CONTACT SPORTS, STRIKES ARE OFTEN TRAINED IN TWO DIFFERENT WAYS: with and without impacts. This study aims to compare the electromyographical activity (EMG) of the triceps brachii (TB), biceps brachii (BB) and brachioradialis (BR) muscles during strikes with and without impacts. Eight Yau-Man Kung Fu practitioners participated in the experiment. Each participant performed 5 sequences of 5 consecutive KF Yau-Man palm strikes with no impact intercalated with 5 sequences of 5 repetitions targeting a KF training shield. Surface EMG signals were obtained from the TB, BB, and RB for 3.0 seconds using an eight-channel module with a total amplifier gain of 2000 and sampled at 3500 Hz. The EMG analyses were done in the time (rms) and frequency (wavelet) domains. For the frequency domain, Morlet wavelet power spectra were obtained and an original method was used to quantify statistically significant regions on the power spectra. The results both in the time and frequency domains indicate a higher TB and BR muscle activity for the strikes with impacts. No significant difference was found for the BB in the two different scenarios. In addition, the results show that the wavelet power spectra pattern for the three analysed muscles obtained from the strikes with and without impacts were similar. Key pointsEMG analysis of a sequence of Kung Fu strikes demonstrates higher Triceps Brachii and Brachioradialis muscle activity for strikes with impact than strikes without impact.An original reliable method for quantifying EMG wavelet transform results is presented.EMG wavelet power spectra describe muscle roles during a Kung Fu sequence of strikes.

Estudo comparativo do consumo de oxigênio e limiar anaeróbio em um teste de esforço progressivo entre atletas profissionais de futebol e futsal / Estudio comparativo del consumo de oxígeno y límite anaeróbico en un test de esfuerzo progresivo entre atletas profesionales de fútbol y fútbol de salón / Comparative study of the oxygen consumption and anaerobic threshold in a progressive exertion test in professional soccer and indoor soccer athletes

O consumo de oxigênio (VO2) tem sido de grande valia na avaliação funcional de atletas. A ergoespirometria é um procedimento não invasivo, utilizado para avaliar o desempenho físico ou a capacidade funcional de um indivíduo, conciliando a análise de gases espirados e variáveis respiratórias. No esporte, esse método de avaliação é de fundamental importância, pois traz significativa contribuição na verificação de índices de aptidão cardiorrespiratória, como é o caso do consumo máximo de oxigênio (VO2 máx.) e o limiar anaeróbio (LA). O presente estudo teve como objetivo realizar uma comparação do consumo de oxigênio e limiar anaeróbio entre atletas profissionais de futebol e futsal em um teste progressivo. Participaram voluntariamente 31 indivíduos do sexo masculino, sendo: 19 atletas profissionais de futebol e 12 atletas profissionais de futsal. Os atletas foram submetidos a um protocolo de avaliação cardiorrespiratória progressiva pelo método ergoespirométrico e os resultados foram analisados quanto a sua diferença estatística através do teste t de Student (p < 0,05). Os valores de VO2 pico médios entre os dois grupos não apresentaram diferença estatisticamente significante (p > 0,05); entretanto, houve diferença estatística entre os dois grupos em relação ao limiar anaeróbio (LA) (p < 0,05). Com base nos resultados obtidos em nosso estudo pudemos concluir que, mesmo praticando esportes com diferentes características, os atletas de ambos os grupos possuem valores similares de consumo de oxigênio, porém, o limiar anaeróbio entre os dois grupos não apresentou a mesma similaridade, sugerido maior predominância do metabolismo anaeróbio durante o exercício nos atletas de futsal.

Oxygen consumption (VO2) has been very useful for the functional evaluation of athletes. Ergospirometry is a non-invasive procedure used to evaluate the physical performance or the functional ability of an individual, connecting the analysis of the inspired gases with the respiratory variables. This evaluation method is extremely important to sports, since it brings significant contribution in the verification of indices of cardiorespiratory aptitude, which is the case f the maximal oxygen consumption (VO2 max) and the anaerobic threshold (AT). The present study had as objective to compare oxygen consumption and anaerobic threshold in professional soccer and indoor soccer athletes in a progressive test. 31 male individuals voluntarily participated in the test, being: 19 professional soccer athletes and 12 professional indoor soccer athletes. The athletes were submitted to a progressive cardiorespiratory evaluation protocol through the ergospirometric method, and the results were analyzed concerning their statistical difference through the t-Student test (p < 0,05). The average VO2peak indices between the two groups did not present statistically significant difference (p > 0,05); however, there was statistically difference between the two groups concerning the anaerobic threshold (AT) (p < 0,05). Based on the results obtained in our study we concluded that even practicing sports with different characteristics, the athletes from both groups have similar indices of oxygen consumption. Nevertheless, the anaerobic threshold between the two groups did not present the same similarity, suggesting higher predominance of anaerobic metabolism during exercise in the indoor soccer athletes.

El consumo de oxígeno (VO2) ha sido de gran valía en la evaluación funcional de atletas. La ergoespirometría es un procedimiento no invasivo, utilizado para evaluar el desempeño físico o la capacidad funcional de un individuo, conciliando el análisis de gases expirados y las variables respiratorias. En el deporte, ese método de evaluación es de fundamental importancia, pues contribuye significativamente en la verificación de índices de aptitud cardiorrespiratoria, como es el caso del consumo máximo de oxígeno (VO2 máx.) y el límite anaeróbico (LA). El presente estudio ha tenido como objetivo realizar una comparación del consumo de oxígeno y límite anaeróbico entre atletas profesionales de fútbol y fútbol de salón en un test progresivo. Participaron voluntariamente 31 individuos del sexo masculino, entre ellos: 19 atletas profesionales de fútbol, y 12 atletas profesionales de fútbol de salón. Los deportistas fueron sometidos a un protocolo de evaluación cardiorrespiratoria progresiva por el método ergoespirométrico, y os resultados fueron analizados en relación a su diferencia estadística a través del test t-Student (p < 0,05). Los valores de VO2 pico medios entre los dos grupos no presentaron diferencia estadística significante (p > 0,05); a pesar de eso hubo diferencia estadística entre los dos grupos en relación al límite anaeróbico (LA) (p < 0,05). Teniendo como base los resultados obtenidos en nuestro estudio pudimos concluir que incluso practicando deportes con diferentes características, los atletas de ambos grupos poseen valores similares de consumo de oxígeno, sin embargo el límite anaeróbico entre los dos grupos no presentó la misma similitud, sugiriendo mayor predominancia del metabolismo anaeróbico durante el ejercicio en los atletas de fútbol de salón.

Symmetry preservation in the evolution of the genetic code.

The standard genetic code is found to exhibit an exact symmetry under a finite group of order 4 known in mathematics as the Klein group. The same symmetry is also present in almost all non-standard codes, mitochondrial as well as nuclear. Analysis of the phylogenetic tree for the evolution of the mitochondrial codes reveals that all changes along the main line of evolution preserve this symmetry, with a tendency towards symmetry enhancement. In the side branches of the evolutionary tree, the majority of changes also respect the symmetry. The few exceptional cases where it is broken correspond to reassignments that appear to be unstable or incomplete. Since the Klein group emerges naturally from the symplectic model for the prebiotic evolution that has led to the standard code, we interpret these results as lending support to the hypothesis that this symmetry has been selected during the evolution of the genetic code, not only before but also after establishment of the standard code.