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1.
Medicine (Baltimore) ; 99(30): e21311, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791718

RESUMO

BACKGROUND: This systematic review will assess the effectiveness and safety neuromuscular electrical stimulation (NMES) for cancer pain (CP) in children with osteosarcoma. METHODS: This systematic review protocol will retrieve the following electronic databases from inception to June 1 in Cochrane Library, MEDLINE, EMBASE, Web of Science, Scopus, CNKI, and VIP database. Manual head-searching of reference lists and conference proceedings will be performed to further examine the articles of interest. No restrictions will be applied to language and publication status. We will utilize a 3-stage approach to scan titles, abstracts, and full-text studies against all eligibility criteria, and collect data from included trials. Study quality will be evaluated by the Cochrane Risk of Bias Tool. If possible, we will narratively summarize study results and carry out meta-analysis. RESULTS: This study will recapitulate the present high quality trials to appraise the effectiveness and safety of NMES for CP in children with osteosarcoma. CONCLUSION: The findings of this study will present evidence to determine whether NMES is effective and safe for CP in children with osteosarcoma.


Assuntos
Dor do Câncer/terapia , Terapia por Estimulação Elétrica/métodos , Osteossarcoma/patologia , Adolescente , Criança , Feminino , Humanos , Masculino , Osteossarcoma/epidemiologia , Segurança , Resultado do Tratamento
2.
Am J Gastroenterol ; 115(9): 1534-1538, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32732620

RESUMO

INTRODUCTION: To determine whether pretreatment vagal efficiency (VE), respiratory sinus arrhythmia, and heart period can predict pain improvement with auricular neurostimulation in pediatric functional abdominal pain disorders. METHODS: A total of 92 adolescents with functional abdominal pain disorders underwent a 4-week randomized, double-blinded, sham-controlled auricular neurostimulation trial. Electrocardiogram-derived variables at baseline were used to predict pain using mixed effects modeling. RESULTS: A 3-way interaction (95% confidence intervals: 0.004-0.494) showed that the treatment group subjects with low baseline VE had lower pain scores at week 3. There was no substantial change in the placebo or high VE treatment group subjects. This effect was supported by a significant correlation between baseline VE and degree of pain reduction only in the treatment group. DISCUSSION: Impaired cardiac vagal regulation measured by VE predicts pain improvement with auricular neurostimulation.


Assuntos
Dor Abdominal/terapia , Terapia por Estimulação Elétrica/métodos , Gastroenteropatias/terapia , Nervo Vago/fisiopatologia , Dor Abdominal/fisiopatologia , Adolescente , Criança , Método Duplo-Cego , Feminino , Gastroenteropatias/fisiopatologia , Humanos , Masculino , Manejo da Dor , Medição da Dor , Resultado do Tratamento
3.
PLoS One ; 15(7): e0235961, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645082

RESUMO

BACKGROUND: Sacral neuromodulation (SNM) is a minimally invasive fully reversible therapy that was approved in 1997 for overactive bladder syndrome (OAB) refractory to behavior modification and pharmacotherapy. Despite being in use for over two decades, the data on medium to long-term safety and efficacy of SNM in OAB is limited. We investigated the medium-term efficacy and safety of SNM along with the predictive factors for its success in patients with refractory OAB. METHODS: A retrospective consecutive case series of 66 patients undergoing SNM for refractory OAB between July 2009 and July 2018. All patients underwent a test period followed by permanent implantation, if there was > = 50% improvement in any symptom. The primary outcome was "success" defined as > = 50% improvement in any clinical parameter based on the subjective assessment of patient's response. The secondary outcomes were number of pads used in 24 hours, post-operative complications and re-operation rates. RESULTS: 66 females with an average age of 62.7 years were included. 55/66 patients (83.3%) had a successful test phase and underwent permanent implantation. After a median follow-up of 32 months, SNM was successful in 41/55 (74.5%) patients. Mean number of pads used in 24 hours decreased significantly from 3.5 preoperatively to 1.2 at last follow-up (p<0.001). 8/55 (14.5%) patients reported complications of pain, lead migration, wound dehiscence and device malfunction. 10/55 (18.2%) patients underwent revision surgeries after a median duration of 21.9 months. Device was explanted in 15/55 (27.3%) patients after a median duration of 24 months. No significant predictor for success was identified. CONCLUSIONS: The success rate of SNM is 75% with a complication rate of 14.5% after a median follow-up of ~3 years. This study suggests medium-term efficacy and safety but a high re-operation rate of SNM in patients with refractory OAB.


Assuntos
Terapia por Estimulação Elétrica/métodos , Plexo Lombossacral/patologia , Sacro/patologia , Bexiga Urinária Hiperativa/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(28): e21088, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664129

RESUMO

BACKGROUND: This study will examine the effectiveness and safety of neuromuscular electrical stimulation (NMES) for the treatment of patients with interstitial cystitis (IC). METHODS: We will retrieve the following electronic databases from their commencements to the March 1, 2020 to discover all related potential studies: MEDLINE, EMBASE, Cochrane Library, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), China National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, and WANFANG Database. Randomized controlled trials related to the NMES for the treatment of patients with IC will be included, regardless publication status and language. Literature selection, data collection, and study quality assessment will be independently performed by 2 authors. The extracted data will be expressed as risk ratio and 95% confidence intervals for dichotomous data, and mean difference or standard mean difference and 95% confidence intervals for continuous data. RevMan V.5.3 software will be employed for statistical analysis. RESULTS: This study will summarize current high quality randomized controlled trials to appraise the effectiveness and safety of NMES for the treatment of patients with IC. CONCLUSION: The findings of this study will provide helpful evidence to determine whether NMES is an effective treatment for patients with IC or not. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020170495.


Assuntos
Cistite Intersticial/terapia , Terapia por Estimulação Elétrica/métodos , Projetos de Pesquisa , Terapia por Estimulação Elétrica/efeitos adversos , Humanos , Medição da Dor , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Micção/fisiologia
5.
Medicine (Baltimore) ; 99(27): e21042, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629729

RESUMO

BACKGROUND: This systematic review protocol will appraise the effectiveness and safety of electrical stimulation (ES) for limb spasticity (LS) in children with stroke. METHODS: Cochrane Library, EMBASE, PUBMED, PsycINFO, Scopus, OpenGrey, CINAHL, ACMD, CNKI, and WANGFANG will be systematically retrieved for randomized controlled trials (RCTs) testing the effectiveness of ES compared with other interventions on LS in children with stroke. Two independent authors will evaluate eligibility using predefined criteria and will perform data extraction and study quality appraisal of eligible trials. Primary outcomes include gait velocity, and limb spasticity status. Limb function, quality of life, pain intensity, and adverse events will be assessed as secondary outcomes. We will perform data analysis using RevMan 5.3 software. RESULTS: This systematic review will summarize the most recent evidence to assess the effectiveness and safety of ES for LS in children with stroke. CONCLUSIONS: The results of this study may help to determine whether ES is effective or not for LS in children with stroke. STUDY REGISTRATION: INPLASY202050115.


Assuntos
Terapia por Estimulação Elétrica/métodos , Espasticidade Muscular/terapia , Acidente Vascular Cerebral/complicações , Criança , Terapia por Estimulação Elétrica/efeitos adversos , Humanos , Espasticidade Muscular/psicologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Resultado do Tratamento , Velocidade de Caminhada/fisiologia
6.
Phys Ther ; 100(9): 1603-1631, 2020 08 31.
Artigo em Inglês | MEDLINE | ID: mdl-32542403

RESUMO

A clinical practice guideline on total knee arthroplasty was developed by an American Physical Therapy (APTA) volunteer guideline development group that consisted of physical therapists, an orthopedic surgeon, a nurse, and a consumer. The guideline was based on systematic reviews of current scientific and clinical information and accepted approaches to management of total knee arthroplasty.


Assuntos
Artroplastia do Joelho/normas , Osteoartrite do Joelho/cirurgia , Fisioterapeutas , Cuidados Pós-Operatórios/normas , Crioterapia/normas , Terapia por Estimulação Elétrica/métodos , Terapia por Estimulação Elétrica/normas , Exercício Físico , Humanos , Terapia Passiva Contínua de Movimento/normas , Movimento , Osteoartrite do Joelho/etiologia , Alta do Paciente , Revisão por Pares , Cuidados Pós-Operatórios/métodos , Cuidados Pré-Operatórios , Prognóstico , Melhoria de Qualidade , Amplitude de Movimento Articular , Treinamento de Resistência/métodos , Treinamento de Resistência/normas , Fatores de Risco
7.
PLoS One ; 15(6): e0234867, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32569300

RESUMO

Different modes of exogenous electrical stimulation at physiological strength has been applied to various diseases. Previously, we extensively demonstrated the usability of mild electrical stimulation (MES) with low frequency pulse current at 55 pulses per second (MES55) for several disease conditions. Here we found that MES with high frequency pulse-current (5500 pulse per second; MES5500) suppressed the overproduction of pro-inflammatory cytokines induced by phorbol myristate acetate/ionomycin in Jurkat T cells and primary splenocytes. MES5500 also suppressed the overproduction of inflammatory cytokines, improved liver damage and reduced mouse spleen enlargement in concanavalin-A-treated BALB/c mice. The molecular mechanism underlying these effects included the ability of MES5500 to induce modest amount of hydrogen peroxide and control multiple signaling pathways important for immune regulation, such as NF-κB, NFAT and NRF2. In the treatment of various inflammatory and immune-related diseases, suppression of excessive inflammatory cytokines is key, but because immunosuppressive drugs used in the clinical setting have serious side effects, development of safer methods of inhibiting cytokines is required. Our finding provides evidence that physical medicine in the form of MES5500 may be considered as a novel therapeutic tool or as adjunctive therapy for inflammatory and immune-related diseases.


Assuntos
Citocinas/imunologia , Terapia por Estimulação Elétrica/métodos , Peróxido de Hidrogênio/imunologia , Imunossupressão/métodos , Inflamação/imunologia , Inflamação/terapia , Animais , Concanavalina A , Feminino , Humanos , Inflamação/induzido quimicamente , Células Jurkat , Fígado/imunologia , Fígado/patologia , Camundongos , Camundongos Endogâmicos BALB C , Baço/imunologia , Baço/patologia
8.
J Laryngol Otol ; 134(5): 447-452, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32493527

RESUMO

OBJECTIVES: This paper aimed to: retrospectively analyse single-centre results in terms of surgical success, respiratory outcomes and adverse events after short-term follow up in obstructive sleep apnoea patients treated with upper airway stimulation; and evaluate the correlation between pre-operative drug-induced sleep endoscopy findings and surgical success. METHODS: A retrospective descriptive cohort study was conducted, including a consecutive series of obstructive sleep apnoea patients undergoing implantation of an upper airway stimulation system. RESULTS: Forty-four patients were included. The total median Apnoea-Hypopnea Index and oxygen desaturation index significantly decreased from 37.6 to 8.3 events per hour (p < 0.001) and from 37.1 to 15.9 events per hour (p < 0.001), respectively. The surgical success rate was 88.6 per cent, and did not significantly differ between patients with or without complete collapse at the retropalatal level (p = 0.784). The most common therapy-related adverse event reported was (temporary) stimulation-related discomfort. CONCLUSION: Upper airway stimulation is an effective and safe treatment in obstructive sleep apnoea patients with continuous positive airway pressure intolerance or failure. There was no significant difference in surgical outcome between patients with tongue base collapse with or without complete anteroposterior collapse at the level of the palate.


Assuntos
Terapia por Estimulação Elétrica/métodos , Apneia Obstrutiva do Sono/terapia , Pressão Positiva Contínua nas Vias Aéreas , Terapia por Estimulação Elétrica/efeitos adversos , Endoscopia/métodos , Feminino , Humanos , Nervo Hipoglosso , Masculino , Pessoa de Meia-Idade , Polissonografia , Cuidados Pós-Operatórios , Cuidados Pré-Operatórios , Estudos Retrospectivos , Sono/efeitos dos fármacos , Decúbito Dorsal , Resultado do Tratamento
11.
Medicine (Baltimore) ; 99(19): e19921, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32384438

RESUMO

BACKGROUND: This study will aim to assess the effectiveness and safety of electrical stimulation (ES) for the treatment of patients with benign prostatic hyperplasia (BPH). METHODS: PubMed, EMBASE, Web of science, Springer, Cochrane Library, PsycINFO, Allied and Complementary Medicine Database, CBM, and China National Knowledge Infrastructure will be retrieved from inception to the September 1, 2019. No language limitation will be applied to this study. Randomized controlled trials (RCTs) that assessed the effectiveness and safety of ES for the treatment of patients with BPH will be considered for inclusion. Literature selection, data collection, and risk of bias assessment will be conducted by 2 investigators independently. Statistical analysis will be carried out using RevMan 5.3 Software. RESULTS: This study will summarize high quality RCTs based on the present evidence of ES for the treatment of BPH in several aspects, including changes in urological symptoms, changes in prostate size, urodynamic parameters, quality of life, and number and severity of adverse events. CONCLUSION: The findings of this study will provide latest evidence to appraise whether ES is an effective and safety intervention for patients with BPH. PROSPERO REGISTRATION NUMBER: PROSPERO CRD42019157241.


Assuntos
Terapia por Estimulação Elétrica/métodos , Hiperplasia Prostática/terapia , Humanos , Masculino , Metanálise como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Revisões Sistemáticas como Assunto , Resultado do Tratamento
13.
BMC Neurol ; 20(1): 217, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32471373

RESUMO

BACKGROUND: Poststroke depression can lead to functional dependence, cognitive impairment and reduced quality of life. The aim of this study was to evaluate the effects of a percutaneous mastoid electrical stimulator (PMES) plus antidepressants on poststroke depression and cognitive function. METHODS: This study was a prospective, randomized, double-blind, and sham-controlled study. A total of 258 clinically depressed ischaemic stroke patients within 14 days of index stroke were randomly assigned to the PMES plus antidepressant (PMES group, N = 125) and sham plus antidepressant (sham group, N = 133) groups. All patients underwent the Montreal Cognitive Assessment (MoCA) and Hamilton Rating Scale for Depression (HRSD) test at 2 weeks (baseline), and 6 months(M6) after ischaemic stroke. Primary outcomes were the percentage of patients showing a treatment response (≥50% reduction in HRSD score) and depression remission (HRSD score ≤ 9) at 6 months. The secondary outcome was the percentage of patients with a MoCA score < 26. RESULTS: The percentages of patients showing a treatment response and depression remission were significantly higher in the PMES group than in the sham group (57.60% vs 41.35%, P = 0.009; 44.00% vs 29.32%, P = 0.014 respectively). The mean value of the HRSD score change [M (month)6-baseline] was significantly higher in the PMES group than in the sham group at 6 months (- 11.93 ± 5.32 vs - 10.48 ± 6.10, P = 0.036, respectively). The percentage of patients with MoCA scores < 26 was lower in the PEMS group than in the sham group (12.0% vs 24.06%, P = 0.012,respectively), and the mean value of the MoCA score change (M6-baseline) was higher in the PMES group than in the sham group (3.50 ± 2.55 vs 2.72 ± 2.52, P = 0.005, respectively). CONCLUSION: These findings demonstrate that PMES adjunctive to antidepressant therapy is effective in reducing depression, achieving remission in the short term, and improving cognition. TRIAL REGISTRATION: This trial was retrospectively registered (registration number: ChiCTR1800016463) on 03 June 2018.


Assuntos
Depressão/etiologia , Depressão/terapia , Terapia por Estimulação Elétrica/métodos , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Antidepressivos/uso terapêutico , Isquemia Encefálica/complicações , Cognição , Terapia Combinada , Método Duplo-Cego , Feminino , Humanos , Masculino , Processo Mastoide , Pessoa de Meia-Idade , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
14.
Am J Cardiol ; 125(11): 1738-1744, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32295701

RESUMO

Transvenous neurostimulation of the phrenic nerve (PNS) is a potentially improved and unique approach to the treatment of central sleep apnea (CSA). There have been multiple studies with limited individuals evaluating the efficacy of PNS. Our aim was to review and pool those studies to better understand whether phrenic nerve stimulation is efficacious in the treatment of CSA. The initial search on Pubmed retrieved a total of 97 articles and after screening all articles, only 5 could be included in our quantitative analysis. Pooling of data from 5 studies with a total of 204 patients demonstrated a reduction of mean apnea hypopnea index with PNS compared to controls by -26.7 events/hour with 95% confidence interval and P value of [CI (-31.99, -21.46), I2 85, p 0.00]. The mean difference in central apnea index was -22.47 [CI (-25.19, -19.76), I2 0, p 0.00]. The mean reduction in the oxygen desaturation index of 4% or more demonstrated a decrease in PNS group by -24.16 events/hour [(CI -26.20, -22.12), I2 0, p 0.00] compared with controls. PNS resulted in mean reduction in arousal index of -13.77 [CI (-16.15, -11.40), I2 0, p 0.00]. The mean change in percent of time spent in rapid eye movement sleep demonstrated a nonsignificant increase in PNS group by 1.01 % [CI (-5.67, 7.86), I293, p 0.75]. In conclusion, PNS therapy for treating CSA demonstrated positive outcomes but larger randomized studies are needed to evaluate the safety and clinical outcomes.


Assuntos
Terapia por Estimulação Elétrica/métodos , Nervo Frênico , Apneia do Sono Tipo Central/terapia , Humanos , Hipóxia/fisiopatologia , Polissonografia , Apneia do Sono Tipo Central/fisiopatologia , Sono REM , Resultado do Tratamento
15.
Medicine (Baltimore) ; 99(17): e19863, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32332648

RESUMO

BACKGROUND: Pregnancy is one of the main risk factor of pelvic floor muscle dysfunction. Postpartum women with extremely weak muscle strength have difficulty to do voluntary pelvic floor muscle training. This study aims to evaluate the effects of different protocols of electrical stimulation in the treatment of postpartum women with extremely weak muscle strength. METHODS: A total of 67 women were randomized into 2 groups: group A received transvaginal electrical stimulation (TVES) for 5 times, and group B received TVES for 3 times with electromyogram (EMG)-triggered neuromuscular stimulation twice. Subjects were evaluated before and after treatment. Pelvic muscle strength was measured by both digital vaginal palpation and EMG variables, and quality of life was investigated by 4 kinds of pelvic floor disease-related questionnaires. RESULTS: According to the intention-to-treat principle, compared with baseline, in group A, EMG of contractile amplitude of endurance phase was significantly elevated (P = .03), variation of contractile amplitude in tonic phase was more stable after treatment (P = .004), and EMG of mean value of final rest was significantly elevated after treatment (P = .047). After 5 times treatments, the incidence of correct pelvic floor muscle contraction in group A was significantly elevated (P = .045). No significant difference of muscle strength test by digital vaginal palpation was detected between the 2 groups, so did questionnaires. CONCLUSION: For postpartum women with extremely weak muscle strength, TVES for 5 times might be more benefit for control ability of pelvic muscle contractions and elevating muscle strength even in short-time treatment.


Assuntos
Terapia por Estimulação Elétrica/métodos , Debilidade Muscular/fisiopatologia , Debilidade Muscular/reabilitação , Distúrbios do Assoalho Pélvico/fisiopatologia , Distúrbios do Assoalho Pélvico/reabilitação , Período Pós-Parto/fisiologia , Adulto , Protocolos Clínicos , Eletromiografia , Feminino , Humanos , Análise de Intenção de Tratamento , Força Muscular/fisiologia , Estudos Prospectivos , Método Simples-Cego , Adulto Jovem
17.
Muscle Nerve ; 61(6): 773-778, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32249950

RESUMO

BACKGROUND: This was a multicenter, double-blind, randomized clinical trial to investigate the efficacy of electrical stimulation of denervated muscle (ESDM) on recovery of patients with peripheral nerve injuries. METHODS: We enrolled 38 patients with traumatic peripheral nerve injuries with axonal damage and clinical impairment of two muscles, who were randomly treated with real or sham electrical stimulation (ES). Clinical and neurophysiological examinations were performed before treatment, at the end of treatment, and 3 mo posttreatment, by the same physician who was blinded to the ES allocation. RESULTS: All patients improved but there was no significant beneficial effect of ESDM compared with sham treatment. CONCLUSIONS: This study failed to demonstrate the efficacy of ESDM for peripheral nerve injuries. However, given the large number of variables related to ES and the heterogeneity in disease etiologies and clinical manifestations, future studies on homogeneous populations using different stimulation protocols may be useful.


Assuntos
Terapia por Estimulação Elétrica/métodos , Denervação Muscular/efeitos adversos , Traumatismos dos Nervos Periféricos/diagnóstico , Traumatismos dos Nervos Periféricos/terapia , Adolescente , Adulto , Método Duplo-Cego , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Traumatismos dos Nervos Periféricos/epidemiologia , Resultado do Tratamento , Adulto Jovem
18.
PLoS One ; 15(3): e0230355, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32226049

RESUMO

OBJECTIVE: To systematically review outcomes in patients with refractory overactive bladder (OAB) patients who underwent sacral neuromodulation therapy (SNM) therapy after unsuccessful onabotulinumtoxinA (BTX) therapy, and to compare outcomes with those who SNM as initial therapy. METHODS: A systematic search of Cochrane Library, Pubmed and Embase databases from July 2002 to November 2019, to analyze randomized controlled trials and retrospective studies of SNM therapy after failed initial BTX therapy. Two reviewers independently screened the studies and extracted data. A quality assessment of the included literature was conducted using Newcastle-Ottawa Scale (NOS), and Stata 12.0 software was used to conduct a meta-analysis of the collected data. RESULTS: A total of seven studies involving 319 patients were finally included. The success rate in refractory OAB patients who used SNM therapy after failed BTX therapy was 58.5%, 95% CI (0.47-0.70). There was no significant difference between refractory OAB patients who chose SNM as replacement therapy after failed BTX therapy and those who used SNM therapy as first choice [RR = 0.96, 95%CI (0.72-1.26), P = 0.735]. CONCLUSION: OAB patients for whom an initial choice of BTX therapy ends in failure or dissatisfaction may consider switching to SNM therapy. There is no difference in outcomes between these patients and those whose first choice was SNM therapy.


Assuntos
Toxinas Botulínicas Tipo A/administração & dosagem , Terapia por Estimulação Elétrica/métodos , Plexo Lombossacral/fisiopatologia , Bexiga Urinária Hiperativa/terapia , Bexiga Urinária/efeitos dos fármacos , Humanos , Plexo Lombossacral/efeitos dos fármacos , Satisfação do Paciente , Ensaios Clínicos Controlados Aleatórios como Assunto , Falha de Tratamento , Bexiga Urinária/inervação , Bexiga Urinária Hiperativa/fisiopatologia
19.
Otolaryngol Head Neck Surg ; 162(6): 985-992, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32343198

RESUMO

OBJECTIVE: The effectiveness of upper airway stimulation via hypoglossal nerve stimulation for obstructive sleep apnea depends upon the pattern of tongue muscle activation produced. This study investigated the nature of contralateral tongue muscle activation by unilateral hypoglossal nerve stimulation using intraoperative nerve integrity monitoring in conjunction with electromyography and explored the relationship between contralateral tongue muscle activation and polysomnographic measures of obstructive sleep apnea severity. STUDY DESIGN: Prospective case series. SETTING: Tertiary care medical center. SUBJECTS AND METHODS: Fifty-one patients underwent unilateral (right) hypoglossal nerve stimulator implantation for obstructive sleep apnea. Neurophysiological data included electromyographic responses in ipsilateral (right) and contralateral (left) genioglossus muscles in response to intraoperative bipolar probe stimulation (0.3 mA) of medial hypoglossal nerve branches. Clinical data included pre- and postoperative apnea-hypopnea indices and oxygen desaturation levels. RESULTS: A subset of patients (20/51, 39%) exhibited electromyographic responses in both the ipsilateral and contralateral genioglossus (bilateral), whereas the remaining patients (31/51, 61%) exhibited electromyographic responses only in the ipsilateral genioglossus (unilateral). The baseline characteristics of bilateral and unilateral responders were similar. Both groups exhibited significant and comparable improvements in apnea-hypopnea index and oxygen desaturations after hypoglossal nerve stimulation. Neither the amplitude nor the latency of contralateral genioglossus responses was predictive of clinical outcomes. CONCLUSION: A subset of patients undergoing unilateral hypoglossal nerve stimulation exhibits activation of contralateral genioglossus muscles. Patients with unilateral and bilateral genioglossus responses exhibit comparable, robust improvements in apnea-hypopnea index and oxygen desaturation levels.


Assuntos
Terapia por Estimulação Elétrica/métodos , Nervo Hipoglosso/fisiopatologia , Apneia Obstrutiva do Sono/terapia , Sono/fisiologia , Língua/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Polissonografia , Estudos Prospectivos , Apneia Obstrutiva do Sono/fisiopatologia , Língua/inervação
20.
J Physiother ; 66(2): 89-96, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32291224

RESUMO

QUESTIONS: Does neuromuscular electrical stimulation (NMES) applied during haemodialysis sessions improve functional capacity in people with end-stage renal disease? Does NMES used in this way also improve muscle strength, muscle mass/architecture, psychological outcomes, cardiovascular outcomes and biochemical variables? Does it have any adverse effects? DESIGN: Systematic review of randomised controlled trials with meta-analysis. PubMed, Web of Science, Scopus and SPORTDiscus were searched from inception to 15 October 2019. PARTICIPANTS: Patients receiving haemodialysis for end-stage renal disease. INTERVENTION: NMES administered during haemodialysis sessions versus control. OUTCOMES MEASURES: Functional capacity, muscle strength, muscle mass, psychological outcomes, cardiovascular outcomes, biochemical variables and adverse events. DATA ANALYSIS: Data were meta-analysed where possible and results were expressed as the pooled mean difference between groups with a 95% confidence interval. RESULTS: Eight studies (221 patients) were included in the analysis. Overall, the methodological quality of the studies was fair to good. NMES improved functional capacity as assessed by the 6-minute walk distance test (MD 31 m, 95% CI 13 to 49) and peak workload attained in incremental exercise (MD 12.5 W, 95% CI 3.2 to 21.9). NMES increased knee extensor muscle strength (MD 3.5 kg, 95% CI 2.3 to 4.7) and handgrip strength (MD 2.4 kg, 95% CI 0.4 to 4.4). Muscle mass/architecture was not substantially affected. NMES was estimated to be beneficial for several domains of quality of life in several studies, although most of these estimates were imprecise. No benefits were found for cardiovascular outcomes. The available data did not establish any clear effects on cardiovascular outcomes or biochemical variables (dialysis efficiency, urea and creatinine). No major NMES-related adverse events were observed. CONCLUSIONS: NMES is safe, practical and effective for improving functional capacity and muscle strength in haemodialysis patients. Further research is needed to confirm the clinical relevance of these findings. REGISTRATION: PROSPERO CRD42018107323.


Assuntos
Terapia por Estimulação Elétrica/métodos , Falência Renal Crônica/complicações , Debilidade Muscular/terapia , Atrofia Muscular/terapia , Esforço Físico , Diálise Renal , Humanos , Falência Renal Crônica/terapia , Debilidade Muscular/etiologia , Atrofia Muscular/etiologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Teste de Caminhada
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