Efficacy of pulsed low-intensity electric neuromuscular stimulation in reducing pain and disability in patients with myofascial syndrome.

Myofascial pain syndrome (MPS) is characterized by chronic pain in multiple myofascial trigger points and fascial constrictions. In recent years, the scientific literature has recognized the need to include the patient with MPS in a multidimensional rehabilitation project. At the moment, the most widely recognized therapeutic methods for the treatment of myofascial syndrome include the stretch and spray pressure massage. Microcurrent electric neuromuscular stimulation was proposed in pain management for its effects on normalizing bioelectricity of cells and for its sub-sensory application. In this study, we tested the efficacy of low-intensity pulsed electric neuromuscular stimulus (PENS) on pain in patients with MPS of cervical spine muscles. We carried out a prospective-analytic longitudinal study at an outpatient clinic during two weeks. Forty subjects (mean age 42±13 years) were divided into two groups: treatment (TrGr, n=20) and control group (CtrlGr, n=20). Visual-analog scale (VAS) values, concerning the spontaneous and movement-related pain in the cervical-dorsal region at baseline (T0) and at the end of the study (T1), showed a reduction from 7 to 3.81 (p < 0.001) in TrGr. In the CtrlGr, VAS was reduced from 8.2 to 7.2 (n.s.). Moreover, the pressure pain threshold at T0 was 2.1 vs 4.2 at T1 (p < 0.001) in TrG. In the CtrlGR we observed no significant changes. Modulated low-intensity PENS is an innovative therapy permitting to act on the transmission of pain and on the restoration of tissue homeostasis. It seems to affect the transmission of pain through the stimulation of A-beta fibers. The above results show that low-intensity PENS can be considered as an effective treatment to reduce pain and disability in patients with MPS.

Lymphatic edema of the lower limbs after orthopedic surgery: results of a randomized, open-label clinical trial with a new extended-release preparation.

The lymphedema is a high interstitial protein concentration edema, caused by impaired lymphatic transport capacity. It can be primary or secondary. The secondary form may be caused by a lesion of the lymphatic vessels and/or lymph nodes during diagnostic or therapeutic procedures such as surgical interventions. Often, in clinical practice, there is lymphedema after orthopedic surgery, even in minor orthopedic surgery. Lymphedema, typically presents symptoms of swelling, pain, inflammation, and itching, and it can generate, over the years, acute disability in the affected limbs. The standard therapy is mainly represented by medical treatment, such as manual lymphatic drainage and compression with bandages and stockings. In literature it is documented that lymphedema is responsive to alpha and the gamma benzopyrones. The aim of this study was to determine the effectiveness of delayed extended-release formulation of a compound containing apha-benzo-pyrone (Coumarin), benzo-gamma-pyrone (Troxuretina) and oligomeric proanthocyanidins from Vitis vinifera (OPC), in addition to compression therapy, in the reduction of lymphatic edema after prosthetic hip and knee surgery. In the group treated, after 30 days, a reduction was observed of the edema of 4.8% in the ankle area (p less than 0.008) and 2.7% in the calf area (p less than 0.013). The control group showed no significant reduction. The treated group showed a marked reduction of all the secondary symptoms considered in the study, although variations were not significant. The results show that the compound used was effective in reducing edema after major orthopedic surgery, and consequently in alleviating some related symptoms, such as pain, itching, and burning. As an edema has extensive inflammatory components in patients with reduced mobility, the final data seems interesting, however, further investigations and a better follow-up are required.

Biomechanical modification and sense motor control of body posture after plastic surgery.

Plastic surgery offers a quite unique window on abrupt and permanent modifications of a human's body schema. Its impact is comparable to amputations or other severe injuries, with the evident advantage from the experimenter's (and patient's) point of view that it is planned, allowing longitudinal studies and quantification of the weight and distribution of modified bodily masses (e.g., weight of the prosthesis). One potential drawback is that modifications due to (aesthetic) plastic surgery are often too little to be revealed by motor control tasks, making it difficult to measure the time course of body schema readaptation. The aim of our study is measuring the capability of the body scheme to re-adapt to significant and abrupt changes, such as the distribution of mass centers, and in particular to assess what is the time course of such re-adaptation. For this reason, we have carried out a longitudinal study on postural modifications on a population of female patients (N = 30) who were subjected to additive or reductive plastic surgery. Posture and stabilometry evaluations were performed before surgery (T0), and after 1 months (T1), 4 months (T2), and 1 year (T3). Posture was reconstructed from spatial tracking system (FastrackTM Polhemus) recordings. Stabilometry analysis was performed by force platform (Globus Italia). The results document a modification in posture and a significant increase in the sway area after body mass alterations. Posture and stabilometry data return to equilibrium after 1 year. Our data suggest that posture control relies on, at least in part, feedforward than only on feedback strategies.

Flexible flatfoot treatment in children with mechanical sound vibration therapy.

UNLABELLED: The flat foot can be defined as a syndrome with multiple etiopathogenesis, characterized by an altered structure of the longitudinal arch of the plantar vault with its reduction in height. The plantar arch collapse can be counteracted by strengthening the muscles involved; for many years, specific physical exercises have been proposed with this purpose in physical and rehabilitation medicine. The aim of our work was to improve the plantar arch muscles' tone using high focal vibration therapy (300Hz) METHODS: 10 children with a 4th degree flat foot (age: 8,7±2,2; height: 132±15cm; weight: 35,2±12,3Kg) underwent 10 sessions, 2 days/wk, of 30 min of focused high vibratory therapy at a frequency of 300 Hz (Vissman, Italy). Before and after treatment stabilometry (StT), static and dynamic baropodometry tests were performed. RESULTS: Evaluation of StT showed an improvement of stability, a decrease of sway area and ellipse area. Baropodometry tests showed a decrease in foot surface. Also dynamic tests showed a decrease in both foot surfaces. DISCUSSION: The results lead us to consider this method as a method of first choice to a conservative approach in the rehabilitation of flat foot syndrome also for the 4th grade in children.

Visual sensory disability: rehabilitative treatment in an aquatic environment.

The outcome of this study is based on the concept of the enormous potentiality that is expressed, after the elimination of myofascial and articular compensation, from the body system. 10 low vision and blind subjects aged between 35 and 50 years. The subjects performed 10 sessions (2/week) for 5 weeks. Each session consisted of a training in the gym (30 minutes) and hydrokinetic therapy (45 minutes) All the subjects at the beginning (T0) and at the end (T1) of the rehabilitation program were tested by static baropodometry and the stabilometric (Milletrix, Diagnostic support, Rome, Italy). Our results shows an increase of the total area of support surface (p0.05). The stabilometry results shows an improvement of the orthostatic balance, sway area and the ellipse area decrease respectively 15% (236,9vs201 p≤0.05) and 41% b(p≤0.05). Thus, the energy expenditure of the patient in maintaining the orthostatic position without visual afferences is lower. Rehabilitative treatment in an aquatic environment resulted effective in improving posture and balance in all patients with increased precision in the execution of the step, which implies less effort during walk, less energy consumption and better quality of life.

Venous insufficiency and foot dysmorphism: effectiveness of visco-elastic rehabilitation systems on veno-muscle system of the foot and of the calf.

Chronic venous disease is very common and widespread. Chronic Venous Insufficiency (CVI) is a condition characterized by hypertension of the venous system of the lower limbs which manifests itself through a large range of symptoms. The main cause of CVI is hypertension of the venous system of lower limbs, which in most cases is due to reflux for the incontinence of the valvar system of veins. Other causes are related to obstruction of the venous outflow, or at a reduced venous emptying due to inefficiency of the system of the veno-muscular pumps of the calf and of the foot. The purpose of this study was to evaluate if the use of a non-invasive rehabilitative mode to improve the efficiency of the veno-muscular pumps of the foot and of the calf using photoplethysmography in reflected light. Fifty (50) patients suffering from flatfoot and ped cavus, were studied doing a stabilometric and baropodometric test to evaluate the angle of the foot and the podalic angle. Patients were evaluated by examining vascular examination and venous reography in basal condition, using corrective visco-elastic insoles for the correction of dysmorphisms that we were studying. An improvement of the angle of the Right and Left axis (p<0.05) and the podalic angle (p<0.001), using the right insole both in the flatfoot and cavus foot, was shown by the podobarographic examination. A not important tendency to improvement was also shown by the use of non-specific insole in both pathologies. The vascular examination showed an improvement of 38 percent in venous emptying capacity of the foot/calf veno-muscular pump in cavus foot with the specific B insole (p<0.002). An important improvement of 24 percent, using the specific A insole (p<0.05), was documented in flatfoot. The photoplethysmography examination documented a significant improvement of the venous emptying capacity of foot-calf veno-muscular system due to the use of specific insoles for the studied dysmorphism, with an improving tendency even with the use of non-specific insoles. The hemodynamic improvement is correlated with the improvement of the analyzed biomechanical parameters: contact time, lenght of the halfstep, podalic angle and angle of the foot. The partial normalization of biomechanical parameters allows a reorganization of relationships of forces between ground and foot, as well as the improvement of the function of the subtalar joint, causing a partial recovery of the complex physiological mechanism of activation of the veno-muscular pumps of the foot and of the calf.

Balance and posture in the elderly: an analysis of a sensorimotor rehabilitation protocol.

Regular training programs are a concrete means to prevent and/or reduce functional decline due to aging. A multisensory training approach seems to obtain better results in the elderly with regard to both balance and quality of life. Forty subjects (age 65+/-10 years, height 165+/-4 cm, weight 73.0+/-4.6 kg) were randomized into two groups (GrHu and GrCl). Participants in the GrHu group received 3 months of balance and postural training, 3 sessions per week, with the use of a multisensory training approach. Those in the GrCl group received 3 months of training with a classical rehabilitation protocol that included isotonic training for the lower limbs and spine. With regard to walking, there was an improvement in step symmetry for participants in the GrHu group compared to baseline (0.93+/-0.09 vs. 0.84+/-0.1; p<0.05). Further, all subjects in the GrHu group showed a significant reduction in the energy used during a 4-min walk. Analysis of stabilometry data also showed a significant improvement in balance for those in the GrHu group, which was independent of age or gender. The multisensory training approach yields an improvement of balance in the elderly, which reduces the risk of falls. The observed improvement is significantly greater than that seen with the classical training program.

Increased heart rate after exercise facilitates the processing of fearful but not disgusted faces.

Embodied theories of emotion assume that emotional processing is grounded in bodily and affective processes. Accordingly, the perception of an emotion re-enacts congruent sensory and affective states; and conversely, bodily states congruent with a specific emotion facilitate emotional processing. This study tests whether the ability to process facial expressions (faces having a neutral expression, expressing fear, or disgust) can be influenced by making the participants' body state congruent with the expressed emotion (e.g., high heart rate in the case of faces expressing fear). We designed a task requiring participants to categorize pictures of male and female faces that either had a neutral expression (neutral), or expressed emotions whose linkage with high heart rate is strong (fear) or significantly weaker or absent (disgust). Critically, participants were tested in two conditions: with experimentally induced high heart rate (Exercise) and with normal heart rate (Normal). Participants processed fearful faces (but not disgusted or neutral faces) faster when they were in the Exercise condition than in the Normal condition. These results support the idea that an emotionally congruent body state facilitates the automatic processing of emotionally-charged stimuli and this effect is emotion-specific rather than due to generic factors such as arousal.

Air pollution monitoring using emission inventories combined with the moss bag approach.

Inventory of emission sources and biomonitoring with moss transplants are two different methods to evaluate air pollution. In this study, for the first time, both these approaches were simultaneously applied in five municipalities in Campania (southern Italy), deserving attention for health-oriented interventions as part of a National Interest Priority Site. The pollutants covered by the inventory were CO, NOx, particulate matter (PM10), volatile organic compounds (VOCs), and some heavy metals (As, Cd, Cr, Cu, Hg, Ni, Pb, Se, and Zn). The biomonitoring survey was based on the use of the devitalized moss Hypnum cupressiforme transplanted into bags, following a harmonized protocol. The exposure covered 40 agricultural and urban/residential sites, with half of them located in proximity to roads. The pollutants monitored were Al, As, Cd, Cr, Cu, Fe, Hg, Ni, Pb, Se, and Zn, as well as total polycyclic aromatic hydrocarbons (PAHs) only in five sites. Using the emission inventory approach, high emission loads were detected for all the major air pollutants and the following heavy metals: Cr, Cu, Ni, Pb and Zn, over the entire study area. Arsenic, Pb, and Zn were the elements most accumulated by moss. Total PAH postexposure contents were higher than the preexposure values (~20-50% of initial value). Moss uptakes did not differ substantially among municipalities or within exposure sites. In the five municipalities, a similar spatial pattern was evidenced for Pb by emission inventory and moss accumulation. Both approaches indicated the same most polluted municipality, suggesting their combined use as a valuable resource to reveal contaminants that are not routinely monitored.

Serum interleukin-10 is an independent prognostic factor in advanced solid tumors.

Interleukin (IL)-10 is a Th2 type pleiotropic cytokine that has been found to be produced at the tumor site and to be increased in sera of patients suffering from different types of cancer. IL-10 has been shown to hinder a number of immune functions, i.e., T lymphocyte proliferation, Th1 type cytokine production, antigen presentation, and lymphokine-activated killer cell cytotoxicity. To assess its prognostic value, we measured serum levels of IL-10 in 118 patients with advanced solid tumors before treatment, after completion of therapy, and during follow-up. Other prognostic variables, to which IL-10 results were compared, were analyzed as well. IL-10 serum levels were found significantly elevated in cancer patients with respect to healthy controls. Of interest, a significant decrease in IL-10 serum levels was observed in the responder group, whereas a significant increase was recorded in the non-responder group. Using univariate and multivariate analyses, a significant relationship was shown between IL-10 serum levels and both overall survival (OS) and time to treatment failure (TTF). Stepwise regression analysis selected IL-10 serum level, performance status (PS), and stage as the best association of variables with significant impact on OS and TTF. In conclusion, this study shows that IL-10 has an independent prognostic significance in patients with advanced solid tumors and may be useful for monitoring disease progression.

Amifostine: A selective cytoprotective agent of normal tissues from chemo-radiotherapy induced toxicity (Review).

Patients receiving systemic cancer chemotherapy must often have their dose intensity of therapeutic agents reduced, because a broad range of organs are adversely affected. Therefore, research and the development of agents protecting the normal tissues from the toxicity of antineoplastic therapy, without reducing the antitumour efficacy, are very important. Amifostine, a prodrug that forms an activated free thiol, when dephosphorylated by alkaline phosphatase, appears selective in its entry in non-malignant cells, and exerts a protective effect from toxicity induced by chemo- or radiotherapy on normal tissues, through free radical scavenging, hydrogen donation and inhibition of DNA damage. Studies in vitro and experimental models have confirmed the protective properties of amifostine in normal cells. In clinical trials pretreatment with amifostine reduced the frequency of cyclophosphamide induced neutropenia and nephro-, oto- and neurotoxicity of platinum compounds. In some cases the use of amifostine have also potentiated the effects of several drugs, such as alkylating agents and, in recent studies, taxanes. The main potentially dose-limiting adverse effect is hypotension, that is often asymptomatic. Amifostine is thus usefully employed in order to obtain a better quality of life in patients receiving oncologic treatments.

Effects of selenium and zinc supplementation on nutritional status in patients with cancer of digestive tract.

OBJECTIVE: To evaluate the effect of oral administration of selenium and zinc tablets in patients with cancer of the digestive tract during chemotherapy. DESIGN: A case-control, randomized study. SETTING: Medical Oncology, II University of Naples, Naples, Italy. SUBJECTS: A total of 60 patients (median age 55 y, range 46-61 y) with diagnosis of gut cancer were randomized in 1999. Patients were treated for 60 days with chemotherapy. INTERVENTIONS: Trace elements were measured by atomic absorption spectroscopy. The nutritional status of the patients was assessed by biochemical and bio-impedance analysis (BIA) parameters in basal condition and after 60 days of treatment. Oral administration of selenium and zinc in oral tablet form for 50 days was Se 200 microg/day (50 microg/tablet) and Zn 21 mg/day (7 mg/tablet). RESULTS: Both in the basal condition and at 60 days all patients were malnourished. Selenium and zinc concentrations were significantly lower (P < 0.01) whereas copper concentration was significantly higher (P < 0.01) in cancer patients than in control subjects. However, 21/30 (70%) of those treated with Se and Zn did not showed a further worsening of nutritional status and experienced a significant decrease of asthenia with an increase of appetite. On the other hand, 24/30 (80%) untreated patients had a significant decline of all parameters studied after 60 days (prealbumin, cholesterol, transferrin, P < 0.05 vs 0 time; total proteins, albumin/globulin ratio, P < 0.01 vs 0 time; fat-free mass, fat mass, Na+/K+ ratio, body mass index P < 0.05 vs 0 time; fat free mass/fat mass, total body water, extra cellular/intra cellular water, basal metabolic rate: P < 0.01 vs 0 time). CONCLUSIONS: Data indicate that Se and Zn supplementation may improve the clinical course of general conditions in patients with gut cancer. These effects of Se and Zn require confirmation in an independent trial of appropriate design before new public health recommendations regarding Se and Zn supplementation can be made.

A study of postural changes after abdominal rectus plication abdominoplasty.

PURPOSE: Factors such as body masses and humour are known to influence human posture. Abdominoplasty, which causes a sudden change in body masses, significantly improves body image and self-esteem. The aim of this study was to assess postural changes after abdominoplasty by studding the position and orientation through space of the body and the centre of pressure. METHODS: Patients affected by excess abdominal skin and/or significant abdominal muscular anterior wall laxity due to undergo an abdominoplasty were enrolled. Posture was evaluated both before and for 1 year after surgery by quantifying the centres of mass, using the Fastrak™ system, and the centre of pressure, using stabilometry. The Wilcoxon signed-rank sum test was used to compare changes. RESULTS: Forty-six patients were enrolled. A retro-positioning of the pelvis with a compensatory advancement of the head and shoulders, confirmed by the baropodometric analysis, was evident in the early post-operative period. The biomechanical system subsequently stabilized, achieving a state of equilibrium 1 year after surgery. CONCLUSIONS: We believe that the change in posture following abdominoplasty is a consequence of both surgery (changes in body masses) and psychological factors that influence posture. Indeed, redundant abdominal skin and abdominal muscular anterior wall weakness are often associated with kyphosis since patients try to hide what they consider to be a source of embarrassment. The discovery of a new body image eliminates dissatisfaction, reduces anxiety and increases self-esteem, which provide psychological and physical benefits that improve the quality of life.

Combined rehabilitation program for postural instability in progressive supranuclear palsy.

BACKGROUND: Progressive supranuclear palsy (PSP) is an atypical parkinsonism clinically characterized by prominent axial extrapyramidal motor symptoms with frequent falls. The clinical response to L-dopa is poor and there is strong need for alternative treatment strategies. METHODS: We tested the efficacy of a rehabilitative program combining a dynamic antigravity postural system (SPAD) and a vibration sound system (ViSS) on postural instability of 10 patients affected by PSP. The patients underwent SPAD and VISS treatments with a 3 sessions/week schedule for 2 months. Patients were clinically examined at baseline, every week during the 2-months treatment, and at 1 month after the end of treatment for the following parameters: baropodometry static, baropodometry dynamic and stabilometry. PSP rating scale and PD36 quality of life scale were also administered. RESULTS: The combined rehabilitative program produced improvement of all the parameters explored (p = 0.01-0.05) at the end of treatment as compared to baseline. Baropodometric dynamics improvement lasted until the end of follow-up. CONCLUSION: Our results suggest that a specific rehabilitation program could improve postural instability in PSP patients. A more continuous treatment protocol would allow stabilizations of results.

Monitoring skin temperature in trained and untrained subjects throughout thermal video.

Skin temperature was monitored during a graded exercise to verify whether trained individuals have different skin thermoregulation from untrained ones. Eighteen subjects (10 trained; 8 untrained) were studied recording thermal videos of their skin temperature during the exercise. Training level was assessed by maximal oxygen uptake measurements. Trained individuals have better skin thermal control than untrained.