Therapeutic ultrasound ameliorates hyperalgesia and edema on CFA-induced persistent inflammatory response in mice

Abstract Background: The present study investigated the effects of pulsed and continuous ultrasound (USP and USC) in edema and hyperalgesia after chronic inflammatory process induced by Complete Freund's Adjuvant-CFA and analyzing the relationship of the application frequency of ultrasound, in pro- and anti-inflammatory cytokine production. Methods: Forty-five animals were divided into 9 groups; all animals from groups 2 to 9 were subjected to a persistent inflammation model induced by CFA in mice. We report the effects and the underlying action mechanisms of USP and USC in the animals which were irradiated two, three or five times a week on the left hind paw. The analyses performed in this study were: evaluation of hind paw edema through the plethysmometer, evaluation of thermal hyperalgesia through withdrawal test using a water container at 44.5°C (± 0.5°C), and the plantar region of the left paw which was removed for analysis of cytokines. Results: Our results showed that USP and USC consistently reduced paw edema, and pulsed ultrasound showed a higher significant effect than the continuous mode. Moreover, groups with irradiation frequency of five times a week presented an inhibition of the edema, and groups with frequency of three or two times a week reduced mainly hyperalgesia, in comparison with the control group. The beneficial effects of the US then seem to be associated with upregulation of anti- and pro-inflammatory mediators, such as IL-10 and IL-6, respectively. Conclusion: This study provided evidence that ultrasound constitutes an important non-pharmacological intervention for the management of inflammatory and pain states.

Early sensory re-education of the hand after peripheral nerve repair based on mirror therapy: a randomized controlled trial

BACKGROUND: Mirror therapy has been used as an alternative stimulus to feed the somatosensory cortex in an attempt to preserve hand cortical representation with better functional results. OBJECTIVE: To analyze the short-term functional outcome of an early re-education program using mirror therapy compared to a late classic sensory program for hand nerve repair. METHOD: This is a randomized controlled trial. We assessed 20 patients with median and ulnar nerve and flexor tendon repair using the Rosen Score combined with the DASH questionnaire. The early phase group using mirror therapy began on the first postoperative week and lasted 5 months. The control group received classic sensory re-education when the protective sensation threshold was restored. All participants received a patient education booklet and were submitted to the modified Duran protocol for flexor tendon repair. The assessments were performed by the same investigator blinded to the allocated treatment. Mann-Whitney Test and Effect Size using Cohen's d score were used for inter-group comparisons at 3 and 6 months after intervention. RESULTS: The primary outcome (Rosen score) values for the Mirror Therapy group and classic therapy control group after 3 and 6 months were 1.68 (SD=0.5); 1.96 (SD=0.56) and 1.65 (SD=0.52); 1.51 (SD=0.62), respectively. No between-group differences were observed. CONCLUSION: Although some clinical improvement was observed, mirror therapy was not shown to be more effective than late sensory re-education in an intermediate phase of nerve repair in the hand. Replication is needed to confirm these findings.

Influence of the number of layers of paris bandage plasters on the mechanical properties speciments used on orthopedic splints / Influência do número de camadas na propriedade mecânica de espécimes fabricados com atadura gessada usados para confeccionar splints ortopédicos

OBJECTIVE: To evaluate the effects of varying numbers of layers of plaster of Paris bandages on the mechanical properties of specimens used on the construction of orthopedic splints. METHODS: Rectangular plate-shaped and cylinder-shaped specimens were constructed and assigned to two groups simulating plaster slabs and cast and further divided into six subgroups according to the number of layers used: 3, 6, 8, 10, 12 and 14 layers. The specimens were subjected to either a three-point bending test (plates/slab) or compressive strength test (cylinders/cast). The following mechanical properties were evaluated: maximum load, elastic limit load and stiffness. Specimen weight was also calculated. Data was analyzed using Kruskal-Wallis and the least significant difference (LSD) tests. RESULTS: Pairwise comparisons of the subgroups 10x12 and 10x14 revealed significant differences for all mechanical properties (p<0.05). The results of this study suggest that when the goal is to construct appliances with high mechanical strength, regardless of weight, such as serial plaster slabs splints for stimulating tissue growth through the application of gradual load, splints made with plaster of Paris bandages with 12 or 14 layers should be preferred. For orthotic devices such as positioning orthotics, the use of 10 layers plaster bandages slab splints is advisable as they were found to have better correlation between mechanical strength and weight in comparison to those made wtih 6 or 8 layers. CONCLUSION: Based on the findings of this study, we suggest the use of 10 layers of plaster of Paris for the construction of orthopedic splints.

OBJETIVO: Avaliar as propriedades mecânicas de amostras fabricadas a partir de ataduras de gesso que são utilizadas em órteses ortopédicas e que variam quanto ao número de camadas. MÉTODOS: Foram confeccionados espécimes em forma de placa retangular e em forma cilíndrica, divididos em dois grupos que simulavam splint e gesso circular, os quais foram divididos em seis subgrupos de acordo com o número de camadas utilizadas, ou seja, três, seis, oito, dez, 12 e 14 camadas. Os espécimes foram submetidos a um teste de inclinação de três pontos (placas/splint) ou teste de resistência à compressão (cilindros/gesso circular). As seguintes propriedades mecânicas foram avaliadas: carga máxima e carga no limite de elasticidade e rigidez. O peso da amostra foi calculado. Os dados foram analisados estatisticamente pelos testes de Kruskal-Wallis e diferença mínima significativa (DMS). Comparações pareadas entre os subgrupos 10x12 e 10x14 revelaram diferenças significativas para todas as propriedades mecânicas (p<0,05). RESULTADOS: Os resultados sugerem que, quando o objetivo é construir aparelhos com alta resistência mecânica, independente do peso, tais como órteses seriadas de posicionamento para simular força gradual aplicada no tecido para a melhoria da amplitude de movimento, talas de 12 ou 14 camadas devem ser preferidas. Para os aparelhos ortopédicos que irão ser submetidos a esforços de baixa intensidade, aconselha-se a utilização de dez camadas para as órteses, porque houve uma melhor correlação entre a resistência mecânica e peso para as amostras fabricadas com dez camadas de atadura gessada comparadas com aquelas confeccionadas com seis ou oito camadas. CONCLUSÂO: Baseado nos achados deste estudo, sugere-se a utilização de dez camadas na confecção de órteses ortopédicas.