Effect of Long-term Peripheral Nerve Stimulation on Neuro-Muscular Complex Morphologic Recovery in Experiment / Efecto de la Estimulación del Nervio Periférico a Largo Plazo sobre la Recuperación Morfológica del Complejo Neuromuscular en Experimento

SUMMARY: Peripheral nerve injury is an extremely important medical and socio-economic problem. It is far from a solution, despite on rapid development of technologies. To study the effect of long-term electrical stimulation of peripheral nerves, we used a domestically produced electrical stimulation system, which is approved for clinical use. The study was performed on 28 rabbits. Control of regeneration was carried out after 3 month with morphologic techniques. The use of long-term electrostimulation technology leads to an improvement in the results of the recovery of the nerve trunk after an injury, both directly at the site of damage, when stimulation begins in the early period, and indirectly, after the nerve fibers reach the effector muscle.

La lesión de los nervios periféricos es un problema médico y socioeconómico extremadamente importante. Sin embargo, y a pesar del rápido desarrollo de las tecnologías, aún no tiene solución. Para estudiar el efecto de la estimulación eléctrica a largo plazo de los nervios periféricos, utilizamos un sistema de estimulación eléctrica de producción nacional, que está aprobado para uso clínico. El estudio se realizó en 28 conejos. El control de la regeneración se realizó a los 3 meses con técnicas morfológicas. El uso de tecnología de electro estimulación a largo plazo conduce a una mejora en los resultados de la recuperación del tronco nervioso después de una lesión, tanto directamente en el lugar del daño, cuando la estimulación comienza en el período temprano, como indirectamente, después de que las fibras nerviosas alcanzan el músculo efector.

Neuromuscular Electrical Stimulation in Facial Aging: an Integrative Literature Review / Estimulación Eléctrica Neuromuscular en el Envejecimiento Facial: Revisión Integradora della Literatura / Estimulação Elétrica Neuromuscular no Envelhecimento Facial: uma Revisão Integrativa da Literatura

ABSTRACT Despite of being a natural physiological process, aging is considered a degenerative process with evident effects on aging skin, such as reduced elasticity, wrinkles, reduced facial fat and muscle tone, sagging, changes in facial contour, and sarcopenia on the face. These changes can generate social stigma, suffering, and psychological discomfort for the patient. Thus, this study aimed to evaluate the effectiveness of Neuromuscular Electrical Stimulation (NMES), a technique used in physical therapy for muscle training, in attenuating the signs of facial aging. For this purpose, a scientific survey of publications indexed on the Medline (PubMed), CINAHL, Embase, PEDro, Lilacs, ERIC, Scopus, Web of Science, and Google Scholar databases was conducted and, based on pre-established criteria, two relevant publications for the topic were selected for discussion. The scientific literature regarding the use of NMES to attenuate the signs of aging is still very scarce. The survey showed the need to discuss the current state of knowledge. Our results suggest that, theoretically, NMES could be a promising method to attenuate the signs of aging; however, there are still no conclusive results regarding the clinical effectiveness of using NMES in the facial muscles since few studies relate NMES to facial rejuvenation. More studies are needed, with greater methodological rigor and low level of bias, using precise techniques in the evaluation and allowing to interpret with greater scientific commitment of the physiological mechanism of the muscular stimulus and its interrelation with the integumentary system, proving its effectiveness in the improvement of skin appearance.

RESUMEN El envejecimiento es un proceso fisiológico natural, aunque se considera un proceso degenerativo. Sus efectos son evidentes en la piel envejecida, que presenta disminución de la elasticidad, grasa y tono muscular, así como arrugas, flacidez, cambios de contorno y sarcopenia. Estos cambios pueden generar un estigma social y malestar psicológico para el portador. En ese contexto, el objetivo de este estudio fue evaluar la efectividad del uso de la estimulación eléctrica neuromuscular (NMES), una técnica utilizada en Fisioterapia de entrenamiento muscular para atenuar los signos del envejecimiento facial. Para ello, se realizó un relevamiento de las publicaciones indexadas en las plataformas MEDLINE (PubMed), CINAHL, Embase, PEDro, LILACS, ERIC, Scopus, Web of Science y Google Scholar, y, con base en criterios preestablecidos, se seleccionaron dos publicaciones relevantes sobre el tema. La literatura científica sobre el uso de NMES en la atenuación de los signos del envejecimiento es aún escasa. La búsqueda reveló la necesidad de una discusión sobre el estado actual del conocimiento. Los resultados de esta revisión sugieren que la NMES puede ser un método prometedor de entrenamiento muscular cuando se aplica para atenuar los signos del envejecimiento. Sin embargo, todavía hay poca evidencia con respecto a la efectividad de NMES en los músculos faciales, ya que pocos estudios relacionan NMES con el rejuvenecimiento facial. Son necesarios estudios con mayor rigor metodológico para minimizar sesgos y el uso de técnicas de evaluación precisas, que permitan dilucidar el mecanismo fisiológico del estímulo muscular y su interrelación con el sistema tegumentario y que permitan probar la eficacia de la NMES en la mejora del aspecto de la piel del rostro.

RESUMO Embora seja um processo fisiológico natural, o envelhecimento é considerado degenerativo. Seus efeitos são evidentes na pele envelhecida, que apresenta redução de elasticidade, gordura e tônus muscular, assim como rugas, flacidez, alteração de contornos e sarcopenia. Tais mudanças podem gerar um estigma social e desconforto psicológico para o seu portador. Nesse contexto, objetivou-se avaliar a eficácia do uso da estimulação elétrica neuromuscular (EENM), uma técnica utilizada na Fisioterapia para o treinamento muscular, visando à atenuação dos sinais do envelhecimento facial. Para isso, foi realizado um levantamento de publicações indexadas nas plataformas MEDLINE (PubMed), CINAHL, Embase, PEDro, LILACS, ERIC, Scopus, Web of Science e Google Scholar e, a partir de critérios preestabelecidos, foram selecionadas duas publicações relevantes sobre o tema. A literatura científica sobre o uso da EENM na atenuação dos sinais do envelhecimento ainda é escassa. O levantamento revelou a necessidade de uma discussão a respeito do estado atual do conhecimento. Os resultados desta revisão sugerem que a EENM pode ser um método promissor de treinamento muscular quando aplicado à atenuação dos sinais de envelhecimento. Contudo, ainda há poucas evidências quanto à eficácia da EENM na musculatura da face, visto que poucos estudos relacionam a EENM ao rejuvenescimento facial. São necessários estudos com maior rigor metodológico, a fim de minimizar vieses, e utilização de técnicas precisas de avaliação, permitindo a elucidação do mecanismo fisiológico do estímulo muscular e sua inter-relação com o sistema tegumentar e possibilitando a comprovação da eficácia da EENM na melhoria da aparência da pele facial.

Terapia de electroestimulación para el tratamiento de la atrofia diafragmática inducida por ventilación mecánica / Electrostimulation therapy for the treatment of diaphragmatic atrophy induced by mechanical ventilation / Terapia de eletroestimulação para o tratamento da atrofia diafragmática induzida por ventilação mecânica

Resumen: Introducción: La atrofia y disfunción del músculo diafragmático es frecuente en pacientes sometidos a ventilación mecánica. La terapia de electroestimulación diafragmática transcutánea (TEDT) ha demostrado mejorar la fuerza en pacientes con debilidad muscular; sin embargo, no ha sido evaluada como tratamiento para la atrofia en la disfunción diafragmática inducida por ventilación mecánica (DDIVM). Objetivo: Determinar si la TEDT puede mejorar el grosor diafragmático de los pacientes que se encuentran bajo ventilación mecánica. Material y métodos: Se realizó un ensayo clínico aleatorizado en dos grupos independientes: un grupo intervención con 15 pacientes y un grupo control con 17 pacientes. El grupo de intervención recibió TEDT con sesiones de 20 minutos cada seis horas en las 72 horas subsecuentes a su inclusión al estudio. El grosor diafragmático basal fue medido mediante ecografía en ambos grupos, después de la TEDT para el grupo intervención y 72 horas después en el grupo control. Resultados: De los 32 pacientes evaluados se documentó una media de grosor diafragmático inicial para el grupo control de 2.04 ± 0.43 mm y de 1.9 ± 0.52 mm para el grupo intervención con un valor de p = 0.652. Posterior a la intervención, se registró una media de grosor diafragmático final de 1.7 ± 0.43 mm para el grupo control y 2.3 ± 0.55 mm para el grupo intervención con un valor de p = 0.002 al comparar ambos grupos. Conclusión: Se encontró diferencia estadísticamente significativa en ambos grupos al aplicar la TEDT, evidenciando un aumento del grosor diafragmático basal en el grupo intervención y disminución del mismo en el grupo control.

Abstract: Introduction: Muscle involvement in critically ill patients is present in the majority of those admitted to the intensive care unit, including alteration of the diaphragmatic muscle, especially during mechanical ventilation (MV). Transcutaneous diaphragmatic electrostimulation therapy (TEDT) has been shown to improve respiratory strength in patients with muscle weakness. However, it has not been evaluated as a treatment for atrophy in Ventilation-Induced Diaphragmatic Dysfunction (DDIVM). Objective: To determine if TEDT can improve diaphragmatic thickness in patients undergoing mechanical ventilation. Material and methods: A randomized clinical trial was carried out in two independent groups: an intervention group with 15 patients and a control group with 17 patients. The intervention group received TEDT with sessions of 20 minutes every 6 hours in the 72 hours after their inclusion in the study. Baseline diaphragm thickness was measured by ultrasound in both groups, after TEDT for the intervention group and 72 hours later in the control group. Results: Of the 32 patients evaluated, a mean initial diaphragmatic thickness was documented for the control group of 2.04 ± 0.43 mm and of 1.9 ± 0.52 mm for the intervention group with a p value of 0.652. After the intervention, a mean final diaphragmatic thickness of 1.7 ± 0.43 mm was recorded for the control group and 2.3 ± 0.55 mm for the intervention group with a p value of 0.002 when comparing both groups. Conclusion: A statistically significant difference was found in both groups when applying TEDT, showing an increase in baseline diaphragmatic thickness in the intervention group and a decrease in it in the control group.

Resumo: Introdução: Atrofia e disfunção do músculo diafragmático é comum em pacientes submetidos à ventilação mecânica. A terapia de estimulação elétrica diafragmática transcutânea (TEDT) demonstrou melhorar a força em pacientes com debilidade muscular, mas não foi avaliada como tratamento para atrofia na disfunção diafragmática induzida pela ventilação (DDIVM). Objetivo: Determinar se a TEDT pode melhorar a espessura diafragmática de pacientes com ventilação mecânica. Material e métodos: Realizou-se um ensaio clínico randomizado em 2 grupos independentes: um grupo intervenção com 15 pacientes e um grupo controle com 17 pacientes. O grupo intervenção recebeu TEDT com sessões de 20 minutos a cada 6 horas por 72 horas após a inclusão no estudo. A espessura diafragmática basal foi medida por ultra-som em ambos os grupos, após TEDT para o grupo de intervenção e 72 horas depois no grupo controle. Resultados: Dos 32 pacientes avaliados, (17 grupo controle, 15 grupo intervenção). Documentou-se uma média da espessura diafragmática basal para o grupo controle de 2.04 ± 0.43 mm e 1.9 ± 0.52 mm para o grupo intervenção com um valor de p = 0.652. Após a intervenção, foi registrada uma espessura média final do diafragma de 1.7 ± 0.43 mm para o grupo controle e 2.3 ± 0.55 mm para o grupo intervenção, com valor de p = 0.002 na comparação entre os dois grupos. Conclusão: Encontrou-se diferença estatisticamente significativa em ambos os grupos na aplicação do TEDT, mostrando aumento da espessura basal do diafragma no grupo intervenção e diminuição da mesma no grupo controle.

The efficacy and safety of electrostimulation of the posterior tibial nerve and antimuscarinic drugs in the treatment of overactive bladder: a meta-analysis and systemic review / 中华泌尿外科杂志

Objective:To systematically review the efficacy and safety of electrostimulation of the posterior tibial nerve and antimuscarinic drugs in the treatment of overactive bladder.Methods:The literature search was conducted using the PubMed, The Cochrane Library, EMbase, Medline, CNKI, CQVIP, Wanfang databases.The retrieval period was from the establishment of the database to February 2021. Literature was screened and evaluated independently by two investigators to compare the safety and efficacy of electrostimulation of the posterior tibial nerve and antimuscarinic drugs in the treatment of overactive bladder. Meta-analysis was performed using Review Manager 5.4 software.Results:A total of 11 clinical trials, including 10 randomized controlled trials and 1 cross-over study were included, involving 605 patients, including 309 in the experimental group (nerve stimulation group) and 296 in the control group(antimuscarinic drugs group). The results of meta-analysis showed as follow. For patients with non-neurogenetic overactive bladder, there was no statistically significant differences between electrostimulation of the posterior tibial nerve therapy and antimuscarinic drugs in the improvement of 24h urination frequency( MD=-0.06, 95% CI -1.67-1.54, P>0.05), 24h urge incontinence frequency( MD=0.04, 95% CI -0.46-0.54, P>0.05), symptoms scores of OAB-q questionnaire( MD=0.37, 95% CI -0.02-0.76, P>0.05)and quality of life scores( SMD=0.32, 95% CI-0.06-0.69, P>0.05). However, compared with antimuscarinic drugs, posterior tibial nerve stimulation had better efficacy satisfaction rate ( OR=1.97, 95% CI 1.16-3.36, P<0.05) and lower side effect rate ( OR=0.24, 95% CI 0.12-0.48, P<0.0001). And the results have significant statistical differences. Conclusions:Electrostimulation of the posterior tibial nerve was almost as effective as antimuscarinic drugs in improving symptoms and quality of life in patients with non-neurogenic OAB. However, compared with antimuscarinic drugs, electrostimulation of the posterior tibial nerve had a higher efficacy satisfaction rate and a lower incidence of side effects. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

Effectiveness of neuromuscular electrostimulation in COPD subjects on mechanical ventilation. A systematic review and meta-analysis

Abstract Objective: To estimate the effectiveness of Neuromuscular Electrostimulation (NMES) in adults with COPD undergoing MV. Method: A sensitive search was performed in MEDLINE, Embase, CENTRAL, CINAHL and other resources. Randomized Controlled Clinical Trials (RCTs) or non-RCTs that enrolled adults with COPD on MV due to an exacerbation of their disease were included. Two independent reviewers screened, extracted information, and assessed the risk of bias (RoB 2 tool) and the certainty of evidence (GRADE approach) from the included studies. Results: Four RCTs (144 participants) were included. Subjects who underwent NMES were able to move from bed to chair independently in less time (MD = 4.98 days less; 95% CI -8.55 to -1.47; 2 RCTs; low certainty of the evidence) and they were fewer days on MV (MD = 2.89 days less; 95% CI -4.58 to -1.21); 3 RCTs; low certainty of the evidence) than the control group. However, the effect of NMES on muscle strength is unclear (very low certainty of the evidence). Conclusions: NMES may improve functional independence and decrease MV time in adults with COPD; however, its effectiveness on muscle strength is uncertain. More and better RCTs are needed to determine with greater certainty the effectiveness of NMES in this population.

La electroestimulación neuromuscular como mecanismo complementario en el entrenamiento deportivo de predominancia anaeróbica / Neuromuscular electro-stimulation as a complementary mechanism in sports training of anaerobic predominance

Introducción: La electroestimulación neuromuscular puede dar un valor agregado a los programas de ejercicio físico de rehabilitación, siempre y cuando se contemplen aspectos como los objetivos propios de cada persona, la tolerancia a la intensidad y las necesidades de recuperación y descanso. Así mismo, puede ser un elemento interesante a agregar en la planificación deportiva con miras a mejorar la recuperación, así como en el aumento del rendimiento físico. Objetivo: El objetivo principal de la presente investigación fue determinar los efectos del ejercicio combinado de electroestimulación neuromuscular y ejercicios de alta intensidad y corta duración en hombres sanos y físicamente activos sobre el índice de fatiga. Metodología: 34 hombres sanos, físicamente activos y estudiantes de educación física (19,4 ± 2,60 años) fueron aleatorizados y organizados en cuatro grupos: G1, programa de electroestimulación neuromuscular; G2, entrenamiento de alta intensidad y corta duración: G3, ejercicio combinado de alta intensidad y corta duración y, electroestimulación neuromuscular; y G4, grupo control. Se aplicó un test de Wingate antes y después del periodo de entrenamiento. Resultados: En el grupo G3 se evidencian aumentos en el rendimiento anaeróbico con diferencias significativas en la potencia promedio relativa al peso (p=0,027), con un aumento de 7,36% y con una disminución de 12,2% en el índice de fatiga (p=0,048). En el grupo G4 se evidencian disminuciones en el rendimiento, evidenciado a través de las diferencias significativas en la potencia media (p=0,030), con una disminución en el rendimiento de 6,32% y una disminución en el rendimiento en la potencia media relativa al peso con diferencia significativa (p=0,010) de 3,92%. Conclusiones: Un programa combinado de electroestimulación neuromuscular y ejercicio intervalico de alta intensidad mejora el rendimiento anaeróbico en la potencia media y relativa al peso, evidenciado a través de un test de Wingate. Así mismo, disminuye el porcentaje de caída del rendimiento anaeróbico, mostrando mejores resultados frente a un entrenamiento de solo ejercicio intervalico de alta intensidad

Introduction: Neuromuscular electrostimulation can add value to rehabilitation physical exercise programs, as long as aspects such as the objectives of each person, tolerance to intensity, and the needs for recovery and rest are considered. Likewise, it can be an interesting element to add in sports planning with a view to improving recovery, as well as increasing physical performance. Objective: The main objective of this research was to determine the effects of combined neuromuscular electrostimulation exercise and high intensity and short duration exercises in healthy and physically active men on the fatigue index. Methodology: 34 healthy, physically active, and physical education male students (19.4 ± 2.60 years) were randomized and organized into four groups: G1, neuromuscular electrostimulation program; G2, high intensity and short duration training; G3, combined exercise of high intensity and short duration, and neuromuscular electrostimulation; and G4, control group, A Wingate test was applied before and after the training period. Results: In the G3 group, there are increases in anaerobic performance with significant differences in the average power relative to weight (p=0.027), with an increase of 7.36%, and a decrease of 12.2% in the fatigue index (p=0.048). In the G4 group there are decreases in performance, evidenced through the significant differences in the average power (p = 0.030), with a decrease in performance of 6.32% and a decrease in the performance in mean power relative to weight with a significant difference (p=0.010) of 3.92%. Conclusions: A combined program of neuromuscular electrostimulation and high-intensity interval exercise improves anaerobic performance in mean power and relative to weight, evidenced through a Wingate test. Likewise, it decreases the percentage of drop in anaerobic performance, showing better results in comparison to training with only high-intensity interval training

Efeito agudo das correntes Russa e Aussie na força muscular de flexores de punho e dedos / Acute effect of the use of Russian and Aussie currents on the muscular strength of fist and finger flexors

Introdução: As alterações motoras e sensoriais da mão diminuem a força dos músculos que compõe esse segmento e pode repercutir na qualidade de vida do indivíduo. No campo da Fisioterapia, a diminuição da força muscular é frequentemente tratada com o emprego de correntes excitomotoras, dentre aquelas comumente empregadas, as correntes russas e Aussie destacam-se por serem de média frequência e promoverem estimulação sensorial confortável. Objetivo: Identificar os efeitos agudos do uso das correntes Aussie e russa sobre a força muscular de flexores de punho e dedos. Métodos: Foi realizado um estudo de caráter experimental, no qual se avaliou a força de preensão palmar antes e após a aplicação de correntes excitomotoras (Aussie e russa). Os voluntários foram divididos em dois grupos, GR, os quais foram submetidos a terapia com corrente russa, e GA, que recebeu a terapia usando a corrente Aussie. A estimulação utilizando a corrente russa foi efetuada com frequência portadora de 2500 Hz com burst de 10 ms, frequência de estimulação de 50 Hz, tempo On 5 segundos e tempo Off 15 segundos e modulação de 20%. Já a estimulação com a corrente Aussie foi realizada com frequência portadora de 1000 Hz com burst de 2 ms, frequência de modulação a 50 Hz, tempo On em 5 segundos, tempo Off 15 segundos, Rampas de subida e descidas fixadas em 2 segundos. Em ambas as estimulações, a intensidade da corrente foi ajustada de acordo com a tolerância do participante, buscando desencadear contração muscular visível, e o tempo total de aplicação foi de 10 minutos. Resultados: As alterações na goniometria e dinamometria foram analisadas por meio de uma ANOVA de dois fatores. Ao analisar os efeitos principais dos dados da goniometria, não foram observadas diferenças estatisticamente significativa entre os grupos [F(2,114) = 2,662; p=0,074] e entre os momentos [F(1,114)= 2,893; p=0,092]. Os dados da dinamometria também não apresentaram efeito principal para os momentos [F(1,114) = 0,392; p=0,533]. No entanto, observou-se efeito principal para grupos com [F(2,114) = 3,119; p=0,048]. Assim, o presente estudo não encontrou diferenças estatísticas significativas no ganho de força de preensão palmar como resultado de uma única aplicação das correntes estudadas. Conclusão: Sugere-se a realização de estudos adicionais utilizando eletroestimulação, buscando estabelecer parâmetros mais indicados para promover maiores ganhos de força muscular e benefícios terapêuticos. (AU)

Introduction: The motor and sensorial changes of the strength decrease of the muscles hand can affect the quality of life. In the field of Physical Therapy, the decrease of muscle strength is often treated with the use of excitomotor currents. Among those commonly used, the Russian and Aussie currents stand out because they are of medium frequency and promote comfortable sensory stimulation. Objective: To identify the acute effects of the use of Aussie and Russian currents on the muscular strength of wrist and finger flexors. Methods: An experimental study was carried out, in which the palmar grip strength was evaluated before and after the application of excitomotor currents (Aussie and Russian). The volunteers were divided into two groups, GR, using the Russian current therapy, and GA, who received the Aussie current. The stimulation using the Russian current was performed with carrier frequency of 2500 Hz with burst of 10 ms, stimulation frequency of 50 Hz, time On 5 seconds, time Off 15 seconds and modulation of 20%. The Aussie current stimulation was performed with a frequency of 1000 Hz with a burst of 2 ms, modulation frequency at 50 Hz, time On in 5 seconds, time Off 15 seconds, ramps up and down fixed in 2 seconds. In both stimulations, the intensity of the current was adjusted according to the tolerance of the participant, seeking to trigger visible muscle contraction, and the total time of application was 10 minutes. Results: Changes in goniometry and dynamometry were analyzed using a two-way ANOVA. When analyzing the main effects of the goniometry data, no statistically significant differences were observed between the groups [F (2,114) = 2,662; p = 0.074] and between the moments [F (1.114) = 2.893; p = 0.092]. The dynamometry data also did not present main effect for the moments [F (1,114) = 0.392; p = 0.533]. However, a major effect was observed for groups with [F (2,114) = 3.119; p = 0.048]. Thus, the present study did not find statistically significant differences in palmar grip strength gain as a result of a single application of the currents studied. Conclusion: We suggested to perform additional studies using electrical stimulation, seeking to establish parameters more indicated to promote greater muscle strength gains and therapeutic benefits. (AU)

Efeitos da fisioterapia na incontinência urinária feminina / Effects of physiotherapy on female urinary incontinence

A incontinência urinaria é definida como qualquer perda involuntária de urina, sendo o sexo feminino o mais atingido. É classificada em três tipos: de esforço, de urgência e mista. A fisioterapia no tratamento de incontinência urinária consiste na normalização do tônus dos músculos do assoalho pélvico, utilizando cinesioterapia e eletroestimulação transcutânea do nervo tibial posterior. OBJETIVO: Avaliar os efeitos da fisioterapia na incontinência urinária feminina. METODOLOGIA: Tratou-se de uma pesquisa clínica, longitudinal e prospectiva. Participaram do estudo 27 mulheres com idade média de 57,4 anos, com diagnóstico de incontinência urinária, encaminhadas para tratamento em Ambulatório de Fisioterapia Escola. As mesmas responderam um questionário de avaliação dos dados demográficos e clínicos e o questionário de qualidade de vida ICIQ-FS, antes e após intervenção fisioterapêutica por meio de cinesioterapia e eletroestimulação tibial posterior. RESULTADOS: A maioria das mulheres possuía incontinência urinária de esforço (55,6%), sendo que 33,3% (n=9) referiram perdas urinárias de 01 a 04 anos e 33,3 % (n=9) de 04 a 08 anos. A frequência de perdas urinárias antes do tratamento na maioria (55,6%) era diversas vezes ao dia e após o tratamento a maioria (55,6%) perdia uma vez por semana ou menos. Houve diminuição significativa na comparação do ICIQ Score antes e após o tratamento fisioterapêutico (p< 0.0001). CONCLUSÃO: A fisioterapia, por meio de cinesioterapia e eletroestimulação, é eficaz no tratamento da Incontinência Urinária feminina.

Urinary incontinence is defined as any involuntary loss of urine, with females being the most affected. It is classified into three types: stress urinary incontinence; urgency; and mixed. Physiotherapy in the treatment of urinary incontinence consists of normalization of the tone of the pelvic floor muscles, using kinesiotherapy and transcutaneous electrostimulation of the posterior tibial nerve. OBJECTIVE: To evaluate the effects of physiotherapy on female urinary incontinence. METHODOLOGY: It was a clinical, longitudinal and prospective study. The study included 27 women with a mean age of 57.4 years, diagnosed with urinary incontinence, referred for treatment at the School Physiotherapy Outpatient Clinic. They answered a questionnaire to assess demographic and clinical data and the ICIQ-FS quality of life questionnaire, before and after physiotherapeutic intervention through kinesiotherapy and posterior tibial electrostimulation. RESULTS: Most women had stress urinary incontinence (55.6%), and 33.3% (n=9) reported urinary losses from 01 to 04 years and 33.3% (n=9) from 04 to 08 years. The frequency of urinary losses before treatment in the majority (55.6%) was several times a day and after treatment the majority (55.6%) lost once a week or less. There was a significant decrease in the comparison of the ICIQ Score before and after physical therapy treatment (p< 0.0001). CONCLUSION: Physiotherapy, through kinesiotherapy and electrostimulation, is effective in the treatment of female urinary incontinence.

Effects of Vagus Nerve Stimulation on Adenosine Monophosphate Activated Protein Kinase-Silent Mating Type Information Regulation 2 Homolog 1 Pathway in Ischemia-reperfusion Rats / 中国康复理论与实践

Objective:To investigate the effect of vagus nerve stimulation (VNS) on the autophagy in penumbra of rats after middle cerebral artery occlusion (MCAO). Methods:A total of 56 Sprague-Dawley rats were divided into control group (n = 14), sham group (n = 14), model group (n = 14) and VNS group (n = 14). The model group and VNS group accepted MCAO for one hour, then reperfusion, and VNS group accepted VNS in the left as MCAO for 0.5 hour. Their infarct volume was detected with TTC staining, neurological impairment was assessed with Longa's score, and the expression of Beclin-1, microtubule-associated protein 1 light chain 3 (LC3)-II/I, phosphorylated adenosine monophosphate activated protein kinase (P-AMPK) and silent mating type information regulation 2 homolog 1 (Sirt1) were detected with Western blotting 24 hours after reperfusion. Results:Compared with the sham group, the infarct volume and Longa's score increased in the model group, while the expression of Beclin-1, LC3-II/I, P-AMPK and Sirt1 decreased significantly (P < 0.001). Compared with the model group, the infarct volume and Longa's score reduced (P < 0.05) in VNS group, while the expression of Beclin-1, LC3-II/I, P-AMPK and Sirt1 increased significantly (P < 0.001). Conclusion:VNS may alleviate cerebral ischemic injury in rats through AMPK-Sirt1 pathway.

Terapia Eléctrica Funcional en el Manejo de la Disfagia / Functional Electrical therapy in the management of Dysphagia

La participación del Fonoaudiólogo en la rehabilitación neuromuscular orofacial y musculatura implicada en la mecánica deglutoria, se ha complementado con el uso de la terapia eléctrica funcional; esta carece de evidencia científica que respalde su efectividad en los procesos de recuperación funcional. Objetivo: Realizar una revisión documental sobre el uso de la terapia eléctrica funcional en el manejo de la disfagia, con el fin de crear un soporte teórico que respalde los procesos de intervención en fonoaudiología. Metodología: La revisión de la literatura se realizó en las bases de datos de Proquest, EBSCO, Scielo, Redalyc y Medic Latina. Fueron revisados artículos entre el 2008 y 2018. Para la selección de los artículos se utilizó el diagrama de flujo PRISMA (Preferred Reporting Hems for Systematic Reviews and Meta analyses). Resultados: Se revisaron 2980 artículos para exclusión por título, quedando 66 artículos en la primera depuración, de los cuales 21 fueron descartados por no cumplir con ningún criterio propuesto, 10 por repetición y 12 por no permitir el acceso al documento. Finalmente fueron considerados 23 artículos y 5 fuentes de consulta física para realizar el respectivo análisis. Conclusiones: Existe escasa evidencia científica que respalde la intervención fonoaudiológica en la disfagia con electroterapia.

The participation of the speech therapist within the orofacial neuromuscular rehabilitation and the musculature involved in swallowing mechanics, has been complemented with the use of functional electrical therapy, which has lacked scientific evidence that supports its effectiveness in faster recovery processes in terms of functionality. Objective: To carry out a documentary review of information related to the use of functional electric therapy on the management of dysphagia, to create a theoretical support that supports the processes of speech therapy intervention. Methodology: The review of the literature was carried out in the databases of Proquest, EBSCO, Scielo, Redalyc and Medic Latina. Articles were reviewed between 2008 and 2018. For the selection of the articles the PRISMA flow chart (Preferred Reporting Hems for Systematic Reviews and Meta analyzes) was used. Results: 2980 articles were reviewed for exclusion by title, leaving 66 articles in the first debugging, of which 21 were discarded for not complying with any proposed criteria, 10 for repetition and 12 for not allowing access to the document. Finally, 23 articles and 5 sources of physical consultation were considered to perform the respective analysis. Conclusions: There is little scientific evidence to support the speech therapy intervention in dysphagia with electrotherapy.

Os efeitos da eletroestimulação transcutânea em pacientes na unidade de terapia intensiva / The effects of transcutaneous electrostimulation in patients in the intensive care unit

INTRODUÇÃO: A fraqueza muscular adquirida em internações prolongadas é comum em cerca de 50 -80% dos pacientes onde apresentam evidências eletrofisiológicas de disfunção neuromuscular. A mobilização e a reabilitação precoce têm demonstrado melhorar os resultados funcionais e a qualidade de vida e neste contexto, a estimulação elétrica neuromuscular (NMS) tem positivas evidências auxiliando na preservação da síntese proteica e na prevenção de atrofia muscular durante o período de imobilização. OBJETIVO: Analisar os benefícios proporcionados pela eletroestimulação em pacientes internados na unidade de terapia intensiva. METODOLOGIA: Para realizar esta revisão, foi realizada uma busca nas seguintes bases de dados: SciELO, Medline, Lilacs, PEDro, PubMed e Cochrane, no período de junho a dezembro de 2018. Foram encontrados 106 artigos e 99 excluídos por não estarem de acordo com nossos descritores. No final, 7 artigos se enquadram nos critérios para a análise final. Os estudos foram selecionados primeiro pelo título, resumos e metodologias. Os critérios de inclusão dos estudos foram: comparador (es): parâmetros da EENM utilizados, força muscular e tempo de terapia por sessão, indivíduos maiores de 18 anos, homens e mulheres, necessitando de ventilação mecânica invasiva por mais de 24 horas. Estudos: Ensaios clínicos, coorte transversal, coorte longitudinal com esse tema. Não foram selecionados estudos de caso, artigos de revisão sistemática, resumos de congressos sobre o assunto, estudos fora do intervalo de tempo escolhido e outras técnicas de mobilização precoce. RESULTADOS: O número total de participantes incluídos nos estudos foi de 594 adultos, 323 em grupos experimentais e 271 em grupos controle, e todos os estudos investigaram os efeitos da NMS em pacientes críticos. Os estudos foram em adultos com diversos diagnósticos, houve grande variabilidade entre os protocolos NMS, número e tempo de sessão realizada. CONCLUSÃO: O NMS tem resultados significativos no aumento da força muscular, melhora a independência funcional, encurta o tempo de internação hospitalar, o tempo do uso de ventilação mecânica invasiva e níveis mais baixos de sedação. No entanto, ainda há necessidade de mais estudos com uma metodologia mais bem descrita para realmente investigar com mais precisão sobre o efeito isolado de NMS em pacientes críticos.

INTRODUCTION: Acquired muscle weakness in prolonged hospitalizations is common in approximately 50 -80% of hospitalized patients where all present electrophysiological evidence of neuromuscular dysfunction. Mobilization and early rehabilitation have been shown to improve functional results and quality of life and in this context, neuromuscular electrical stimulation (NMS) has positive evidences aiding in the preservation of protein synthesis and in the prevention of muscle atrophy during the immobilization period. OBJECTIVE: To analyze the benefits of electrostimulation in patients in the intensive care unit. METHODOLOGY: To carry out this review a search was performed in the following databases: SciELO, Medline, Lilacs, PEDro, PubMed and Cochrane, in the period from June to December 2018. 106 articles were found and 99 were excluded because they were not in accordance with our descriptors. In the end, 7 articles fit the criteria for the final analysis. The studies were selected first by the title, abstracts and methodologies. The criteria for inclusion of the studies were: comparator (es): NMS parameters used, muscle strength and therapy time per session, individuals over 18 years old, male and female, requiring invasive mechanical ventilation for more than 24 hours. Studies: Clinical trials, cross-sectional cohort, longitudinal cohort with this theme. No case studies, Systematic review articles, congress summaries on the subject, studies outside the chosen time interval, and other early mobilization techniques were selected. RESULTS: The total number of participants included in the studies was 594 adults, 323 in experimental groups and 271 in control groups, and all studies investigated the effects of NMS in critical patients. The studies were in adults with diverse diagnoses, there was great variability between the NMS protocols, number and time of session performed. CONCLUSION: The NMS has significant results in the increase of muscle strength, Improves functional independence, shortens hospital admission time, shortens time for invasive mechanical ventilation and lower levels of sedation. However, there is still a need for further studies with a better described methodology to actually investigate more accurately about the isolated effect of NMS in critical patients.

Clinical effect analysis of electrostimulation combined with biofeedback therapy for patients with dysuria after radical hysterectomy / 中国实用妇科与产科杂志

OBJECTIVE: To investigate the clinical efficacy and safety of electrostimulation combined with biofeedback therapy for patients with dysuria after radical hysterectomy and to provide clinical reference for the evaluation of safety of electrostimulation for tumors.METHODS: Totally 40 patients with dysuria which presented two weeks after radical hysterectomy for cervical cancer in Foshan First People's Hospita were enrolled as research subjects,and they were randomly assigned into control group and experimental group,each with 20 cases.Patients in control group only received standard treatment,while standard treatment combined with electrostimulation and biofeedback treatment in sacral nerve root surface projection area,bladder area,vaginal respectively were carried out in experimental group.The baseline condition of dysuria of all cases were evaluated in two weeks after radical surgery.The therapeutic effect in the patients in two groups were evaluated according to the recovery of bladder sensory function,international lower urinary tract symptom score,urinary symptom distress score and urodynamic measurement at 8 weeks and 12 weeks after the operation,respectively.Also,regular and normative surveillance and follow-up for tumor were implemented.RESULTS: Through our study,we found that electrical stimulation combined with biofeedback thearpy will greatly shorten the recovery time of bladder sensory function,and 12 weeks after the operation,the number of patients who had normal bladder sensory function in experimental group was twice as many as that of the control group(16/8).In addition,at 8 and 12 weeks after operation,all indexs of the urinary symptom disturbance score and international lower urinary tract symptom score at the same period in the experimental group were superior to those in control group(P<0.05).Furthermore,the pressure of bladder detrusor muscle at 12 weeks after operation was(44.31±5.51)cm H2 O(1 cm H2 O=0.098 k Pa)in experimental group,which was close to the normal level,while it was only(38.11±5.81)cm H2 O in control group,showing a significant difference(P<0.05).All patients were followed up more than three years and no evidence of tumor recurrence was found.CONCLUSION: Low-frequency electrical stimulation combined with biofeedback treatment is safe and effective for patients wtih dysuria after radical hysterectomy,which can shorten the recovery time of dysuria and improve the quality of life of patients.

Análise da eletroestimulação transcutânea e percutânea do nervo tibial para tratamento da bexiga hiperativa em Parkinsonianos: revisão sistemática / Analysis of transcutaneous and percutaneous tibial nerve electrostimulation for treatment of overactive bladder in Parkinsonians: systematic review

Parkinson é uma doença de sintomas motores e não motores, podendo incluir neste último, a bexiga neurogênica, que se caracteriza por sintomas de urgência, com ou sem urge-incontinência, normalmente acompanhada de polaciúria e noctúria. Objetivo: Analisar a eletroestimulação transcutânea e a percutânea do nervo tibial para tratamento da bexiga hiperativa em Parkinsonianos. Metodologia: Foram incluí­dos todos os artigos que mencionaram o tratamento da bexiga hiperativa, com eletroestimulação transcutânea e percutânea do tibial posterior, em pacientes com Parkinson. Realizou-se a busca de março a novembro de 2017, nas bases de dados US National Library of Medicine (MEDLINE), Scientific Eletronic Library Online (SciELO), Physiotherapy Evidence Database (PEDro), Biblioteca Virtual em Saúde (BVS) e Google acadêmico, sem limites de data. Foram utilizados como descritores contidos nos Descritores em Ciências da Saúde (DeCS) as palavras-tí­tulo: bexiga hiperativa, Parkinson e eletroestimulação transcutânea e percutânea do tibial posterior. Foram utilizados como descritores contidos no Medical Subject Headings (MeSH) as palavras-tí­tulo: overactivity bladder, Parkinson"™s disease, electrical stimulation transcutaneous, percutaneous electrical stimulation. Resultados: Dos 8 artigos recuperados, 1 estava duplicado e 2 foram excluí­dos por não estarem disponí­veis, restando cinco artigos: 2 ECRs, 2 experimentais e 1 estudo piloto. Conclusão: a terapia de eletroestimulação tibial, tanto transcutânea, quanto percutânea, se mostra benéfica para tratamento da bexiga hiperativa, em pacientes com Parkinson, porém, se faz necessário a realização de novos estudos, principalmente os de intervenção, para padronização do método. (AU)

Parkinson's disease is a disease of motor and non-motor symptoms, and may include neurogenic bladder, which is characterized by urgency symptoms, with or without urge incontinence. Objective: To analyze the transcutaneous and percutaneous electrostimulation of the tibial nerve for treatment of overactive bladder in Parkinsonians. Methodology: All articles mentioning the treatment of overactive bladder, with transcutaneous and percutaneous electrostimulation of the posterior tibial, were included in patients with Parkinson's disease. The search was carried out from March to November 2017, in the databases National Library of Medicine (Medline), Scientific Electronic Library Online (SciELO), Physiotherapy Evidence Database (PEDro), Virtual Health Library (VHL) and Google academic, without date limits. The descriptors included were: hyperactive bladder, Parkinson's and transcutaneous and percutaneous electrostimulation of the posterior tibial. The descriptors included in the Medical Subject Headings (MeSH) were: overactivity bladder, Parkinson's disease, electrical stimulation transcutaneous, percutaneous electrical stimulation. Results: Of the 8 articles retrieved, 1 was duplicated and 2 were excluded because they were not available, leaving five articles: 2 RCTs, 2 experimental and 1 pilot study. Conclusion: Transcutaneous and percutaneous tibial electrostimulation therapy is beneficial for the treatment of overactive bladder in patients with Parkinson disease. However, it is necessary to carry out new studies, especially interventional ones, to standardize the method. (AU)

Etiology, Evaluation, and Treatment of Failed Back Surgery Syndrome

The study aimed to review the etiology of failed back surgery syndrome (FBSS) and to propose a treatment algorithm based on a systematic review of the current literature and individual experience. FBSS is a term that groups the conditions with recurring low back pain after spine surgery with or without a radicular component. Since the information on FBSS incidence is limited, data needs to be retrieved from old studies. It is generally accepted that its incidence ranges between 10% and 40% after lumbar laminectomy with or without fusion. Although the etiology of FBSS is not completely understood, it is possibly multifactorial, and the causative factors may be categorized into preoperative, operative, and postoperative factors. The evaluation of patients with FBSS symptoms should ideally initiate with reviewing the patients' clinical history (observing “red flags”), followed by a detailed clinical examination and imaging (whole-body X-ray, magnetic resonance imaging, and computed tomography). FBSS is a complex and difficult pathology, and its accurate diagnosis is of utmost importance. Its management should be multidisciplinary, and special attention should be provided to cases of recurrent disc herniation and postoperative spinal imbalance.

Observation of the clinical effects on perimenopausal syndrome treated with the transcutaneous electrostimulation at Shuitu (ST 10) and the seed-pressure therapy at the auricular points / 中国针灸

OBJECTIVE@#To compare the differences in the clinical therapeutic effects on perimenopausal syndrome (PMS) between the combined treatment with the transcutaneous electrostimulation at Shuitu (ST 10) and the seed-pressure therapy at the auricular points and the hormone replacement therapy.@*METHODS@#A total of 64 PMS patients were divided into an observation group (30 cases) and a control group (34 cases) according to patient's willingness. In the observation group, the transcutaneous electrostimulation at Shuitu (ST 10) was combined with the seed-pressure therapy at the auricular points. The stimulation intensity at Shuitu (ST 10) was ranged from 15 to 20 mA, for 20 min in each treatment, twice a week. The 8 treatments made one course and 3 courses were required. Additionally, the seed-pressure therapy was used at neifenmi (CO), Shenmen (TF), luanchao, zigong, gan (CO), shen (CO), once a week, retained for 5 days. The 4-week treatment was as one course and a total of 3 courses were required. In the control group, the hormone replacement therapy was applied. On Day 5 of menstruation, progynova was prescribed for oral administration, 1 mg, once a day, continuously for 21 days. On Day 12 in the oral administration of progynova, dydrogesterone was used, 20 mg, once every day, continuously for 10 days. Totally, 3 courses were required. Separately, before treatment and in 1 and 3 months after treatment, Kuppermann score, the sexual hormone levels [follicle-stimulating hormone (FSH), luteinizing hormone (LH) and estradiol (E)] and the adverse reactions were observed in the patients of the two groups.@*RESULTS@#In 1 and 3 months after treatment, Kuppermann scores were reduced significantly as compared with those before treatment in the two groups (all 0.05). In the control group, the incidences of the adverse reactions such as vaginal bleeding, bread distending pain and endometrial thickening were higher than those in the observation group [17.6% (6/34) vs 0% (0/30), 20.6% (7/34) vs 3.3% (1/30), 8.8% (3/34) vs 0% (0/30), all <0.05].@*CONCLUSION@#The combined treatment with the transcutaneous electrostimulation at Shuitu (ST 10) and the seed-pressure therapy at the auricular points achieves the similar therapeutic effects on PMS as compared with the hormone replacement therapy. This combined therapy effectively relieves the clinical symptoms and improves the sexual hormone levels. The adverse reactions and the complications are less obviously as compared with the hormone replacement therapy.

Pelvic muscle floor rehabilitation as a therapeutic option in lifelong premature ejaculation: Long-term outcomes / 亚洲男科学杂志(英文版)

The aim of the study was to evaluate the long-term outcomes of pelvic floor muscle (PFM) rehabilitation in males with lifelong premature ejaculation (PE), using intravaginal ejaculatory latency time (IELT) and the self-report Premature Ejaculation Diagnostic Tool (PEDT) as primary outcomes. A total of 154 participants were retrospectively reviewed in this study, with 122 completing the training protocol. At baseline, all participants had an IELT ≤60 s and PEDT score >11. Participants completed a 12-week program of PFM rehabilitation, including physio-kinesiotherapy treatment, electrostimulation, and biofeedback, with three sessions per week, with 20 min for each component completed at each session. The effectiveness of intervention was evaluated by comparing the change in the geometric mean of IELT and PEDT values, from baseline, at 3, 6, and 12 months during the intervention, and at 24 and 36 months postintervention, using a paired sample 2-tailed t-test, including the associated 95% confidence intervals. Of the 122 participants who completed PFM rehabilitation, 111 gained control of their ejaculation reflex, with a mean IELT of 161.6 s and PEDT score of 2.3 at the 12-week endpoint of the intervention, representing an increase from baseline of 40.4 s and 17.0 scores, respectively, for IELT and PEDT (P < 0.0001). Of the 95 participants who completed the 36-month follow-up, 64% and 56% maintained satisfactory ejaculation control at 24 and 36 months postintervention, respectively.

Efeitos da eletroestimulação associada ao treino mastigatório em pessoas com síndrome de down / Effects of electrostimulation associated with masticatory training in individuals with down syndrome

RESUMO Objetivo Investigar e mensurar os efeitos da eletroestimulação na musculatura orofacial e nas funções de mastigação, respiração e deglutição dos indivíduos com síndrome de Down. Método Participaram da pesquisa 16 indivíduos com Síndrome de Down, sendo seis do gênero masculino e dez do gênero feminino com idade entre 9 e 25 anos, participantes de um projeto de extensão institucional. Foram realizadas avaliações fonoaudiológicas com uso do protocolo AMIOFE antes e após a intervenção, que consistiu em oito sessões de eletroestimulação semanais. A corrente utilizada foi a Functional Electrical Estimulation (FES), com uma frequência de 10Hz no aquecimento e 30 Hz na aplicação, em um tempo ON de 5s e OFF de 10s comuns nas duas etapas, e com a largura de pulso de 200(µs) no aquecimento e 250(µs) na aplicação. Resultados Observaram-se diferenças significativas após aplicação da eletroestimulação (FES) em relação ao aspecto das bochechas quando comparadas flacidez/arqueamento pré e pós o estímulo elétrico, diferenças na mobilidade de língua (lateralidade direita e esquerda), no comportamento da musculatura na execução das funções estomatognáticas de respiração, melhoria no comportamento dos lábios durante a deglutição e mudanças expressivas no processo de mastigação (mordida e trituração). Conclusão Foi identificado estatisticamente que houve efeito após a eletroestimulação associada ao treino mastigatório nos músculos masseteres, com ganhos funcionais na execução da mastigação, respiração e deglutição, em pessoas com Síndrome de Down.

ABSTRACT Purpose Investigate and measure the effects of electrostimulation on the orofacial musculature and on the chewing, breathing and swallowing functions of individuals with Down syndrome. Methods Study participants were 16 individuals with Down syndrome (six males and 10 females) from an institutional extension project aged nine to 25 years. Speech-language pathology assessment was performed using the protocol of Orofacial Myofunctional Evaluation with Scores (OMES) pre- and post-intervention. This protocol comprised eight weekly electrostimulation sessions. Functional Electrical Stimulation (FES) current was used at a frequency of 10Hz in warm-up and 30Hz in application, intermittent stimulation (cycling pulses) with ON-time of 5s and OFF-time of 10s common to both stages, and pulse width of 200μs in warm-up and 250μs in application. Results Significant differences were observed between pre- and post-application of FES regarding cheek appearance (flaccidity and arching), tongue mobility (right and left laterality), and musculature behavior during performance of functions of the stomatognathic system: respiration, deglutition (lip behavior), and mastication (bite and trituration). Conclusion Effects of electrostimulation associated with masticatory training of the masseter muscles were statistically identified, with functional gains in chewing, breathing and swallowing performance in individuals with Down syndrome.

Análise comparativa do pico de força e controle motor do músculo tibial anterior após cinesioterapia e estimulação neuromuscular / Comparative analysis of strength peak, and motor control of the tibialis anterior muscle after Kinesiotherapy and Neuromuscular stimulation

Introdução: O fortalecimento muscular pode ser realizado por exercícios ativos, ativos resistidos e também, a estimulação elétrica neuromuscular (EENM), são algumas dentre as diversas técnicas terapêuticas utilizadas pelo fisioterapeuta. Objetivo: Analisar se existe diferença entre o fortalecimento muscular ativo somente e com associação de Eletroestimulação Neuromuscular no músculo Tibial Anterior em mulheres sedentárias. Métodos: Participaram 18 voluntárias, selecionadas aleatoriamente, divididas em 3 grupos com a mesma quantidade em cada, sendo que o primeiro grupo foi realizado apenas fortalecimento ativo com carga (Cinesioterapia), o segundo grupo realizou o fortalecimento ativo com carga do músculo tibial anterior associado a estimulação com a corrente FES, e o terceiro grupo, fortalecimento ativo com carga associado a estimulação com a corrente Russa. Para avaliação foram coletados o Pico máximo de força e Controle motor através da célula de carga. Resultados: Com relação ao pico de força, o grupo que obteve um melhor desempenho mantendo a média mais próxima do valor anterior foi o grupo que associou a corrente FES, já no controle motor o grupo que teve menor variação após a terapêutica foi o que associou a corrente Russa, seguida da que associou corrente FES porém, apenas 48 horas depois. Conclusão Os exercícios de fortalecimento associado a corrente FES teve um melhor desempenho no pico máximo de força, e o grupo associado à corrente Russa teve um melhor controle motor após a terapêutica....(AU)

Introduction: Muscle strengthening can be accomplished by active exercise, weathered assets and also the neuromuscular electrical stimulation (NMES), are some among the various therapeutic techniques used by the physiotherapist. Goal: Analyze whether there are differences between the active muscle strengthening and only with neuromuscular electrical stimulation association in anterior tibialis muscle in sedentary women. Methods: 18 volunteers participated, selected randomly divided into 3 groups with the same amount in each, and the first group was conducted only active strengthening load (kinesiotherapy), the second group performed the active strengthening with load of the tibialis anterior muscle associated with the stimulation current FES, and the third group, strengthening active with load associated with stimulation with Russian current. For evaluation were collected the maximum peak strength and motor control through the load cell. Results: with relation to strength peak, the group that achieved a better performance by keeping the closest measure of the previous value, was the group that used the FES current, about the motor control, the group that had less variation after therapy, was the group that used the Russian current, followed by those who used the FES current, however, only 48 hour after. Conclusion: Strengthening exercises associated with FES current performed better at the max strength peak, and the group associated with the current Russian had a better motor control after therapy...(AU)

Electroestimulación del músculo diafragma para el retiro temprano de la ventilación mecánica y seguimiento de los cambios en el grosor con ultrasonido / Electroestimulation of the diaphragm muscle for the early withdrawal of mechanical ventilation and monitoring changes in thickness with ultrasound / Eletroestimulação diafragmática para a retirada precoce da ventilação mecânica e seguimento das mudanças no espessor com ultra-som

Resumen: El diafragma es una estructura músculo-aponeurótica que separa las cavidades pleural y peritoneal y provee la principal fuerza mecánica a la ventilación. Del grupo de músculos respiratorios, este es el que mayor participación tiene en lograr el retiro de la ventilación mecánica; sin embargo, también la falta de integridad del mismo en cuanto a su trofismo, nutrición y conducción puede convertirse en el mayor de los problemas para el destete. En este estudio llevamos a cabo la electroestimulación no invasiva del músculo diafragma para mejorar la conducción, así como atender su atrofia o hipotrofia, la cual es condicionada por múltiples factores, entre los que destacan fármacos, sepsis y ventilación mecánica per se. En la unidad de terapia intensiva de la nueva torre quirúrgica del Hospital General de México, se realizó el estudio de tipo experimental, prospectivo, transversal y analítico, en una población de 23 pacientes (n = 23), correspondientes a un grupo etario entre 19 y 75 años de edad, con una media de 40 años, divididos en tres grupos: A, B, C, donde a los del grupo «A¼ se les aplicó terapia de electroestimulación del músculo diafragma, dos sesiones al día de 15 minutos cada una; en el grupo «B¼, tres sesiones al día de 15 minutos cada una, y en el grupo «C¼, cuatro sesiones al día de 15 minutos cada una. Cada impulso del electroestimulador fue de una intensidad de 10 hasta 300 mA, lo que se determinó con base en el grado de tolerancia del paciente, el cual se encontraba despierto, con RASS de 0 a -1 y cooperador, aun con tubo endotraqueal, pero que cumplió con todas las condiciones previamente para iniciar el retiro de la ventilación mecánica. Para la ubicación de los electrodos, nos basamos en los puntos de inserción anteriores y laterales para músculo diafragma, número de electrodos empleados (cuatro); previo a la electroestimulación, se tomó en cuenta la presión soporte inicial, así como el volumen corriente inspirado y el grosor del músculo diafragma, el cual se verificó con visión directa en apoyo con ultrasonido. Al final de la terapia, se tomaron en cuenta las mismas variables para observar diferencias. Se obtuvieron resultados con una p significativa de 0.048 para el aumento del grosor del músculo diafragma a tres días en el grupo C (cuatro sesiones al día), con un intervalo de confianza de 95% en su límite inferior de 0.01 y límite superior de 1.65. Pero los resultados al observar la diferencia entre grupos en cuanto a la disminución de la presión soporte fueron aún más significativos (p < 0.05) para este mismo grupo a tres días de la terapia.

Abstract: The diaphragm is a muscle-aponeurotic structure, which separates the pleural and peritoneal cavities and provides the main force of mechanical ventilation. Among the group of respiratory muscles, this has the greater participation in achieving the withdrawal of mechanical ventilation; however, the lack of integrity in its trophism, nutrition and driving, can also become the greatest problems for weaning. In this study we conducted the non-invasive electro-stimulation of the diaphragm muscle to improve conduction, as well as to treat its atrophy or hypotrophy, which is conditioned by various factors, including drugs, sepsis, and mechanical ventilation per se. In the intensive therapy unit of the new surgical tower of the Hospital General de Mexico, we carried out this experimental, prospective, and cross-analytical study in a population of 23 patients (n = 23) aged between 19 and 75 years, with an average of 40 years, divided into three groups: A, B, and C; group «A¼ received electro-muscle stimulation of the diaphragm two 15-minute sessions per day; group «B¼, three 15- minute sessions per day, and group «C¼, four 15-minute sessions per day. Each impulse of the electro-stimulator had an intensity of 10 to 300 mA that was determined based on the grade of tolerance of the patient, who was awake, with RASS of 0 to-1 and cooperative, even with the endotracheal tube, but that had previously met all the conditions to start the removal of the mechanical ventilation. We based the location of the electrodes on the anterior and lateral points of inclusion for diaphragm muscle, number of electrodes used (four): prior to the electro-stimulation, we considered the initial pressure support, as well as the inspired tidal volume and the thickness of the diaphragm muscle, which was verified with direct vision supported by ultrasound. At the end of the therapy, the same variables were taken into account for observed differences. We obtained results with a p significant of 0.048 for the increase of the thickness of the diaphragm muscle in three days in group C (four sessions per day), with a range of confidence of 95% in its lower limit of 0.01 and upper limit of 1.65. However, the results when observing the difference between groups with regard to the decrease of the pressure support were even more significant (p < 0.05) for this same group after three days of therapy.

Resumo: O diafragma é uma estrutura músculo-aponeurótica que separa as cavidades pleural e peritoneal e fornece a principal força mecânica para a ventilação. Entre o grupo de músculos respiratórios, este é o que tem maior participação na retirada da ventilação mecânica; no entanto, a falta de integridade do mesmo em quanto ao seu trofismo, nutrição e condução, podem se tornar os maiores problemas para o desmame. Neste estudo realizamos a eletroestimulação não-invasiva do músculo diafragma para melhorar a condução, bem como para tratar sua atrofia ou hipotrofia, que é condicionada por vários fatores, incluindo medicamentos, sepsis e ventilação mecânica per se. Na unidade de terapia intensiva da nova torre cirúrgica do Hospital General de México, realizamos este estudo experimental, prospectivo, transversal e analítico, em uma população de 23 pacientes (n = 23) com idade entre 19 e 75 anos, com uma média de 40 anos, divididos em três grupos: A, B e C; grupo «A¼ recebeu terapia de eletroestimulação do músculo diafragma, duas sessões por dia de 15 minutos cada uma; grupo «B¼, três sessões por dia de 15 minutos cada uma e grupo «C¼, quatro sessões por dia de 15 minutos cada uma. Cada impulso do eletroestimulador teve uma intensidade de 10 à 300 mA, que foi determinado com base no grau de tolerância do paciente, quem estava acordado, com RASS de 0 a -1 e cooperativo, mesmo com o tubo endotraqueal, mas que preenchia todas as condições prévias para iniciar a remoção da ventilação mecânica. Para a localização dos eletrodos determinamos os pontos de inserção anteriores e laterais do músculo diafragma, número de eletrodos usados (quatro); antes da eletroestimulação, consideramos a pressão suporte inicial, o volume corrente inspirado e a espessura do músculo, que foi verificado com visão direta por ultra-som. No final da terapia, as mesmas variáveis foram consideradas para observar as diferenças. Obtivemos resultados com uma p significativa de 0.048 para o aumento da espessura do músculo diafragma em três dias no grupo C (quatro sessões por dia), com um intervalo de confiança de 95% no seu limite inferior de 0.01 e limite superior de 1.65. No entanto, os resultados ao observar a diferença entre os grupos em relação à a diminuição da pressão suporte foram ainda mais significativas (p <0.05) para este mesmo grupo após três dias de terapia.

Electroacupuncture Delaying Tumor Growth and its Effect on PCNA Expression in HepG2 Nude Mice / 上海针灸杂志

Objective To explore the effect of electroacupuncture intervention on tumor growth and PCNA expression in HepG2 nude mice.Methods Thirty-two nude mice were randomized to electroacupuncture, electrostimulation, model and blank control groups, 8 mice each. A nude mouse model of subcutaneous tumor was made with HepG2. The electroacupuncture group received electroacupuncture at points Zusanli and Sanyinjiao on bilateral lower limbs and the electrostimulation group, direct electrical stimulation of the same points. The tumor volume, the tumor/weight ratio and the tumor growth inhibition rate were observed. PCNA expression in the tumor tissue was determined.Results There was no statistically significant pre-/post-intervention difference in the tumor volume in the electroacupuncture, electrostimulation and model groups (P>0.05). There was no statistically significant post-intervention difference in the tumor volume between the electroacupuncture or electrostimulation group and the model group (P>0.05), but tumor growth tended to slow in the electroacupuncture group. There was no statistically significant pre-/post-intervention difference in the nude mouse weight in every group (P>0.05). There was a statistically significant post-intervention difference in the tumor/weight ratio between the electroacupuncture group and the electrostimulation or model group (P0.05). There was a statistically significantpost-intervention difference in the tumor growth inhibition rate between the electroacupuncture and electrostimulation groups (P0.05).Conclusion Electroacupuncture can delay HepG2 tumor growth to a certain extent.