Características Psicomotoras e Sensoriais de crianças com Transtorno do Espectro Autista (TEA) em atendimento terapêutico ocupacional / Características psicomotoras y sensoriales de niños con trastorno del espectro autístico (TEA) en atención de Terapia Ocupacional / Psychomotoral and sensory characteristics of children with autistic spectrum disorder (tea) in occupational therapeutic care

Atualmente o autismo tem sido classificado como Transtorno do Espectro Autista (TEA), podendo apresentar como critério diagnóstico os atrasos no desenvolvimento psicomotor e alterações sensoriais, além das características típicas. Objetivo: Identificar as características psicomotoras e sensoriais de crianças com diagnóstico de TEA atendidas no setor de Terapia Ocupacional na Unidade Saúde Escola da Universidade Federal de São Carlos (USE-UFSCar). Método: Trata-se de uma pesquisa exploratória e descritiva, de abordagem quantitativa. Participaram nove crianças de quatro a dez anos de idade com diagnóstico de TEA, e seus responsáveis. Os instrumentos utilizados para coleta de dados foram um Questionário de dados gerais da criança; Perfil sensorial e Bateria Psicomotora. A coleta dos dados ocorreu na própria Unidade,sendo que os dados dos instrumentos padronizados foram analisados a partir das instruções pré-existentes, e os dados do Questionário de forma descritiva. Resultados: Identificou-se que as crianças participantes apresentam déficits psicomotores nos seguintes aspectos: noção do corpo, estruturação espaço-tempo, praxia global e fina. Em relação ao sistema sensorial, as alterações identificadas no presente estudo foram na audição, sistema vestibular e multissensorial, constante procura sensorial, inatenção e na motricidade fina. Conclusão: Aponta-se para a importância de maiores investimentos nesse campo, uma vez que pode favorecer as intervenções voltadas a esse público.

Actualmente, el autismo se ha clasificado como trastorno del espectro autista (TEA), y puede presentarse como criterio de diagnóstico de retrasos en el desarrollo psicomotor y cambios sensoriales, además de las características típicas. Objetivo: identificar las características psicomotoras y sensoriales de los niños diagnosticados con TEA tratados en el sector de terapia ocupacional en la Unidad de la Escuela de Salud de la Universidad Federal de São Carlos (USE-UFSCar). Método: Esta es una investigación exploratoria y descriptiva, con un enfoque cuantitativo. Participaron nueve niños de cuatro a diez años diagnosticados con TEA y sus padres. Los instrumentos utilizados para la recopilación de datos fueron un cuestionario de datos generales del niño; Perfil sensorial y batería psicomotora. La recopilación de datos tuvo lugar en la propia Unidad, y los datos de los instrumentos estandarizados se analizaron utilizando instrucciones preexistentes y los datos del Cuestionario de manera descriptiva. Resultados: Se identificó que los niños participantes tienen déficits psicomotores en los siguientes aspectos: noción del cuerpo, estructuración espacio-tiempo, praxis global y fina. Con respecto al sistema sensorial, los cambios identificados en el presente estudio fueron en el sistema auditivo, vestibular y multisensorial, búsqueda sensorial constante, falta de atención y en el motricidad fina. Conclusión: señala la importancia de mayores inversiones en este campo, ya que puede favorecer intervenciones dirigidas a esta audiencia.

Currently, autism has been classified as Autism Spectrum Disorder (ASD), and may present as a diagnostic criterion delays in psychomotor development and sensory changes, in addition to the typical characteristics. Objective: To identify the psychomotor and sensory profile of children diagnosed with ASD. Method: This is a survey study, exploratory and descriptive, with a qualitative and quantitative approach. Nine children from four to ten years old diagnosed with a diagnosis of ASD participated, linked to the School Health Unit (uSE)­UFSCar and their guardians. The instruments used for data collection were a questionnaire of general data of the child; Sensory profile and Psychomotor Battery. Data collection took place at the Unit itself, and data from standardized instruments were analyzed based on pre-existing instructions, and data from the Questionnaire were analyzed descriptively. Results: Children with ASD have psychomotor deficits in the following aspects: body notion, space-time structuring, global and global and fine praxis. Regarding the sensory system, the changes identified were in hearing, vestibular and multisensory system, constant sensory search, inattention and fine motor. Conclusion: It points to the importance of greater investments in this field, since it can favor interventions aimed at this audience.

Caracterización neurofisiológica de la función de fibra pequeña en mujeres heterocigotas con enfermedad de Fabry / Neurophysiologic characterization of small fiber function in heterozigous women with Fabry disease

RESUMEN INTRODUCCIÓN: La enfermedad de Fabry (EF) es una enfermedad genética, causada por el déficit de la enzima alfa galactosidasa A (α-Gal A), lo que provoca la acumulación de glicoesfingolípidos en los tejidos. Sus manifestaciones clínicas son variables. Estudios en mujeres heterocigotas reportan la existencia de dolor neuropático como manifestación de neuropatía de fibra pequeña. OBJETIVO: Determinar la presencia de neuropatía de fibra pequeña en mujeres heterocigotas para la EF, mediante la prueba cuantitativa sensorial. MATERIALES Y MÉTODOS: Se evaluaron 33 mujeres heterocigotas para EF y 33 mujeres sanas, con características demográficas similares. A todas se les aplicó la prueba cuantitativa sensorial (Quantitative Sensory Testing por medio de la detección de umbrales de frío (Colà Detection Threshold), calor (Warm Detection Threshold), dolor inducido por calor (Heat-pain Detection Thresholds) y vibración (Vibratory Detection Threshold) en los miembros superior e inferior, utilizando un sistema asistido por computador versión IV (CASE IV, WR Medical Electronics Co., Stillwater, MN). Adicionalmente, al grupo de mujeres heterocigotas para EF, se le evaluó la percepción subjetiva de dolor neuropàtico mediante el cuestionario de síntomas sensitivos neuropáticos positivos (Positive Neuropathic Sensory Symptom). Los resultados de la prueba cuantitativa sensorial se compararon entre los grupos. También se estableció la correlación entre la prueba cuantitativa sensorial y los resultados del cuestionario de síntomas sensitivos neuropáticos positivos. RESULTADOS: Se encontró una diferencia estadísticamente significativa en las pruebas de vibración (p = 0,008), calor (p = 0,017) y dolor inducido por calor (p = 0,04) en el miembro inferior en las mujeres heterocigotas para EF, comparado con el grupo control. Se encontró una correlación inversa estadísticamente significativa entre la intensidad del dolor quemante y el dolor inducido por calor en el miembro inferior (p = 0,018, r = -0,48) y entre la intensidad del dolor al ser rozado o tocado y el dolor inducido por calor en el miembro inferior (p = 0,006, r = -0,49). CONCLUSIÓN: En las mujeres heterocigotas para EF, las pruebas objetivas para establecer la presencia de neuropatía de fibra pequeña son anormales en miembros inferiores y se correlacionan con los síntomas sensitivos.

SUMMARY INTRODUCTION: Fabry disease is a genetic condition caused by alpha-galactosidase A deficiency triggering glycosphingolipid accumulation in tissues. Clinical manifestations are variable. Studies in heterozigous females report the existence of neuropathic pain as manifestation of small fiber neuropathy. OBJECTIVE: To determine presence of small fiber neuropathy in heterozigous females with Fabry disease through Quantitative Sensory Testing (QST). MATERIALS AND METHODS: 33 heterozigous females with fabry disease and 33 healthy females with similar demographic characteristics were evaluated. QST was performed to every female evaluating Cold detection Threshold (CDT), Warm Detection Threshold (WDT), Heat-pain Detection Threshold (HPDT) and Vibratory Detection Threshold (VDT) in upper and lower limbs through Computer Assisted Sensory Examination software (CASE IV, WR Medical Electronics Co., Stillwater, MN). Subjective perception of neuropathic pain was measured through Positive Neuropathic Sensory Symptom questionnaire (P-NSS) in heterozigous females with Fabry disease. QST results were compared between groups. Correlations between QST and P-NSS were established. RESULTS: Statistically significant differences were observed in VDT (p= 0,008), WDT (p= 0,017) and HPDT (p= 0,04) in lower limbs of heterozigous females with Fabry disease compared with control group. Negative correlation was found among burning pain intensity and HPDT at lower limbs (p= 0,018, r= -0,48) and among pain intensity to light touch and HPDT in lower limbs (p= 0,006, r=-0,49). CONCLUSIONS: Objective tests to establish presence of small fiber neuropathy in heterozigous females with Fabry disease are abnormal at lower limbs and correlate with sensory symptoms.

Evaluation of skin sensitivity in individuals presented with temporomandibular disorder / Avaliação da sensibilidade cutânea em indivíduos com disfunção temporomandibular

ABSTRACT Purpose: to identify the occurrence of a difference in skin sensitivity between analogous points on the face in individuals with temporomandibular disorder. Methods: a total of 60 individuals of both genders, aged 18 to 73 years, participated in the study. People classified with TMD signs and symptoms with the Fonseca Anamnestic Questionnaire were included. The skin sensitivity was evaluated with a Semmes-Weinstein esthesiometer. Sensitivity change was defined in this study as the occurrence of a difference between analogous points on both hemifaces. The localization of the points followed the regional block anatomical description and was confirmed with a neuromuscular electrostimulation device. The collected data were analyzed statistically with a 5% significance level. Results: the occurrence of a difference in sensitivity between the analogous points had a significant association with age group and severity of TMD. However, no association was perceived between sensitivity change and gender. Conclusion: in the population studied, the more severe the temporomandibular disorder, the greater the skin sensitivity change on the face. Also, the older the person, the higher the number of analogous points with a difference in sensitivity.

RESUMO Objetivo: identificar a ocorrência de diferença da sensibilidade cutânea entre pontos análogos da face em indivíduos com disfunção temporomandibular. Métodos: participaram do estudo 60 indivíduos, de ambos os sexos, com idades entre 18 e 73 anos. Foram incluídas pessoas classificadas com sinais e sintomas de DTM pelo Questionário Anamnésico de Fonseca. A avaliação da sensibilidade cutânea ocorreu com o auxílio de um estesiômetro Semmes-Weinstein. Para esse estudo, definiu-se alteração da sensibilidade a ocorrência de diferença entre pontos análogos das duas hemifaces. A localização dos pontos seguiu a descrição anatômica de bloqueio regional e foram confirmados com a utilização do aparelho de eletroestimulação neuromuscular. Foi realizada análise estatística dos dados coletados com nível de significância de 5%. Resultados: a ocorrência de diferença de sensibilidade entre os pontos análogos teve associação significante com as variáveis faixa etária e severidade da disfunção temporomandibular. Contudo, não foi percebida entre a alteração da sensibilidade e o sexo. Conclusão: na população estudada, quanto mais severa a disfunção temporomandibular, maior a alteração de sensibilidade cutânea ao longo da face, assim como, quanto maior a idade, maior a quantidade de pontos análogos com diferença de sensibilidade.

Observation on therapeutic efficacy of heat-sensitive moxibustion plus Western medicine for diabetic peripheral neuropathy / 针灸推拿医学（英文版）

Objective: To observe the clinical efficacy of heat-sensitive moxibustion plus Western medicine in treating patients with diabetic peripheral neuropathy (DPN). Methods: A total of 70 patients with DPN were divided into an observation group and a control group by sealed envelope method combined with the random number table method, with 35 cases in each group. The control group was treated with routine medicine, and the observation group was treated with heat-sensitive moxibustion on the basis of the treatment in the control group. After 2 courses of treatment, the scores of Toronto clinical scoring system (TCSS) and vibration perception threshold (VPT) in both groups were observed, and the clinical efficacy was compared. Results: During treatment, 3 cases dropped out in the control group and 4 cases in the observation group. After treatment, the total effective rate in the observation group was higher than that in the control group (P<0.05). The scores of TCSS and VPT in both groups decreased after treatment, and the intra-group comparison showed statistical significance (both P<0.05). The scores of TCSS and VPT in the observation group were lower than those in the control group, and the differences were statistically significant (both P<0.05). Conclusion: Heat-sensitive moxibustion plus Western medicine can improve the symptoms in patients with DPN, and has a better curative effect than the Western medicine alone.

Quantitative sensory testing in elderly: longitudinal study / Teste sensitivo quantitativo em idosos: estudo longitudinal

ABSTRACT Objective: To evaluate elderly patients in a geriatric service, along with their sensory characteristics and their association with clinical aspects. Methods: This was a descriptive longitudinal study. We enrolled 36 healthy participants of both sexes in this study. The following instruments were used and evaluations performed: clinical evaluation, Mini-Mental State Exam, and quantitative sensory testing. Results: During the follow-up, there was reduction of mean corpuscular volume at each evaluation (p < 0.001) and significant increase in mean corpuscular hemoglobin concentration (p < 0.001). There was an increase of the olfactory (p < 0.001), salty (p = 0.024), sour (p = 0.020), bitter (p = 0.001), facial cold (p = 0.019), hand cold (p = 0.004), facial tactile (p < 0.001), hand tactile (p = 0.012) and facial vibration (p = 0.018) thresholds. Previous existing morbidities were associated with sensitivity changes in the individuals in this sample. Conclusion: This longitudinal study suggests that the loss of sensitivity with aging may be associated with the presence of morbidities in elders.

RESUMO Objetivo: Avaliar pacientes idosos em um serviço de geriatria, juntamente com as características sensitivas e sua associação com aspectos clínicos. Métodos: Este é um estudo longitudinal descritivo. Foram avaliados 36 sujeitos saudáveis de ambos os sexos. Os seguintes instrumentos e avaliações foram realizados: Avaliação clínica, Mini Exame de Estado Mental (Mini-Mental) e testes sensitivos quantitativos. Resultados: Durante o acompanhamento houve redução do volume corpuscular médio (VCM) em cada avaliação (P < 0,001) e aumento significativo das concentrações de hemoglobina corpuscular média (CHCM) (P < 0,001). Houve aumento dos limiares olfativos (p < 0,001), salgado (p = 0,024), azedo (p = 0,020), amargo (p = 0,001), frio face (p = 0,019), frio mão (p = 0,004), tato face (p < 0,001), tato mão (p = 0.012) e vibração face (p = 0,018). Morbidades prévias foram associadas às alterações de sensibilidade nos indivíduos desta amostra. Conclusão: Este estudo longitudinal sugere que a perda de sensibilidade no envelhecimento pode estar associada à presença de morbidades em idosos.

Patterns of Nerve Conduction Abnormalities in Patients with Type 2 Diabetes Mellitus According to the Clinical Phenotype Determined by the Current Perception Threshold

BACKGROUND: Clinical manifestations of diabetic peripheral neuropathy (DPN) vary along the course of nerve damage. Nerve conduction studies (NCS) have been suggested as a way to confirm diagnoses of DPN, but the results have limited utility for evaluating clinical phenotypes. The current perception threshold (CPT) is a complementary method for diagnosing DPN and assessing DPN symptoms. We compared NCS variables according to clinical phenotypes determined by CPT measurements. METHODS: We retrospectively enrolled patients with type 2 diabetes mellitus who underwent both NCS and CPT tests using a neurometer. CPT grades were used to determine the clinical phenotypes of DPN: normoesthesia (0 to 1.66), hyperesthesia (1.67 to 6.62), and hypoesthesia/anesthesia (6.63 to 12.0). The Michigan Neuropathy Screening Instrument (MNSI) was used to determine a subjective symptom score. DPN was diagnosed based on both patient symptoms (MNSI score ≥3) and abnormal NCS results. RESULTS: A total of 202 patients (117 men and 85 women) were included in the final analysis. The average age was 62.6 years, and 71 patients (35.1%) were diagnosed with DPN. The CPT variables correlated with MNSI scores and NCS variables in patients with diabetes. Linear regression analyses indicated that hypoesthesia was associated with significantly lower summed velocities and sural amplitudes and velocities, and higher summed latencies, than normoesthesia. Sural amplitude was significantly lower in patients with hyperesthesia than in patients with normoesthesia. CONCLUSION: NCS variables differed among patients with diabetes according to clinical phenotypes based on CPT and decreased sural nerve velocities was associated with hyperesthesia.

Applications of current perception threshold evaluations in discovering early diabetic peripheral neuropathy / 中国医师杂志

Diabetic neuropathy is one of the common long-term complications of diabetes,which occurs in the peripheral nervous system and the central nervous system,and its most common type is diabetic peripheral neuropathy (DPN).Diabetic peripheral neuropathy can not only cause pain,numbness and limitation of activity in limbs,but also lead to diabetic foot ulcers even amputations due to hypoesthesia and anesthesia,ultimately affects the quality of life of patients with diabetes and increases the mortality.Nearly half of patients with DPN do not have any clinical symptoms,thus the early detection and diagnosis of diabetic peripheral neuropathy are particularly critical.Current perception threshold (CPT) evaluation is considered as a mean of early detection of DPN,which gains more and more attentions because of its non-invasive feature,simple operation and high sensitivity.So far,there is scarcely any article summarizing CPT evaluations' applications in researching the relationships between DPN and its risk factors.This review will discuss the principles and advantages of CPT evaluations,and its relationship with DPN will also be summarized as follows.

Penile sensory thresholds in subtypes of premature ejaculation: Implications of comorbid erectile dysfunction / 亚洲男科学杂志(英文版)

Penile hypersensitivity plays an important role in premature ejaculation (PE), but differences in penile sensitivity among subtypes of PE are unknown. Therefore, we compared penile sensory thresholds in PE subtypes of lifelong and acquired PE, PE with and without erectile dysfunction (ED), PE with an intravaginal ejaculation latency time ≤1 min and >1 min, and PE with and without orgasmic pleasure perceptual dysfunction. During August 2014 to January 2016, 136 patients with PE were included. Penile warm, cold, and vibratory thresholds were measured. Data of clinical characteristics, sexual life, Premature Ejaculation Diagnostic Tool (PEDT) score, and the 5-item version of the International Index of Erectile Function (IIEF-5) score were collected. Vibratory thresholds of the PE with ED group were higher in the right coronal sulcus (median amplitude: 4.92 vs 3.65 μ m, P = 0.02) and the right penile shaft (median amplitude: 3.87 vs 3.30 μ m, P = 0.03), while differences in penile sensory thresholds between other subtypes were not significant. The median PEDT score was lower in the PE without ED group (12 vs 14, P < 0.001). The IIEF-5 and PEDT scores were negatively correlated (r = -0.29, P < 0.001). Patients with orgasmic pleasure perceptual dysfunction had a lower median IIEF-5 score (20 vs 21, P = 0.02). Patients with PE and ED had lower penile sensitivity, and ED was associated with more severe symptoms and weaker orgasmic pleasure perception. In men with PE, management of comorbid ED is necessary. In case of side effects in erectile function, topical anesthetics should be cautiously used in men with PE and ED.

The effect of proprioceptive training on knee joint recovery among patients with total knee replacement:A Meta-analysis of randomized controlled trials / 中华老年医学杂志

Objective To systematically review the effect of proprioceptive training for knee joints recovery among patients with total knee replacement (TKR).Methods We searched Chinese BioMedical Literature Database,CNKI,WanFang database,Chinese Scientific Journals Full-text Database,PubMed,EMbase,MEDLINE and Cochrane Library for randomized controlled trials (RCT) about proprioceptive training for knee joint recovery after TKR and the retrieval covered the period to November 2017.Two reviewers independently selected studies,extracted data,evaluated quality,and analyzed data,which was conducted using the RevMan software.Results Five studies involving 278 patients were selected.Meta-analysis showed that the knee joint function score was significantly increased in the proprioceptive training group than that in the control group [standard mean difference (SMD) =0.38,95％ CI (0.26,049),P＜0.0001].Moreover,proprioceptive training could significantly improve the joints' function (P=0.0006),up-regulate the joints' range of motion (P=0.006) and increase the strength (P=0.005) and stability (P＜0.0001) of knee joints compared with those in the control group.Conclusions Proprioceptive training on the basis of routine rehabilitation can improve the joints' stability,enhance the balance and coordination,and increase the quality of life in elderly patients after TKR,and could be recommended as a comprehensive rehabilitation program.

A artroplastia total do cotovelo provoca déficit proprioceptivo / Total Elbow Arthroplasty Causes Proprioceptive Deficits

A artroplastia total é necessária no tratamento de casos graves de fraturas, artrite reumatoide e osteoartrose do cotovelo. Durante o procedimento, a cápsula articular é parcialmente ressecada, levando à perda de mecanorreceptores que seriam importantes para a percepção do movimento passivo em condições normais. Acreditamos que o desenvolvimento de um equipamento capaz de realizar a medição da cinestesia, através do limiar de percepção do movimento passivo (LPMP), ajudará a esclarecer o quanto este procedimento impacta negativamente a propriocepção, e se esse efeito repercute na esfera clínica. O Propriomaq II foi criado nesse contexto, permitindo a mobilização passiva da articulação e o acionamento de um botão pelos sujeitos examinados ao perceberem o movimento, viabilizando o cálculo do seu limiar de percepção. Vinte e um pacientes hígidos foram submetidos ao teste, repetindo as medidas após ao menos um dia, visando validar o método. Com o objetivo de esclarecer o efeito da artroplastia total sobre o LPMP do cotovelo, oito pacientes portadores de prótese total foram submetidos ao exame, comparando o lado operado ao contralateral. Os resultados demonstraram latência significativamente maior para a percepção do movimento passivo nos cotovelos operados, ou seja, pior propriocepção quando comparados ao lado contralateral. Não foi encontrado, entretanto, correlação significativa entre o LPMP e os resultados funcionais no lado artroplastia. O Propriomaq II apresentou boa reprodutibilidade (R2=0,94) na medição do LPMP do cotovelo, e evidenciou conclusivamente o prejuízo proprioceptivo presente em cotovelos submetidos a artroplastia total. Esses resultados demonstram a necessidade de maior preservação das partes moles periarticulares durante a artroplastia total do cotovelo, e uma ênfase da reabilitação fisioterapêutica visando recuperação da propriocepção

Total elbow arthroplasty is necessary in the treatment of severe fractures, rheumatoid arthritis and degenerative elbow arthritis. During the procedure, the articular capsule is partially resected, leading to loss of mechanoreceptors that would be important for the perception of articular motion in normal conditions. We believe that the creation of an equipment capable of assessing kinesthesia through the measurement of threshold to detection of passive motion (TDPM) will help quantify the negative effects this procedure has on elbow proprioception, and understand if this has any relevant impact in the clinical sphere. The Propriomaq II was created in this context, allowing passive mobilization of the elbow joint and the activation of a button by the examined subjects when motion is perceived, thus providing a means of calculating it's detection threshold. Twenty-one healthy patients were subjected to the test, repeating the measurements after at least one day, so the method could be validated. In order to clarify the effects of total arthroplasty on elbow TDPM, eight patients were subjected to the test, comparing the total elbow side to the contralateral side. The results revealed significantly higher thresholds to detection of motion, or worse proprioception, on the prosthesis side in comparison to the contralateral side. These results held no correlation, however, to the clinical outcome of the elbow replacement. The Propriomaq II proved reproducible (R2=0,94) in the measurement of elbow TDPM and has conclusively exposed the proprioceptive deficits present in total arthroplasty elbows. These results demonstrate the need for greater preservation of peri-articular soft tissues during total elbow arthroplasty, and an emphasis of rehabilitation on the recovery of proprioception

Avaliação da percepção sensorial ao gosto doce em pessoas com Diabetes Mellitus tipo 2 / Evaluation of the sensory perception of sweet taste in people with Diabetes Mellitus type 2

Avaliar a percepção sensorial de pacientes com Diabetes Mellitus tipo 2, por meio do teste de índicelimiar para o gosto doce. Métodos: estudo transversal, composto por 80 adultos de ambos os sexos, divididosem dois grupos: controle, composto por não diabéticos, e teste, formado por pacientes diabéticos. Avaliação dapercepção sensorial realizada pelo teste de sensibilidade para determinação do índice limiar. Testes conduzidosem cinco sessões, contendo as concentrações diferentes de sacarose. Análise estatística por meio do teste t,adotado p˂0,05. Resultados: ao comparar a média dos limiares para detecção do gosto doce entre diabéticos enão diabéticos foi notório que os diabéticos são menos sensíveis ao estímulo doce. Conclusão: indivíduos comDiabetes Mellitus 2 apresentam valor de índice limiar maior para o gosto doce, o que pode contribuir para oaumento do consumo de açúcar.

Objective: to evaluate the perception of patients with type 2 diabetes through the threshold index test for the sweet taste. Methods: a cross-sectional study with 80 adults of both genders, divided into two groups: control, composed of non-diabetics, and test, with diabetic patients. The evaluation of sensory perception held by the sensitivity test to determine the threshold index. The tests were conducted on five sections containing different concentrations of sucrose. Statistical analysis was held using the t test, adopted P<0.05. Results: when comparing the average of the thresholds to detect sweet taste between diabetics and non-diabetics, it was known that diabetics are less sensitive to sweet stimuli. Conclusion: individuals with Diabetes Mellitus 2 have higher threshold index value for the sweet taste, which may contribute to the increase in sugar consumption.

Effect of interferential current of different amplitude-modulated frequencies, on threshold and number of accommodations on healthy painless individuals / Efeito da corrente interferencial de diferentes frequências moduladas pela amplitude no limiar e número de acomodações em indivíduos saudáveis sem dor

BACKGROUND AND OBJECTIVES: Despite the widespread use of interferential current, controversy exists in the literature on the optimal stimulation parameters. The aim of this study was to evaluate the threshold and the total number of accommodations in subjects stimulated by different amplitude-modulated frequencies. METHODS: The study is a clinical, cross-over trial with randomized and blinded convenience sample consisted of 20 healthy subjects, with mean age of 20.35 years, of both genders. Volunteers underwent interferential current for 20 minutes, the bipolar form, with electrodes placed on the elbow joint being positioned one above the superficiality of the ulnar nerve and the other of the median nerve. Equipment parameters were: base frequency of 4,000Hz, amplitude-modulated frequencies 1, 10 or 100Hz (according to the subgroup). Threshold and total number of accommodations were assessed. RESULTS: For the accommodation threshold no significant differences were found (p>0.05). With regard to the number of accommodations, there have been significant differences between the frequencies of 10 and 100Hz (p<0.05). CONCLUSION: There was no significant difference in the accommodation threshold; however, we observed significant differences between the frequencies of 10 and 100Hz. .

JUSTIFICATIVA E OBJETIVOS: Apesar do uso generalizado da corrente interferencial, há controvérsias na literatura sobre os parâmetros ideais de estimulação utilizados. O objetivo deste estudo foi avaliar o limiar e o número total de acomodações em indivíduos estimulados por diferentes frequências moduladas pela amplitude. MÉTODOS: Trata-se de um ensaio clínico, cruzado, com amostra de conveniência aleatorizada e encoberta, composta por 20 indivíduos saudáveis, com idade média de 20,35 anos, de ambos os gêneros. Os voluntários foram submetidos a corrente interferencial por 20 minutos, na forma bipolar, com os eletrodos localizados na articulação do cotovelo, sendo posicionados um sobre a superficialidade do nervo ulnar e outro do nervo mediano. Os parâmetros do equipamento foram: frequência base de 4.000Hz, frequências moduladas pela amplitude de 1, 10 ou 100Hz (de acordo com o subgrupo do dia). Foi avaliado o limiar de acomodação e o número total de acomodações. RESULTADOS: Para o limiar de acomodação não foram encontradas diferenças significativas (p>0,05); quanto ao número de acomodações houve diferenças significativas entre as frequências de 10 e 100Hz (p<0,05). CONCLUSÃO: Observou-se que não houve diferença estatística quanto ao limiar de acomodações, porém, houve diferenças significativas entre as frequências de 10 e 100Hz. .

Application of slow and rapid liquid nutrient load tests for evaluating proximal gastric perception and accommodation / 中华消化杂志

Objective To evaluate the possibility of slow and rapid liquid nutrient loading test (LNLT) in the proximal gastric function assessment according to the results of gastric barostat testing.Methods From April to August in 2013,20 healthy volunteer were selected.The sensitivity of gastric,basic abdominal pressure,gastric sensing threshold,gastric discomfort and pain thresholds were examined by barostat.The average gastric volume after fasting was tested by barostat,which reflected gastric accommodation.And then 200 mL liquild meal was taken in five minutes by the volunteers.The difference value between the maximum gastric volume in 60 minutes after taking the meal minus the average gastric volume after fasting was used to evaluate the proximal gastric adapted diastolic function.In LNLT,volunteers drank 100 mL/min and 15 mL/min (rapid and slow) liquid meal.The threshold value of drinking volume,satiety drinking volume and maximum drinking volume were determined.Pearson correlation analyses were performed in the results of fast and slow LNLT,correlation between LNLT and sensitivity of gastric,gastric adapted diastolic function tested by barostat.Results The basic abdominal pressure,gastric sensing threshold,gastric discomfort and pain thresholds,gastric volume after fasting,maximum gastric volume and adapted diastolic volume was (6.8±1.2) mmHg (1 mmHg=0.133 kPa),(2.7±1.9) mmHg,(5.2±2.0) mmHg,(7.3-±-2.1) mmHg,(188.7-±-80.0) mL,(505.2±133.7) mL and (316.5±87.7) mL,respectively.The maximum gastric volume after the meal was at (9.8±3.3) min after meal.In rapid LNLT,the threshold value of drinking volume,satiety drinking volume and maximum drinking volume of volunteers was (209-±-96),(501±148) and (674±199) mL,respectively,and that in slow LNLT was (107 ± 43),(340 ± 134) and (524 ± 213) mL,respectively,there was correlation between rapid and slow LNLT (r=0.768,0.825 and 0.856,all P＜0.01).The maximum drinking volume of rapid and slow LNLT was at (8.6± 1.2) and (34.9±6.4) minutes after meal.Threshold value of drinking volume in the slow drinking test was positively correlated with the gastric sensing threshold (r=0.714,P＜0.01).Satiety drinking volume in the slow drinking test was correlated with gastric sensing threshold,gastric discomfort and pain thresholds (r=0.599,0.650 and 0.622,all P＜0.01).The proximal gastric adapted diastolic volume was related with slow satiety drinking volume,rapid satiety drinking volume,slow maximum drinking volume and rapid drinking volume (r＝0.543,0.636,0.527 and 0.493,all P＜0.05).Conclusions Threshold value of drinking volume and satiety drinking volume in the slow LNLT is more suitable for evaluating the sensitivity of stomach.Satiety drinking volume in the rapid LNLT is more suitable for the evaluating of gastric adapted diastolic function.

Sniffin’ Sticks test in evaluating olfactory function in Parkinson’ s disease / 中华神经科杂志

Objective To evaluate the olfactory function and its influence factors by using Sniffin ’ Sticks test, and to compare the quality of Parkinson ’s disease (PD) recognition between Sniffin’ Sticks and 16 kinds of odor identification in Sniffin ’ Sticks(SS-16) tests.Methods The Sniffin’Sticks test was used to assess the olfactory function of 68 PD patients and 76 healthy volunteers , and the relationship between smell and age, disease duration, Unified Parkinson’ s Disease Rating Scale score, Hoehn-Yahr (H-Y) rating, and cognitive function level (Montreal Cognitive Assessment) was analyzed.Results (1)The prevalence of olfactory dysfunction in PD group (83.3%) was significantly higher than that in control group (21.2%).The Sniffin’ Sticks test showed that the odor threshold score (6.6 ±3.2, P=0.000), odor discrimination score (6.6 ±3.3, P=0.000), 16 kinds of odor identification score (6.8 ±2.4, P=0.000) in PD group were significantly lower than those in control group.( 2 ) When comparing the PD cases and healthy controls in recognition , the sensitivity and the specificity of the Sniffin ’ Sticks test were 0.897 and 0.737, respectively, similar to the SS-16 test.However, the Sniffin’ Sticks test showed advantage compared with odor threshold and odor discrimination.( 3 ) The olfactory score in PD group was positively correlated with cognitive function (r=0.243, P=0.046), and was unrelated with age, gender, disease duration, and disease severity.The olfactory score in control group was negatively correlated with age (r=-0.270, P=0.018), but positively correlated with cognitive function (r=0.281, P=0.014).Conclusions There is a higher incidence of olfactory dysfunction in PD patients than in control group.Sniffin’ Sticks test is superior to SS-16 test in quantitative and qualitative analysis of olfactory function in PD patients.Two tests both have high sensitivity and specificity in the recognition of PD .

Avaliação da sensibilidade cutânea do retalho perfurante da artéria pudenda interna nas reconstruções perineais / Evaluation of cutaneous sensibility of the internal pudendal artery perforator flap in perineal reconstructions

INTRODUÇÃO: O tratamento das neoplasias malignas anorretais exige ressecções que podem levar ao surgimento de defeitos perineais extensos. Esses defeitos necessitam de reconstrução que deve ser realizada, preferencialmente, com retalhos. Dentre eles, destacamos o retalho perfurante da artéria pudenda interna, localizado no sulco glúteo, vascularizado por vasos perfurantes cutâneos da artéria pudenda interna, e inervado por ramos do nervo pudendo e do nervo cutâneo femoral posterior. Esse retalho apresenta diversas vantagens em comparação com os outros utilizados para reconstrução perineal, e os dados relacionados à avaliação de sua sensibilidade cutânea são escassos, discrepantes e sujeitos a críticas metodológicas. OBJETIVO: Avaliar a sensibilidade cutânea do retalho perfurante da artéria pudenda interna após 12 meses da reconstrução perineal em cirurgias de amputação abdominoperineal de reto, e compará-la com a sensibilidade cutânea pré-operatória do sulco glúteo (área doadora do retalho). MÉTODOS: Estudo prospectivo com 25 pacientes submetidos à amputação abdominoperineal de reto por neoplasias malignas anorretais e reconstruídos com o retalho perfurante da artéria pudenda interna de avanço VY bilateral. As modalidades de sensibilidade tátil, dolorosa, térmica e vibratória foram analisadas em quatro áreas do sulco glúteo no pré-operatório e nas quatro áreas correspondentes do retalho 12 meses após a cirurgia. A avaliação da sensibilidade tátil foi realizada com o Pressure Specified Sensory Device(TM) (PSSD(TM)), aparelho que quantifica a pressão aplicada à pele, estática ou em movimento. As outras modalidades de sensibilidade foram analisadas com o método de escolha forçada, utilizando ponta de agulha para sensibilidade dolorosa, contato quente/frio para sensibilidade térmica e diapasão de 128 Hz para sensibilidade vibratória. RESULTADOS: Os limiares de sensibilidade tátil medidos com o PSSD(TM) no retalho perfurante da artéria pudenda interna...

INTRODUCTION: The treatment of anorectal malignancies requires resection that can lead to extensive perineal defects. These defects require reconstruction which should be performed, preferably, with flaps. Among them, we highlight the internal pudendal artery perforator flap, located on the gluteal fold, vascularized by cutaneous perforator vessels from the internal pudendal artery, and innervated by branches from the pudendal nerve and the posterior femoral cutaneous nerve. This flap has many advantages compared to others used for perineal reconstruction, and data related to the evaluation of its cutaneous sensibility are scarce, discrepant and subject to methodological criticisms. OBJECTIVE: To evaluate cutaneous sensibility of the internal pudendal artery perforator flap 12 months after perineal reconstruction in abdominoperineal resection of rectum, and compare it with the preoperative cutaneous sensibility of the gluteal fold (flap donor area). METHODS: A prospective study of 25 patients undergoing abdominoperineal resection of rectum for anorectal malignancies, and reconstruction with the internal pudendal artery perforator flap, in bilateral VY advancement. The modalities of tactile, pain, thermal and vibration sensibility were analyzed in four areas of the gluteal fold preoperatively and in the four corresponding areas of the flap 12 months after surgery. Tactile sensibility was assessed using the Pressure Specified Sensory Device(TM) (PSSD(TM)), a device that measures the pressure applied to the skin, static or moving. The other types of sensibility were analyzed with the forced-choice method, using a needle for pain sensibility, hot/cold contact for thermal sensibility and 128 Hz tuning-fork for vibration sensibility. RESULTS: The tactile sensibility thresholds measured with PSSD(TM) on the internal pudendal artery perforator flap 12 months after perineal reconstruction were similar to tactile sensibility thresholds...

Evaluation of sensitivity, motor and pain thresholds across the menstrual cycle through medium-frequency transcutaneous electrical nerve stimulation

OBJECTIVES: The aim of this study was to identify variations in nervous thresholds in different phases of the menstrual cycle in eumenorrheic women and users of oral contraceptives. METHOD: An observational study was performed including 56 volunteers, consisting of 30 eumenorrheic women who were non-users of oral contraceptives and 26 users of oral contraceptives. An electrical stimulator was employed to assess their nervous thresholds, with pulses applied at a fixed frequency of 2,500 Hz, modulated at 50 Hz, with phase variances of 20 μs, 50 μs and 100 μs. Sensitivity, motor and pain thresholds were evaluated during five menstrual cycle phases: phase 1 - menstrual, phase 2 - follicular, phase 3 - ovulatory, phase 4 - luteal and phase 5 - premenstrual. RESULTS: The results indicated low sensitivity thresholds of 100 μs for non-users of oral contraceptives and 50 μs for oral contraceptive users in phase 5. Low motor thresholds of 20 μs, 50 μs and 100 μs were observed for non-users of oral contraceptives in phase 5, while that of oral contraceptive users was 100 μs. Finally, a low pain threshold of 100 μs was observed in phase 5, but only in the oral contraceptive group. CONCLUSION: Nervous thresholds vary systematically across the phases of the menstrual cycle, with or without the use of oral contraceptives. These variations should be taken into account during research performed in women. .

Quantitative sensory testing in trigeminal traumatic neuropathic pain and persistent idiopathic facial pain / Teste sensitivo quantitativo em dor neuropática trigeminal pós-traumática e dor facial idiopática persistente

The objective of this article was to investigate, with a systematic protocol of quantitative sensory testing, patients with persistent idiopathic facial pain (PIFP) and others with trigeminal traumatic neuropathic pain (TTN) compared to controls. Thirty patients with PIFP, 19 with TTN, and 30 controls were evaluated on subjective numbness and dysesthesia and with a systematic protocol of quantitative sensory testing for thermal evaluation (cold and warm), mechanical detection (touch and pinpricks for mechanical pain), superficial pain thresholds, and corneal reflex. We found that PIFP and TTN had numbness and dysesthesia higher than controls (p<0.001 and p=0.003), and that in both of them mechanical pain by pinpricks detection was abnormal intra and extra orally at the mandibular branch (p<0.001). Cold, warm, and tactile detections and pain thresholds were similar among the groups. Corneal reflex was abnormal in TTN (p=0.005). This study supports neuropathic mechanisms involving pain processing in PIFP and that the criterion on absence of sensorial variations in PIFP should be revised.

O objetivo deste artigo foi investigar, com um protocolo sistemático de testes sensitivos quantitativos, pacientes com dor facial idiopática persistente (DFIP) e outros com dor neuropática trigeminal traumática (DNTT) comparado aos controles. Trinta pacientes com DFIP, 19 com DNTT e 30 controles foram avaliados quanto à dormência e à disestesia subjetiva e por meio de um protocolo sistemático de testes sensitivos quantitativos, que incluiu avaliação térmica (frio e quente), detecção mecânica (táctil e alfinetes), limites de dor superficial e reflexo córneo-palpebral. Foi observado que os pacientes apresentaram mais dormência e disestesia do que os controles (p<0,001 e p=0,003), além de mais anormalidades intra e extraorais no ramo mandibular (p<0,001). As alterações de calor, frio, dor e tato foram semelhantes entre os grupos. O reflexo córneo-palpebral foi anormal somente no grupo com DNTT (p=0,005). Este estudo suporta mecanismos de dor neuropática envolvidos no processamento da DFIP, e o critério de ausência de variações sensoriais nesta deve ser revisto.

Efeitos do ΔF sobre a acomodação da corrente interferencial em sujeitos saudáveis / ΔF effects on the interferential current accommodation in healthy subjects

OBJETIVO: Avaliar em quanto tempo ocorre acomodação da corrente interferencial (CI), e quantas vezes essa acomodação acontece em 10 minutos usando diferentes padrões de variações na frequência de estimulação: ∆F nulo = 0, ∆F baixo = 30% e ∆F alto = 70%. MATERIAIS E MÉTODOS: Ensaio clínico cruzado, com 15 voluntários saudáveis, com idade média de 22,53 ± 0,91 anos, de ambos os gêneros. Os pacientes foram submetidos a CI por 10 minutos na forma bipolar com os eletrodos longitudinalmente dispostos sobre as vértebras L1 e S1. OS PARÂMETROS DO EQUIPAMENTO FORAM: frequência base de 4.000Hz, AMF 100Hz, rampa de entrega do ΔF 1:1, ΔF dependendo do dia e do subgrupo, por 10 minutos. Foi avaliado o limiar de acomodação e quantas vezes a corrente acomodou no tempo total de estimulação. RESULTADOS: Para o tempo da primeira acomodação e pelo número de acomodações, não houve diferença significativa (p > 0,05). CONCLUSÃO: Observou-se que não houve efeito com a variação dos diferentes ∆F analisados.

AIM: to evaluate in how much time the IC current accommodates and how many times this accommodation happens in 10 minutes using different patterns of variations in the frequency of stimulation: ∆F null= 0, ∆F low= 30% and ∆F high= 70%. MATERIALS AND METHODS: crossover trial, with 15 volunteers, with mean age of 22.53 ± 0.91 years, of both genders. The patients were submitted to IC for 10 minutes as bipolar with the electrodes longitudinally arranged on the vertebrae L1 and S1. THE EQUIPMENT PARAMETERS WERE: base frequency of 4000Hz, AMF 100 Hz, delivery ramp of, ΔF 1:1, ΔF depending on the day and the subgroup, for 10 minutes. The threshold of accommodation was evaluated as well as how many times the current accommodated in the total time of stimulation. RESULTS: Based on the time of the first accommodation and by the number of accommodation, no significant difference was observed (p>0.05). CONCLUSION: there was no effect with the variation of the different ∆F analyzed.

Relationship between hearing threshold and peripheral neuropathy in type 2 diabetic patients / 中华内分泌代谢杂志

Objective In order to investigate the relationship between hearing loss and diabetic peripheral neuropathy( DPN ) via comparing the pure tone thresholds and vibration perception threshold(VPT) in type 2 diabetic patients and control person without diabetes. Methods 173 subjects including 138 type 2 diabetic patients(DM)and 35 non-diabetes controls were examined for VPT and hearing threshold. Nerve conducting velocity ( NCV )including sensory nerve conducting velocity( SCV )and motorial nerve conducting velocity( MCV )of diabetic patients were determined. The participants were divided into three groups: control group (n = 35 ), DM group without peripheral neuropathy( non-PN group, n = 74 ), and DM group complicated with peripheral neuropathy (PN group,n = 64 ). The clinical characteristics, biochemical parameters , the incidence of sensorineural hearing loss ( SNHL),pure tone threshold, and VPT were compared among three groups. At last, the relationship between hearing thresholds and NCV were analyzed. Results The incidence of hearing impairment of sensorineural type was 29.69% in PN group, which was significantly higher than that of non-PN group( 17.57% )and control group( 17. 14% ). There was significant differences in age, duration of diabetes, glycolated hemoglobin (HbA1c), glycolated serum albumin ( GA), Fasting blood glucose( FPG), 2h postprandial blood glucose( PPG), VPT, and hearing threshold among the three groups( all P＜0. 05 ). The value of hearing threshold increased significantly( all P＜0. 05 ) in 3 VPT subgroups with VPT≤ 15 V, VPT 16-25 V, and VPT ＞25 V. The Spearman correlation analysis showed median NCV was negatively correlated with hearing threshold on 1.00, 2.00, 4. 00, and 8. 00 kHz ( All P ＜ 0. 05 ). The logistic regression analysis indicated that the age( regression coefficient =0. 088, P＜0. 01 ) was the independent risk factor of SNHL, median nerve MCV ( regression coefficient = -0. 135, P = 0. 046 ) was the important influencing factor of SNHL. Conclusion Diabetic patients are more likely to suffer from impaired middle-frequency and high-frequency hearing, DPN in patients is often complicated with hearing impairment. Age and median nerve MCV were major risk factors of SNHL in diabetic patients.

Odor Thresholds and Breathing Changes of Human Volunteers as Consequences of Sulphur Dioxide Exposure Considering Individual Factors

OBJECTIVES: Though sulfur dioxide (SO2) is used widely at workplaces, itseffects on humans are not known. Thresholds are reportedwithout reference to gender or age and occupational exposure limits are basedon effects on lung functioning,although localized effects in the upper airways can be expected.This study's aim is to determine thresholds with respect to age and gender and suggests a new approach to risk assessment using breathing reflexes presumably triggered by trigeminal receptors in the upper airways. METHODS: Odor thresholds were determined by the ascending method of limits in groups stratified by age and gender.Subjects rated intensities of different olfactory and trigeminal perceptions at different concentrations of SO2. During the presentation of the concentrations, breathing movements were measured by respiratory inductive plethysmography. RESULTS: Neither age nor gender effects were observed for odor threshold. Only ratings of nasal irritation were influenced bygender. A benchmark dose analysis on relative respiratory depth revealed a 10%-deviation from baseline at about 25.27 mg/m3. CONCLUSION: The proposed new approach to risk assessment appearsto be sustainable. We discuss whether a 10%-deviation of breathingdepth is relevant.