Advances in stem cell transplantation for traumatic spinal cord injury at different stages / 中国修复重建外科杂志

OBJECTIVE@#To summarize the research progress of stem cell transplantation in treating spinal cord injury (SCI) at different stages based on the pathophysiological mechanism of SCI.@*METHODS@#The relevant research literature at home and abroad was extensively reviewed to explore the impact of transplantation timing on the effectiveness of stem cell transplantation in treating SCI.@*RESULTS@#Researchers performed different types of stem cell transplantation for subjects at different stages of SCI through different transplantation approaches. Clinical trials have proved the safety and feasibility of stem cell transplantation at acute, subacute, and chronic stages, which can alleviate inflammation at the injured site and restore the function of the damaged nerve cells. But the reliable clinical trials comparing the effectiveness of stem cell transplantation at different stages of SCI are still lacking.@*CONCLUSION@#Stem cell transplantation has a good prospect in treating SCI. In the future, the multi-center, large sample randomized controlled clinical trials are needed, with a focus on the long-term effectiveness of stem cell transplantation.

Experimental study of electric field stimulation combined with polyethylene glycol in the treatment of spinal cord injury in rats / 生物医学工程学杂志

Electric field stimulation (EFS) can effectively inhibit local Ca 2+ influx and secondary injury after spinal cord injury (SCI). However, after the EFS, the Ca 2+ in the injured spinal cord restarts and subsequent biochemical reactions are stimulated, which affect the long-term effect of EFS. Polyethylene glycol (PEG) is a hydrophilic polymer material that can promote cell membrane fusion and repair damaged cell membranes. This article aims to study the combined effects of EFS and PEG on the treatment of SCI. Sprague-Dawley (SD) rats were subjected to SCI and then divided into control group (no treatment, n = 10), EFS group (EFS for 30 min, n = 10), PEG group (covered with 50% PEG gelatin sponge for 5 min, n = 10) and combination group (combined treatment of EFS and PEG, n = 10). The measurement of motor evoked potential (MEP), the motor behavior score and spinal cord section fast blue staining were performed at different times after SCI. Eight weeks after the operation, the results showed that the latency difference of MEP, the amplitude difference of MEP and the ratio of cavity area of spinal cords in the combination group were significantly lower than those of the control group, EFS group and PEG group. The motor function score and the ratio of residual nerve tissue area in the spinal cords of the combination group were significantly higher than those in the control group, EFS group and PEG group. The results suggest that the combined treatment can reduce the pathological damage and promote the recovery of motor function in rats after SCI, and the therapeutic effects are significantly better than those of EFS and PEG alone.

Clinical effects of two combinations of olfactory agents on olfactory dysfunction after upper respiratory tract infection during olfactory training

SUMMARY OBJECTIVE To compare two combinations of olfactory agents for olfactory training therapy of olfactory dysfunction after upper respiratory tract infection (URTI) and investigate the influencing factors on clinical effects. METHODS 125 patients with olfactory dysfunction were randomly divided into two groups: test and control. During the olfactory training, four odors were used in both groups. The olfactory training lasted for 24 weeks. Then, participants were tested using Sniffin' Sticks and threshold-discrimination-identification (TDI) composite scoring before treatment and at 1, 3, and 6 months after treatment. The TDI scores were compared at different time points between the groups and within them, and influence factors were analyzed. RESULTS There was no significant difference in TDI scores between both groups. Furthermore, TDI scores did not significantly change after one month of treatment in either of the groups. After 3 and 6 months of treatment, TDI scores both significantly increased, and the odor discrimination and identification abilities significantly strengthened in both groups; however, the odor thresholds did not improve. The course of the disease was a significant influencing factor on the therapeutic effect of olfactory training for both groups. CONCLUSION The combination of essential balm, vinegar, alcohol, and rose perfume for olfactory training, which are scents commonly found in daily life, can effectively cure URTI-induced olfactory dysfunction, and significantly improve the odor discrimination and identification abilities. Furthermore, prolonging the treatment time can help with the recovery of olfactory functions, and earlier olfactory training can improve the therapeutic effect.

RESUMO OBJETIVO Comparar duas combinações de agentes olfativos para uso em terapia de treinamento olfativo no tratamento de disfunção olfatória após infecção do trato respiratório superior (ITRS) e investigar os fatores que influenciam os efeitos clínicos. METODOLOGIA 125 pacientes com disfunção olfativa foram divididos aleatoriamente em dois grupos: teste e controle. Durante o treinamento olfativo, quatro odores foram utilizados em ambos os grupos. O treinamento olfativo durou 24 semanas. Em seguida, os participantes foram testados usando Sniffin' Sticks e o escore de discriminação, limiar e identificação (TDI) antes do tratamento e 1, 3 e 6 meses após o ele. Os escores de TDI foram comparados em momentos diferentes, entre os grupos e dentro deles, e os fatores de influência foram analisados. RESULTADOS Não houve diferença significativa nos escores de TDI entre os dois grupos. Além disso, os escores de TDI não demonstração nenhuma alteração significa após um mês de tratamento em ambos os grupos. Após 3 e 6 meses de tratamento, ambos os escores de TDI aumentaram significativamente, e as habilidades de identificação e discriminação de odores melhoraram significativamente em ambos os grupos; contudo, os limiares de odor não demonstraram melhora. O curso da doença foi um importante fator de influência no efeito terapêutico do treinamento olfativo em ambos os grupos. CONCLUSÃO A combinação de bálsamo essencial, vinagre, álcool, e perfume de rosas no treinamento olfativo, todos aromas comumente encontrados na vida cotidiana, podem efetivamente curar disfunção olfativa induzida por ITRS e melhorar significativamente as habilidades de discriminação e identificação de odores. Além disso, a prolongamento do tempo de tratamento pode ajudar na recuperação das funções olfativas, e o início antecipado do treinamento olfativo pode melhorar o efeito terapêutico.

Effects of high- and moderate-intensity exercise on central hemodynamic and oxygen uptake recovery kinetics in CHF-COPD overlap

The oxygen uptake (V˙O2) kinetics during onset of and recovery from exercise have been shown to provide valuable parameters regarding functional capacity of both chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) patients. To investigate the influence of comorbidity of COPD in patients with CHF with reduced ejection fraction on recovery from submaximal exercise, 9 CHF-COPD male patients and 10 age-, gender-, and left ventricle ejection fraction (LVEF)-matched CHF patients underwent constant-load exercise tests (CLET) at moderate and high loads. The V˙O2, heart rate (HR), and cardiac output (CO) recovery kinetics were determined for the monoexponential relationship between these variables and time. Within-group analysis showed that the recovery time constant of HR (P<0.05, d=1.19 for CHF and 0.85 for CHF-COPD) and CO (P<0.05, d=1.68 for CHF and 0.69 for CHF-COPD) and the mean response time (MRT) of CO (P<0.05, d=1.84 for CHF and 0.73 for CHF-COPD) were slower when moderate and high loads were compared. CHF-COPD patients showed smaller amplitude of CO recovery kinetics (P<0.05) for both moderate (d=2.15) and high (d=1.07) CLET. Although the recovery time constant and MRT means were greater in CHF-COPD, CHF and CHF-COPD groups were not differently affected by load (P>0.05 in group vs load analysis). The ventilatory efficiency was related to MRT of V˙O2 during high CLET (r=0.71). Our results suggested that the combination of CHF and COPD may further impair the recovery kinetics compared to CHF alone.

Funcionalidade e velocidade da caminhada de pacientes após alta da unidade de terapia intensiva / Patient functionality and walking speed after discharge from the intensive care unit

RESUMO Objetivo: Mensurar e comparar a funcionalidade de pacientes após alta da unidade de terapia intensiva e no momento da alta hospitalar. Métodos: Pesquisa quantitativa de coorte prospectiva realizada entre agosto de 2016 e dezembro de 2017 em um hospital universitário. Foi realizado o teste de caminhada de 10m em dois momentos: após a alta da unidade de terapia intensiva e anteriormente à alta hospitalar. Os dados foram expressos pelos testes t de Student e a correlação de Pearson ou Spearman. O programa utilizado para análise foi o Statistical Package for Social Science (SPSS), versão 21.0, e o nível de significância adotado foi de p ≤ 0,05. Resultados: Foram avaliados 40 pacientes, com média de idade de 57,1 ± 12,2 anos, com predomínio do sexo masculino (60%). No teste pós-unidade de terapia intensiva verificou-se média de velocidade de 0,48m/s e no pré-alta hospitalar, houve aumento para 0,71m/s, evidenciando evolução da funcionalidade durante a internação hospitalar (p < 0,001). Conclusão: Houve melhora significativa da velocidade da marcha no momento da alta hospitalar quando comparada com a velocidade atingida no momento da alta da unidade de terapia intensiva.

ABSTRACT Objective: To measure and compare the functionality of patients after discharge from the intensive care unit and at the time of hospital discharge. Methods: Quantitative study of a prospective cohort performed between August of 2016 and December of 2017 at a university hospital. A 10-meter walk test was performed at 2 timepoints: after discharge from the intensive care unit and prior to hospital discharge. The data were analyzed using Student's t-test and Pearson or Spearman correlation. Statistical Package for Social Science (SPSS) version 21.0 was used for the analysis, and p ≤ 0.05 was adopted as the level of significance. Results: Forty patients, with a mean age of 57.1 ± 12.2 years and with a predominance of males (60%), were evaluated. For the post-intensive care unit test, a mean speed of 0.48m/s was observed, and for the pre-hospital discharge test, there was an increase to 0.71m/s, evidencing functional evolution during the hospital stay (p < 0.001). Conclusion: There was significant improvement in walking speed at the time of hospital discharge when compared to the walking speed at the time of intensive care unit discharge.

Implementación de un modelo de atención kinesiológico, temprano y prospectivo, en personas con cáncer de mama / Implementation of an early and prospective physical therapy model care in people with breast cancer

Resumen El cáncer de mama es un problema de salud pública en Chile y el mundo por su alta incidencia. La cirugía es un pilar fundamental en el tratamiento del cáncer de mama. Hasta un 60% de las personas tratadas por cáncer de mama presentan alteraciones funcionales en el miembro superior. Existen modelos sanitarios para la rehabilitación de las alteraciones funcionales, sin embargo, en Chile no es un estándar en la atención de salud. Este artículo describe: 1) las alteraciones del miembro superior secundarias a la cirugía por cáncer de mama y 2) un modelo de atención kinesiológico, temprano y prospectivo, para personas tratadas por cáncer de mama.

Breast cancer is a public health problem in Chile and the world due to high incidence. Surgery is the mainstay in the breast cancer treatment. Up to 60% of people receiving this management have functional morbidity in the upper limb. There are rehabilitation health models care for the functional morbidity, however, in Chile is not a standard in the health care. This article describes: 1) upper limb morbidity secondary to breast cancer surgery, and 2) early and prospective physical Therapy model care for people with breast cancer.

Effect of Leap Motion-based 3D Immersive Virtual Reality Usage on Upper Extremity Function in Ischemic Stroke Patients / Efeito do uso imersivo da realidade virtual 3D baseada em movimento de salto na função de extremidade superior em pacientes com AVC isquêmico

ABSTRACT Immersive virtual reality (VR) is a technology that provides a more realistic environmental design and object tracking than ordinary VR. The aim of this study was to investigate the effectiveness of immersive VR on upper extremity function in patients with ischemic stroke. Sixty-five patients with ischemic stroke were included in this randomized, controlled, double-blind study. Patients were randomly divided into VR (n = 33) and control (n = 32) groups. The VR group received 60 minutes of the upper extremity immersive VR rehabilitation program and the control group received 45 minutes of conventional therapy and 15 minutes of a sham VR program. Rehabilitation consisted of 18 sessions of therapy, three days per week, for six weeks. The outcome measures were the Action Research Arm Test (ARAT), Functional Independence Measure (FIM), Fugl-Meyer Upper Extremity Scale (FMUE) and Performance Assessment of Self-Care Skills (PASS). In both the VR and control groups all parameters except the PASS improved over time. However independent t-test results showed that all of the FMUE, ARAT, FIM and PASS scores were significantly higher in the VR group compared with the control (p < 0.05). The minimal clinically important difference (MCID) scores of the FMUE and ARAT were higher than the cut-off MCID scores described in the literature in the VR group, whereas the FIM scores were below the cut-off MCID scores. All scores in the control group were below the cut-off scores. Immersive VR rehabilitation appeared to be effective in improving upper extremity function and self-care skills, but it did not improve functional independence.

RESUMO A VR imersiva é uma tecnologia que fornece design ambiental e rastreamento de objetos mais realistas do que a VR comum. O objetivo deste estudo foi investigar a eficácia da VR imersiva na função da extremidade superior em pacientes com AVC isquêmico. Sessenta e cinco pacientes com AVC isquêmico foram incluídos neste estudo randomizado, controlado e duplo-cego (clinictrials.gov. ID: NCT03135418). Os pacientes foram divididos aleatoriamente em VR (n = 33) e controle (n = 32). O grupo VR recebeu 60 minutos do programa de reabilitação imersiva da extremidade superior e o grupo controle recebeu 45 minutos de terapia convencional e 15 minutos de um programa falso de VR. A reabilitação consistiu em 18 sessões de terapia, 3 dias por semana, durante 6 semanas. As medidas de resultado foram Teste de braço de pesquisa-ação (ARAT), Medida de independência funcional (FIM), Escala de extremidades superiores de Fugl-Meyer (FMUE) e Avaliação de desempenho de habilidades de autocuidado (PASS). Nos grupos VR e controle, todos os parâmetros, exceto o PASS, melhoraram com o tempo. No entanto, os resultados dos testes t independentes mostraram que todos os escores FMUE, ARAT, FIM e PASS foram significativamente maiores no grupo VR em comparação ao controle (p <0,05). Os escores de FMUE e ARAT de diferença minimamente clinicamente importante (MCID) foram maiores que os pontos de corte de MCID descritos na literatura no grupo VR, enquanto os escores de FIM estiveram abaixo dos pontos de corte de MCID. Todas as pontuações no grupo controle estiveram abaixo das pontuações de corte. A reabilitação imersiva da VR parece ser eficaz para melhorar a função da extremidade superior e as habilidades de autocuidado, mas não melhora a independência funcional.

Factors affecting urinary continence and sexual potency recovery after robotic-assisted radical prostatectomy

ABSTRACT Introduction Robot-assisted radical prostatectomy (RARP) is the most recent surgical technique for localized prostate cancer. The Da Vinci (Intuitive Surgical, Sunnyvale, CA) system was first introduced in Brazil in 2008, with a fast growing number of surgeries performed each year. Objective Our primary endpoint is to analyze possible predictors of functional outcomes, related to patient and tumor features. As secondary endpoint, describe functional outcomes (urinary continence and sexual potency) from RARP performed in the Sírio-Libanês Hospital (SLH), a private institution, in São Paulo, from April 2008 to December 2015. Materials and Method Data from 104 consecutive patients operated by two surgeons from the SLH (MA and SA) between 2008 and 2015, with a minimum 12 months follow-up, were collected. Patient features (age, body mass index - BMI, PSA, date of surgery and sexual function), tumor features (tumor stage, Gleason and surgical margins) and follow-up data (time to reach urinary continence and sexual potency) were the variables collected at 1, 3, 6 and 12 month and every 6 months thereafter. Continence was defined as the use of no pad on medical interview and sexual potency defined as the capability for vaginal penetration with or without fosphodiesterase type 5 inhibitors. Results Mean age was 60 years old and mean BMI was 28.45 kg/m2. BMI >30kg/m2 (p<0.001) and age (p=0.011) were significant predictors for worse sexual potency after surgery. After 1, 3, 6 and 12 months, 20.7%, 45.7%, 60.9% and 71.8% from patients were potent, respectively. The urinary continence was reached in 36.5%, 80.3%, 88.6% and 92.8% after 1, 3, 6 and 12 months, respectively. Until the end of the study, only one patient was incontinent and 20.7% were impotent. Conclusion Age was a predictor of urinary and erectile function recovery in 12 months. BMI was significant factor for potency recovery. We obtained in a private hospital good functional results after 12 months of follow-up.

Comparison of long-term functional results between standard supracricoid laryngectomy and modified technique with sternohyoid muscle / Comparação de resultados funcionais a longo prazo entre laringectomia padrão supracricoide e técnica modificada com músculo esterno-hióideo

Abstract Introduction: Laryngeal cancer is the most common cancer of the upper respiratory tract. The main methods of treatment included surgery (partial laryngectomy and total laryngectomy) and radiation therapy. Laryngeal dysfunction is seen after both treatment modalities. Objective: The aim of the study is to compare postoperative functional results of the standard supracricoid partial laryngectomy technique and a modified supracricoid partial laryngectomy technique using the sternohyoid muscle. Methods: In total, 29 male patients (average years 58.20 ± 9.00 years; range 41-79 years) with laryngeal squamous cell carcinoma who underwent supra cricoid partial laryngectomy were included. The patients were divided into two groups in terms of the surgical techniques. In Group A, all patients underwent standard supracricoid partial laryngectomy technique between January 2007 and November 2011. In Group B, all patients underwent modified supracricoid partial laryngectomy between August 2010 and November 2011. Fiberoptic endoscopic evaluation of swallowing test, short version of the voice handicap index scores, and the MD Anderson dysphagia inventory, the time of oral feeding and the decanulation of the patients after surgery of each groups were compared. Results: The mean maximum phonation time was 8.68 ± 4.21 s in Group A and 15.24 ± 6.16 s in Group B (p > 0.05). The S/Z (s/s) ratio was 1.23 ± 0.35 in Group A and 1.08 ± 0.26 in Group B (p > 0.05); the voice handicap index averages were 9.86 ± 4.77 in Group A and 12.42 ± 12.54 in Group B (p > 0.05); the fiberoptic endoscopic evaluation of swallowing test averages were calculated as 12.73 ± 3.08 in Group A and 13.64 ± 1.49 in Group B (p > 0.05). In the MD Anderson dysphagia inventory, evaluation of swallowing, the emotional, physical, and functional scores were 29.21 ± 4.11, 32.21 ± 6.85, and 20.14 ± 2.17 in the Group B, and 29.20 ± 2.54, 32.4 ± 4.79, and 19 ± 1.92 in Group A, respectively. Conclusion: Although there is no statistical difference in functional outcome comparisons, if rules are adhered to in preoperative patient selection, modified supracricoid partial laryngectomy can be applied safely and meaningful gains can be achieved in functional outcomes.

Resumo Introdução: O câncer laríngeo é o câncer mais comum do trato respiratório superior. Os principais métodos de tratamento incluem cirurgia (laringectomia parcial e laringectomia total) e radioterapia. A disfunção laríngea é observada em ambas as modalidades de tratamento. Objetivos: Comparar os resultados funcionais pós-operatórios da técnica de laringectomia padrão supracricoide e a técnica de laringectomia supracricoide modificada com o uso do músculo esterno-hióideo. Método: Foram incluídos 29 pacientes do sexo masculino (média de 58,20 ± 9,00 anos, intervalo de 41 a 79) com carcinoma espinocelular de laringe submetidos à laringectomia supracricoide parcial. Os pacientes foram divididos em dois grupos em termos de técnicas cirúrgicas. Todos os pacientes do Grupo A foram submetidos à laringectomia padrão supracricoide entre janeiro de 2007 e novembro de 2011. No Grupo B, todos os pacientes foram submetidos à laringectomia supracricoide modificada entre agosto de 2010 e novembro de 2011. A avaliação endoscópica da deglutição por fibra ótica, os escores da versão curta do Voice Handicap Index e do MD Anderson Dysphagia Inventory, o tempo de alimentação oral e a decanulação dos pacientes foram comparados após a cirurgia em cada grupo. Resultados: A média do tempo máximo de fonação foi de 8,68 ± 4,21 segundos no Grupo A e 15,24 ± 6,16 segundos no Grupo B (p > 0,05). A razão S/Z (seg/seg) foi de 1,23 ± 0,35 no Grupo A e 1,08 ± 0,26 no Grupo B (p > 0,05); as médias do Voice Handicap Index foram 9,86 ± 4,77 no Grupo A e 12,42 ± 12,54 no Grupo B (p > 0,05); as médias da avaliação endoscópica da deglutição por fibra ótica foram calculadas como 12,73 ± 3,08 no Grupo A e 13,64 ± 1,49 no Grupo B (p > 0,05). Na avaliação da deglutição pelo MD Anderson Dysphagia Inventory, os escores emocional, físico e funcional foram 29,21 ± 4,11, 32,21 ± 6,85 e 20,14 ± 2,17 no Grupo B e 29,20 ± 2,54, 32,4 ± 4,79 e 19 ± 1,92 no Grupo A, respectivamente. Conclusão: Embora não haja diferença estatística nas comparações de resultados funcionais, se as regras forem respeitadas na seleção pré-operatória do paciente, a laringectomia supracricoide parcial modificada pode ser aplicada com segurança e ganhos significativos podem ser alcançados em termos de resultados funcionais.

Efectos de un programa de entrenamiento multicomponente en la marcha funcional en pacientes con Parkinson / Multicomponent physical training in patients with Parkinson disease

Background: Multicomponent physical training in patients with Parkinson disease may improve their functional independence, especially in terms of gait speed and coordination. Aim: To assess the effects of an eight weeks multicomponent physical training program in patients with Parkinson disease. Material and Methods: Fourteen patients with Parkinson disease participated in a physical training program that lasted eight weeks. Three sessions lasting 60 minutes per week were carried out. Patients were assessed using the six minutes walk, timed up and go and the unipodal stance test. Results: After the training period, significant improvements in the six minute walk test and timed up and go were observed. No significant changes were observed in the unipodal stance test. Conclusions: The eight weeks training program improved gait speed and functional status in these patients with Parkinson disease.

Escala Perme como preditor de funcionalidade e complicações após a alta da unidade de terapia intensiva em pacientes submetidos a transplante hepático / The Perme scale score as a predictor of functional status and complications after discharge from the intensive care unit in patients undergoing liver transplantation

RESUMO Objetivo: Avaliar a pontuação da escala Perme de mobilidade como preditor de funcionalidade e complicações no pós-operatório de pacientes submetidos a transplante hepático. Métodos: A amostra foi composta por 30 pacientes que realizaram transplante hepático. Os pacientes foram avaliados em dois momentos, a fim de verificar a percepção da dor, o grau de dispneia, a força muscular periférica e a funcionalidade do paciente de acordo com a escala Perme. Os dados coletados foram analisados por estatística descritiva e inferencial. Para comparar médias entre as avaliações, foi aplicado o teste t de Student para amostras pareadas. Em caso de assimetria, o teste de Wilcoxon foi utilizado. Na avaliação da associação entre as variáveis quantitativas, os testes de correlação de Pearson ou Spearman foram aplicados. Resultados: Foram incluídos 30 indivíduos que realizaram transplante hepático. Houve predomínio de pacientes do sexo masculino, e a média de idade foi 58,4 ± 9,9 anos. A patologia de base mais prevalente foi a cirrose por vírus C (23,3%). Foram registradas associações significativas entre o tempo de ventilação mecânica e a escala Perme na alta da unidade de terapia intensiva (r = -0,374; p = 0,042) e entre o número de atendimentos fisioterapêuticos (r = -0,578; p = 0,001). Quando comparados os resultados da avaliação inicial e na alta hospitalar, houve significativa melhora da funcionalidade (p < 0,001). Conclusão: Mobilidade funcional, força muscular periférica, percepção da dor e dispneia melhoram significativamente no momento da alta hospitalar em relação à admissão na unidade de internação.

ABSTRACT Objective: To assess the Perme mobility scale score as a predictor of functional status and complications in the postoperative period in patients undergoing liver transplantation. Methods: The sample consisted of 30 patients who underwent liver transplantation. The patients were evaluated at two time points to determine their perception of pain, degree of dyspnea, peripheral muscle strength, and functional status according to the Perme scale. The collected data were analyzed by descriptive and inferential statistics. To compare the means between the evaluations, Student's t test for paired samples was applied. In case of asymmetry, the Wilcoxon test was used. In the evaluation of the association between the quantitative variables, the Pearson or Spearman correlation tests were applied. Results: A total of 30 individuals who underwent liver transplantation were included. The patients were predominantly male, and the mean age was 58.4 ± 9.9 years. The most prevalent underlying pathology was cirrhosis C virus (23.3%). Significant associations of the time on mechanical ventilation with the Perme scale score at discharge from the intensive care unit (r = -0.374; p = 0.042) and the number of physical therapy treatments (r = -0.578; p = 0.001) were recorded. When comparing the results of the initial evaluation and the evaluation at hospital discharge, there was a significant improvement in functional status (p < 0.001). Conclusion: Functional mobility, peripheral muscle strength, pain perception, and dyspnea are significantly improved at hospital discharge compared with those at inpatient unit admission.

Capacidade funcional em idosos e idosos mais velhos após alta da unidade de terapia intensiva. Coorte prospectiva / Functional ability in younger and older elderlies after discharge from the intensive care unit. A prospective cohort

RESUMO Objetivo: Comparar a capacidade funcional de indivíduos idosos (60 a 79 anos) com a dos idosos mais velhos (≥ 80 anos) nos primeiros 6 meses após a alta da unidade de terapia intensiva. Métodos: Coorte prospectiva multicêntrica, na qual foram coletados dados referentes à internação na unidade de terapia intensiva e aos desfechos após a alta hospitalar (no pós-alta imediato, após 3 meses e após 6 meses). A força muscular foi avaliada por meio do protocolo do Medical Research Council e da dinamometria (preensão palmar); a capacidade de execução das Atividades de Vida Diária e independência funcional pelo índice de Barthel e pelo nível habitual de atividade física (International Physical Activity Questionnaire); e a qualidade de vida pelo 12-Item Short-Form Health Survey Versão 2. Resultados: Dentre os 253 pacientes incluídos, 167 eram idosos entre 61 a 79 anos, e 86 eram idosos mais velhos. Os idosos mais velhos, no sexto mês de avaliação, apresentaram maior necessidade de cuidador (69,0% versus 49,5%; p = 0,002). A funcionalidade prévia à unidade de terapia intensiva e no terceiro mês após alta foi menor nos idosos mais velhos em comparação aos mais jovens (Barthel anterior à unidade de terapia intensiva: 73,0 ± 30,0 versus 86,5 ± 22,6; p < 0,001; Barthel no terceiro mês: 63,5 ± 34,0 versus 71,5 ± 35,5; p = 0,03), assim como o nível habitual de atividade física (International Physical Activity Questionnaire no terceiro mês: ativo/muito ativo 3,4% versus 18,3%; nenhuma atividade física 64,4% versus 39,7%; p < 0,001; e International Physical Activity Questionnaire no sexto mês: ativo/muito ativo 5,8% versus 20,8%; nenhuma atividade física 69,2% versus 43,4%; p = 0,005). Os idosos mais velhos apresentaram menor força muscular ao serem avaliados pela preensão palmar no membro dominante (14,5 ± 7,7 versus 19,9 ± 9,6; p = 0,008) e do não dominante (13,1 ± 6,7 versus 17,5 ± 9,1; p = 0,02). Não houve diferença na perda da funcionalidade e na qualidade de vida referida, entre os grupos etários. Conclusão: Mesmo com grande perda funcional após a alta da unidade de terapia intensiva em ambos os grupos etários, não houve diferença na magnitude da perda da funcionalidade de indivíduos idosos (60 a 79 anos) quando comparados aos idosos mais velhos (≥ 80 anos) nos primeiros 6 meses após a alta da unidade de terapia intensiva.

ABSTRACT Objective: To compare the functional capacity of younger elderly individuals (60 to 79 years old) with that of older elderly individuals (≥ 80 years old) during the first 6 months after discharge from the intensive care unit. Methods: A multicenter prospective cohort study was conducted, in which data on intensive care unit admission and outcomes after hospital discharge (immediate post-discharge, after 3 months and after 6 months) were collected. Muscle strength was evaluated through the protocol of the Medical Research Council and dynamometry (handgrip); the ability to perform activities of daily life and functional independence were assessed by the Barthel index and the usual level of physical activity (International Physical Activity Questionnaire); and quality of life was assessed by the 12-Item Short-Form Health Survey Version 2. Results: Among the 253 patients included, 167 were younger elderly (between 61 and 79 years old), and 86 were older elderly (≥ 80 years old). During the sixth month of evaluation, the older elderlies presented a higher need for a caregiver (69.0% versus 49, 5%, p = 0.002). Functional capacity prior to intensive care unit admission and in the third month after discharge was lower in older elderlies than in younger ones (Barthel prior to the intensive care unit: 73.0 ± 30.0 versus 86.5 ± 22.6; p <0.001, Barthel in the third month: 63.5 ± 34.0 versus 71.5 ± 35.5, p = 0.03), as was the usual level of physical activity (International Physical Activity Questionnaire in the third month: active/very active 3.4% versus 18.3%, no physical activity 64.4% versus 39.7%, p < 0.001, and International Physical Activity Questionnaire in the sixth month: active/very active 5.8% versus 20.8%, no physical activity 69.2% versus 43.4%, p = 0.005). Older elderlies had lower muscle strength when assessed according to handgrip in both the dominant (14.5 ± 7.7 versus 19.9 ± 9.6, p = 0.008) and non-dominant limb (13.1 ± 6.7 versus 17.5 ± 9.1, p = 0.02). There were no differences in functional capacity loss or reported quality of life between the age groups. Conclusion: Although there were great functional capacity losses after discharge from the intensive care unit in both age groups, there was no difference in the magnitude of functional capacity loss between younger (60 to 79 years) and older elderly individuals (≥ 80 years old) during the first 6 months after discharge from the intensive care unit.

Correlation between motor function recovery and daily living activity outcomes after brachial plexus surgery / Correlação entre a recuperação motora funcional e as atividades de vida diária após cirurgia do plexo braquial

ABSTRACT Objective To establish the correlation between clinical evaluation of motor function recovery and daily living activities in 30 patients with upper traumatic brachial plexus injury submitted to surgery. Methods The score of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the Louisiana State University Health Sciences Center (LSUHSC) scale were determined in 30 patients. Epidemiologic factors were also examined and correlations were determined. Results There was a significant correlation between the clinical evaluation and the daily living activities after a 12-month period (r = 0.479 and p = 0.007). A direct correlation was observed between the functional recovery of the upper limb and the time between injury and surgery (r = 0.554 and p = 0.001). The LSUHSC scores (p = 0.049) and scores from the DASH questionnaire (p = 0.013) were better among patients who returned to work. Conclusions Clinical evaluation and daily living activities in adult patients who underwent nerve transfer after brachial plexus injury showed significant and measurable improvements.

RESUMO Objetivo Avaliar a correlação entre a avaliação clínica e as atividades de vida diária em 30 paciente adultos com lesão do plexo braquial superior. Métodos O valor do questionário Dash (Disabilities of the Arm, Shoulder and Hand) e da escala Louisiana State University Health Sciences Center (LSUHSC) foram quantificados prospectivamente em 30 pacientes. Fatores epidemiológicos foram também examinados e correlações específicas determinadas. Resultados Houve correlação significativa entre avaliação clínica e as atividades de vida diária 12 meses após a cirurgia (r = 0.479 e p = 0.007). Uma correlação direta foi observada entre a recuperação funcional do membro superior e o tempo entre a lesão e a cirurgia (r = 0.554 e p = 0.001). Os valores da escala LSUHSC (p = 0.049) e do DASH (p = 0.013) foram melhores entre aqueles que retornaram ao trabalho. Conclusões A avaliação clínica e as atividades de vida diária em pacientes submetidos à cirurgia de transferência de nervos após lesão do plexo braquial mostraram correlação significativa.

Recurrence plots: a new tool for quantification of cardiac autonomic nervous system recovery after transplant

Abstract Objective: To evaluate a possible evolutionary post-heart transplant return of autonomic function using quantitative and qualitative information from recurrence plots. Methods: Using electrocardiography, 102 RR tachograms of 45 patients (64.4% male) who underwent heart transplantation and that were available in the database were analyzed at different follow-up periods. The RR tachograms were collected from patients in the supine position for about 20 minutes. A time series with 1000 RR intervals was analyzed, a recurrence plot was created, and the following quantitative variables were evaluated: percentage of determinism, percentage of recurrence, average diagonal length, Shannon entropy, and sample entropy, as well as the visual qualitative aspect. Results: Quantitative and qualitative signs of heart rate variability recovery were observed after transplantation. Conclusion: There is evidence that autonomic innervation of the heart begins to happen gradually after transplantation. Quantitative and qualitative analyses of recurrence can be useful tools for monitoring cardiac transplant patients and detecting the gradual return of heart rate variability.

Local inhibition of nitrergic activity in tenotomized rats accelerates muscle regeneration by increasing fiber area and decreasing central core lesions

Muscular atrophy is a progressive degeneration characterized by muscular proteolysis, loss of mass and decrease in fiber area. Tendon rupture induces muscular atrophy due to an intrinsic functional connection. Local inhibition of nitric oxide synthase (NOS) by Nω-nitro-L-arginine methyl ester (L-NAME) accelerates tendon histological recovery and induces functional improvement. Here we evaluate the effects of such local nitrergic inhibition on the pattern of soleus muscle regeneration after tenotomy. Adult male Wistar rats (240 to 280 g) were divided into four experimental groups: control (n=4), tenotomized (n=6), vehicle (n=6), and L-NAME (n=6). Muscular atrophy was induced by calcaneal tendon rupture in rats. Changes in muscle wet weight and total protein levels were determined by the Bradford method, and muscle fiber area and central core lesion (CCL) occurrence were evaluated by histochemical assays. Compared to tenotomized (69.3±22%) and vehicle groups (68.1%±17%), L-NAME treatment induced an increase in total protein level (108.3±21%) after 21 days post-injury. A reduction in fiber areas was observed in tenotomized (56.3±1.3%) and vehicle groups (53.9±3.9%). However, L-NAME treatment caused an increase in this parameter (69.3±1.6%). Such events were preceded by a remarkable reduction in the number of fibers with CCL in L-NAME-treated animals (12±2%), but not in tenotomized (21±2.5%) and vehicle groups (19.6±2.8%). Altogether, our data reveal that inhibition of tendon NOS contributed to the attenuation of atrophy and acceleration of muscle regeneration.

Recuperación cardiovascular durante ejercicio intermitente en pacientes con hipertensión y diabetes tipo 2 altamente adherentes / Cardiovascular recovery during intermittent exercise in highly-adherent partic pants with hypertension and type 2 diabetes mellitus

Background: Despite the evidence supporting metabolic benefits of high intensity interval exercise (HIIT), there is little information about the cardiovascular response to this type of exercise in patients with type 2 diabetes (T2D) and hypertension (HTA). Aim: To analyze the changes in heart rate at rest, at the onset and at the end of each interval of training, after twelve weeks of a HIIT program in T2D and HTA patients. Material and Methods: Twenty-three participants with T2D and HTA (20 women) participated in a controlled HIIT program. Fourteen participants attended 90% of more session of exercise and were considered as adherent. Adherent and non-adherent participants had similar body mass index (BMI), and blood pressure. A “1x2x10” (work: rest-time: intervals) HIIT exercise protocol was used both as a test and as training method during twelve weeks. The initial and finishing heart rate (HR) of each of the ten intervals before and after the intervention were measured. Results: After twelve weeks of HIIT intervention, adherent participants had a significant reduction in the heart rate at the onset of exercise, and during intervals 4, 5, 8 and 10. A reduction in the final heart rate was observed during intervals 8 and 10. In the same participants the greatest magnitude of reduction, at the onset or end of exercise was approximately 10 beats/min. No significant changes in BMI, resting heart rate and blood pressure were observed. Conclusions: A HIIT program reduces the cardiovascular effort to a given work-load and improves cardiovascular recovery after exercise.

Effects of intracutaneous injections of sterile water in patients with acute low back pain: a randomized, controlled, clinical trial

Intracutaneous sterile water injection (ISWI) is used for relief of low back pain during labor, acute attacks of urolithiasis, chronic neck and shoulder pain following whiplash injuries, and chronic myofascial pain syndrome. We conducted a randomized, double-blinded, placebo-controlled trial to evaluate the effect of ISWI for relief of acute low back pain (aLBP). A total of 68 patients (41 females and 27 males) between 18 and 55 years old experiencing aLBP with moderate to severe pain (scores ≥5 on an 11-point visual analogue scale [VAS]) were recruited and randomly assigned to receive either ISWIs (n=34) or intracutaneous isotonic saline injections (placebo treatment; n=34). The primary outcome was improvement in pain intensity using the VAS at 10, 45, and 90 min and 1 day after treatment. The secondary outcome was functional improvement, which was assessed using the Patient-Specific Functional Scale (PSFS) 1 day after treatment. The mean VAS score was significantly lower in the ISWI group than in the control group at 10, 45, and 90 min, and 1 day after injection (P<0.05, t-test). The mean increment in PSFS score of the ISWI group was 2.9±2.2 1 day after treatment, while that in the control group was 0.9±2.2. Our study showed that ISWI was effective for relieving pain and improving function in aLBP patients at short-term follow-up. ISWI might be an alternative treatment for aLBP patients, especially in areas where medications are not available, as well as in specific patients (e.g., those who are pregnant or have asthma), who are unable to receive medications or other forms of analgesia because of side effects.

The Brief Kinesthesia test is feasible and sensitive: a study in stroke

BACKGROUND: Clinicians lack a quantitative measure of kinesthetic sense, an important contributor to sensorimotor control of the hand and arm. OBJECTIVES: The objective here was to determine the feasibility of administering the Brief Kinesthesia Test (BKT) and begin to validate it by 1) reporting BKT scores from persons with chronic stroke and a healthy comparison group and 2) examining the relationship between the BKT scores and other valid sensory and motor measures. METHOD: Adults with stroke and mild to moderate hemiparesis (N=12) and an age-, gender-, and handedness-matched healthy comparison group (N=12) completed the BKT by reproducing three targeted reaching movements per hand with vision occluded. OTHER MEASURES: the Hand Active Sensation Test (HASTe), Touch-Test(tm) monofilament aesthesiometer, 6-item Wolf Motor Function Test (Wolf), the Motor Activity Log (MAL), and the Box and Blocks Test (BBT). A paired t-test compared BKT scores between groups. Pearson product-moment correlation coefficients assessed the relationship between BKT scores and other measures. RESULTS: Post-stroke participants performed more poorly on the BKT than comparison participants with their contralesional and ipsilesional upper extremity. The mean difference for the contralesional upper extremity was 3.7 cm (SE=1.1, t=3.34; p<0.008). The BKT score for the contralesional limb was strongly correlated with the MAL-how much (r=0.84, p=0.001), the MAL-how well (r=0.76, p=0.007), Wolf (r=0.69, p=0.02), and the BBT (r=0.77, p=0.006). CONCLUSIONS: The BKT was feasible to administer and sensitive to differences in reaching accuracy between persons with stroke and a comparison group. With further refinement, The BKT may become a valuable clinical measure of post-stroke kinesthetic impairment.

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

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

Negative emotions affect postoperative scores for evaluating functional knee recovery and quality of life after total knee replacement

This study aimed to determine whether psychological factors affect health-related quality of life (HRQL) and recovery of knee function in total knee replacement (TKR) patients. A total of 119 TKR patients (male: 38; female: 81) completed the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), State Trait Anxiety Inventory (STAI), Eysenck Personality Questionnaire-revised (EPQR-S), Knee Society Score (KSS), and HRQL (SF-36). At 1 and 6 months after surgery, anxiety, depression, and KSS scores in TKR patients were significantly better compared with those preoperatively (P<0.05). SF-36 scores at the sixth month after surgery were significantly improved compared with preoperative scores (P<0.001). Preoperative Physical Component Summary Scale (PCS) and Mental Component Summary Scale (MCS) scores were negatively associated with extraversion (E score) (B=-0.986 and -0.967, respectively, both P<0.05). Postoperative PCS and State Anxiety Inventory (SAI) scores were negatively associated with neuroticism (N score; B=-0.137 and -0.991, respectively, both P<0.05). Postoperative MCS, SAI, Trait Anxiety Inventory (TAI), and BAI scores were also negatively associated with the N score (B=-0.367, -0.107, -0.281, and -0.851, respectively, all P<0.05). The KSS function score at the sixth month after surgery was negatively associated with TAI and N scores (B=-0.315 and -0.532, respectively, both P<0.05), but positively associated with the E score (B=0.215, P<0.05). The postoperative KSS joint score was positively associated with postoperative PCS (B=0.356, P<0.05). In conclusion, for TKR patients, the scores used for evaluating recovery of knee function and HRQL after 6 months are inversely associated with the presence of negative emotions.