Repetitive peripheral sensory stimulation for motor recovery after stroke: a scoping review.

BACKGROUND AND PURPOSE: Enhancing afferent information from the paretic limb can improve post-stroke motor recovery. However, uncertainties exist regarding varied sensory peripheral neuromodulation protocols and their specific impacts. This study outlines the use of repetitive peripheral sensory stimulation (RPSS) and repetitive magnetic stimulation (rPMS) in individuals with stroke. METHODS: This scoping review was conducted according to the JBI Evidence Synthesis guidelines. We searched studies published until June 2023 on several databases using a three-step analysis and categorization of the studies: pre-analysis, exploration of the material, and data processing. RESULTS: We identified 916 studies, 52 of which were included (N = 1,125 participants). Approximately 53.84% of the participants were in the chronic phase, displaying moderate-to-severe functional impairment. Thirty-two studies used RPSS often combining it with task-oriented training, while 20 used rPMS as a standalone intervention. The RPSS primarily targeted the median and ulnar nerves, stimulating for an average of 92.78 min at an intensity that induced paresthesia. RPMS targeted the upper and lower limb paretic muscles, employing a 20 Hz frequency in most studies. The mean stimulation time was 12.74 min, with an intensity of 70% of the maximal stimulator output. Among the 114 variables analyzed in the 52 studies, 88 (77.20%) were in the "s,b" domain, with 26 (22.8%) falling under the "d" domain of the ICF. DISCUSSION AND CONCLUSION: Sensory peripheral neuromodulation protocols hold the potential for enhancing post-stroke motor recovery, yet optimal outcomes were obtained when integrated with intensive or task-oriented motor training.

Intra and inter-raters reliability and agreement of stimulus electrodiagnostic tests with two different electrodes in sedated critically-ill patients.

Objective: The aim of the present study was to verify the intra- and inter-rater reliability and agreement of the stimulus electrodiagnostic test (SET) measurements obtained by pen and square electrodes in the vastus lateralis and tibialis anterior muscles. Design: An intra- and inter-rater reliability and agreement study was performed for the SET by two independent raters. Two different sizes of cathode electrodes (1 cm2 and 25 cm2) and two muscles were assessed (tibialis anterior and vastus lateralis). Results: Chronaxie did not change according to the different electrodes. A high intra-rater reliability (0.72 ≤ r ≤ 0.88) was detected independently of the electrode and muscle assessed. Moreover, moderate and almost perfect agreements (0.51 ≤ Kappa ≤ 1.00) were detected on intra-rater assessment. Similar correlations (0.74 ≤ r ≤ 0.79) were found for intra-rater reliability. However, dissimilar inter-rater agreement was detected: Kappa ≤ 0.40 for tibialis anterior and Kappa = 1.00 for vastus lateralis. Conclusion: The SET presented high reliability and moderate agreement in intra-rater evaluations. A fair agreement was found in the inter-rater assessment of the tibialis anterior. Evaluations performed with different electrode sizes did not influence the results. Therefore, the SET should be performed by a unique rater in test retest situations.

Neuromuscular electrical stimulation in critically ill traumatic brain injury patients attenuates muscle atrophy, neurophysiological disorders, and weakness: a randomized controlled trial.

BACKGROUND: Critically ill traumatic brain injury (TBI) patients experience extensive muscle damage during their stay in the intensive care unit. Neuromuscular electrical stimulation (NMES) has been considered a promising treatment to reduce the functional and clinical impacts of this. However, the time needed for NMES to produce effects over the muscles is still unclear. This study primarily aimed to assess the time needed and effects of an NMES protocol on muscle architecture, neuromuscular electrophysiological disorder (NED), and muscle strength, and secondarily, to evaluate the effects on plasma systemic inflammation, catabolic responses, and clinical outcomes. METHODS: We performed a randomized clinical trial in critically ill TBI patients. The control group received only conventional physiotherapy, while the NMES group additionally underwent daily NMES for 14 days in the lower limb muscles. Participants were assessed at baseline and on days 3, 7, and 14 of their stay in the intensive care unit. The primary outcomes were assessed with muscle ultrasound, neuromuscular electrophysiology, and evoked peak force, and the secondary outcomes with plasma cytokines, matrix metalloproteinases, and clinical outcomes. RESULTS: Sixty participants were randomized, and twenty completed the trial from each group. After 14 days, the control group presented a significant reduction in muscle thickness of tibialis anterior and rectus femoris, mean of - 0.33 mm (- 14%) and - 0.49 mm (- 21%), p < 0.0001, respectively, while muscle thickness was preserved in the NMES group. The control group presented a higher incidence of NED: 47% vs. 0% in the NMES group, p < 0.0001, risk ratio of 16, and the NMES group demonstrated an increase in the evoked peak force (2.34 kg/f, p < 0.0001), in contrast to the control group (- 1.55 kg/f, p < 0.0001). The time needed for the NMES protocol to prevent muscle architecture disorders and treat weakness was at least 7 days, and 14 days to treat NED. The secondary outcomes exhibited less precise results, with confidence intervals that spanned worthwhile or trivial effects. CONCLUSIONS: NMES applied daily for fourteen consecutive days reduced muscle atrophy, the incidence of NED, and muscle weakness in critically ill TBI patients. At least 7 days of NMES were required to elicit the first significant results. TRIAL REGISTRATION: The trial was registered at ensaiosclinicos.gov.br under protocol RBR-8kdrbz on 17 January 2016.

Evaluating trace element bioavailability and potential transfer into marine food chains using immobilised diatom model species Phaeodactylum tricornutum, on King George Island, Antarctica.

In order to evaluate trace element bioavailability and potential transfer into marine food chains in human impacted areas of the Fildes Peninsula (King George Island, South Shetland Islands Archipelago), element levels (Cr, Ni, Cu, Zn, Cd, and Pb) were determined in water, sediments, phytoplankton, and in diatom Phaeodactylum tricornutum Bohlin (Bacillariophyceae) cells immobilised in alginate and exposed to water and sediments, from the Bellingshausen Dome (reference site) and Ardley Cove (human impacted area), during January 2014. High element concentrations in exposed P. tricornutum indicated element mobilisation from sediments into the water. Levels in exposed cells reflected the sediment element content pattern, comparable to those found in phytoplankton, supporting phytoplankton as an important path of trace element entry into marine food chains. This study clearly shows immobilised P. tricornutum as good proxy of phytoplankton concerning element accumulation efficiency, and an effective tool to monitor trace element contamination in polar coastal ecosystems.

Environmental hazard assessment of contaminated soils in Antarctica: Using a structured tier 1 approach to inform decision-making.

Generally, Antarctica is considered to be an untouched area of the planet; however, the region's ecosystems have been subject to increased human pressure for at least the past half-century. This study assessed soils of Fildes Peninsula, where trace element pollution is thought to prevail. Four soil samples were collected from different locations and assessed following tier 1 methodologies for chemical and ecotoxicological lines of evidence (LoE) used in typical soil Environmental Risk Assessment (ERA). Trace element quantification was run on soil samples and sequential extracts, and elutriates were used to address their ecotoxicity using a standard ecotoxicological battery. The highest levels of trace elements were found for Cr, Cu, Ni and Zn, which were well above baseline levels in two sites located near previously identified contamination sources. Trace element concentrations in soils were compared with soil quality guidelines to estimate the contribution of the chemical LoE for integrated risk calculations; risk was found high, above 0.5 for all samples. Total concentrations in soil were consistent with corresponding sequentially extracted percentages, with Cu and Zn being the most bioavailable elements. Bacteria did not respond consistently to the elutriate samples and cladocerans did not respond at all. In contrast, the growth of microalgae and macrophytes was significantly impaired by elutriates of all soil samples, consistently to estimated trace element concentrations in the elutriate matrix. These results translated into lower risk values for the ecotoxicological compared to the chemical LoE. Nevertheless, integrated risk calculations generated either an immediate recommendation for further analysis to better understand the hazardous potential of the tested soils or showed that the soils could not adequately sustain natural ecosystem functions. This study suggests that the soil ecosystem in Fildes has been inadequately protected and supports previous claims on the need to reinforce protection measures and remediation activities.

Trace element contamination and availability in the Fildes Peninsula, King George Island, Antarctica.

The Ardley Cove area (located on the Maxwell Bay shoreline, Fildes Peninsula, King George Island, Antarctica) is characterized not only by its high biodiversity, but also by a high density of scientific stations, making it potentially one of the most impacted areas of Antarctica. In order to assess the source, contamination levels, distribution and availability of several trace elements (Cr, Ni, Cu, Zn, As, Pb, Cd and Hg) in and around Maxwell Bay, soil and seawater samples were collected. Soil samples were also collected in the study reference site near the Bellingshausen Dome area, as it lies far from centers of human activity and associated infrastructure. Enrichment factors (EFs) and sequential extractions were also used to assess the degree of contamination and availability of the trace elements under investigation. The results obtained in this study pointed to the existence of several contamination hotspots, mainly related to high levels of Zn, Pb, Cd, Cr and Ni. Comparison of the contaminant distribution patterns with data from earlier studies allowed the identification of anthropogenic sources. Use of the EF approach and sequential extractions confirmed these findings. In particular, higher extraction proportions were obtained for Zn and Pb (68 and 71%, respectively), which were also the same elements where the highest EFs were determined. The results obtained in this study clearly point to human impact on the natural environment in this region of Antarctica and we recommend the implementation of appropriate contamination control and remediation methods.

Assessing trace element contamination in Fildes Peninsula (King George Island) and Ardley Island, Antarctic.

King George Island, situated in the South Shetland Islands archipelago, is one of the most visited sites in Antarctica. This has contributed to a high density of scientific stations and shelters in the region, especially in Fildes Peninsula. In order to evaluate the natural and anthropogenic sources of trace elements (As, Cd, Cu, Zn, Pb and Hg) soil and moss samples were collected from different sites in January 2013. In general, the results revealed homogeneous concentrations (µgg(-)(1)) for each element in the majority of collected samples (As: 3.8±1.4; Cd: 0.4±0.9; Cu: 34±4; Zn: 115±13; Pb: 20±5; Hg; 0.011±0.009). However, some samples in specific areas of Fildes Bay showed the existence of local anthropogenic activities that have contributed to the enrichment of contaminants in soils and moss samples that correlated to one another (e.g. Pb: 1101µgg(-)(1)). Human presence is linked to examples of contamination and environmental perturbation, making essential the implementation of this type of study in order to understand and protect unique places in Antarctica.

Análise comparativa do equilíbrio postural de indivíduos com e sem histórico de labirintite: estudo preliminar / Comparative analysis of postural balance between individuals with and without labyrinthitis: preliminary study

O objetivo deste estudo foi comparar o equilíbrio postural entre indivíduos com e sem histórico de labirintite por meio de um estudo transversal controlado, cuja amostra foi composta por um grupo de 12 participantes jovens, sem labirintite, do sexo feminino com média de idade de 22 ± 2,23 anos e índice de massa corporal 21,12 ± 2,09 e outro grupo composto por 12 indivíduos do sexo feminino com histórico de labirintite, porém fora de crise e com média de idade de 22 ± 1,46 anos e índice de massa corporal de 23,42 ± 3,52. O registro do deslocamento do centro de pressão foi realizado por uma plataforma de pressão F-Mat modelo 3100 do sistema F-Scan com software versão 4.2 (Tekscan, Inc., South Boston, MA), sendo avaliado o comprimento total da trajetória (CT), o deslocamento ântero-posterior (AP), médio-lateral (ML) e a velocidade máxima (VM). O teste t para amostras independentes encontrou diferenças estatisticamente significativas no parâmetro comprimento total da trajetória (CT) entre as medidas dos grupos, demonstrando que os indivíduos com histórico de labirintite estudados, mesmo fora da crise, mostraram equilibro postural deficitário quando comparado aos indivíduos do grupo sem histórico de labirintite.

The purpose of this study was to compare postural balance between individuals with and without history of labyrinthitis through a cross-controlled study, whose sample was composed by a group of 12 young participants females, without labyrinthitis, 22 ± 2.23 years old and body mass index of 21.12 ± 2.09, and another group composed of 12 individuals female with history of labyrinthitis beyond crisis, 22 ± 1.46 years old and body mass index 23.42 ± 3.52. The record of the displacement of the center of pressure was conducted by a platform of pressure F-Mat model 3100 of the F-Scan system with software version 4.2 (Tekscan, Inc., South Boston, MA), being measured total length path, anterior-posterior and medial-lateral displacement and maximum speed. The t-test for independent samples found significant differences statistical in the parameter total length path between the actions of groups demonstrating that individuals with a history of labyrinthitis studied showed postural balance deficit when compared to individuals in the group without history of labyrinthitis.

Factors associated with survival of very-low-birth-weight infants in a Brazilian fee-paying maternity in the 1990s.

This study describes intra-hospital survival rates of very-low-birth-weight infants, as well as factors present at birth associated with survival, during a period of 10 years. This is a Retrospective cohort study performed in a 3rd level nursery at Santa Joana Maternity Hospital, a fee-paying institution in Sao Paulo, Brazil. From January 1991 to December 2000, 963 live-born infants with a birth weight of 500-1499 g, without congenital anomalies, were followed until discharge. Survival was studied according with year of birth, and stratified by birth weight and gestational age. Factors present at birth associated with survival were analyzed by logistic regression. Patient characteristics were: birth weight 500-999 g (38%), gestational ages or=750 g, and gestational age >or=26 weeks.

Sobrevida de recém-nascidos de muito baixo peso em maternidade privada de nível terciário / Survival of very low birth weight infants in level III private maternity hospital

Objetivo: descrever a sobrevida intra-hospitalar dos recém-nascidos de muito baixo peso, de acordo com as faixas de peso ao nascer (PN) e idade gestacional (IG) no período de 4 anos, em naternidade privada de nível terciário. Métodos: Coorte prospectiva de 146 RN com PN de 500 a 1499g, sem anolmalias congênitas incompatíveis com a vida, com IG superior a 22 semanas, que nasceram e permaneceram internados na Maternidade Pro-Matre Paulista até a alta, no período de março de 2000 a fevereiro de 2004. Descreve-se a taxa de sobrevida por faixa de PN e IG e nalisam-se fatores presentes ao nascimento, associados à sobrevida intra-hospitalar por meio de regressão logística. Resultados: características dos 146 RN: PN 1096+-284g, IG 29,4+-3,2 semanas, pequeno/IG 42 por cento, gestações múltiplas 39 por cento, sexo masculino 47 por cento e parto cesáreo 79 por cento. A sobrevida, nas faixas de 500-749g, 1000-1249g e 1250-1499g foi, respectivamente, 39, 78, 85 e 98 por cento. A sobrevida dos pacientes de 23-24, 25-27 semanas, 28-30 e 31-33 semanas foi respectivamente, 36, 69, 86 e 94 por cento. A análise de regressão mostrou que a sobrevida intra-hospitalar aumentou com a elevação do PN (OR 0,995; IC 95 por cento 0,993-0,997) e não teve influêncian dos fatores IG, adequação PN/IG, gestação múltipla, sexo, parto ou ano de nascimento. Conclusões: em 4 anos, a sobrevida foi crescente de acordo com o aumento do peso ao nascer. Esforços devem ser direcionados para que taxas maiores de sobrevida sejam obtidas, em especial, nos nascidos entre 500 e 750g e/ou idade gestacional entre 23 e25 semanas.

A survey of the incidence of neonatal sepsis by group B Streptococcus during a decade in a Brazilian maternity hospital.

Group B Streptococcus (GBS) is the main etiological agent of neonatal sepsis in developed countries, however there is no detailed information on its incidence in Brazil. We registered the incidence and lethality of GBS infection in a Brazilian private maternity hospital from April 1991 to March 2000. Maternal risk factors contributing to neonatal infections were also scored. The rate of infection was determined by checking for GBS in the blood and liquor of symptomatic neonates within 72 hours of birth. Sepsis and/or early onset meningitis were diagnosed in 43 neonates (32 cases in blood, 1in liquor and 10 in blood and liquor). The overall incidence was 0.39 per thousand neonates and remained quite constant throughout the period, ranging from 0.25-0.63. Septic shock occurred in 33 neonates within 1 to 36 hours of birth (mean 15 hours). Among those patients, 26 (60%) died between the 5th and the 85th hour after birth. Maternal risk factors, according to CDC criteria, included: gestational age below 37 weeks in 26 cases (60%), amniorrhexis equal or superior to 18 hours in 7 cases (16%), and maternal temperature equal or superior to 38(o)C in 4 cases (9%). None of the mothers had received prophylactic antibiotics during labor nor were urine, rectal or vaginal swabs screened for GBS. Although the incidence of GBS infection in the population in this study was lower than that found in developed countries, its rate of mortality was higher. The death rate could be reduced through recognition of the risk factors and prophylactic antibiotics during labor.

A survey of the incidence of neonatal sepsis by group B Streptococcus during a decade in a Brazilian maternity hospital

Group B Streptococcus (GBS) is the main etiological agent of neonatal sepsis in developed countries, however there is no detailed information on its incidence in Brazil. We registered the incidence and lethality of GBS infection in a Brazilian private maternity hospital from April 1991 to March 2000. Maternal risk factors contributing to neonatal infections were also scored. The rate of infection was determined by checking for GBS in the blood and liquor of symptomatic neonates within 72 hours of birth. Sepsis and/or early onset meningitis were diagnosed in 43 neonates (32 cases in blood, 1in liquor and 10 in blood and liquor). The overall incidence was 0.39 per thousand neonates and remained quite constant throughout the period, ranging from 0.25-0.63. Septic shock occurred in 33 neonates within 1 to 36 hours of birth (mean 15 hours). Among those patients, 26 (60) died between the 5th and the 85th hour after birth. Maternal risk factors, according to CDC criteria, included: gestational age below 37 weeks in 26 cases (60), amniorrhexis equal or superior to 18 hours in 7 cases (16), and maternal temperature equal or superior to 38(o)C in 4 cases (9). None of the mothers had received prophylactic antibiotics during labor nor were urine, rectal or vaginal swabs screened for GBS. Although the incidence of GBS infection in the population in this study was lower than that found in developed countries, its rate of mortality was higher. The death rate could be reduced through recognition of the risk factors and prophylactic antibiotics during labor.

Listeriose neonatal / Neonatal listeriosis

Os autores descrevem e discutem três casos de infecçäo por Listeria mono cytogenes no período de janeiro de 1994 a dezembro de 1995, diagnosticados na Unidade Neonatal do Hospital e Maternidade Santa Joana, Säo Paulo. Nos três casos observamos líquido amniótico meconial. Em dois havia história materna de infecçäo de vias urinárias, fisometria e a idade gestacional (IG) era menor que 35 semanas. O quadro clínico nestes casos foi mais grave, evoluindo para óbito em menos de 24 horas. O terceiro recém-nascido(RN) tinha uma IG de 37 semanas, sem antecedentes de patologias maternas e a evoluçäo clínica foi satisfatória. É importante lembrar que o obstetra de estar atento para situaçöes de risco, já que o tratamento precoce da mäe pode modificar a...

Análise clínica laboratorial na sensibilizaçäo eritrocitária perinatal com a realizaçäo de estudo imuno-hematológico pela gel-centrifugaçäo / Clinico-laboratorial analysis in perinatal erythrocytic sensitivity with the immuno-hematologic study by gel centrifugation

O estudo da rotina imuno-hematológica materno-fetal de 4.340 partos, objetiva correlacionar os resultados positivos dos testes de Coombs Indireto com uma possível icterícia na clínica evolutiva dos recém-nascidos. A rotina consiste na análise do sangue materno (tipagem ABO/Rh-fenotipagem Rh e Kell-Teste de Coombs indireto) e do sangue do recém-nascido (tipagem ABO/Rh-fenotipagem Rh e Kell - Teste de Coombs Direto) obtidos pela metodologia em gel-centrifugaçäo. Em 4340 partos, foram identificados 135 (3,1 por cento) testes de Coombs positivos. As especialidades fos anticorpos encontrados fcoram as seguintes: 94 (69,6 por cento) no sistema ABO; 16 (11,8 por cento) nos vários sistemas, tais como Kell, Duffy, MNSs e HI; 14 (10,4 por cento) no sistema Rh (CcDEe); e 11 (8,2 por cento) no sistema Lewis. Dos 135 testes de Coombs positivo, 104 apresentaram Teste de Coombs direto positivo, onde 87 (83,7 por cento) dos recém-nascidos desenvolveram ictericia. Do total de 135 casos apenas 9 (6,7 por cento) apresentaram positividade para ambos os testes de Coombs, com 100 por cento dos recém-nascidos apresentando icterícia. Os resultados obtidos foram de grande valia, pois com o diagnóstico da hemólise eritrocitária pela causa imunohematológica, obtidos pela utilizaçäo de uma técnica mais sensível, observamos a predominância na positividade do Coombs direto (104 casos - 72,2 por cento), independente do sistema sangüineo materno, mostrando que é aconselhável manter o recém-nascido sob observaçäo por um período mínimo de 72 horas para melhor avaliaçäo da evoluçäo clínica laboratorial da doença hemolítica perinatal