Efeitos adversos da eletrotermofototerapia em clínicas da cidade de Cascavel - PR / Los efectos adversos del electrotermofototerapia en clínicas de la ciudad de Cascavel - PR / Adverse effects of electrothermal phototherapy in clinics in the city of Cascavel - PR

RESUMO Esta pesquisa teve como objetivo identificar os principais efeitos adversos observados por fisioterapeutas com o uso de aparelhos de eletrotermofototerapia em clínicas da cidade de Cascavel, Paraná. A amostra contou com 35 clínicas e destas, 25 foram alvo de coleta após triagem, cujos dados foram obtidos por questionários em forma de entrevista semiestruturada. Nestes se questionava aos responsáveis pelo serviço de eletrotermofototerapia sobre a ocorrência de efeitos adversos experienciados durante atividades laborais na clínica. Observou-se que a Neuroestimulação Elétrica Transcutânea (TENS) apresentou problemas em 64% dos casos, com 36% devido a irritações cutâneas e 28% a dor. O aparelho de ondas curtas apresentou efeitos adversos em 60%, em que 40% foram queixas de dor e 20% causaram queimaduras leves. Já acerca do ultrassom terapêutico foram relatados efeitos adversos em 52%, sendo 32% de quadros de dor e 20% de casos com náuseas. A laserterapia de baixa potência demonstrou efeito adverso em 36%, com relatos de aumento da sensibilidade local. Por fim, os aparelhos de média frequência apresentaram efeitos adversos em apenas 20% dos casos, de queixas de náuseas. A quantidade de tais efeitos encontrados foi importante, porém sua gravidade não causou grande preocupação.

RESUMEN Este estudio propone identificar los principales efectos adversos observados por fisioterapeutas con el uso de aparatos de electrotermofototerapia en clínicas de la ciudad de Cascavel, Paraná (Brasil). De la muestra han participado 35 clínicas, de las cuales restaron 25 después del triaje, cuyos datos fueron obtenidos por cuestionarios en forma de entrevista semiestructurada. Estos contenían preguntas al responsable del servicio de electrotermofototerapia sobre la ocurrencia de los efectos adversos ocurridos durante el trabajo en la clínica. Se observó que el Electroestimulación Transcutánea (TENS, en inglés) presentó problemas en un 64 % de los casos, con un 36 % debido a irritaciones de la piel y un 28 % al dolor. En el aparato de ondas cortas se verificó efectos adversos en un 60 %, de las cuales un 40 % fueron de quejas de dolor y un 20 % de quemaduras leves. Sobre el ultrasonido terapéutico, se han divulgado los efectos adversos en un 52 %, de los cuales un 32 % fueron síntomas de dolor y un 20 % casos con náuseas. La terapia con láser de baja intensidad resultó en efectos adversos en el 36 %, con informes de aumento de la sensibilidad local. Por último, los dispositivos de frecuencia media revelaron efectos adversos en sólo el 20 % de los casos de las quejas de náuseas. La cantidad de estos efectos encontrados es importante, pero su gravedad no demostró gran preocupación.

ABSTRACT This study aimed to identify the main adverse effects observed by physical therapists using electrothermal phototherapy devices in clinics in the city of Cascavel, Paraná. The sample comprised 35 clinics, of which 25 were submitted to data collection after sorting. Data were collected through questionnaires in the form of semi-structured interview. In these questionnaires, the responsible for providing the electrothermal phototherapy service were asked about the occurrence of adverse effects experienced during labor activities at the clinic. Transcutaneous electrical nerve stimulation (TENS) showed problems in 64% of cases, being 36% due to skin irritations and 28% due to pain. The shortwave apparatus showed adverse effects in 60% of cases, of which 40% consisted of complaints of pain and 20% caused minor burns. Regarding therapeutic ultrasound, adverse effects were reported in 52% of cases, of which 32% were episodes of pain and 20% of nausea. The low-power laser therapy showed adverse effect on 36% of cases, with reports of increased local sensitivity. Finally, the medium frequency devices had adverse effect in only 20% of cases, being complaints of nausea. The amount of such effects found was important, but their gravity did not cause major concern.

Repulsive Environment Attenuation during Adult Mouse Optic Nerve Regeneration.

The regenerative capacity of CNS tracts has ever been a great hurdle to regenerative medicine. Although recent studies have described strategies to stimulate retinal ganglion cells (RGCs) to regenerate axons through the optic nerve, it still remains to be elucidated how these therapies modulate the inhibitory environment of CNS. Thus, the present work investigated the environmental content of the repulsive axon guidance cues, such as Sema3D and its receptors, myelin debris, and astrogliosis, within the regenerating optic nerve of mice submitted to intraocular inflammation + cAMP combined to conditional deletion of PTEN in RGC after optic nerve crush. We show here that treatment was able to promote axonal regeneration through the optic nerve and reach visual targets at twelve weeks after injury. The Regenerating group presented reduced MBP levels, increased microglia/macrophage number, and reduced astrocyte reactivity and CSPG content following optic nerve injury. In addition, Sema3D content and its receptors are reduced in the Regenerating group. Together, our results provide, for the first time, evidence that several regenerative repulsive signals are reduced in regenerating optic nerve fibers following a combined therapy. Therefore, the treatment used made the CNS microenvironment more permissive to regeneration.

Comparison of morphological and functional outcomes of mouse sciatic nerve repair with three biodegradable polymer conduits containing poly(lactic acid).

Poly(lactic acid) (PLA)-containing nerve guidance conduits (NGCs) are currently being investigated for nerve repair as an alternative to autograft, which leads to permanent functional impairment in the territory innervated by the removed nerve. Combination of polymers modifies the physical properties of the conduits, altering their nerve-guidance properties. Conduits made from PLA-only or combined with other polymers have been used successfully for nerve repair, but their efficiency has not been compared. We compared the morphological and functional outcomes of peripheral nerve repair by using NGCs made of poly(lactic acid) and combined or not with polycaprolactone (PLA/PCL) or polyvinylpyrrolidone (PLA/PVP). To assess the functional recovery, we employed a mechanical hyperalgesia analysis, sciatic functional index (SFI), and electroneuromyography. The mechanical hyperalgesia analysis showed that the PLA group improved more rapidly than the PLA/PVP and PLA/PCL groups; similarly, in the electroneuromyography assay, the PLA group exhibited higher amplitude than the PLA/PCL and PLA/PVP groups. However, the SFI improvement rates did not differ among the groups. Morphologically, the PLA group showed more vascularization, while the nerve fiber regeneration did not differ among the groups. In conclusion, the PLA-only conduits were superior to the other NGCs tested for nerve repair.

Absence of galectin-3 promotes neuroprotection in retinal ganglion cells after optic nerve injury.

A trauma to the mature central nervous system (CNS) often leads to persistent deficits, due to the inability of axons to regenerate after being injured. Increasing evidence suggests that pro-inflammatory and pro-apoptotic genes can present a major obstacle to promoting neuroprotection of retinal ganglion cells and consequently succeed in axonal regeneration. This study evaluated the effect of the absence of galectin-3 (Gal-3) on retinal ganglion cells (RGC) survival and axonal regeneration/degeneration after optic nerve crush injury. Two weeks after crush there was a 2.6 fold increase in the rate of cell survival in Gal-3-/- mice (1283±79.15) compared to WT animals (495.4±53.96). However, no regeneration was observed in the Gal-3-/- mice two weeks after lesion. Furthermore, axonal degeneration presented a particular pattern on those mice; Electron Microscopy (EM) analysis showed incomplete axon degeneration while the WT mice presented an advanced stage of degeneration. This suggests that the removal of the nerve fibers in the Gal 3-/- mice could be deficient and this would cause a delay in the process of Wallerian degeneration once there is a decrease in the number of macrophages/microglia in the nerve. This study demonstrates how the absence of Gal-3 can affect RGC survival and optic nerve regeneration/degeneration after lesion. Our results suggest that the absence of Gal-3 plays an important role in the survival of RGC and thus can be a potential target for therapeutic intervention in RGC neuroprotection.

Olfactory ensheathing glia cell therapy and tubular conduit enhance nerve regeneration after mouse sciatic nerve transection.

The regenerative potential of the peripheral nervous system (PNS) is widely known, but functional recovery, particularly in humans, is seldom complete. Therefore, it is necessary to resort to strategies that induce or potentiate the PNS regeneration. Our main objective was to test the effectiveness of Olfactory Ensheathing Cells (OEC) transplantation into a biodegradable conduit as a therapeutic strategy to improve the repair outcome after nerve injury. Sciatic nerve transection was performed in C57BL/6 mice; proximal and distal stumps of the nerve were sutured into the collagen conduit. Two groups were analyzed: DMEM (acellular grafts) and OEC (1×105/2µL). Locomotor function was assessed weekly by Sciatic Function Index (SFI) and Global Mobility Test (GMT). After eight weeks the sciatic nerve was dissected for morphological analysis. Our results showed that the OEC group exhibited many clusters of regenerated nerve fibers, a higher number of myelinated fibers and myelin area compared to DMEM group. The G-ratio analysis of the OEC group showed significantly more fibers on the most suitable sciatic nerve G-ratio index. Motor recovery was accelerated in the OEC group. These data provide evidence that the OEC therapy can improve sciatic nerve functional and morphological recovery and can be potentially translated to the clinical setting.

Evaluation of biodegradable polymer conduits--poly(L-lactic acid)--for guiding sciatic nerve regeneration in mice.

Polymeric biomaterials are often used for stimulating nerve regeneration. Among different conduits, poly(lactide acid) - PLA polymer is considered to be a good substrate due to its biocompatibility and resorbable characteristics. This polymer is an aliphatic polyester which has been mostly used in biomedical application. It is an organic compound with low allergenic potential, low toxicity, high biocompatibility and predictable kinetics of degradation. In this study we fabricated and evaluated a PLA microporous hollow fiber as a conduit for its ability to bridge a nerve gap in a mouse sciatic nerve injury model. The PLA conduit was prepared from a polymer solution, throughout extrusion technique. The left sciatic nerve of C57BL/6 mouse was transected and the nerve stumps were placed into a resorbable PLA (PLA group) or a PCL conduit (PCL group), n=5 each group. We have also used another group in which the nerves were repaired by autograft (autograft group, n=5). Motor function was analyzed according to sciatic functional index (SFI). After 56days, the regenerated nerves were processed for light and electron microscopy and morphometric analyses were performed. A quantitative analysis of regenerated nerves showed significant increase in the number of myelinated fibers and blood vessels in animals that received PLA conduit. The PLA group exhibited better overall tissue organization compared to other groups. Presenting well-organized bundles, many regenerating clusters composed of preserved nerve fibers surrounded by layers of compacted perineurium-like cells. Also the SFI revealed a significant improvement in functional recovery. This work suggests that PLA conduits are suitable substrate for cell survival and it provides an effective strategy to be used to support axonal growth becoming a potential alternative to autograft.

The non-competitive blockade of GABAA receptors by an aqueous extract of water hemlock (Cicuta douglasii) tubers.

Water hemlocks (Cicuta spp.) are acutely toxic members of the Umbellierae family; the toxicity is due to the presence of C17-polyacetylenes such as cicutoxin. There is only limited evidence of noncompetitive antagonism by C17-polyacetylenes at GABAA receptors. In this work with WSS-1 cells, we documented the noncompetitive blockade of GABAA receptors by an aqueous extract of water hemlock (Cicuta douglasii) and modulated the actions of the extract with a pretreatment of 10 µM midazolam.

A combination of Schwann-cell grafts and aerobic exercise enhances sciatic nerve regeneration.

BACKGROUND: Despite the regenerative potential of the peripheral nervous system, severe nerve lesions lead to loss of target-organ innervation, making complete functional recovery a challenge. Few studies have given attention to combining different approaches in order to accelerate the regenerative process. OBJECTIVE: Test the effectiveness of combining Schwann-cells transplantation into a biodegradable conduit, with treadmill training as a therapeutic strategy to improve the outcome of repair after mouse nerve injury. METHODS: Sciatic nerve transection was performed in adult C57BL/6 mice; the proximal and distal stumps of the nerve were sutured into the conduit. Four groups were analyzed: acellular grafts (DMEM group), Schwann cell grafts (3×105/2 µL; SC group), treadmill training (TMT group), and treadmill training and Schwann cell grafts (TMT + SC group). Locomotor function was assessed weekly by Sciatic Function Index and Global Mobility Test. Animals were anesthetized after eight weeks and dissected for morphological analysis. RESULTS: Combined therapies improved nerve regeneration, and increased the number of myelinated fibers and myelin area compared to the DMEM group. Motor recovery was accelerated in the TMT + SC group, which showed significantly better values in sciatic function index and in global mobility test than in the other groups. The TMT + SC group showed increased levels of trophic-factor expression compared to DMEM, contributing to the better functional outcome observed in the former group. The number of neurons in L4 segments was significantly higher in the SC and TMT + SC groups when compared to DMEM group. Counts of dorsal root ganglion sensory neurons revealed that TMT group had a significant increased number of neurons compared to DMEM group, while the SC and TMT + SC groups had a slight but not significant increase in the total number of motor neurons. CONCLUSION: These data provide evidence that this combination of therapeutic strategies can significantly improve functional and morphological recovery after sciatic injury.

Neurotrauma and mesenchymal stem cells treatment: From experimental studies to clinical trials.

Mesenchymal stem cell (MSC) therapy has attracted the attention of scientists and clinicians around the world. Basic and pre-clinical experimental studies have highlighted the positive effects of MSC treatment after spinal cord and peripheral nerve injury. These effects are believed to be due to their ability to differentiate into other cell lineages, modulate inflammatory and immunomodulatory responses, reduce cell apoptosis, secrete several neurotrophic factors and respond to tissue injury, among others. There are many pre-clinical studies on MSC treatment for spinal cord injury (SCI) and peripheral nerve injuries. However, the same is not true for clinical trials, particularly those concerned with nerve trauma, indicating the necessity of more well-constructed studies showing the benefits that cell therapy can provide for individuals suffering the consequences of nerve lesions. As for clinical trials for SCI treatment the results obtained so far are not as beneficial as those described in experimental studies. For these reasons basic and pre-clinical studies dealing with MSC therapy should emphasize the standardization of protocols that could be translated to the clinical set with consistent and positive outcomes. This review is based on pre-clinical studies and clinical trials available in the literature from 2010 until now. At the time of writing this article there were 43 and 36 pre-clinical and 19 and 1 clinical trials on injured spinal cord and peripheral nerves, respectively.

Sanitizer residues in the milk of cows which had passed through footbaths / Resíduos de sanitizantes em vacas de leite após passagem por pedilúvio

Copper sulfate and sodium hypochlorite are used in footbath solutions for the prevention and treatment of bovine digital diseases; however, data on the residues of such elements in milk are sparse in Brazil. This study evaluated the cost of applying the footbath treatment and the total amount of copper and chlorite residues in the milk of healthy cows after they had passed through these footbath solutions. Two groups of 7 cows each (GI and GII) were studied. In the case of GI, 1% sodium hypochlorite was used and for GII 5% copper sulfate was employed in the footbath. The milk samples were collected before the 7-day footbath treatment period (M0) and 24 h (M1), 48 h (M2), 72 h (M3) and 15 days (M15) after the last footbath. Statistical analysis to compare the different samples within each group was carried out by applying Friedman's test, followed by Dunn's test (p<0.05). It was concluded that the amount of total chlorites and copper in the milk of healthy cattle after routine daily footbaths for a period of 7 days presented some variations. However, the concentrations observed were considered insufficient to represent a risk to human health. The cost of the footbath solutions was found to be reasonable.

O sulfato de cobre e o hipoclorito de sódio são empregados na prevenção e tratamento das enfermidades digitais dos bovinos, mas os valores residuais desses elementos foram pouco estudados. Neste estudo, avaliou-se a presença de resíduos de cobre e cloretos totais no leite de vacas saudáveis após passagens dos animais em pedilúvio contendo soluções formuladas com estas substâncias e estimou-se os custos das soluções. Utilizou-se 14 vacas saudáveis distribuídas em dois grupos (GI e GII) de sete animais cada. Em GI, empregou-se solução de hipoclorito de sódio a 1% e, em GII, sulfato de cobre a 5%. As amostras de leite foram colhidas antes da passagem pelo pedilúvio (M0), após 24 (M1), 48 (M2) e 72 (M3) horas, além de 15 dias (M15) subsequentes à última passagem. Na análise estatística, a comparação entre momentos dentro de cada grupo foi realizada com teste de Friedman, seguido pelo teste de Dunn's (p<0,05). Concluiu-se que os valores de cloretos totais e de cobre no leite de bovinos saudáveis, após passagens diárias dos animais em pedilúvio por um período de sete dias, apresentaram algumas variações consideradas insuficientes para provocarem danos à saúde humana e as soluções medicamentosas não apresentaram custos exorbitantes.