A systematic review on the effectiveness of perturbation-based balance training in postural control and gait in Parkinson's disease.

BACKGROUND: Pharmacological and surgical interventions do not improve postural control and gait effectively in people with Parkinson's disease (PD). An innovative and promising therapeutic intervention is perturbation-based balance training (PBT). OBJECTIVE: To perform a systematic review to summarise the current evidence for PBT on postural control and gait in people with PD. Intervention studies including PBT, in isolation or associated with other physical interventions, were included. LITERATURE SURVEY: PubMed, SciELO, PEDro and Cochrane databases were searched between June 2000 and March 2020. METHODS: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and is registered in the PROSPERO database (CRD42020203961). The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation. Studies were assessed for methodological quality using the PEDro scale. Two of the authors reviewed the search results and selected studies using predefined selection criteria. No restrictions based on severity of PD, time since diagnosis or age were used. SYNTHESIS: Eleven studies were selected for final evaluation. Most outcomes were downgraded in quality of evidence, mainly because of publication bias and limitations. The most consistent results indicate that PBT can improve postural control and gait in people with PD, including a reduction in the number of falls and a decrease in the severity of PD. CONCLUSION: PBT may be a promising option for the treatment of people with PD, and an adjunct to conventional physiotherapeutic treatment. However, deficiencies in the methodological quality and quality of evidence of studies included in this review have limited the reliability of the conclusions. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020203961.

Sol-gel based calcium phosphates coatings deposited on binary Ti-Mo alloys modified by laser beam irradiation for biomaterial/clinical applications.

Ti-15Mo alloy samples were irradiated by pulsed Yb: YAG laser beam under air and atmospheric pressure. Calcium phosphate coatings were deposited on the irradiated surfaces by the sol-gel method. The sol was prepared from the precursors Ca (NO3)2.4H2 O and H3 PO4. The modified surfaces were submitted to heat treatment conditions at 350 and 600 °C. The results showed that the two conditions established have a sufficient energy to promote ablation on the laser beam irradiated surfaces. Likewise, it has been demonstrated the processes of fusion and fast solidification from the laser beam irradiation, under ambient atmosphere, inducing the formation of stoichiometric TiO2 and non-stoichiometric titanium oxides, including Ti3O5, TiO, Ti3O and Ti6O with different oxide percentages depending on the fluency used. Besides that, laser modification has allowed a clean and reproducible process, providing no traces of contamination, an important feature for clinical applications. The physico-chemical and morphological properties indicated the formation of a mixture of phases: calcium pyrophosphate, hydroxyapatite and ß-TCP for the procedure (PA: calcination temperature), whereas HA (hydroxyapatite) and ß-TCP (tricalcium phosphate) were obtained by the procedure (PB: calcination temperature). Therefore, it was possible to obtain a Ti-15Mo alloy surface consisted on calcium phosphate ceramics of biological interest using the procedure (PB). Thus, the laser beam irradiation associated to bioactive coatings of calcium phosphates of biological interest have shown to be promising and economically feasible for use in dental and orthopedic implants.

Surface physical chemistry properties in coated bacterial cellulose membranes with calcium phosphate.

Bacterial cellulose has become established as a new biomaterial, and it can be used for medical applications. In addition, it has called attention due to the increasing interest in tissue engineering materials for wound care. In this work, the bacterial cellulose fermentation process was modified by the addition of chondroitin sulfate to the culture medium before the inoculation of the bacteria. The biomimetic process with heterogeneous calcium phosphate precipitation of biological interest was studied for the guided regeneration purposes on bacterial cellulose. FTIR results showed the incorporation of the chondroitin sulfate in the bacterial cellulose, SEM images confirmed the deposition of the calcium phosphate on the bacterial cellulose surface, XPS analysis showed a selective chemical group influences which change calcium phosphate deposition, besides, the calcium phosphate phase with different Ca/P ratios on bacterial cellulose surface influences wettability. XTT results concluded that these materials did not affect significantly in the cell viability, being non-cytotoxic. Thus, it was produced one biomaterial with the surface charge changes for calcium phosphate deposition, besides different wettability which builds new membranes for Guided Tissue Regeneration.

Natural rubber latex coated with calcium phosphate for biomedical application.

Natural rubber latex (NRL) is a flexible biomembrane that possesses angiogenic properties and has recently been used for guided bone regeneration, enhancing healing without fibrous tissue, allergies or rejection. Calcium phosphate (Ca/P) ceramics have chemical, biological, and mechanical properties similar to mineral phase of bone, and ability to bond to the host tissue, although it can disperse from where it is applied. Therefore, to create a composite that could enhance the properties of both materials, NRL biomembranes were coated with Ca/P. NRL biomembranes were soaked in 1.5 times concentrated SBF solution for seven days, avoiding the use of high temperatures. SEM showed that Ca/P has been coated in NRL biomembrane, XRD showed low crystallinity and FTIR showed that is the carbonated type B. Furthermore, hemolysis of erythrocytes, quantified spectrophotometrically using materials (Ca/P, NRL, and NRL + Ca/P) showed no hemolytic effects up to 0.125 mg/mL (compounds and mixtures), indicating no detectable disturbance of the red blood cell membranes. The results show that the biomimetic is an appropriate method to coat NRL with Ca/P without using high temperatures, aiming a new biomembrane to improve guided bone regeneration.

Radiculopathy due to iatrogenic fistula between subclavian artery and internal jugular vein.

Central venous cannulation is a routine procedure. We describe a rare complication of internal jugular vein catheterization leading to radiculopathy of the right upper arm. MRI of the neck showed compression of the spinal cord and C2-C7 roots by the engorged veins. Digital subtraction angiography demonstrated a fistula between subclavian artery and internal jugular vein. The fistula was successfully occluded by stent placement in the artery.