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BACKGROUND: Since elevated mechanical stress along with loss of plantar protective sensation are considered relevant factors in skin breakdown resulting in diabetic foot ulcerations, the assessment of plantar pressure is important for the prevention of diabetic foot complications. Prediabetes subjects are at risk of chronic hyperglycemia complications, among them neuropathy, but information about plantar loading in this population is not available. We aimed to compare baropodometric parameters of individuals with prediabetes versus healthy persons and persons with diabetes mellitus (DM). METHODS: Baropodometric data from 73 subjects (15 with prediabetes (pre-DM), 28 with type 2 DM, 30 healthy) aged between 29 and 69 years of both genders were registered through a pressure platform with self-selected gait speed and first-step protocol. Peak plantar pressure, stance time, percentage of contact time, percentage of contact area and pressure-time integral were assessed in five plantar foot regions: heel, midfoot, metatarsals, hallux, and toes 2 to 5. Groups were compared by one-way analysis of variance with Scheffé post hoc (α = 0.05). RESULTS: Age, body mass index, gender, and arch height index did not differ between groups. Pre-DM and DM subjects presented increased peak pressure and pressure-time integral in metatarsals (p = .010; p > .001), as well as increased percentage of contact time in midfoot (p = .006) and metatarsals (p = .004) regions when compared with healthy subjects. Stance time was significantly higher (p = .017) in DM subjects. CONCLUSIONS: Pre-DM subjects seem to exhibit an altered plantar pressure distribution pattern similar to that often found in DM subjects.

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Transplantation with olfactory ensheathing cells (OECs) has been adopted after several models of spinal cord injury (SCI) with the purpose of creating a favorable environment for the re-growth of injured axons. However, a consensus on the efficacy of this cellular transplantation has yet to be reached. In order to explore alternative parameters that could demonstrate the possible restorative properties of such grafts, the present study investigated the effects of olfactory lamina propria (OLP) transplantation on hyperreflexia and myelinated fiber regeneration in adult rats with complete spinal cord transection. The efficacy of OLP (graft containing OECs) and respiratory lamina propria (RLP, graft without OECs) was tested at different post-injury times (acutely, 2- and 4-week delayed), to establish the optimum period for transplantation. In the therapeutic windows used, OLP and RLP grafts produced no considerable improvements in withdrawal reflex responses or on the low-frequency dependent depression of H-reflex. Both lamina propria grafts produced comparable results for the myelinated fiber density and for the estimated total number of myelinated fibers at the lesion site, indicating that the delayed transplantation approach does not seem to limit the regenerative effects. However, animals transplanted with OLP 2 or 4 weeks after injury exhibit smaller myelin sheath thickness and myelinated fiber area and diameter at the lesion site compared to their respective RLP groups. Despite the ongoing clinical use of OECs, it is important to emphasize the need for more experimental studies to clarify the exact nature of the repair capacity of these grafts in the treatment of SCI.

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OBJECTIVES: This study evaluated plantar thermography sensitivity and specificity in diagnosing diabetic polyneuropathy using cardiac tests (heart rate variability) as a reference standard because autonomic small fibers are affected first by this disease. METHODS: Seventy-nine individuals between the ages of 19 and 79 years old (28 males) were evaluated and divided into three groups: control (n = 37), pre-diabetics (n = 13) and type 2 diabetics (n = 29). The plantar images were recorded at baseline and then minutes after a provocative maneuver (Cold Stress Test) using an infrared camera that is appropriate for clinical use. Two thermographic variables were studied: the thermal recovery index and the interdigital anisothermal technique. Heart rate variability was measured in a seven-test battery that included three spectral indexes (in the frequency domain) and four Ewing tests (the Valsalva maneuver, the orthostatic test, a deep breathing test, and the orthostatic hypotension test). Other classically recommended tests were applied, including electromyography (EMG), Michigan inventory, and a clinical interview that included a neurological physical examination. RESULTS: Among the diabetic patients, the interdigital anisothermal technique alone performed better than the thermal recovery index alone, with a better sensitivity (81.3%) and specificity (46.2%). For the pre-diabetic patients, the three tests performed equally well. None of the control subjects displayed abnormal interdigital anisothermal readouts or thermal recovery indices, which precluded the sensitivity estimation in this sample of subjects. However, the specificity (70.6%) was higher in this group. CONCLUSION: In this study, plantar thermography, which predominately considers the small and autonomic fibers that are commonly associated with a sub-clinical condition, proved useful in diagnosing diabetic neuropathy early. The interdigital anisothermal test, when used alone, performed best.

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OBJECTIVES: This study evaluated plantar thermography sensitivity and specificity in diagnosing diabetic polyneuropathy using cardiac tests (heart rate variability) as a reference standard because autonomic small fibers are affected first by this disease. METHODS: Seventy-nine individuals between the ages of 19 and 79 years old (28 males) were evaluated and divided into three groups: control (n = 37), pre-diabetics (n = 13) and type 2 diabetics (n = 29). The plantar images were recorded at baseline and then minutes after a provocative maneuver (Cold Stress Test) using an infrared camera that is appropriate for clinical use. Two thermographic variables were studied: the thermal recovery index and the interdigital anisothermal technique. Heart rate variability was measured in a seven-test battery that included three spectral indexes (in the frequency domain) and four Ewing tests (the Valsalva maneuver, the orthostatic test, a deep breathing test, and the orthostatic hypotension test). Other classically recommended tests were applied, including electromyography (EMG), Michigan inventory, and a clinical interview that included a neurological physical examination. RESULTS: Among the diabetic patients, the interdigital anisothermal technique alone performed better than the thermal recovery index alone, with a better sensitivity (81.3%) and specificity (46.2%). For the pre-diabetic patients, the three tests performed equally well. None of the control subjects displayed abnormal interdigital anisothermal readouts or thermal recovery indices, which precluded the sensitivity estimation in this sample of subjects. However, the specificity (70.6%) was higher in this group. CONCLUSION: In this study, plantar thermography, which predominately considers the small and autonomic fibers that are commonly associated with a sub-clinical condition, proved useful in diagnosing diabetic neuropathy early. The interdigital anisothermal test, when used alone, performed best.

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Quantitative sensory testing (QST) is defined as the determination of thresholds for sensory perception under controlled stimulus. Our aim was to validate a new QST device for Brazilian sample. In 20 healthy adults, thermoalgesic thresholds were assessed using a QST prototype (Heat Pain Stimulator-1.1.10; Brazil). A 30 × 30 mm² thermode with a 1°C/s stimulus change rate were applied. Thresholds of three consecutive stimuli were averaged in two different sessions separated by at least two weeks. Additionally long thermal heat pain stimulus was performed. To evaluate the consistency of our method we also analyzed 11 patients with small fiber neuropathy. Results showed good reproducibility of thermal perception thresholds in normal individuals and plausible abnormal thresholds in patients. We conclude that our QST device is reliable when analyzing the nociceptive pathway in controls and patients.

Teste de quantificação sensitiva (TQS) significa determinação de limiares de percepção sensitiva frente a um estímulo de intensidade controlada. Nosso objetivo foi validar um novo equipamento de TQS adaptado à população brasileira. Em 20 adultos saudáveis, limiares termoalgésicos foram avaliados, utilizando um aparelho protótipo do TQS (Heat Pain Stimulator-1.1.10; Brazil). Foi utilizado um termodo de 30 × 30 mm², com estímulo térmico de 1°C/s. A média dos limiares de três estímulos consecutivos foi obtida em duas sessões diferentes, separadas por pelo menos 2 semanas. Adicionalmente, foram aplicados estímulos térmicos dolorosos de longa duração. Para avaliar a consistência do nosso método, foram também analisados 11 pacientes com neuropatia de fibras finas. Os resultados mostraram boa reprodutibilidade dos limiares de percepção nos indivíduos saudáveis, assim como limiares anormais nos pacientes. Em conclusão, nosso aparelho de TQS apresentou boa confiabilidade ao analisar a via nociceptiva de controles e pacientes.

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The purpose of this study was to investigate the possible effects of a treadmill training program on regeneration in young (3-month-old) and mature (13-month-old) rats with sciatic nerve crush using functional, electrophysiological, and morphometric analyses. When compared to both the young and mature untrained injury groups, those groups that underwent a treadmill training showed improved sensorimotor function evaluated by narrow beam test (p<0.04 and p<0.001, respectively), while muscle action potential amplitude was only greater in the young group (p<0.02). The treadmill training program was able to reduce myelinated fiber density in the young group (p<0.001), which appeared to increase after nerve injury (poly-innervation), but decreased with training, which means that the innervation became more functional. The data indicate that treadmill training is able to promote functional, electrophysiological and morphological recovery in young animals. However, in mature animals, improvement was only seen in terms of functional recovery.

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Quantitative sensory testing (QST) is defined as the determination of thresholds for sensory perception under controlled stimulus. Our aim was to validate a new QST device for Brazilian sample. In 20 healthy adults, thermoalgesic thresholds were assessed using a QST prototype (Heat Pain Stimulator-1.1.10; Brazil). A 30 × 30 mm(2) thermode with a 1°C/s stimulus change rate were applied. Thresholds of three consecutive stimuli were averaged in two different sessions separated by at least two weeks. Additionally long thermal heat pain stimulus was performed. To evaluate the consistency of our method we also analyzed 11 patients with small fiber neuropathy. Results showed good reproducibility of thermal perception thresholds in normal individuals and plausible abnormal thresholds in patients. We conclude that our QST device is reliable when analyzing the nociceptive pathway in controls and patients.

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A eletroneuromiografia (ENMG) é empregada como método de diagnóstico complementar no diagnóstico de radiculopatia desde 1950, contribuindo com importantes informações para o esclarecimento diagnóstico, planejamento do tratamento e acompanhamento evolutivo dos pacientes. A presente revisão baseada em evidências buscou referências com ênfase na indicação, sensibilidade, especificidade, reprodutibilidade e limitações do uso desse exame na avaliação das radiculopatias cervicais e lombossacrais. As referências apontam a ENMG como um exame bastante útil tanto na triagem quanto no diagnóstico diferencial na suspeita de radiculopatia cervical ou lombossacra, bem como na avaliação do grau e extensão da lesão, quando respeitadas as limitações da técnica.

Electromyography (EMG) has been employed as a complementary method in the diagnosis of radiculopathy since 1950, contributing important information for diagnostic clarification, treatment planning and patient follow-up. This evidence based review sought references with emphasis on the recommendation, sensibility, specificity, reproducibility and limitations of the use of this test in the evaluation of cervical and lumbosacral radiculopathy. The references point to EMG as being an extremely useful test both in the screening and in the differential diagnosis in the suspicion of cervical or lumbosacral radiculopathy, as well as in the evaluation of the degree and extent of the injury, when the limitations of the technique are considered.

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Este estudo prospectivo propôs-se a demonstrar a Mesoterapia como nova modalidade no tratamento conservador de casos de LER/DORT*, atualmente grande causa de absenteísmo em empresas de vários ramos e atividades.Em pacientes oriundos de 02 empresas e funçöes ocupacionais diferentes, classificados pelo Médico do Trabalho como "falha terapêutica" aos trabalhos usuais, foram aplicados Mesoterapia sob protocolos específicos por diagnóstico e tempo de evoluçäo.O número total de sessöes variou de um a cinco, com intervalos entre sete e dez dias, sendo os resultados avaliados em ÖtIMOS, BONS, REGULARES e Ruins. Encontramos ÖTIMOS resultados em 37 tratamentos (71 por cento), BONS em onze (vinte e um por cento), REGULARES em três (oito por cento) e nenhum RUIM, tendo sido também avaliados os resultados por diagnósticos específicos.Concluímos que a Mesoterapia demonstrou-se técnica reprodutível e eficaz no manejo de DORT. A técnica, se aplicada adequadamente e com seriedade, apresenta baixos índices de complicaçöes e boa resposta terapêutica

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A amostra compreendeu todas as mulheres submetidas a parto vaginal ou cesárea no mês de janeiro de 1988 no Hospital de Clínicas de Porto Alegre. Destas, 96 eram fumantes (29,44%) e 230 näo fumantes. Nos dois grupos a média de idade foi semelhante e ocorreu maior incidência de mäes brancas. O grupo fumante apresentou um maior número de pacientes sem estabilidade conjugal e menor número e puérperas com nível superior. Houve maior incidência de RNs PIG, RNs com menos de 2500g e FM no grupo fumante. Os índices de APGAR no primeiro minuto foram semelhantes nos dois grupos, no quinto minuto ocorreu um maior índice de APGAR baixo (0-6) no grupo fumante. Quando comparadas as faixas de consumo de cigarros, encontrou-se um maior número de RN PIG na faixa que consumia de 10 a 40 cigarros/dia (diferença estatisticamente significativa

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