Use of skin graft punch graft type for the healing of leg ulcers in treated Hansen's disease patients

Hansen's disease is an infectious illness caused by Mycobacterium leprae. It affects preferentially the skin and the peripheral nervous system leading to incapacities, such as leg ulcers, which happens due to the direct action of the bacillus on the organs or its indirect action on the peripheral nervous system. Leg ulcers can occur by two physiopathologic processes. There are many treatments for general leg ulcers, which include the ones caused by Hansen's disease sequels. Among them, surgical treatment shows to be effective when using skin graft, which can be performed by several techniques. Considering the low number of techniques known for treating leg ulcers in Hansen's disease sequels, the aims of this work were to standardize alternative techniques, to detect the main bacteria found in ulcer secretion cultures, to analyze the patients profile and the ulcers, to describe the histophatologies found, and to correlate these data with those of literature from all over the world. Skin graft punch type was carried out and analyzed; males had a mean age of 59.4 years old and females, 54.2 years old. Patients were 73.6% male and 26.3% female. Lepromatous type was present in 89.4% patients and tuberculoid type was seen in 10.5% of them. Associated systemic diseases were observed in 26.3% patients. Mean time of ulcers evolution was 11.6 years in male and 12.8 years in women. The average diameter of ulcers in the pre-treatment period was 8.5 X 9.5 cm in male and 10.2 X 6.8 cm in women. After the graft, their average diameters were 3.2 X 2.7 cm in male and 5.1 X 5.6 cm in women. Statistical analysis showed that there was no significant correlation between the ulcer diameter and its reduction or not in the post-surgery period (p=0.269732). The mean age of patients whose ulcers diameter did not change or reduced by only 20% was 63.5 years. Using the Spearman's coefficient, it was possible to observe that there was no significant correlation between the patients' age and the ulcers diameter reduction after the skin graft (p=0.222531). Evolution time of ulcers that did not present any satisfactory result in the post-surgery period was 12.1 years. The Spearman's coefficient showed that there was no significant correlation between the ulcers evolution time and the ulcers diameter reduction in the post-surgery period (p=0.191655). Cultures presented 50% of cases with Pseudomonas aeruginosa. Statistical analysis showed there is no correlation between the bacterial types found and the ulcer evolution in the post-surgery period (p=0.697531). The average of the ulcers diameter reduction was 42.4%, and in 26.3% of the patients the lesions disappeared after the skin graft.

Leg muscles recruitment pattern in soccer players and active individuals during isometric contractions

This study aimed to compare the torque, torque ratio (Hamstrings:Quadriceps - H:Q), electromyographic (EMG) activity and EMG ratio (knee flexors:knee extensors EMG) in soccer players (SG, N=10) and active subjects (AG, N=10). Subjects performed three maximal voluntary isometric knee extensions and flexions at 45° and 90° to determine the peak torque and EMG activity. Torque and EMG activity of the knee flexor (biceps femoris [BF] and semitendinosus [ST]) were divided by the torque and EMG activity of the knee extensor (vastuls lateralis [VL] and rectus femoris [RF]) to calculate torque ratios (H:Q) and EMG ratios (BF:VL, BF:RF, ST:VL, ST:RF). The flexion torque was significantly higher for SG (p<0.05) in 45° and 90°. EMG activity for SG was significantly higher in agonist contractions for VL, RF and ST, and significantly lower in antagonist contractions for RF and ST when compared to AG Torque and EMG ratios were similar between groups and there were good correlations between torque ratio and BF:VL ratio (r=0.71, p=0.02) and BF:RF ratio (r=0.81, p=0.004) at 45. The EMG results could overestimate the joint balance calculated using torque ratios. Differences in recruitment pattern between soccer players and non-athletes can be related to the training routines and the EMG ratios presents applicable in trained populations.

3-D Space Vector PWM implementation for Four-Leg Voltage Source Inverter

The Space Vector PWM implementation and operation for a Four-leg Voltage Source Inverter (VSI) is detailed and discussed in this paper. Although less common, four-leg VSIs are a viable solution for situations where neutral connection is necessary, including Active Power Filter applications. This topology presents advantages regarding the VSI DC link and capacitance, which make it useful for high power devices. Theory, implementation and simulations are also discussed in this paper. © 2011 IEEE.

Influence of enclosure size on growth of breast and leg muscle fibers in domestic fowl

This experiment evaluated the growth of breast and leg muscle fibers of domestic fowl raised in two enclosure sizes (SE: Small Enclosure, 1.125 m2/10 birds; LE: Large Enclosure, 5.25 m2/10 birds). In breast muscles, the number of fibers per area decreased over time and higher values were observed in broilers housed in SE compared to LE. The fiber size increased with age and was greater in LE than SE at 56 days of age, suggesting greater hypertrophic growth of fibers in breast muscle for broilers maintained in LE. In leg muscles, the muscle cross-sectional area was greater for broilers raised in LE than SE at 56 days of age and decreased from 42 to 56 days of age in broilers raised in SE, suggesting leg muscle atrophy in these birds. The Fast Glycolytic (FG), Fast Oxidative-Glycolytic (FOG) and Slow Oxidative (SO) fibers grew until 42 days of age in both enclosure sizes. The area of FOG fibers was greater in broilers raised in LE than those in SE at 28 and 56 days of age; in LE-raised broilers, the SO area was greater at 28, 42 and 56 days of age, suggesting that the muscles of broilers housed in LE are more oxidative. The BW gain was greater for broilers raised in LE than SE, whereas BW, feed intake and feed conversion were not influenced by enclosure size. Thus, the enclosure space affected hypertrophic growth and metabolic characteristics of breast and leg muscle fibers. © Asian Network for Scientific Information, 2012.

Effect of different rest intervals, between sets, on muscle performance during leg press exercise, in trained older women

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Age-related differences in time-limit performance and force platform-based balance measures during one-leg stance

Poor posture control has been associated with an increased risk of falls and mobility disability among older adults. This study was conducted to assess the test-retest reliability and sensitivity to group differences regarding the time-limit (TLimit) of one-leg standing and selected balance parameters obtained with a force platform in older and young adults. A secondary purpose was to assess the relationship between TLimit and these balance parameters. Twenty-eight healthy older adults (age: 69±5years) and thirty young adults (age: 21±4years) participated in this study. Two one-leg stance tasks were performed: (1) three trials of 30s maximum and (2) one TLimit trial. The following balance parameters were computed: center of pressure area, RMS sway amplitude, and mean velocity and mean frequency in both the anterio-posterior and medio-lateral directions. All balance parameters obtained with the force platform as well as the TLimit variable were sensitive to differences in balance performance between older and young adults. The test-retest reliability of these measures was found to be acceptable (ICC: 0.40-0.85), with better ICC scores observed for mean velocity and mean frequency in the older group. Pearson correlations coefficients (r) between balance parameters and TLimit ranged from -0.16 to -0.54. These results add to the current literature that can be used in the development of measurement tools for evaluating balance in older and young adults. © 2013 Elsevier Ltd.

Energy expenditure during multiple sets of leg press and bench press

The purpose of this study was to quantify energy expenditure (EE) during multiple sets of leg press (LP) and bench press (BP) exercises in 10 males with at least 1 yr of resistance training (RT). The subjects underwent two sessions to determine 1 repetition maximum (1RM) on the BP and LP and one protocol consisting of a warm up and 4 sets for 10 repetitions at 70% 1RM with a 3-min rest period between sets for each exercise. Energy expenditure was calculated as the sum of oxygen uptake (aerobic component), EPOC, and lactate production (anaerobic component). There were no significant differences in EE between exercises for sets 1 to 4 and the total energy expended. However, statistical analysis revealed a significant difference (P<0.05) between exercises in RT economy (BP, 0.0206 ± 0.0044 kcal·kg-1 vs. LP, 0.0051 ± 0.0015 kcal·kg-1). Within exercise comparison showed set 4 was significantly different from sets 1 and 3 for BP, and for LP a significant difference was found between set 4 and sets 1, 2 and 3. Our results point to an increase in EE during multiple sets at 70% 1RM and show that in spite of the difference in muscle mass involved and total work done during each type of exercise, EE was not different due to greater economy during the LP.

Evidências clínico-patológicas de ovinos intoxicados experimentalmente com sementes de Crotalaria spectabilis (Leg.papilionoidea)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Intoxicação experimental de cães com sementes de Crotalaria spectabilis (Leg. Papilionoideae)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Análise de assimetria dos membros inferiores por meio de salto horizontal unipodal e resistência muscular unilateral utilizando Leg Press horizontal

Pós-graduação em Engenharia Mecânica - FEG

Translation, cultural adaptation to Brazil and validation of the venous leg ulcer quality of life questionnaire (VLU-QoL-Br)

Objetivo:traduzir o instrumento Venous legulcer quality of life questionnaire (VLU-QoL), adaptá-lo culturalmente para o português do Brasil e validá-lo com pacientes do Hospital das Clínicas da Faculdade de Medicina de Botucatu (FMB) da Universidade Estadual Paulista (Unesp). Métodos:o questionário foi traduzido por um tradutor profissional e por dois dermatologistas especialistas na área de úlceras venosas (UV), sendo reformulado em reunião com os três tradutores. O constructo (VLU-QoL-Br) foi submetido a pré-entrevista com 10 portadores de UV para a adaptação da linguagem. Posteriormente, foi aplicado em pacientes do HC-Unesp, e como teste-reteste para verificação de sua reprodutibilidade. Resultados:foram avaliados 82 pacientes, sendo 56 (68%) do sexo feminino. A idade média foi de 67,3 anos. O questionário foi traduzido, adaptado e aplicado aos pacientes. O constructo apresentou alta consistência interna (alfa= 0,94) e adequada correlação item-total. Quando avaliados os 32 retestes, observou-se correlação intraclasse para concordância de 0,78 (p < 0,01), indicando boa reprodutibilidade do constructo. A análise fatorial confirmatória corroborou as dimensões do questionário original: atividades, psicológico e sintomas. Escores do VLU-QoL-Br se associaram, independentemente, à área total das úlceras e a menor escolaridade dos sujeitos (p < 0,01). Conclusão:a tradução, a adaptação e a validação do questionário VLU-Qol-Br demonstrou boa performance psicométrica, permitindo seu uso clínico no Brasil. É importante avaliar seu desempenho em outras regiões e em diferentes amostras de indivíduos.

Quality of life profile and correlated factors in chronic leg ulcer patients in the mid-west of São Paulo State, Brazil

BACKGROUND: Chronic leg ulcer may have an impact on patients' quality of life.OBJECTIVES:This study aimed to identify the impact of leg ulcers on patient's quality of life using the Dermatology Life Quality Index and to define the main factors correlated with this perception.METHOD:Cross-sectional, non-probabilistic sampling study. We included patients with chronic leg ulcers being treated for at least 3 months. A sociodemographic and clinical survey was conducted to assess the profile of the ulcers. We administered a screening for depressive symptoms and the Dermatology Life Quality Index. We performed a descriptive statistical analysis, chi-square test and Mann-Whitney test for categorical data, Pearson for numeric variables, and multiple regression for categorical data.RESULTS:Forty-one patients were assessed. Their mean age was 61.78 years. Venous ulcers (48.8%) were the most prevalent. Seventy-three percent of the sample perceived no impact/low impact on quality of life in the past week, and 26.8% perceived moderate/high impact. A multiple regression analysis identified the causes of lesion, pain related to the ulcers, time of onset, and severity of the depressive symptoms as the variables that had an influence on quality of life.CONCLUSIONS:The majority of the sample perceived low or no impact of the condition on the quality of the life. The variables etiology of the lesion (p<0.001), pain related to the ulcers (p=0.001), time of onset (p=0.006), and severity of the depressive symptoms (p<0.001) had an influence on the quality of life, suggesting the need for further studies with more robust designs to confirm the causal relationship between these characteristics and quality of life.

Factors that influence healing of chronic venous leg ulcers: a retrospective cohort

BACKGROUND: Venous ulcers have a significant impact on patient quality of life, and constitute a worldwide public health problem. Treatment is complex, with high failure rates.OBJECTIVES: To identify clinical and therapeutic factors that influence healing of venous ulcers.METHODS: Retrospective cohort study of patients with venous ulcers. Ulcer area was measured at the first visit (T0) and after 6 months (T6) and 1 year (T12). A reduction in ulcer area of 50% or more at T6 and T12 was the outcome of interest, weighted by clinical, demographic and treatment aspects.RESULTS: Ninety-four patients were included (137 ulcers). A reduction in ulcer area of 50% or more was seen in 40.1% of patients (95% CI 31.9 to 48.4%) at T6 and 49.6% (95% CI 41.2 to 58.1%) at T12. Complete healing occurred in 16.8% (95% CI 10.5 to 23.1%) at T6 and 27% (95% CI 19.5 to 39.5%) at T12. The lowest ulcer area reductions at T6 were associated with longstanding ulcer (RR=0.95; 95% CI 0.91 to 0.98), poor adherence to compression therapy (RR=4.04; 95% CI 1.31 to 12.41), and infection episodes (RR=0.42; 95% CI 0.23 to 0.76). At T12, lower reductions were associated with longstanding ulcer (RR=0.95; 95% CI 0.92 to 0.98), longer topical antibiotic use (RR=0.93; 95% CI 0.87 to 0.99), and systemic antibiotic use (RR=0.63; 95% CI 0.40 to 0.99).CONCLUSIONS: Longstanding ulcer, infection, poor adherence to compression therapy, and longer topical and systemic antibiotic use were independently correlated with worse healing rates.

Interactions of age and leg muscle fatigue on unobstructed walking and obstacle crossing

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Clinical and Microbiologic Evaluation of Chronic Leg Ulcers: A Cross-sectional Study

OBJECTIVE: This study aimed at evaluating the flora and bacterial load of chronic leg ulcers (CLUs) according to the clinical judgment of colonization or infection.DESIGN: This was an analytical and cross-sectional study.SETTING: This study was conducted in an outpatient wound care unit in the Dermatology Department of the Botucatu School of Medicine-UNESP, Brazil.PARTICIPANTS: The participants were patients with CLUs who did not use systemic antibiotics.METHODS: The ulcers were clinically divided into 3 groups: ulcers with good granulation tissue (GGT), critical colonization (CC), and infection. Secretion was collected from a 1-cm(2) area using a swab and seeded by the semiquantitative method.OUTCOME MEASURES: The main outcome measures were genus and species of the bacteria found in the cultures and result of the semiquantitative culture correlating with the clinical diagnosis of GGT, CC, and infection.MAIN RESULTS: Seventy-seven ulcers were evaluated: 27 with GGT, 29 with CC, and 21 with infection. Gram-negative bacteria were most often found in all groups (81%): Pseudomonas aeruginosa, in granulation and colonized ulcers, and Proteus mirabilis, in infected ulcers. Ulcers from the infected group showed higher bacterial load.CONCLUSIONS: The flora of CLUs was predominantly constituted by gram-negative bacteria, and P aeruginosa was the most prevalent. The bacterial load of infected ulcers was higher as compared with the others, although some ulcers with GGT also presented a high load. The interpretation of microbiologic tests based on the swab techniques and even on semiquantitative analysis requires close clinical correlation.