A Catuama e o bilobalide na regeneração nervosa periférica de ratos submetidos à secção do nervo isquiático

The Catuama((R)) is composed of four Brazilian plants extracts (Paullinia cupana, Trichilia catigua, Ptychopetalum olacoides e Zingiber officinale). The Catuama((R)) is known as having neuroprotector, anti-inflammatory, antioxidant and antidepressant effects. Bilobalide, extracted from leaves of Ginkgo biloba, is known by its neuroprotective effect in the central and peripheral nervous systems. The present study evaluates the effect of Catuama((R)) and bilobalide on peripheral nerve regeneration in rats following a sciatic nerve section. Sciatic nerve of forty adult rats was transected with a 10-mm gap and the proximal and distal nerve stumps were fixed in a silicone tube filled with liquid collagen. The animals were divided into four groups: the control group (A), two groups treated with Catuama((R)) by gavage along 28 days after the surgery in different doses of 100 (B) and 400mg. kg(-1) (C) and the group using 200 mu M bilobalide (D) associated with the liquid collagen in the silicone tube. Evaluations were done by a walk test on the first, fifth and tenth week after the surgery. Electrophysiological stimulation and quantitative and qualitative histological analyses of the sciatic nerve and gastrocnemius muscle were also performed on the tenth week after the surgery. All groups showed good regeneration but no statistical difference was found between treatments and control groups (P > 0.05).

Factorial design and characterization studies for articaine hydrochloride loaded alginate/chitosan nanoparticles

Nowadays, articaine hydrochloride (ATC) is a local anesthetic widely used in dental procedures, but its side effects include paresthesia and nerve injury. Alginate/chitosan nanoparticles (AG/CSnano) can be used as carrier for drugs, overcoming the problems. The aim of this work was to evaluate the factors (Calcium/alginate [Ca2+:AG] and Chitosan/alginate [CS:AG] mass ratios) influence on the average size, polydispersity index, zeta potential and encapsulation efficiency of ATC. AG/CSnano containing ATC were prepared by ionic pregelation method. A three-level factorial design was carried out and the factors varied were Ca2+/AG mass ratio and CS/AG mass ratio. There were obtained nanoparticles with size range of 340–550 nm and polydispersity index between 0.2 and 0.5, zeta potential range –19 and –22 mV and encapsulation efficiency of ATC in AG/Csnano between 22 and 45%. According to the results, the average size, polydispersity index and encapsulation efficiency were significantly affected to the variation of Ca2+/AG and CS/AG mass ratio, but the zeta potential didn't change significantly with factor variations. The factorial design showed it was possible to identify formulations that presented better results for the parameters measured. The factor chosen for the suitable formulations was the encapsulation efficiency. Through this parameter, one formulation was chosen with highest encapsulation efficiency of ATC and presented good colloidal stability parameters aiming future clinical applications.

Screening of Conditions for the Preparation of Poly( -Caprolactone) Nanocapsules Containing the Local Anesthetic Articaine

The local anesthetic articaine (ATC) is widely used in dentistry; however, its side effects can include paresthesia and nerve injury. Polymeric nanocapsules (PN) can be used as carriers for drugs, and help to reduce undesirable symptoms. The objective of this study was to evaluate the influence of different factors on the average size, polydispersion, and encapsulation efficiency of PN containing ATC. Poly(ε-caprolactone) (PCL) nanocapsules containing ATC were prepared by the oil-in-water emulsion/solvent evaporation method. The final ATC concentration was 2%. The preparation conditions were optimized using a central composite blocked cube-star design to investigate the influence of two variables at five levels, with 22 factorial points (–1 and +1), two replicates of the central point, 2×2 axial points (–1.414 and +1.414), and an orthogonal distribution, resulting in 10 experiments. The factors varied were the PVA concentration and the sonication time. The nanocapsules showed a satisfactory size range, a polydispersivity index less than 0.2, and high encapsulation efficiency. The values of the factors had no significant influence on either average size or polydispersion, although the encapsulation efficiency was significantly influenced by the sonication time. Improved formulations were identified using the central composite design, which revealed that the main consideration in selecting a suitable formulation was the encapsulation efficiency. Two of the formulations showed both high encapsulation efficiency and colloidal characteristics appropriate for the route of administration.

Treatment of condylar fractures with an intraoral approach using an angulated screwdriver: Results of a multicentre study

Background This multicentre study aimed to investigate long-term radiographic and functional results following the treatment of condylar fractures using an angulated screwdriver system and open rigid internal fixation with an intraoral surgical approach. Methods Twenty-nine patients with a total of 32 condylar fractures were evaluated. The patients were investigated prospectively based on the following variables: age, sex, aetiology, side, location and classification of the fracture, degree of displacement, associated fractures, surgical approach, oral health status, type of osteosynthesis plate, duration of surgery, mouth-opening, complications, and duration of follow-up. Results The fractures were classified as subcondylar (n = 25) or condylar neck (n = 7). Mean patient age was 36.38 ± 16.60 years. The median duration of postoperative follow-up was 24.39 ± 13.94 months. No joint noise, weakness of the facial nerve, joint pain, or muscle pain was observed. An additional retromandibular approach was necessary to enable the treatment of one subcondylar fracture with medial displacement. Conclusion Subcondylar or condylar neck fractures with medial or lateral displacement can be treated using an intraoral approach with satisfactory results with the advantages of the absence of visible scarring, the avoidance of facial nerve injury, and the ability to obtain rapid access to the fracture.

Treatment of condylar fractures with an intraoral approach using an angulated screwdriver: Results of a multicentre study

Background: This multicentre study aimed to investigate long-term radiographic and functional results following the treatment of condylar fractures using an angulated screwdriver system and open rigid internal fixation with an intraoral surgical approach.Methods: Twenty-nine patients with a total of 32 condylar fractures were evaluated. The patients were investigated prospectively based on the following variables: age, sex, aetiology, side, location and classification of the fracture, degree of displacement, associated fractures, surgical approach, oral health status, type of osteosynthesis plate, duration of surgery, mouth-opening, complications, and duration of follow-up.Results: The fractures were classified as subcondylar (n = 25) or condylar neck (n = 7). Mean patient age was 36.38 +/- 16.60 years. The median duration of postoperative follow-up was 24.39 +/- 13.94 months. No joint noise, weakness of the facial nerve, joint pain, or muscle pain was observed. An additional retromandibular approach was necessary to enable the treatment of one subcondylar fracture with medial displacement.Conclusion: Subcondylar or condylar neck fractures with medial or lateral displacement can be treated using an intraoral approach with satisfactory results with the advantages of the absence of visible scarring, the avoidance of facial nerve injury, and the ability to obtain rapid access to the fracture. (C) 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Clinico-genetic aspects of a pediatric non-neurofibromatosis type 1 malignant triton tumor with loss of chromosome X

Malignant triton tumor (MTT) is an aggressive peripheral nerve sheath tumor with rhabdomyoblastic differentiation. Less than 100 cases have been described, being mostly male children with type 1 neurofibromatosis. We report a 6-year-old female with MTT and no diagnostic criteria for neurofibromatosis type 1. Cytogenetic analysis showed a 46,X,-X[4]/46,XX[16] karyotype. She underwent a transfemoral amputation and chemotherapy and is free of disease 15 months after diagnosis. The few cytogenetic studies of MTT described in the literature have been inconclusive. Further cytogenetic analyses are needed to understand the role of chromosome X monosomy in the pathogenesis of this rare tumor. Pediatr Blood Cancer 2012; 59: 13201323. (C) 2012 Wiley Periodicals, Inc.

Clinicopathologic and immunohistochemical features of oral neurofibroma

Objective. The purposes of this study were to assess clinical, histopathological and immunohistochemical features of 22 oral neurofibromas (NFs) and discuss with previously described literature, addressing the main aspects regarding the differential diagnosis. Materials and methods. Immunohistochemical reactions included S-100, CD34, GLUT-1, EMA, Ki-67, p53 and Collagen IV and histochemical reactions for Alcian blue. Results. Clinically, the preferential location was the maxillary bones, tongue and buccal mucosa. Microscopically, widely spread spindle-shaped cells with scant cytoplasm and elongated nuclei were observed. Immunostaining revealed that the tumor cells weakly expressed GLUT-1, Collagen IV, Ki-67 and p53. They were variably positive for CD34, S-100 protein and membrane epithelial antigen (EMA). Conclusions. The different types of nerve sheath cells observed in the present series reinforce the presence of heterogeneous population in NFs. The strong positivity for S-100 suggests that the lesions were more composed by S-100-positive Schwann cells than other cells. Besides, the high number of CD34-positive cells suggests that this marker can be useful for the differential diagnosis of NFs against PEN, traumatic neuromas and Schwannomas. Finally, the low immunostaining for p53 and Ki-67 may indicate that NFs massively composed by S-100-positive Schwann cells present low potential of aggressiveness and malignant transformation.

Effectiveness of low-level laser therapy for patients with carpal tunnel syndrome: design of a randomized single-blinded controlled trial

Background: Carpal tunnel syndrome is the most common neuropathy in the upper extremity, resulting from the compression of the median nerve at wrist level. Clinical studies are essentials to present evidence on therapeutic resources use at early restoration on peripheral nerve functionality. Low-level laser therapy has been widely investigated in researches related to nerve regeneration. Therefore, it is suggested that the effect of low-level laser therapy associated with other conservative rehabilitation techniques may positively affect symptoms and overall hand function in compressive neuropathies such as carpal tunnel syndrome. The aim of this study is to evaluate the effectiveness of low-level laser therapy in addition to orthoses therapy and home orientations in patients with carpal tunnel syndrome. Methods/Design: Patients older than 18 years old will be included, with clinical diagnosis of carpal tunnel syndrome, excluding comorbidies. A physiotherapist will conduct intervention, with a blinding evaluator. Randomization will be applied to allocate the patients in each group: with association or not to low-level laser therapy. All of them will be submitted to orthoses therapy and home orientations. Outcome will be assessed through: pain visual analogic scale, Semmes Weinstein monofilaments (TM) threshold sensibility test, Pinch Gauge T, Boston Carpal Tunnel Questionnaire and two point discrimination test. Discussion: This paper describes the design of a randomized controlled trial, which aim to assess the effectiveness of conservative treatment added to low-level laser therapy for patients with carpal tunnel syndrome. Trial registration: Brazilian Clinical Trials Registry (ReBec) - 75ddtf / Universal Trial Number: U1111-1121-5184

Inspiratory Muscle Training Reduces Sympathetic Nervous Activity and Improves Inspiratory Muscle Weakness and Quality of Life in Patients With Chronic Heart Failure A CLINICAL TRIAL

PURPOSE: To evaluate the effect of inspiratory muscle training (IMT) on cardiac autonomic modulation and on peripheral nerve sympathetic activity in patients with chronic heart failure (CHF). METHODS: Functional capacity, low-frequency (LF) and high-frequency (HF) components of heart rate variability, muscle sympathetic nerve activity inferred by microneurography, and quality of life were determined in 27 patients with CHF who had been sequentially allocated to 1 of 2 groups: (1) control group (with no intervention) and (2) IMT group. Inspiratory muscle training consisted of respiratory exercises, with inspiratory threshold loading of seven 30-minute sessions per week for a period of 12 weeks, with a monthly increase of 30% in maximal inspiratory pressure (PImax) at rest. Multivariate analysis was applied to detect differences between baseline and followup period. RESULTS: Inspiratory muscle training significantly increased PImax (59.2 +/- 4.9 vs 87.5 +/- 6.5 cmH(2)O, P = .001) and peak oxygen uptake (14.4 +/- 0.7 vs 18.9 +/- 0.8 mL.kg(-1).min(-1), P = .002); decreased the peak ventilation (V. E) +/- carbon dioxide production (V-CO2) ratio (35.8 +/- 0.8 vs 32.5 +/- 0.4, P = .001) and the (V) over dotE +/-(V) over dotCO(2) slope (37.3 +/- 1.1 vs 31.3 +/- 1.1, P = .004); increased the HF component (49.3 +/- 4.1 vs 58.4 +/- 4.2 normalized units, P = .004) and decreased the LF component (50.7 +/- 4.1 vs 41.6 +/- 4.2 normalized units, P = .001) of heart rate variability; decreased muscle sympathetic nerve activity (37.1 +/- 3 vs 29.5 +/- 2.3 bursts per minute, P = .001); and improved quality of life. No significant changes were observed in the control group. CONCLUSION: Home-based IMT represents an important strategy to improve cardiac and peripheral autonomic controls, functional capacity, and quality of life in patients with CHF.

Ação do laser terapêutico e do ultrassom na regeneração nervosa periférica

OBJETIVO: Avaliar a ação precoce do laser terapêutico e do ultrassom no processo de regeneração de uma lesão experimental em ratos. MÉTODO: Utilizou-se 24 ratos. Dezoito foram submetidos ao procedimento cirúrgico de lesão do nervo ciático por compressão, através de uma pinça hemostática acima da fossa poplítea. Os animais foram divididos em três grupos com seis animais em cada. Grupo controle normal. GI: controle lesado sem intervenção terapêutica. GII: intervenção terapêutica do laser ArGaAl. GIII: intervenção terapêutica do ultrassom Pulsado. Iniciamos as intervenções terapêuticas 24 horas após a lesão, com aplicações diárias, por um período de quatorze dias consecutivos. RESULTADOS: Ao avaliar a perimetria dos músculos da coxa direita obteve-se os seguintes valores médios de diminuição (mm), para cada grupo GI: 0,45; GII: 0,42; GIII: 0,40. Quanto ao tempo de deslocamento tanto o GII e GIII apresentaram diferença significativa, quando comparados ao GI. Na avaliação final do IFC o GII sobressaiu ao GIII. Quanto a cicatrização observou-se grande melhora no GII e GIII. CONCLUSÃO: Os resultados evidenciaram que a recuperação nervosa foi maior com a aplicação do laser. Nível de evidência II, Estudos terapêuticos - Investigação dos resultados do tratamento

Funktionelle Analyse der Gliazellwanderung im Drosophila-Embryo

Gliazellen kommen in allen höheren Organismen vor und sind sowohl für die korrekte Entwicklung, als auch für die Funktionalität des adulten Nervensystems unerlässlich. Eine der mannigfachen Funktionen dieses Zelltyps ist die Umhüllung von Axonen im zentralen und peripheren Nervensystem (ZNS und PNS). Um eine vollständige Umhüllung zu gewährleisten, wandern Gliazellen während der Neurogenese zum Teil über enorme Distanzen von ihrem Entstehungsort aus. Dies trifft insbesondere auf die Gliazellen zu, durch deren Membranausläufer die distalen Axonbereiche der peripheren Nerven isoliert werden.rnIn dieser Arbeit wurde die Migration von Gliazellen anhand des Modelorganismus Drosophila untersucht. Ein besonderes Interesse galt dabei der Wanderung einer distinkten Population von Gliazellen, den sogenannten embryonalen Peripheren Gliazellen (ePG). Die ePGs werden überwiegend im sich entwickelnden ventralen Bauchmark geboren und wandern anschließend entlang der peripheren Nerventrakte nach dorsal aus, um diese bis zum Ende der Embryogenese zu umhüllen und dadurch die gliale Blut-Nerv-Schranke zu etablieren. Das Hauptziel dieser Arbeit bestand darin, neue Faktoren bzw. Mechanismen aufzudecken, durch welche die Migration der ePGs reguliert wird. Dazu wurde zunächst der wildtypische Verlauf ihrer Wanderung detailliert analysiert. Es stellte sich heraus, dass in jedem abdominalen Hemisegment eine invariante Anzahl von 12 ePGs von distinkten neuralen Vorläuferzellen generiert wird, die individuelle Identitäten besitzen und mittels molekularer Marker auf Einzelzellebene identifiziert werden können. Basierend auf der charakteristischen Lage der Zellen erfolgte die Etablierung einer neuen, konsistenten Nomenklatur für sämtliche ePGs. Darüber hinaus offenbarten in vivo Migrationsanalysen, dass die Wanderung individueller ePGs stereotyp verläuft und demzufolge weitestgehend prädeterminiert ist. Die genaue Kenntnis der wildtypischen ePG Migration auf Einzelzellebene diente anschließend als Grundlage für detaillierte Mutantenanalysen. Anhand derer konnte für den ebenfalls als molekularen Marker verwendeten Transkriptionsfaktor Castor eine Funktion als zellspezifische Determinante für die korrekte Spezifizierung der ePG6 und ePG8 nachgewiesen werden, dessen Verlust in einem signifikanten Migrationsdefekt dieser beiden ePGs resultiert. Des Weiteren konnte mit Netrin (NetB) der erste diffusible und richtungsweisende Faktor für die Migration von ePGs enthüllt werden, der in Interaktion mit dem Rezeptor Uncoordinated5 speziell die Wanderung der ePG6 und ePG8 leitet. Die von den übrigen Gliazellen unabhängige Navigation der ePG6 und ePG8 belegt, dass zumindest die Migration von Gruppen der ePGs durch unterschiedliche Mechanismen kontrolliert wird, was durch die Resultate der durchgeführten Ablationsexperimente bestätigt wird. rnFerner konnte gezeigt werden, dass während der frühen Gliogenese eine zuvor unbekannte, von Neuroblasten bereitgestellte Netrinquelle an der initialen Wegfindung der Longitudinalen Gliazellen (eine Population Neuropil-assoziierter Gliazellen im ZNS) beteiligt ist. In diesem Kontext erfolgt die Signaldetektion bereits in deren Vorläuferzelle, dem Longitudinalen Glioblasten, zellautonom über den Rezeptor Frazzled. rnFür künftige Mutantenscreens zur Identifizierung weiterer an der Migration der ePGs beteiligter Faktoren stellt die in dieser Arbeit präsentierte detaillierte Beschreibung eine wichtige Grundlage dar. Speziell in Kombination mit den vorgestellten molekularen Markern liefert sie die Voraussetzung dafür, individuelle ePGs auch im mutanten Hintergrund zu erfassen, wodurch selbst subtile Phänotypen überhaupt erst detektiert und auf Einzelzellebene analysiert werden können. Aufgrund der aufgezeigten voneinander unabhängigen Wegfindung, erscheinen Mutantenanalysen ohne derartige Möglichkeiten wenig erfolgversprechend, da Mutationen vermutlich mehrheitlich die Migration einzelner oder weniger ePGs beeinträchtigen. Letzten Endes wird somit die Aussicht verbessert, weitere neuartige Migrationsfaktoren im Modellorganismus Drosophila zu entschlüsseln, die gegebenenfalls bis hin zu höheren Organismen konserviert sind und folglich zum Verständnis der Gliazellwanderung in Vertebraten beitragen.

Caratterizzazione clinica, eziopatogenetica e ricerca di marker diagnostici nella poliradicoloneurite acuta idiopatica del cane

La poliradicoloneurite acuta idiopatica (ACIP) è una patologia infiammatoria che interessa le radici di più nervi spinali, descritta soprattutto nel cane, più raramente nel gatto, caratterizzata da insorgenza acuta di paresi/paralisi flaccida. L’ACIP mostra notevoli similitudini con la sindrome di Guillan-Barrè dell’uomo (GBS), in cui la patogenesi è su base autoimmunitaria ed è stata correlata con la presenza di alcuni fattori scatenanti (trigger). Lo scopo di questo lavoro è stato quello di caratterizzare l’ACIP in 26 cani, descrivendone la sintomatologia, l’evoluzione clinica, i risultati degli esami diagnostici. La diagnosi si è basata sui riscontri dell’anamnesi, della visita neurologica e del decorso confermata, quando possibile, dai rilievi elettrodiagnostici. Su tutti i cani è stata valutata l’esposizione a specifici agenti infettivi (Toxoplasma gondii, Neospora canunim, Ehrlichia canis, Leishmania infantum), o altri fattori (come vaccinazioni) che potrebbero aver agito da “trigger” per l’instaurarsi della patologia; sull’intera popolazione e su 19 cani non neurologici (gruppo di controllo), si è proceduto alla ricerca degli anticorpi anti-gangliosidi. La sintomatologia di più frequente riscontro (25/26) ha coinvolto la funzione motoria (paresi/plegia) con prevalente interessamento dei 4 arti (24/25) . Sei cani hanno ricevuto una terapia farmacologica, che non ne ha influenzato il decorso, favorevole in 24/26 casi. In 9 pazienti è stata rilevata una precedente esposizione a potenziali trigger; in 10 casi si è riscontrato un titolo anticorpale positivo ad almeno un agente infettivo testato. In 17/26 cani si è ottenuto un titolo anticorpale anti-GM2 e anti-GA1; nella popolazione di controllo solo un caso è risultato positivo. Questi risultati hanno contribuito a consolidare le conoscenze di questa patologia, validando l’utilità della ricerca anticorpale anti-gangliosidica per la diagnosi di ACIP e facendo intravedere la possibilità che l’ACIP possa essere assimilate alla GBS anche dal punto di vista patogenetico, per la quale potrebbe essere considerata come modello animale spontaneo.

Newly designed, self-coiling catheters for regional anesthesia--an imaging study

A major concern with the use of continuous peripheral nerve block is the difficulty encountered in placing the catheters close enough to the nerves to accomplish effective analgesia. The aim of this study was to investigate if a self-coiling catheter would remain close to the sciatic nerve once introduced through needles placed under ultrasound guidance and if contrast dye injected through the pigtail catheter made direct contact to the nerves.

Vasculitides associated with IgG antineutrophil cytoplasmic autoantibodies in childhood

Immunoglobulin (Ig)G antineutrophil cytoplasmic autoantibodies are causally associated with necrotizing vasculitides that are characterized immunopathologically by little or no deposition of immunoreactants, such as Wegener granulomatosis, microscopic polyangiitis, Churg-Strauss angiitis, "renal-limited" vasculitis and a number of drug-induced vasculitides. Clinical routine testing targets the antigens myeloperoxidase and proteinase 3. However, in all of the conditions mentioned, the renal histopathologic findings are indistinguishable. Churg-Strauss angiitis (characterized by necrotizing vasculitis, granulomatous inflammation and tissue eosinophilia), Wegener granulomatosis (characterized by necrotizing vasculitis and granulomatous inflammation) and microscopic polyangiitis (characterized by necrotizing vasculitis) often present with fever, weight loss and a multisystem involvement (ear, nose, throat, lung, eyes, peripheral nerve and heart). Fifty years ago these conditions were very often fatal within 6 months of diagnosis. The introduction of corticosteroids and cyclophosphamide has resulted in a dramatic clinical benefit. Patients who develop treatment-related morbidity can be switched from cyclophosphamide to azathioprine after achieving remission. In patients with less severe disease, methotrexate achieves remission with a success rate similar to that of cyclophosphamide. Plasma exchange, in association with immunosuppression, is likely to be a beneficial therapy for patients with severe kidney disease or pulmonary hemorrhage.

In vivo assessment of HCN channel current (I(h)) in human motor axons

The "Trond" protocol of nerve excitability tests has been used widely to assess axonal function in peripheral nerve. In this study, the routine Trond protocol was expanded to refine assessment of cAMP-dependent, hyperpolarization-activated current (I(h)) activity. I(h) activity is generated by hyperpolarization-activated, cyclic nucleotide-modulated (HCN) channels in response to hyperpolarization. It limits activity-dependent hyperpolarization, contributes to neuronal automaticity, and is implicated in chronic pain states. Published data regarding I(h) activity in motor nerve are scant. We used additional strong, prolonged hyperpolarizing conditioning stimuli in the threshold electrotonus component of the Trond protocol to demonstrate the time-course of activation of I(h) in motor axons. Fifteen healthy volunteers were tested on four occasions during 1 week. I(h) action was revealed in the threshold electrotonus by the limiting and often reversal, after about 100 ms, of the threshold increase caused by strong hyperpolarizing currents. Statistical analysis by repeated-measures analysis of variance enabled confidence limits to be established for variation between subjects and within subjects. The results demonstrate that, of all the excitability parameters, those dependent on I(h) were the most characteristic of an individual, because variance between subjects was more than four times the variance within subjects. This study demonstrates a reliable method for in vivo assessment of I(h,) and also serves to document the normal variability in nerve excitability properties within subjects.