Uso de estimulación eléctrica medular en el manejo de síndrome doloroso regional complejo: revisión sistemática

La estimulación eléctrica medular (EEM), es una técnica mínimamente invasiva, segura, con pocos efectos secundarios y resultados favorables en patologías crónicas asociadas a dolor severo de difícil manejo, tal como es el caso del Síndrome Doloroso Regional Complejo (SDRC). La evidencia actual señala beneficios en esta patología particular, motivo por el cuál es de interés hacer una revisión actualizada sobre la EEM en SDRC.

Reference values of mechanical and thermal pain tests in a pain-free population

Quantitative sensory tests are widely used in human research to evaluate the effect of analgesics and explore altered pain mechanisms, such as central sensitization. In order to apply these tests in clinical practice, knowledge of reference values is essential. The aim of this study was to determine the reference values of pain thresholds for mechanical and thermal stimuli, as well as withdrawal time for the cold pressor test in 300 pain-free subjects. Pain detection and pain tolerance thresholds to pressure, heat and cold were determined at three body sites: (1) lower back, (2) suprascapular region and (3) second toe (for pressure) or the lateral aspect of the leg (for heat and cold). The influences of gender, age, height, weight, body-mass index (BMI), body side of testing, depression, anxiety, catastrophizing and parameters of Short-Form 36 (SF-36) were analyzed by multiple regressions. Quantile regressions were performed to define the 5th, 10th and 25th percentiles as reference values for pain hypersensitivity and the 75th, 90th and 95th percentiles as reference values for pain hyposensitivity. Gender, age and/or the interaction of age with gender were the only variables that consistently affected the pain measures. Women were more pain sensitive than men. However, the influence of gender decreased with increasing age. In conclusion, normative values of parameters related to pressure, heat and cold pain stimuli were determined. Reference values have to be stratified by body region, gender and age. The determination of these reference values will now allow the clinical application of the tests for detecting abnormal pain reactions in individual patients.

Quantitative stress echocardiography in coronary artery disease using contrast-based myocardial blood flow measurements: prospective comparison with coronary angiography

AIM: To test whether quantitative stress echocardiography using contrast-based myocardial blood flow (MBF, ml x min(-1) x g(-1)) measurements can detect coronary artery disease in humans. METHODS: 48 patients eligible for pharmacological stress testing by myocardial contrast echocardiography (MCE) and willing to undergo subsequent coronary angiography were prospectively enrolled in the study. Baseline and adenosine-induced (140 microg x kg(-1) x min(-1)) hyperaemic MBF was analysed according to a three-coronary-artery-territory model. Vascular territories were categorised into three groups with increasing stenosis severity defined as percentage diameter reduction by quantitative coronary angiography. RESULTS: Myocardial blood flow reserve (MBFR)-that is, the ratio of hyperaemic to baseline MBF, was obtained in 128 (89%) territories. Mean (SD) baseline MBF was 1.073 (0.395) ml x min(-1) x g(-1) and did not differ between territories supplied by coronary arteries with mild (<50% stenosis), moderate (50%-74% stenosis) or severe (>or=75% stenosis) disease. Mean (SD) hyperaemic MBF and MBFR were 2.509 (1.078) ml x min(-1) x g(-1) and 2.54 (1.03), respectively, and decreased linearly (r2 = 0.21 and r2 = 0.39) with stenosis severity. ROC analysis revealed that a territorial MBFR <1.94 detected >or=50% stenosis with 89% sensitivity and 92% specificity. CONCLUSION: Quantitative stress testing based on MBF measurements derived from contrast echocardiography is a new method for the non-invasive and reliable assessment of coronary artery disease in humans.

Widespread sensory hypersensitivity is a feature of chronic whiplash-associated disorder but not chronic idiopathic neck pain

Objectives: To investigate sensory changes present in patients with chronic whiplash-associated disorders and chronic idiopathic neck pain using a variety of quantitative sensory tests to better understand the pain processing mechanisms underlying persistent symptoms. Methods: A case control study was used with 29 subjects with chronic whiplash-associated disorders, 20 subjects with chronic idiopathic neck pain, and 20 pain-free volunteers. Pressure pain thresholds were measured over the articular pillars of C2-C3, C5-C6, the median, radial, and ulnar nerve trunks in the arm and over a remote site, the muscle belly of tibialis anterior. Heat pain thresholds, cold pain thresholds, and von Frey hair sensibility were measured over the cervical spine, tibialis anterior, and deltoid insertion. Anxiety was measured with the Short-Form of the Spielberger State Anxiety Inventory. Results: Pressure pain thresholds were decreased over cervical spine sites in both subject groups when compared with controls (P < 0.05). In the chronic whiplash-associated disorders group, pressure pain thresholds were also decreased over the tibialis anterior, median, and radial nerve trunks (P < 0.001). Heat pain thresholds were decreased and cold pain thresholds increased at all sites (P < 0.03). No differences in heat pain thresholds or cold pain thresholds were evident in the idiopathic neck pain group at any site compared with the control group (P > 0.27). No abnormalities in von Frey hair sensibility were evident in either neck pain group (P > 0.28). Discussion: Both chronic whiplash-associated disorders and idiopathic neck pain groups were characterized by mechanical hyperalgesia over the cervical spine. Whiplash subjects showed additional widespread hypersensitivity to mechanical pressure and thermal stimuli, which was independent of state anxiety and may represent changes in central pain processing mechanisms. This may have implications for future treatment approaches.

Contribution of individual, workplace, psychosocial and physiological factors to neck pain in female office workers

This study investigated the relative contribution of individual, workplace, psychosocial and physiological features associated with neck pain in female office workers towards developing appropriate intervention programs. Workers without disability (Neck Disability Index (NDI) score≤8, n=33); workers with neck pain and disability (NDI≥9/100, n=52) and 22 controls (women who did not work and without neck pain) participated in this study. Two logistic regression models were constructed to test the association between various measures in (1) workers with and without disability, and (2) workers without disability and controls. Measures included those found to be significantly associated with higher NDI in our previous studies: psychosocial domains; individual factors; task demands; quantitative sensory measures and measures of motor function. In the final model, higher score on negative affectivity scale (OR=4.47), greater activity in the neck flexors during cranio-cervical flexion (OR=1.44), cold hyperalgesia (OR=1.27) and longer duration of symptoms (OR=1.19) remained significantly associated with neck pain in workers. Workers without disability and controls could only be differentiated by greater muscle activity in the cervical flexors and extensors during a typing task. No psychosocial domains remained in either regression model. These results suggest that impairments in the sensory and motor system should be considered in any assessment of the office worker with neck pain and may have stronger influences on the presenting symptoms than workplace and psychosocial features.

Field-Portable Microfluidics-Based Imaging Flow Cytometer

Clinical microscopy is a versatile and robust tool used for the diagnosis of a plethora of diseases. However, due to various reasons, it remains inaccessible in resource limited settings. In this paper, we present an automated and cost-effective alternative to microscopy for use in clinical diagnostics. With the use of custom optics and microfluidics, we demonstrate a field-portable imaging flow cytometry system. Using the presented system, we have been able to image 586 cells per second. We demonstrate the clinical relevance of the proposed system by differentiating between suspensions of healthy and sphered RBCs based on high-throughput morphometric analysis. The instrument presented here is a major advancement in the domain of field portable diagnostics as it enables fast and robust quantitative diagnostic testing at the point-of-care.

O comportamento clínico e neurofisiológico da neuropatia durante os episódios reacionais da hanseníase

A hanseníase, uma doença conhecida por suas lesões de pele anestésicas, é a principal causa de neuropatia periférica nos países endêmicos. Os episódios reacionais são classicamente conhecidos por promover piora da função nervosa através das chamadas neurites que variam de quadros exuberantes a assintomáticos. Estas características da neuropatia tornam o diagnóstico precoce excepcionalmente desafiador assim como a necessidade de se intervir para se prevenir lesões permanentes nos nervos. Este estudo clínico, prospectivo, foi realizado selecionando-se pacientes com hanseníase, independente da forma clínica, no Ambulatório Souza Araujo, Fiocruz, Rio de Janeiro, que apresentavam episódios reacionais. O objetivo foi estudar o perfil neurológico clínico, eletroneurofisiológico e por imagem do nervo antes e após o tratamento das reações. Foram avaliados vinte e cinco pacientes levando-se em conta: exame neurológico, avaliação fisioterápica, estudo de condução nervosa, avaliação de espessura e ecogenicidade nervosa pelo método ultrassonográfico, fluxometria por laser Doppler e teste quantitativo da sensibilidade durante e um ano após o tratamento da reação. Estes pacientes foram divididos em três grupos: oito pacientes com neurite aguda, nove pacientes com neurite silenciosa e oito pacientes com reação cutânea sem neurite. Nos pacientes com episódios reacionais, observou-se predomínio do sexo masculino (60%), do grupo multibacilar (80%) e da forma clínica borderline-lepromatosa (36%). A neurite isolada foi o tipo de reação mais frequente, seguida de neurite associada à reação do tipo1, seguida da neurite associada à reação do tipo 2. O nervo motor mais acometido por neurite foi o fibular seguido pelo ulnar, enquanto o nervo sensitivo mais acometido foi o sural. O padrão eletroneuromiográfico característico dos episódios reacionais foi a mononeurite múltipla. A ultrassonografia, a fluxometria por laser Doppler e o teste quantitativo de sensibilidade, associados à clínica e ao estudo da condução nervosa, foram tidos como exames úteis para avaliação inicial e para acompanhar o tratamento dos episódios reacionais. Após o tratamento, foi constatada melhora nos parâmetros referentes à função motora, mas o mesmo não ocorreu para sensibilidade. Com esse estudo, observa-se a necessidade de acompanhamento multidiciplinar com exames especializados para os pacientes com hanseníase a fim de diagnóstico de reação e tratamento precoce evitando sequelas neurológicas.

Entwicklung und Validierung der Steigbildmethode zur Differenzierung von ausgewählten Lebensmitteln aus verschiedenen Anbausystemen und Verarbeitungsprozessen

Zusammenfassung (deutsch) Seit den 1980iger Jahren wächst die Bedeutung der sog. Bildschaffenden Methoden für die Bestimmung der Qualität ökologischer Produkte. Zu diesen Methoden gehört die Biokristallisation, Steigbild und Rundfilter-Chromatographie. Die Ergebnisse dieser Methoden sind Bilder, die anhand definierter Kriterien ausgewertet werden. Bei der Biokristallisation sind es mehr oder weniger geordnete Kristallisationen auf einer Glasplatte, bei dem Steigbild zweidimensionale Strukturen auf Chromatographiepapier. In der Vergangenheit wurden die Bilder von Spezialisten ausgewertet, die nach einer längeren Schulung produktspezifische Kriterien entwickelt hatten. Im Gegensatz zur Dünnschicht-Chromatographie, wo der einzelne Stoff von der Matrix separiert wird, ist das Ziel beim Steigbild, Strukturen der möglichst ganzen Probe zu erzeugen. Die Methode wurde von Kolisko in den 1929iger Jahren entwickelt, wobei eine Kombination aus Chromatographieprozess und Metallkomplexreaktionen genutzt wurde. Die Firma WALA entwickelte die Methode für die Kontrolle ihrer Produkte und setze Silbernitrat und Eisensulfat ein. Bisher wurde die Methode qualitativ beschreibend ausgewertet, wobei einzelne Bildelemente und deren Interaktion beschrieben wurden. Deshalb musste für die vorliegende Arbeit Auswertungsmethoden entwickelt werden, mit denen auch eine statistische Bearbeitung der Ergebnisse möglich ist (nominale Unterscheidung von proben anhand der Bilder). Die Methode wurde bisher in einer Reihe von Studien eingesetzt (u.a. die Unterscheidung von Produktionsweisen). Obwohl die Bilder nur qualitativ ausgewertet wurden, konnten geschulte Prüfpersonen Proben aus verschiedenen Anbausystemen anhand der Bilder trennen. Die Ergebnisse wurden aber nicht so dokumentiert, dass sie den Erfordernissen internationaler Standardnormen für Laboratorien genügten. Deshalb mussten für diese Arbeit zunächst die Prozeduren dokumentiert und eine systematische Untersuchung zu den Einflussgrößen durchgeführt werden. Dazu wurde die visuelle Bildauswertung entwickelt und standardisiert. Die visuelle Bildauswertung basiert auf morphologischen Kriterien der Bilder von den untersuchten Weizen- und Möhrenproben. Ein Panel aus geschulten Personen entwickelte dann die Kriterien und legte sie anhand von Referenzbildern fest. Die Bilder der vorliegenden Arbeit wurden mit der einfach beschreibenden Prüfung ausgewertet, wie sie aus der sensorischen Prüfung von Lebensmitteln übernommen werden konnte. Mit geschulten und ungeschulten Prüfpersonen wurden Weizenproben und verschiedene Möhrensäfte mit der sog. Dreiecksprüfung ausgewertet (von ISO 4120). Alle Laborprozeduren wurden dokumentiert. Mit der Anwendung dieser Prozeduren wurden Vergleichsversuche mit Laboren in Dänemark und Holland (BRAD, LBI) durchgeführt. Die Ergebnisse waren sowohl für Weizen- als auch für Möhrenproben vergleichbar, wobei alle drei Labore zwischen jeweils zwei Proben unterscheiden konnten. Die systematische Untersuchung zu den Einflussgrößen zeigte, dass das Unterscheidungsvermögen der Methode vor allem von den klimatischen Bedingungen während der Steigphasen beeinflusst wird. Auch die Präkonditionierung der Papiere hat einen großen Einfluss, während die Wasserqualität (ultra-filtriert, de-ionisiert, destilliert) eine untergeordnete Bedeutung hat. Für Weizen- und Möhrenproben wurde sowohl die Wiederholbarkeit als auch die Reproduzierbarkeit getestet. Die Unterschiede in den Bildern der verschiedenen Proben waren dabei immer größer als die Variation durch Proben- und Bildwiederholung und das Labor. Die so charakterisierte Methode wurde auf kodierte Proben von definierten Feldversuchen und auf Marktproben (Paarvergleich von Anbausystemen ökologisch und konventionell) angewandt, wobei als Ergebnis mehr als 90% der Proben mit der einfach beschreibenden Prüfung anhand der Bilder unterschieden werden konnten. Die Auswertung mit der Dreiecksprüfung zeigte, dass sowohl Sorten und Verarbeitungsschritte (Saft) als auch Anbauweisen signifikant getrennt wurden. Darüber hinaus wurde die Methode auch erfolgreich auf Apfelproben angewandt. Weitere Untersuchungen müssen zeigen, ob sich das Potential der Methode, verschiedene Fragen wie die Authentizitätsprüfung von Lebensmitteln verifizieren lassen.

Ranking of parameters of pain hypersensitivity according to their discriminative ability in chronic low back pain

Low back pain is associated with plasticity changes and central hypersensitivity in a subset of patients. We performed a case-control study to explore the discriminative ability of different quantitative sensory tests in distinguishing between 40 cases with chronic low back pain and 300 pain-free controls, and to rank these tests according to the extent of their association with chronic pain. Gender, age, height, weight, body mass index, and psychological measures were recorded as potential confounders. We used 26 quantitative sensory tests, including different modalities of pressure, heat, cold, and electrical stimulation. As measures of discrimination, we estimated receiver operating characteristics (ROC) and likelihood ratios. Six tests seemed useful (in order of their discriminative ability): (1) pressure pain detection threshold at the site of most severe pain (fitted area under the ROC, 0.87), (2) single electrical stimulation pain detection threshold (0.87), (3) single electrical stimulation reflex threshold (0.83), (4) pressure pain tolerance threshold at the site of most severe pain (0.81), (5) pressure pain detection threshold at suprascapular region (0.80), and (6) temporal summation pain threshold (0.80). Pressure and electrical pain modalities seemed most promising and may be used for diagnosis of pain hypersensitivity and potentially for identifying individuals at risk of developing chronic low back pain over time.

Oesophageal afferent pathway sensitivity in non-erosive reflux disease

Patients with non-erosive reflux disease (NERD) report symptoms which commonly fail to improve on conventional antireflux therapies. Oesophageal visceral hyperalgaesia may contribute to symptom generation in NERD and we explore this hypothesis using oesophageal evoked potentials. Fifteen endoscopically confirmed NERD patients (four female, 29–56 years) plus 15 matched healthy volunteers (four female, 23–56 years) were studied. All patients had oesophageal manometry/24-h pH monitoring and all subjects underwent evoked potential and sensory testing, using electrical stimulation of the distal oesophagus. Cumulatively, NERD patients had higher sensory thresholds and increased evoked potential latencies when compared to controls (P = 0.01). In NERD patients, there was a correlation between pain threshold and acid exposure as determined by DeMeester score (r = 0.63, P = 0.02), with increased oesophageal sensitivity being associated with lower DeMeester score. Reflux negative patients had lower pain thresholds when compared to both reflux positive patients and controls. Evoked potentials were normal in reflux negative patients but significantly delayed in the reflux positive group (P = 0.01). We demonstrate that NERD patients form a continuum of oesophageal afferent sensitivity with a correlation between the degree of acid exposure and oesophageal pain thresholds. We provide objective evidence that increased oesophageal pain sensitivity in reflux negative NERD is associated with heightened afferent sensitivity as normal latency evoked potential responses could be elicited with reduced afferent input. Increased oesophageal afferent pain sensitivity may play an important role in a subset of NERD and could offer an alternate therapeutic target.

Testing the reliability of the JEOL FEGSEM 6500F electron microprobe for quantitative major element analysis of glass shards from rhyolitic tephra.

Electronprobe microanalysis is now widely adopted in tephra studies as a technique for determining the major element geochemistry of individual glass shards. Accurate geochemical characterization is crucial for enabling robust tephra-based correlations; such information may also be used to link the tephra to a specific source and often to a particular eruption. In this article, we present major element analyses for rhyolitic natural glass standards analysed on three different microprobes and the new JEOL FEGSEM 6500F microprobe at Queen’s University Belfast. Despite the scatter in some elements, good comparability is demonstrated among data yielded from this new system, the previous Belfast JEOL-733 Superprobe, the JEOL-8200 Superprobe (Copenhagen) and the existing long-established microprobe facility in Edinburgh. Importantly, our results show that major elements analysed using different microprobes and variable operating conditions allow two high-silica glasses to be discriminated accurately.

Testing the role of sensory systems in the migratory heading of a songbird

The identification of the sensory cues and mechanisms by which migratory birds are able to reach the same breeding and wintering grounds year after year has eluded biologists despite more than 50 years of intensive study. While a number of environmental cues have been proposed to play a role in the navigation of birds, arguments still persist about which cues are essential for the experience based navigation shown by adult migrants. To date, few studies have tested the sensory basis of navigational cues used during actual migration in the wild: mainly laboratory based studies or homing during the non-migratory season have been used to investigate this behaviour. Here we tested the role of olfactory and magnetic cues in the migration of the catbird (Dumetella carolinensis) by radio tracking the migration of birds with sensory manipulations during their actual migratory flights. Our data suggest that adult birds treated with zinc sulphate to produce anosmia were unable to show the same orientation as control adults, and instead reverted to a direction similar to that shown by juveniles making their first migration. The magnetic manipulation had no effect on the orientation of either adults or juveniles. These results allow us to propose that the olfactory sense may play a role in experience based migration in adult catbirds. While the olfactory sense has been shown to play a role in the homing of pigeons and other birds, this is the first time it has been implicated in migratory orientation.

Qualitative and quantitative characterization of aluminium alloys after corrosion testing

The 2024 and 7050 aluminium alloys used as aircraft components were subjected to laboratory corrosion tests in sodium chloride solution, Light-microscope examinations make it possible to characterise morphological aspects of the localised corrosion. Image analysis was used to determine both depth and width of pits over corroded surfaces. It has been concluded that the annealing could reduce the pit growth in both alloys, by means of grains recrystallization or recovery. The 2024 alloy also tends to present an exfoliation mechanism, mainly throughout non-recrystallized and recrystallized grain boundaries, increasing the width and sustaining the depth of pit cavities during exposition to saline atmosphere. SEM and EDS analysis reveal the morphology and elemental distribution of the corrosion products formed after immersion corrosion test. Some of these products were identified by X-ray diffraction analysis. For 2024, Al(OH)(3), MS(OH)(2) and Cu2O were found. AI(OH)(3) and Cu2O were also found in 7050 samples.

Quantitative repeated open application testing with a rinse-off product in methyldibromo glutaronitrile-sensitive patients: results of the IVDK

While the use of methyldibromo glutaronitrile (MDBGN) in leave-on products is clearly associated with high sensitization or elicitation risk, such a clear-cut relation could be questioned with regard to rinse-off products.