Association between the il28b rs12979860 polymorphism and therapy response in patients infected with genotype 1 of hepatitis c virus in Central Brazil

v. 45, n.2, p.152-160, abr/.jun. 2016.

Introduction to the Special Issue on Biomedical and Bioelectronic Circuits for Enhanced Diagnosis and Therapy

The 22 papers in this special issue focus on biomedical and biolectronic circuits for enhanced diagnosis and therapy.

Information and Communication Technologies (ICT) to Improve Prescription Appropriateness and Therapy Adherence in the Multi-morbid Elderly

Multimorbidity patients pose severe challenges to which information and communication technology (ICT) can help patients and doctors to answer with effective and efficient care.

Modifications in Early Rehabilitation Protocol after Rotator Cuff Repair : EMG Studies

La déchirure de la coiffe des rotateurs est une des causes les plus fréquentes de douleur et de dysfonctionnement de l'épaule. La réparation chirurgicale est couramment réalisée chez les patients symptomatiques et de nombreux efforts ont été faits pour améliorer les techniques chirurgicales. Cependant, le taux de re-déchirure est encore élevé ce qui affecte les stratégies de réhabilitation post-opératoire. Les recommandations post-chirurgicales doivent trouver un équilibre optimal entre le repos total afin de protéger le tendon réparé et les activités préconisées afin de restaurer l'amplitude articulaire et la force musculaire. Après une réparation de la coiffe, l'épaule est le plus souvent immobilisée grâce à une écharpe ou une orthèse. Cependant, cette immobilisation limite aussi la mobilité du coude et du poignet. Cette période qui peut durer de 4 à 6 semaines où seuls des mouvements passifs peuvent être réalisés. Ensuite, les patients sont incités à réaliser les exercices actifs assistés et des exercices actifs dans toute la mobilité articulaire pour récupérer respectivement l’amplitude complète de mouvement actif et se préparer aux exercices de résistance réalisés dans la phase suivante de la réadaptation. L’analyse électromyographique des muscles de l'épaule a fourni des évidences scientifiques pour la recommandation de beaucoup d'exercices de réadaptation au cours de cette période. Les activités sollicitant les muscles de la coiffe des rotateurs à moins de 20% de leur activation maximale volontaire sont considérés sécuritaires pour les premières phases de la réhabilitation. À partir de ce concept, l'objectif de cette thèse a été d'évaluer des activités musculaires de l'épaule pendant des mouvements et exercices qui peuvent théoriquement être effectués au cours des premières phases de la réhabilitation. Les trois questions principales de cette thèse sont : 1) Est-ce que la mobilisation du coude et du poignet produisent une grande activité des muscles de la coiffe? 2) Est-ce que les exercices de renforcement musculaire du bras, de l’avant-bras et du torse produisent une grande activité dans les muscles de la coiffe? 3) Au cours d'élévations actives du bras, est-ce que le plan d'élévation affecte l'activité de la coiffe des rotateurs? Dans notre première étude, nous avons évalué 15 muscles de l'épaule chez 14 sujets sains par électromyographie de surface et intramusculaire. Nos résultats ont montré qu’avec une orthèse d’épaule, les mouvements du coude et du poignet et même quelques exercices de renforcement impliquant ces deux articulations, activent de manière sécuritaire les muscles de ii la coiffe. Nous avons également introduit des tâches de la vie quotidienne qui peuvent être effectuées en toute sécurité pendant la période d'immobilisation. Ces résultats peuvent aider à modifier la conception d'orthèses de l’épaule. Dans notre deuxième étude, nous avons montré que l'adduction du bras réalisée contre une mousse à faible densité, positionnée pour remplacer le triangle d’une orthèse, produit des activations des muscles de la coiffe sécuritaires. Dans notre troisième étude, nous avons évalué l'électromyographie des muscles de l’épaule pendant les tâches d'élévation du bras chez 8 patients symptomatiques avec la déchirure de coiffe des rotateurs. Nous avons constaté que l'activité du supra-épineux était significativement plus élevée pendant l’abduction que pendant la scaption et la flexion. Ce résultat suggère une séquence de plan d’élévation active pendant la rééducation. Les résultats présentés dans cette thèse, suggèrent quelques modifications dans les protocoles de réadaptation de l’épaule pendant les 12 premières semaines après la réparation de la coiffe. Ces suggestions fournissent également des évidences scientifiques pour la production d'orthèses plus dynamiques et fonctionnelles à l’articulation de l’épaule.

Characteristics of microRNAs and their potential relevance for the diagnosis and therapy of the acute respiratory distress syndrome: from bench to bedside

Acute respiratory distress syndrome (ARDS) is a complex disease associated with high morbidity and mortality. Biomarkers and specific pharmacologic treatment of the syndrome are lacking. MicroRNAs (miRNAs) are small (∼19–22 nucleotides) noncoding RNA molecules whose function is the regulation of gene expression. Their uncommon biochemical characteristics (eg, their resistance to degradation because of extreme temperature and pH fluctuations, freeze-thaw cycles, long storage times in frozen conditions, and RNAse digestion) and their presence in a wide range of different biological fluids and the relatively low number of individual miRNAs make these molecules good biomarkers in different clinical conditions. In addition, miRNAs are suitable therapeutic targets as their expression can be modulated by different available strategies. The aim of the present review is to offer clinicians a global perspective of miRNA, covering their structure and nomenclature, biogenesis, effects on gene expression, regulation of expression, and features as disease biomarkers and therapeutic targets, with special attention to ARDS. Because of the early stage of research on miRNAs applied to ARDS, attention has been focused on how knowledge sourced from basic and translational research could inspire future clinical studies.

Modifications in Early Rehabilitation Protocol after Rotator Cuff Repair : EMG Studies

La déchirure de la coiffe des rotateurs est une des causes les plus fréquentes de douleur et de dysfonctionnement de l'épaule. La réparation chirurgicale est couramment réalisée chez les patients symptomatiques et de nombreux efforts ont été faits pour améliorer les techniques chirurgicales. Cependant, le taux de re-déchirure est encore élevé ce qui affecte les stratégies de réhabilitation post-opératoire. Les recommandations post-chirurgicales doivent trouver un équilibre optimal entre le repos total afin de protéger le tendon réparé et les activités préconisées afin de restaurer l'amplitude articulaire et la force musculaire. Après une réparation de la coiffe, l'épaule est le plus souvent immobilisée grâce à une écharpe ou une orthèse. Cependant, cette immobilisation limite aussi la mobilité du coude et du poignet. Cette période qui peut durer de 4 à 6 semaines où seuls des mouvements passifs peuvent être réalisés. Ensuite, les patients sont incités à réaliser les exercices actifs assistés et des exercices actifs dans toute la mobilité articulaire pour récupérer respectivement l’amplitude complète de mouvement actif et se préparer aux exercices de résistance réalisés dans la phase suivante de la réadaptation. L’analyse électromyographique des muscles de l'épaule a fourni des évidences scientifiques pour la recommandation de beaucoup d'exercices de réadaptation au cours de cette période. Les activités sollicitant les muscles de la coiffe des rotateurs à moins de 20% de leur activation maximale volontaire sont considérés sécuritaires pour les premières phases de la réhabilitation. À partir de ce concept, l'objectif de cette thèse a été d'évaluer des activités musculaires de l'épaule pendant des mouvements et exercices qui peuvent théoriquement être effectués au cours des premières phases de la réhabilitation. Les trois questions principales de cette thèse sont : 1) Est-ce que la mobilisation du coude et du poignet produisent une grande activité des muscles de la coiffe? 2) Est-ce que les exercices de renforcement musculaire du bras, de l’avant-bras et du torse produisent une grande activité dans les muscles de la coiffe? 3) Au cours d'élévations actives du bras, est-ce que le plan d'élévation affecte l'activité de la coiffe des rotateurs? Dans notre première étude, nous avons évalué 15 muscles de l'épaule chez 14 sujets sains par électromyographie de surface et intramusculaire. Nos résultats ont montré qu’avec une orthèse d’épaule, les mouvements du coude et du poignet et même quelques exercices de renforcement impliquant ces deux articulations, activent de manière sécuritaire les muscles de ii la coiffe. Nous avons également introduit des tâches de la vie quotidienne qui peuvent être effectuées en toute sécurité pendant la période d'immobilisation. Ces résultats peuvent aider à modifier la conception d'orthèses de l’épaule. Dans notre deuxième étude, nous avons montré que l'adduction du bras réalisée contre une mousse à faible densité, positionnée pour remplacer le triangle d’une orthèse, produit des activations des muscles de la coiffe sécuritaires. Dans notre troisième étude, nous avons évalué l'électromyographie des muscles de l’épaule pendant les tâches d'élévation du bras chez 8 patients symptomatiques avec la déchirure de coiffe des rotateurs. Nous avons constaté que l'activité du supra-épineux était significativement plus élevée pendant l’abduction que pendant la scaption et la flexion. Ce résultat suggère une séquence de plan d’élévation active pendant la rééducation. Les résultats présentés dans cette thèse, suggèrent quelques modifications dans les protocoles de réadaptation de l’épaule pendant les 12 premières semaines après la réparation de la coiffe. Ces suggestions fournissent également des évidences scientifiques pour la production d'orthèses plus dynamiques et fonctionnelles à l’articulation de l’épaule.

Defining a role for the subthalamic nucleus within operative theoretical models of subcortical participation in language

Objective:To investigate the effects of bilateral, surgically induced functional inhibition of the subthalamic nucleus (STN) on general language, high level linguistic abilities, and semantic processing skills in a group of patients with Parkinson’s disease. Methods:Comprehensive linguistic profiles were obtained up to one month before and three months after bilateral implantation of electrodes in the STN during active deep brain stimulation (DBS) in five subjects with Parkinson’s disease (mean age, 63.2 years). Equivalent linguistic profiles were generated over a three month period for a non-surgical control cohort of 16 subjects with Parkinson’s disease (NSPD) (mean age, 64.4 years). Education and disease duration were similar in the two groups. Initial assessment and three month follow up performance profiles were compared within subjects by paired t tests. Reliability change indices (RCI), representing clinically significant alterations in performance over time, were calculated for each of the assessment scores achieved by the five STN-DBS cases and the 16 NSPD controls, relative to performance variability within a group of 16 non-neurologically impaired adults (mean age, 61.9 years). Proportions of reliable change were then compared between the STN-DBS and NSPD groups. Results:Paired comparisons within the STN-DBS group showed prolonged postoperative semantic processing reaction times for a range of word types coded for meanings and meaning relatedness. Case by case analyses of reliable change across language assessments and groups revealed differences in proportions of change over time within the STN-DBS and NSPD groups in the domains of high level linguistics and semantic processing. Specifically, when compared with the NSPD group, the STN-DBS group showed a proportionally significant (p

Redefining functional models of basal ganglia organisation: Role for the posteroventral pallidum in linguistic processing?

Traditionally the basal ganglia have been implicated in motor behavior, as they are involved in both the execution of automatic actions and the modification of ongoing actions in novel contexts. Corresponding to cognition, the role of the basal ganglia has not been defined as explicitly. Relative to linguistic processes, contemporary theories of subcortical participation in language have endorsed a role for the globus pallidus internus (GPi) in the control of lexical-semantic operations. However, attempts to empirically validate these postulates have been largely limited to neuropsychological investigations of verbal fluency abilities subsequent to pallidotomy. We evaluated the impact of bilateral posteroventral pallidotomy (BPVP) on language function across a range of general and high-level linguistic abilities, and validated/extended working theories of pallidal participation in language. Comprehensive linguistic profiles were compiled up to 1 month before and 3 months after BPVP in 6 subjects with Parkinson's disease (PD). Commensurate linguistic profiles were also gathered over a 3-month period for a nonsurgical control cohort of 16 subjects with PD and a group of 16 non-neurologically impaired controls (NC). Nonparametric between-groups comparisons were conducted and reliable change indices calculated, relative to baseline/3-month follow-up difference scores. Group-wise statistical comparisons between the three groups failed to reveal significant postoperative changes in language performance. Case-by-case data analysis relative to clinically consequential change indices revealed reliable alterations in performance across several language variables as a consequence of BPVP. These findings lend support to models of subcortical participation in language, which promote a role for the GPi in lexical-semantic manipulation mechanisms. Concomitant improvements and decrements in postoperative performance were interpreted within the context of additive and subtractive postlesional effects. Relative to parkinsonian cohorts, clinically reliable versus statistically significant changes on a case by case basis may provide the most accurate method of characterizing the way in which pathophysiologically divergent basal ganglia linguistic circuits respond to BPVP.

Measurement of functional ability following traumatic brain injury using the Clinical Outcomes Variable Scale: A reliability study

This study determined the inter-tester and intra-tester reliability of physiotherapists measuring functional motor ability of traumatic brain injury clients using the Clinical Outcomes Variable Scale (COVS). To test inter-tester reliability, 14 physiotherapists scored the ability of 16 videotaped patients to execute the items that comprise the COVS. Intra-tester reliability was determined by four physiotherapists repeating their assessments after one week, and three months later. The intra-class correlation coefficients (ICC) were very high for both inter-tester reliability (ICC > 0.97 for total COVS scores, ICC > 0.93 for individual COVS items) and intra-tester reliability (ICC > 0.97). This study demonstrates that physiotherapists are reliable in the administration of the COVS.

Does anticipation of back pain predispose to back trouble?

Limb movement imparts a perturbation to the body. The impact of that perturbation is limited via anticipatory postural adjustments. The strategy by which the CNS controls anticipatory postural adjustments of the trunk muscles during limb movement is altered during acute back pain and in people with recurrent back pain, even when they are pain free. The altered postural strategy probably serves to protect the spine in the short term, but it is associated with a cost and is thought to predispose spinal structures to injury in the long term. It is not known why this protective strategy might occur even when people are pain free, but one possibility is that it is caused by the anticipation of back pain. In eight healthy subjects, recordings of intramuscular EMG were made from the trunk muscles during single and repetitive arm movements. Anticipation of experimental back pain and anticipation of experimental elbow pain were elicited by the threat of painful cutaneous stimulation. There was no effect of anticipated experimental elbow pain on postural adjustments. During anticipated experimental back pain, for single arm movements there was delayed activation of the deep trunk muscles and augmentation of at least one superficial trunk muscle. For repetitive arm movements, there was decreased activity and a shift from biphasic to monophasic activation of the deep trunk muscles and increased activity of superficial trunk muscles during anticipation of back pain. In both instances, the changes were consistent with adoption of an altered strategy for postural control and were similar to those observed in patients with recurrent back pain. We conclude that anticipation of experimental back pain evokes a protective postural strategy that stiffens the spine. This protective strategy is associated with compressive cost and is thought to predispose to spinal injury if maintained long term. © Guarantors of Brain 2004; all rights reserved

Hemispheric contributions to lexical ambiguity resolution: Evidence from individuals with complex language impairment following left-hemisphere lesions

Nine individuals with complex language deficits following left-hemisphere cortical lesions and a matched control group (n 5 9) performed speeded lexical decisions on the third word of auditory word triplets containing a lexical ambiguity. The critical conditions were concordant (e.g., coin–bank–money), discordant (e.g., river–bank–money), neutral (e.g., day–bank– money), and unrelated (e.g., river–day–money). Triplets were presented with an interstimulus interval (ISI) of 100 and 1250 ms. Overall, the left-hemisphere-damaged subjects appeared able to exhaustively access meanings for lexical ambiguities rapidly, but were unable to reduce the level of activation for contextually inappropriate meanings at both short and long ISIs, unlike control subjects. These findings are consistent with a disruption of the proposed role of the left hemisphere in selecting and suppressing meanings via contextual integration and a sparing of the right-hemisphere mechanisms responsible for maintaining alternative meanings.

High frequency (1000 Hz) tympanometry in normal neonates

The characteristics of high frequency (1000 Hz) acoustic admittance results obtained from normal neonates were described in this study. Participants were 170 healthy neonates (96 boys and 74 girls) aged between 1 and 6 days (mean = 3.26 days, SD = 0.92). Transient evoked otoacoustic emissions (TEOAEs), and 226 Hz and 1000 Hz probe tone tympanograms were obtained from the participants using a Madsen Capella OAE/middle ear analyser. The results showed that of the 170 neonates, 34 were not successfully tested in both ears, 14 failed the TEOAE screen in one or both ears, and 122 (70 boys, 52 girls) passed the TEOAE screen in both ears and also maintained an acceptable probe seal during tympanometry. The 1000 Hz tympanometric data for the 122 neonates (244 ears) showed a single-peaked tympanogram in 225 ears (92.2 %), a flat-sloping tympanogram in 14 ears (5.7 %), a double-peaked tympanogram in 3 ears (1.2 %) and other unusual shapes in 2 ears (0.8 %). There was a significant ear effect, with right ears showing significantly higher mean peak compensated static admittance and tympanometric width, but lower mean acoustic admittance at +200 daPa and gradient than left ears. No significant gender effects or its interaction with ear were found. The normative tympanometric data derived from this cohort may serve as a guide for detecting middle ear dysfunction in neonates.

Language disorders in dementia of the Alzheimer type

The language profile of a group of 18 Alzheimer patients is documented and their performance on a standard aphasia test battery compared to a group of institutionalized, nonneurologically impaired control subjects matched for age, sex, and educational level. The Alzheimer patients scored significantly lower than the controls in the areas of verbal expression, auditory comprehension, repetition, reading, and writing. Articulation abilities were the same in each group. A language deficit was evident in all Alzheimer patients. The language disorder exhibited resembled a transcortical sensory aphasia. Syntax and phonology remained relatively intact but semantic abilities were impaired. The results support the inclusion of a language deficit as a diagnostic criterion of Alzheimer's disease.

Speech recognition in noise for cochlear implant listeners: Benefits of residual hearing

The purpose of this study was to explore the potential advantages, both theoretical and applied, of preserving low-frequency acoustic hearing in cochlear implant patients. Several hypotheses are presented that predict that residual low-frequency acoustic hearing along with electric stimulation for high frequencies will provide an advantage over traditional long-electrode cochlear implants for the recognition of speech in competing backgrounds. A simulation experiment in normal-hearing subjects demonstrated a clear advantage for preserving low-frequency residual acoustic hearing for speech recognition in a background of other talkers, but not in steady noise. Three subjects with an implanted "short-electrode" cochlear implant and preserved low-frequency acoustic hearing were also tested on speech recognition in the same competing backgrounds and compared to a larger group of traditional cochlear implant users. Each of the three short-electrode subjects performed better than any of the traditional long-electrode implant subjects for speech recognition in a background of other talkers, but not in steady noise, in general agreement with the simulation studies. When compared to a subgroup of traditional implant users matched according to speech recognition ability in quiet, the short-electrode patients showed a 9-dB advantage in the multitalker background. These experiments provide strong preliminary support for retaining residual low-frequency acoustic hearing in cochlear implant patients. The results are consistent with the idea that better perception of voice pitch, which can aid in separating voices in a background of other talkers, was responsible for this advantage.