Selective serotonin reuptake inhibitors (SSRIs) are currently widely used in the field of the neuromodulation not only because of their anti-depressive effects but also due to their ability to promote plasticity and enhance motor recovery in patients with stroke. Recent studies showed that fluoxetine promotes motor recovery after stroke through its effects on the serotonergic system enhancing motor outputs and facilitating long term potentiation, key factors in motor neural plasticity. However, little is known in regards of the exact mechanisms underlying these effects and several aspects of it remain poorly understood. In this manuscript, we discuss evidence supporting the hypothesis that SSRIs, and in particular fluoxetine, modulate inhibitory pathways, and that this modulation enhances reorganization and reestablishment of excitatory-inhibitory control; these effects play a key role in learning induced plasticity in neural circuits involved in the promotion of motor recovery after stroke. This discussion aims to provide important insights and rationale for the development of novel strategies for stroke motor rehabilitation.
Purpose: The purpose of this systematic review is to evaluate motor cortex reorganization in amputees as indexed by transcranial magnetic stimulation (TMS) cortical mapping and its relationship with phantom limb pain (PLP).Methods: Pubmed database were systematically searched. Three independent researchers screened the relevant articles, and the data of motor output maps, including the number of effective stimulation sites, center of gravity (CoG) shift, and their clinical correlations were extracted. We calculated a pooled CoG shift for motor cortex TMS mapping.Results: The search yielded 468 articles, 11 were included. Three studies performed correlation between the cortical changes and PLP intensity, and only one study compared cortical mapping changes between amputees with pain and without pain. Results showed (i) enlarged excitable area and a shift of CoG of neighboring areas toward the deafferented limb area; (ii) no correlation between motor cortex reorganization and level of pain and (iii) greater cortical reorganization in patients with PLP compared to amputation without pain.Conclusion: Our review supports the evidence for cortical reorganization in the affected hemisphere following an amputation. The motor cortex reorganization could be a potential clinical target for prevention and treatment response of PLP.
The findings suggest that periodontal changes can be associated with osteoporosis in postmenopausal women.
Background. Although recent evidence has shown a new role of fluoxetine in motor rehabilitation, results are mixed. We conducted a randomized clinical trial to evaluate whether combining repetitive transcranial magnetic stimulation (rTMS) with fluoxetine increases upper limb motor function in stroke. Methods. Twenty-seven hemiparetic patients within 2 years of ischemic stroke were randomized into 3 groups: Combined (active rTMS + fluoxetine), Fluoxetine (sham rTMS + fluoxetine), or Placebo (sham rTMS + placebo fluoxetine). Participants received 18 sessions of 1-Hz rTMS in the unaffected primary motor cortex and 90 days of fluoxetine (20 mg/d). Motor function was assessed using Jebsen-Taylor Hand Function (JTHF) and Fugl-Meyer Assessment (FMA) scales. Corticospinal excitability was assessed with TMS. Results. After adjusting for time since stroke, there was significantly greater improvement in JTHF in the combined rTMS + fluoxetine group (mean improvement: −214.33 seconds) than in the placebo (−177.98 seconds, P = 0.005) and fluoxetine (−50.16 seconds, P < 0.001) groups. The fluoxetine group had less improvement than placebo on both scales (respectively, JTHF: −50.16 vs −117.98 seconds, P = 0.038; and FMA: 6.72 vs 15.55 points, P = 0.039), suggesting that fluoxetine possibly had detrimental effects. The unaffected hemisphere showed decreased intracortical inhibition in the combined and fluoxetine groups, and increased intracortical facilitation in the fluoxetine group. This facilitation was negatively correlated with motor function improvement (FMA, r2 = −0.398, P = 0.0395). Conclusion. Combined fluoxetine and rTMS treatment leads to better motor function in stroke than fluoxetine alone and placebo. Moreover, fluoxetine leads to smaller improvements than placebo, and fluoxetine’s effects on intracortical facilitation suggest a potential diffuse mechanism that may hinder beneficial plasticity on motor recovery.
The CBCT analysis is the best methodology for the investigation and localization of mandibular anatomical variations, which provides a good image quality of the bone tissue and details of the anatomical structures, reducing the risk of injury to the lower alveolar vascular-nervous bundle and, consequently, cause paralysis and hemorrhage in the anterior region of the mandible and adjacent structures.
RESUMOO emprego de fibras vegetais na confecção de compósitos tem grande viabilidade, no que diz respeito ao uso de materiais oriundos de fontes renováveis, à biodegradabilidade e aos benefícios socioeconômicos gerados na produção de matéria-prima vegetal. As fibras de sisal são altamente higroscópicas e esta característica se apresenta como um dos principais problemas na produção de compósitos induzindo a variações dimensionais sob a influência da umidade, deposição dos produtos da matriz em seus poros e a degradação. Os tratamentos de acetilação nas fibras de sisal foram aplicados em diferentes temperaturas e tempos reacionais, e a eficiência desses tratamentos, considerando-se a redução da hidrofilicidade e a manutenção do desempenho mecânico das fibras, foi avaliada pela capacidade de absorção de água por imersão, ensaios de resistência mecânica e por espectroscopia de infravermelho. Fibras acetiladas apresentaram reduções de peso por absorção de até 50% quando comparadas com as não tratadas. Os tratamentos por 3 h apresentaram as maiores perdas na resistência mecânica e a 120 °C por 1h indicaram as melhores características físico-mecânicas, além de incremento satisfatório de grupos apolares com o tratamento. Palavras-chave: Agave sisalana, tratamento de fibras, hidrofilicidadeStudy of the effects of acetylation treatments on sisal fiber ABSTRACTThe use of vegetable fibers in composites is highly viable regarding about the use of materials from renewable sources, the biodegradability and the socioeconomic advantages in the production of raw vegetable. The sisal fibers are highly hygroscopic and this is a main problem in the production of composites, inducing dimensional changes under moisture influence, deposition of the matrix products and degradation. The treatment of the acetylation was applied at different temperatures and reaction times, and the efficiency of treatments, considering the reduction of the hydrophilicity and maintenance of the mechanical properties, was evaluated by water sorption, mechanical properties and the infrared spectroscopy. With acetylation the fibers had weight reductions for water sorption up to 50% compared to untreated. The treatments for 3 h decreased the mechanical properties while the 120 °C for 1 h showed better physico-mechanical properties and increase of apolar groups.
Introdução: O contexto atual de abordagem multiprofissional em saúde fundamenta-se na qualidade do atendimento e segurança ao paciente, com contribuição importante do cirurgião-dentista na equipe hospitalar para melhoria de saúde dos hospitalizados. Objetivo: Caracterizar o perfil sistêmico e bucal de pacientes atendidos em clínica médica de um Hospital Universitário do Sistema de Saúde Pública do Brasil, visando fornecer subsídios no direcionamento da assistência odontológica ao atendimento multidisciplinar em âmbito hospitalar. Métodos: Foi realizado estudo observacional retrospectivo em 104 fichas clínicas com coleta de dados sobre características gerais, alterações sistêmicas, hábitos, situação bucal e tratamentos odontológicos de pacientes internados, atendidos pelo odontólogo. Resultados: Verificou-se alta frequência de pacientes hipertensos (36,5%) e com problemas cardíacos (33,6%). Observou-se associação significativa de diabetes (60%) e hipertensão (50%) na faixa etária de 60 a 75 anos de idade. Para a maioria dos pacientes, a higiene bucal foi realizada menos que três vezes ao dia (54,3%), sem uso de fio dental (85,7%). Biofilme (73,3%), cálculo dental (70,5%), uso de próteses (25,7%), com higiene deficiente (14,3%), e estomatite protética (8,6%) foram registradas. Dentre os tratamentos realizados, destacam-se a terapia básica periodontal (71,4%) e exodontias (39%). Conclusão: A alta frequência de presença de biofilme, cálculo dental, próteses com higiene deficiente e a terapia básica periodontal executada durante o período de internação denotam a necessidade de atuação odontológica com atividades preventivas.
O bruxismo do sono é uma das atividades parafuncionais mais abordados na Odontologia, especialmente devido a questões controversas quanto à sua prevalência e etiologia. Os estudos realizados na área conseguem, tão somente, amenizar seu potencial destrutivo, mas não estabelecem, todavia, uma relação direta entre causa e efeito. A literatura considera atualmente o estresse, a fisiologia do sono, algumas drogas e, em menor escala, a oclusão, como fatores desencadeadores deste comportamento parafuncional. O objetivo deste trabalho foi investigar a relação entre bruxismo do sono e distúrbios do sono, em policiais militares da cidade de São Luís-MA. Os resultados revelaram que não houve associação significante entre bruxismo do sono e distúrbios do sono (p=0,07). Conclui-se, portanto que apesar de o bruxismo ocorrer durante o sono, ele não interfere na qualidade do mesmo
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