Mirror therapy: A potential intervention for pain management.

The consequences of chronic pain and associated disabilities to the patient and to the health care system are well known. Medication is often the first treatment of choice for chronic pain, although side effects and high costs restrict long-term use. Inexpensive, safe and easy to self-administer non-pharmacological therapies, such as mirror therapy, are recommended as adjuncts to pain treatment. The purpose of this review is to describe the principles of use of mirror therapy so it can be incorporated into a health care delivery. The physiological rationale of mirror therapy for the management of pain and the evidence of clinical efficacy based on recent systematic reviews are also discussed. Mirror therapy, whereby a mirror is placed in a position so that the patient can view a reflection of a body part, has been used to treat phantom limb pain, complex regional pain syndrome, neuropathy and low back pain. Research evidence suggests that a course of treatment (four weeks) of mirror therapy may reduce chronic pain. Contraindications and side effects are few. The mechanism of action of mirror therapy remains uncertain, with reintegration of motor and sensory systems, restored body image and control over fear-avoidance likely to influence outcome. The evidence for clinical efficacy of mirror therapy is encouraging, but not yet definitive. Nevertheless, mirror therapy is inexpensive, safe and easy for the patient to self-administer

Development of new physical gels based on chitosan for wound healing.

Purpose: To investigate the potential of new chitosan-based physical gels, alone or loaded with plant extract or growth factors, for wound healing. Methods: Chitosan (CHI) was autoclaved and then dissolved at 2% w/w in acetic acid 0.1 M; the resulting dispersion was sonicated and then placed under vacuum for 48h. CHI gels were differently loaded depending of the considered active. In particular, gels loaded with PDGF and FGF-?? were prepared by co-dissolution of the growth factors with CHI in acetic acid 0.1 M. Alternatively, Centella asiatica (CEN) or Echinacea angustifolia (ECH) were added to the preformed gel. Thermal and rheological analysis were carried out to highlight the differences due to the heat treatment on the viscoelastic properties of gels. In addition, the effects of the gels on human fetal foreskin fibroblasts (HFFF-2) viability, proliferation and migration were investigated. Finally, the effect of the different gels on wound healing was investigated on C57BL/6J mice using an experimental model of pressure ulcer. Results: The differential scanning calorimeter (DSC) analysis showed that, the thermal treatment modifies the chemical and physical characteristics of the CHI powder. Furthermore, the formulations with non-autoclaved CHI showed a rheological behavior typical of an entangled network, while gels prepared from the autoclaved CHI have a typical gel behavior. The loading of actives into the gel did not affect the rheological properties of the formulations. In vitro tests on HFFF-2 showed that CHI gels were not toxic and led to increased cell proliferation and migration. Finally, the presence of PDGF ,FGF-??, CEN or ECH in the gels shows also to enhance the migration, the proliferation without affecting the vitality of fibroblasts. In vivo, CHI gel enhanced wound healing compared to untreated mice. This effect was higher when using CHI gels containing PDGF, FGF-??, CEN or ECH. Studies are in progress to determine the gel with the highest effect on wound healing, as well as the mechanism driving the tissue regeneration. Conclusions: The rheological properties of the developed CHI gels as well as in vitro and in vivo results, demonstrated a high potential as new products for the medication of wound, i.e. pressure ulcers

Sviluppo di nuovi gel fisici a base di chitosano per il trattamento di piaghe da decubito.

L???obiettivo di questo lavoro è stato lo sviluppo e la caratterizzazione di nuovi gel fisici sterili a base di chitosano, solo o in associazione a estratti vegetali, quali Centella asiatica (CEN) ed Echinacea angustifolia (ECH), e/o fattori di crescita, quali PDGF e FGF-????????? per il trattamento di piaghe da decubito. Per tutte le formulazioni sono stati determinate le proprietà viscoelastiche e termiche, mediante analisi reologica e Calorimetria a Scansione Differenziale (DSC). Infine è stato saggiato l???effetto delle diverse formulazioni su fibroblasti umani di prepuzio (HFFF-2) e sono stati effettuati studi in vivo su modelli sperimentali di piaghe da decubito indotte in topi C57BL/6J. L???analisi DSC ha evidenziato che la sterilizzazione in autoclave della polvere di CHI ne modifica le caratteristiche fisico-chimiche e ne cambia il comportamento reologico, che diventa quello tipico di un gel. Le sostanze attive caricate nei gel non influenzano in maniera significativa le proprietà reologiche delle formulazioni. Gli studi condotti su cellule HFFF-2 hanno evidenziato che i gel a base di CHI non sono tossici e inducono proliferazione e migrazione cellulare. L???impiego di sostanze attive caricate nei gel comporta un significativo aumento della migrazione e della proliferazione, soprattutto quando in miscela tra loro. Gli studi in vivo hanno confermato che i gel a base di CHI, soprattutto quando caricati con sostanze attive, aumentano la velocità di rigenerazione di tessuti lesi

Retro-inversal of intracellular selected ?-amyloid-interacting peptides: implications for a novel Alzheimer's disease treatment

The aggregation of ?-amyloid (A?) into toxic oligomers is a hallmark of Alzheimer's disease pathology. Here we present a novel approach for the development of peptides capable of preventing amyloid aggregation based upon the previous selection of natural all-l peptides that bind A?1-42. Using an intracellular selection system, successful library members were further screened via competition selection to identify the most effective peptides capable of reducing amyloid levels. To circumvent potential issues arising from stability and protease action for these structures, we have replaced all l residues with d residues and inverted the sequence. These retro-inverso (RI) peptide analogues therefore encompass reversed sequences that maintain the overall topological order of the native peptides. Our results demonstrate that efficacy in blocking and reversing amyloid formation is maintained while introducing desirable properties to the peptides. Thioflavin-T assays, circular dichroism, and oblique angle fluorescence microscopy collectively indicate that RI peptides can reduce amyloid load, while 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assays demonstrate modest reductions in cell toxicity. These conclusions are reinforced using Drosophila melanogaster studies to monitor pupal hatching rates and fly locomotor activity in the presence of RI peptides delivered via RI-trans-activating transcriptional activator peptide fusions. We demonstrate that the RI-protein fragment complementation assay approach can be used as a generalized method for deriving A?-interacting peptides. This approach has subsequently led to several peptide candidates being further explored as potential treatments for Alzheimer's disease