Kinetics and kinematics of diabetic foot in type 2 diabetes mellitus with and without peripheral neuropathy: a systematic review and meta-analysis.

Diabetes mellitus patients are at increased risk of developing diabetic foot with peripheral neuropathy, vascular and musculoskeletal complications. Problems develop with a relatively high risk of infection, gangrene and amputation. In addition, altered plantar pressure distribution is an important etiopathogenic risk factor for the development of foot ulcers. The purpose of this systematic review is to understand the biomechanical changes involved through studies of foot kinematic and kinetic in type 2 diabetes mellitus. Scientific articles were identified using electronic databases including Science Direct, CINAHL, Springer Link, Medline, Web of Science, and Pubmed. The selection of articles to include in the systematic review was narrorwed after reading the full text, focusing on studies that used experimental designs relating to the biomechanics of diabetic foot. The meta-analysis report on gait velocity (neuropathy = 128 and non-diabetes = 131) showed that there was a significantly lower gait velocity in neuropathy participants compared to non-diabetes age-matched participants at a high effect level (-0.09, 95% CI -0.13 to 0.05; p < 0.0001). Regarding knee-joint flexion range, there was a significant difference between neuropathy and non-diabetes groups (4.75, 95% CI, -7.53 to 1.97, p = 0.0008). The systematic review found significant differences in kinematic and kinetic variables among diabetic with neuropathy, diabetic without neuropathy and non-diabetic individuals. The review also found that the sample sizes used in some studies were not statistically significant enough contribute reliably to the meta-analysis, so further studies with higher sample sizes are required

Auditory Processing Assessment In Children With Obstructive Sleep Apnea Syndrome [avaliação Do Processamento Auditivo Em Crianças Com Síndrome Da Apnéia/hipopnéia Obstrutiva Do Sono]

Introduction: The obstructive sleep apnea syndrome (OSAS) is a respiratory disorder that occurs during sleep and it is relatively common in children. Aim: The goal of this paper is to verify if there is a relationship between the obstructive sleep apnea syndrome (OSAS) and auditory processing. Methods: In order to do that, three groups of children ranging in age from 5 to 11 were studied, including a normal group. Twenty subjects who made up the study group were submitted to ear, nose and throat (ENT) exams and to polysomnography (PSG), and were divided in two groups: GROUP I (RO) comprised of 10 children who presented oral breathing and displayed normal PSG, and GROUP II (SAS) comprised of 10 children who presented oral breathing and displayed abnormal PSG. Their performance was compared to the performance of the third group - GROUP III (REN) comprised of 10 children who did not refer ENT difficulties. All the subjects completed a basic audiometric assessment as well as an auditory processing diagnosis. Results: The analyses of the results revealed a statistically significant difference in ENT exams related to the turbinate and the palatine tonsils. Group II presented a higher incidence of turbinate hypertrophy levels II and III (p < 0.001) and palatine tonsils hypertrophy grades III and IV (p 0.007). Regarding the auditory processing assessment, a statistically significant difference (p < 0.001) was obtained in the dichotic digits test. Group II performed worse than group III. Also, for the non-verbal sequence memory test, Group II obtained a worse result (p < 0.022) than Group I. Conclusion: Subjects with OSAS obtained worse results in auditory processing tests.723321327Rosen, C.L., Obstructive sleep apnea syndrome (OSAS) in children: Diagnostic challenges (1996) Sleep, 19 (10), pp. 274-277Marcus, C.L., Sleep-disordered breathing in children (2000) Pediatr, 12, pp. 208-212Marcus, C.L., Sleep-disordered breathing in children (2001) Am J Respir Crit Care Med, 164, p. 16Goldstein, N.A., Fatima, M., Campbell, T.F., Rosenfeld, R.M., Child behavior and quality of life before and after tonsillectomy and adenoidectomy (2002) Arch Otolaryngol Head Neck Surg, 128, pp. 770-775Morton, S., Rosen, C., Larkin, E., Tishler, P., Aylo, J., Redlin, S., Predictors of sleep-disordered breathing in children with a history of tonsillectomy and adenoidectomy (2001) Sleep, 24 (7), pp. 823-829Clinical practice guideline: Diagnosis and management of childhood obstructive sleep apnea syndrome (2002) Pediatrics, 109 (4), pp. 704-712. , American Academy of PediatricsChervin, R.D., Archbold, K.H., Dillon, J.E., Panahi, P., Pituch, K.J., Dahl, R.E., Guilleminault, C., Innatention, hyperactivity, and symptoms of sleep-disordered breathing (2002) Pediatrics, 109 (3), pp. 449-456O'Brien, L.M., Gozal, D., Neurocognitive dysfunction and sleep in children: From human to rodent (2004) The Pediatr Clin N Am, 51, pp. 187-202Pereira, L.D., Processamento auditivo central - Abordagem passo a passo (1997) Processamento Auditivo Central - Manual de Avaliação, pp. 49-60. , Pereira LD, Schochat E. São Paulo: LoviseSilman, S., Silverman, C.A., (1991) Auditory Diagnosis, , San Diego: Academic Press IncCarvallo, R.M.M., Imitanciometria (2004) Tratado de Fonoaudiologia, pp. 569-584. , Ferreira LP, Befi-Lopes DM, Limongi, SCO, organizadoras. São Paulo: RocaChami, F.A.I., (1997) Avaliação Nasofibroscópica e Radiológica de Pacientes Com Hiperplasia de Amígdala Faríngea, , [tese de mestrado]. São Paulo: Universidade Federal de São Paulo - Escola Paulista de MedicinaBrodsky, L., Modern assessment of tonsils and adenoids (1989) Ped Clin North America, 36 (6), pp. 1551-1571Standards and indications for cardiopulmonary sleep studies in children (1996) Am J Respirat Crit Care Med, 153, pp. 866-878. , American Thoracic SocietyCorona, A.P., (2000) Processamento Auditivo Central: Seqüencialização Verbal de Três e Quatro Sílabas Em Escolares de Três a Doze Anos [Monografia de Especialização], , Salvador: Universidade Federal da BahiaSantos, M.F.C., Pereira, L.D., Escuta com dígitos (1997) Processamento Auditivo Central - Manual de Avaliação, pp. 147-150. , Pereira LD, Schochat E. São Paulo: LoviseCarrol, J.L., Longhlin, G.M., Obstrutive sleep apnea syndrome in infants and children: Clinical features and pathophysiology (1995) Principles and Practice of Sleep Medicine in the Child, , Feber R, Kryger M. Philadelphia: WB SaundersCentral auditory processing - Current strategies and implications of clinical practice (1996) Am J Audiology, 5 (2), pp. 41-54. , American Speech Language Hearing AssociationBellis, T.J., (2003) Assessment and Management of Central Auditory Processing Disorders in the Educational Setting: From Science to Practice, , San Diego: Delmar LearningMusiek, F.E., Assessment of central auditory dysfunction: The dichotic digits tests revisited (1983) Ear Hear, 4, pp. 79-83Musiek, F.E., Kibbe, K., Baran, J.A., Neuroaudiological results from splitbrain patients (1984) Seminars in Hearing, 5, pp. 219-229Guilleminault, C., Li, K., Quo, S., Inouye, R.N., A prospective study on the surgical outcomes of children with sleep disordered breathing (2004) Sleep, 27 (1), pp. 95-100Gozal, D., Sleep-disordered breathing and school performance in children (1998) Pediatrics, (102), pp. 616-620Lipton, A.J., Gozal, D., Treatment of obstructive sleep apnea in children: Do we really know how? (2003) Sleep Med Rev, 7, pp. 61-80Brown, A.W., Brierley, J.B., The earliest alterations in rat neurons and astrocytes after anoxia-ischaemia (1973) Acta Neuropathol, 23, pp. 9-22Shiomi, T., Guilleminault, C., Stoohs, R., Schnittger, I., Obstructed breathing in children during sleep monitored by echocardiography (1993) Acta Paediatr, (82), pp. 863-87

Plant regeneration from proroplasts of alfalfa (Medicago sativa) via somatic embryogenesis Regeneração de plantas a partir de protoplastos de alfafa (Medicago sativa) via embriogênese somática

Alfalfa is one of the most frequently studied species from the production of tissue culture-derived embryos point of view. In this study, five alfalfa cultivars were analyzed with reference to their ability to regenerate plants from protoplast cultures via somatic embryogenesis. Plant regeneration from leaf-derived protoplasts isolated from the cultivar Rangelander was achieved using a protocol defined for alfalfa cell suspension-derived embryogenesis. Because of its high efficiency, this procedure is recommended for protoplast electroporation-mediated genetic transformation of alfalfa.<br>A alfafa é uma das espécies mais freqüentemente estudadas do ponto de vista da produção de embriões somáticos derivados da cultura de tecidos. Neste trabalho, cinco cultivares de alfafa foram analisados com referência à capacidade de regenerar plantas a partir de culturas de protoplastos via embriogênese somática. Regeneração de plantas a partir de protoplastos isolados de folhas da cultivar Rangelander foi obtida usando-se um protocolo definido para embriogênese somática derivada de suspensões celulares de alfafa. Em função da sua alta eficiência, recomenda-se o uso deste procedimento para transformação genética de alfafa mediada por eletroporação de protoplastos