Percepções e estimulações elétricas por correntes senoidais

OBJECTIVE: To analyze the relationship between perceptions and electrical senoidal current stimulation (ESCS). METHOD: The study population comprise 100 healthy volunteers. ESCS of 5 Hz and 2 kHz were applied to the left index finger at one and 1.5 sensory threshold. Following each stimulus train a list of eight words (four related to thin fiber sensations and four related to thick fiber sensations) was presented to the subjects who were asked to choose the three words closer to the experienced sensation. Each chosen word was given a score 1; final results were obtained by the sum of the scores for the words related to thin and thick fiber systems for each situation. RESULTS: For 5 Hz ESCS at one and 1.5 sensory threshold thin fibers had significantly higher scores than thick fibers; for 2 kHz ESCS, thick fibers had significantly higher scores. CONCLUSION: These results show that there is a relation between different sensations and ESCS of different frequencies.OBJETIVO: Estudar a relação entre as sensações evocadas por estimulação elétrica por corrente senoidal (ESCS). MÉTODO: 100 voluntários normais foram estudados. ESCS a 5 Hz e 2 kHz foram aplicadas no dedo indicador esquerdo com uma e 1,5 vezes o limiar sensorial. Listas de oito palavras (4 relacionadas a fibras grossas, 4 a fibras finas) foram apresentadas após cada estimulação e foi solicitado que o sujeito escolhesse as 3 palavras que mais se aproximassem das sensações experimentadas. Às palavras escolhidas foi dado o escore 1. Os resultados finais para análise foram obtidos da soma dos escores para as palavras relacionadas aos diferentes sistemas de fibras. RESULTADOS: Para ESCS a 5 Hz sensações relacionadas a fibras finas foram significantemente mais escolhidas, já para estimulações a 2 kHz sensações relacionadas a fibras grossas foram significantemente mais escolhidas. CONCLUSÃO: Estes resultados mostram um relação entre diferentes percepções e diferentes freqüências de correntes elétricas senoidais.City of São Paulo UniversityUNIFESP Neurology and Neurosurgery DepartmentFederal University of Minas Gerais Electrical Engineering DepartmentUNIFESP, Neurology and Neurosurgery DepartmentSciEL

Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Expression of praxis induction on cortical excitability in juvenile myoclonic epilepsy

Objective: This study aimed to evaluate the effects of praxis induction on sensorimotor cortical and transcallosal excitability in juvenile myoclonic epilepsy (JME). Methods: A total of 36 subjects (18-62 years) were included. The JME group was screened by video-electroencephalography neuropsychological protocol and divided into JME without praxis induction [JME-WI (n = 12)], JME with praxis-induced seizures or epileptiform discharges [JME-PI (n = 10)], and healthy controls (n = 14). Motor and somatosensory cortical excitability and transcallosal pathways were evaluated through single-pulse transcranial magnetic stimulation (sTMS) and somatosensory evoked potentials (SEPs). Results: Motor and transcallosal excitabilities tested with sTMS were not different in the motor-dominant or non-dominant hemisphere among groups. Significant differences were found in cortical SEP amplitudes in the P27 component of the non-dominant hemisphere (p = 0.03, Cohen's d = 0.98), N35 in the dominant hemisphere (p = 0.04, Cohen's d = 0.96), and P27-35 interpeak amplitude in both somatosensory cortices of the JME-PI group (p = 0.03, Cohen's d = 0.96p = 0.02, Cohen's d = 1.05) when compared with healthy controls. Giant SEPs were observed in two (16.7%) and five (50%) patients of the JME-WI and JME-PI groups, respectively. Cortical latencies did not reveal differences. Conclusions: Praxis induction was associated with enhanced excitability in the somatosensory cortex of JME patients. Significance: These findings may help clarifying the less favorable therapeutic response in the JME-PI group and indicate identifying praxis induction as an important determinant in differentiating between JME patients. (C) 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.FAPESP, Sao Paulo, BrazilUniv Fed Sao Paulo UNIFESP, Div Neurol, Dept Neurol & Neurosurg, Sao Paulo, BrazilUniv Fed Sao Paulo UNIFESP, Div Neurol, Dept Neurol & Neurosurg, Clin Neurophysiol Sect, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Neurol & Neurosurg, Unidade Pesquisa & Tratamento Epilepsias UNIPETE, BR-04024002 Sao Paulo, BrazilUniv Fed Sao Paulo UNIFESP, Div Neurol, Dept Neurol & Neurosurg, Sao Paulo, BrazilUniv Fed Sao Paulo UNIFESP, Div Neurol, Dept Neurol & Neurosurg, Clin Neurophysiol Sect, Sao Paulo, BrazilUniv Fed Sao Paulo, Dept Neurol & Neurosurg, Unidade Pesquisa & Tratamento Epilepsias UNIPETE, BR-04024002 Sao Paulo, BrazilWeb of Scienc