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Neurorestorative Effects of Constraint-Induced Movement Therapy after Stroke: An Integrative Review

Neuroscience & Medicine 2013年第4期4卷 253-262页

作者： Marina Lucas Pedro Ribeiro Mauricio Cagy Silmar Teixeira fernanda chaves Diana Carvalho Caroline Peressutti Sérgio Machado Juliana Bittencourt Bruna Velasques Roberto Piedade Brain Mapping and Sensory Motor Integration Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ) Rio de Janeiro Brazil Brain Mapping and Sensory Motor Integration Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ) Rio de Janeiro Brazil Physiotherapy Laboratory Veiga de Almeida University (UVA) Rio de Janeiro Brazil Physiotherapy Department Piquet Carneiro Policlinic State University of Rio de Janeiro (UERJ) Rio de Janeiro Brazil Brain Mapping and Sensory Motor Integration Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ) Rio de Janeiro Brazil School of Physical Education Bioscience Department Federal University of Rio de Janeiro (EEFD/UFRJ) Rio de Janeiro Brazil Institute of Applied Neuroscience (INA) Rio de Janeiro Brazil Brain Mapping and Sensory Motor Integration Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ) Rio de Janeiro Brazil Institute of Applied Neuroscience (INA) Rio de Janeiro Brazil Division of Epidemiology and Biostatistic Institute of Health Community Federal Fluminense University (UFF) Rio de Janeiro Brazil Laboratory of Panic and Respiration Federal University of Rio de Janeiro (UFRJ) Rio de Janeiro Brazil Physical Activity Neuroscience Laboratory Salgado de Oliveira University Rio de Janeiro Brazil

Stroke has been considered as one of the main causes of death and of motor and cognitive sequels. Especially, many patients with upper limb hemiparesis improved their motor action and showed meaningful cortical changes after treatment with constraint-induced movement therapy. Therefore, this review aims to verify the literature about neuroimaging and behavioral evidences in the cortical reorganization through the use of the constraint-induced movement therapy. So, we conducted the literature research in indexed journals from many databases like Pubmed, Medline, Cochrane Database, Lilacs and Scielo. We concluded that the behavioral and neuroimaging studies using traditional and modified constraint-induced movement therapy promote cortical reorganization.

关键词： Stroke Constraint-Induced-Movement-Therapy Neuroplasticity Cerebral Reorganization

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Deep sedation during gastrointestinal endoscopy: Propofol-fentanyl and midazolam-fentanyl regimens

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World Journal of Gastroenterology 2013年第22期19卷 3439-3446页

作者： Marcos Eduardo Lera dos Santos Fauze Maluf-Filho Dalton Marques chaves Sergio Eiji Matuguma Edson Ide Gustavo de Oliveira Luz Thiago Ferreira de Souza fernanda C Simoes Pessorrusso Eduardo Guimares Hourneaux de Moura Paulo Sakai Department of Gastroenterology Hospital das Clínicas University of Sao Paulo Medical School Sao Paulo CEP 05403-900 Brazil Cancer Institute of Sao Paulo State Sao Paulo CEP 01246-000 Brazil

AIM: To compare deep sedation with propofol-fentanyl and midazolam-fentanyl regimens during upper gastrointestinal endoscopy. METHODS: After obtaining approval of the research ethics committee and informed consent, 200 patients were evaluated and referred for upper gastrointestinal endoscopy. Patients were randomized to receive propofol-fentanyl or midazolam-fentanyl (n = 100/group).We assessed the level of sedation using the observer's assessment of alertness/sedation (OAA/S) score and bispectral index (BIS). We evaluated patient and physician satisfaction, as well as the recovery time and complication rates. The statistical analysis was performed using SPSS statistical software and included the MannWhitney test, χ 2 test, measurement of analysis of variance, and the κ statistic. RESULTS: The times to induction of sedation, recovery, and discharge were shorter in the propofolfentanyl group than the midazolam-fentanyl group. According to the OAA/S score, deep sedation events occurred in 25% of the propofol-fentanyl group and 11% of the midazolam-fentanyl group (P = 0.014). Additionally, deep sedation events occurred in 19% of the propofol-fentanyl group and 7% of the midazolamfentanyl group according to the BIS scale (P = 0.039). There was good concordance between the OAA/S score and BIS for both groups (κ = 0.71 and κ = 0.63, respectively). Oxygen supplementation was required in 42% of the propofol-fentanyl group and 26% of the midazolam-fentanyl group (P = 0.025). The mean time to recovery was 28.82 and 44.13 min in the propofolfentanyl and midazolam-fentanyl groups, respectively (P < 0.001). There were no severe complications in either group. Although patients were equally satisfied with both drug combinations, physicians were more satisfied with the propofol-fentanyl combination. CONCLUSION: Deep sedation occurred with propofolfentanyl and midazolam-fentanyl, but was more frequent in the former. Recovery was faster in the propofol-fentanyl group.

关键词： Endoscopy Deep sedation Anesthetic administration Anesthetic dose Adverse effects

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