Use your imagination for better performance. Effects of analogy instruction in motor skills. A systematic review and Meta-Analysis.

This systematic review and meta-analysis examined the effects of analogy instruction (ANA) on motor performance and knowledge declared (KD) compared with explicit learning (EXP) and control conditions. Five databases were included. The study analyzed 16 randomized controlled trials. Subsequent analysis was performed for moderators variables as age, skill, retention, stress situations number of rules, specificity and number of trials. The ANA instruction demonstrated greater efficacy than the control (ES = 0.32, p=0.03) or EXP condition (ES = 0.29, p=0.02) in motor tasks performance in general terms. ANA instructions also showed superiority in motor performance when compared to control conditions in retention (ES = 5.72, p=0.004), and a trend towards significance was found under stress (ES = 1.18, p=0.05). ANA also showed superiority in motor performance when compared to EXP instruction (ES = 0.29, p=0.02). ANA demonstrated greater effects than EXP in retention (ES = 7.25, p=0.01), but not under stress (ES = 0.62, p=0.18). Sub-analyses demonstrated that children (all p < 0.01) and novices (all p < 0.01) are more likely to benefit from ANA instruction when compared to control or EXP. A subgroup analysis based on quantity of information comparing ANA versus EXP condition shows that ANA is more effective for enhancing motor performance than EXP when the number of rules are similar. Sub-analyses comparing ANA versus CNT shows that as the number of repetitions increases and the task becomes less specific, ANA instruction significantly improves performance. A comparison between ANA and EXP indicates no significant differences in performance regarding the number of repetitions and task specificity. A secondary analysis examined KD of different instructions. KD was greater in EXP instructions (ES = -1.48, p < 0.001) when compared to ANA. Findings suggest that analogy instruction may improve motor performance, especially in novice and child populations. However, caution is needed due to concerns when comparing with other instructional types and environments, as well as due to high heterogeneity in most of the comparisons and high risk of bias in included studies.

Long-term benefit of ustekinumab in ulcerative colitis in clinical practice: ULISES study.

BACKGROUND: Ustekinumab is approved for ulcerative colitis (UC). AIMS: To assess the durability of ustekinumab in patients with UC and its short-term effectiveness, durability and tolerability in clinical practice. METHODS: Retrospective, multicentre study of patients who had received their first ustekinumab dose at least 16 weeks before inclusion. Patients were followed until treatment discontinuation or last visit. Only patients with active disease at the start of ustekinumab treatment were considered in the effectiveness analysis. Patients who stopped ustekinumab before their last visit were considered not to be in subsequent remission. RESULTS: We included 620 patients; 155 (25%) discontinued ustekinumab during follow-up (median 12 months). Rate of discontinuation was 20% per patient-year of follow-up. Anaemia at baseline (hazard ratio, HR 1.5; 95% confidence interval [CI] 1.1-2.1), steroids at baseline (HR 1.5; 95% CI 1.06-2.08) and more severe clinical activity at baseline (HR 1.5; 95% CI 1.09-2.06) were associated with higher risk of discontinuation. At the end of induction, 226 (40%) patients were in steroid-free clinical remission. Moderate-severe vs mild disease activity at baseline (odds ratio [OR] 0.3; 95% CI 0.2-0.5), male sex (OR 0.5; 95% CI 0.4-0.8), and increased number of previous biologics (OR 0.6; 95% CI 0.6-0.8) were associated with lower likelihood of steroid-free clinical remission at week 16. One hundred and seventy-six patients (28%) had at least one adverse event. We observed no negative impact of ustekinumab on extraintestinal manifestations and/or immune-mediated diseases. CONCLUSIONS: Ustekinumab durability in UC was relatively high, and treatment was effective in highly refractory patients. The safety profile was consistent with previous studies.

Influence of competitive padel matches on physical fitness and perceptual responses in high-level players.

BACKGROUND: Padel is a sport that requires a combination of physical and technical skills. Fatigue is a major modulator of padel players' performance. The aim of this study was to analyze the changes in neuromuscular performance and perceived effort among high-level padel players. METHODS: Countermovement jump and handgrip strength of 58 participants (men: N.=38 age = 28.3±7.05 years, height = 178.9±8.41 cm; body mass = 75.25±8.2 kg. women: N.=21, age = 23.07±4.6 years, height = 163.86±10.34 cm; body mass = 59.9±6.13 kg) were assessed pre- and post-match in 43 official matches during the Padel Master 2021 of the Andalusian Padel Federation. Additionally, the Rating of Perceived Exertion (RPE) Scale was used to assess players' subjective perception of effort after each match. RESULTS: Players experienced significant increases in postmatch jump height, with no changes in handgrip strength. Moreover, changes in jump height were greater in male players after the match when compared to their female counterparts, but the match duration was not determinant when comparing CMJ or handgrip between 2-sets and 3-sets matches. Finally, players reported a higher RPE after longer matches, but perceived effort was not different between sexes. CONCLUSIONS: These findings suggest that the internal load generated during competitive padel matches is insufficient to cause a declination in performance of the studied variables. It is also concluded that players' warm-up routines could be optimized to enhance neuromuscular performance at the start of matches.

Relación entre el clima educacional y el sindrome de agotamiento profesional en médicos residentes del Hospital Nacional / Relationship between the educational climate and the syndrome of professional exhaustion in resident physicians of the Hospital Nacional

RESUMEN Introducción: el clima educacional (CE) de posgrado en el ambiente hospitalario puede determinar la manera en como los médicos residentes (MR) se adaptan a su nueva etapa, durante el cual el sindrome agotamiento profesional (SAP) es altamente probable de producirse en algún momento. Objetivo: determinar la relación entre el clima educacional y el agotamiento profesional en médicos de los programas de residencias médicas del Hospital Nacional 2023-2024. Metodología: estudio observacional transversal de una muestra por conveniencia de MR de ambos sexos de todas las especialidades médicas del Hospital Nacional entre noviembre 2023 y enero 2024, se excluyeron MR con rotación externa y/o vacaciones. Calculo muestral; 136 MR. Se envió un formulario en línea de Google al correo electrónico del MR solicitando la participación voluntaria. El SAP fue medido con el método estándar Maslach Burnout Inventory (MBI) con subescalas; agotamiento emocional (AE), despersonalización (DESP), realización personal (RP), existiendo SAP con puntuaciones altas de AE, DESP y bajas de RP. El CE fue valorado con la medida del entorno educativo de posgrado hospitalario (PHEEM) con subescalas; percepción autonomía de roles (PAR), percepción enseñanza (PE), percepción soporte social (PSS), a mayor puntaje mejor CE. Se recopiló variables demográficos, académicos, puntajes del MBI y PHEEM, el SAP fue considerado dependiente, como resultado principal la relación predictiva del PHEEM sobre el SAP. Se compararon datos con χ², prueba t o U de Mann-Whitney, ANOVA y regresión lineal (p-valor significativo =<0,05). Resultados: de 233 participantes, la edad media fue de 28,75 (± 2,20), el 63,94 % (149) mujeres, la prevalencia general del SAP; 70,38 % (164/233), SAP en hombres 75 % (63/84) y mujeres 67,78 % (101/149) p=0,0014, los 2 primeros años con mayor frecuencia de SAP; 65 (85,52 %), 59 (86,76 %) repectivamente p=0,0009, de especialidades quirúrgicas 63 (90 %) p=0,0071. Las subescalas del MBI el AE;79,82 % (186) con un promedio de 35,39 (± 11,61) puntos. El PHEEM de los MR con SAP; 107,9( 19,6) puntos y sin SAP; 136,3( 12,1) puntos IC 95 % 18,1­25,0 p= 0,0001. El PHEEM predijo el AE con R2=0,619, PPS; B= -0,18 (±0,009) p=0,001, y la DESP; R2= 0,385, PPS; B= -0,001 (±0,004) p=0,009 siendo PSS predictor significativo con correlación inversa en ambas. Conclusión: existe relación inversa entre el clima educativo y el sindrome de agotamiento profesional en la población estudiada, con alta prevalencia de este en residentes hombres de especialidades quirúrgicas, siendo el soporte social del ambiente educativo hospitalario un predictor significativo para el desarrollo del sindrome de agotamiento profesional.

ABSTRACT Introduction: the postgraduate educational climate (CE) in the hospital environment can determine the way in which resident physicians (MRs) adapt to their new stage, during which professional burnout syndrome (PAS) is highly likely to occur at some point. Objective: to determine the relationship between the educational climate and professional burnout in physicians in the medical residency programs of the National Hospital 2023-2024. Methodology: cross-sectional observational study of a sample of MR convenience of both sexes from all medical specialties of the National Hospital between November 2023 and January 2024, MR with external rotation and/or vacations were excluded. Sample calculation; 136 MR. An online form from Google was sent to the MR email requesting voluntary participation. The SAP was measured with the standard Maslach Burnout Inventory (MBI) method with subscales; emotional exhaustion (EA), depersonalization (DESP), personal fulfillment (PR), with PAS with high scores of AE, DESP and low RP. The EC was assessed with the measure of the hospital postgraduate educational environment (PHEEM) with subscales; perception of role autonomy (PAR), perception of teaching (PE), perception of social support (PSS), the higher the score, the better the EC. Demographic and academic variables, MBI and PHEEM scores were collected, and the SAP was considered dependent, as the main result was the predictive relationship of the PHEEM on the SAP. Data were compared with χ², t-test or Mann-Whitney U, ANOVA and linear regression (p-significant value =<0.05). Results: of 233 participants, the mean age was 28.75 (±2.20), 63.94 % (149) women, the general prevalence of PAS; 70.38 % (164/233), PAS in men 75 % (63/84) and women 67.78 % (101/149) p=0.0014, the first 2 years with the highest frequency of PAS; 65 (85.52 %), 59 (86.76 %) respectively p=0.0009, 63 (90 %) p=0.0071 surgical specialties. The subscales of the MBI, the AE; 79.82 % (186) with an average of 35.39 (± 11.61) points. The CE of MRs with SAP; 107.9 (19.6) dots and without PAS; 136.3 (12.1) dots 95 % CI 18.1­25.0 p= 0.0001. The PHEEM predicted the AE with R2=0.619, B= -0.18 (±0.009) p=0.001, and the DESP; R2= 0.385, B= -0.001(0.004) p=0.009, PSS being a significant predictor with inverse correlation in both. Conclusion: there is an inverse relationship between the educational climate and burnout syndrome in the population studied, with a high prevalence of burnout in male residents of surgical specialties, with the social support of the hospital educational environment being a significant predictor for the development of burnout syndrome.

Efectividad de un programa de capacitación intensiva en reanimación cardiopulmonar y uso del desfibrilador externo automático entre representantes de centros de concurrencia masiva en Asunción 2023

Introducción: La capacitación en reanimación cardiopulmonar (RCP) y uso correcto del desfibrilador externo automático (DEA) permite la intervención de los ciudadanos legos en situaciones de paro cardíaco extrahospitalario (PCEH). En Paraguay, la Ley n° 5.578/2016 establece el uso obligatorio del DEA en centros de concurrencia masiva (CCM). Objetivo: Evaluar la efectividad de un programa de capacitación intensiva en reanimación cardiopulmonar y uso del desfibrilador externo automático entre representantes de centros de concurrencia masiva en Asunción julio-setiembre 2023. Metodología: Estudio cuasiexperimental antes/después en representantes de CCM (Universidades, Shoppings, Clubes sociales/deportivos Gimnasios, Consecionario Automotríz, Complejos residenciales y Supermercados). Se obtuvieron datos de universidades del Ministerio de Educación y Ciencias, de fuentes municipales y la Cámara de Comercio. Se capacitó entre 1-3 representantes/CCM mediante talleres teórico-práctico sobre RCP básico y uso correcto del DEA en PCEH con un cuestionario validado (alfa de Cronbach: 0,75). Se compararon datos con χ² y prueba t o U de Mann-Whitney (p-valor significativo =<0,05). Resultados: De 194 participantes, la edad meda fue; 29±5años; el 60,31% (117) del sexo masculino, 38,65%(70) representantes de shoppings, 60,82% (118) tenian formación universitaria, y el 45,36% (88) se desempeñaban en atención al cliente. El 59, 228% (115) no habia recibido capacitación en RCP anteriormente y el 86,08% (167) tampoco tenia entrenamiento en uso del DEA. Se pudo observar una diferencia estadisticamente significativa entre la puntaje antes y después, observandose una diferencia de 4,791 1,012 puntos (p=0,0001). Discusión: El programa de capacitación intensiva es efectivo para elevar el nivel de conocimiento y práctica en RCP básica y uso del DEA entre representantes legos de CCM.

Introduction: Training in cardiopulmonary resuscitation (CPR) and correct use of the automated external defibrillator (AED) allows the intervention of lay citizens in situations of out-of-hospital cardiac arrest (EHPA). In Paraguay, Law No. 5,578/2016 establishes the mandatory use of the AED in mass attendance centers (CCM). Methodology: quasi-experimental before/after study in CCM representatives (Universities, shopping malls, Social/Sports Clubs, Gyms, Automotive Dealership, Residential Complexes and Supermarkets). Data were obtained from universities of the Ministry of Education and Sciences, municipal sources, and the Chamber of Commerce. Between 1-3 representatives/MCCs were trained through theoretical-practical workshops on basic CPR and correct use of the AED in HCWP with a validated questionnaire (Cronbach's alpha: 0.75). Data were compared with χ² and Mann-Whitney t-test or U test (p-significant value =<0.05). Results: Of 194 participants, the mean age was 29±5; 60.31% (117) were male, 38.65% (70) were shopping mall representatives, 60.82% (118) had a university education, and 45.36% (88) worked in customer service. 59.228% (115) had not previously received CPR training and 86.08% (167) had no AED training. A statistically significant difference was observed between the before and after score, with a difference of 4.791(1.012 points (p=0.0001). Discussion: The intensive training program is effective in raising the level of knowledge and practice in basic CPR and AED use among lay CCM representatives.

HIV infection is associated with a less aggressive phenotype of inflammatory bowel disease. A multicenter study of the ENEIDA registry.

BACKGROUND: The coexistence of human immunodeficiency virus (HIV) infection and inflammatory bowel disease (IBD) is uncommon. Data on the impact of HIV on IBD course and its management is scarce. AIM: To describe the IBD phenotype, therapeutic requirements and prevalence of opportunistic infections (OI) in IBD patients with a coexistent HIV infection. METHODS: Case-control, retrospective study including all HIV positive patients diagnosed with IBD in the ENEIDA registry. Patients with positive HIV serology (HIV-IBD) were compared to controls (HIV seronegative), matched 1:3 by year of IBD diagnosis, age, gender and type of IBD. RESULTS: A total of 364 patients (91 HIV-IBD and 273 IBD controls) were included. In the whole cohort, 58% had ulcerative colitis (UC), 35% had Crohn's disease (CD) and 7% were IBD unclassified. The HIV-IBD group presented a significantly higher proportion of proctitis in UC and colonic location in CD but fewer extraintestinal manifestations than controls. Regarding treatments, non-biological therapies (37.4% vs. 57.9%; P=0.001) and biologicals (26.4% vs. 42.1%; P=0.007), were used less frequently among patients in the HIV-IBD group. Conversely, HIV-IBD patients developed more OI than controls regardless of non-biological therapies use. In the multivariate analysis, HIV infection (OR 4.765, 95%CI 2.48-9.14; P<0.001) and having ≥1 comorbidity (OR 2.445, 95%CI 1.23-4.85; P=0.010) were risk factors for developing OI, while CD was protective (OR 0.372, 95%CI 0.18-0.78;P=0.009). CONCLUSIONS: HIV infection appears to be associated with a less aggressive phenotype of IBD and a lesser use of non-biological therapies and biologicals but entails a greater risk of developing OI.

Early Mediterranean-Based Nutritional Intervention Reduces the Rate of Gestational Diabetes in Overweight and Obese Pregnant Women: A Post-Hoc Analysis of the San Carlos Gestational Prevention Study.

Obesity is a risk factor for the development of gestational diabetes mellitus (GDM). However, the most optimal type of nutritional intervention to prevent GDM in high-risk women is not clearly defined. This study investigates if nutritional treatment based on the Mediterranean diet (MedDiet) before the 12th gestational week (GW) in women at high risk due to a body mass index (BMI) ≥ 25 kg/m2 reduces the rate of GDM and metabolic syndrome (MetS) at 3 years postpartum. We performed a post-hoc analysis of the San Carlos Gestational Prevention Study. A total of 735 women with BMI ≥ 25 kg/m2 were evaluated between 2015 and 2018, with 246 in the standard diet control group (CG) and 489 in the MedDiet intervention group (IG). The rate of GDM was significantly lower in IG compared to CG (25.1% vs. 31.7%), relative risk (95% confidence interval), and 0.89 (0.78-0.99); p = 0.037. Postnatal follow-up was completed by 141 women in CG (57%) and 312 women in IG (64%). At 3 years postpartum, we observed a reduction in the rates of impaired fasting glucose (IFG) (0.51 (0.28-0.92); p = 0.019), obesity (0.51 (0.28-0.92); p = 0.041), waist circumference (WC) ≥ 89.5 cm (0.54 (0.31-0.94); p = 0.022), and MetS (0.56 (0.33-0.94); p = 0.003). MedDiet reduces the rate of GDM and postpartum MetS in women with BMI) ≥ 25 kg/m2, suggesting that its implementation should be routinely recommended from the first GWs.

Nutritional Strategies for Optimizing Health, Sports Performance, and Recovery for Female Athletes and Other Physically Active Women: A Systematic Review.

CONTEXT: Despite the progress toward gender equality in events like the Olympic Games and other institutionalized competitions, and the rising number of women engaging in physical exercise programs, scientific studies focused on establishing specific nutritional recommendations for female athletes and other physically active women are scarce. OBJECTIVE: This systematic review aimed to compile the scientific evidence available for addressing the question "What dietary strategies, including dietary and supplementation approaches, can improve sports performance, recovery, and health status in female athletes and other physically active women?" DATA SOURCES: The Pubmed, Web of Science, and Scopus databases were searched. DATA EXTRACTION: The review process involved a comprehensive search strategy using keywords connected by Boolean connectors. Data extracted from the selected studies included information on the number of participants and their characteristics related to sport practice, age, and menstrual function. DATA ANALYSIS: A total of 71 studies were included in this review: 17 focused on the analysis of dietary manipulation, and 54 focused on the effects of dietary supplementation. The total sample size was 1654 participants (32.5% categorized as competitive athletes, 30.7% as highly/moderately trained, and 37.2% as physically active/recreational athletes). The risk of bias was considered moderate, mainly for reasons such as a lack of access to the study protocol, insufficient description of how the hormonal phase during the menstrual cycle was controlled for, inadequate dietary control during the intervention, or a lack of blinding of the researchers. CONCLUSION: Diets with high carbohydrate (CHO) content enhance performance in activities that induce muscle glycogen depletion. In addition, pre-exercise meals with a high glycemic index or rich in CHOs increase CHO metabolism. Ingestion of 5-6 protein meals interspersed throughout the day, with each intake exceeding 25 g of protein favors anabolism of muscle proteins. Dietary supplements taken to enhance performance, such as caffeine, nitric oxide precursors, ß-alanine, and certain sport foods supplements (such as CHOs, proteins, or their combination, and micronutrients in cases of nutritional deficiencies), may positively influence sports performance and/or the health status of female athletes and other physically active women. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration no. CRD480674.

Influence of Menstrual Cycle and Oral Contraceptive Phases on Bone (re)modelling Markers in Response to Interval Running.

To explore how sex hormone fluctuations may affect bone metabolism, this study aimed to examine P1NP and ß-CTX-1 concentrations across the menstrual and oral contraceptive (OC) cycle phases in response to running. 17ß-oestradiol, progesterone, P1NP and ß-CTX-1 were analysed pre- and post-exercise in eight eumenorrheic females in the early-follicular, late-follicular, and mid-luteal phases, while 8 OC users were evaluated during the withdrawal and active pill-taking phases. The running protocol consisted of 8 × 3min treadmill runs at 85% of maximal aerobic speed. 17ß-oestradiol concentrations (pg·ml-1) were lower in early-follicular (47.22 ± 39.75) compared to late-follicular (304.95 ± 235.85;p = < 0.001) and mid-luteal phase (165.56 ± 80.6;p = 0.003) and higher in withdrawal (46.51 ± 44.09) compared to active pill-taking phase (10.88 ± 11.24;p < 0.001). Progesterone (ng·ml-1) was higher in mid-luteal (13.214 ± 4.926) compared to early-follicular (0.521 ± 0.365; p < 0.001) and late-follicular phase (1.677 ± 2.586;p < 0.001). In eumenorrheic females, P1NP concentrations (ng·ml-1) were higher in late-follicular (69.97 ± 17.84) compared to early-follicular (60.96 ± 16.64;p = 0.006;) and mid-luteal phase (59.122 ± 11.77;p = 0.002). ß-CTX-1 concentrations (ng·ml-1) were lower in mid-luteal (0.376 ± 0.098) compared to late-follicular (0.496 ± 0.166; p = 0.001) and early-follicular phase (0.452 ± 0.148; p = 0.039). OC users showed higher post-exercise P1NP concentrations in withdrawal phase (61.75 ± 8.32) compared to post-exercise in active pill-taking phase (45.45 ± 6;p < 0.001). Comparing hormonal profiles, post-exercise P1NP concentrations were higher in early-follicular (66.91 ± 16.26;p < 0.001), late-follicular (80.66 ± 16.35;p < 0.001) and mid-luteal phases (64.57 ± 9.68;p = 0.002) to active pill-taking phase. These findings underscore the importance of studying exercising females with different ovarian hormone profiles, as changes in sex hormone concentrations affect bone metabolism in response to running, showing a higher post-exercise P1NP concentrations in all menstrual cycle phases compared with active pill-taking phase of the OC cycle.

Transforming body composition with semaglutide in adults with obesity and type 2 diabetes mellitus.

Background: Glucagon-like peptide-1 receptor-agonists (GLP-1ra), such as semaglutide, have emerged as promising treatments, demonstrating sustained weight reduction and metabolic benefits. This study aims to assess the impact of oral and subcutaneous semaglutide on body composition and metabolic parameters in patients with T2DM and obesity. Methods: A 24-week quasi-experimental retrospective study including adults with T2DM and obesity (BMI ≥ 30 kg/m²) who were treated with either daily-oral or weekly-subcutaneous semaglutide. Body composition was measured using bioelectrical impedance analysis, evaluating fat mass, fat-free mass, total body water, skeletal muscle mass, and whole-body phase angle. Analytical parameters included lipid profile and glycaemic control. Statistical analyses were performed using SPSS v.26. Results: Participants (n=88) experienced significant weight loss after treatment with semaglutide (9.5% in subcutaneous, 9.4% in oral, P<0.001). Weight reduction primarily resulted from fat mass reduction without substantial lean mass compromise. Visceral fat area decreased, whiles phase-angle remained stable. Improvements in lipid profiles and glycaemic control were observed, with a decrease in both HbA1c and insulin requirements. Multivariate analysis demonstrated comparable impacts of oral and subcutaneous semaglutide on body composition. Conclusion: Semaglutide, administered orally or subcutaneously, demonstrated positive effects on body composition, metabolic and glycaemic control in patients with T2DM and obesity. This real-world study highlights the potential of bioelectrical impedance analysis in assessing antidiabetic drugs' impact on body composition, providing valuable insights for future research and clinical applications.

Need for therapeutic escalation in patients with refractory ulcerative proctitis: Results from the PROCU study of the ENEIDA registry.

BACKGROUND: Ulcerative proctitis (UP) can have a milder, less aggressive course than left-sided colitis or extensive colitis. Therefore, immunosuppressants tend to be used less in patients with this condition. Evidence, however, is scarce because these patients are excluded from randomised controlled clinical trials. Our aim was to describe the characteristics of patients with refractory UP and their disease-related complications, and to identify the need for immunosuppressive therapies. METHODS: We identified patients with UP from the prospective ENEIDA registry sponsored by the GETECCU. We evaluated socio-demographic data and complications associated with immunosuppression. We defined immunosuppression as the use of immunomodulators, biologics and/or small molecules. We used logistic regression to identify factors associated with immunosuppressive therapy. RESULTS: From a total of 34,716 patients with ulcerative colitis, we identified 6281 (18.1%) with UP; mean ± SD age 53 ± 15 years, average disease duration of 12 ± 9 years. Immunosuppression was prescribed in 11% of patients, 4.2% needed one biologic agent and 1% needed two; 2% of patients required hospitalisation, and 0.5% underwent panproctocolectomy or subtotal colectomy. We identified 0.2% colorectal tumours and 5% extracolonic tumours. Patients with polyarthritis (OR 3.56, 95% CI 1.86-6.69; p < 0.001) required immunosuppressants. CONCLUSIONS: Among patients with refractory UP, 11% required immunosuppressant therapy, and 4.2% required at least one biologic agent.

Persistence, effectiveness and safety of ustekinumab and vedolizumab therapy for complex perianal fistula in Crohn's disease: The HEAL study from GETECCU.

BACKGROUND: The efficacy of ustekinumab and vedolizumab for treating complex perianal fistula in Crohn's disease has been barely studied. We aimed to assess treatment persistence, clinical remission, and safety of these drugs in this context. METHODS: Crohn's disease patients who had received ustekinumab or vedolizumab for the indication of active complex perianal fistula, were included. Clinical remission was defined according to Fistula Drainage Assessment Index (no drainage through the fistula upon gentle pressure) based on physicians' assessment. RESULTS: Of 155 patients, 136 received ustekinumab, and 35 vedolizumab (16 received both). Median follow-up for ustekinumab was 27 months. Among those on ustekinumab, 54 % achieved remission, and within this group, 27 % relapsed during follow-up. The incidence rate of relapse was 11 % per patient-year. Multivariate analysis found no variables associated with treatment discontinuation or relapse. Median follow-up time for patients receiving vedolizumab was 19 months. Remission was achieved in 46 % of the patients receiving vedolizumab, and among them, 20 % relapsed during follow-up. The incidence rate of relapse was 7 % per patient-year. Adverse events were mild in 6 % on ustekinumab and 8 % on vedolizumab. CONCLUSION: Ustekinumab and vedolizumab appear effective, achieving remission in around half of complex perianal fistula patients, with favorable safety profiles.

Trends in Targeted Therapy Usage in Inflammatory Bowel Disease: TRENDY Study of ENEIDA.

Markers that allow for the selection of tailored treatments for individual patients with inflammatory bowel diseases (IBD) are yet to be identified. Our aim was to describe trends in real-life treatment usage. For this purpose, patients from the ENEIDA registry who received their first targeted IBD treatment (biologics or tofacitinib) between 2015 and 2021 were included. A subsequent analysis with Machine Learning models was performed. The study included 10,009 patients [71% with Crohn's disease (CD) and 29% with ulcerative colitis (UC)]. In CD, anti-TNF (predominantly adalimumab) were the main agents in the 1st line of treatment (LoT), although their use declined over time. In UC, anti-TNF (mainly infliximab) use was predominant in 1st LoT, remaining stable over time. Ustekinumab and vedolizumab were the most prescribed drugs in 2nd and 3rd LoT in CD and UC, respectively. Overall, the use of biosimilars increased over time. Machine Learning failed to identify a model capable of predicting treatment patterns. In conclusion, drug positioning is different in CD and UC. Anti-TNF were the most used drugs in IBD 1st LoT, being adalimumab predominant in CD and infliximab in UC. Ustekinumab and vedolizumab have gained importance in CD and UC, respectively. The approval of biosimilars had a significant impact on treatment.

The Effect of a Novel Video Game on Young Soccer Players' Sports Performance and Attention: Randomized Controlled Trial.

Background: Currently, the fusion of technology and sports is inevitable. The integration of various systems and devices has brought about significant transformations in established sports practices, impacting not only the rules but also physiological, biomechanical, and even psychological aspects. Objective: The purpose of this study was to analyze the effect of an attention intervention through a video game on young soccer players. Methods: Twelve young male soccer players (age: mean 8.5, SD 1 years) were divided into 2 groups: a control group (CG; n=10) and an experimental group (EG; n=10). During the 6-week training program, the EG received attention training through a video game twice a week for 15 minutes per session. Pre- and postintervention measurements included a specific decision-making soccer test and interviews with coaching staff. Additionally, success in the video game, muscular activity, and sweat levels were monitored. Results: The EG demonstrated a significant improvement in video game success following the intervention program, as indicated by the achieved level (P<.001). However, no significant differences were found between groups regarding electromyographic (EMG) activity (P=.21) and sweating (P=.20). Prior to implementing the attention training program, both groups exhibited similar data for variables related to decision-making and execution mechanisms (≤10%). Only 2 decision-making variables exceeded 10% but remained below 15% (Shot_D=13.35%; Marking_with_Ball_D=-12.64%). Furthermore, changes in attacking action variables were more pronounced in execution-related variables, except for dribbling and fixing. Conversely, in defensive action variables, changes were greater in decision-related variables, except for marking with the ball and marking without the ball. Conclusions: Our findings reveal that incorporating a specific attentional video game into a soccer training program enhances decision-making compared to a program without the video game. Therefore, it is advisable for practitioners to consider using this tool due to its high efficiency in terms of economic and temporal costs, particularly in improving a key psychological variable.

A Simplified Screening Model to Predict the Risk of Gestational Diabetes Mellitus in Caucasian and Latin American Pregnant Women.

The pathophysiology of gestational diabetes mellitus (GDM) comprises clinical and genetic factors. In fact, GDM is associated with several single nucleotide polymorphisms (SNPs). This study aimed to build a prediction model of GDM combining clinical and genetic risk factors. A total of 1588 pregnant women from the San Carlos Cohort participated in the present study, including 1069 (67.3%) Caucasian (CAU) and 519 (32.7%) Latin American (LAT) individuals, and 255 (16.1%) had GDM. The incidence of GDM was similar in both groups (16.1% CAU and 16.0% LAT). Genotyping was performed via IPLEX Mass ARRAY PCR, selecting 110 SNPs based on literature references. SNPs showing the strongest likelihood of developing GDM were rs10830963, rs7651090, and rs1371614 in CAU and rs1387153 and rs9368222 in LAT. Clinical variables, including age, pre-pregnancy body mass index, and fasting plasma glucose (FPG) at 12 gestational weeks, predicted the risk of GDM (AUC 0.648, 95% CI 0.601-0.695 in CAU; AUC 0.688, 95% CI 0.628-9.748 in LAT), and adding SNPs modestly improved prediction (AUC 0.722, 95%CI 0.680-0.764 in CAU; AUC 0.769, 95% CI 0.711-0.826 in LAT). In conclusion, adding genetic variants enhanced the prediction model of GDM risk in CAU and LAT pregnant women.