Giant True Lipoma Resection in the Inguinal Canal.

The inguinal canal lipoma, known as spermatic cord lipoma in men or round ligament lipoma in women, has a variable incidence (22.5% to 75%) during inguinal hernioplasty procedures. The presence of a true lipoma in this region is considered rare and often underestimated by surgeons. A young female patient was diagnosed with a large true inguinal canal lipoma. Resection was performed using both videolaparoscopic and conventional techniques, based on a careful preoperative evaluation of anatomical parameters. The high incidence of lipomas in the inguinal canal contributes, in part, to the interpretation of fatty masses as "lipomas" during herniorrhaphy procedures. However, many of these are actually extrusions of extraperitoneal adipose tissue, maintaining dimensions within the physiological limits of the region. This confusion in classification highlights the complexity of differentiating between true lipomas and adipose protrusions. Based on a case report enriched with distinct clinical features and images, we sought to exemplify a surgical approach to a large true inguinal canal lipoma. This report not only emphasizes the rarity of the pathology but also underscores the importance of an effective and differentiated surgical approach for true lipomas in this location.

Improving accuracy of early dental carious lesions detection using deep learning-based automated method.

OBJECTIVE: To investigate the effectiveness of a convolutional neural network (CNN) in detecting healthy teeth and early carious lesions on occlusal surfaces and to assess the applicability of this deep learning algorithm as an auxiliary aid. MATERIALS AND METHODS: A total of 2,481 posterior teeth (2,459 permanent and 22 deciduous teeth) with varying stages of carious lesions were classified according to the International Caries Detection and Assessment System (ICDAS). After clinical evaluation, ICDAS 0 and 2 occlusal surfaces were photographed with a professional digital camera. VGG-19 was chosen as the CNN and the findings were compared with those of a reference examiner to evaluate its detection efficiency. To verify the effectiveness of the CNN as an auxiliary detection aid, three examiners (an undergraduate student (US), a newly graduated dental surgeon (ND), and a specialist in pediatric dentistry (SP) assessed the acquired images (Phase I). In Phase II, the examiners reassessed the same images using the CNN-generated algorithms. RESULTS: The training dataset consisted of 8,749 images, whereas the test dataset included 140 images. VGG-19 achieved an accuracy of 0.879, positive agreement of 0.827, precision of 0.949, negative agreement 0.800, and an F1-score of 0.887. In Phase I, the accuracy rates for examiners US, ND, and SP were 0.543, 0.771, and 0.807, respectively. In Phase II, the accuracy rates improved to 0.679, 0.886, and 0.857 for the respective examiners. The number of correct answers was significantly higher in Phase II than in Phase I for all examiners (McNemar test;P<0.05). CONCLUSIONS: VGG-19 demonstrated satisfactory performance in the detection of early carious lesions, as well as an auxiliary detection aid. CLINICAL RELEVANCE: Automated detection using deep learning algorithms is an important aid in detecting early caries lesions and improves the accuracy of the disease detection, enabling quicker and more reliable clinical decision-making.

Lazer e favela: produção do conhecimento em periódicos especializados / Leisure and favela: production of knowledge in specialized journals

Esta pesquisa tem como objetivo analisar a produção acadêmica acerca do tema "Lazer e Periferia" nos periódicos especializados do campo do Lazer no Brasil. Buscaremos a partir desta análise, observar, por exemplo, se a periferia tem sido tratada como um lugar de ausência ou um espaço de produção cultural. Além disso, vamos investigar em que medida o Lazer se constitui como um direito para a população periférica, a partir destas publicações. Para tanto, foi realizada uma revisão de literatura, levando em conta os periódicos voltados ao campo do Lazer no Brasil, que possuem Qualis Capes B4 ou superior. Os estudos apontam para três principais categorias de análise para compreendermos a relação entre o Lazer e a Periferia: "Equipamentos de Lazer", "Atuação e Formação Profissional de Lazer" e "Políticas Públicas". A partir destas três categorias, foi possível observar que a intervenção estatal no âmbito da garantia do direito ao Lazer precisa, antes de tudo, estar alinhada às próprias demandas das comunidades, sem, contudo, negligenciar o acesso ao patrimônio histórico-cultural que precisa ser garantido à população periférica.

This research aims to analyze the academic production on the theme "Leisure and Periphery" in specialized journals in the field of Leisure in Brazil. Based on this analysis, we will seek to observe, for example, whether the periphery has been treated as a place of absence or a space for cultural production. In addition, we will investigate to what extent Leisure constitutes a right for the peripheral population, based on these publications. For that, a literature review was carried out, taking into account the journals focused on the field of Leisure in Brazil, which have Qualis Capes B4 or higher. The studies point to three main categories of analysis to understand the relationship between Leisure and the Periphery: "Leisure Equipment", "Leisure Activities and Professional Training" and "Public Policies". From these three categories, it was possible to observe that state intervention in the scope of guaranteeing the right to Leisure needs, above all, to be aligned with the communities' own demands, without, however, neglecting access to the historical and cultural heritage that needs to be guaranteed to the peripheral population.

Phylogenomic Analysis of the Parrots of the World Distinguishes Artifactual from Biological Sources of Gene Tree Discordance.

Gene tree discordance is expected in phylogenomic trees and biological processes are often invoked to explain it. However, heterogeneous levels of phylogenetic signal among individuals within data sets may cause artifactual sources of topological discordance. We examined how the information content in tips and subclades impacts topological discordance in the parrots (Order: Psittaciformes), a diverse and highly threatened clade of nearly 400 species. Using ultraconserved elements from 96% of the clade's species-level diversity, we estimated concatenated and species trees for 382 ingroup taxa. We found that discordance among tree topologies was most common at nodes dating between the late Miocene and Pliocene, and often at the taxonomic level of the genus. Accordingly, we used two metrics to characterize information content in tips and assess the degree to which conflict between trees was being driven by lower-quality samples. Most instances of topological conflict and nonmonophyletic genera in the species tree could be objectively identified using these metrics. For subclades still discordant after tip-based filtering, we used a machine learning approach to determine whether phylogenetic signal or noise was the more important predictor of metrics supporting the alternative topologies. We found that when signal favored one of the topologies, the noise was the most important variable in poorly performing models that favored the alternative topology. In sum, we show that artifactual sources of gene tree discordance, which are likely a common phenomenon in many data sets, can be distinguished from biological sources by quantifying the information content in each tip and modeling which factors support each topology. [Historical DNA; machine learning; museomics; Psittaciformes; species tree.].

Assessment of corn wet distillers grains fed to crossbred bulls on feeding behavior, rumen morphology, liver abscesses and blood parameters.

Corn ethanol production has been growing in Brazil in the last ten years, generating by-products to feedlot diets. This study evaluates the effects of the inclusion of low-fat corn wet distillers grains (LF-WDG) on feeding behavior, ruminal health, liver abscesses and blood parameters of F1 Angus-Nellore bulls feedlot finished. Our hypothesis is that evaluation of data from feeding behavior, rumen and liver health would help to explain animal performance. In this trail, one-hundred animals were fed for 129 days with diets containing amounts of 0 (control), 15, 30 and 45% of LF-WDG replacing corn grain and soybean meal. Evaluations of fluctuation of dry matter intake (DMI) were carried out. Additionally, feeding behavior data were assessed by monitoring (24-h period) the feeding, rumination, time spent eating (TSE), and time expended on other activities (resting and number of meals per day). Blood variables such as pH, bicarbonate, total CO2 content, and base excess in extracellular fluid (Beecf) were determined. After slaughter, rumen epithelium was classified according to the incidence of lesions (rumenitis) and abnormalities (papillae clumped), and samples were collected for morphology and histology evaluations. Moreover, livers were scored for severity of abscesses as follow: as unabscessed (0), one or two small abscesses (A-), two to four small active abscesses (A) or one or more large, active abscesses (A+). The DMI (kg/day) differed (P = 0.03) among treatments and there is a tendency of 15 and 30 LF-WDG (% DM) had lower %DMI fluctuation compared to 0 or 45%. The TSE increased linearly (P < 0.01) as the amounts of inclusion of LF-WDG increased. Moreover, neutral detergent fiber (NDF) intake, NDF consumption rate and NDF rumination efficiency increased linearly (P < 0.01) in response to LF-WDG feeding. The incidence of rumenitis tended (P = 0.08) to be greater at 45% LF-WDG, while keratin thickness decreased linearly in bulls fed LF-WDG (P < 0.01). The severity of liver abscesses (score A+) increased linearly (P = 0.02). Regarding blood parameters, only Beecf decreased linearly (P < 0.01) in response to LF-WDG feeding. Therefore, the hypothesis of the current study was confirmed. We previous reported that F1 Angus-Nellore bulls fed LF-WDG show greater weight gain (1.94 ± 0.09 kg/day) and final body weight (620 ± 18.8 kg) when compare to control (1.8 ± 0.09 kg/day and 602 ± 18.8 kg, respectively). Here, we conclude that inclusion of 15 to 30% LF-WDG in feedlot diets improved feeding behavior without impairing ruminal health and blood parameters, driving performance and weigh gain of crossbred bulls. However, bulls fed 45% LF-WDG had greater severity of liver abscesses.

Association of magnesium abnormalities at intensive care unit admission with kidney outcomes and mortality: a prospective cohort study.

BACKGROUND: Magnesium abnormalities have been associated with adverse kidney outcomes and mortality in critically ill patients, however, this association remains inconsistent. This study aimed to investigate the association of magnesium abnormalities at intensive care unit (ICU) admission with kidney outcomes (i.e., acute kidney injury (AKI) and kidney function recovery) and mortality risk in a large cohort of critically ill patients. METHODS: A prospective cohort study was conducted by collecting data from three ICUs in Brazil. The ICU admission serum magnesium level was used to define hypomagnesemia (< 1.60 mg/dL) and hypermagnesemia (> 2.40 mg/dL). The Kidney Disease Improving Global Outcomes AKI Guideline was used to define AKI based on serum creatinine levels. Kidney function recovery was defined as full recovery, partial recovery, and non-recovery at ICU discharge. Mortality was screened up to 28 days during ICU stay. RESULTS: A total of 7,042 patients was analyzed, hypomagnesemia was found in 18.4% (n = 1,299) and hypermagnesemia in 4.4% (n = 311). Patients with hypomagnesemia were 25% more likely to develop AKI after adjustment for confounding variables (OR = 1.25; 95% CI 1.08-1.46). No significant association was found for hypermagnesemia and AKI (OR = 1.18; 95% CI 0.89-1.57). Kidney function recovery was similar among groups but hypermagnesemia had lower non-recovery rates. Both hypomagnesemia and hypermagnesemia were associated with 65 and 52% higher mortality risk after adjustments for confounders, respectively (HR = 1.65; 95% CI 1.32-2.06 and 1.52; 95% CI 1.01-2.29). CONCLUSIONS: Hypomagnesemia, but not hypermagnesemia, at ICU admission was associated with AKI development. On the other hand, both hypomagnesemia and hypermagnesemia were associated with higher mortality risks.

Community Pharmacy Services in Malanje City, Angola: A Survey of Practices, Facilities, Equipment, and Staff.

A community pharmacy, also known as a retail pharmacy, is the most common type of pharmacy that allows the public access to their medications and advice about their health. The conditions existing in the community pharmacy, as well as the qualification of the staff who work there, are fundamental for the compliance of good pharmacy practices. OBJECTIVE: To assess the practices, facilities, equipment, and personnel of community pharmacies in the Municipality of Malanje. METHODS: A cross-sectional observational study with a quantitative and qualitative approach. Through a simple random sampling technique, 20 pharmacies were selected from a universe of 73 reported by official authorities. RESULTS: no pharmacist was acting in the local pharmacies, and their activity was supported by other professionals, particularly intermediate nursing technicians (57%). Most pharmacies were in the peri-urban area, and their functional areas, equipment, and utilities were not in accordance with Angolan law. In addition, the distribution of some drugs that are not over-the-counter was observed. CONCLUSION: community pharmacies in Malanje develop their activity in disregard of the law, constituting a considerable weakness that affects the observance of pharmacy service standards.

Multiple species and deep genomic divergences despite little phenotypic differentiation in an ancient Neotropical songbird, Tunchiornis ochraceiceps (Sclater, 1860) (Aves: Vireonidae).

Several bird taxa have been recently described or elevated to full species and almost twice as many bird species than are currently recognized may exist. Defining species is one of the most basic and important issues in biological science because unknown or poorly defined species hamper subsequent studies. Here, we evaluate the species limits and evolutionary history of Tunchiornis ochraceiceps-a widespread forest songbird that occurs in the lowlands of Central America, Chocó and Amazonia-using an integrative approach that includes plumage coloration, morphometrics, vocalization and genomic data. The species has a relatively old crown age (~9 Ma) and comprises several lineages with little, if any, evidence of gene flow among them. We propose a taxonomic arrangement composed of four species, three with a plumage coloration diagnosis and one deeply divergent cryptic species. Most of the remaining lineages have variable but unfixed phenotypic characters despite their relatively old origin. This decoupling of genomic and phenotypic differentiation reveals a remarkable case of phenotypic conservatism, possibly due to strict habitat association. Lineages are geographically delimited by the main Amazonian rivers and the Andes, a pattern observed in studies of other understory upland forest Neotropical birds, although phylogenetic relationships and divergence times among populations are idiosyncratic.

Application of the principal component analysis, cluster analysis, and partial least square regression on crossbreed Angus-Nellore bulls feedlot finished.

Principal component analysis (PCA) and the non-hierarchical clustering analysis (K-means) were used to characterize the most important variables from carcass and meat quality traits of crossbred cattle. Additionally, partial least square (PLS) regression analysis was applied between the carcass measurements and meat quality traits on the classes defined by the cluster analysis. Ninety-seven non-castrated F1 Angus-Nellore bulls feedlot finished were used. After slaughter, hot carcass weight, carcass yield, cold carcass weight, carcass weight losses, pH, and backfat thickness (BFT) were measured. Subsequently, samples of the longissimus thoracis were collected to analyze shear force (SF), cooking loss (CL), meat color (L*, chroma, and hue), intramuscular fat, protein, collagen, moisture, and ashes. Principal component 1 (PC1) was correlated with colorimetric variables, while PC2 was correlated with carcass weights. Afterwards, three clusters (k = 3) were formed and projected in the gradient defined by PC1 and PC2 and allowed distinguishing groups with divergent values for collagen, protein, moisture, CL, SF, and BFT. Animals from high chroma group presented meat with more attractive colors and tenderness (SF = 1.97 to 4.84 kg). Subsequently, the PLS regression on the three chroma groups revealed a good fitness and the coefficients are used to predict the chroma variable from the explanatory variables, which may have practical importance in attempts to predict meat color from carcass and meat quality traits. Thus, PCA, K-means, and PLS regression confirmed the relationship between meat color and tenderness.

The inclusion of de-oiled wet distillers grains in feedlot diets reduces the expression of lipogenic genes and fat content in Longissimus muscle from F1 Angus-Nellore cattle.

The inclusion of agro-industry by-products originated from corn ethanol production has increased in animal nutrition in Brazil, reducing formulation costs. In the literature, there is no consensus on how the high inclusion of de-oiled wet distillers grains can affect beef quality and the expression of lipogenic genes in Longissimus muscle. The aim of this study was to evaluate the effects of WDG in the diet of F1 Angus-Nellore cattle on meat quality characteristics, chemical composition and expression of genes involved in lipid metabolism. A hundred F1 Angus-Nellore bulls, with average initial body weight (BW) of 369.5 ± 49 kg were used. The experiment was carried out in a randomized block design, and the animals were divided into two blocks (light and heavy) according to the initial body weight. The animals were fed diets containing levels of 0 (control), 15, 30 and 45% of WDG replacing dry corn and soybean meal. After 129 days of feedlot, the animals were slaughtered and samples of the longissimus thoracis (LT) muscle were collected for quality analyzes such as shear force (3, 10 and 17 aging days), color (luminosity, red, Chroma and Hue), cooking losses, pH and chemical composition (moisture, protein, lipids and ash contents). In addition, the expression of the PPARα, PPARγ, SREBP-1c, SCD1, LPL, FABP4, FASN, ACOX, CPT2, GPX1 and ACACA genes was investigated in the LT muscle by real-time reverse transcription polymerase chain reaction (RT-PCR). Data were analyzed using polynomial contrasts (linear, quadratic and control vs. WDG). There was no interaction (P > 0.05) between aging times and the inclusion of WDG in the diets on the meat quality (pH, cooking losses, coloration and tenderness). However, diets with increasing levels of WDG caused a linear reduction (P = 0.01) in the intramuscular fat of LT. The lipogenic genes SCD1, PPARγ, FASN and CPT2 were less expressed (P < 0.05) in response to the inclusion of WDG. These results suggest that the inclusion of WDG reduced the expression of lipogenic genes and consequently the marbling of LT muscle without affecting tenderness (shear force) and meat color traits.

A dynamic continental moisture gradient drove Amazonian bird diversification.

The Amazon is the primary source of Neotropical diversity and a nexus for discussions on processes that drive biotic diversification. Biogeographers have focused on the roles of rivers and Pleistocene climate change in explaining high rates of speciation. We combine phylogeographic and niche-based paleodistributional projections for 23 upland terra firme forest bird lineages from across the Amazon to derive a new model of regional biological diversification. We found that climate-driven refugial dynamics interact with dynamic riverine barriers to produce a dominant pattern: Older lineages in the wetter western and northern parts of the Amazon gave rise to lineages in the drier southern and eastern parts. This climate/drainage basin evolution interaction links landscape dynamics with biotic diversification and explains the east-west diversity gradients across the Amazon.

Why is Amazonia a 'source' of biodiversity? Climate-mediated dispersal and synchronous speciation across the Andes in an avian group (Tityrinae).

Amazonia is a 'source' of biodiversity for other Neotropical ecosystems, but which conditions trigger in situ speciation and emigration is contentious. Three hypotheses for how communities have assembled include (1) a stochastic model wherein chance dispersal events lead to gradual emigration and species accumulation, (2) diversity-dependence wherein successful dispersal events decline through time due to ecological limits, and (3) barrier displacement wherein environmental change facilitates dispersal to other biomes via transient habitat corridors. We sequenced thousands of molecular markers for the Neotropical Tityrinae (Aves) and applied a novel filtering protocol to identify loci with high utility for dated phylogenomics. We used these loci to estimate divergence times and model Tityrinae's evolutionary history. We detected a prominent role for speciation driven by barriers including synchronous speciation across the Andes and found that dispersal increased toward the present. Because diversification was continuous but dispersal was non-random over time, we show that barrier displacement better explains Tityrinae's history than stochasticity or diversity-dependence. We propose that Amazonia is a source of biodiversity because (1) it is a relic of a biome that was once more extensive, (2) environmentally mediated corridors facilitated emigration and (3) constant diversification is attributed to a spatially heterogeneous landscape that is perpetually dynamic through time.

Tecnologias educacionais no empoderamento do adolescente acerca da depressão / Educational technologies in adolescent empowerment about depression

Objetivo: descrever a experiência do uso da tecnologia educativa como forma de empoderar o adolescente de escola pública sobre a depressão e os fatores associados à mesma. Método: trata-se de estudo descritivo, tipo relato de experiência, oriundo de intervenções realizadas por integrantes do grupo de pesquisa Laboratório de Tecnologias de Informação e Comunicação em Saúde, de uma universidade federal. Informa-se que as ações ocorreram mediante a aplicação de um jogo educativo desenvolvido pela equipe para trabalhar a temática depressão na adolescência. Resultados: proporcionou-se, por meio da atividade educativa, associada ao jogo, a criação de um contexto favorável ao diálogo acerca dos fatores associados à depressão em adolescentes, a partir da ludicidade e da interação ativa dos participantes. Conclusão: percebeu-se um ambiente favorável ao compartilhamento do conhecimento em saúde para os estudantes viabilizado pela utilização de tecnologia educativa, sendo estratégia no incentivo ao empoderamento dos adolescentes na busca do autocuidado.(AU)

Perfil sociodemográfico e clínico de mortalidade materna / Sociodemorgraphical and clinical profile of maternal mortality

Objetivo: conhecer o perfil sociodemográfico e clínico sobre a mortalidade materna. Método: trata-se de estudo quantitativo, transversal e descritivo, sendo o universo da pesquisa composto por todos os óbitos maternos ocorridos no período de 2004 a 2015 no Estado da Bahia/Brasil. Deu-se a coleta de dados por meio de dados secundários disponíveis on-line no Sistema de Informação de Mortalidade do Ministério da Saúde. Utilizaram-se para a tabulação e a análise dos dados, o programa Microsoft Office Excel, versão 2016, apresentando-se os resultados em forma de tabelas e figuras. Resultados: constatou-se que o número de mortes maternas no período analisado correspondeu a 1.907, com maior prevalência na faixa etária entre 20 e 29 anos (39,12%), em mulheres de cor parda (59,25%), solteiras (50,87%) e a ocorrência em ambiente hospitalar (88,99%). Viu-se que as causas obstétricas diretas (61,46%) ocorreram significativamente por eclâmpsia (12,89%). Conclusão: evidenciam-se nos resultados que a mortalidade materna é um grave problema de saúde pública e que o conhecimento sobre as circunstâncias e ocorrências das mortes maternas é fundamental para o planejamento de ações e estratégias de saúde.(AU)

Evidence for mtDNA capture in the jacamar Galbula leucogastra/chalcothorax species-complex and insights on the evolution of white-sand ecosystems in the Amazon basin.

Jacamar species occur throughout Amazonia, with most species occupying forested habitats. One species-complex, Galbula leucogastra/chalcothorax, is associated to white sand ecosystems (WSE). Previous studies of WSE bird species recovered shallow genetic structure in mtDNA coupled with signs of gene flow among WSE patches. Here, we characterize diversification of the G. leucogastra/chalcothorax species-complex with dense sampling across its distribution using mitochondrial and genomic (Ultraconserved Elements, UCEs) DNA sequences. We performed concatenated likelihood and Bayesian analysis, as well as a species-tree analysis using ∗BEAST, to establish the phylogenetic relationships among populations. The mtDNA results recovered at least six geographically-structured lineages, with G. chalcothorax embedded within lineages of G. leucogastra. In contrast, both concatenated and species-tree analyses of UCE data recovered G. chalcothorax as sister to all G. leucogastra lineages. We hypothesize that the mitochondrial genome of one of the G. leucogastra lineage (Madeira) was captured into G. chalcothorax in the past. We discuss how WSE evolution and the coevolution of mtDNA and nuclear genes might have played a role in this apparently rare event.

Test timed up and go and its correlation with age and functional exercise capacity in asymptomatic women / Teste "Timed up and go" e sua correlação com a idade e capacidade funcional de exercício em mulheres assintomáticas

Abstract Introduction: The Timed Up and Go test (TUG) is widely used and valid in chronic patients, but rarely addressed in asymptomatic individuals. Objective: To assess the reliability, the age-related changes and the correlation between TUG and the Functional Exercise Capacity (FEC) adjusted for non-institutionalized middle-aged and elderly women. Methods: Ninety-eight women (57 ± 10 years) were selected and stratified into age groups. We have performed the tests TUG, Berg Balance Scale (BBS) and evaluation of usual gait speed (UGS). Fifty-eight participants (57 ± 10 years) also performed incremental shuttle walk test (ISWT). Results: Worse performance in TUG (p < 0,05) for participants aged ≥ 70 years for age groups 40-49 and 50-59 years. The reliability of TUG was excellent between the first and second TUG (intraclass correlation coefficient, 0.933; confidence interval of 95%, from 0.901 to 0.955) and between the second and third TUG (0.958, 0.938 to 0.972). The group of 58 participants who underwent further the ISWT, TUG correlated significantly (p <0.05) with ISWT (r = -0.72), VUM (r = -0.54) and BBS (r= 0.58). A multiple linear regression analysis selected TUG (R2 = 0.517) and VUM (R2 = 0.083) as determinants of FEC. Conclusion: TUG adapted for asymptomatic women is reliable and able to assess the decline of physical mobility with advancing age and it also crucial to the FEC.

Resumo Introdução: Amplamente utilizado, o teste Timed up and Go (TUG) é válido para doentes crônicos, porém pouco abordado em indivíduos assintomáticos. Objetivo: Avaliar a confiabilidade do TUG modificado na detecção do declínio da mobilidade física com o avanço da idade em mulheres de meia idade e idosas não institucionalizadas e sua correlação com a capacidade funcional de exercício (CFE). Metodologia: Noventa e oito mulheres (57 ± 10 anos) foram selecionadas e estratificadas em grupos etários. Realizamos os testes TUG, escala de equilíbrio de Berg (EEB) e avaliação da velocidade usual da marcha (VUM). Cinquenta e oito participantes (57 ± 10 anos) realizaram também o Teste de Caminhada com Carga Progressiva (TCCP). Resultados: Pior desempenho no TUG (p < 0,05) para as participantes com idade ≥ 70 anos em relação aos grupos etários 40-49 e 50-59 anos. A confiabilidade foi excelente entre o 1° e o 2° TUG (coeficiente de correlação intraclasse, 0,933; intervalo de confiança de 95%, 0,901 - 0,955) e entre o 2° e o 3° (0,958; 0,938 - 0,972). No subgrupo que realizou ISWT, o TUG correlacionou-se significativamente (p < 0,05) com o TCCP (r = -0,72), a VUM (r = -0,54) e a EEB (r = - 0,58). A análise de regressão selecionou o TUG (R2 = 0,517) e a VUM (R2 = 0,083) como determinantes para a CFE. Conclusão: o TUG adaptado para mulheres assintomáticas é confiável e capaz de avaliar o declínio da mobilidade física com o avanço da idade, sendo também determinante para a CFE.

Translation, Cross-cultural Adaptation, and Clinimetric Testing of Instruments Used to Assess Patients With Ankle Sprain in the Brazilian Population.

Study Design Clinical measurement study. Background Ankle sprain is a common condition. Therefore, translated, culturally adapted, and clinimetrically tested instruments for measuring the ankle are needed. Objectives To translate and cross-culturally adapt the Sports Athlete Foot and Ankle Score (SAFAS) and the global rating of change (GROC) into Brazilian Portuguese. This study also aimed to test the measurement properties of the SAFAS, the GROC, and the existing Brazilian-Portuguese versions of the numeric pain-rating scale (NPRS) and the ankle-hindfoot scale of the American Orthopaedic Foot and Ankle Society (AOFAS) in a group with ankle sprain. Methods The SAFAS and GROC instruments were cross-culturally adapted into Brazilian Portuguese and pretested in this population (n = 18). The measurement properties of the SAFAS, GROC, NPRS, and AOFAS (internal consistency, ceiling and floor effects, construct validity, reproducibility, and responsiveness) were tested in a test-retest design in patients with ankle sprain at baseline (n = 63) and at follow-up periods of 48 to 72 hours (n = 53) and 4 weeks (n = 43) after baseline. Results The SAFAS, GROC, NPRS, and AOFAS yielded considerable internal consistency (Cronbach alpha ranging from .76 to .97), moderate reliability (intraclass correlation coefficient model 2,1 ranging from 0.59 to 0.80), and dubious agreement (percentage of the standard error of measurement ranging from 13% to 22.43%). The highest correlations on construct validity were observed among the 4 SAFAS subscales (Pearson r = 0.75 to 0.86, P<.01), but statistically significant values appeared in the intercorrelation of instruments. There were no observed floor or ceiling effects in any of the instruments. All of their scores of change showed moderate correlation with the GROC (r = -0.48 to 0.30, P<.05) and could be classified as responsive. Conclusion The Brazilian-Portuguese versions of the SAFAS, GROC, NPRS, and AOFAS had acceptable measurement properties in high-performing athletes. J Orthop Sports Phys Ther 2016;46(12):1042-1050. Epub 8 Nov 2016. doi:10.2519/jospt.2016.6218.

Nociceptive vocalization response in guinea pigs modulated by opioidergic, GABAergic and serotonergic neurotransmission in the dorsal raphe nucleus.

The dorsal raphe nucleus (DRN) is involved in the control of several physiological functions, including nociceptive modulation. This nucleus is one of the main sources of serotonin to the CNS and neuromodulators such as opioids and GABA may be are important for its release. This study evaluated the influence of serotonergic, GABAergic and opioidergic stimulation, as well as their interactions in the DRN, on vocalization nociceptive response during a peripheral noxious stimulus application in guinea pigs. Morphine (1.1 nmol), bicuculline (0.50 nmol) and alpha-methyl-5-HT (1.6 nmol) microinjection on the DRN produces antinociception. The antinociception produced by morphine (1.1 nmol) and alpha-methyl-5-HT (1.6 nmol) into the DRN was blocked by prior microinjection of naloxone (0.7 nmol). The alpha-methyl-5-HT effect blocked by naloxone may indicate the existence of 5-HT2A receptors on enkephalinergic interneurons within the dorsal raphe. Pretreatment with muscimol (0.26 nmol) also prevented the antinociceptive effect caused by morphine (1.1 nmol) when administered alone at the same site, indicating an interaction between GABAergic and opioidergic interneurons. The antinociception produced by bicuculline (0.5 nmol) in the DRN was blocked by prior administration of 8-OH-DPAT (0.5 nmol), a 5-HT1A agonist. This may indicate that the 5-HT autoreceptor activation by 8-OH-DPAT at DRN effector neurons can oppose the bicuculline disinhibition effect applied to the same effectors. Thus, we suggest that 5-HT2 receptor activation in the DRN promotes endorphin/enkephalin release that may disinhibit efferent serotonergic neurons of this present structure by inhibiting GABAergic interneurons, resulting in antinociception.

Glutamate/GABA balance in ACC modulates the nociceptive responses of vocalization: an expression of affective-motivational component of pain in guinea pigs.

Evidence corroborates the role of the anterior cingulate cortex (ACC) in the modulation of cognitive and emotional functions. Its involvement in the motivational-affective component of pain has been widely investigated using different methods to elucidate the specific role of different neurotransmitter systems. We used the peripheral noxious stimulus-induced vocalization algesimetric test to verify glutamatergic and GABAergic neurotransmission in the guinea pig ACC. Microinjection of homocysteic acid (DLH; 30 nmol) in the left guinea pig ACC increased the amplitude of vocalizations (pronociception) compared to controls injected with saline. Moreover, microinjection of MK-801 (3.6 nmol), an NMDA receptor antagonist, did not alter the amplitude of vocalizations, but its microinjection prior to DLH prevented the increase in vocalizations induced by this drug. Regarding the GABAergic system, blockade of GABAA receptors with bicuculline (1 nmol) increased the amplitude of vocalizations, while three different doses of the GABAA agonist muscimol (0.5, 1 and 2 nmol) did not influence nociceptive vocalization responses. Finally, a combination of MK-801 (3.6 nmol) and muscimol (1 nmol) reduced the amplitude of vocalizations (antinociception), suggesting that a combination of glutamate and GABA in the ACC modulates the expression of affective-motivational pain response. We suggest that activation of NMDA receptors or blockade of GABAergic neurotransmission promotes pronociception and that the antinociceptive effect of muscimol depends on the blockade of NMDA receptors.

Opioidergic, GABAergic and serotonergic neurotransmission in the dorsal raphe nucleus modulates tonic immobility in guinea pigs.

Tonic immobility (TI) is an innate defensive behavior that can be elicited by physical restriction and postural inversion and is characterized by a profound and temporary state of akinesis. Our previous studies demonstrated that the stimulation of serotonin receptors in the dorsal raphe nucleus (DRN) appears to be biphasic during TI responses in guinea pigs (Cavia porcellus). Serotonin released by the DRN modulates behavioral responses and its release can occur through the action of different neurotransmitter systems, including the opioidergic and GABAergic systems. This study examines the role of opioidergic, GABAergic and serotonergic signaling in the DRN in TI defensive behavioral responses in guinea pigs. Microinjection of morphine (1.1 nmol) or bicuculline (0.5 nmol) into the DRN increased the duration of TI. The effect of morphine (1.1 nmol) was antagonized by pretreatment with naloxone (0.7 nmol), suggesting that the activation of µ opioid receptors in the DRN facilitates the TI response. By contrast, microinjection of muscimol (0.5 nmol) into the DRN decreased the duration of TI. However, a dose of muscimol (0.26 nmol) that alone did not affect TI, was sufficient to inhibit the effect of morphine (1.1 nmol) on TI, indicating that GABAergic and enkephalinergic neurons interact in the DRN. Microinjection of alpha-methyl-5-HT (1.6 nmol), a 5-HT(2) agonist, into the DRN also increased TI. This effect was inhibited by the prior administration of naloxone (0.7 nmol). Microinjection of 8-OH-DPAT (1.3 nmol) also blocked the increase of TI promoted by morphine (1.1 nmol). Our results indicate that the opioidergic, GABAergic and serotonergic systems in the DRN are important for modulation of defensive behavioral responses of TI. Therefore, we suggest that opioid inhibition of GABAergic neurons results in disinhibition of serotonergic neurons and this is the mechanism by which opioids could enhance TI. Conversely, a decrease in TI could occur through the activation of GABAergic interneurons.