Patient-reported outcome measures after thrombectomy in patients with acute stroke: fine-tuning the modified Rankin Scale.

BACKGROUND: In patients with stroke undergoing endovascular treatment (EVT), long-term outcome is usually only evaluated by the modified Rankin Scale (mRS). Patient-reported outcomes (PROMs) are standardized assessments that consider clinical outcomes from the perspective of the patient. We aimed to evaluate PROMs through a smartphone-based communication platform in patients with stroke who received EVT. METHODS: Consecutive patients with stroke who underwent EVT were offered to participate in the PROMs-through-App program (NORA). A set of standardized PROMs were collected at 7, 30 and 90 days after discharge. Disability was determined by clinicians (mRS) at 90 days. To characterize the potential ceiling effect of mRS in the assessment of different domains, the rate of abnormal PROMs among patients with excellent outcome (mRS 0-1) was calculated. RESULTS: From June 2020 to October 2021, 186 patients were included. The median PROMs collection rate per patient was 80% (50-100%). A correlation was consistently seen between disability measured by mRS and the different PROMs. The rate of abnormal PROMs ranged from 20.83% (HADS at 7 days) to 59.61% (Mental PROMIS at 7 days). At 90 days, among patients with an excellent outcome, the rate of abnormal PROMs ranged from 8.7% (HADS) to 47.83% (Physical PROMIS). CONCLUSIONS: A specifically designed digital platform allows a high collection rate of PROMs among stroke patients who underwent EVT. The mRS score shows a ceiling effect and seems insufficient to fine-tune long-term clinical results. The use of PROMs may allow a better characterization of long-term outcome profiles after EVT.

Redefining Disability: Patient-Reported Outcome Measures After Minor Stroke and Transient Ischemic Attack.

BACKGROUND: Long-term outcome assessment patients with stroke is not fully captured by usual clinical scales such as the modified Rankin Scale (mRS). Patient-reported outcome measures (PROMs) are standardized and validated assessments that consider clinical outcomes from the patient perspective. We aim to analyze the added value of PROMs in patients with transient ischemic attack and minor stroke. METHODS: We included consecutive patients with minor stroke or transient ischemic attack (National Institutes of Health Stroke Scale score 0-5) from April 2020 to October 2021 that participated in the PROMs-through-App program (NORA, NoraHealth Barcelona Spain). Clinician and self-evaluated outcomes were assessed at 90 days: clinician-evaluated mRS, self-reported mRS, the 10-item patient-reported outcome measures questionnaire global health survey (v1.2), Hospital Anxiety and Depression Scale, and the Fatigue Assessment Scale. We evaluated the acceptability (response rate), reliability (internal consistency), and construct validity (correlation with mRS and between scales) of each questionnaire. RESULTS: We included 355 patients in the analysis, response rate was patient-reported outcome measures questionnaire 71.3% (253), Hospital Anxiety and Depression Scale 70.7% (251), Fatigue Assessment Scale 71.8% (255), and self-assessed mRS 66.8% (237). PROMS internal consistency was good or excellent, while agreement between clinician and self-reported mRS was fair (k=0.34). Rate of abnormal PROMS scores were as follows (all responders versus clinician-reported mRS score 0-2): patient-reported outcome measures questionnaire mental health (43.1% versus 36.3%), physical health (48.6% versus 43.6%); Hospital Anxiety and Depression Scale-anxiety (21.9% versus 17.7%) and depression (17.1% versus 13.3%); and Fatigue Assessment Scale (40.8% versus 36.4%). PROMs scores correlated with clinician and self-reported mRS at 90 days. CONCLUSIONS: Evaluation of PROMs using a mobile-app-based communication system is a reliable and valid strategy to assess the outcome of patients from their perspective after a mild stroke or transient ischemic attack.

"Sacbe", a Comprehensive Intervention to Decrease Body Mass Index in Children with Adiposity: A Pilot Study.

Interventions in children with adiposity decrease less than 0.2 the body mass index (BMI) z-score less than 0.2 and only in 21⁻23% of cases. Experts recommend focusing on the habits of a healthy lifestyle (HLS) but considering the sociocultural context of children and their parents. Our objective was to achieve a higher percentage of success in lowering the BMI z-score in children with adiposity and their parents through a pilot program "Sacbe" based on HLS, sensitive to the sociocultural context previously explored and with the active participation of parents. This is a pilot study in children aged 8 to 18 years with adiposity according to the BMI z-score. The program consisted of two workshops on HLS and nutrition given by the pediatric endocrinologist in group sessions with 3⁻5 families and reinforcements in each visit by registered dietitians. We recorded lifestyle habits and anthropometric characteristics of children and their parents at the baseline visit and every month for 3⁻4 months. Forty-nine families, 55 children and 64 parents participated, 60% of the children were female, the average age was 13.95 ± 3.3 years, 72.7% and 86.7% lowered the z score of the BMI due to intention to treat and protocol analysis (p < 0.001), respectively; BMI z-score decreased by 0.22 ± 0.21, from 2.13 ± 0.57 to 1.91 ± 0.58 (p < 0.001). In total, 83% of the parents involved were mothers, the average age was 45.8 ± 9.4 years, 77% lost weight and body fat (p < 0.001), the frequency of unhealthy habits decreased. The results of "Sacbe" exceeded expectations by combining the active participation of parents, sessions in groups, and the education on various components of an HLS inside sociocultural context. The main challenge will be to standardize and reproduce this type of complex interventions, as well as to assure long-term success.

Divalent metal modulation of Japanese flounder (Paralichthys olivaceus) purinergic P2X7 receptor.

Paralichthys olivaceus P2X7 receptor (poP2X7R) is a recently identified as a P2X7 purinergic receptor involved in innate immunity of the Japanese flounder Paralichthys olivaceus. Divalent metals are allosteric modulators of mammalian P2XRs, but there is no information for fish P2XRs. Here, we characterized the effects of divalent metals on poP2X7R channel activity by electrophysiology and molecular biology techniques. Copper, zinc and mercury inhibited poP2X7R-mediated currents with different maximal inhibition potency, while cadmium had no effect on poP2X7R activity. Mercury-induced inhibition was irreversible, but the inhibitory effects of copper and zinc were reversed after washout. Cooper and zinc also reduced poP2X7R-mediated interleukin-1 mRNA production. These findings suggest that divalent metals have potential effects on the Japanese flounder innate immune response through modulation of poP2X7R activity.

Evaluación postural y presencia de dolor osteomuscular en trabajadores de una clínica materno-infantil, en la ciudad de Lima / Postural evaluation and presence of osteo-muscular pain in workers of a mother-child clinic in the city of Lima

Gran parte de la población no presenta una postura bípeda ideal, presentando un desequilibrio postural y predisponiendo a sufrir trastornos musculoesqueléticos, que pueden ser agravados por las condiciones del trabajo. Objetivo: Determinar la frecuencia de dolor osteomuscular y de las alteraciones posturales del personal de una clínica materno infantil de Lima. Material y métodos: Estudio de tipo transversal. La recolección de información se realizó durante las evaluaciones médicas ocupacionales periódicas de 188 trabajadores. Se evaluaron los segmentos corporales empleándose la cuadrícula postural y la prueba de Adams, mientras que para evaluar los rangos de movimiento articular tanto pasivos como activos, el goniómetro. Para la calificación de la intensidad del dolor se empleó la Escala Visual Analógica del dolor. Resultados: En la evaluación estática la alteración más frecuente fue la elevación de alguno de los hombros en 90,4%, luego la inclinación de cabeza 85,1%, alteraciones en columna lumbar 58%, la rotación de cabeza 49,5% y las alteraciones en pie 41%. Los trabajadores refirieron dolor en la evaluación dinámica de la columna vertebral en 64%, de las extremidades en 30% y en ambas zonas 6%. Conclusiones: Se encontró una frecuencia elevada de alteraciones posturales a predominio de columna vertebral lumbar, tanto sintomáticas y no sintomáticas. La inclusión de la evaluación postural en los exámenes médicos ocupacionales identificó que el 39% de los evaluados con alteraciones posturales estaban asintomáticos, requiriendo acciones preventivas integrales. (AU)

A great proportion of the population does not exhibit an ideal posture leading to suffer skeletal muscle disorders that can be exacerbated by conditions at work. Objective: To determine the frequency of postural abnormalities among workers of a mother-child clinic in Lima. Methods: A cross-sectional study was conducted during periodic medical evaluations of the center. Body segments were evaluated using postural evaluations and Adam´s test, while range of movement was evaluated with the goniometer. The visual analog pain scale was used to measure intensity of pain. Results: In the static evaluation, the most common disorder was elevation of shoulders in 90.4%, followed by inclination of the head in 85,1%, alterations in the lumbar spine in 58%, head rotation in 49.5%, and foot alterations in 41%. The health workers referred pain at the dynamic evaluation of the spine in 64%, of the extremities in 30% and in both areas in 6%. Conclusions: A high prevalence of postural abnormalities was found in this study with a predominance of both symptomatic and asymptomatic disorders of the spine. The inclusion of postural evaluation in routine occupational examination allowed to detect that 39% of those evaluated had postural defects requiring preventive action. (AU)

Nano and micro architectures for self-propelled motors.

Self-propelled micromotors are emerging as important tools that help us understand the fundamentals of motion at the microscale and the nanoscale. Development of the motors for various biomedical and environmental applications is being pursued. Multiple fabrication methods can be used to construct the geometries of different sizes of motors. Here, we present an overview of appropriate methods of fabrication according to both size and shape requirements and the concept of guiding the catalytic motors within the confines of wall. Micromotors have also been incorporated with biological systems for a new type of fabrication method for bioinspired hybrid motors using three-dimensional (3D) printing technology. The 3D printed hybrid and bioinspired motors can be propelled by using ultrasound or live cells, offering a more biocompatible approach when compared to traditional catalytic motors.

Impacto da reconstrução mamária na qualidade de vida de pacientes mastectomizadas atendidas no Serviço de Cirurgia Plástica do Hospital Universitário Walter Cantídio / The impact of breast reconstruction on the quality of life of patients after mastectomy at the Plastic Surgery Service of Walter Cantídio University Hospital

INTRODUÇÃO: A reconstrução mamária tem por objetivo restabelecer a estética corporal e melhorar a autoimagem da paciente, restaurando o volume perdido e assegurando simetria com a mama contralateral. O objetivo deste trabalho é verificar a qualidade de vida de pacientes mastectomizadas e submetidas a reconstrução mamária imediata ou tardia, abordando os domínios físico, psicológico e social. MÉTODO: Foram estudadas 27 pacientes submetidas a reconstrução mamária no Hospital Universitário Walter Cantídio, entre agosto de 2007 e agosto de 2012. Foi realizado um estudo transversal, com avaliação da qualidade de vida por meio da aplicação do questionário World Health Organization Quality of life (WHOQOL) abreviado. RESULTADOS: As pacientes entrevistadas avaliaram positivamente sua qualidade de vida, com atribuição da nota 4 (boa) por 41% e 5 (muita boa) por 33% das entrevistadas à pergunta "Como você avaliaria sua qualidade de vida?". Dentre as pacientes entrevistadas, 81% foram submetidas a reconstrução imediata e a maioria delas (45%) atribuiu nota 4 (boa) à pergunta "Como você avaliaria sua qualidade de vida?". Por outro lado, 60% das pacientes submetidas a reconstrução tardia atribuíram nota 5 (muito boa) a essa pergunta. CONCLUSÕES: Os resultados demonstram que a reconstrução mamária possibilita à mulher mastectomizada incorporar ao tratamento do câncer de mama conceitos de qualidade de vida, trazendo benefícios físicos, psicológicos e sociais.

INTRODUCTION: The aim of breast reconstruction is to restore body contour and improve the patient's self-image by replacing the volume loss and ensuring proper symmetry with the contralateral breast. This study evaluated the quality of life and physical, psychological, and social aspects of patients who underwent mastectomy and immediate or delayed breast reconstruction. METHODS: Twenty-seven patients underwent breast reconstruction at Walter Cantídio University Hospital between August 2007 and August 2012. The World Health Organization Quality of Life survey was used to conduct a cross-sectional study to evaluate patient quality of life. RESULTS: The patients positively evaluated their quality of life. A score of 4 (good) and 5 (very good) was assigned by 41% and 33% of women, respectively, to the question "How would you rate your quality of life?" Among the patients, 81% underwent immediate reconstruction and most (45%) assigned a score of 4 (good) to the question "How would you evaluate your quality of life?" A total of 60% of patients who underwent delayed reconstruction attributed a score of 5 (very good) to this question. CONCLUSIONS: These results demonstrate that breast reconstruction after mastectomy results in good or very good quality of life and is associated with physical, psychological, and social benefits.