Prospective study of consecutive patch testing in patients with contact dermatitis using an adapted Latin American baseline series.

Summary: Background. Contact dermatitis is characterized by pruritic skin lesions with high prevalence rates. Our objective is to describe the clinical and epidemiological characteristics of a population with suspected contact dermatitis who underwent to a patch testing using an adapted Latin American baseline series.Methods. Observational, descriptive, analytical clinical study with prospective data collection was performed. 208 participants who underwent patch testing using an adapted Latin American baseline series containing 40 allergens were analyzed. The prevalence of contact allergies was compared with data from the literature. Pearson's chi-square test was used for qualitative variables. Quantitative variables were compared using the Mann-Whitney U test. The significance of the regression parameters was tested using the Wald statistical test. Results. A total of 69.7% had one or more positive tests. Among those, 82.8% were women (OR 1.371; p = 0.398). The hands were the most commonly affected site at 43%. An occupational history was detected in 19.2%. The most common allergens were nickel sulfate (32.2%), sodium tetrachloropalladate (19.7%), fragrance mix I (15.4%), and methylisothiazolinone (13.5%). In multivariate logistic regression models, nickel was significantly related to female sex, as well as palladium. Fragrance mix I was related to a family history of allergy (p less than 0.05). Methylisothiazolinone was statistically significantly related to face and hand lesions. Conclusions. This study demonstrated a detailed profile of a population with suspected allergic contact dermatitis. Our patch test results, using an adapted Latin American baseline series, represent a significant update of this important diagnostic tool.

Case report of Curtobacterium isolated from a catheter tip sample misidentified as Cronobacter.

The Curtobacterium genus is a member of the family Microbacteriaceae, and Curtobacterium species are recognized as plant pathogens. The aim of this study was to investigate a dubious result of species identification for an infection located on a catheter tip of a patient with Covid-19. A strain isolated from a catheter tip sample, identified by VITEK® 2 as Cronobacter spp., was submitted to polyphasic analysis: Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) using VITEK® MS, real-time polymerase chain reaction targeting dnaG gene, and 16S rRNA full gene Sanger sequencing analysis for confirmation. The strain presented negative result using qPCR and could not identified by MALDI-TOF MS. 16S rRNA full gene Sanger sequencing analysis identified the strain as Curtobacterium spp. The Gram-variable characteristic (Gram-negative instead of Gram-positive) of the isolated strain was the responsible for the misidentification by VITEK® 2 and VITEK® MS did not identify the strain. 16S rRNA full gene sequencing analysis identified the strain as Curtobacterium genus, but other complementary techniques are necessary to identify at species level.

Treatment of keloids and hypertrophic scars. Position statement of the Brazilian expert group GREMCIQ.

Keloids (K) and hypertrophic scars (HS) are abnormal responses to wound healing that occur as the result of dermal inflammation. Despite the advances on their treatment, many patients still suffer from the negative effects of excessive scarring; its approach is impaired by the lack of objective data on different treatments and the large genetic variability among patients and the difficulties in producing multicentre studies. Their incidence among the Brazilian population is high, as the result of an admixture of Amerindians, Europeans and Africans ancestral roots. With the aim of producing multicentre studies on K and HS, a panel of senior Brazilian dermatologists focused on their treatment was invited to contribute with the K and HS Treatment Brazilian Guidelines. In the first part of this study, different treatment modalities for keloids and HS are fully reviewed by the panel. The second part of the study presents a consensus recommendation of treatment for different types of lesions. More than a literature review, this article aims to show the pitfalls and pearls of each therapeutic option, as well as a therapeutic approach by the Panel of Experts on keloids and Scars on a highly mixed population, providing simple guidelines.

Risk factors for developmental defects of enamel in children from southeastern Brazil.

INTRODUCTION: Developmental Defects of Enamel (DDEs) comprise qualitative and/or quantitative changes to the enamel during amelogenesis. The aetiology of DDE remains inconclusive. AIM: To determine the association of pre, peri, and postnatal factors with the presence of DDE. DESIGN: Cross-sectional study with 353 children (8 to 11 years-old) in a Brazilian town. METHODS: One calibrated dentist assessed DDE using the Developmental Defects of Enamel Index and a questionnaire collected medical and sociodemographic data. MAIN OUTCOMES: Children with at least one type of DDE were categorized into the DDE group. Subtypes of DDE were also recorded. RESULTS: 63.1% of children had at least one type of DDE. Diffuse opacity was present in 36.7%, demarcated opacity in 14.8%, and hypoplasia in 5.83% of the children. In multivariate analysis, demarcated opacities and hypoplasia were associated with birth weight ⟨ 2500g (OR = 4.82; 95% CI 1.23-1.95). CONCLUSION: Low birth weight predicted DDE.

Lecanicillium aphanocladii: snake venom phospholipases A2 and proteases as tools to prospect enzymatic inhibitors.

Natural enzyme inhibitors have been widely described in literature because of its pharmacological and cosmetic applications. Fungi found in caves represent a promising source of bioactive substances that are still little explored scientifically. Thus, the present work evaluated the presence of enzymatic modulators in a filtrate obtained from the cultivation of the cave fungus Lecanicillium aphanocladii (Family: Cordycipitaceae). Snake venoms from Bothrops alternatus and Bothrops atrox were used as an enzymatic source for the induction of the phospholipase, proteolytic, thrombolytic, cytotoxic and coagulant activities. Compounds present in the fungal filtrate inhibited 50, 23·8, 26·6, 50·9 and 52·5% of the proteolytic, phospholipase, haemolytic, thrombolytic and coagulant activities respectively. The filtrate was not cytotoxic on erythrocytes, but induced partial dissolution of thrombi. Fungal enzyme inhibitors that have low or no toxicity and can be obtained on a large scale and at low cost are relevant in the medical-scientific context. Therefore, the inhibition of phospholipases A2 and proteases observed in the present work highlights the potential of fungal metabolites for the development of drugs that can be used in the treatment of haemostasis and inflammation-related disorders. SIGNIFICANCE AND IMPACT OF THE STUDY: In this study, secondary metabolites synthesized by Lecanicillium aphanocladii, a fungus isolated from caves, demonstrated modulating action on proteases and phospholipases A2 present in snake venoms of the Bothrops genus, widely used as tools for the study of pathophysiology processes related to haemostasis and inflammation. The results suggest the possibility of future applications for these metabolites in the development of pharmaceuticals of medical-scientific interest.

Fcγ-RI, Fcγ-RII and IL-10 as predictive biomarkers for post-therapeutic cicatrization time in monocytes from cutaneous leishmaniasis patients.

Cutaneous leishmaniasis (CL) treatment is based on therapy with Glucantime® , yet, there are few laboratory methods to monitor its success. In this study, ex vivo and in vitro evaluations of peripheral blood monocytes were performed in a longitudinal study to characterize the impact of Glucantime® on overall phenotypic/functional features of these cells from CL patients to identify predictive biomarkers for post-therapeutic monitoring by flow cytometry. The ex vivo evaluation from CL patients demonstrated a modulatory profile before treatment, with a decrease in TLR-2, FcγRII, HLA-DR, CD86, IFN-γR, TNF, IL-12, NO, and an increase in FcγRIII and IL-10R. Conversely, treatment changes some of these biomarker expressions by decreasing FcγRIII and IL-10R and increasing IFN-γR, IL-12 and NO. Moreover, an in vitro analysis of these patients showed a reduced phagocytic capacity of Leishmania braziliensis and higher levels of IL-10 and TGF-ß modulating functional profile. Regardless of the compromised L. braziliensis phagocytic capacity, treatment re-established the production of IL-12, IL-10, TGF-ß and NO at the basal level. Notably, monocytes from patients with early cicatrization showed enhanced FcγRI and FcγRII expressions and reduced IL-10, which was further corroborated by a baseline fold change analysis. Finally, the logistic regression model emphasized the performance of FcγRI, FcγRII and IL-10 as robust predictive biomarkers for post-therapeutic cicatrization during cutaneous leishmaniasis.

A putative OTU domain-containing protein 1 deubiquitinating enzyme is differentially expressed in thyroid cancer and identifies less-aggressive tumours.

BACKGROUND: This study aimed to identify novel biomarkers for thyroid carcinoma diagnosis and prognosis. METHODS: We have constructed a human single-chain variable fragment (scFv) antibody library that was selected against tumour thyroid cells using the BRASIL method (biopanning and rapid analysis of selective interactive ligands) and phage display technology. RESULTS: One highly reactive clone, scFv-C1, with specific binding to papillary thyroid tumour proteins was confirmed by ELISA, which was further tested against a tissue microarray that comprised of 229 thyroid tissues, including: 110 carcinomas (38 papillary thyroid carcinomas (PTCs), 42 follicular carcinomas, 30 follicular variants of PTC), 18 normal thyroid tissues, 49 nodular goitres (NG) and 52 follicular adenomas. The scFv-C1 was able to distinguish carcinomas from benign lesions (P=0.0001) and reacted preferentially against T1 and T2 tumour stages (P=0.0108). We have further identified an OTU domain-containing protein 1, DUBA-7 deubiquitinating enzyme as the scFv-binding antigen using two-dimensional polyacrylamide gel electrophoresis and mass spectrometry. CONCLUSIONS: The strategy of screening and identifying a cell-surface-binding antibody against thyroid tissues was highly effective and resulted in a useful biomarker that recognises malignancy among thyroid nodules and may help identify lower-risk cases that can benefit from less-aggressive management.

Peptides derived from phage display libraries as potential neutralizers of Shiga toxin-induced cytotoxicity in vitro and in vivo.

AIMS: To use the phage display technique to develop peptides with the capability to neutralize the cytotoxicity induced by Stx1 and Stx2 toxins produced by Shiga toxin-producing Escherichia coli (STEC). METHODS AND RESULTS: The phage display technique permitted the development of three peptides, named PC7-12, P12-26 and PC7-30, which bind to the globotriaosylceramide (Gb3) receptor for Shiga toxins produced by STEC. Moreover, these peptides were capable of competing efficiently with the Shiga toxins for binding to Gb3. The peptides described herein partially inhibited the Stx-induced cytotoxicity of cell-free filtrates of STEC O157 : H7 and purified Stx toxins in Vero cells. The inhibition of lethality induced by Stx toxins in mice indicated that peptide PC7-30 inhibited the lethality caused by Stx1 (2LD50) in mice. CONCLUSIONS: The phage display technique permitted the development of peptides that inhibited the cytotoxicity induced by Stx toxins in vitro. Peptide PC7-30 inhibited the lethality of Stx1 in vivo; this molecule would be a promising candidate for the development of therapeutic agents for STEC-related diseases in humans. SIGNIFICANCE AND IMPACT OF THE STUDY: The selection of Gb3, the common receptor for Stx1 and Stx2, may contribute to the development of efficient neutralizers for both toxins, and our approach would be an interesting alternative for the development of therapeutic molecules for the treatment of diseases caused by STEC strains.

[Prosody and reading: Temporal and melodic characteristics in the dyslexic child in reading and narration]. / Prosodie et lecture: particularités temporelles et mélodiques de l'enfant dyslexique en lecture et en narration.

Dyslexia is widely associated to a massive phonological awareness deficit. This deficit leads to difficulties in grapheme to phoneme conversions in reading and difficulties in words and sentences productions. The origin of the phonological deficit is partially explained by the magnocellular, cerebellar and articulatory theories. Recently, an increasing number of studies demonstrated the relationship between prosody and reading and, more specifically, the potential key role of suprasegmental phonology in the healthy development of phonological representations. The aim of this study is to explore part of prosodic features in dyslexics and normal developing children in reading and narration tasks, in French. We examined reading accuracy, reading rate, pauses frequency and duration, inter-pausal units (IPUs) duration and instantaneous variations of F0. Results show correct decoding skills for all subjects but a lack of automation of this procedure for dyslexics. Differences in pauses frequency and duration, IPUS duration and F0 variations observed between dyslexics and controls confirm the link between prosodic reading and automaticity. The longer pause duration in narrative form a temporal feature of dyslexic's production. This temporal characteristic reflects the cognitive cost done by a speech generation task involving lexical selection, syntactic planning and articulatory programming processes. This result is a first step towards evidence of a suprasegmental phonological deficit in spoken language that could be an early marker of later reading difficulties.

Strategies enhancing the patient experience in mammography: A scoping review.

INTRODUCTION: A positive experience in mammography is essential for increasing patient attendance and reattendance at these examinations, whether conducted for diagnostic or screening purposes. Mammograms indeed facilitate early disease detection, enhance the potential for cure, and consequently reduce breast cancer mortality. The main objective of this review was to identify and map the strategies aiming to improve the patient experience in diagnostic and screening mammography. METHODS: This scoping review was performed following the JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Searches were performed through databases of MEDLINE, Embase.com, CINAHL, APA PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, ProQuest Dissertation and Theses, and three clinical trial registries. This review considered studies evaluating the effect of interventions, occurring within the mammography department, on the patient experience. RESULTS: The literature search yielded 8113 citations of which 60, matching the inclusion criteria, were included. The strategies were classified into eight categories. The most represented one was breast compression and positioning, followed by relaxation techniques and analgesic care, communication and information, screening equipment, examination procedures, patient-related factors, physical environment, and finally staff characteristics. The studied outcomes related to patient experience were mainly pain, anxiety, comfort, and satisfaction. Other types of outcomes were also considered in the studies such as image quality, technical parameters, or radiation dose. Most studies were conducted by radiographers, on female patients, and none mentioned the inclusion of male or transgender patients. CONCLUSION: This review outlined a diversity of strategies to improve patient experience, although technique-based interventions were predominant. Further research is warranted, notably on psychological strategies, and on men and transgender people. IMPLICATIONS FOR PRACTICE: This scoping review provides guidance to healthcare providers and services for better patient/client-centered care.

Approaches to reduce medical imaging departments' environmental impact: A scoping review.

INTRODUCTION: Global warming stands as a paramount public health issue of our time, and it is fundamental to explore approaches to green medical imaging departments/(MID). This study aims to map the existing actions in the literature that promote sustainable development in MID towards the promotion of environmental impact reduction. METHODS: Following the JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), this literature search was conducted on MEDLINE, Embase and CINAHL to encompass studies published after 2013. Combinations of keywords and relevant terms related to environmental sustainability, recycling, medical waste, and greening radiology were applied for this review. Three independent reviewers screened abstracts, titles, and eligible full-text. Disagreement was solved through consensus. RESULTS: 38 out of 4630 articles met all inclusion criteria, and four additional articles were identified and added through reference search. A third of the studies included were published after 2022, and most were conducted in developed countries (36/41). Articles focused on computed tomography (9/41), magnetic resonance imaging (6/41), interventional radiology (4/41), conventional radiography (4/41), ultrasound (2/41), mixed modalities (10/41), or not applicable to an imaging modality (6/41). Four principal categories were identified to decrease ecological footprint: energy consumption, waste management, justification and environmental pollution. CONCLUSION: To minimise the environmental impact of MIDs raising awareness and promoting education is fundamental. Examinations must be justified adequately, energy consumption must be reduced, and waste management practices need to be implemented. Further studies are required to prioritise the most effective strategies, supporting decision-making among stakeholders. IMPLICATIONS FOR PRACTICE: Several strategies are already possible to implement to reduce the environmental impact of MIDs and improve the healthcare outcomes for patients.

Nuclear medicine technologists practice impacted by AI denoising applications in PET/CT images.

PURPOSE: Artificial intelligence (AI) in positron emission tomography/computed tomography (PET/CT) can be used to improve image quality when it is useful to reduce the injected activity or the acquisition time. Particular attention must be paid to ensure that users adopt this technological innovation when outcomes can be improved by its use. The aim of this study was to identify the aspects that need to be analysed and discussed to implement an AI denoising PET/CT algorithm in clinical practice, based on the representations of Nuclear Medicine Technologists (NMT) from Western-Switzerland, highlighting the barriers and facilitators associated. METHODS: Two focus groups were organised in June and September 2023, involving ten voluntary participants recruited from all types of medical imaging departments, forming a diverse sample of NMT. The interview guide followed the first stage of the revised model of Ottawa of Research Use. A content analysis was performed following the three-stage approach described by Wanlin. Ethics cleared the study. RESULTS: Clinical practice, workload, knowledge and resources were de 4 themes identified as necessary to be thought before implementing an AI denoising PET/CT algorithm by ten NMT participants (aged 31-60), not familiar with this AI tool. The main barriers to implement this algorithm included workflow challenges, resistance from professionals and lack of education; while the main facilitators were explanations and the availability of support to ask questions such as a "local champion". CONCLUSION: To implement a denoising algorithm in PET/CT, several aspects of clinical practice need to be thought to reduce the barriers to its implementation such as the procedures, the workload and the available resources. Participants emphasised also the importance of clear explanations, education, and support for successful implementation. IMPLICATIONS FOR PRACTICE: To facilitate the implementation of AI tools in clinical practice, it is important to identify the barriers and propose strategies that can mitigate it.

Alumni, radiographers, clinical placement tutors and industry insights about current radiographers practice, competences and autonomy in western Switzerland.

INTRODUCTION: Radiographers' profession is constantly evolving, which demands adaptation of education and training programs to build up medical imaging and radiation therapy professionals (MIRTPs) that provide healthcare to improve patient experience and outcomes. This study aimed to map radiographers' practices, competences, and autonomy level in Western Switzerland. METHODS: Data was collected by 2 cross-sectional online surveys targeting Alumni, radiographers, clinical placement tutors and medical imaging equipment specialists from industry, with opened and closed-end questions. Descriptive statistics and thematic analysis were used to analyse the data. RESULTS: 81 Alumni and 93 Chief-Radiographers, clinical tutors, practitioner-radiographers and industry answered the questionnaires. The competences considered as the most "acquired or completely acquired" by the Alumni were: adopt a reflective posture on practice (90.1 %; 73/81), adopt ethical behaviour (90.1 %; 73/81), carrying out and providing radiological services for diagnostic, therapeutic and preventive purposes (81.5 %; 68/81), adapting communication to the other surrounding persons (81.5 %; 66/81), and check compliance of procedures with standards (69.1 %; 56/81). Similar results were referred by Employers. The autonomy of the participant radiographers was considered as average, and it focuses only the preparation of the patient and the protocol optimisation. The development and integration of research is weak as well as the application of competences regarding professionalism. CONCLUSIONS: A better link between educational institutions and clinical practice can help on the integration of research and evidence-based on practice, necessary to progress the radiographers' profession in Western Switzerland. The autonomy needs to be further developed and leadership courses must be integrated in the curricula to facilitate the implementation of new approaches to reinforce radiographer's profession. IMPLICATIONS FOR PRACTICE: Practice must be revised to integrate evidence-based; to facilitate research development, the managers need to increase support.

Response of high-risk of recurrence/progression bladder tumours expressing sialyl-Tn and sialyl-6-T to BCG immunotherapy.

BACKGROUND: High risk of recurrence/progression bladder tumours is treated with Bacillus Calmette-Guérin (BCG) immunotherapy after complete resection of the tumour. Approximately 75% of these tumours express the uncommon carbohydrate antigen sialyl-Tn (Tn), a surrogate biomarker of tumour aggressiveness. Such changes in the glycosylation of cell-surface proteins influence tumour microenvironment and immune responses that may modulate treatment outcome and the course of disease. The aim of this work is to determine the efficiency of BCG immunotherapy against tumours expressing sTn and sTn-related antigen sialyl-6-T (s6T). METHODS: In a retrospective design, 94 tumours from patients treated with BCG were screened for sTn and s6T expression. In vitro studies were conducted to determine the interaction of BCG with high-grade bladder cancer cell line overexpressing sTn. RESULTS: From the 94 cases evaluated, 36 had recurrence after BCG treatment (38.3%). Treatment outcome was influenced by age over 65 years (HR=2.668; (1.344-5.254); P=0.005), maintenance schedule (HR=0.480; (0.246-0.936); P=0.031) and multifocality (HR=2.065; (1.033-4.126); P=0.040). sTn or s6T expression was associated with BCG response (P=0.024; P<0.0001) and with increased recurrence-free survival (P=0.001). Multivariate analyses showed that sTn and/or s6T were independent predictive markers of recurrence after BCG immunotherapy (HR=0.296; (0.148-0.594); P=0.001). In vitro studies demonstrated higher adhesion and internalisation of the bacillus to cells expressing sTn, promoting cell death. CONCLUSION: s6T is described for the first time in bladder tumours. Our data strongly suggest that BCG immunotherapy is efficient against sTn- and s6T-positive tumours. Furthermore, sTn and s6T expression are independent predictive markers of BCG treatment response and may be useful in the identification of patients who could benefit more from this immunotherapy.

Autoantibodies to MUC1 glycopeptides cannot be used as a screening assay for early detection of breast, ovarian, lung or pancreatic cancer.

BACKGROUND: Autoantibodies have been detected in sera before diagnosis of cancer leading to interest in their potential as screening/early detection biomarkers. As we have found autoantibodies to MUC1 glycopeptides to be elevated in early-stage breast cancer patients, in this study we analysed these autoantibodies in large population cohorts of sera taken before cancer diagnosis. METHODS: Serum samples from women who subsequently developed breast cancer, and aged-matched controls, were identified from UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS) and Guernsey serum banks to formed discovery and validation sets. These were screened on a microarray platform of 60mer MUC1 glycopeptides and recombinant MUC1 containing 16 tandem repeats. Additional case-control sets comprised of women who subsequently developed ovarian, pancreatic and lung cancer were also screened on the arrays. RESULTS: In the discovery (273 cases, 273 controls) and the two validation sets (UKCTOCS 426 cases, 426 controls; Guernsey 303 cases and 606 controls), no differences were found in autoantibody reactivity to MUC1 tandem repeat peptide or glycoforms between cases and controls. Furthermore, no differences were observed between ovarian, pancreatic and lung cancer cases and controls. CONCLUSION: This robust, validated study shows autoantibodies to MUC1 peptide or glycopeptides cannot be used for breast, ovarian, lung or pancreatic cancer screening. This has significant implications for research on the use of MUC1 in cancer detection.

Effects of caffeine chewing gum supplementation on exercise performance: A systematic review and meta-analysis.

The aim of this systematic review with meta-analysis was to determine the effect of caffeine gum (Caff-gum) on exercise performance-related outcomes. Several databases were searched for studies assessing the effect of Caff-gum in placebo-controlled protocols involving healthy adults. Random-effects meta-analyses using standardized mean differences (SMD) were performed to determine the effect of Caff-gum on exercise outcomes with several sub-analyses (training status, exercise type, timing and dose) for potential modifying factors. 14 studies were included, totalling 200 participants. There was a significant overall effect of Caff-gum compared to placebo (SMD = 0.21, 95%CI: 0.10-0.32; p = 0.001). Subgroup analysis showed improved performance for trained (SMD = 0.23, 95%CI: 0.08-0.37; p = 0.004), but not for untrained (SMD = 0.14, 95%CI: -0.02-0.29; p = 0.07) individuals. Caff-gum improved both endurance (SMD = 0.27, 95%CI: 0.12-0.42; p = 0.002) and strength/power (SMD = 0.20, 95%CI: 0.03-0.37; p = 0.03) performance outcomes. Caff-gum was ergogenic when consumed within 15 min prior to initiating exercise (SMD = 0.27, 95%CI: 0.07-0.4; p = 0.01), but not when provided >15 min prior (SMD = -0.48, 95%CI = -1.7-0.82; p = 0.25). There was no significant effect of Caff-gum with doses <3 mg/kg body mass (BM) (SMD = 0.20, 95%CI: -0.03-0.43; p = 0.07), but there was a significant effect when the dose was ≥3 mg/kg BM (SMD = 0.22, 95%CI: 0.07-0.37; p = 0.01). Caff-gum supplementation may be an effective ergogenic strategy for trained athletes involved in both endurance and strength/power exercise, using a recommended dose of ≥3 mg/kg BM consumed within 15 min of initiating exercise.HighlightsThis study determined the effect of Caff-gum on exercise performance, using a systematic review and meta-analysis. Fourteen studies, totalling 200 participants performing a variety of endurance and strength/power exercise tests were included. The relative Caff-gum dose ranged from 1.27-4.26 mg/kg BM and timing ranged from 120 min prior to exercise up to intra-test application.Caff-gum was shown to be an effective ergogenic aid for trained individuals involved in both endurance and strength/power exercise.Supplement dose and timing modified the efficacy of Caff-gum. Supplementation with Caff-gum was effective when provided in doses ≥3 mg/kg BM and within 15 min prior to initiating exercise.Trained endurance or strength/power athletes seeking to benefit from caffeine in the form of chewing gum should supplement within 15 min prior to initiating an exercise task, in doses ≥3 mg/kg BM.

Optimisation of exposure parameters using a phantom for thoracic spine radiographs in antero-posterior and lateral views.

INTRODUCTION: To investigate the exposure parameters for thoracic spine/(TS) radiography that allows the image acquisition at the lowest dose possible, while maintaining an adequate image quality/(IQ) to identify all relevant anatomical criteria. METHODS: An experimental phantom study was conducted, and 48 different radiographs of TS (24 AP/24 lateral) were acquired. The Automatic Exposure Control/(AEC) with the central sensor was used to select the beam intensity, while Source-to-Detector-Distance/(SDD) (AP:115/125 cm; Lateral:115/150 cm), tube potential (AP:70/81/90 kVp; Lateral: 81/90/102 kVp), use of grid/no grid and focal spot (fine/broad) were manipulated. IQ was assessed by observers with ViewDEX. Effective Dose (ED) was estimated using PCXMC2.0 software. Descriptive statistics paired with intraclass correlation coefficient (ICC) were applied to analyse data. RESULTS: The ED increased with a greater SDD for lateral-view, presenting a significant difference (p = 0.038), however IQ was not affected. For both AP and lateral, the use of grid had a significant effect on ED (p < 0.001). Despite the images acquired without grid had lower IQ scores, the observers considered the IQ adequate for clinical use. A 20% reduction in ED (0.042mSv-0.033 mSv) was observed when increasing the beam energy from 70 to 90 kVp for AP grid in. The observers ICC ranged from moderate to good (0.5-0.75) in lateral and good to excellent (0.75-0.9) for AP views. CONCLUSIONS: The optimised parameters in this context were 115 cm SDD, 90 kVp with grid for the best IQ and lowest ED. Further studies in clinical setting are necessary to enlarge the context and cover different body habitus and equipment. IMPLICATIONS FOR PRACTICE: The SDD impacts on dose for TS; Higher kVp and grid are necessary to better image quality.

Lack of correlation between sealer penetration into dentinal tubules and sealability in nonbonded root fillings.

AIM: To determine the correlation between leakage and sealer penetration into dentinal tubule. METHODOLOGY: The root canal of 60 mandibular central incisor teeth were prepared and filled under standardized conditions. Teeth were placed into a device to assess glucose penetration using 15 psi pressure application. After 1 h, glucose concentrations in the lower chamber were measured using an enzymatic reaction. Each specimen was then sectioned horizontally at 3, 6 and 8 mm from the apex, and a standard metallographic preparation was performed. The coronally facing surface of each slice was examined in a high-resolution stereomicroscope and under Confocal Laser Scanning Microscope. For each slice, the external outline of the root canal, the internal circumference of the root canal walls and the areas along the canal walls where the sealer had penetrated into the dentinal tubules (sealer tags) were outlined and measured. Afterwards, the percentage of the sealer penetration in each section was calculated. The Spearman correlation test was used to verify the correlation between the variables studied (glucose leakage and sealer penetration into dentinal tubules). RESULTS: The means and standard deviations of glucose leakage were 0.744 g L(-1) (±0.5), and the percentage of the dentinal tubule sealer penetration varied between teeth from 5.6% to 42.21%, with an average of 13.7 ± 17.2%. The Spearman correlation test revealed no significant correlation between the two factors analysed (P = 0.082). The r(2) value was equal to 0.12. CONCLUSIONS: There was no significant correlation between sealability sealer penetration into dentinal tubules. The lack of correlation reported is of relevance as sealer penetration into dentinal tubules has been used as an advantageous property during the launch of new root filling materials and techniques.

Autism-friendly MRI: Improving radiography practice in the UK, a survey of radiographer practitioners.

INTRODUCTION: Autistic individuals undergoing magnetic resonance imaging (MRI) examinations may face significant challenges, mainly due to sensory overload and MRI environment-related limitations. This study aimed to explore radiographers' perspectives and experiences regarding MRI scanning of autistic individuals. METHODS: Data collection was achieved using a specifically designed mixed methods questionnaire on Qualtrics. The snowball technique was used. This UK-wide survey was electronically distributed by three main recruitment agencies between December 2020 and February 2021. RESULTS: 130 valid responses were received. A lack of relevant training and knowledge related to autism was noted. Effective communication, optimisation and customisation of the MRI examination, and MRI environment adjustments facilitated the completion of a safe and effective MRI examination. Poor patient-radiographer communication, unavailability of Special Educational Needs (SEN) experts, lack of specialised radiographer training and lack of specific guidelines were identified as the main barriers to successful MRI examinations. CONCLUSION: Although routine MRI safety and patient care rules will apply, MRI scanning of autistic individuals requires customisation and reasonable adjustments in communication, environment, and training of clinical teams. In addition, guidelines should be established to be used as a reference point to improve clinical practice. The adjustments proposed by radiographers were all consistent with the interventions in the wider literature. IMPLICATIONS FOR PRACTICE: MRI practice for personalised care of autistic individuals should be aligned with current evidence, to customise communication and offer workflow and environmental adjustments. Formal training related to autism, integrated within radiography academic curricula and better co-ordination and communication of interdisciplinary teams would provide the necessary skill mix to deliver safe, high quality MRI scans with optimal experience for autistic service users and their carer(s).

Thalamic deep brain stimulation for post-traumatic neuropathic limb pain: Efficacy at five years' follow-up and effective volume of activated brain tissue.

Chronic neuropathic pain affects 7%-10% of the population. Deep brain stimulation (DBS) has shown variable but promising results in its treatment. This study prospectively assessed the long-term effectiveness of DBS in a series of patients with chronic neuropathic pain, correlating clinical results with neuroimaging. Sixteen patients received 5 years' post-surgical follow-up in a single center. Six had phantom limb pain after amputation and 10 had deafferentation pain after traumatic brachial plexus injury. Patient-reported outcome measures were completed before and after surgery, using VAS, UWNPS, BPI and SF-36 scores. Neuroimaging evaluated electrode location and effective volumes of activated tissue (VAT). Two subgroups were created based on the percentage of VAT superimposed upon the ventroposterolateral thalamic nucleus (eVAT), and clinical outcomes were compared. Analgesic effect was assessed at 5 years and compared to preoperative pain, with an improvement on VAS of 76.4% (p=0.0001), on UW-NPS of 35.2% (p=0.3582), on BPI of 65.1% (p=0.0505) and on SF-36 of 5% (p=0.7406). Eight patients with higher eVAT showed improvement on VAS of 67.5% (p=0.0017) while the remaining patients, with lower eVAT, improved by 50.6% (p=0.03607). DBS remained effective in improving chronic neuropathic pain after 5 years. While VPL-targeting contributes to success, analgesia is also obtained by stimulating surrounding posterior ventrobasal thalamic structures and related spinothalamocortical tracts.