The Validation of the Greulich and Pyle Atlas for Radiological Bone Age Assessments in a Pediatric Population from the Canary Islands.

Bone age assessments measure the growth and development of children and adolescents by evaluating their skeletal maturity, which is influenced by various factors like heredity, ethnicity, culture, and nutrition. The clinical standards for this assessment should be up to date and appropriate for the specific population being studied. This study validates the GP-Canary Atlas for accurately predicting bone age by analyzing posteroanterior left hand and wrist radiographs of healthy children (80 females and 134 males) from the Canary Islands across various developmental stages and genders. We found strong intra-rater reliability among all three raters, with Raters 1 and 2 indicating very high consistency (intra-class coefficients = 0.990 to 0.996) and Rater 3 displaying slightly lower but still strong reliability (intra-class coefficients = 0.921 to 0.976). The inter-rater agreement was excellent between Raters 1 and 2 but significantly lower between Rater 3 and the other two raters, with intra-class coefficients of 0.408 and 0.463 for Rater 1 and 0.327 and 0.509 for Rater 2. The accuracy analysis revealed a substantial underestimation of bone age compared to chronological age for preschool- (mean difference = 17.036 months; p < 0.001) and school-age males (mean difference = 13.298 months; p < 0.001). However, this was not observed in females, where the mean difference was minimal (3.949 months; p < 0.239). In contrast, the Atlas showed greater accuracy for teenagers, showing only a slight overestimation (mean difference = 3.159 months; p = 0.823). In conclusion, the GP-Canary Atlas demonstrates overall precision but requires caution as it underestimates the BA in preschool children and overestimates it in school-age girls and adolescents.

The Endocannabinoid Peptide RVD-Hemopressin Is a TRPV1 Channel Blocker.

Neurotransmission is critical for brain function, allowing neurons to communicate through neurotransmitters and neuropeptides. RVD-hemopressin (RVD-Hp), a novel peptide identified in noradrenergic neurons, modulates cannabinoid receptors CB1 and CB2. Unlike hemopressin (Hp), which induces anxiogenic behaviors via transient receptor potential vanilloid 1 (TRPV1) activation, RVD-Hp counteracts these effects, suggesting that it may block TRPV1. This study investigates RVD-Hp's role as a TRPV1 channel blocker using HEK293 cells expressing TRPV1-GFP. Calcium imaging and patch-clamp recordings demonstrated that RVD-Hp reduces TRPV1-mediated calcium influx and TRPV1 ion currents. Molecular docking and dynamics simulations indicated that RVD-Hp interacts with TRPV1's selectivity filter, forming stable hydrogen bonds and van der Waals contacts, thus preventing ion permeation. These findings highlight RVD-Hp's potential as a therapeutic agent for conditions involving TRPV1 activation, such as pain and anxiety.

Hierarchical organization and skilled workforces for constructing the Tartessic earthen building at Casas del Turuñuelo (Guareña, Spain).

This article presents the results of the geoarchaeological study of earthen building materials used in a Tartessic public building at Casas del Turuñuelo. The construction dates back to the fifth century BCE and is one of the monumental buildings of Tartessic culture, characterized by its complex architecture, prestige goods, and intentional destruction after a feast and animal sacrifice. We applied an integrated methodology combining macro and micro approaches to investigate earthen construction processes, such as techniques, labour organization, workers' specialization, and environmental exploitation. The sample mainly consists of mudbricks, but we also include other forms of earthen materials such as mud plasters, mud mortars, and geological soils for comparison. In total, 64 samples from different building parts were studied through X-ray fluorescence, X-ray diffraction, thin-section petrography, and CHN analyses. The results reveal that the workforce involved in the construction process used different resources and presented different skill levels, but was centrally planned and organized. This study reflects on the communities' knowledge of the environment, the logistic effort and technical skill employed in the building process, and the existence of strong political structures capable of managing the erection of the complex Tartessic buildings.

Sleep problems and circadian rhythm functioning in autistic children, autism with co-occurring attention deficit hyperactivity disorder, and typically developing children: A comparative study.

LAY ABSTRACT: Sleep problems are common in autism spectrum disorder (ASD) and different factors can contribute to its occurrence in this population. Misalignment of the biological clock (our circadian system) has been described as one possible explanation. While there is a body of research on sleep problems, relatively less is known about circadian functioning and the specific population of autistic children with co-occurring attention deficit hyperactivity disorder (ADHD). Using an ambulatory circadian monitoring (ACM) system, which resembles a common watch, we gathered sleep parameters and the different rhythms obtained from measuring motor activity, light exposure and distal temperature in 87 autistic children and adolescents, 27 of whom were diagnosed with co-occurring ADHD, and 30 neurotypical children and adolescents as a comparison group. Autistic children and, especially, those with co-occurring ADHD showed greater motor activity during sleep which would be worth studying in future projects which could better define this restless sleep. Of note, we observed an atypical pattern of wrist temperature, with higher values in neurotypical children, followed by autistic children and, ultimately, those with co-occurring ADHD. Temperature is one of the most valuable factors evaluated here as it is closely connected to sleep-wakefulness and the hormone melatonin. Its special pattern during day and nighttime would support the hypothesis of an atypical secretion of melatonin in autistic individuals which would also link with the higher presence of sleep problems in this neurodevelopmental condition.

Effect of Mirror Therapy on Post-Needling Pain Following Deep Dry Needling of Myofascial Trigger Point in Lateral Elbow Pain: Prospective Controlled Pilot Trial.

Background: This prospective randomized, controlled pilot trial to explore the immediate effect of adding Mirror Visual Feedback Therapy on pain sensitivity and motor performance among subjects suffering from post-needling pain diagnosed as Lateral Elbow Pain. Methods: A total of 49 participants (23 female, 26 male) were enrolled and randomly allocated to either the experimental group, which received Deep Dry Needling in the m. Brachioradialis, Ischemic Compression, Cold Spray, Stretching, and Mirror Visual Feedback Therapy (n = 25), or a control group without Mirror Visual Feedback Therapy (n = 24). Pre- and post-treatment evaluations included assessments of post-needling pain intensity, pressure pain threshold, two-point discrimination threshold, and maximum hand grip strength. Results: Intergroup analysis revealed a statistically significant reduction in post-needling pain intensity favoring the experimental group (U = 188.00, p = 0.034). Additionally, intragroup analysis showed significant improvements in post-needling pain intensity (MD = 0.400, SEM = 0.271, W = 137.00, p = 0.047) and pressure pain threshold (MD = 0.148 Kg/cm2, SEM = 0.038, W = 262.00, p < 0.001) within the experimental group following the intervention. Conclusions: These findings suggest a potential benefit of integrating Mirror Visual Feedback Therapy into treatment protocols for individuals with Lateral Elbow Pain experiencing post-needling discomfort. Further research is necessary to fully elucidate the clinical implications of these findings.

A scoping review of advanced pharmacy practice experience readiness assessment measures across schools of pharmacy.

BACKGROUND: The development and implementation of Advanced Pharmacy Practice Experience (APPE) readiness assessments has been an area of increased interest to the academy since the publication of the Accreditation Council for Pharmacy Education (ACPE) standards in 2016. This scoping literature review aims to provide an updated summary of current APPE readiness assessment practices among ACPE-accredited institutions in the United States (US). METHODS: A literature search was conducted between 2022 and 2024 using the terms "APPE student readiness," "APPE readiness assessment," "APPE preparedness," "APPE student preparedness," "pharmacy" AND "readiness assessment", "pharmacy" AND "practice readiness," and "pharmacy" AND "student practice readiness" in Pubmed and Embase. The websites for the American Journal of Pharmaceutical Education and Currents in Pharmacy Teaching and Learning were also searched using these terms. Abstracts for all results were reviewed. Abstract only and poster presentations were excluded, as well as articles centered on non-US and/or non-ACPE-accredited institutions. Data was collected regarding the outcomes assessed, type of assessment activity, and how the assessment was implemented. Results were reviewed by a second author to ensure consistency in reporting. RESULTS: A total of 289 unique abstracts were reviewed by author pairs for inclusion based on relevance to the review objectives. A total of 13 articles were included in the final analysis. Each institution measured different knowledge areas, abilities, and entrustable professional activities (EPAs). Most programs had a summative component, with APPE readiness being primarily assessed in the final didactic year of the pharmacy curriculum. Most programs report at least one source of validity. IMPLICATIONS: Given the lack of specific APPE readiness assessment requirements in the ACPE Standards 2016, the different assessment methods among programs were not surprising. However, the commonalities identified can be leveraged with the release of the Curricular Outcomes and Entrustable Professional Activities (COEPA) 2022 to promote a standardized definition of APPE readiness. Future research should focus on formative assessment methods embedded throughout the didactic curriculum to identify "at-risk" students prior to a "high-stakes" summative assessment at the end of the didactic curriculum that impedes student progression to the APPE year.

Production of activated carbon from agave residues and its synergistic application in a hybrid adsorption-AOPs system for effective removal of sulfamethazine from aqueous solutions.

Tequila production in Mexico generates large quantities of agave bagasse (AB), a waste that could be used more efficiently. AB has a high cellulose, hemicellulose, and lignin content, which allows its use as a precursor for synthesizing carbonaceous materials. In the present work, the synthesis of activated carbon impregnated with Fe2+ (AG-Fe-II) and Fe3+ (AG-Fe-III) was carried out and evaluated in a hybrid adsorption-AOP (advanced oxidation process) methodology for sulfamethazine removal (SMT). The materials were characterized before and after the process to determine their morphological, textural, and physicochemical properties. Subsequently, the effect of the main operational variables (pH, initial SMT concentration, mass, and activator dosage) on the hybrid adsorption-degradation process was studied. The Fenton-like reaction was selected as the AOP for the degradation step, and potassium persulfate (K2S2O8) was used as an activating agent. The main iron crystallographic phases in AG-Fe-II were FeS, with a uniform distribution of iron particles over the material's surface. The main crystallographic phase for AG-Fe-III was Fe3O4. The hybrid process achieved 61% and 78% removal efficiency using AG-Fe-II and AG-Fe-III samples, respectively. The pH and initial SMT concentration were the most critical factors for removing SMT from an aqueous phase. Finally, the material was successfully tested in repeated adsorption-degradation cycles.

Porous carbonaceous materials simultaneously dispersing N, Fe and Co as bifunctional catalysts for the ORR and OER: electrochemical performance in a prototype of a Zn-air battery.

Infiltration of the mesoporous structure of SBA-15 silica as a hard template with phenanthroline complexes of Fe3+ and Co2+ allowed the simultaneous dispersion of nitrogen, iron and cobalt species on the surface of the obtained carbonaceous CMK-3 silica replica, with potential as bifunctional heterogeneous catalysts for the cathodic oxygen reduction and evolution reactions (ORR and OER). The textural properties and mesopore structure depended on the composition of the material. The carbonaceous FeCoNCMK-3 (1/1), obtained with an Fe/Co molar ratio of 1/1, exhibited an ordered cylindrical mesoporous structure with a high mesopore volume, a rather homogeneous composition in terms of total and surface concentrations of iron and cobalt, and a balanced presence of pyridinic-, pyrrolic- and graphitic-N species. FeCoNCMK-3 (1/1) could improve the ORR kinetics by adsorption and reduction of O2 through the 4-electron mechanism with a current density of -17.37 mA cm-2, Eonset of 1.13 V vs. RHE and E1/2 of 0.75 V when compared to metal-free, monometallic or bimetallic electrocatalysts with a higher amount of cobalt than that of iron. In addition, FeCoNCMK-3 (1/1) exhibited activity for the OER, presenting lower values of Eonset (1.52 V), Ej10 (1.78 V) and the Tafel slope (76.3 mV dec-1) with respect to other catalysts. When evaluated as a cathode in a prototype of a Zn-air battery, FeCoNCMK-3 (1/1) exhibited a high open circuit voltage of 1.41 V, a peak power density of 66.84 mW cm-2, a large specific capacity of 818.88 mA h gZn-1, and cycling for 20 h but with deactivation upon cycling.

Performance of novel Ca-biocomposites produced from banana peel and eggshell for highly efficient removal and recovery of phosphate from domestic wastewater.

Using biowaste-based adsorbents to remove phosphorus (P) from wastewater offers significant benefits concerning eutrophication mitigation and addressing waste management challenges. In this work, Ca-biocomposites were prepared by pyrolysis (700 °C) of a mixture of banana peel (BP) and eggshell (ES). The mass ratio of BP to ES was varied in 2:1, 1:1, and 1:2 ratios. Among the tested mixtures, the BPES-1:2 sample exhibited excellent P removal performance, reaching a maximum P adsorption capacity (Qmax) of 214 ± 5 mg P/g. The adsorption process fitted well with the Avrami order kinetic model (R2 > 0.996) and the Liu isotherms model (R2 > 0.997). The excellent fit of the experimental data to the Avrami model suggests that chemisorption is the dominant interaction mechanism, leading to precipitation through the formation of calcium phosphates. Additionally, the Liu model anticipates that the energetic characteristics of the adsorbent's active sites cannot be identical. This is in agreement with the presence of Ca(OH)2 and CaCO3 in the adsorbent material, where the Ca(OH)2 active sites are preferred by the adsorbate molecules (PO43-) for occupation. Furthermore, thermodynamic analysis revealed that P adsorption is a spontaneous process of exothermic nature (ΔH° < 0). The calculated activation energy for the process (72.81 kJ/mol) suggests the P adsorption mechanism involves strong chemical bonding between the adsorbent and P species. In addition, precipitation of apatite (Ca5(PO4)3OH), a vital component in fertilizer production, was observed during the adsorption process. In tertiary treated wastewater applications, the BPES-1:2 biocomposite demonstrated a P removal efficiency of 90%. The solubility of P in a 2% formic acid solution was 100%, while the water-soluble P content was measured at 5.6%. These findings highlight the product's sustainable and environmentally beneficial nature by demonstrating its potential as a slow-release fertilizer, contributing to the application of the 3R slogan: Reduce, Reuse, Recycle. This value-added product is promising in supplying nutrients to plants over an extended period while minimizing the risk of nutrients leaching into the environment.

Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review.

Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.

Social support in low-income women with Fibromyalgia Syndrome from a sub-urban and peri-urban areas of Tenerife (Canary Islands, Spain): a mixed method study.

BACKGROUND: Women with Fibromyalgia Syndrome (FMS) can benefit form adequate social support to fight the consequences of their illness, but the extent to which this is available to those with low incomes who live in depressed areas of Tenerife (Canary Islands, Spain) is currently unknown. The purpose of this study was to explore social support in low-incomes women with FMS in sub-urban and peri-urban areas of Tenerife. METHODOLOGY: A sequential exploratory mixed method study was carried out from January 20, 2023, to June 10, 2023, at the Fibromyalgia and Chronic Fatigue Association of Tenerife (AFITEN) using non-probability convenience sampling. Social support was analyzed quantitatively through MOS-SSS survey and Duke-UNC-11 questionnaire, while qualitative data were obtained through semi-structured interviews to identify social support providers and analyze their satisfactions levels. RESULTS: A total of 49 women, with a mean age of 57.80 years-old (SD = 13.25) were finally included in this study. MOSS-SSS and Duke-UNC-11 both indicated lower social support levels at 68.6 (SD =16.3) and 38.0 (SD = 9.74), respectively. The qualitative analysis revealed that partners and friends provided the most significant support with the highest satisfaction scores. CONCLUSIONS: The socioeconomic status of low-income women with FMS living in sub-urban and peri-urban areas of Tenerife (Canary Islands, Spain) influences on their social support, with the affective support and confidentiality being the most affected dimensions.

Mass animal sacrifice at casas del Turuñuelo (Guareña, Spain): A unique Tartessian (Iron Age) site in the southwest of the Iberian Peninsula.

Zooarchaeological analyses of the skeletal remains of 52 animals unearthed in the courtyard of an Iron Age Tartessian building known as Casas del Turuñuelo (Badajoz, Spain) shed light on a massive sacrifice forming part of a series of rituals linked to the site's last period of activity and final abandonment. The rites took place towards the end of the 5th century BCE when both the building (intentionally destroyed) and the sacrificed animals were intentionally buried under a tumulus 90 m in diameter and 6 m high. The main objective of the zooarchaeological and microstratigraphic analyses was to determine the phasing of the sacrificial depositions. Evidence gathered from taphonomic assessments and a series of radiocarbon datings indicate that the sacrifices fall into three consecutive phases spanning several years. The findings of the zooarchaeological analyses clearly point to a selection of equid and cattle males. Adult equids predominate (MNI = 41) followed by adult and sub-adult cattle (MNI = 6). Pigs, in turn, are only represented by a few adults and sub-adult females (MNI = 4). Among the animals is a single dog of undetermined sex between 3 and 4 years of age. The fact that the animals are mostly adults discards the likelihood that they died from natural causes or an epidemic. In addition, the scenographic deposition of certain equids in pairs, as well as evidence of the burning of plant offerings, suggest an intentional ritualistic sacrifice. Nine of the initial depositions of Phase 1 in the SE quadrant were scattered and certain of their bones bear marks characteristic of both prolonged open air exposure and scavengers. Another 31 animals from Phases 1 and 2 are represented by almost complete, articulated skeletons, indicating they were promptly covered. Phase 3, by contrast, reveals both almost complete and partial animals bearing clear signs of processing for human consumption. This study thus sheds light on both the sequence of the animal sacrifices and the protocols linked to rites accompanied by the celebration of banquets. Certain features associated with the sealing of this building under a tumulus offer evidence of the decline of the Tartessian Culture. This study thus advances notions serving to contextualize ritual animal sacrifices in the framework of practice observed at other Iron Age sites in the Iberian Peninsula and elsewhere throughout Europe.

Precision and Accuracy of Radiological Bone Age Assessment in Children among Different Ethnic Groups: A Systematic Review.

AIM: The aim was to identify, evaluate, and summarize the findings of relevant individual studies on the precision and accuracy of radiological BA assessment procedures among children from different ethnic groups. MATERIALS AND METHODS: A qualitative systematic review was carried out following the MOOSE statement and previously registered in PROSPERO (CRD42023449512). A search was performed in MEDLINE (PubMed) (n = 561), the Cochrane Library (n = 261), CINAHL (n = 103), Web of Science (WOS) (n = 181), and institutional repositories (n = 37) using MeSH and free terms combined with the Booleans "AND" and "OR". NOS and ROBINS-E were used to assess the methodological quality and the risk of bias of the included studies, respectively. RESULTS: A total of 51 articles (n = 20,100) on radiological BA assessment procedures were precise in terms of intra-observer and inter-observer reliability for all ethnic groups. In Caucasian and Hispanic children, the Greulich-Pyle Atlas (GPA) was accurate at all ages, but in youths, Tanner-Whitehouse radius-ulna-short bones 3 (TW3-RUS) could be an alternative. In Asian and Arab subjects, GPA and Tanner-Whitehouse 3 (TW3) overestimated the BA in adolescents near adulthood. In African youths, GPA overestimated the BA while TW3 was more accurate. CONCLUSION: GPA and TW3 radiological BA assessment procedures are both precise but their accuracy in estimating CA among children of different ethnic groups can be altered by racial bias.

A multi-laboratory preclinical trial in rodents to assess treatment candidates for acute ischemic stroke.

Human diseases may be modeled in animals to allow preclinical assessment of putative new clinical interventions. Recent, highly publicized failures of large clinical trials called into question the rigor, design, and value of preclinical assessment. We established the Stroke Preclinical Assessment Network (SPAN) to design and implement a randomized, controlled, blinded, multi-laboratory trial for the rigorous assessment of candidate stroke treatments combined with intravascular thrombectomy. Efficacy and futility boundaries in a multi-arm multi-stage statistical design aimed to exclude from further study highly effective or futile interventions after each of four sequential stages. Six independent research laboratories performed a standard focal cerebral ischemic insult in five animal models that included equal numbers of males and females: young mice, young rats, aging mice, mice with diet-induced obesity, and spontaneously hypertensive rats. The laboratories adhered to a common protocol and efficiently enrolled 2615 animals with full data completion and comprehensive animal tracking. SPAN successfully implemented treatment masking, randomization, prerandomization inclusion and exclusion criteria, and blinded assessment of outcomes. The SPAN design and infrastructure provide an effective approach that could be used in similar preclinical, multi-laboratory studies in other disease areas and should help improve reproducibility in translational science.

Sargassum macroalgae from Quintana Roo as raw material for the preparation of high-performance phosphate adsorbent from aqueous solutions.

Currently, the large volumes of Sargassum biomass (Sgs) arriving on Caribbean coasts are a problem that must be solved quickly. One alternative is to obtain value-added products from Sgs. In this work, Sgs is demonstrated to be a high-performance Ca - bioadsorbent for phosphate removal by a heat pretreatment at 800 °C that produces biochar. According to XRD analysis, calcined Sgs (CSgs) have a composition of 43.68%, 40.51%, and 8.69% of Ca(OH)2, CaCO3, and CaO, making CSgs a promising material for phosphate removal and recovery. Results demonstrated that CSgs have a high capacity to adsorb P over a wide range of concentrations (25-1000 mg P/L). After P removal, at low P concentration, the adsorbent material is rich in apatite (Ca5(PO4)3OH), and at high P concentration, brushite (CaHPO4•2H2O) was the main P compound. The CSg reached a Qmax of 224.58 mg P/g, which is higher than other high-performance adsorbents reported in the literature. The phosphate adsorption mechanism was dominated by chemisorption, followed by precipitation according to the pseudo-second-order kinetic model. The solubility of P (74.5 wt%) in formic acid solution and the water-soluble P (24.8 wt%) for CSgs after P adsorption indicated that the final product presents the potential to be used as fertilizer for acid soils. This biomass's processability and high phosphate adsorption performance for P removal make CSgs a potential material for wastewater treatment, and subsequent use of these residues as fertilizer offers a circular economy solution to this problem.

Exercise-based rehabilitation on functionality and quality of life in head and neck cancer survivors. A systematic review and meta-analysis.

Head and Neck Cancer (HNC) is a globally rare cancer that includes a variety of tumors affecting the upper aerodigestive tract. It presents with difficulty breathing or swallowing and is mainly treated with radiation therapy, chemotherapy, or surgery for tumors that have spread locally or throughout the body. Alternatively, exercise can be used during cancer treatment to improve function, including pain relief, increase range of motion and muscle strength, and reduce cancer-related fatigue, thereby enhancing quality of life. Although existing evidence suggests the adjunctive use of exercise in other cancer types, no previous studies have examined the effects on HNC survivors. The aim of this meta-analysis was to quantify the effect of exercise-based rehabilitation on functionality and quality of life in HNC survivors who underwent surgery and/or chemoradiotherapy. A systematic review and meta-analysis were carried out following PRISMA statement and registered in PROSPERO (CRD42023390300). The search was performed in MEDLINE (PubMED), Cochrane Library, CINAHL and Web of Science (WOS) databases from inception to 31st December 2022 using the terms "cancer", "head and neck neoplasms", "exercise", "rehabilitation", "complications", "muscle contraction", "muscle stretching exercises" combining with booleans "AND"/"OR". PEDro scale, Cochrane Risk of Bias Tool and GRADE were used to assess methodological quality, risk of bias and grade of recommendation of included studies respectively. 18 studies (n = 1322) were finally included which 1039 (78.6%) were men and 283 (21.4%) were women. In patients who underwent radio-chemotherapy, overall pain [SMD = - 0.62 [- 4.07, 2.83] CI 95%, Z = 0.35, p = 0.72] and OP [SMD = - 0.07 [- 0.62, 0.48] CI 95%, Z = 0.25, p = 0.81] were slightly reduced with exercise in comparison to controls. Besides, lower limb muscle strength [SMD = - 0.10 [- 1.52, 1.32] CI 95%, Z = 0.14, p = 0.89] and fatigue [SMD = - 0.51 [- 0.97, - 0.057] CI 95%, Z = 2.15, p < 0.01] were also improved in those who receive radio-chemoradiation. In HNC survivors treated with neck dissection surgery, exercise was superior to controls in overall pain [SMD = - 1.04 [- 3.31, 1.23] CI 95%, Z = 0.90, p = 0.37] and, in mid-term, on shoulder pain SMD = - 2.81 [- 7.06, 1.43] CI 95%, Z = 1.76, p = 0.08]. No differences in quality of life were found at any of the follow-up periods. There is evidence of fair to good methodological quality, low to moderate risk of bias, and weak recommendations supporting the use of exercise-based rehabilitation to increase functionality. However, no evidence was found in favor of the use of this modality for improving the quality of life of HNC survivors who underwent chemoradiotherapy or surgery.

Percutaneous Electrical Nerve Stimulation (PENS) for Infrapatellar Saphenous Neuralgia Management in a Patient with Myasthenia gravis (MG).

Myasthenia gravis is a neuromuscular transmission disorder characterized by weakness of the cranial and skeletal muscles, however, neuropathies are extremely rare. In this case report we present a case of a 61-year-old man diagnosed Myasthenia gravis who came to our attention due to a 1 week of acute deep pain [NPRS 8/10] in the anterior and medial right knee which occurred during walking [NPRS 8/10] or stair climbing [NPRS 9/10]. A complete medical record and clinical examination based on physical exploration and ultrasound assessment confirmed a infrapatellar saphenous neuralgia. Therapeutic interventions included Percutaneous nerve electrical stimulation combined with pain neuroscience education, neural mobilization of the saphenous nerve and quadriceps resistance exercises. After 4 weeks, pain intensity [NRPS = 1/10], knee functionality [OKS = 41/48] and lower limb functionality [LLFI = 80%] were notably improved, nevertheless, fatigue [RPE = 2/10] was similar than baseline. At 2 months of follow-up, the effect on intensity of pain NRPS [0/10] and functionality OKS [40/48] and LLFI [82%] was maintained, however, no significant clinical changes were detected on perceived fatigue RPE Scale [2/10]. Despite the important methodological limitations of this study, our case report highlights the efficacy of percutaneous electrical nerve stimulation combined with physical agents modalities for pain and functionality of infrapatellar saphenous neuralgia in the context of Myasthenia gravis.

E2/E3-independent ubiquitin-like protein conjugation by Urm1 is directly coupled to cysteine persulfidation.

Post-translational modifications by ubiquitin-like proteins (UBLs) are essential for nearly all cellular processes. Ubiquitin-related modifier 1 (Urm1) is a unique UBL, which plays a key role in tRNA anticodon thiolation as a sulfur carrier protein (SCP) and is linked to the noncanonical E1 enzyme Uba4 (ubiquitin-like protein activator 4). While Urm1 has also been observed to conjugate to target proteins like other UBLs, the molecular mechanism of its attachment remains unknown. Here, we reconstitute the covalent attachment of thiocarboxylated Urm1 to various cellular target proteins in vitro, revealing that, unlike other known UBLs, this process is E2/E3-independent and requires oxidative stress. Furthermore, we present the crystal structures of the peroxiredoxin Ahp1 before and after the covalent attachment of Urm1. Surprisingly, we show that urmylation is accompanied by the transfer of sulfur to cysteine residues in the target proteins, also known as cysteine persulfidation. Our results illustrate the role of the Uba4-Urm1 system as a key evolutionary link between prokaryotic SCPs and the UBL modifications observed in modern eukaryotes.