In vitro and in silico evaluation of the anti-leishmania activity of synthetic chalcones.

Leishmaniasis is a group of neglected, vector-borne infectious diseases that affect millions of people around the world. The medications available for its treatment, especially in cases of visceral leishmaniasis, are old, outdated and have serious side effects. In this work, 10 chalcones were synthesised and evaluated in vitro against promastigotes and axenic amastigotes of Leishmania infantum. Compounds CP04 and CP06 were the most promising, respectively presenting IC50 values = 13.64 ± 0.25 and 11.19 ± 0.22 µM against promastigotes, and IC50 = 18.92 ± 0.05 and 22.42 ± 0.05 µM against axenic amastigotes. Only compound CP04 did not show cytotoxicity against peripheral blood mononuclear cells (PBMCs). Molecular docking studies conducted with sterol 14-alpha demethylase (CYP-51) (PDB: 3L4D) and trypanothione reductase (PDB: 5EBK) enzymes from L. infantum evidenced the great affinity of compound CP04 for these targets, presenting Moldock score values of -94.0758 and -50.5692 KJ/mol-1.

The Multitarget Action of Vitamins in the Ischemic Stroke.

A stroke, also known as a cerebral hemorrhage, occurs when there is an interruption in the blood supply to a part of the brain, resulting in damage to brain cells. This issue is one of the leading causes of death in developed countries, currently killing about 5 million people annually. Individuals who survive ischemic stroke often face serious vision problems, paralysis, dementia, and other sequelae. The numerous efforts to prevent and/or treat stroke sequelae seem insufficient, which is concerning given the increasing global elderly population and the well-known association between aging and stroke risk. In this review, we aim to present and discuss the importance of vitamins in stroke prevention and/or incidence. Vitamins from diet or dietary supplements influence the body at various levels; they are a relevant factor but are reported only in isolated articles. This review reports and updates the multitarget role of vitamins involved in reducing stroke risk.

A dataset of new occurrence records of primates from the arc of deforestation, Brazil.

​​​​​​​The so-called arc of deforestation is a major agricultural and industrial frontier in southern Amazonia and northern Cerrado of Brazil. As arboreal mammals, the primates in this region are therefore threatened by forest loss and fragmentation. At the same time, knowledge about the taxonomic diversity and distribution ranges of these taxa is incomplete, which might hamper efficient conservation measurements. New species have been recently discovered in this region, and their ranges remain imprecise because only a few occurrence records are available for each species. Here we present 192 new records of 22 species and subspecies of Alouatta, Aotus, Ateles, Cebus, Chiropotes, Lagothrix, Leontocebus, Pithecia, Plecturocebus, Saimiri, and Sapajus, collected in 56 different localities during 10 field expeditions across the arc of deforestation between 2015 and 2018. Based on these new records, we extend the ranges of Alouatta puruensis, Ateles chamek, and Saimiri collinsi; identify potential hybridization zones between A. puruensis and A. discolor, and between At. chamek and At. marginatus; redefine the range of Plecturocebus moloch; and clarify the ranges of P. baptista and P. hoffmannsi. Moreover, these results and the dataset are valuable for further research on, for example, species distribution and habitat use modeling, for assessing species extinction risks, and for supporting efforts for the conservation of species increasingly threatened on a global deforestation frontier.

Chemical characterisation, thermal analysis, and antibacterial activity of honeys from Caatinga stingless bees of Melipona spp.

In the present study, chemical characterisation, thermal analysis and antibacterial activity of honeys from Melipona spp. with occurrence in Caatinga biome of Brazil. The honeys presented pH from 4.07 to 4.14, density of 1.41 g/cm3 and °Brix value of 79.90. The thermogravimetry (TG) analysis presented six-seven events and differential thermal analysis (DTA) presented three-four endothermic peaks. HPLC fingerprint revealed a predominant presence of gallic acid and vanillin. Antioxidant activity evaluated using in vitro 2,2-diphenyl-1-picrylhydrazyl radical (DPPH) radical scavenging with IC50 values in the range of 14.5404 to 15.2454 mg/mL. The honeys also showed antimicrobial activities against Staphylococcus aureus and Pseudomonas aeruginosa using a modified agar diffusion and microdilution method. The results of the present study demonstrate that the honey from stingless bees by Caatinga biome indicate polyphenol compounds, antioxidant activity and in vitro antimicrobial potential. The analytical methos permitted of fingerprint of samples.

Resistance Training with Instability Does Not Hamper Total Training Volume and Muscle Strength Gains in Older Adults: a Secondary Analysis from REI Study.

Background: Resistance training with instability (REI) emerged as a promising training modality for older adults aiming to counteract age-related changes. Objectives: We compared the effects of 12 weeks of REI and traditional resistance exercise (RE) on muscle strength in older adults with cognitive impairment. We further explored if total training volume (TTV) significantly differs among training groups. Methods: This is a secondary analysis of the REI study. Participants were randomly assigned to REI (n=22) or RE (n=23). RE protocol involved moderate-intensity, free-weight, and machines-based resistance exercises (3 sets, 10-15 repetitions). REI received a similar training protocol, in which exercises were simultaneously performed with instability/unstable devices (e.g., squat exercise under a foam pad or Bosu® ball). Maximal isometric strength and isokinetic parameters were assessed at baseline and after completion of a 12-week intervention through a hydraulic handgrip and isokinetic dynamometer, respectively. TTV (sets × repetitions × load) was computed based on external training load over the 12 weeks. Results: No differences were observed between groups (p=.35) after the intervention. Over 12 weeks, REI and RE improved isometric handgrip strength (p<.001) and isokinetic performance (p=.04). We also did not find differences in the TTV between training groups (p=.28). Conclusion: We demonstrated that both REI and RE training induced similar gains in muscle strength. Combining unstable surfaces/instability devices did not hamper TTV, which may have clinical applications in the context of exercise for older adults.

Chilean Darwin Wasps (Ichneumonidae): Biogeographic Relationships and Distribution Patterns.

Ichneumonidae, or Chilean Darwin wasps, are an important component of South American hymenopteran diversity, but the taxonomic and distributional knowledge on this insect is still deficient. Taking advantage of recently updated taxonomic knowledge, we assessed biogeographic relationships at the genus level and biodiversity spatial patterns along the latitudinal gradient. The results show the presence of 264 species in Chile, arranged in 102 genera and 22 subfamilies. Biogeographic relationships are based on six elements (cosmopolitan (n = 50; 36%), endemic (n = 29; 21%), Neotropical (n = 22; 16%), Holarctic-Oriental (n = 19; 14%), south-temperate (n = 16; 11%) and Australasian) and composed of just three genera: Anacis, Labena, and Meringops. Species and genera show a bimodal distribution along the latitudinal gradient: around 34° and 38° S. From an ecoregional perspective, richness is concentrated in the Valdivian temperate forests, but when assessed at a 0.5 × 0.5 cell scale, several outstanding cells are in the contact zone between the temperate forests and the Chilean Matorral. On the other hand, the Atacama Desert shows little or no presence of Darwin wasps. The results agree with Charles Porter, who identified a northern province composed of Neotropical and cosmopolitan genera with their own representatives in the far north (11 genera), a distributional gap in the core of the Atacama Desert, and around 128 genera in Porter's Neantarctic realm, covering all of Chile from 25° S to Cape Horn, including the Juan Fernandez islands. These results reinforce knowledge gaps and the need for more sampling and studies of available collections. Due to sampling gaps at this stage, identifying a continued increase or decrease in richness towards higher latitudes is not possible. More taxonomic and distributional information is also needed to assess potential threats to endemic genera and species.

Comparison of the Electromyography Activity during Exercises with Stable and Unstable Surfaces: A Systematic Review and Meta-Analysis.

The effect of electromyographic (EMG) activity on agonist muscles during exercises performed on stable and unstable surfaces remains uncertain. We aimed to review the literature regarding the comparison of the EMG activity of the agonist muscles of exercises performed on stable and unstable surfaces. Eighty-six studies that evaluated the EMG activity of 1783 individuals during exercises for the lower limbs, upper limbs, and core were included. The EMG activities of the pectoralis major (SMD = 0.28 [95% CI 0.09, 0.47]) and triceps brachii muscles (SMD = 0.45 [95% CI 0.25, 0.66]) were significantly increased when the unstable device was added to the exercise. Likewise, the EMG activity of all core muscles showed a significant increase with the unstable surface during the exercises, such as the rectus abdominis (SMD = 0.51 [95% CI 0.37, 0.66]), external oblique (SMD = 0.44 [95% CI 0.28, 0.61]), internal oblique (SMD = 1.04 [95% CI 0.02, 2.07]), erector spinae (SMD = 0.37 [95% CI 0.04, 0.71]), and lumbar multifidus (SMD = 0.35 [95% CI 0.08, 0.61]). However, the lower limb muscles did not show greater EMG activity during the exercise with unstable surfaces compared to the stable surface. In conclusion, unstable conditions increase the EMG activity of some upper limb and core muscles compared to a stable surface.

Use of a peanut ball, positioning and pelvic mobility in parturient women shortens labour and improves maternal satisfaction with childbirth: a randomised trial.

QUESTION: What is the effect of a protocol targeted at the various stages of labour - with a peanut ball, positioning and pelvic mobility - on the duration of labour, pain severity, fatigue, maternal outcomes, neonatal outcomes and satisfaction in parturients without analgesia? DESIGN: A randomised trial with concealed allocation, blinding of assessors and intention-to-treat analysis. PARTICIPANTS: One hundred women in active labour. INTERVENTION: The experimental group received the protocol targeted at the various stages of labour, with a peanut ball, positioning and pelvic mobility, whilst the control group received usual care. OUTCOME MEASURES: The primary outcomes were the duration of labour and pain severity. The secondary outcomes were maternal fatigue, mode of delivery, risk of perineal laceration, severity of perineal laceration, use of synthetic oxytocin, satisfaction with delivery, Apgar scores, admission of the neonate to an intensive care unit and resuscitation of the neonate in the delivery room. In the active phase of labour, the numerical rating scale and maternal perception of childbirth fatigue questionnaire were applied; they were taken again when the parturient had 8 to 10 cm of dilation. The numerical rating scale was also applied postpartum to evaluate satisfaction with childbirth. RESULTS: The use of the protocol with a peanut ball reduced the duration of active and expulsive phases and the total duration of labour, with mean differences of 82 minutes (95% CI 41 to 125), 8 minutes (95% CI 0 to 18) and 89 minutes (95% CI 45 to 132), respectively. Maternal satisfaction was better in the experimental group: mean between-group difference on the 10-point scale was 1.1 (95% CI 0.4 to 1.8). The effects on the other outcomes were either similar between groups or unclear. CONCLUSION: A protocol with a peanut ball, positioning and pelvic mobility reduced the duration of labour and improved maternal satisfaction with childbirth. REGISTRATION: RBR-74wcnjc.

Effects of 12-Weeks of Home-Based Exercise Training on Physical and Cognitive Function of Older Adults: Randomized Trial Comparing Virtual Versus Minimal Supervision in the Context of the Covid-19 Pandemic in Brazil.

Background: We investigated the effects of a 12-week home-based exercise program delivered with virtual or minimal supervision on the physical and cognitive function of community-dwelling older adults in the context of the COVID-19 pandemic in Brazil. Methods: The study was registered on the Brazilian Registry of Clinical Trials platform (code: RBR-8qby2wt). Thirty-eight older adults (81% female and 68±7 years old), non-disabled, and without cognitive impairment or dementia, were randomly assigned to a 12-week home-based exercise program: 1) virtual supervision (classes remotely delivered through video conference by trained staff), or 2) minimal supervision (once-weekly contact to touch base through standardized text messages). The participants initially performed two sets of 10 repetitions three times a week, with a 60-second interval. The volume and complexity of the exercises were progressively increased. (e.g., the number of sets increased to 3 and later to 4). At baseline and follow-up, we collected remote measurements of physical function (muscle strength and power, functional muscular fitness) and cognition (processing speed, inhibitory control, verbal fluency). Results: Participants in the minimal supervision home-based exercise group significantly improved the Stroop test (-1.6 sec, 95% CI = -3.20; -0.09). No significant between-group differences were observed for physical and cognitive outcomes. Conclusion: A home-based exercise program delivered with virtual or minimal supervision can produce similar effects, and may help to maintain physical and cognitive capabilities among healthy, high-functioning older adults who experienced mobility restrictions due to the COVID-19 pandemic in Brazil.

Synopsis of Lusius Tosquinet, 1903 (Hymenoptera: Ichneumonidae: Phaeogenini) from South America: a new species, new records, and key to Neotropical species.

A new species of Lusius Tosquinet, 1903 (Hymenoptera: Ichneumonidae: Phaeogenini) is described from the northwestern Andes of Colombia, and additionally, the geographic distribution of Lusius ferrugineus Graf, 2000 is expanded to Bahia and Rio Grande do Sul states, Brazil. New comparative diagnoses, distribution maps, and an illustrated key to Neotropical species are also provided.

Adherence and dropout in exercise-based interventions in childhood obesity: A systematic review of randomized trials.

Our objective was to systematically examine the characteristics of exercise interventions on adherence and dropout in children and adolescents with obesity. PubMed, Embase, PsycINFO, Lilacs, Scielo, and The Cochrane Central Register of Controlled Trials and reference lists of relevant articles were searched. We included randomized controlled trials with exercise interventions for pediatric patients with obesity presenting data on dropout and/or adherence. Two reviewers screened the records independently for eligibility with disagreements being resolved by a third reviewer. Twenty-seven studies with 1268 participants were included. Because of high heterogeneity and poor reporting of adherence, it was not possible to perform a meta-analysis. Dropout prevalence was calculated, and subgroup analyses comparing different types of exercise and a meta-regression with potential moderators were performed. We found a dropout rate of 13%. Subgroup analyses did not identify significant differences. The duration of the exercise presented a moderating effect on dropout, suggesting that longer exercise sessions may lead to higher dropout in children and adolescents with obesity. Because of the poor adherence data, it is not clear which exercise characteristics may moderate adherence. To improve the quality of childhood obesity care, it is mandatory that future studies present adherence data. Systematic review registration: PROSPERO CRD42021290700.

Racial disparities in breast cancer survival after treatment initiation in Brazil: a nationwide cohort study.

BACKGROUND: Breast cancer is a public health priority in Brazil and ensuring equity in health care is one of the cancer control plan goals. Our aim was to present the first assessment on the influence of race or skin colour on breast cancer survival at the national level. METHODS: In this nationwide cohort study, data on women who initiated treatment for breast cancer in the public health-care system (Sistema Unico de Saúde), Brazil, were assembled through record linkage of administrative and mortality information systems. The administrative information systems were the Outpatient Information System (data from high complexity procedure authorisations) and the Hospital Information System (data from hospitalisation authorisations). We included women aged 19 years or older who started treatment between Jan 1, 2008, and Nov 30, 2010; self-identified as having White, Black, or Brown race or skin colour; had tumour stage I-IV; and were treated with chemotherapy or radiotherapy, or both. Patients were followed up until Dec 31, 2015. Patients with only hormone therapy records or who underwent only surgery were excluded. The Kaplan-Meier method was used to estimate crude overall survival for race or skin colour by time since treatment initiation, and Cox regression to estimate all-cause mortality hazard ratios (HRs) before and after adjustment for other covariates. FINDINGS: We identified 59 811 women treated for stage I-IV breast cancer. 37 318 (62·4%) women identified themselves as White, 18 779 (31·4%) as Brown, and 3714 (6·2%) as Black. 5-year overall survival probability was higher for White women (74% [95% CI 73-74]) than Black women (64% [62-65]; p<0·0001). In adjusted regression models stratified by the absence of hormone therapy, Black women had a 24% (HR 1·24 [95% CI 1·16-1·34]; p<0·0001) higher risk of all-cause death than White women, and in the presence of hormone therapy Black women had a 25% (1·25 [1·14-1·38]; p<0·0001) higher risk of all-cause death than White women. INTERPRETATION: Black skin colour was identified as a statistically significant risk marker for lower 5-year survival probability and higher risk of all-cause death among women treated for breast cancer by the Sistema Unico de Saúde. Actions to understand and mitigate this unfair difference in health results are urgently needed. FUNDING: Conselho Nacional de Desenvolvimento Científico e Tecnológico and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior and Pró-Reitoria de Pesquisa da Universidade Federal de Minas Gerais.

Efficacy of educational instructions on pelvic floor muscle training in the treatment of urinary incontinence: Systematic review and meta-analysis.

OBJECTIVE: The present study aimed to investigate the efficacy of educational interventions on pelvic floor (PF) muscle training in the treatment of urinary incontinence (UI). METHODS: This is a systematic review of literature with meta-analysis, performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). To do so, randomized clinical trials that performed educational interventions of PF, UI, and developed the training of PF muscles (TPFM) for incontinent women, performing group or individual comparisons, with control and experimental groups or with two or more experimental groups were selected. The search for papers was performed in the following databases: PubMed, Scopus, Embase, Web of Science, and SciELO, no specific publication date was chosen. The risk of bias was performed using the PEDro scale and the quality of the evidence was performed using GRADE. RESULTS: The review included six studies with 1003 participants. Most studies presented 5-8 points regarding risk of bias. Most of the studies were performed in the last 5 years, with women of various ages, high educational level and prevalence of UI of effort. The present study showed that offering educational instructions and guiding women on TPFM was capable of reducing urinary symptoms. When compared to control, significant between-group differences were found in the studies, in which the control group did not receive any kind of instructions or treatment (p < 0.05). The use of technologies through mobile apps was efficient in the treatment of incontinent women (p < 0.05). Performing TPFM individually or in groups did not present differences in the results, with both improving urinary symptoms. The meta-analysis presented a mean effect and a clinically important difference in three studies. CONCLUSION: The interventions involving instructions to TPFM associated to health education brought improvements to urinary symptoms.

Effects of a workplace-based exercise program on shoulder pain and function in fruit workers: A randomized controlled trial.

BACKGROUND: Shoulder pain affects millions of workers worldwide and is considered one of the leading causes of absenteeism and presenteeism. Therefore, using exercises in the work environment emerges as a strategy to prevent or reduce shoulder pain. OBJECTIVE: The objective of this study was to evaluate the effects of a workplace-based exercise program on shoulder pain and function in fruit workers. METHODS: This was an 8-week parallel two-arm randomized controlled trial. Forty-four fruit workers who reported chronic shoulder pain were randomized to an Experimental Group (EG) or Control Group (CG). The EG was submitted to a program of resistance and stretching exercises for eight weeks, twice a week. The CG received a booklet with muscle stretching and mobility exercises. The primary outcome was shoulder pain intensity; the secondary outcomes were Shoulder Pain and Disability Index (SPADI) and perceived global effect. RESULTS: Both groups showed reductions in pain intensity EG: 4.26 (95% CI 2.78-5.74) and CG: 3.74 (95% CI 1.98-5.50) points. The SPADI results showed an average reduction of 17.76 (CI 95% 3.10-32.43) for the EG and 18.39 (CI 95% 3.66-33.13) for the CG. The mean value of the perceived global effect for the CG was 3.45±2.01, and for the EG, the mean was 4.13±1.24. No differences were observed between groups in any outcome analyzed. CONCLUSION: Both groups showed significant changes in the analyzed outcomes. However, the workplace-based exercise program was not superior to the exercise booklet.

Effects of an eight-week physical exercise program on low back pain and function in fruit workers: A randomized controlled trial.

BACKGROUND: Low back pain is prevalent in workers' health and functional performance. OBJECTIVE: To evaluate the effects of a physical exercise program on low back pain and disability in fruit workers. METHODS: This randomized controlled trial assigned 44 workers (37 ± 9 years) to two groups. The experimental group consisted of 10 men and 12 women with an average age of 38 (± 9) years, and the control group consisted of 8 men and 14 women with an average age of 36 (± 10) years. The experimental group (EG) performed a program of strength and flexibility exercises for eight weeks, twice a week. The control group (CG) received minimal care, with a booklet with guidelines for performing exercises. The primary outcomes included changes in perceived disability and the intensity of pain evaluated by the Rolland-Morris questionnaire and the Numerical Pain Scale, respectively. All outcomes were measured at baseline and after eight weeks of intervention. RESULTS: A significant difference was observed in the within-group analysis, with a mean reduction in pain intensity in the EG and CG of -4.55 (95%CI -7.01 to -2.09) and -3.81 (95%CI 1.72-5.90), respectively. For disability, a reduction of -4.45 (95% CI -8.89 to -0.02) was observed in the EG and of -4.43 (-7.38 to -1.48) in the CG. There were no significant differences in the between-groups analysis. CONCLUSIONS: The exercise program was not superior to using the educational booklet. However, both interventions showed substantial decreases in pain and disability levels.

Epidemiological study of penile cancer in a northeastern state - Brazil.

OBJECTIVE: to trace the clinical and epidemiological profile of penile cancer in Rio Grande do Norte/Brazil and relate them to data published in the literature. METHODS: a cross-sectional study was conducted with 94 patients diagnosed with penile cancer in 2011-2018, treated at the Liga Norte Riograndense Contra o Cancer. RESULTS: all patients were diagnosed with squamous cell carcinoma, mainly aged over 50 years, from the states interior, brown, illiterate, or with incomplete primary education. At diagnosis, 68% of patients were classified as having tumors =T2, and 30% had lymph node involvement. Distant metastases were detected in 2.1% of patients at diagnosis. Most patients received the diagnosis in the initial phase of the disease, but 20.2% were diagnosed in stage IV. Partial penectomy was the most performed surgery, and 10% of patients relapsed, mainly in the lymph nodes (87.5%). The mean follow-up of the patients was 18 months, with an estimated overall survival at five years of 59.1%. However, 25% of patients were followed up for up to 3 months, losing follow-up. CONCLUSION: the State of Rio Grande do Norte has a high incidence of penile cancer with a high frequency of locally advanced tumors at diagnosis and in younger patients younger than 50. Furthermore, socioeconomic factors interfere with early diagnosis and hinder access to specialized services.

Notes on the distribution and habitat use of marmosets (Callitrichidae: Mico) from south-central Amazonia.

Currently, 15 species of Amazon marmosets (genus Mico) are known to science. The Amazon marmosets occur primarily in southern Brazilian Amazonia, the arc of deforestation, and are among the least studied primates of the neotropics. This is particularly the case for M. acariensis and M. chrysoleucos, both endemic to the Aripuanã-Sucundurí interfluve, south-central Amazonia. Mico acariensis was not studied beyond the species description, and the only information currently available is the pelage colouration of the holotype, inferred coordinates of the type locality, and a field report with two additional localities of occurrence. Regarding M. chrysoleucos, in addition to the species description, there are taxonomic reviews, the report of a second occurrence record, and a study on the species range. We provide here new occurrence records that extend the distribution of M. chrysoleucos; provide new records for and update the distribution of M. acariensis; and propose the existence of a hybrid zone in the Aripuanã-Sucundurí interfluve, i.e. around the known distribution boundaries of M. acariensis, M. chrysoleucos, and M. melanurus, and we also discuss habitat use patterns of Amazon marmosets.

Primary colorectal diffuse large B-cell lymphoma: A report of eighteen cases in a tertiary care center.

Primary colorectal diffuse large B-cell lymphoma (DLBCL) is very rare colon malignancy. It is important to know the main demographic and clinical characteristics of these patients. We conducted a retrospective analysis of 18 patients diagnosed with primary colorectal DLBCL during a 17-year period at the National Cancer Institute of Brazil (INCA) between 2000 and 2018. Demographic characteristics, tumor localization, HIV status, lactate dehydrogenase (LDH) levels, treatment modality and follow-up status were obtained from medical records. Survival was estimated from the date of diagnosis until death. There were 11 male and seven female patients in our cohort, the median age at diagnosis was 59.5 years and four patients were HIV positive. Tumor was mainly localized in the right colon. Patients were treated with chemotherapy (CT) and/or surgical resection. Eleven patients died during a median follow-up of 59 months and the median survival time was 10 months. Six or more cycles of CT (HR=0.19; CI 95% 0.054-0.660, p = 0.009), LDH levels below 350 U/L (HR=0.229; CI 95% 0.060-0.876, p = 0.031) and surgical resection (HR=0.23; CI 95% 0.065-0.828, p = 0.030) were associated with reduced risk of death in univariate analysis. Patient's age and DLBCL right colon localization should be considered at diagnosis to distinguish between DLBCL and other diseases for differential diagnosis. Six cycles of CT, LDH levels below 350 U/L and surgical resection were associated with better survival. Our results are consistent with previous publications and address the importance of correct colorectal DLBCL diagnosis and treatment.

Accuracy, Precision, and Residual Volume of Commonly Used Syringes for Intravitreal Injections and the Impact on Intraocular Pressure.

PURPOSE: To compare accuracy, precision, and residual volume of commonly used syringes for intravitreal injections (IVIs) and to assess the intraocular pressure (IOP) rise by variations in volumes delivered. DESIGN: Experimental laboratory study. SUBJECTS: No subjects were involved in this study. METHODS: We tested 8 syringe models with 2 different needle setups, with 2 different solutions (distilled water or glycerin) and target volumes (50 and 70 µL). To obtain the delivered and residual volumes, we weighed the syringe-needle setups with scale before liquid withdrawal, with liquid, and after liquid release. We also created an experimental eye model to determine the transient rise in IOP following stepwise 10-µL increases in injection volumes. MAIN OUTCOME MEASURES: Delivered and residual volumes, IOP rise. RESULTS: We tested a total of 600 syringe-needle setups. Becton Dickinson (BD) Ultra-Fine (0.34 ± 0.28 µL), Zero Residual (1.53 ± 1.15 µL), and Zero Residual Silicone Oil-free (1.40 ± 1.16 µL) syringes showed the lowest residual volume (P < 0.001) in comparison with the others (range: 24.86 ± 1.78 µL for Injekt-F to 51.97 ± 3.37 µL for Omnifix-F). The most accurate setups were (percentage deviation from target volume): Zero Residual Silicone Oil-free (+ 0.70%), Zero Residual 0.3 ml (+ 4.49%), BD Ultra-Fine (+ 7.83%), Injekt-F (9.42%), Norm-Ject (+ 15.88%), Omnifix-F (+ 16.96%), BD Plastipak Brazil (+17.96%), and BD Plastipak Spain syringes (+ 19.41%). There was a statistically significant difference between the Zero Residual Silicone Oil-free syringe and all other syringes (P < 0.0001), except for the Zero Residual 0.3-ml syringe (P = 0.029). The coefficient of variation was low for all syringes. The modeled IOP rise ranged from 32.3 (standard deviation [SD], 1.4) mmHg for 20-µL injection volume to 76.5 (SD, 1.0) mmHg for 80-µL injection volume. For the standard 50-µL injection volume, the peak pressure was 50.7 (SD, 0.1) mmHg, and the pressure rise duration was 28 (SD, 2) minutes. CONCLUSIONS: There were significant differences in accuracy and residual volume between syringes, whereas they showed a high precision. Volume excess results in a considerable increase in IOP rise after injection. These findings may provide a relevant overview to clinicians and to both device and drug manufacturers regarding pharmacoeconomic, safety, and efficacy issues. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Effects of two different dual-task training protocols on gait, balance, and cognitive function in community-dwelling older adults: a 24-week randomized controlled trial.

Background: Although alternating dual-task (ADT) training is functionally easier for older adults, a large part of the motor and cognitive tasks is simultaneously performed, especially during activities of daily living that require maintaining body balance. Objective: To evaluate the effects of mixed dual-task training on mobility, cognitive function, and balance in community-dwelling older adults. Methods: Sixty participants were randomly allocated at a 1:1 ratio into the experimental group-single motor task (SMT) and simultaneous dual task (SDT) interchangeably in stage 1 (for 12 weeks) and after strictly with SDT in stage 2 (the last 12 weeks)-or into the control group-only SMT and SDT interchangeably in stages 1 and 2. Gait parameters were acquired by two inertial sensors. Physical and cognitive performance were acquired by specific questionnaires. Generalized linear mixed models were used for analyzing interaction and main effects. Results: No between-group difference was observed for gait performance. Both protocols improved mobility (mean change ((MC) = 0.74)), dual-task effect (MC = -13.50), lower limb function (MC = 4.44), static (MC = -0.61), and dynamic balance (MC = -0.23), body sway (MC = 4.80), and cognitive function (MC = 41.69). Conclusion: Both dual-task training protocols improved these outcomes.