Cervical manipulation versus thoracic or cervicothoracic manipulations for the management of neck pain. A systematic review and meta-analysis.

BACKGROUND: Cervical and thoracic thrust or non-thrust manipulations have shown to be effective in patients with neck pain, but there is a lack of studies comparing both interventions in patients with neck pain. OBJECTIVE: To investigate the effects of cervical thrust or non-thrust manipulations compared to thoracic or cervicothoracic manipulations for improving pain, disability, and range of motion in patients with neck pain. DESIGN: Systematic review and meta-analysis. METHOD: Searches were performed in PubMed, PEDro, Cochrane Library, CINHAL, and Web of Science databases from inception to May 22, 2023. Randomized clinical trials comparing cervical thrust or non-thrust manipulations to thoracic or cervicothoracic manipulations were included. Methodological quality was assessed with PEDro scale, and the certainty of evidence was evaluated using GRADE guidelines. RESULTS: Six studies were included. Meta-analyses revealed no differences between cervical thrust or non-thrust manipulations and thoracic or cervicothoracic manipulations in pain intensity, disability, or cervical range of motion in any plane. The certainty of evidence was downgraded to very low for pain intensity, to moderate or very low for disability and to low or very low for cervical range of motion. CONCLUSION: There is moderate to very low certainty evidence that there is no difference in effectiveness between cervical thrust or non-thrust manipulations and thoracic or cervicothoracic manipulations for improving pain, disability, and range of motion in patients with neck pain. PROSPERO REGISTRATION: CRD42023429933.

Optimal experimental design (OED) for the growth rate of microbial populations. Are they really more "optimal" than uniform designs?

Secondary growth models from predictive microbiology can describe how the growth rate of microbial populations varies with environmental conditions. Because these models are built based on time and resource consuming experiments, model-based Optimal Experimental Design (OED) can be of interest to reduce the experimental load. In this study, we identify optimal experimental designs for two common models (full Ratkowsky and Cardinal Parameters Model (CPM)) for a different number of experiments (10-30). Calculations are also done fixing one or more model parameters, observing that this decision strongly affects the layout of the OED. Using in silico experiments, we conclude that OEDs are more informative than conventional (equidistant) designs with the same number of experiments. However, OEDs cluster the experiments near the growth limits (Xmin and Xmax) resulting in impractical designs with aggregated experimental runs ~10 times longer than conventional designs. To mitigate this, we propose a novel optimality criterion (i.e., the objective function) that accounts for the aggregated time. The novel criterion provides a reduction in parameter uncertainty with respect to the conventional design, without an increase in the experimental load. These results underline that an OED is only based on information theory (Fisher information), so the results can be impractical when actual experimental limitations are considered. The study also emphasizes that most OED schemes identify where to measure, but do not give an indication on how many experiments should be made. In this sense, numerical simulations can estimate the parameter uncertainty that would be obtained for a particular experimental design (OED or not). These results and methodologies (available in Open Code) can guide the design of future experiments for the development of secondary growth models.

Modelling the low temperature growth boundaries of Salmonella Enteritidis in raw and pasteurized egg yolk, egg white and liquid whole egg: Influence of the initial concentration.

Salmonella is the most frequently reported cause of foodborne outbreaks with known origin in Europe, with eggs and egg products standing out as the most frequent food source (when it was known). The growth and survival of Salmonella in eggs and egg products have been extensively studied and, recently, it has been reported that factors such as the initial concentration and thermal history of the egg product can also influence its growth capability. Therefore, the objective of this study was to define the boundary zones of the growth/no growth domain of Salmonella Enteritidis (4 strains) as a function of temperature (low temperature boundary) and the initial concentration in different egg products. A series of polynomial logistic regression equations were successfully adjusted, allowing the study of these factors and their interaction on the probability of growth of S. Enteritidis in these products. Results obtained indicate that the minimum growth temperatures of Salmonella Enteritidis are higher in egg white (9.5-18.3 °C) than in egg yolk (7.1-7.8 °C) or liquid whole egg (7.2-7.9 °C). Results also demonstrate that in raw liquid whole egg and raw and pasteurized egg white, the minimum growth temperature of Salmonella Enteritidis does depend on the initial concentration. Similarly, the previous thermal history of the egg product only influenced the minimum growth temperature in some of them. On the other hand, large differences in the minimum growth temperatures among strains were observed in some products (up to approx. 6 °C in egg white). Finally, it should be noted that none of the strains grew at 5 °C under any of the conditions assayed. Therefore, storage of egg products (particularly whole liquid egg and egg yolk) below this temperature might be regarded/proposed as a good management approach. Our experimental approach has allowed us to provide a more accurate prediction of S. Enteritidis minimum growth temperatures in egg products by taking into account additional factors (initial concentration and thermal history) while also providing a quantification of the intra-specie variability. This would be of high relevance for improving the safety of egg products.

The Effects of Soft-Tissue Techniques and Exercise in the Treatment of Patellar Tendinopathy-Systematic Review and Meta-Analysis.

BACKGROUND: Patellar tendinopathy is a degenerative clinical disorder that causes load-related pain in the lower pole of the patella or patellar tendon. It predominantly affects young male athletes engaged in sports involving repetitive tendon loading, particularly explosive jumping. The combination of manual techniques with therapeutic exercise is hypothesized to provide greater benefits than exercise alone. OBJECTIVE: The aim of this study is to analyze the scientific evidence regarding the effects of soft-tissue techniques combined with therapeutic exercise versus therapeutic exercise alone on pain intensity and function in individuals with patellar tendinopathy. METHODS: A systematic review with meta-analysis was conducted following the PRISMA guidelines. PubMed, Lilacs, IBECS, CENTRAL, WOS, SciELO, Academic Search, CINAHL, SportDiscus, PEDro, and Google Scholar databases were consulted. Randomized controlled trials and quasi-randomized trials focusing on the effects of soft-tissue techniques combined with therapeutic exercise (experimental group) versus therapeutic exercise alone (control group) on pain and function in individuals aged 16 years and older with patellar tendinopathy were selected. The Cochrane tool for risk-of-bias assessment and the PEDro scale for methodological quality were used. RESULTS AND DISCUSSION: A total of six studies (n = 309; age range = 16-40 years), considered to have a low risk of bias and moderate-to-high methodological quality, were included. The results showed improvements in function in the experimental group (mean of 60% on the Visa-P scale) and pain in the experimental group (mean decrease of 2 points in the VAS scale). There were improvements in 50% of the studies when comparing variables between the experimental and control groups. CONCLUSIONS: The combination of manual techniques, such as dry needling, percutaneous electrolysis, transverse friction massage, and stretching, along with a squat on a 25° inclined plane, appears to be effective in the treatment of patellar tendinopathy. Static stretching of the quadriceps before and after the squat five times per week, along with dry needling or percutaneous electrolysis sessions twice a week for 8 weeks, is recommended. However, future studies analyzing groups with passive techniques versus therapeutic exercise are needed to standardize the treatment and establish the optimal dose.

Is device guided training targeted to the craniocervical flexor and extensor muscles efficacious? A preliminary randomized controlled trial in a cervicogenic headache population.

BACKGROUND: Specific neck exercise is effective in the management of cervicogenic headache (CH). The Spinertial device was designed to facilitate craniocervical flexion and extension training, but its efficacy, judged on change in headache impact, has not been tested. OBJECTIVE: To compare guided and progressive resisted specific neck exercise targeted to the craniocervical flexors and extensors (SNE-fe) performed with Spinertial device to progressive SNE-fe without the device in a cohort with CH. DESIGN: Randomised controlled trial. METHODS: Twenty-eight participants with CH were randomly allocated to the Spinertial group (SG) or SNE-fe exercise group without the device (EG). Both groups performed 12 sessions of SNE-fe over six-weeks. The primary outcome was headache impact (HIT-6). Secondary outcomes were the craniocervical flexion test (CCFT), upper cervical (UCS) and lower cervical range of movement, flexion rotation test (FRT) analysed as more or less restricted side (MRS, LRS), the self-reported global rating of change (GROC-scale) and satisfaction with the exercise program (PACES). Outcomes were measured at baseline, post-intervention (T1) and after 1-month (T2). RESULTS: Significant between-groups differences were found favouring the SG for HIT-6 (T1 p = 0.010, d = 0.5; T2 p < 0.004, d = 0.4), CCFT, UCS ROM, FRT MRS, FRT LRS, PACES and GROC-scale (T1: all p < 0.01; T2: all p < 0.01). Effects sizes were large (>0.8) at T1 and T2. No between-groups differences were found for lower cervical ROM. CONCLUSION: Training with the Spinertial was more effective than SNE without the device for improving the impact of headache, the endurance of deep neck flexors and UCS ROM in participants with CH.

The effects of end-range interventions in the management of primary adhesive capsulitis of the shoulder: a systematic review and meta-analysis.

PURPOSE: To compare the effects of end-range manual therapy versus other conservative intervention on pain intensity, shoulder range of movement (ROM), and physical function in adhesive capsulitis (AC). METHODS: Two reviewers conducted a comprehensive search from inception to December 2022. PUBMED, Cochrane Library, CINAHL, EMBASE, and PEDro databases were searched. Clinical trials investigating the effects of end-range mobilisation techniques on pain, ROM, and physical function in patients with AC were included. Methodological quality was evaluated using the PEDro scale, and bias risk was assessed using the Cochrane Collaboration tool. GRADE was used to assess the certainty of the evidence. Data were presented using forest plots, and the random effects models were applied according to the Cochrane handbook. RESULTS: Ten randomised controlled trials were reviewed, involving 424 AC patients aged 20-70 years. Methodological quality of studies ranged from high to low. The end-range mobilisation showed improvements in pain intensity, shoulder abduction, internal rotation, and external rotation, and physical function compared to other conservative interventions in the short-and medium-terms. Certainty of the evidence was downgraded to very low. CONCLUSIONS: Very low certainty evidence suggests that end-range mobilisation techniques improve pain intensity, shoulder ROM, and physical function in the short-and medium-term in AC.

The Kaltenborn, Maitland, and Mulligan concepts are the most commonly used manual therapy approaches for adhesive capsulitis.The End-range mobilisation techniques seem to improve pain intensity, shoulder range of motion, and physical function at short- and medium-term of follow-up.The certainty of evidence was rated as very low for all the outcome measures.Despite the low certainty of evidence, it is recommended to continue using manual therapy for adhesive capsulitis due to the improvements demonstrated until further studies either confirm or refute its definitive efficacy.

Systematic review and meta-analysis showed that complementary and alternative medicines were not effective for infantile colic.

AIM: Osteopathy and chiropractic techniques are used for babies for different reasons, but it is unclear how effective they are. The aim of this study was to evaluate their effectiveness in reducing crying time and increasing sleeping time in babies with infantile colic. METHODS: A systematic review and meta-analysis was conducted on infantile colic studies that used complementary and alternative medicine techniques as interventions. The outcome measures were hours spent crying and/or sleeping. We used the PubMed, Physiotherapy Evidence Database, Cochrane Library, Embase, Web of Science, Scopus, Osteopathic Medicine Digital Database and Google Scholar databases from inception to 11 November 2022. RESULTS: The methodological quality of the randomised control trials ranged from fair to high. We focused on five studies with 422 babies. Complementary treatments failed to decrease the crying time (mean difference -1.08, 95% CI: -2.17 to 0.01, I2 = 92%) and to increase sleeping time (mean difference 1.11, 95% CI: -0.20 to 2.41; I2 : 91%), compared with no intervention. The quality of the evidence was rated as very low for both outcome measures. CONCLUSION: Osteopathy and chiropractic treatment failed to reduce the crying time and increase sleeping time in babies with infantile colic, compared with no additional intervention.

Effects of diacutaneous fibrolysis in patients with tension-type headache: A randomized controlled trial.

BACKGROUND: Manual therapy appears to be effective for the relief of tension-type headache (TTH), just as diacutaneous fibrolysis (DF) has shown to be a beneficial technique for the relief of symptoms in other dysfunctions. However, no studies have evaluated the potential beneficial effect of DF in TTH. The aim of this study is to analyze the effect of three sessions of DF in patients with TTH. METHODS: Randomized controlled trial in 86 subjects (43 intervention/ 43 control group). The headache frequency, the headache intensity, the pressure pain thresholds (PPTs) at trapeziometacarpal joint, upper trapezius, suboccipital, frontal and temporal muscles, parietal sutures and the cervical mobility were measured at baseline, at the end of the third intervention and one-month after the last intervention. RESULTS: Statistically significant differences with p values <0.05 were observed between groups in favor of the intervention group in the one-month follow-up in the following variables: headache frequency, headache intensity, flexion, extension, right and left side-bending, right and left rotation, PPTs in left trapeziometacarpal joint, right suboccipital muscle, right and left temporal muscle, left frontal muscle and right and left parietal. CONCLUSIONS: DF provides a beneficial effect in reducing headache frequency, relieving pain, and improving cervical mobility in patients with TTH.

The effectiveness of Schroth method in Cobb angle, quality of life and trunk rotation angle in adolescent idiopathic scoliosis: a systematic review and meta-analysis.

INTRODUCTION: The Schroth method is one of the most common physiotherapeutic scoliosis-specific exercises intervention applied in adolescent idiopathic scoliosis (AIS). This method consists of three-dimensional correction of the specific curve pattern of the patient using a combination of sensorimotor, postural, and corrective breathing exercises. The aim of this systematic review and meta-analysis was to analyse the effects of the Schroth method in isolation on Cobb angle, quality of life, and trunk rotation angle compared to no intervention or other conservative treatments in patients with AIS. EVIDENCE ACQUISITION: PubMed, Physiotherapy Evidence Database, Scopus, Cochrane Library, and Web of Science databases were searched. Studies were included if they were randomized controlled trials that compared the effects of the Schroth method in isolation to conservative interventions or no intervention. The quality of the studies was assessed with the PEDro Scale, and the risk of bias with the Cochrane Collaboration tool. Two independent assessors extracted data through a standardized form. Meta-analyses were conducted using fixed or random effects models according to the heterogeneity assessed with I2 coefficient. Data on outcomes of interest were extracted by a researcher using RevMan 5.4 software. EVIDENCE SYNTHESIS: A total of 317 studies were screened. Six were included in the meta-analysis involving 144 patients with AIS. The methodological quality of the included studies ranged from high to low. Schroth method in isolation showed significant improvements in Cobb angle (mean difference [MD] =-3.18º; 95% CI: -4.30, -2.07; I2: 0%), quality of life (MD=0.28; 95% CI: 0.18, 0.38; I2: 0%) and trunk rotation angle (MD=-2.12º; 95% CI: -3.44, -0.80; I2: 71%) in the short-term. CONCLUSIONS: The Schroth method in isolation is effective for reducing the Cobb angle and the trunk rotation angle and for improving the QoL in the short-term compared to no intervention or other conservative therapies in AIS, but the improvement in Cobb angle did not exceed the minimum clinically important difference.

Strength Training vs. Aerobic Training for Managing Pain and Physical Function in Patients with Knee Osteoarthritis: A Systematic Review and Meta-Analysis.

(1) Background: Strength training (ST) and aerobic training (AT) are the most recommended interventions in patients with knee OA. These recommendations are supported by high-quality evidence, but it is still unknow whether one type of exercise is superior to the other. Thus, the aim was to investigate whether one type of exercise (ST or AT) is superior to the other for improving pain and physical function in patients with knee osteoarthritis. (2) Methods: A systematic review and meta-analysis was carried out following the PRISMA statement. The search strategy was conducted in PubMed, PEDro, Scopus, Web of Science and Cochrane Library databases. Randomized controlled trials comparing ST and AT on pain intensity and physical function in patients with knee osteoarthritis were included. Methodological quality and risk of bias were assessed with a PEDro scale and risk-of-bias tool, respectively. The certainty of evidence was evaluated using GRADE guidelines. (3) Results: Four studies (6 publications) were included. The qualitative and quantitative synthesis showed that ST produces no more improvement in pain intensity (SMD after intervention: 0.02; 95%CI: -0.15, 0.19; I2: 0%; three studies; 426 patients) and physical function (SMD after intervention: 0.07; 95%CI: -0.10, 0.24; I2: 0%; three studies; 426 patients) compared to AT in patients with knee osteoarthritis. The certainty of evidence was rated as very low. (4) Conclusions: Both type of exercises showed clinical benefits in people with knee osteoarthritis, but no differences between ST and AT were found.

Clinical and Psychological Variables in Female Patients with Cervical Syndromes: A Cross-Sectional and Correlational Study.

Background: The objectives of this study were: (1) to compare the pain intensity, cervical range of motion (ROM), psychological distress and kinesiophobia in patients with cervicogenic dizziness (CGD), tension-type headache (TTH), and mechanical chronic neck pain (MCNP); and (2) to investigate the relationships between pain intensity and cervical ROM and between psychological distress and kinesiophobia. Methods: a cross-sectional and correlational study was designed. In total, 109 patients (32 patients with CGD, 33 with TTH and 44 with MCNP) were included. Pain intensity, cervical ROM, psychological distress and kinesiophobia were assessed. Results: Statistically significant differences were found between the groups in pain intensity, psychological distress and kinesiophobia. The patients with MCNP showed higher pain intensity compared to the other groups (p < 0.001). The patients with CGD showed higher depression and kinesiophobia values compared to the MCNP and TTH groups (p < 0.05). No differences were found for cervical flexion, extension, lateral flexion, or rotation ROM (p > 0.05). The CGD and MCNP groups found a moderate positive correlation between psychological distress and kinesiophobia (p < 0.05). The patients with TTH and MCNP showed a moderate positive correlation between pain intensity, psychological distress and kinesiophobia (p < 0.05). Conclusion: Pain intensity, psychological distress and kinesiophobia should be considered in the three groups. Psychological distress was correlated with kinesiophobia in the CGD and MCNP groups. The MCNP group showed a correlation between pain intensity, psychological distress and kinesiophobia.

The Addition of Diacutaneous Fibrolysis to a Pharmacological Intervention in Patients with Tension-Type Headache: A Randomized Controlled Trial.

Background: Tension-type headache (TTH) is the most common headache worldwide. Pharmacological interventions are the most investigated therapies in patients with TTH. The addition of physical therapy treatments such as diacutaneous fibrolysis (DF) may have promising results. The aim of this study was to investigate the addition of three sessions of DF to a pharmacological intervention in patients with TTH. Methods: A single-blinded randomized controlled trial was carried out. Participants were randomly assigned to the standard care group or to the DF group. Both groups received a pharmacological intervention. Three sessions of DF in the thoracic and cervicocranial region were added in the DF group. The impact caused by headache (HIT-6), headache intensity, and cervical range of motion were measured by blinded assessors at baseline, after the intervention, and at 1 month follow-up. Results: Eighty-two patients with TTH were included (41 standard care group; 41 DF group). Statistically significant differences were found between both groups in all the variables after the intervention and at 1 month follow-up (p < 0.001). No adverse effects or side-effects were reported during the study. Conclusions: The addition of three sessions of DF to a pharmacological therapy provided improvements in the impact caused by headache, headache intensity, and cervical range of motion after the intervention and at 1 month follow-up compared to a pharmacological therapy in isolation. Further research is needed to investigate long-term effects.

Students' perceptions, engagement and satisfaction with the use of an e-rubric for the assessment of manual skills in physiotherapy.

INTRODUCTION: In recent years, formative assessment has gained importance in health care education to facilitate and enhance learning throughout the training period. Within the frame of active methodologies, rubrics have become an essential instrument for formative assessment. Most rubric-based assessment procedures focus on measuring the effects of rubrics on teachers. However, few studies focus their attention on the perception that students have of the evaluation process through rubrics. METHODS: A cross-sectional survey study was carried out with 134 students enrolled in the pre-graduate Physiotherapy education. Assessment of manual skills during a practical examination was performed using an e-rubric tool. Peer-assessment, self-assessment and teacher´s assessment were registered. After completion of the examination process, students' perceptions, satisfaction and engagement were collected. RESULTS: Quantitative results related to students' opinion about e-rubric based assessment, students' engagement, perceived benefits and drawbacks of the e-rubric as well as the overall assessment of the learning experience were obtained. 86.6% of the students agreed upon the fact that "the rubric allowed one to know what it is expected from examination" and 83.6% of the students agreed upon the fact that "the rubric allowed one to verify the level of competence acquired". A high rate of agreement (87.3%) was also reached among students concerning feedback. CONCLUSIONS: E-rubrics seemed to have the potential to promote learning by making criteria and expectations explicit, facilitating feedback, self-assessment and peer-assessment. The importance of students in their own learning process required their participation in the assessment task, a fact that was globally appreciated by the students. Learning experience was considered interesting, motivating, it promoted participation, cooperative work and peer-assessment. The use of e-rubrics increased engagement levels when attention was focused on their guidance and reflection role.

Combination of Two Manipulative Techniques for the Treatment of Cervicogenic Dizziness: A Randomized Controlled Trial.

Cervicogenic dizziness is clinically associated with upper cervical spine dysfunctions. It seems that manual therapy decreases the intensity of dizziness in these subjects, but what happens to pain measured by pressure pain threshold (PPT) has not been studied. Purpose: analyze the short-term effects of combination two manipulation techniques protocol in worst dizziness intensity (wVAS), dizziness and cervical disability, upper cervical spine mobility and mechanosensivity of cervical tissue. Methods: Assessor-blinded randomized controlled trial was developed. A total of 40 patients with cervicogenic dizziness were randomly divided into two groups. The experimental group received three treatments consisting of a functional massage and a manipulation technique, and compared with a control group. The wVAS, dizziness handicap inventory (DHI), neck disability index (NDI), UCS mobility, and PPTs were measured. Measurements were made at the baseline, first follow-up 48 h after intervention and second follow-up 1 month after the intervention. Results: at second follow-up wVAS (p < 0.001), NDI (p < 0.001), DHI (p < 0.001), and upper right trapezius (p < 0.022) and right suboccipital (p < 0.043) PPTs showed a difference between groups in favor of the experimental group. Conclusions: apparently, the proposed intervention protocol decreases the intensity of dizziness and the mechanosensitivity of the cervical tissue and improves the feeling of disability due to neck pain and dizziness.

Relationship between iron bioavailability and Salmonella Typhimurium fitness in raw and pasteurized liquid whole egg.

SALMONELLA: Enteritidis growth rates in liquid whole egg have been shown to be dependent on the initial inoculum dose and on the egg product's thermal history. This study's objective is to obtain further insight into the mechanisms underlying both phenomena. First we verified that Salmonella Typhimurium ATCC 14028s cells displayed the behavior already described for S. Enteritidis cells. Then, we carried out supplementation assays by adding different concentrations of egg-white antimicrobial proteins, iron, or siderophores to the egg samples (raw or pasteurized liquid whole egg, depending on the assay). These experiments revealed that addition of lysozyme (at the concentration at which it is present in liquid whole egg) did not affect Salmonella growth in pasteurized liquid whole egg, but that ovotransferrin as well as Ex-FABP caused a significant (p < 0.05) reduction in Salmonella growth rates in whole egg pasteurized at 70 °C for 1.5 min. Furthermore, we observed that the inactivation of ovotransferrin was dependent on treatment intensity within the range studied. On the other hand, addition of iron or siderophores to raw or low temperature (60 °C/3.5 min) pasteurized liquid whole egg increased the growth rate of Salmonella cells inoculated at a low initial dose. The concentration of these supplements required to reach the growth rate of cells inoculated at a high dose was lower for pasteurized than for raw egg. Finally, growth of a set of deletion mutants in genes coding for proteins related to different iron uptake systems, along with supplementation assays using spent medium revealed the key role of salmochelin in growth of S. Typhimurium in raw whole egg. In summary, our results strongly suggest that iron bioavailability determines the fitness (growth rates) of Salmonella cells in liquid whole egg. Thus, the higher the intensity of the thermal treatment applied to liquid egg, the more iron would be available, a phenomenon that would be linked to the denaturation of iron and/or siderophore binding egg proteins. Further work is still required to fully elucidate why lower Salmonella initial doses lead to lower growth rates, but it can be hypothesized that this might be related to a lower amount of siderophores being released to the medium (especially salmochelin), which would also limit iron bioavailability.

Short-term effects of the traction-manipulation protocol in dizziness intensity and disability in cervicogenic dizziness: a randomized controlled trial.

PURPOSE: Analyse the short-term effects of traction-manipulation protocol in dizziness and pain intensity and disability, cervical mobility and postural instability. MATERIALS AND METHODS: Randomized controlled assessor-blind clinical trial. The traction-manipulation protocol was carried out in the intervention group and compared with a control group where the subjects were kept supine. The intervention protocol follows the IFOMPT safety recommendations. Dizziness and pain intensity, Dizziness Handicap Inventory (DHI), cervical mobility and balance were measured after 48 h and a one-month follow-up. RESULTS: Forty subjects with cervicogenic dizziness were randomly assigned to an intervention or control group. Significant differences were found in favour of the intervention protocol group in: dizziness intensity (p < 0.001; d = 1.31), DHI (p < 0.001; d = 0.76) pain intensity (p < 0.007; d = 0.92), upper cervical flexion (p < 0.032; d = 0.30) and extension (p < 0.012; d = 0.80) at 48 h follow up. At one-month follow up there were significant differences in favour of the intervention group in: dizziness intensity (p < 0.001; d = 0.95), DHI (p < 0.001; d = 0.0.92) pain intensity (p < 0.001; d = 1.38) and upper cervical extension (p < 0.005; d = 0.92). Postural instability improved in mediolateral displacement static with eyes closed (p < 0.032; d = 0.79) and in dynamic with eyes open (p = 0.003; d = 0.55) at one-month follow-up in the intervention group. CONCLUSION: The traction-manipulation protocol reduces the dizziness and pain intensity, ameliorates disability and improves upper cervical mobility and postural instability.IMPLICATIONS FOR REHABILITATIONThe intervention protocol reduces the dizziness and pain intensity, and improves self-perceived disability in patients with cervicogenic dizziness.Manual therapy improves the cervical range of motion and the postural instability in the cervicogenic dizziness.The intervention protocol follows the safety recommendations of the International Federation of Orthopaedic Manipulative Physical Therapists.

Relationship between growth ability, virulence, and resistance to food-processing related stresses in non-typhoidal Salmonellae.

The ability of Salmonella to resist and adapt to harsh conditions is one of the major features that have made this microorganism such a relevant health hazard. However, the impact of these resistance responses on other aspects of Salmonella physiology, such as virulence and growth ability, is still not fully understood. The objective of this study was to determine the maximum growth rates (in three different media), virulence (adhesion and invasion of Caco-2 cells), and other phenotypic characteristics (biofilm-forming ability and antimicrobial resistance) of 23 Salmonella strains belonging to different serovars, and to compare them with their previously determined stress resistance parameters. Significant differences (p < 0.05) in growth rates, virulence, and biofilm-forming ability were found among the 23 strains studied. Nevertheless, whereas less than 3-fold change between the lowest and the highest growth rate was observed, the percentage of cells capable of invading Caco-2 cells varied more than 100-fold, that to form biofilms more than 30-fold, and the antibiotic MICs varied up to 512-fold, among the different strains. Results indicate that those strains with the highest cell adhesion ability were not always the most invasive ones and suggest that, in general terms, a higher stress resistance did not imply a reduced growth ability (rate). Similarly, no association between stress resistance and biofilm formation ability (except for acid stress) or antibiotic resistance (with minor exceptions) was found. Our data also suggest that, in Salmonella, acid stress resistance would be associated with virulence, since a positive correlation of that trait with adhesion and a negative correlation with invasion was found. This study contributes to a better understanding of the physiology of Salmonella and the relationship between bacterial stress resistance, growth ability, and virulence. It also provides new data regarding intra-specific variability of a series of phenotypic characteristics of Salmonella that are relevant from the food safety perspective.

Influence of the Initial Cell Number on the Growth Fitness of Salmonella Enteritidis in Raw and Pasteurized Liquid Whole Egg, Egg White, and Egg Yolk.

Salmonella growth in egg and egg products has been widely studied, but there are still some aspects that are not fully known. The objective of this work was to study the influence of the initial cell number on the growth fitness of Salmonella Enteritidis in raw and pasteurized egg products. Growth curves of five Salmonella Enteritidis strains in raw and pasteurized egg products, starting from different initial numbers, were obtained and fitted to the Baranyi and Roberts model. The results revealed that lower initial numbers led to longer lag phases (λ) and lower maximum specific growth rates (µmax) in raw liquid whole egg. Similar results were observed in raw egg white (except for one strain). Conversely, no influence (p > 0.05) of the initial concentration on Salmonella growth parameters in raw egg yolk was observed. On the other hand, no influence of the initial number of cells on Salmonella growth fitness in commercial pasteurized liquid whole egg was observed. The results obtained demonstrate that the disappearance of this initial-dose dependency phenomenon was dependent on the intensity of the thermal treatment applied. Finally, the influence of the initial number was, in general, lower in pasteurized than in raw egg white, but large differences among strains were observed.

Acute Increase in Blood αCGRP at Maximal Exercise and Its Association to Cardiorespiratory Fitness, Carbohydrate Oxidation and Work Performed: An Exploratory Study in Young Men.

This study aimed to explore if the acute variations in plasma concentration of α-calcitonin gene-related peptide (αCGRP) induced by a single maximal exercise bout may be associated to cardiorespiratory fitness and carbohydrate oxidation in humans. Twelve young adult Caucasian men (24.3 ± 0.9 years-old; 179.2 ± 1.9 cm of height; 23.9 ± 0.6 kg·m-2 body mass index) performed a graded exercise test. A venous catheter was placed before testing, and blood samples were taken at baseline, maximal effort and recovery. αCGRP was measured in plasma using a commercial double-sandwich enzyme-linked-immunoassay. A two-way repeated measurements ANOVA was used to compare the values obtained at baseline, maximal effort and recovery. In the whole sample, αCGRP increased at maximal effort and its concentration correlated directly, albeit non-significantly, with the muscle mass normalised VO2, VCO2, carbohydrate oxidation and relative power. Two thirds of the participants showed an increase in αCGRP concentration at maximal effort. Post hoc analysis showed that in these individuals, the muscle mass normalised VO2, VCO2, carbohydrate oxidation rate and relative power were higher than in the participants lacking this molecular response. Therefore, our data suggest that (a) a majority of young men respond to exercise with an increase in blood αCGRP concentration; and (b) individuals exhibiting this response also show a higher cardiorespiratory fitness, carbohydrate oxidation and work performed. These findings suggest that this neuropeptide could act as an exerkine with potential effects on physical performance.