Memory complaint in a middle-income country: a four-year longitudinal study in a cohort with low-education.

BACKGROUND: Memory complaints are frequent in older adults and are associated with higher risk of cognitive decline. OBJECTIVE: To investigate the functional outcome of individuals with memory complaints followed up at primary care centers. METHODS: Data were collected between 2016 e 2020 in primary health care centers in Brazil. Patients underwent the Brief Cognitive Screening Battery, and the Functional Activities Questionnaire. RESULTS: The initial sample (2016) comprised 91 individuals classified into those with subjective cognitive decline (SCD, n = 15), mild cognitive impairment (MCI, n = 45), or dementia (n = 31). During follow-up, 8 individuals (8.8% of the initial sample) died and 26 (28.5% of the initial sample) were not found. Fifty-seven participants underwent clinical reassessment. Of 15 individuals with SCD, 7 were not found (46.7%), 4 (26.7%) progressed to MCI, and 4 (26.7%) remained stable. Of 45 individuals with MCI, 11 were not found (24.4%), 2 (4.4%) died, 6 (13.4%) progressed to dementia, 12 (26.7%) regressed to SCD, and 14 (31.1%) remained stable. Of 31 individuals with dementia, 8 were not found (25.8%), 6 (19.4%) died, 2 (6.5%) regressed to SCD, 7 (22.6%) regressed to MCI, and 8 remained stable (25.8%). Clinical improvement was due to the treatment of reversible causes, such as B12 hypovitaminosis and mood disorders. Older age, lower Mini-Mental State Examination, and higher scores of memory complaint, but not the use of benzodiazepines and of proton pump inhibitors, were predictors of functional status. CONCLUSION: Despite their limits (short sample size, missing data), these results support the idea that adequate screening, follow-up, and treatment of reversible causes of dementia in primary care are essential.

ANTECEDENTES: Queixas de memória são frequentes em idosos e estão associadas ao maior risco de declínio cognitivo. OBJETIVO: Investigar o desfecho funcional de indivíduos com queixas de memória acompanhados em centros atenção primária. MéTODOS: Os dados foram coletados entre 2016 e 2020 em centros de atenção primária à saúde no Brasil. Os pacientes foram submetidos à Bateria Cognitiva Breve e ao Questionário de Atividades Funcionais. RESULTADOS: A amostra inicial (2016) foi composta por 91 indivíduos, classificados como tendo declínio cognitivo subjetivo (DCS, n = 15), comprometimento cognitivo leve (CCL, n = 45), ou demência (n = 31). Durante o seguimento, 8 indivíduos (8,8% da amostra inicial) faleceram e 26 (28,5% da amostra inicial) não foram encontrados. Cinquenta e sete participantes foram submetidos à reavaliação clínica. Dos 15 indivíduos com DCS, 7 não foram encontrados (46,7%), 4 (26,7%) declinaram para CCL e 4 (26,7%) permaneceram estáveis. Dos 45 indivíduos com CCL, 11 não foram encontrados (24,4%), 2 (4,4%) morreram, 6 (13,4%) declinaram para demência, 12 (26,7%) evoluíram para DCS e 14 (31,1%) permaneceram estáveis. Dos 31 indivíduos com demência, 8 não foram encontrados, (25,8%), 6 (19,4%) morreram, 2 (6,5%) evoluíram para DCS e 7 (22,6%) para CCL; e 8 permaneceram estáveis (25,8%). A melhora clínica deveu-se ao tratamento de causas reversíveis, como hipovitaminose B12 e transtornos de humor. A idade avançada, a baixa pontuação no Mini-Exame do Estado Mental e os escores de queixa de memória mais altos, mas não o uso de benzodiazepínicos e inibidores da bomba de prótons, foram preditores de declínio funcional. CONCLUSãO: Apesar de suas limitações (amostra pequena, dados ausentes), esses resultados corroboram que a triagem adequada, o acompanhamento e o tratamento de causas reversíveis de demência na atenção primária são essenciais.

Efficacy and safety of microvascular decompression with or without partial sensory rhizotomy: a comprehensive meta-analysis and systematic review in treating trigeminal neuralgia.

Classical trigeminal neuralgia (TN), caused by vascular compression of the nerve root, is a severe cause of pain with a considerable impact on a patient's quality of life. While microvascular decompression (MVD) has lower recurrence rates when compared with partial sensory rhizotomy (PSR) alone, refractoriness can still be as high as 47%. We aimed to assess the efficacy and safety profile of MVD + PSR when compared to standalone MVD for TN. We searched Medline, Embase, and Web of Science following PRISMA guidelines. Eligible studies included those with ≥ 4 patients, in English, published between January 1980 and December 2023, comparing MVD vs. MVD + PSR for TN. Endpoints were pain cure, immediate post-operative pain improvement, long-term effectiveness, long-term recurrence, and complications (facial numbness, hearing loss, and intracranial bleeding). We pooled odds ratios (OR) with 95% confidence intervals with a random-effects model. I2 was used to assess heterogeneity, and sensitivity and Baujat analysis were conducted to address high heterogeneity. Eight studies were included, comprising a total of 1,338 patients, of whom 1,011 were treated with MVD and 327 with MVD + PSR. Pain cure analysis revealed a lower likelihood of pain cure in patients treated with MVD when compared to patients treated with MVD + PSR (OR = 0.30, 95% CI: 0.13 to 0.72). Immediate postoperative pain improvement assessment revealed a lower likelihood of improvement in the MVD group when compared with the MVD + PSR group (OR = 0.31, 95% CI: 0.10 to 0.95). Facial numbness assessment revealed a lower likelihood of occurrence in MVD alone when compared to MVD + PSR (OR = 0.08, 95% CI: 0.04 to 0.15). Long-term effectiveness, long-term recurrence, hearing loss, and intracranial bleeding analyses revealed no difference between both approaches. Our meta-analysis identified that MVD + PSR was superior to MVD for pain cure and immediate postoperative pain improvement for treating TN. However, MVD + PSR demonstrated a higher likelihood of facial numbness complications. Furthermore, identified that hearing loss and intracranial bleeding complications appear comparable between the two treatments, and no difference between long-term effectiveness and recurrence.

Validation of the Equidyn protocol for evaluation of dynamic balance in older adults through a smartphone application.

BACKGROUND: Different tasks and proxy measurements have been employed to evaluate dynamic balance in older individuals. However, due to inherent limitations, results from most evaluations could hardly be taken as valid measurements of dynamic balance. RESEARCH QUESTION: Is the Equidyn smartphone application-based protocol valid and sensitive for assessment of dynamic balance in older adults? METHODS: Dynamic balance was evaluated in 52 physically active individuals, age range 60-80 years (M = 69.36). The dynamic tasks were one-leg sway either in the mediolateral (ML) or anteroposterior (AP) direction while supported on the contralateral leg, and cyclic sit-to-stand with a narrow support base. These tasks were performed under standardized movement amplitude and rhythm. Outcomes were correlated with unipedal quiet standing. A smartphone was attached to the trunk backside, and a custom-made application (Equidyn) was employed to provide guidance throughout evaluation, timed beeps to pace the movements, and three-dimensional trunk acceleration measurement for balance evaluation. RESULTS: Our data showed (a) that both ML and AP leg sway tasks were sensitive to aging and to direction of leg sway movements; (b) referenced to quiet unipedal stance, moderate/strong correlations for the ML/AP leg sway tasks and moderate correlations for the sit-to-stand task; and (c) moderate/strong correlations between the ML and AP leg sway tasks, and moderate correlations between the sit-to-stand and the two unipedal dynamic tasks in the ML acceleration direction. SIGNIFICANCE: The current results support the conclusion that the Equidyn protocol is a sensitive and valid tool to evaluate dynamic balance in healthy older individuals. The protocol tasks standardized in amplitude and rhythm favor their reproducibility and trunk acceleration data interpretation. As the whole assessment is made through a smartphone application, this dynamic balance evaluation could be made in a low-cost simple way both in the laboratory and clinical settings.

The deep and the deeper: Spinal cord and deep brain stimulation for neuropathic pain.

Neuropathic pain occurs in people experiencing lesion or disease affecting the somatosensorial system. It is present in 7 % of the general population and may not fully respond to first- and second-line treatments in up to 40 % of cases. Neuromodulation approaches are often proposed for those not tolerating or not responding to usual pharmacological management. These approaches can be delivered surgically (invasively) or non-invasively. Invasive neuromodulation techniques were the first to be employed in neuropathic pain. Among them is spinal cord stimulation (SCS), which consists of the implantation of epidural electrodes over the spinal cord. It is recommended in some guidelines for peripheral neuropathic pain. While recent studies have called into question its efficacy, others have provided promising data, driven by advances in techniques, battery capabilities, programming algorithms and software developments. Deep brain stimulation (DBS) is another well-stablished neuromodulation therapy routinely used for movement disorders; however, its role in pain management remains limited to specific research centers. This is not only due to variable results in the literature contesting its efficacy, but also because several different brain targets have been explored in small trials, compromising comparisons between these studies. Structures such as the periaqueductal grey, posterior thalamus, anterior cingulate cortex, ventral striatum/anterior limb of the internal capsule and the insula are the main targets described to date in literature. SCS and DBS present diverse rationales for use, mechanistic backgrounds, and varying levels of support from experimental studies. The present review aims to present their methodological details, main mechanisms of action for analgesia and their place in the current body of evidence in the management of patients with neuropathic pain, as well their particularities, effectiveness, safety and limitations.

Symmetric unipedal balance in quiet stance and dynamic tasks in older individuals.

Previous evidence of increased difference of muscular strength between the dominant and non-dominant legs in older adults suggests the possibility of dissimilar balance control between the legs (between-leg asymmetry) associated with aging. In the current investigation, we evaluated between-leg asymmetries in older adults when performing quiet and dynamic balance tasks. Fifty-two physically active and healthy older adults within the age range of 60 to 80 years were recruited. Participants performed balance tasks in unipedal stance, including quiet standing and cyclic sway (rhythmic oscillation) of the non-supporting leg in the anteroposterior or mediolateral directions, producing foot displacements with amplitudes of 20 cm paced in 1 Hz through a metronome. Body balance was evaluated through trunk accelerometry, by using the sensors embedded into a smartphone fixed at the height of the 10th-12th thoracic spines. Analysis revealed lack of significant differences in balance control between the legs either when comparing the right versus left or the preferred versus non-preferred legs, regardless of whether they were performing quiet stance or dynamic tasks. Further examination of the data showed high between-leg correlation coefficients (rs range: 0.71-0.84) across all tasks. Then, our results indicated symmetric and associated between-leg balance control in the examined older adults.

Therapeutic plasma exchange for neuromyelitis optica attacks: Evidence and challenges from a real-world cohort from Brazil.

Therapeutic plasma exchange (TPE) can improve disability recovery after neuromyelitis optica spectrum disease (NMOSD) attacks, but its effectiveness and safety in Latin-American patients with access barriers and diverse ethnicity is underexplored. We carried out a retrospective cohort study with NMOSD patients that underwent TPE. 84 NMOSD attacks in 68 patients were evaluated. Despite a median 25-day delay from symptom onset to TPE, 65,5% of patients showed significant improvement. Adverse events occurred in 39% of patients, usually transitory and with no fatalities.

Filling gaps in experiences religious understanding of people living with cancer in palliative care: a phenomenological qualitative study.

BACKGROUND: According to a phenomenology of contemporary religion, the analysis of religious experiences finds that they are part of an individual's search for something powerful that overcomes him seeking not only a need, but the meaning of all existence. The present study aims to contribute to a deeper understanding of the religious experiences of people living with cancer in palliative care (PC) and fill gaps in access to experience, with regard to how it was properly lived. METHODS: A qualitative, phenomenological, cross-sectional study was conducted with 14 people living with cancer undergoing PC at two outpatient clinics of a public hospital. The experiences were accessed through in-depth interviews and the results were analysed according to the principles of classical phenomenology. RESULTS: The patients confidently surrendered to the divine, attributing to it the power of continuity of life or not, which sustained them and launched them into horizons of hope, directing them to possibilities of achieving meaning in life, which it fed back their faith and to continue living, opening them up to an intense perception of the value of life. CONCLUSIONS: The religious positions of confident surrender to the divine, to his will and a belief in his intervention, regardless of the outcome, opened possibilities to patients for the belief in the continuity of life by the power of faith. This position allowed the patients in this study to visualize achievements in the present and in the future, opening a horizon of hope, meaning and value of living. This study showed how this elements are presented and sustained, providing subsidies to health professionals seeking to provide more holistic care.

Modified Atkins diet for drug-resistant epilepsy: A systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To evaluate the effectiveness and side-effect profile of the modified Atkins diet (MAD) compared to the usual diet (UD) in reducing seizure frequency among patients with drug-resistant epilepsy (DRE). METHODS: In February 2023, we conducted an extensive search in PubMed, EMBASE, and Cochrane databases to find randomized controlled trials (RCTs) comparing MAD to UD in patients with drug-resistant epilepsy (DRE) on standard anti-seizure medication (ASM). We used random-effects meta-analyses and the Risk of Bias 2 tool to evaluate treatment effects and assess the quality of the included RCTs, respectively. RESULTS: Six studies were evaluated in the meta-analysis, including 575 patients, of whom 288 (50.1 %) were randomized to the MAD. Average follow-up period was 12 weeks. MAD plus standard drug therapy was associated with a higher rate of 50 % or greater reduction in seizure frequency compared to UD plus drug therapy (RR 6.28; 95 % CI 3.52-10.50; p<0.001), both in children (RR 6.28; 95 % CI 3.43-11.49; p<0.001) and adults with DRE (RR 6.14; 95 % CI 1.15-32.66; p = 0.033). MAD was also associated with a higher seizure freedom rate compared to UD (RR 5.94; 95 % CI 1.93-18.31; p = 0.002). Five studies reported adverse events with MAD; constipation was reported in 17 % of patients (95 % CI 5-44 %), lethargy in 11 % (95 % CI 4-25 %), and anorexia in 12 % (95 % CI 8-19 %). Due to limited information about the ASM regimens, we were unable to further analyze the interaction between MAD and ASM. SIGNIFICANCE: This meta-analysis, comprising 575 patients from 6 RCTs, revealed that MAD led to higher rates of seizure freedom and underscored its role in seizure frequency reduction by 50 % or more in both adults and children, with no significant adverse events concerns.

Morphological changes in the anterior vaginal wall caused by aging: a scanning electron microscopy study.

INTRODUCTION AND HYPOTHESIS: Collagen is a protein that confers robustness and resilience to several tissues. In the female reproductive system, collagen plays a critical role in maintaining the health and function of the vaginal walls. Aging leads to collagen reduction, which may cause vaginal dryness, irritation, and prolapse. We aim to analyze the structure and profile of collagen in the anterior vaginal wall of healthy pre-menopausal (pre-M) and post-menopausal (post-M) women under a scanning electron microscope (SEM). METHODS: Fragments of the anterior vaginal wall were collected and processed for light and scanning electron microscopy. Histological preparations were performed at first with Weigert's resorcin-fuchsin stain. Decellularized preparations were conducted, and the specimens were placed under an SEM to allow observation of the 3D organization of collagen. RESULTS: Decellularized preparations of the pre-M specimens showed a vaginal wall with an irregular subepithelial layer, organized with ECM projections. The subepithelium evidenced the network of collagen fibrils, which seemed to support the epithelium as a basal layer. In specimens of post-M, a fusion of a network of fibrils from different direction axes was evidenced, with plate formation observed in the subepithelial plane, disfiguring the structural organization of fibrils. CONCLUSIONS: Older specimens showed a remodeling of collagen organization in comparison with younger samples of the anterior vaginal wall.

Real-world application of the 2022 diagnostic criteria for first-ever episode of optic neuritis.

Optic neuritis (ON) admits diverse differential diagnoses. Petzold proposed diagnostic criteria for ON in 2022, although real-world application of these criteria is missing. We conducted a retrospective review of patients with ON. We classified patients into definite or possible ON, and into groups A (typical neuritis), B (painless), or C (binocular) and estimated the frequency of etiologies for each group. We included 77 patients, with 62% definite and 38% possible ON. CRION and NMOSD-AQP4 negative-ON were less commonly seen in definite ON. Application of the 2022 criteria revealed a lower-than-expected frequency of definite ON, particularly for seronegative non-MS causes.

A comparative study of visual outcome in patients with optic neuritis treated with five or seven days of intravenous corticosteroid treatment.

BACKGROUND: Optic neuritis (ON), a major cause of visual impairment in young adults, is generally associated with rapid visual recovery when treated with intravenous methylprednisolone treatment (IVMPT). However, the optimal duration of such treatment is unknown, ranging from three to seven days in clinical practice. We aimed to compare the visual recovery in patients treated with 5-day or 7-day duration IVMPT. METHODS: We performed a retrospective cohort study of consecutive patients with ON in São Paulo, Brazil, from 2016 to 2021. We compared the proportion of participants with visual impairment in 5-day and 7-day treatment schedules at discharge, at 1 month and between 6 and 12 months after the diagnosis of ON. The findings were adjusted to age, severity of the visual impairment, co-intervention with plasma exchange, time from symptom onset to IVMPT and the etiology of the ON to mitigate indication bias. RESULTS: We included 73 patients with ON treated with 5 or 7-day duration of 1 g/d intravenous methylprednisolone therapy. Visual impairment at 6-12 months in the 5-day or the 7-day treatment groups was similar (57% x 59%, p > 0.9, Odds Ratio 1.03 [95% CI 0.59-1.84]). The results were similar after adjusting for prognostic variables and when observed at different time points. CONCLUSION: Visual recovery is similar in patients treated with 5-day and 7-day duration treatments of 1 g/day intravenous methylprednisolone, suggesting a ceiling effect. Limiting the duration of the treatment can reduce hospital stay and costs, without interfering with clinical benefit.

Aging effects in the extracellular matrix of the clitoris: A scanning electron microscopic analysis.

OBJECTIVE OF THE STUDY: The present work aims to observe the clitoris' extracellular matrix in young and old women with a scanning electron microscope. MATERIALS AND METHODS: After approval of the local research ethics committee, samples of the clitoris body were obtained from cadavers of women between 20 and 40 old (G1) and from cadavers over the age of 60 (G2). The samples were decellularized with NaOH to maintain the extracellular matrix framework, submitted to silver sputter coating, and observed under a scanning electron microscope. RESULTS: The mean age of the cadavers in G1 was 28 years old and 75±6 years old in G2. The groups were composed of 10 cadavers each. It was observed that the collagen was arranged in a disorganized fashion in the samples from the G2 in several regions. There was also a decrease in elastic fibers that anchored the collagen in these samples. The concentration of collagen showed an increase in the older samples in comparison to the G1 samples. Conclusions Female sexual dysfunction is a condition prevalent in a significantly large portion of women and it is more common in elderly women. It is known that the tumescence mechanism requires integrity of the extracellular matrix. The changes observed herein may alter the function of the organ and are similar to observations in studies of men with erectile dysfunction. CONCLUSION: Female sexual dysfunction is a condition prevalent in a significantly large portion of women and it is more common in elderly women. It is known that the tumescence mechanism requires integrity of the extracellular matrix. The changes observed herein may alter the function of the organ and are similar to observations in studies of men with erectile dysfunction. .

The development of hand, foot, trunk, hearing, and visual lateral preference throughout the lifespan.

This research investigated the developmental process of five lateral preference dimensions (hand, foot, trunk, hearing, and visual preference). A total of 1236 volunteers participated in this study, divided into five age groups: 07-12 (n = 247); 13-17 (n = 234); 18-30 (n = 227); 31-60 (n = 225); and 61-90 years old (n = 303). Lateral preference was assessed via questionnaire with the Global Lateral Preference Inventory. By assessing the degree and direction of lateral preference in different ages, our results revealed a pattern of lateralization strengthening with aging in all the analyzed dimensions. We also verified significant correlation between hand preference and the other dimensions for all age groups, but correlation was stronger in the 7-12 group for all correlation pairs. Our results lead to the suggestion of an underlying general lateralization process in early ages (7-12 years old) followed by specific developmental trajectories of each preference dimension (13 years forward), likely startled by hemisphere and functional specialization related to innate developmental patterns of neural structures and social/environmental influences.

Burst Transspinal Magnetic Stimulation Alleviates Nociceptive Pain in Parkinson Disease-A Pilot Phase II Double-Blind, Randomized Study.

BACKGROUND AND AIMS: Nociception is the most prevalent pain mechanism in Parkinson disease (PD). It negatively affects quality of life, and there is currently no evidence-based treatment for its control. Burst spinal cord stimulation has been used to control neuropathic pain and recently has been shown to relieve pain of nociceptive origin. In this study, we hypothesize that burst transspinal magnetic stimulation (bTsMS) reduces nociceptive pain in PD. MATERIALS AND METHODS: Twenty-six patients were included in a double-blind, sham-controlled, randomized parallel trial design, and the analgesic effect of lower-cervical bTsMS was assessed in patients with nociceptive pain in PD. Five daily induction sessions were followed by maintenance sessions delivered twice a week for seven weeks. The primary outcome was the number of responders (≥ 50% reduction of average pain intensity assessed on a numerical rating scale ranging from 0-10) during the eight weeks of treatment. Mood, quality of life, global impression of change, and adverse events were assessed throughout the study. RESULTS: Twenty-six patients (46.2% women) were included in the study. The number of responders during treatment was significantly higher after active than after sham bTsMS (p = 0.044), mainly owing to the effect of the first week of treatment, when eight patients (61.5%) responded to active and two (15.4%) responded to sham bTsMS (p = 0.006); the number needed to treat was 2.2 at week 1. Depression symptom scores were lower after active (4.0 ± 3.1) than after sham bTsMS (8.7 ± 5.3) (p = 0.011). Patients' global impressions of change were improved after active bTsMS (70.0%) compared with sham bTsMS (18.2%; p = 0.030). Minor adverse events were reported in both arms throughout treatment sessions. One major side effect unrelated to treatment occurred in the active arm (death due to pulmonary embolism). Blinding was effective. CONCLUSION: BTsMS provided significant pain relief and improved the global impression of change in PD in this phase-II trial. CLINICAL TRIAL REGISTRATION: The Clinicaltrials.gov registration number for the study is NCT04546529.

Lumbar lordosis variation according the type of positioner used in lumbar arthrodesis / Variação da lordose lombar segundo os tipos de posicionadores utilizados em artrodese lombar / Variación de la lordosis lumbar según el tipo de posicionador utilizado en artrodesis lumbar

ABSTRACT Objective: Evaluate the influence of the most used surgical positioners for lumbar lordosis (LL) in asymptomatic individuals. Methods: Cross-sectional study based on demographic data and radiographic parameters of asymptomatic individuals. For this study, 16 volunteers, 15 males, and one female were selected, and the average age was 24.6 years. They were submitted to lateral radiographs of the lumbar spine in orthostasis in use of the following positioners: gel cushion, gel cushion with hip extension, four-point Relton-Hall and Wilson-type positioner. Results: The mean LL in the orthostatic position was 58.76º, whereas in the gel cushion positioner it was 52.51; on the gel cushion with hip extension of 58.23º, Relton-Hall/4points 37.63º and, finally, on the Wilson-type positioner of 40.87º. An average reduction of 5.42º of the LL was observed when positioning on the gel cushion in relation to the orthostasis. In the linear regression analysis, the data presented statistically significant results (p<0.05), demonstrating that the L4-S1 segment influences 60% in LL. Conclusion: The positioner with gel cushion and hip extension reproduces an LL similar to physiological values. Relton-Hall and Wilson-type positioners with hip flexion promote hypolordotic positioning compared to basal lordosis in orthostasis. Hip extension alone generated a 5.96º increase in the subject's lordosis. The L4-S1 segment has a 60% influence on the LL when the individuals are in the positioners. Level of evidence III; Controlled cross-sectional study.

RESUMO: Objetivo: Avaliar a influência dos posicionadores cirúrgicos na lordose lombar (LL) em indivíduos assintomáticos. Métodos: Estudo transversal com dados demográficos e parâmetros radiográficos de indivíduos assintomáticos. Utilizamos 16 voluntários, sendo 15 do gênero masculino e uma do gênero feminino, com idade média de 24,6 anos. Foram submetidos a realização de radiografias em perfil da coluna lombar em ortostase nos seguintes posicionadores: coxim em gel, coxim em gel com extensão do quadril, Relton-Hall em quatro pontos e posicionador tipo Wilson. Resultados: A média de LL na posição ortostática foi de 58,76º, já no posicionador coxim em gel de 52,51; no coxim em gel com extensão dos quadris de 58,23º, Relton-Hall/4pontos 37,63º e, por último, no posicionador tipo Wilson, de 40,87º. Houve redução média de 5,42º da LL ao posicionar no coxim em gel em relação a ortostase, na análise de regressão linear os dados apresentaram resultados estaticamente significativos (p<0,05), demostrando que o seguimento L4-S1 apresenta uma influência de 60% na LL. Conclusão: O posicionador coxins em gel e extensão do quadril reproduz uma LL semelhante à fisiológica. Posicionadores do tipo Relton-Hall e Wilson com flexão do quadril promovem um posicionamento hipolordótico comparada a lordose basal em ortostase. A extensão do quadril por si só foi capaz de gerar um aumento de 5,96º na lordose do indivíduo. O seguimento L4-S1 apresenta uma influência de 60% na LL quando os indivíduos estão nos posicionadores. Nível de Evidência III; Estudo Transversal Controlado.

RESUMEN: Objetivo: Evaluar la influencia de los posicionadores quirúrgicos para la lordosis lumbar (LL) en individuos asintomáticos. Métodos: Estudio transversal con datos demográficos y parámetros radiográficos de individuos asintomáticos. Utilizamos 16 voluntarios, 15 hombres y una mujer, edad media de 24,6 años. Sometidos a radiografías laterales de la columna lumbar en ortostasis en los siguientes posicionadores: almohadilla de gel, almohadilla de gel con extensión de cadera, posicionador de cuatro puntos y posicionador tipo Wilson. Resultados: El promedio de LL en posición ortostática fue de 58,76º, en el posicionador de almohadilla de gel fue de 52,51º; en almohadilla de gel con extensión de cadera de 58,23º, 4 puntos 37,63º y, por último, en posicionador tipo Wilson de 40,87º. Se observó una reducción promedio de 5,42º de LL al posicionarse sobre la almohadilla de gel en relación a ortostasis. En el análisis de regresión lineal, los datos presentaron resultados estadísticamente significativos (p<0,05), demostrando que el segmento L4-S1 tiene una influencia de 60% en LL. Conclusión: El posicionador con almohadilla de gel y con extensión de cadera reproduce una LL similar a la fisiológica. Relton-Hall y Wilson con flexión de cadera promueven el posicionamiento hipolordótico en comparación con la lordosis basal. La extensión de la cadera por sí sola fue capaz de generar un aumento de 5,96º en la lordosis. El segmento L4-S1 tiene una influencia del 60% en la LL cuando los individuos están en los posicionadores. Nivel de evidencia III; Estudio Transversal Controlado.

Queue profile for pediatric scoliosis surgery in a reference hospital in the brazil's midwest / Perfil da fila para cirurgia de escoliose pediátrica em hospital referência do centro oeste / Perfil de la fila para cirugía de escoliosis pediátrica en hospital de referencia en el centro oeste de brasil

ABSTRACT: Objective: To describe the epidemiological profile of the list of patients with pediatric scoliosis (0 to 18 years old) treated at a tertiary public hospital in the Midwest Region. Methods: A cross-sectional analytical study of patients with scoliosis from the orthopedic service of a reference center was carried out, and data collected on age, sex, date of menarche, weight, height, etiology, curve classification, form of referral, treatment performed before and after care and waiting time for surgery after indication. The sample consisted of 60 patients randomly selected among those treated. Results: 60 patients were evaluated, 44 (73.3%) were female, and 16 (26.7%) were male, with a mean age of 13.4 years. Until the moment of the study, six patients underwent surgery after being treated at the reference center. Idiopathic scoliosis was the most frequent in 38 (63%) patients. No conduct had been performed in 47 (78.3%) patients before referral to the reference center. Aftercare at the reference center, surgical treatment was indicated in 44 (73.3%) patients. The mean waiting time for surgery after the indication was 22 months, ranging from 6 to 40 months. Conclusions: The list of patients with pediatric scoliosis treated at the reference center in the Midwest region is composed of young girls with idiopathic scoliosis who, for the most part, did not have the indication of using a brace before being referred to the reference center, and most of them had an indication for surgery for adequate treatment. Level of Evidence IV; Descriptive Study.

RESUMO: Objetivo: Descrever o perfil epidemiológico da lista de pacientes com escoliose pediátrica (0 a 18 anos) atendidos em hospital público terciário da Região Centro-Oeste. Métodos: Foi realizado estudo analítico transversal de pacientes com escoliose do serviço de ortopedia do centro de referência e coletados dados de idade, sexo, data da menarca, peso, altura, etiologia, classificação da curva, forma de encaminhamento, tratamento realizado antes e após o atendimento e tempo de espera para cirurgia após indicação. A amostra foi composta por 60 pacientes selecionados randomicamente. Resultados: Dos 60 pacientes avaliados, 44 (73,3%) eram do sexo feminino e 16 (26,7%) do sexo masculino, com idade média de 13,4 anos. Até o momento do estudo, seis pacientes foram submetidos a cirurgia após o atendimento no centro de referência. A escoliose idiopática foi a mais frequente em 38 (63%) pacientes. Nenhuma conduta havia sido realizada em 47 (78,3%) pacientes antes do encaminhamento ao centro de referência. Após o atendimento no centro de referência, o tratamento cirúrgico foi indicado em 44 (73,3%) pacientes. O tempo médio de espera pela cirurgia após a indicação foi de 22 meses, variando de 6 a 40 meses. Conclusões: A lista de pacientes com escoliose pediátrica atendidos no único centro de referência da região Centro-oeste é composta por meninas jovens, com escoliose idiopática, que em grande parte não tiveram a indicação do uso de colete antes do encaminhamento ao centro de referência, e tiveram em sua maioria indicação de cirurgia para tratamento adequado. Nível de Evidência IV; Estudo Descritivo.

RESUMEN: Objetivo: Describir el perfil epidemiológico de pacientes con escoliosis pediátrica (0 a 18 años) atendidos en un hospital público terciario de la Región Centro Oeste. Métodos: Se realizó un estudio analítico transversal de pacientes con escoliosis del servicio de ortopedia del centro de referencia y se recogieron datos sobre edad, sexo, fecha de la menarquia, peso, talla, etiología, clasificación de la curva, forma de derivación, tratamiento realizado antes y después de la atención y el tiempo de espera para la cirugía después de la indicación. La muestra estuvo constituida por 60 pacientes seleccionados aleatoriamente. Resultados: De los 60 pacientes, 44 (73,3%) eran mujeres y 16 (26,7%) hombres, con edad media de 13,4 años. Hasta el momento del estudio, seis pacientes fueron intervenidos quirúrgicamente. La escoliosis idiopática fue la más frecuente, en 38 (63%) pacientes. En 47 (78,3%) pacientes no se había realizado ninguna conducta antes de la derivación al centro de referencia. Tras la atención en el centro de referencia, se indicó tratamiento quirúrgico en 44 (73,3%) pacientes. El tiempo medio de espera de la cirugía fue de 22 meses, con un rango de 6 a 40 meses. Conclusiones: La lista de pacientes con escoliosis pediátrica atendidos en el único centro de referencia de la región Centro Oeste está compuesta por niñas jóvenes, quienes en su mayor parte no tenían indicación de uso de ortesis, y la mayoría tenía indicación de cirugía para un adecuado tratamiento. Nivel de evidencia IV; Estudio Descriptivo.

Penalty feet positioning rule modification and laterality effect on soccer goalkeepers' diving kinematics.

In 2019, a new rule was applied in soccer. It allows the goalkeeper to have only one foot or part of it on the goal line when the kicker hits the ball, unlike the previous rule that determined the goalkeeper should have both feet on the line. The purpose of the present study was to analyze how the change in the rule and the lower limbs laterality influences on the diving save kinematic performance in penalties. Six goalkeepers, two professionals and four amateurs, performed a total of 20 dives in the laboratory and had their force and impulse exerted by the lower limb and displacement/velocity data from the center of body mass collected through force plates and kinematic analysis. The side preference was collected through an inventory. The results showed that goalkeepers dive further (p < 0.001) and faster (p < 0.001) when diving according to the new rule. Dives for the non-dominant side presented higher values than the trials for the dominant side in mediolateral (p = 0.02) and resultant (p = 0.03) displacements. Concluding, the goalkeepers performed better with the new rule in the analyzed variables and the lower limb preference has influenced only the mediolateral and resultant displacement.

TiO2 nanoparticles added to dense bovine hydroxyapatite bioceramics increase human osteoblast mineralization activity.

OBJECTIVES: This study evaluated the effect of TiO2 nanoparticles + dense hydroxyapatite (HA) on human osteoblast cells (SAOS-2). METHODS: Particulate bovine HA powder with or without the addition of either 5 or 8 % TiO2 (HA, HA/TiO2Np5 % or HA/TiO2Np8 %) were pressed into disks (Ø = 12.5 mm; thickness = 1.3 mm) uniaxially (100 MPa) and isostatically (200 MPa/1 min) and sintered at 1300 °C. Y-TZP disks were used as control. The following tests were performed: Scanning Electron Microscopy and Dispersive Energy Spectroscopy (SEM/EDS), Atomic Force Microscopy (AFM), cell viability assay (Alamar Blue-AB) and mineralized matrix deposition (Alizarin Red-AR). AB and AR data were submitted to 2-way ANOVA/Tukey tests and ANOVA/Tukey tests, respectively. RESULTS: SEM revealed that the surface of HA/TiO2Np5% resembles DPBHA surface, but also contains smaller granules. HA/TiO2Np8% characteristics resembles HA/TiO2Np5% surface, but with irregular topography. Y-TZP showed a typical oxide ceramic surface pattern. EDS revealed Ca, O, and P in all samples. C, O, and Zr appeared in Y-TZP samples. AFM data corroborates SEM analysis. AB test revealed excellent cellular viability for HA/TiO2Np5% group. AR test showed that all groups containing TiO2np had more mineralized matrix deposition than all other groups, with statistically differences between HA/TiO2Np8% and HA cultivated in non-osteogenic medium. Culture in osteogenic medium exhibited much more mineralized matrix deposition by TiO2np groups. SIGNIFICANCE: In conclusion, the addition of TiO2np showed chemical, superficial, and biological changes in the reinforced materials. HA/TiO2Np5% showed the best results for cell viability and HA/TiO2Np8% for mineralized matrix deposition.

Trace Elements in Beef Cattle: A Review of the Scientific Approach from One Health Perspective.

The objective was to investigate the context, approach and research topics present in the papers that analysed trace elements in beef cattle to identify gaps and scientific perspectives for the sustainable management of trace elements in livestock. The main research groups came from the United States, Spain, Japan, Brazil, India and Slovakia, which represented 31% of the papers produced. Only 37% of studies addressed aspects that integrated animal, environmental and human health. The reviewed papers concerned 56 elements and 15 bovine tissues (Cu, Zn, Pb, liver, muscle and kidney highlighted). The main gaps were (1) lack of research in developing countries, (2) the need to understand the impact of different environmental issues and their relationship to the conditions in which animals are raised, and (3) the need to understand the role of many trace elements in animal nutrition and their relationship to environmental and human health. Finally, we highlight possible ways to expand knowledge and provide innovations for broad emerging issues, primarily through expanding collaborative research networks. In this context, we suggest the adoption of the One Health approach for planning further research on trace elements in livestock. Moreover, the One Health approach should also be considered for managers and politicians for a sustainable environmental care and food safety.

Changes in fatty acid composition as a response to glyphosate toxicity in Pseudomonas fluorescens.

Excessive use of herbicides decreases soil biodiversity and fertility. The literature on the xenobiotic response by microorganisms is focused on herbicide biodegradation as a selective event. Non-degradation systems independent of selection could allow the survival of tolerant bacteria in contaminated environments, impacting xenobiotic turnover and, consequently, bioremediation strategies. However, it is uncertain whether the response based on these systems requires selective pressure to be effective. The objective here was to analyze non-degradation phenotypes, enzymatic and structural response systems, of Pseudomonas fluorescens CMA-55 strain, already investigated the production pattern of quorum sensing molecules in response to glyphosate, not present at the isolation site. One mode of response was associated with decrease in membrane permeability and effective antioxidative response for 0-2.30 mM glyphosate, at the mid-log growing phase, with higher activities of Mn-SOD, KatA, and KatB, and presence of fatty acids as nonadecylic acid, margaric and lauric acid. The second response system was characterized by lower antioxidative enzymes activity, presence of KatC isoform, and pelargonic, capric, myristic, stearic, palmitoleic and palmitic acid as principal fatty acids, allowing the strain to face stressful conditions in 9.20-11.50 mM glyphosate at the stationary phase. Therefore, the bacterial strain could modify the fatty acid composition and the permeability of membranes in two response modes according to the herbicide concentration, even glyphosate was not previously selective for P. fluorescens, featuring a generalist system based on physiological plasticity.