Shear wave elastography for assessing the anterior scalene elasticity in patients with neck pain.

PURPOSE: Shear-wave elastography (SWE) provides quantitative and absolute metrics for analyzing the elasticity of soft tissues. Despite the anterior scalene muscle (AS) is a key structure in patients with neck pain and nerve compressive syndromes, the majority of SWE studies only included asymptomatic subjects. This study aimed to analyze the Young's modulus and shear wave speed test-retest reliability in a sample of patients with neck pain symptoms to characterize the AS stiffness. METHODS: A diagnostic accuracy study acquiring a set of ultrasound images at C7 level in 42 patients with mechanical neck pain by one experienced examiner. After blinding the participants' identity, trial and side, the Young's modulus and shear wave velocity were measured by an independent experienced rater in randomized order. Intra-class correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable changes (MDC) and coefficient of variation (CV%) were calculated. RESULTS: The sample reported moderate pain intensity (5.9/10 points) and disability (17.38/100 points). AS stiffness metrics assessed showed no significant differences between males and females, left and right side nor painful and non-painful side. (all, p > 0.05). Intra-examiner reliability was excellent for calculating the Young's modulus for shear wave speed (ICC > 0.90). CONCLUSION: The results support the use of this procedure for assessing the AS stiffness in populations with mechanical neck pain as excellent reliability estimates were obtained. However, future research should analyze case-control differences and the association between SWE metrics with clinical severity indicators.

Reliability of Panoramic Ultrasound in Assessing Rectus Femoris Size, Shape, and Brightness: An Inter-Examiner Study.

Extended field-of-view ultrasound (US) imaging, also known as panoramic US, represents a technical advance that allows for complete visualization of large musculoskeletal structures, which are often limited in conventional 2D US images. Currently, there is no evidence examining whether the experience of examiners influences muscle shape deformations that may arise during the glide of the transducer in panoramic US acquisition. As no studies using panoramic US have analyzed whether two examiners with differing levels of experience might obtain varying scores in size, shape, or brightness during the US assessment of the rectus femoris muscle, our aim was to analyze the inter-examiner reliability of panoramic US imaging acquisition in determining muscle size, shape, and brightness between two examiners. Additionally, we sought to investigate whether the examiners' experience plays a significant role in muscle deformations during imaging acquisition by assessing score differences. Shape (circularity, aspect ratio, and roundness), size (cross-sectional area and perimeter), and brightness (mean echo intensity) were analyzed in 39 volunteers. Intraclass correlation coefficients (ICCs), standard error of measurements (SEM), minimal detectable changes (MDC), and coefficient of absolute errors (CAE%) were calculated. All parameters evaluated showed no significant differences between the two examiners (p > 0.05). Panoramic US proved to be reliable, regardless of examiner experience, as no deformations were observed. Further research is needed to corroborate the validity of panoramic US by comparing this method with gold standard techniques.

Reproducibility of Anterior Scalene Stiffness Measurement with Shear Wave Elastography: An Inter-Examiner Reliability Study.

PURPOSE: Although previous studies have highlighted the clinical relevance of the anterior scalene muscle (AS) in patients with neck pain or nerve compressive syndromes, evidence reporting the diagnostic accuracy of shear wave elastography (SWE) for assessing the AS stiffness properties is lacking. This study aimed to analyze the SWE inter-examiner reliability for calculating the Young's modulus and shear wave speed of the AS muscle in asymptomatic subjects. MATERIALS AND METHODS: Using a linear transducer, ultrasound images of the antero-lateral neck region at the C7 level were acquired in 35 healthy volunteers by one experienced examiner and one novice examiner. After codifying the images to blind the participants' identity, the trial, and the side, Young's modulus and shear wave speed were obtained by an independent experienced rater in randomized order. Intra-class correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable changes (MDC), and coefficient of variation (CV%) were calculated. RESULTS: The assessed AS metrics showed no side-to-side differences (p>0.05). Sex differences were found for muscle size (p=0.002), but muscle brightness and stiffness were similar (p>0.05). Inter-examiner reliability was good for determining the AS muscle stiffness (ICC = 0.881 for Young's modulus and 0.850 for shear wave speed). CONCLUSION: The obtained results suggest that assessing the AS stiffness properties in asymptomatic subjects is a reliable procedure. Further studies should verify the SWE capacity for discriminating healthy and clinical populations and identify potential factors contributing to the variance of measurement errors.

A novel mobile phone and tablet application for automatized calculation of pain extent.

BACKGROUND: Pain drawings (PDs) are used for assessing pain extent as a complementary outcome to other pain measurements, consisting of shading a body chart template to report the location and extent of pain. However, the accuracy and reliability of digital PDs remain controversial due to the heterogeneity of methods used. This study aimed to develop an easy-to-use application for assessing its diagnostic accuracy in comparison with the classic paper-and-pencil method. METHODS: A test-retest reliability study was conducted, recruiting 95 patients with musculoskeletal pain symptoms. Participants shaded 2 sets of 3 different PDs (paper-and-pencil PD, digital PD using the finger and digital PD using the digital stylus). Intraclass correlation coefficients (ICC), standard error of measurement and minimal detectable changes (MDC) were calculated for each method. Finally, repeated measure analysis of variance assessed the mean differences between trials and methods and the convergent validity between methods was calculated using Pearson's correlation coefficients. RESULTS: All methods were excellently reliable (all, ICC>0.94). However, digital PDs obtained higher ICCs (ICC≥0.970) and greater accuracy to detect whether changes reflect a real change and are not due to a measurement errors (MDC = 0.72%-0.80 % for digital PDs versus MDC = 1.13 % for paper-and-Pencil PDs). No significant score differences were found among the instruments for assessing pain extent (p > 0.05). Finally, the PAIN EXTENT app showed adequate convergent validity (r > 0.850). CONCLUSION: The PAIN EXTENT app is a fast and easy-to-use instrument compatible with operative systems and devices commonly used for assessing and monitoring pain extent in the clinical and research settings.

Skin Bioimpedance Analysis to Determine Cellular Integrity by Phase Angle in Women with Fibromyalgia: A Cross-Sectional Study.

Oxidative stress has been proposed as a significant part of the pathogenesis of fibromyalgia, and the phase angle in bioelectrical impedance analysis has been explored as a potential technique to screen oxidative abnormalities. This study recruited 35 women with fibromyalgia and 35 healthy women, who underwent bioelectrical impedance analysis and maximum isometric handgrip strength tests. Women with fibromyalgia showed lower bilateral handgrip strength (right hand: 16.39 ± 5.87 vs. 27.53 ± 4.09, p < 0.001; left hand: 16.31 ± 5.51 vs. 27.61 ± 4.14, p < 0.001), as well as higher body fat mass (27.14 ± 10.21 vs. 19.94 ± 7.25, p = 0.002), body fat percentage (37.80 ± 8.32 vs. 30.63 ± 7.77, p < 0.001), and visceral fat area (136.76 ± 55.31 vs. 91.65 ± 42.04, p < 0.01) compared with healthy women. There was no statistically significant difference in muscle mass between groups, but women with fibromyalgia showed lower phase angles in all body regions when compared with healthy control women (right arm: 4.42 ± 0.51 vs. 4.97 ± 0.48, p < 0.01; left arm: 4.23 ± 0.48 vs. 4.78 ± 0.50, p < 0.001; trunk: 5.62 ± 0.77 vs. 6.78 ± 0.84, p < 0.001; right leg: 5.28 ± 0.56 vs. 5.81 ± 0.60, p < 0.001; left leg: 5.07 ± 0.51 vs. 5.69 ± 0.58, p < 0.001; whole body: 4.81 ± 0.47 vs. 5.39 ± 0.49, p < 0.001). Moreover, whole-body phase-angle reduction was only predicted by the presence of fibromyalgia (R2 = 0.264; ß = 0.639; F(1,68) = 24.411; p < 0.001). Our study revealed significantly lower phase angle values, lower handgrip strength, and higher fat levels in women with fibromyalgia compared to healthy controls, which are data of clinical relevance when dealing with such patients.

Neuromuscular but Not Technical Performance is Affected by Time-of-Day in Semiprofessional, Female Basketball Players.

Purpose: The aim of this study was to determine whether variations in technical and neuromuscular performance occur across different times of the day in basketball players. Methods: Twenty semiprofessional, female basketball players (23 ± 4 years) competing in a second-division national basketball competition completed separate testing batteries in the morning (08:30) and in the afternoon (17:30) in a randomized counterbalanced order. Testing sessions consisted of a free-throw accuracy test to assess technical performance, as well as flexibility (ankle dorsiflexion range-of-motion test), dynamic balance (modified star excursion balance test), vertical jump height (squat jump, countermovement jump with and without arm swing), strength (isometric handgrip), change-of-direction speed (V-cut test), and linear speed (20-m sprint) tests to assess neuromuscular performance. Mechanism variables were also obtained including tympanic temperature, urinary specific gravity, and rating of perceived exertion at each session. Results: Squat jump height (6.7%; p = .001; effect size (ES) = 0.33), countermovement jump height with (4.1%; p = .018; ES = 0.27) and without arm swing (5.9%; p = .007; ES = 0.30), and 20-m sprint time (-1.4%; p = .015; ES = -0.32) were significantly superior in the afternoon compared to morning. Tympanic temperature was significantly higher in the afternoon than morning (1.4%; p < .001; ES = 1.31). In contrast, no significant differences between timepoints were evident for all remaining variables (p > .05; ES = -0.33 to 0.16). Conclusions: Some neuromuscular variables exhibited a time-of-day effect with better jump and sprint performance in the afternoon compared to morning in semiprofessional, female basketball players.

Estimating fat-free mass in recreationally resistance-trained young men: Longitudinal and cross-sectional validation of different methods.

Several techniques exist to measure fat-free mass (FFM). Accordingly, this study is based on data from our recent trial comparing the sensitivity of the main field methods available with that of dual-energy X-ray absorptiometry (DXA) as reference and analyzing the cross-sectional accuracy of these field methods in recreationally resistance-trained males. We hypothesized that the use of these techniques would lead to varying estimates of FFM compared with DXA. Participants (N = 23; 21.4 ± 3.3 years) completed a 10-week resistance training plus diet intervention designed to optimize hypertrophy. FFM was determined by bioelectrical impedance analysis (BIA), 23 anthropometric equations, and DXA. After the intervention, FFM increased significantly according to BIA and most anthropometric estimates, but this increase was not detected by 2 anthropometric equations or by DXA. Only 1 of these 2 equations showed significant correlation with DXA and no standardized or significant differences to this reference method, although it did display significant heteroscedasticity. In our cross-sectional analysis, only 1 anthropometric equation gave rise to good accuracy as confirmed by DXA. Our findings indicate that the use of different techniques to assess FFM gains in response to a hypertrophic intervention yields different results. BIA with general embedded equations should not be used to monitor a young male adult's body composition. To monitor FFM over time, we would recommend the Dunne et al. equation (2) as the most sensitive field method, and to assess FFM cross-sectionally, equation (1) of these authors is the most accurate field method.

A Procedure for Measuring Anterior Scalene Morphology and Quality with Ultrasound Imaging: An Intra- and Inter-rater Reliability Study.

OBJECTIVE: Ultrasound (US) imaging is an essential tool for clinicians because of its cost-effectiveness and accessibility for assessing multiple muscle metrics including muscle quality, size and shape. Although previous studies highlighted the importance of the anterior scalene muscle (AS) in patients with neck pain, studies analyzing the reliability of US measurements for this muscle are lacking. This study aimed to develop a protocol for assessing AS muscle shape and quality measured with US and investigating its intra- and inter-examiner reliability. METHODS: Through use of a linear transducer, B-mode images of the anterolateral neck region at the C7 level were acquired in 28 healthy volunteers by two examiners (one experienced and one novel). Cross-sectional area, perimeter, shape descriptors and mean echo-intensity were measured twice by each examiner in randomized order. Intra-class correlation coefficients (ICCs), standard errors of measurement and minimal detectable changes were calculated. RESULTS: Results indicated no muscle side-to-side asymmetries (p > 0.05). Gender differences were found for muscle size (p < 0.01), but muscle shape and brightness were comparable (p > 0.05). Intra-examiner reliability was good to excellent for all metrics for the experienced and (ICC >0.846) and novel (ICC >780) examiners. Although inter-examiner reliability was good for most of the metrics (ICC >0.709), the estimates for assessing solidity and circularity were unacceptable (ICC <0.70). CONCLUSION: This study found that the described ultrasound procedure for locating and measuring anterior scalene muscle morphology and quality is highly reliable in asymptomatic individuals.

Exploring the correlations between epi indicators of COVID-19 and the concentration of pharmaceutical compounds in wastewater treatment plants in Northern Portugal.

The COVID-19 pandemic caused by the SARS-CoV-2 virus led to changes in the lifestyle and human behaviour, which resulted in different consumption patterns of some classes of pharmaceuticals including curative, symptom-relieving, and psychotropic drugs. The trends in the consumption of these compounds are related to their concentrations in wastewater systems, since incompletely metabolised drugs (or their metabolites back transformed into the parental form) may be detected and quantified by analytical methods. Pharmaceuticals are highly recalcitrant compounds and conventional activated sludge processes implemented in wastewater treatment plants (WWTP) are ineffective at degrading these substances. As a results, these compounds end up in waterways or accumulate in the sludge, being a serious concern given their potential effects on ecosystems and public health. Therefore, it is crucial to evaluate the presence of pharmaceuticals in water and sludge to assist in the search for more effective processes. In this work, eight pharmaceuticals from five therapeutic classes were analysed in wastewater and sludge samples collected in two WWTP located in the Northern Portugal, during the third COVID-19 epidemic wave in Portugal. The two WWTP demonstrated a similar pattern with respect to the concentration levels in that period. However, the drugs loads reaching each WWTP were dissimilar when normalising the concentrations to the inlet flow rate. Acetaminophen (ACET) was the compound detected at highest concentrations in aqueous samples of both WWTP (98. 516 µg L - 1 in WWTP2 and 123. 506 µg L - 1in WWTP1), indicating that this drug is extensively used without the need of a prescription, known of general public knowledge as an antipyretic and analgesic agent to treat pain and fever. The concentrations determined in the sludge samples were below 1.65 µg g - 1 in both WWTP, the highest value being found for azithromycin (AZT). This result may be justified by the physico-chemical characteristics of the compound that favour its adsorption to the sludge surface through ionic interactions. It was not possible to establish a clear relationship between the incidence of COVID-19 cases in the sewer catchment and the concentration of drugs detected in the same period. However, looking at the data obtained, the high incidence of COVID-19 in January 2021 is in line with the high concentration of drugs detected in the aqueous and sludge samples but prediction of drug load from viral load data was unfeasible.

Correlation between Body Composition and Inter-Examiner Errors for Assessing Lumbar Multifidus Muscle Size, Shape and Quality Metrics with Ultrasound Imaging.

Ultrasound imaging (US) is widely used in several healthcare disciplines (including physiotherapy) for assessing multiple muscle metrics such as muscle morphology and quality. Since measuring instruments are required to demonstrate their reliability, accuracy, sensitivity, and specificity prior to their use in clinical and research settings, identifying factors affecting their diagnostic accuracy is essential. Since previous studies analyzed the impact of sociodemographic but not body composition characteristics in US errors, this study aimed to assess whether body composition metrics are correlated with ultrasound measurement errors. B-mode images of the lumbar multifidus muscle at the fifth lumbar vertebral level (L5) were acquired and analyzed in 49 healthy volunteers by two examiners (one experienced and one novel). Cross-sectional area, muscle perimeter and mean echo intensity were calculated bilaterally. A multivariate correlation matrix was calculated for assessing the inter-examiner differences with body composition metrics. Results demonstrated excellent reliability (intraclass correlation coefficient, ICC > 0.9) for assessing the muscle cross-sectional area and perimeter, and good reliability for assessing the muscle shape and mean echo intensity (ICC > 0.7). Inter-examiner errors for estimating muscle size were correlated with participants' age (p value, p < 0.01), weight (p < 0.05), total and trunk lean mass (both, p < 0.01) and water volume (p < 0.05). Greater shape descriptors and mean brightness disagreements were correlated with older ages (p < 0.05) and total lean mass (p < 0.05). No correlations between age and body composition metrics were found (p > 0.05). This study found US to be a reliable tool for assessing muscle size, shape and mean brightness. Although aging showed no correlations with body composition changes in this sample, it was the main factor correlated with US measurement errors.

Changes in stiffness at active myofascial trigger points of the upper trapezius after dry needling in patients with chronic neck pain: a randomized controlled trial.

BACKGROUND/OBJECTIVE: Since, to our knowledge, the effects of dry needling (DN) on active myofascial trigger point (MTrP) stiffness have not been analyzed previously with shear wave elastography (SWE), our aim was to compare the effects of a single session of DN and sham DN applied to the most active MTrP located in the upper trapezius muscle on clinical outcomes. METHODS: A randomized, double-blinded sham-controlled trial was conducted; 60 patients were randomized into an experimental (DN) or sham (sham DN) group. Baseline data including sociodemographic and clinical characteristics were collected. SWE and pain pressure thresholds (PPTs) at the MTrP and a control point located 3 cm laterally were the main outcomes assessed before and 10 min after the interventions. RESULTS: Patients receiving DN interventions experienced greater increases in the control point PPTs immediately after receiving the intervention compared with sham DN (p < 0.05), but no differences were found for the MTrP (p > 0.05). Post-intervention PPT improvements were found at both locations for both groups (p < 0.01). No significant changes for either MTrP or control locations were found for SWE outcomes in either group (all ps > 0.05). No significant within-group SWE differences were found in the DN or sham DN groups (p > 0.05). CONCLUSION: A single session of DN or sham DN applied to active MTrPs located in the upper trapezius muscle produced no detectable changes in stiffness at the MTrP or control locations. Real DN induced an immediate analgesic response at both MTrP and control locations, while sham DN induced an immediate MTrP response. TRIAL REGISTRATION NUMBER: NCT04832074 (ClinicalTrials.gov).

Antioxidant vitamin supplementation on muscle adaptations to resistance training: A double-blind, randomized controlled trial.

OBJECTIVES: The aim of this study was to examine whether antioxidant vitamin supplementation with vitamin C (VitC) and vitamin E (VitE) affects the hypertrophic and functional adaptations to resistance training in trained men. METHODS: This was a double-blind, randomized controlled trial in which participants were supplemented daily with VitC and VitE ( n = 12) or placebo ( n = 11) while completing a 10-wk resistance training program accompanied by a dietary intervention (300 kcal surplus and adequate protein intake) designed to optimize hypertrophy. Body composition (dual-energy x-ray absorptiometry), handgrip strength, and one-repetition maximum (1-RM), maximal force (F0), velocity (V0), and power (Pmax) were measured in bench press (BP) and squat (SQ) tests conducted before and after the intervention. To detect between-group differences, multiple-mixed analysis of variance, standardized differences, and qualitative differences were estimated. Relative changes within each group were assessed using a paired Student's t test. RESULTS: In both groups, similar improvements were produced in BP 1-RM , SQ 1-RM SQ, and BP F0 (P < 0.05) after the resistance training program. A small effect size was observed for BP 1-RM (d = 0.53), BP F0 (d = 0.48), and SQ 1-RM (d = -0.39), but not for SQ F0 (d = 0.03). Dominant handgrip strength was significantly increased only in the placebo group (P < 0.05). According to body composition data, a significant increase was produced in upper body fat-free mass soft tissue (FFMST; P < 0.05) in the placebo group, whereas neither total nor segmental FFMST was increased in the vitamin group. Small intervention effect sizes were observed for upper body FFSMT (d = 0.32), non-dominant and dominant leg FFMST (d = -0.39; d = -0.42). Although a significant increase in total body fat was observed in both groups (P < 0.05) only the placebo group showed an increase in visceral adipose tissue (P < 0.05), showing a substantial intervention effect (d = 0.85). CONCLUSIONS: The data indicated that, although VitC/VitE supplementation seemed to blunt upper body strength and hypertrophy adaptations to resistance training, it could also mitigate gains in visceral adipose tissue elicited by an energy surplus.

Association between Gray-Scale Ultrasound Imaging and Serological Creatine Kinase for Quantifying Exercise-Induced Muscle Damage: An Observational Study.

Limited evidence has verified if ultrasound imaging (US) can detect post-exercise muscle damage based on size, shape, and brightness metrics. This study aimed to analyze the correlation between creatine kinase (CK) concentration and (as a biomarker of muscle damage) changes in US gray-scale metrics after an exercise-induced muscle damage protocol. An observational study was conducted at a private university lab located in Madrid. Twenty-five untrained and asymptomatic volunteers were enrolled in this study. Baseline demographic data and body composition metrics were collected. In addition, the rectus femoris US data and CK concentration were assessed at baseline and after inducing muscle damage (24 and 48 h later). After calculating time differences for all the outcomes, the correlation between the changes observed with US and biomarkers was assessed. Significant CK concentration increases were found 24 h (p = 0.003) and 48 h (p < 0.001) after exercise. However, no significant changes in muscle size, shape, or brightness were found in any location (p > 0.05 for all). In addition, no significant associations were found between CK changes and US changes (p > 0.05 for all). Gray-scale US is not a sensitive tool for detecting muscle damage, as a protocol of exercise-induced muscle damage confirmed with CK produced no significant gray-scale US changes after 24 or 48 h. In addition, US and CK changes after 24 and 48 h were not associated with each other.

The effects of global postural re-education on sleep quality and stress in university women lecturers: a randomized controlled trial.

Objective: The present study aimed to evaluate the effect of global postural re-education (GPR) on sleep quality and stress in female health science lecturers. Methods: A total of 24 female university lecturers were allocated in this randomized controlled trial into intervention (n = 12) and control (n = 12) groups. The intervention group underwent familiarization and training on the therapy to execute an 8-week treatment with GPR. Data collected on sleep quality were analyzed using 24-h accelerometry (Actigraphy GT3X+) in addition to the Pittsburgh Sleep Quality Index (PSQI) questionnaire score as well as the State-Trait Anxiety Inventory (STAI) anxiety questionnaire. Data on stress were collected by measuring salivary cortisol. Results: After comparing the GPR of the groups, there was a main effect of the group (F = 5.278, p = 0.044) for PSQI. The post-hoc analysis revealed that both groups decreased scores between pre- and post-treatment. Additionally, post-treatment, there were differences between groups. For sleep latency, there were main effects of group (F = 6.118, p = 0.031) and score × group (F = 9.343, p = 0.011) interactions. The post-hoc analysis revealed that treatment groups decreased scores between pre- and post-treatment, and there were differences between groups (all p < 0.050). Conclusion: The self-administered GPR improves sleep quality in female university lecturers, providing a valuable self-regulation tool for enhanced sleep quality and enhanced academic performance. Further study may help to develop this as a potential tool to help university lecturers' job performance.

POWERbreathe® Inspiratory Muscle Training in Amyotrophic Lateral Sclerosis.

Inspiratory muscle training may benefit respiratory function, cardiocirculatory parameters, quality of life and functionality in neuromuscular diseases. This pilot study aimed to demonstrate the POWERbreathe® inspiratory muscle training effects on maximum inspiratory pressure (PImax), heart rate (HR) and HR variability, as well as the quality of life impairment and functionality in patients with Amyotrophic Lateral Sclerosis (ALS). A pilot single-blinded, non-randomized controlled clinical trial was carried out. A total of 20T ALS patients were enrolled and divided into experimental (n = 10) and control (n = 10) groups. The experimental group received POWERbreathe® inspiratory muscle training in conjunction with usual care, and the control group received only usual care for 8 weeks. PImax (measured by POWERbreathe® KH1), HR and HR variability (evaluated by Polar H7), quality of life impairment [measured by the Amyotrophic Lateral Sclerosis Assessment Questionnaire­40 items (ALSAQ-40)] and functionality [assessed by the ALS Functional Rating Scale Revised (ALSFRS-R)] were collected at baseline and after 8 weeks of intervention. We detected statistically significant differences (p < 0.05) with an effect size ranging from medium to large (Cohen's d = 0.72−1.37); relative to the control group, the experimental group had an increased PImax (mean difference = 10.80 cm H2O; 95% CI = 3.42−18.17) and ALSFRS-R score (mean difference = 5.30 points; 95% CI = −0.03−10.63) and reduced HR (mean difference = −8.80 beats-per-minute; 95% CI = −20.27−2.67) and R-R interval (mean difference = 78.30 ms; 95% CI = 2.89−153.70). POWERbreathe® inspiratory muscle training, in addition to usual care, may improve inspiratory strength and heart rate in patients with ALS. These results encourage larger and longer trials investigating potential clinically relevant benefits of inspiratory muscle training to these patients over the disease course.

Exercise Physiology at "Conversational Level" Is Not Impaired in Healthy Young Subjects Wearing Masks or Respirators.

OBJECTIVE: The aim of this study was to evaluate the effects of the use of both surgical masks and FFP2 respirators on the inspiratory muscle strength, metabolic parameters, heart rate, subjective perceived exertion, and dyspnea perception, before and during 30 min stable load exercise at "conversational level". METHODS: A randomized cross-over study was carried out. Nineteen healthy adults completed 3 conditions (without a mask, with a surgical mask or an FFP2 respirator) during a 30-min steady-state test at the lactate threshold intensity. Inspiratory muscle strength was measured before and after the test, and metabolic parameters, heart rate, subjective perceived exertion, and dyspnea perception were collected at baseline, during, and after the test. RESULTS: There was a significant reduction in inspiratory muscle strength after the 30-min test in all conditions (control: 6.26 mm Hg, p < 0.5; surgical mask: 8.55 mm Hg, p < 0.01; FFP2 respirator: 12.42 mm Hg, p < 0.001), but without significant differences between them (p = 0.283). Data showed a statistically significant effect for time, but did not show a statistically significant interaction between condition and time for heart rate (p = 0.674), oxygen saturation (p = 0.297), blood lactate level (p = 0.991), rating perceived exertion (p = 0.734) and dyspnea (p = 0.532) comparisons. CONCLUSIONS: The present study findings suggested that inspiratory muscle strength and physiological parameters during "conversational level" exercise were not impaired under wearing masks in healthy, nonsmoking young adults.

The Main Role of Diaphragm Muscle as a Mechanism of Hypopressive Abdominal Gymnastics to Improve Non-Specific Chronic Low Back Pain: A Randomized Controlled Trial.

BACKGROUND: Chronic low back pain (LBP) has been stated as one of the main health concerns in the XXI century due to its high incidence. OBJECTIVE: The objective of this study was to determine the effects of an 8-week program of hypopressive abdominal gymnastics (HAG) on inspiratory muscle strength, diaphragm thickness, disability and pain in patients suffering from non-specific chronic LBP. METHODS: A total of 40 patients with chronic LBP were randomly divided into two groups. The experimental group carried out an 8-week supervised program of HAG (two sessions/week), whereas the control group did not receive any treatment. Outcomes were measured before and after the intervention, comprising diaphragm thickness during relaxed respiratory activity, maximal inspiratory pressure (PImax), pain intensity (NRS), pressure pain threshold and responses to four questionnaires: Physical Activity Questionnaire (PAQ), Roland-Morris Disability Questionnaire (RMQ), Central Sensitization Inventory (CSI) and Tampa Scale of Kinesiophobia-11 Items (TSK-11). RESULTS: Statistically significant differences (p < 0.05) were observed for greater thickness of the left and right hemi-diaphragms at inspiration, as well as higher PImax and decreased NRS, CSI and RMQ scores in the intervention group. After treatment, the increases in the thickness of the left and right hemi-diaphragms at inspiration and PImax, as well as the decrease in the NRS and RMQ scores, were only predicted by the proposed intervention (R2 = 0.118-0.552). CONCLUSIONS: An 8-week HAG intervention seemed to show beneficial effects and predicted an increase in diaphragm thickness and strength during inspiration, as well as a reduction in pain intensity, central sensitization and disability, in patients suffering from chronic non-specific LBP with respect to non-intervention.

Multi-residue analysis of fifty pesticides in river waters and in wastewaters.

Three sampling campaigns were performed in the Lis River (Leiria, Portugal) in February of 2018, November of 2018, and May of 2019. River water and wastewater (influent and effluent) samples of two wastewater treatment plants were target of the study. A total of 25 samples were collected and 50 pesticides were monitored, including organochlorines, triazines, pyrethroids, and organophosphorus, among others. Most of the detected pesticides were insecticides and mainly organochlorines. Concentrations between 1.29 and 2134 ng/L were found. Aldrin, γ-HCH, and cypermethrin were detected in some samples in µg/L, being γ-HCH the pesticide most frequently detected with concentration in µg/L level. The pesticides with the highest detection frequency were (i) cypermethrin, HCB, methoxychlor, and ζ-HCH in river waters; (ii) isoproturon, cypermethrin, methoxychlor, pyrimethanil, γ-HCH, dieldrin, diuron, α-HCH, and α-endosulfan in effluents; and (iii) diuron and isoproturon in influents. The detection of the organochlorides and their degradation products is a consequence of their persistence in the environment, as their usage has long been prohibited in the European Union. Pesticides were grouped by their types in herbicides, insecticides, or fungicides and the detection and concentration for each type were discussed with the climatic conditions. Pesticide toxicity index was determined in the samples collected in the river.

Is Shear-Wave Elastography a Clinical Severity Indicator of Myofascial Pain Syndrome? An Observational Study.

Since manual palpation is a subjective procedure for identifying and differentiate Myofascial Trigger Points -MTrPs-, the use of Shear Wave Elastography -SWE- as an objective alternative is increasing. This study aimed to analyze pain pressure thresholds -PPTs- and SWE differences between active MTrPs, latent MTrPs and control points located in the upper trapezius to analyze the association of SWE features with clinical severity indicators (e.g., pain extension area, PPTs, neck pain and neck disability). An observational study was conducted to calculate the correlation and to analyze the differences of sociodemographic, clinical and SWE features on 34 asymptomatic subjects with latent MTrPs and 19 patients with neck pain and active MTrPs. Significant PPT differences between active with latent MTrPs (p < 0.001) and control points (p < 0.001) were found, but no differences between latent MTrPs and control points (p > 0.05). No stiffness differences were found between active MTrPs with latent MTrPs or control points (p > 0.05). However, significant control point stiffness differences between-samples were found (p < 0.05). SWE showed no significant correlation with clinical severity indicators (p > 0.05). No stiffness differences between active and latent MTrPs were found. Neck pain patients showed increased control point stiffness compared with asymptomatic subjects. SWE showed no association with clinical severity indicators.

Efectos analgésicos del ejercicio físico en pacientes con dolor crónico musculoesquelético durante el confinamiento por la pandemia COVID-19 / Analgesic effects of physical exercise in patients with chronic musculoskeletal pain during confinement by the COVID -19 pandemic

INTRODUCCIÓN: El confinamiento vivido durante la pandemia del COVID-19 en España durante más de dos meses, podría afectar severamente a la condición y calidad de vida de los pacientes que sufren dolor crónico musculoesquelético. Teniendo en cuenta los efectos analgésicos que el ejercicio físico puede generar, gran parte de la población ha realizado ejercicio físico en sus domicilios como mecanismo del control del dolor, durante este periodo. OBJETIVO: El objetivo de este estudio fue conocer el tipo y la dosis de ejercicio físico realizado, así como la percepción de los pacientes en la reducción del dolor, durante el periodo de confinamiento por el COVID-19. MATERIAL Y MÉTODO: Se realizó una encuesta ad hoc a través de Google Forms a 86 pacientes para conocer su estado, el tipo de ejercicio que realizaron y la cantidad de ejercicio, así como si habían percibido una reducción de su dolor durante el periodo de confinamiento. RESULTADOS: La intensidad de dolor disminuyó de forma significativa (p = 0,001) cuando se hizo algún tipo de ejercicio físico. El ejercicio de fuerza fue elegido por el 51% de la población de forma exclusiva, y las frecuencias y el tiempo de sesión no fueron diferentes de forma significativa entre los sujetos que sintieron una reducción del dolor y los que no. CONCLUSIÓN: Una programación de ejercicio físico de 4 días a la semana, durante al menos 50 minutos y con intensidades del 77% de FCmax de ejercicio aeróbico o de fuerza sería recomendable en un paciente con dolor crónico, como estrategia para la reducción del dolor. Los resultados de nuestro estudio no aconsejan, para pacientes con dolor crónico, sesiones de terapia combinada, independientemente de la localización primaria del dolor

INTRODUCTION: The confinement experienced during the COVID-19 pandemic in Spain for more than two months, could severely affect the condition and quality of life of patients suffering from chronic musculoskeletal pain. Taking into account the analgesic effects that physical exercise can generate, a large part of the population has carried out some kind of physical exercise at home as a mechanism for pain control, during this period. OBJECTIVE: The objective of this study was to know the type and dosage of the exercise performed, as well as the perception of the patient ́s pain during the confinament period. MATERIAL AND METHOD: An ad hoc survey by a Google Form was conducted in 86 patients to find out the health status of the patients, the type of exercise they performed and the dossage of the exercise, as well as whether they had perceived a reduction in their pain during the period of confinement. RESULTS: The pain intensity was reduced significantly (p = 0.001) when some kind of exercise was done. Strength exercise exclusively was chosen by 51% of the population, and the frequencies and session time were not significantly different bet-ween the subjects who felt a reduction in pain and those who did not. CONCLUSION: A schedule of physical exercise 4 days a week, for at least 50 minutes and with intensities around 77% of HR-máx of aerobic or strength training would be recommended in patients with chronic pain, as a strategy for pain reduction. The results of our study do not advise, for patients with chronic pain, combined therapy sessions, regardless of the primary location of the pain