Cervical Multifidus Stiffness Assessment in Individuals with and without Unilateral Chronic Neck Pain: An Inter-Examiner Reliability Study.

This study aimed to evaluate the inter-examiner reliability of shear wave elastography (SWE) for measuring cervical multifidus (CM) muscle stiffness in asymptomatic controls and patients with chronic neck pain. A longitudinal observational study was conducted to assess the diagnostic accuracy of a procedure. SWE images, following a detailed procedure previously tested, were acquired by two examiners (one novice and one experienced) to calculate the shear wave speed (SWS) and Young's modulus. The painful side was examined for the experimental cases while the side examined in the control group was selected randomly. Data analyses calculated the intra-class correlation coefficients (ICCs), absolute errors between examiners, standard errors of measurement, and minimal detectable changes. A total of 125 participants were analyzed (n = 54 controls and n = 71 cases). The Young's modulus and SWS measurements obtained by both examiners were comparable within the asymptomatic group (both, p > 0.05) and the chronic neck pain group (both, p > 0.05). Nonetheless, a notable distinction was observed in the absolute error between examiners for shear wave speed measurements among patients with neck pain, where a significant difference was registered (p = 0.045), pointing to a sensitivity in measurement consistency affected by the presence of chronic neck pain. ICCs demonstrated moderate-to-good reliability across both groups, with ICC values for asymptomatic individuals reported as >0.8. Among the chronic neck pain patients, ICC values were slightly lower (>0.780). The study revealed moderate-to-good consistency, highlighting the practicality and generalizability of SWE.

Tempol effect on oxidative and mitochondrial markers in preclinical models for prostate cancer.

Background: Tempol is a redox-cycling nitroxide considered a potent antioxidant. The present study investigated the tempol effects on oxidative stress and mitochondrial markers on prostate cancer (PCa). Methods: PC-3 and LnCaP cells were exposed to tempol. Cell viability test, western blot and Amplex Red analyses were performed. In vivo, five experimental groups evaluated tempol effects in the early (CT12 and TPL12 groups) and late stages (CT20, TPL20-I, and TLP20-II) of PCa development. The TPL groups were treated with 50 or 100 mg/kg tempol doses. Control groups received water as the vehicle. The ventral lobe of the prostate and the blood were collected and submitted to western blotting or enzymatic activity analyses. Results: In vitro, tempol decreased cell viability and differentially altered the H2O2 content for PC-3 and LNCaP. Tempol increased SOD2 levels in both cell lines and did not alter Catalase protein levels. In vivo, tempol increased SOD2 levels in the early stage and did not change Catalase levels in the different PCa stages. Systemically, tempol decreased SOD2 levels in the late-stage and improved redox status in the early and late stages, which was confirmed by reduced LDH in tempol groups. Alterations on energetic metabolism and oxidative phosphorylation were observed in TRAMP model. Conclusion: Tempol can be considered a beneficial therapy for PCa treatment considering its antioxidant and low toxicity properties, however the PCa progression must be evaluated to get successful therapy.

Exploring Symptom Responses to Upper Limb Neural Test Variations of the Radial Nerve in Patients With Lateral Epicondylalgia: An Observational Study.

OBJECTIVE: Clinical practice guidelines recommend the radial nerve mechanosensitivity evaluation in patients with lateral epicondylalgia. Despite different positions and sequences having been described, no research analyzed how each variation triggers symptoms associated with lateral epicondylalgia. The aim of this study was to explore the effects of different positions and sequences in the upper limb neural tension test 2b (ULNT2b) in symptom responses in patients with lateral epicondylalgia. METHODS: In this observational study, 66 patients underwent 4 test conditions: standard ULNT2b, ULNT2b proximal to distal, ULNT2B with resisted supination, and resisted supination isolated. Paresthesia sensations, symptom reproduction, pain intensity (measured using a visual analog scale), and distribution of painful symptoms data were collected. RESULTS: Significant differences in paresthesia sensations were observed between groups, with significant differences between the standard ULNT2B and other ULNT variations or resisted supination maneuvers. Symptom reproduction also differed significantly across groups, with significant differences between the standard ULNT2B and other ULNT or resisted supination tests. The positive/negative test and percentage of distribution of painful symptoms scores varied significantly across 4 conditions in both lateral and frontal views. Although pain intensity scores during tests were comparable among the tests, distribution of painful symptoms differed significantly. CONCLUSION: Variations in the ULNT2b test can affect symptom responses in patients with lateral epicondylalgia. The standard ULNT2b test appears more effective at reproducing symptoms, intensity of paresthesia, and distribution of painful symptoms compared to other ULNT variations and the resisted supination test. IMPACT: ULNT2b sequences have been shown to elicit varying responses concerning paresthesia, replication of familiar symptoms, positive/negative test results, and distribution of painful symptoms. Clinicians should consider specific test variations during the patients' radial nerve mechanosensitivity assessment to identify aggravating factors reproducing recognizable symptoms. A control group of asymptomatic participants and the role of presence of other comorbidities, psychological factors, or the duration of symptoms were not considered in this study and might play an important role influencing the results of the tests.

Fighting pathogenic yeasts with plant defensins and anti-fungal proteins from fungi.

Fungal infections represent a significant health risk worldwide. Opportunistic infections caused by yeasts, particularly by Candida spp. and their virulent emerging isolates, have become a major threat to humans, with an increase in fatal cases of infections attributed to the lack of effective anti-yeast therapies and the emergence of fungal resistance to the currently applied drugs. In this regard, the need for novel anti-fungal agents with modes of action different from those currently available is undeniable. Anti-microbial peptides (AMPs) are promising candidates for the development of novel anti-fungal biomolecules to be applied in clinic. A class of AMPs that is of particular interest is the small cysteine-rich proteins (CRPs). Among CRPs, plant defensins and anti-fungal proteins (AFPs) of fungal origin constitute two of the largest and most promising groups of CRPs showing anti-fungal properties, including activity against multi-resistant pathogenic yeasts. In this review, we update and compare the sequence, structure, and properties of plant defensins and AFPs with anti-yeast activity, along with their in vitro and in vivo potency. We focus on the current knowledge about their mechanism of action that may lead the way to new anti-fungals, as well as on the developments for their effective biotechnological production. KEY POINTS: • Plant defensins and fungal AFPs are alternative anti-yeast agents • Their multi-faceted mode of action makes occurrence of resistance rather improbable • Safe and cost-effective biofactories remain crucial for clinical application.

Physiological and Biochemical Aspects of Silicon-Mediated Resistance in Maize against Maydis Leaf Blight.

Maydis leaf blight (MLB), caused by the necrotrophic fungus Bipolaris maydis, has caused considerable yield losses in maize production. The hypothesis that maize plants with higher foliar silicon (Si) concentration can be more resistant against MLB was investigated in this study. This goal was achieved through an in-depth analysis of the photosynthetic apparatus (parameters of leaf gas exchange chlorophyll (Chl) a fluorescence and photosynthetic pigments) changes in activities of defense and antioxidative enzymes in leaves of maize plants with (+Si; 2 mM) and without (-Si; 0 mM) Si supplied, as well as challenged and not with B. maydis. The +Si plants showed reduced MLB symptoms (smaller lesions and lower disease severity) due to higher foliar Si concentration and less production of malondialdehyde, hydrogen peroxide, and radical anion superoxide compared to -Si plants. Higher values for leaf gas exchange (rate of net CO2 assimilation, stomatal conductance to water vapor, and transpiration rate) and Chl a fluorescence (variable-to-maximum Chl a fluorescence ratio, photochemical yield, and yield for dissipation by downregulation) parameters along with preserved pool of chlorophyll a+b and carotenoids were noticed for infected +Si plants compared to infected -Si plants. Activities of defense (chitinase, ß-1,3-glucanase, phenylalanine ammonia-lyase, polyphenoloxidase, peroxidase, and lipoxygenase) and antioxidative (ascorbate peroxidase, catalase, superoxide dismutase, and glutathione reductase) enzymes were higher for infected +Si plants compared to infected -Si plants. Collectively, this study highlights the importance of using Si to boost maize resistance against MLB considering the more operative defense reactions and the robustness of the antioxidative metabolism of plants along with the preservation of their photosynthetic apparatus.

PHASE ANGLE AS A PREDICTOR OF MUSCLE MASS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE.

BACKGROUND: Malnutrition/sarcopenia is frequent in patients with inflammatory bowel diseases (IBD), and results in muscle catabolism, impacting treatment response, postoperative complications, and quality of life. OBJECTIVE: This study aims to assess whether the phase angle (PhA) is a parameter for predicting reduced muscle mass in patients with IBD. METHODS: Adult patients with IBD were included in this cross-sectional study. For the estimation of muscle mass and the calculation of the PhA, we used bioelectrical impedance analysis (BIA). Crohn's disease (CD) and ulcerative colitis (UC) activity scores were defined using the Harvey-Bradshaw index and partial Mayo score, respectively. The area under the ROC curve was calculated to identify the PhA cut-off point for reduced muscle mass. RESULTS: The sample consisted of 145 patients, with 39 (26.9%) with IBD in the active phase. There was a correlation of the PhA with skeletal muscle mass (SMM) (rs 0.35, P<0.001) and with the skeletal muscle mass index (SMI) (rs 0.427, P<0.001), and the associations remained in the most active form (moderate or severe) of IBD. The ROC curve analysis indicated that the cut-offs points of the PhA ≤5.042 for female and PhA ≤6.079 for male can be used to predict muscle mass reduction. CONCLUSION: The PhA can be considered a predictor of muscle mass reduction in IBD patients, and we can use it for screening and monitoring the evolution of malnutrition. BACKGROUND: • This study aims to assess whether the phase angle is a parameter for predicting reduced muscle mass in patients with inflammatory bowel disease. BACKGROUND: • There was a correlation of the phase angle with skeletal muscle mass and the associations remained in disease activity. BACKGROUND: • The ROC curve analysis indicated that the cut-off point of the PhA ≤5.042° for women and PhA ≤6,079° for men can be used to predict muscle mass reduction. BACKGROUND: • The phase angle can be considered a predictor of muscle mass reduction in inflammatory bowel disease.

Studies on the biological role of the antifungal protein PeAfpA from Penicillium expansum by functional gene characterization and transcriptomic profiling.

Antifungal proteins (AFPs) from filamentous fungi have enormous potential as novel biomolecules for the control of fungal diseases. However, little is known about the biological roles of AFPs beyond their antifungal action. Penicillium expansum encodes three phylogenetically different AFPs (PeAfpA, PeAfpB and PeAfpC) with diverse profiles of antifungal activity. PeAfpA stands out as a highly active AFP that is naturally produced at high yields. Here, we provide new data about the function of PeAfpA in P. expansum through phenotypical characterization and transcriptomic studies of null mutants of the corresponding afpA gene. Mutation of afpA did not affect axenic growth, conidiation, virulence, stress responses or sensitivity towards P. expansum AFPs. However, RNA sequencing evidenced a massive transcriptomic change linked to the onset of PeAfpA production. We identified two large gene expression clusters putatively involved in PeAfpA function, which correspond to genes induced or repressed with the production of PeAfpA. Functional enrichment analysis unveiled significant changes in genes related to fungal cell wall remodeling, mobilization of carbohydrates and plasma membrane transporters. This study also shows a putative co-regulation between the three afp genes. Overall, our transcriptomic analyses provide valuable insights for further understanding the biological functions of AFPs.

An Educational, Exercise and Occupational Therapy-Based Telerehabilitation Program versus 'Wait-and-See' for Improving Self-Perceived Exertion in Patients with post-COVID Fatigue and Dyspnea: A Randomized Clinical Trial.

OBJECTIVE: To compare the effectiveness of a tele-rehabilitation exercise program versus 'wait-and-see' on physical exertion, quality of life, dyspnea severity, heart rate and oxygen saturation in patients with post-COVID fatigue and dyspnea. DESIGN: Sixty-four patients were enrolled in this randomized clinical trial. A tele-rehabilitation program based on patient education, physical activity, airway clearing, and breathing exercise interventions was conducted. Self-perceived physical exertion during daily living activities, dyspnea severity, health-related quality of life and physiological outcomes and the 6-minute walking test (6MWT) were assessed at baseline, after the program and at 1- and 3-months follow-up periods. RESULTS: The experimental group experienced greater improvements in self-perceived physical exertion during daily living activities, dyspnea severity, health-related quality of life and 6MWT (all, p < 0.001). Additionally, patients undergoing the tele-rehabilitation program reported lower exertion scores at rest and after the 6MWT (both, p < 0.001). Between-group oxygen saturation differences were found at rest (p < 0.001), but not after the 6MWT (p = 0.024). Finally, significant between-group differences were found for heart rate after the 6MWT (p < 0.001). CONCLUSION: Although both groups showed a significant improvement after 3 months of follow-up, the group receiving the tele-rehabilitation program described a greater improvement compared with the group receiving no intervention.

Estudo da diferenciação semelhante à lactacional no carcinoma secretório com origem em glândula salivar / Lactational-like differentiation in secretory carcinoma of salivary gland origin

O carcinoma secretório em glândula salivar é uma neoplasia recentemente descrita que tem os mesmos aspectos morfológicos, imuno-histoquímicos e genéticos do carcinoma secretório de origem mamária. O carcinoma secretório tem características celulares reminiscentes de uma célula secretora lactacional, isto é, um citoplasma vacuolado repleto de gotas lipídicas e um material secretado, por vezes de forma apócrina, que pode lembrar o leite. Mais recentemente, algum nível de diferenciação lactacional foi sugerida no carcinoma secretório de origem salivar. O objetivo do estudo foi verificar se existe uma diferenciação do tipo lactacional em carcinomas secretórios de origem salivar, comparando a outros tipos de carcinomas salivares mais comuns. Foram realizadas reações imuno-histoquímicas para as seguintes proteínas: receptores hormonais (receptor de prolactina e receptor do hormônio do crescimento), proteínas associadas ao produto de secreção da glândula mamária lactacional (mucina-1 (MUC-1), MUC4, globulina de gordura 1 do leite humano, lactoferrina) e proteínas associadas à via Akt-mTOR (PTEN, p-Akt, p-mTOR, p4EBP1, eIF4E, pS6). A maioria dos casos de carcinoma secretório foi negativa para receptor de prolactina e de hormônio do crescimento. Lactoferrina foi positiva em todos os grupos tumorais, porém somente em carcinoma secretório observou-se um padrão de marcação intensa, difuso tanto em célula como em secreção. Todos os casos de carcinoma secretório foram positivos para globulina de gordura do tipo 1, porém o mesmo padrão de marcação foi observado em outros tumores. A maioria dos casos de carcinoma secretório foram positivos para MUC1 e MUC4. Nenhum caso de carcinoma secretório foi positivo para Akt, mas PTEN foi difusamente expresso em 57,1% dos casos. mTOR foi expresso em mais da metade dos casos de carcinoma secretório e dos outros tumores salivares. Entre as proteínas à jusante de mTOR, somente eIF4E demonstrou alta expressão no grupo de estudo. A expressão de marcadores lactacionais não é exclusiva do carcinoma secretório, porém a expressão de lactoferrina é distinta neste grupo de tumores quando comparado aos demais tumores salivares estudados.

Analysis of internal heat recovery capability in air-cooled indirect fired GAX-based absorption chiller in part-load operation.

Single-effect absorption chillers are the most popular because of their low cost, despite their low COP. Among them, GAX-based AirCooled absorption chillers are very interesting because they have improved COP because of their ability to recover internal heat at low thermal lifts. This workshop analysed the ability of these types of chillers to recover internal heat at high thermal lifts by changing the pressure drop of an extra valve, a feature of the Robur absorption chiller when operating in subzero applications. The complete differential mathematical model analyses the components involved in heat supply and recovery and provides information on their operation. A thorough assessment of exergy destruction in the absorption refrigeration system was carried out. The main results show that when the chiller is driven at a temperature of 210 °C and an ambient temperature of 40 °C, a rise in the pressure drop of the additional valve, ΔPval1, from 175 to 700 kPa causes the extension of the vapour purification process to be reduced by 13.7% in the column of distillation and by 70.6% in the rectifier. Despite the adverse effect of ΔPval1 increase on the cooling capacity, there is no risk that the distillation column operates in weeping mode. However, this adjustment increases the internal thermal load of the generator by 26.9%. Furthermore, the mass fraction of the refrigerant flow is very similar. In addition, the occurrence of a two-phase solution flow at the input of a solution cooling absorber is the practical upper limit of ΔPval1. The refrigerant flow in the solution cooling absorber is reduced by 21.3%. Finally, the contribution of the heat recovery loop to the total exergy destruction in the refrigeration system rises slightly by 2.7% when ΔPval1 increases due to the contribution of the vapour purification system, which increases at the expense of that of the re-boiler and the SolutionCooled absorber. The results of this study show to what extent the modified GAX-based cycle can function effectively at high thermal lifts.

First Description of Marinoquinoline Derivatives' Activity against Toxoplasma gondii.

Toxoplasmosis is a globally prevalent zoonotic disease with significant clinical implications, including neurotoxoplasmosis, a leading cause of cerebral lesions in AIDS patients. The current pharmacological treatments for toxoplasmosis face clinical limitations, necessitating the urgent development of new therapeutics. Natural sources have yielded diverse bioactive compounds, serving as the foundation for clinically used derivatives. The exploration of marine bacteria-derived natural products has led to marinoquinolines, which feature a pyrroloquinoline core and demonstrate in vitro and in vivo anti-Plasmodium activity. This study investigates the in vitro anti-Toxoplasma gondii potential of six marinoquinoline derivatives. Additionally, it conducts absorption, distribution, metabolism, excretion, and toxicity (ADMET) predictions, and evaluates the in vivo efficacy of one selected compound. The compounds displayed half-maximal effective concentration (EC50) values between 1.31 and 3.78 µM and half-maximal cytotoxic concentration (CC50) values ranging from 4.16 to 30.51 µM, resulting in selectivity indices (SI) from 3.18 to 20.85. MQ-1 exhibiting the highest in vitro SI, significantly reduced tachyzoite numbers in the peritoneum of RH-infected Swiss mice when it was orally administered at 12.5 mg/kg/day for eight consecutive days. Also, MQ-1 significantly reduced the cerebral parasite burden in chronically ME49 infected C57BL/6 mice when it was orally administered at 25 mg/kg/day for 10 consecutive days. These findings underscore the promising anti-T. gondii activity of marinoquinolines and their potential as novel therapeutic agents against this disease.

Enhancement of the CO2 adsorption and hydrogenation to CH4 capacity of Ru-Na-Ca/γ-Al2O3 dual function material by controlling the Ru calcination atmosphere.

Integrated CO2 capture and utilization (ICCU) technology requires dual functional materials (DFMs) to carry out the process in a single reaction system. The influence of the calcination atmosphere on efficiency of 4% Ru-8% Na2CO3-8% CaO/γ-Al2O3 DFM is studied. The adsorbent precursors are first co-impregnated onto alumina and calcined in air. Then, Ru precursor is impregnated and four aliquotes are subjected to different calcination protocols: static air in muffle or under different mixtures (10% H2/N2, 50% H2/N2 and N2) streams. Samples are characterized by XRD, N2 adsorption-desorption, H2 chemisorption, TEM, XPS, H2-TPD, H2-TPR, CO2-TPD and TPSR. The catalytic behavior is evaluated, in cycles of CO2 adsorption and hydrogenation to CH4, and temporal evolution of reactants and products concentrations is analyzed. The calcination atmosphere influences the physicochemical properties and, ultimately, activity of DFMs. Characterization data and catalytic performance discover the acccomodation of Ru nanoparticles disposition and basic sites is mostly influencing the catalytic activity. DFM calcined under N2 flow (RuNaCa-N2) shows the highest CH4 production (449 µmol/g at 370°C), because a well-controlled decomposition of precursors which favors the better accomodation of adsorbent and Ru phases, maximizing the specific surface area, the Ru-basic sites interface and the participation of different basic sites in the CO2 methanation reaction. Thus, the calcination in a N2 flow is revealed as the optimal calcination protocol to achieve highly efficient DFM for integrated CO2 adsorption and hydrogenation applications.

Levator Scapulae Stiffness Measurement Reliability in Individuals with and without Chronic Neck Pain by Experienced and Novel Examiners.

The levator scapulae muscle is a key structure in the etiopathology of neck and shoulder musculoskeletal pain. Although previous studies used shear-wave elastography (SWE) for characterizing this muscle elasticity, limited evidence assessed the inter-examiner reliability of this procedure. This study aimed to analyze the inter-examiner reliability for calculating Young's modulus and shear wave speed in a cohort of participants with and without chronic neck pain. A diagnostic accuracy study was conducted, acquiring a set of SWE images at the C5 level in participants with and without neck pain (n = 34 and 33, respectively) by two examiners (one experienced and one novel). After blinding the participants' identity, examiner involved, and side, the stiffness indicators were calculated by an independent rater in a randomized order. Intra-class correlation coefficients (ICC), standard error of measurement, minimal detectable changes, and coefficient of variation were calculated. Both cohorts had comparable sociodemographic characteristics (p > 0.05). No significant levator scapulae elasticity differences were found between genders, sides, or cohorts (all, p > 0.05). Inter-examiner reliability for calculating Young's modulus and shear wave speed was moderate-to-good for assessing asymptomatic individuals (ICC = 0.714 and 0.779, respectively), while poor-to-moderate in patients with neck pain (ICC = 0.461 and 0.546, respectively). The results obtained in this study support the use of this procedure for assessing asymptomatic individuals. However, reliability estimates were unacceptable to support its use for assessing elasticity in patients with chronic neck pain. Future studies might consider that the shear wave speed is more sensitive to detect real changes in comparison with Young's modulus.

The Added Value of Face-to-Face Supervision to a Therapeutic Exercise-Based App in the Management of Patients with Chronic Low Back Pain: A Randomized Clinical Trial.

Low back pain (LBP) is a significant global health challenge due to its high prevalence, and chronicity and recurrence rates, with projections suggesting an increase in the next years due to population growth and aging. The chronic and recurrent nature of LBP, responsible for a significant percentage of years lived with disability, underscores the need for effective management strategies, including self-management strategies advocated by current guidelines, to empower patients and potentially improve healthcare efficiency and clinical outcomes. Therefore, the aim of this study was to analyze the added value of face-to-face visits in patients with chronic LBP undergoing a self-management program based on therapeutic exercises on pain intensity, disability, quality of life and treatment adherence and satisfaction. A randomized clinical trial was conducted, allocating 49 patients into a experimental group with a mobile health (mHealth) app usage and face-to-face sessions and 49 patients into an active control group without face-to-face sessions. Pain intensity, disability and quality of life were assessed at baseline, 4 weeks postintervention and 12 weeks postintervention. Patients' satisfaction and adherence were assessed at the end of the study. The multivariate general model revealed no statistically significant time × group interaction for any outcome (p > 0.0068) but mental quality of life (p = 0.006). Within-group differences revealed significant improvements for all the clinical indicators (all, p < 0.001). Patients allocated to the experimental group reported greater satisfaction and adherence (both, p < 0.001) compared to the control group. The use of mHealth apps such as Healthy Back® as part of digital health initiatives may serve as a beneficial approach to enhance the management of LBP.

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.

Role of DNA ploidy in diagnosis and prognosis of high-grade cervical intraepithelial neoplasia: A prospective cohort study.

OBJECTIVE: To compare the sensitivity and specificity of DNA ploidy with cytology, human papillomavirus (HPV) testing and colposcopy in diagnosis of high-grade cervical intraepithelial neoplasia (CIN) and to assess the role of aneuploidy in cervical lesions with the worst prognosis. A prospective observational cohort study was conducted on 254 women with altered colpocytology. METHODS: Colposcopy, biopsy, DNA-ICM and HPV examinations were applied to cervical cytological and histological samples. Participants were evaluated every 6 months and divided into two groups: 'Harm' and 'No-harm'. Logistic regression and multivariate COX model were used to identify independent risk factors for diagnosis and prognosis of high-grade CIN, and ROC curve to assess the sensitivity and specificity of methods. RESULTS: Variables 'age greater than or equal to 30 years', 'lesion size greater than 20%', 'aneuploidy' and 'HPV 16' were associated with diagnosis of high-grade CIN and 'aneuploidy' and 'women living with HIV', with a worse prognosis. Agreement for colposcopy was good, with a sensitivity of 79.3% and specificity of 94.4%; DNA-ICM and cytology were moderate, with sensitivity of 74.6% and 72.3% and specificity of 85.3% and 76.1%, respectively. High-risk HPV and HPV 16 tests were weak, with sensitivity of 75.0% and 43.75% and specificity of 50.0% and 88.64%, respectively. CONCLUSIONS: In relation to high-grade CIN diagnosis, DNA-ICM presented similar sensitivity and specificity to cytology and high-risk HPV test when associated with HPV 16. Regarding prognosis, this research certifies that aneuploidy is considered a predictor of more severe cervical injury.

Ângulo de fase como preditor de massa muscular em pacientes com doença inflamatória intestinal / Phase angle as a predictor of muscle mass in patients with inflammatory bowel disease

ABSTRACT Malnutrition/sarcopenia is frequent in patients with inflammatory bowel diseases (IBD), and results in muscle catabolism, impacting treatment response, postoperative complications, and quality of life. Objective: This study aims to assess whether the phase angle (PhA) is a parameter for predicting reduced muscle mass in patients with IBD. Methods: Adult patients with IBD were included in this cross-sectional study. For the estimation of muscle mass and the calculation of the PhA, we used bioelectrical impedance analysis (BIA). Crohn's disease (CD) and ulcerative colitis (UC) activity scores were defined using the Harvey-Bradshaw index and partial Mayo score, respectively. The area under the ROC curve was calculated to identify the PhA cut-off point for reduced muscle mass. Results: The sample consisted of 145 patients, with 39 (26.9%) with IBD in the active phase. There was a correlation of the PhA with skeletal muscle mass (SMM) (rs 0.35, P<0.001) and with the skeletal muscle mass index (SMI) (rs 0.427, P<0.001), and the associations remained in the most active form (moderate or severe) of IBD. The ROC curve analysis indicated that the cut-offs points of the PhA ≤5.042 for female and PhA ≤6.079 for male can be used to predict muscle mass reduction. Conclusion: The PhA can be considered a predictor of muscle mass reduction in IBD patients, and we can use it for screening and monitoring the evolution of malnutrition.

RESUMO A desnutrição/sarcopenia é frequente em pacientes com doenças inflamatórias intestinais (DII), resultando em catabolismo muscular, com impacto nas respostas aos tratamentos, complicações cirúrgicas e na qualidade de vida. Objetivo: Este estudo tem como objetivo, avaliar se o ângulo de fase (AF) é um parâmetro para a predição de redução de massa muscular em pacientes com DII. Métodos: Pacientes adultos com DII foram incluídos neste estudo transversal. A estimativa da massa muscular e o cálculo do AF foram realizados a partir do exame de bioimpedância elétrica (BIA). As atividades da doença de Crohn e retocolite ulcerativa foram definidas pelo índice Harvey-Bradshaw e escore parcial de Mayo, respectivamente. A área de curva ROC foi calculada para identificar o ponto de corte do AF para a massa muscular reduzida. Resultados: A amostra foi composta por 145 pacientes, sendo 39 (26.9%) com DII em fase ativa. Houve correlação do AF com massa muscular esquelética (MME) (rs 0.35, P<0.001) e com o índice de massa muscular esquelética (IMME) (rs 0.427, P<0.001), mantendo-se as associações na forma mais ativa (moderada ou grave) da DII. A análise da curva ROC indicou que os pontos de corte de AF ≤5.042 para mulheres e ≤6.079 para homens podem ser usados para prever a redução da massa muscular. Conclusão: O AF pode ser considerado um preditor de redução de massa muscular nos pacientes com DII e ser utilizado para triagem e acompanhamento da evolução da desnutrição.

Estratificação de Risco e Profilaxia do Tromboembolismo Venoso no Mieloma Múltiplo / Venous Thromboembolism Risk Stratification and Prophylaxis in Multiple Myeloma / Estratificación del Riesgo y Profilaxis del Tromboembolismo Venoso en el Mieloma Múltiple

A trombose representa um desafio no cenário do mieloma múltiplo. O avanço no arsenal terapêutico para o tratamento desse câncer trouxe aumento de sobrevida, mas paralelamente acarretou aumento na incidência dos eventos trombóticos, com impacto na morbidade e na mortalidade. Além disso, o perfil epidemiológico dessa população favorece a coexistência de doença cardiovascular, que compartilha com o câncer mecanismos fisiopatológicos trombogênicos. Assim, apesar do uso de anticoagulantes e antiagregantes plaquetários, a estratégia ideal para profilaxia permanece obscura e o desafio vai além da padronização do modelo de avaliação de risco e da terapia anticoagulante. Este trabalho buscou apresentar o estado da arte sobre o tema com o objetivo de discutir a tromboprofilaxia no mieloma múltiplo, enfatizando a abordagem da doença cardiovascular como parte integrante da estratégia.

Venous thromboembolism (VTE) is the second main cause of death of cancer patients and can be the first manifestation of neoplasms or occur at any time point of the course of the disease1-3. Subgroups have different risks with higher rates observed in specific cancers, including pancreas, stomach and multiple myeloma (MM)1.Associated with higher risk of death, thrombotic events do have an important adverse impact as they may lead to treatment interruption, increased morbidity and economic burden4. In this scenario, MM is challenging, it is the second most common hematologic cancer with a risk of VTE nine-fold higher than in the general population1,5. The high-risk results from patient, treatment and disease-related factors. The epidemiologic profile of the patient with MM favors the coexistence of additional thromboembolic risks, nevertheless, advances of oncologic treatment increased global survival and thrombotic risk4. It is known that 10% of the population with MM will develop VTE at some time point of the disease's course4,6, with high incidence in the first six months post-diagnosis5.Inconsistencies in applying the current thromboprophylaxis recommendations have been found. Due to the lack of robust data and standardized models of risk stratification, many physicians tend to rely on their clinical experience7.The ideal thromboprophylaxis of MM remains unknown

Consensus document for lipid profile testing and reporting in Spanish clinical laboratories: what parameters should a basic lipid profile include?

Cardiovascular diseases (CVD) continue to be the main cause of death in our country. Adequate control of lipid metabolism disorders is a key challenge in cardiovascular prevention that is far from being achieved in real clinical practice. There is a great heterogeneity in the reports of lipid metabolism from Spanish clinical laboratories, which may contribute to its poor control. For this reason, a working group of the main scientific societies involved in the care of patients at vascular risk, has prepared this document with a consensus proposal on the determination of the basic lipid profile in cardiovascular prevention, recommendations for its realization and unification of criteria to incorporate the lipid control goals appropriate to the vascular risk of the patients in the laboratory reports.