Association Between Visual Acuity and Prospective Fall Risk in Generally Healthy and Active Older Adults: The 3-Year DO-HEALTH Study.

OBJECTIVE: Although aging has a strong impact on visual acuity (VA) and falls, their interaction is understudied in generally healthy older adults. This study aimed to examine if and to what extent baseline VA is associated with an increased risk of all and injurious falls over 3 years in generally healthy community-dwelling older adults. DESIGN: Observational analysis of DO-HEALTH, a double-blind, randomized controlled trial. SETTING AND PARTICIPANTS: Multicenter trial with 7 European centers: Zurich, Basel, Geneva (Switzerland), Berlin (Germany), Innsbruck (Austria), Toulouse (France), and Coimbra (Portugal), including 2157 community-dwelling adults aged 70 years and older without any major health events in the 5 years prior to enrollment, sufficient mobility, and good cognitive status. METHODS: The numbers of all and injurious falls were recorded prospectively by diary and in-person assessment every 3 months. Decreased VA at baseline was defined as better-eye VA lower than 1.0. We applied negative binomial regression models for all and injurious falls, adjusted for age, sex, prior falls, treatment allocation, study site, baseline body mass index, and use of walking aids. RESULTS: Among the 2131 participants included in this analysis (mean age: 74.9 years, 61.7% were women, 82.6% at least moderately physically active), 1464 (68.7%) had decreased VA. Overall, 3290 falls including 2116 injurious falls were recorded over 3 years. Decreased VA at baseline was associated with a 22% increased incidence rate of all falls [adjusted incidence rate ratio (aIRR) = 1.22, 95% CI 1.07, 1.38, P = .003] and 20% increased incidence rate of injurious falls (aIRR = 1.20, 95% CI 1.05, 1.37, P = .007). CONCLUSIONS AND IMPLICATIONS: Our findings suggest that decreased VA is an independent predictor of an about 20% increased risk of all and injurious falls, highlighting the importance of regular eye examinations and VA measurements for fall prevention, even in generally healthy and active older adults.

Remission definitions guiding immunosuppressive therapy in rheumatoid arthritis: which is best fitted for the purpose?

OBJECTIVE: To assess which definition of remission best predicts good radiographic outcome (GRO) and good functional outcome (GFO) in rheumatoid arthritis, focusing the updated American College of Rheumatology/European Alliance of Associations for Rheumatology criteria. MATERIAL AND METHODS: Meta-analyses of individual patient data (IPD) from randomised controlled trials (RCTs). Six definitions of remission were considered: (1) Boolean with Patient Global Assessment (PGA)≤1 (Boolean); (2) Simplified Disease Activity Index (SDAI)≤3.3; (3) Clinical Disease Activity Index (CDAI)≤2.8; (4) Boolean with PGA≤2 (Updated-Boolean); (5) Boolean with Physician Global Assessment (PhGA≤1) replacing PGA (Boolean-PhGA) and (6) Boolean excluding PGA (3VBoolean). GRO was defined as a worsening ≤0.5 units in radiographic score and GFO as a no worsening in Health Assessment Questionnaire (HAQ), that is, ∆HAQ-DI≤0.0 units. Relationships between each remission definition at 6 and/or 12 months and GRO and GFO during the second year were analysed. Pooled probabilities for each outcome for each definition and their predictive accuracy were estimated. RESULTS: IPD from eight RCTs (n=4423) were analysed. Boolean, SDAI, CDAI, Updated-Boolean, Boolean-PhGA and 3VBoolean were achieved by 24%, 27%, 28%, 32%, 33% and 43% of all patients, respectively. GRO among patients achieving remission ranged from 82.4% (3VBoolean) to 83.9% (SDAI). 3VBoolean showed the highest predictive accuracy for GRO: 51.1% versus 38.8% (Boolean) and 44.1% (Updated-Boolean). The relative risk of GFO ranged from 1.16 (Boolean) to 1.05 (3VBoolean). However, the proportion of GFO correctly predicted was highest for the 3VBoolean (50.3%) and lowest for the Boolean (43.8%). CONCLUSION: 3VBoolean definition provided the most accurate prediction of GRO and GFO, avoiding the risk of overtreatment in a substantial proportion of patients without increment in radiographic damage progression, supporting the proposal that 3VBoolean remission is preferable to guide immunosuppressive treatment. The patient's perspective, which must remain central, is best served by an additional patient-oriented target: a dual-target approach.

10-year experience of early arthritis clinic at a tertiary rheumatology center: achievements and challenges.

OBJECTIVES: To characterize patients evaluated in our Early Arthritis Clinic (EAC) in the first ten years; to assess diagnostic delay and its underlying causes; and to evaluate the level of agreement between the referring physician and the rheumatologist regarding the presence of referral criteria. METHODS: Cross-sectional study including patients attending EAC between 2012 and 2021. Demographic data, provenience, final diagnosis, referral criteria and time related to diagnosis delay were retrieved from clinical files and the Portuguese Registry of Rheumatic Patients (reuma.pt). Characteristics of the patients and the time variables were analysed with descriptive statistical analysis. The agreement between the referring physician and rheumatologist regarding the referral criteria was evaluated using Cohen's Kappa. RESULTS: A total of 440 patients (68.9% females, mean age of 54±16.7 years) were referred, mostly from primary care (71.6%). Inflammatory Rheumatic Disease was diagnosed in 65.7% of the patients, with 58.9% classified as early arthritis. The median time from onset of symptoms to referral for EAC was 76 days (IQR 33.5-144.0); the median time from referral to the first EAC was 34 (IQR 19.0-46.0) days, and the median time from onset of symptoms to first EAC was 114.5 (IQR 66.8-190.3) days (16.3 weeks). Only about 10% were observed by a Rheumatologist before six weeks after symptom onset. The level of agreement between the referring physician and the rheumatologist was slight to fair to clinical criteria and moderate to substantial to laboratory criteria. CONCLUSIONS: A significant delay still is observed in patients with early arthritis suspicion, being the time from onset of symptoms to referral is the most relevant. A low agreement between referral and Rheumatologists suggests that non-rheumatologists education/training is needed. Identifying the barriers that prevent the adequate referral of patients is necessary to define strategies to improve it.

Antibacterial and Antiviral Properties of Chenopodin-Derived Synthetic Peptides.

Antimicrobial peptides have been developed based on plant-derived molecular scaffolds for the treatment of infectious diseases. Chenopodin is an abundant seed storage protein in quinoa, an Andean plant with high nutritional and therapeutic properties. Here, we used computer- and physicochemical-based strategies and designed four peptides derived from the primary structure of Chenopodin. Two peptides reproduce natural fragments of 14 amino acids from Chenopodin, named Chen1 and Chen2, and two engineered peptides of the same length were designed based on the Chen1 sequence. The two amino acids of Chen1 containing amide side chains were replaced by arginine (ChenR) or tryptophan (ChenW) to generate engineered cationic and hydrophobic peptides. The evaluation of these 14-mer peptides on Staphylococcus aureus and Escherichia coli showed that Chen1 does not have antibacterial activity up to 512 µM against these strains, while other peptides exhibited antibacterial effects at lower concentrations. The chemical substitutions of glutamine and asparagine by amino acids with cationic or aromatic side chains significantly favoured their antibacterial effects. These peptides did not show significant hemolytic activity. The fluorescence microscopy analysis highlighted the membranolytic nature of Chenopodin-derived peptides. Using molecular dynamic simulations, we found that a pore is formed when multiple peptides are assembled in the membrane. Whereas, some of them form secondary structures when interacting with the membrane, allowing water translocations during the simulations. Finally, Chen2 and ChenR significantly reduced SARS-CoV-2 infection. These findings demonstrate that Chenopodin is a highly useful template for the design, engineering, and manufacturing of non-toxic, antibacterial, and antiviral peptides.

Blood biochemical, hormonal, and hematological responses of native sheep submitted to different environmental conditions.

The aim of this study was to evaluate the biochemical, hormonal, and hematological blood responses of native sheep subjected to five temperatures (20°, 24°, 28°, 32°, and 36 °C), using 24 sheep of the following breeds: Santa Inês (SI), Morada Nova (MN), Soinga (SO) and no defined racial pattern (NDRP), kept in collective pens inside the climatic chamber. The experimental design was completely randomized, in a 5 × 4 factorial scheme (5 temperatures and 4 breeds) with 6 animals of each breed at each temperature. There was interaction for urea (P < .0001), glucose (P < .0001), cholesterol (P < .0001), and magnesium (P < .0001) as a function of breed and air temperature. Urea (P = .001), glucose (P < .0001), triglycerides (P = .033), cholesterol (P = .004), and magnesium (P < .0001) showed differences according to breed. It was observed that T4 (P < .0001) and cortisol (P < .0001) showed an interaction between breed and temperature, while T4 (P = .001) and cortisol (P = .001) an effect of breed. The highest magnesium concentration was observed in MN, and the lowest was in NDRP, SO, and SI, which are statistically similar, and SI and NDRP are statistically similar. The hormones showed a significant effect (P < .0001) for temperature, where cortisol increased, and thyroid hormones decreased with increasing temperature. Temperatures of 32° and 36 °C contribute to changes in blood, hormone, and hematological biochemical responses of native sheep.

Giants of the Amazon: How does environmental variation drive the diversity patterns of large trees?

For more than three decades, major efforts in sampling and analyzing tree diversity in South America have focused almost exclusively on trees with stems of at least 10 and 2.5 cm diameter, showing highest species diversity in the wetter western and northern Amazon forests. By contrast, little attention has been paid to patterns and drivers of diversity in the largest canopy and emergent trees, which is surprising given these have dominant ecological functions. Here, we use a machine learning approach to quantify the importance of environmental factors and apply it to generate spatial predictions of the species diversity of all trees (dbh ≥ 10 cm) and for very large trees (dbh ≥ 70 cm) using data from 243 forest plots (108,450 trees and 2832 species) distributed across different forest types and biogeographic regions of the Brazilian Amazon. The diversity of large trees and of all trees was significantly associated with three environmental factors, but in contrasting ways across regions and forest types. Environmental variables associated with disturbances, for example, the lightning flash rate and wind speed, as well as the fraction of photosynthetically active radiation, tend to govern the diversity of large trees. Upland rainforests in the Guiana Shield and Roraima regions had a high diversity of large trees. By contrast, variables associated with resources tend to govern tree diversity in general. Places such as the province of Imeri and the northern portion of the province of Madeira stand out for their high diversity of species in general. Climatic and topographic stability and functional adaptation mechanisms promote ideal conditions for species diversity. Finally, we mapped general patterns of tree species diversity in the Brazilian Amazon, which differ substantially depending on size class.

Thermal stress index for native sheep.

The first objective of this study was to develop a thermal stress index for sheep based on environmental and animal data collected in a climate chamber under various environmental conditions. The second objective was to compare published indices of thermal comfort and the proposed index, testing them with the data from this study, with the objective of pointing out the most adequate index to be used by breeders when choosing management procedures. A total of 3024 data were obtained for the physiological variables of the sheep exposed to the eight thermal conditions in the climatic chamber and in ambient condition, kept three days in each thermal condition. A principal component analysis summarized the measurements of physiological variables into only one variable (y1). Using SigmaPlot software, multiple regression of y1 with the environmental variables and their combinations produced a number of indices. The equation chosen was the heat stress index for sheep, TSI = 24.153 - (0.0523*AT) + (0.746*BGT) + (4.104*Vp), with R2 = 0.668. The correlations presented high values, where these correlation values were assumed to indicate the efficiency of each index as indicators of the animals' response to the environment. Thus, it was assumed that the TSI presents a high efficiency.

Physical Fitness Profile of High-Level Female Portuguese Handball Players.

We characterized the physical and physiological profiles of high-level female Portuguese handball players and examined the relationships between their anthropometric characteristics, general motor performance and cardiopulmonary fitness. Twenty-four high-level female handball players with an average age of 23.6 ± 5.5 years, height of 173.6 ± 5.1 cm and body mass of 72.6 ± 9.1 kg volunteered to participate. A Pearson correlation test was used to assess the relationship between variables. Direct relationships were observed between the players' height and arm span (r = 0.741), as well as between their squat jump and countermovement jump performances with regard to body mass (r = 0.448 and 0.496, respectively). The 9 m jump shot has a large relationship with the 7 m standing throw (r = 0.786) and between left hand dynamometry and body mass index (r = 0.595). The 30 m sprint has a relationship with the 7 m standing throw (r = -0.526) and the 9 m jump throw (r = -0.551). Oxygen uptake has a relationship with the players' height (r = -0.482) and time limit (r = 0.513), while the fitness index has a relation to the players' height (r = -0.488) and arm span (r = -0.422). Our results should be considered when using physical testing to plan optimal physical training regimens in elite team handball.

Brazilian Society of Surgical Oncology: Guidelines for the management of anal canal cancer.

BACKGROUND: Anal canal squamous cell carcinoma (SCC) is a relatively uncommon neoplasia, and it is mostly a local-regional cancer, of low metastatic potential (only 15%), resulting in cure in most cases treated with definitive chemoradiation. On the other hand, its incidence has been steadily increasing over the last decades, which makes it an important public health problem. In an effort to provide surgeons and oncologists who treat patients with anal cancer with the most updated information based on the best scientific evidence, the Brazilian Society of Surgical Oncology (SBCO) has produced the present guideline for the management of anal canal SCC, focused on the main topics related to daily clinical practice. OBJECTIVES: The SBCO developed the present guidelines to provide recommendations on the main topics related to the management of anal canal squamous cell carcinoma (SCC) based on current scientific evidence. METHODS: Between October 2022 and January 2023, 14 experts met to develop the guidelines for the management of anal canal cancer. A total of 30 relevant topics were distributed among the participants. The methodological quality of a final list with 121 sources was evaluated, all the evidence was examined and revised, and the management guidelines were formulated by the 14-expert committee. To reach a final consensus, all the topics were reviewed in a meeting that was attended by all the experts. RESULTS: The proposed guidelines contained 30 topics considered to be highly relevant in the management of anal canal cancer, covering subjects related to screening recommendations, preventive measures, tests required for diagnosing and staging, treatment strategies, response assessment after chemoradiotherapy, surgical technique-related aspects, and follow-up recommendations. In addition, screening and response assessment algorithms, and a checklist were proposed to summarize the important information and offer an updated tool to assist surgeons and oncologists who treat anal canal cancer and in providing the best care to their patients. CONCLUSION: These guidelines summarize recommendations based on the most current scientific evidence on relevant aspects of anal canal cancer management and are a practical guide to help surgeons and oncologists who treat anal canal cancer make the best therapeutic decisions.

Influence of contextual factors and reliability of ultrasound skin measures in persons with systemic sclerosis and healthy controls.

OBJECTIVES: To examine the influence of contextual factors upon the evaluation of skin thickness and stiffness by ultrasound and to assess the reliability of these parameters. METHODS: Ultrasound dermal thickness (by B-mode, 18MHz) and skin stiffness (by shear-wave elastography, 9MHz) were assessed in persons with systemic sclerosis (SSc) and in healthy controls. The influence of contextual factors upon repeated measures was evaluated: (i) room temperature (16-17ºC vs. 22-24ºC); (ii) time of day (morning vs. afternoon), and (iii) menstrual cycle phase (menstrual vs. ovulatory). Differences were analysed using the related-samples Wilcoxon signed-rank test. Inter- and intra-rater reliability of ultrasound skin thickness and stiffness were evaluated in the 17 skin Rodnan sites of 20 persons with SSc and 20 healthy controls, under stable contextual conditions. RESULTS: A significant increase in ultrasound dermal thickness was observed at the leg in the afternoon vs morning, in both patients and controls. Similar observations were made for skin stiffness at the leg (in SSc) and at the foot (in SSc and controls) in the afternoon. No significant changes were observed in association with room temperature and menstrual cycle. Intra- and inter-rater-reliability was good to excellent for ultrasound dermal thickness and stiffness, both in SSc and healthy controls. CONCLUSIONS: The timing of the ultrasound procedure within each day seems to influence the ultrasound measures at the legs and feet. Our study corroborates that ultrasound dermal thickness and skin stiffness are reliable domains to quantify skin involvement in SSc.

Parameniscal cyst: an important differential diagnosis in slow growing masses of the knee.

INTRODUCTION: Parameniscal cysts are small cystic lesions, near the meniscus, involving medial and lateral compartments at equal frequency. Frequently, parameniscal cysts are so small that patients do not notice them, being asymptomatic. However, they can grow and exceed 2 centimeters in diameter, causing pain and alarm due to the slow growing mass. Magnetic Resonance Imaging (MRI) is the gold standard for diagnosis. METHODS: Case report of a patient admitted to rheumatology department in the Centro Hospitalar e Universitário de Coimbra. RESULTS: We report a case of a 47-year-old male with idiopathic juvenile arthritis, who presented with a slow-growing mass over the medial aspect of the right knee. MRI revealed a conspicuous cystic ovoid lesion, compatible with a parameniscal cyst, associated with structural heterogeneity of the posterior edge of the internal meniscus with a longitudinal fracture at this level. CONCLUSION: This is the first case of parameniscal cyst reported in patients with inflammatory rheumatic disease and the differential diagnosis with synovial cyst, baker cyst, ganglion cyst, bursitis, hematoma and neoplasms is of utmost importance.

Recent Patents on the Industrial Application of Biosurfactants.

BACKGROUND: Biosurfactants are natural bioactive compounds produced from fungi, bacteria and plants. These molecules have several properties that enable them to be involved in various industrial applications. The surface-active properties of biosurfactants allow their use in various sectors, such as agriculture, health, cosmetics, bioremediation/ petroleum, mining, and bioprocess. OBJECTIVE: The objective of this study was to analyze the patents deposited in intellectual property databases for applications of biosurfactants in the areas of agriculture, health, cosmetics, bioremediation/petroleum, mining, and bioprocesses, with the research period consisting of the last six years. METHODS: This study targeted the use of biosurfactants in various industrial sectors. The patent search was carried out using the Google Patents platform, a platform that is commonly used for this purpose and freely accessible. RESULTS: During the search for patents related to applications of biosurfactants in industry filed in the last 6 years, results were found to be distributed in the following areas: agriculture (70), cosmetics (2311), bioremediation/petroleum (179), health (1794), mining (5), and bioprocess (133). Six patents were selected from each area, except for health and mining, for which the search resulted in only 5 and 4 patents, respectively, to be discussed and provide information on the biotechnological applications of biosurfactants in the industry. CONCLUSION: The present study showed a wide area of application of biosurfactants in industry. The interest in the inclusion of biosurfactants in the industry is directly related to the need for more sustainable solutions to solve real market problems. The cosmetics sector presented the most patents that employ the use of biosurfactants.

Ensino da empatia em saúde: revisão integrativa / Teaching empathy in healthcare: an integrative review / Enseñar empatía en salud: una revisión integradora

Resumo Empatia pressupõe a capacidade e sobretudo a vontade de compreender o outro e se colocar em seu lugar. Considerando isso, espera-se que profissionais envolvidos em cuidados de saúde sejam mais empáticos e capazes de ler o mundo ao seu redor com olhar humanizado, crítico e reflexivo. Objetivou-se investigar, mediante revisão integrativa, o que tem sido discutido a respeito do ensino da empatia nos cursos de graduação da área da saúde nos últimos cinco anos. Foram selecionados 27 artigos das bases de dados MEDLINE e LILACS, por meio dos quais se identificou que a maioria dos estudos disponíveis foram realizados nas áreas de medicina e enfermagem. Além disso, constatou-se que, apesar de o tema empatia remeter à subjetividade, a metodologia quantitativa com aplicação de escalas padronizadas foi a mais utilizada para mensurar níveis de empatia e que, por fim, o ensino da empatia ocorreu por meio de metodologias ativas.

Abstract Empathy presupposes the ability and, most importantly, the willingness to understand others and put oneself in their place. Hence, health personnel are expected to be more empathetic and able to read the world around them with a humanized, critical, and reflexive look. This integrative review examines the studies on teaching empathy in undergraduate health programs published in the last five years. A total of 27 studies were selected from the MEDLINE and LILACS databases, most of which were published in the fields of medicine and nursing. Although a subjective element, most studies measured empathy using standardized scales (quantitative approach). Finally, empathy was taught using active methodologies.

Resumen La empatía es una capacidad, sobre todo una voluntad, de comprender al otro y de ponerse en su piel. Así se espera que los profesionales involucrados en el cuidado de la salud sean más empáticos y tengan una mirada humanizada, crítica y reflexiva sobre el mundo. Esta es una revisión integradora para identificar cómo se enseña la empatía en las carreras de graduación en el área de la salud en los últimos cinco años. Se seleccionaron 27 artículos de las bases de datos MEDLINE y LILACS, y se identificó que la mayoría de los estudios disponibles fueron de las áreas de Medicina y Enfermería. Se constató también que, aunque el tema de la empatía se refiera a la subjetividad, el método cuantitativo con la aplicación de escalas estandarizadas fue el más utilizado para medir los niveles de empatía y que la enseñanza de la empatía ocurrió por metodologías activas.

Gênero: (re)politizando a psicanálise / Gender: (re)politicizing psychoanalysis / Genre: (re)politiser la psychanalyse / Género: (re)politizando el psicoanálisis

Este texto tem por propósito, em primeiro lugar, construir uma reflexão acerca da ideia de que gênero, além de ser um problema de todos, inclusive da psicanálise e dos/das/des psicanalistas, é um conceito imprescindível para a escuta clínica no contemporâneo. Em segundo lugar, tem por objetivo apontar tarefas teóricas e clínico-políticas para que possamos, coletivamente, desobstruir a nossa escuta e ampliar o nosso horizonte ético e político, mas, mais do que isso, para que possamos perder o medo de abrir mão de velhos conceitos e criarmos coragem de escutar as demandas do nosso tempo, inventando novos rumos e, consequentemente, novos conceitos para as psicanálises.

The purpose of this text is, firstly, to build a reflection on the idea that gender, in addition to being a problem for everyone, including psychoanalysis and psychoanalysts, is an essential concept for clinical listening in the contemporary world. Secondly, it aims to point out theoretical and clinical-political tasks so that we can collectively clear our listening and broaden our ethical and political horizons, but more than that, so that we can lose the fear of giving up old concepts and create the courage to listen to the demands of our time, inventing new directions and, consequently, new concepts for psychoanalysis.

L'objet de ce texte est, dans un premier temps, de construire une réflexion sur l'idée que le genre, en plus d'être un problème pour tous, y compris la psychanalyse et les psychanalystes, est un concept essentiel pour l'écoute clinique dans le monde contemporain. Deuxièmement, il vise à souligner les tâches théoriques et clinico-politiques afin que nous puissions collectivement éclaircir notre écoute et élargir nos horizons éthiques et politiques, mais plus que cela, afin que nous puissions perdre la peur d'abandonner les vieux concepts et créer le courage écouter les exigences de notre temps, inventer de nouvelles directions et, par conséquent, de nouveaux concepts pour la psychanalyse.

Este texto tiene por propósito, en primer lugar, construir una reflexión acerca de la idea de género, além de ser um problema de todos, inclusive da psicanálise e dos/das/des psicanalistas, é um conceito imprescindível para a escuta clinic no contemporâneo. Em segundo lugar, tem por objectivo apontar tarefas teóricas e clínico-politicas para que possamos, coletivamente, desobstruir a nossa escuta e ampliar o nosso horizonte ético e político, mas, mais do que isso, para que possamos perder o medo de open mão de Velhos conceitos e criarmos coragem de escutar as demanded do nosso tempo, inventando novos rumos e, consequentemente, novos conceitos para as psicanálises.

Normal percentile reference curves for skin ultrasound thickness and stiffness at Rodnan sites.

OBJECTIVES: Our primary objective was to establish preliminary normal reference curves for ultrasound-dermal thickness and skin stiffness in the 17 Rodnan skin sites, considering the effect of gender and age on these measures. As an exploratory objective, we investigated the effect of body mass index and the menopause on skin ultrasound measures. METHODS: A cross-sectional study was conducted involving 140 healthy volunteers, aged 20-79 years. Recruitment was stratified by gender and age (10-year categories). Ultrasound-dermal thickness and skin stiffness were assessed by high-frequency ultrasound and shear-wave elastography, respectively, at the 17 Rodnan skin sites. Outcomes were evaluated through a mixed linear model, univariate and multivariate regressions. Normal reference curves were derived for both ultrasound measures in each skin site. An online calculator of the percentiles of skin ultrasound measures was developed. RESULTS: Ultrasound-dermal thickness and stiffness measures were higher in men than women in all Rodnan skin sites (except in chest for ultrasound-dermal thickness). Age had also a significant impact in both ultrasound measures, but only in some skin sites. Gender and age percentile curves (97.5th, 95th, 75th, 50th, 25th, 5th, 2.5th) were plotted for each of the measures in each skin site. CONCLUSIONS: Gender and age are strongly associated with skin ultrasound parameters, imposing the need for gender-specific and age-specific reference values. Normal reference percentile curves are provided as a basis for future cooperative work to strengthen its evidence basis, representativeness and refinement regarding potentially influential factors.

Shear-Wave Elastography Evaluation of Major Salivary Glands in Primary Sjögren's Syndrome.

OBJECTIVES: Salivary glands ultrasonography has recently been shown to be useful in the diagnosis of Primary Sjögren's Syndrome (pSS). Shear-wave elastography (SWE) is a promising tool for the quantitative assessment of tissues stiffness, but studies evaluating its role in pSS diagnosis are limited. This study aimed at investigating the diagnostic performance of SWE in pSS. MATERIALS AND METHODS: Cross-sectional study including patients fulfilling the 2016 ACR/EULAR classification criteria for pSS and healthy subjects. The four major salivary glands were assessed using SGUS. B-mode scans were rated using the Hocevar score, and shear-wave velocity (SWV) values were obtained using SWE. Intraclass-correlation coefficient (ICC) estimates were used to assess reliability. Cut-off values for differentiating pSS patients from healthy subjects were calculated using Receiver-Operating Characteristics (ROC) curves. RESULTS: We included 50 pSS and 25 healthy subjects. Inter-rater reliability of SWE was moderate (ICC=0.64) and intra-rater reliability was moderate to good (ICC= 0.73 to 0.83). Total SWV (2.09 m/s (0.32); p < 0.001), parotid SWV (2.25 m/s (0.40)) and submandibular SWV (1.92 m/s (0.38)) were significantly higher in pSS patients. Total and parotid SWV presented good diagnostic performance for pSS diagnosis (AUROC= 0.80 and 0.81, respectively). The Hocevar score demonstrated excellent diagnostic performance (AUROC= 0.98) and combining it with total SWV did not result in statistically significant improvement (p=0.301). CONCLUSIONS: SWE may contribute to the diagnosis of pSS. Large prospective studies including sicca and secondary SS patients, as well as the standardisation of SWE protocols, are warranted to assess the role of SWE in pSS management.