A Scoping Review on Carotenoid Profiling in Passiflora spp.: A Vast Avenue for Expanding the Knowledge on the Species.

The Passiflora genus is recognised for its ethnopharmacological, sensorial, and nutritional significance. Yet, the screening of its dietary and bioactive molecules has mainly targeted hydrophilic metabolites. Following the PRISMA-P protocol, this review assessed the current knowledge on carotenoid composition and analysis within Passiflora, examining 968 records from seven databases and including 17 studies focusing on carotenoid separation and identification in plant parts. Those publications originated in America and Asia. P. edulis was the most frequently examined species of a total of ten, while pulp was the most studied plant part (16 studies). Carotenoid analysis involved primarily high-performance liquid chromatography separation on C18 columns and detection using diode array detectors (64.71%). Most studies identified the provitamin A ß-carotene and xanthophylls lutein and zeaxanthin, with their geometric configuration often neglected. Only one study described carotenoid esters. Besides the methodology's insufficient description, the lack of use of more accurate techniques and practices led to a high risk of bias in the carotenoid assignment in 17.65% of the articles. This review highlights the opportunity to broaden carotenoid studies to other species and parts within the diverse Passiflora genus, especially to wild, locally available fruits, which may have a strategic role in enhancing food diversity and security amidst climatic changes. Additionally, it urges the use of more accurate and efficient analytical methods based on green chemistry to better identify Passiflora carotenoids.

In Vitro Astroglial Dysfunction Induced by Neurotoxins: Mimicking Astrocytic Metabolic Alterations of Alzheimer's Disease.

Astrocytes play fundamental roles in the maintenance of brain homeostasis. The dysfunction of these cells is widely associated with brain disorders, which are often characterized by variations in the astrocyte protein markers GFAP and S100B, in addition to alterations in some of its metabolic functions. To understand the role of astrocytes in neurodegeneration mechanisms, we induced some of these metabolic alterations, such as energy metabolism, using methylglyoxal (MG) or fluorocitrate (FC); and neuroinflammation, using lipopolysaccharide (LPS) and streptozotocin (STZ), which is used for inducing Alzheimer's disease (AD) in animal models. We showed that MG, LPS, STZ and FC similarly caused astrocyte dysfunction by increasing GFAP and reducing S100B secretion. In the context of AD, STZ caused an amyloid metabolism impairment verified by increases in Aß1-40 peptide content and decreases in the amyloid degradation enzymes, IDE and NEP. Our data contribute to the understanding of the role of astrocytes in brain injury mechanisms and suggest that STZ is suitable for use in vitro models for studying the role of astrocytes in AD.

Microrheological comparison of melanoma cells by atomic force microscopy.

Melanoma is one of the most severe cancers due to its great potential to form metastasis. Recent studies showed the importance of mechanical property assessment in metastasis formation which depends on the cytoskeleton dynamics and cell migration. Although cells are considered purely elastic, they are viscoelastic entities. Microrheology atomic force microscopy (AFM) enables the assessment of elasticity and viscous properties, which are relevant to cell behavior regulation. The current work compares the mechanical properties of human neonatal primary melanocytes (HNPMs) with two melanoma cell lines (WM793B and 1205LU cells), using microrheology AFM. Immunocytochemistry of F-actin filaments and phosphorylated focal adhesion kinase (p-FAK) and cell migration assays were performed to understand the differences found in microrheology AFM regarding the tumor cell lines tested. AFM revealed that HNPMs and tumor cell lines had distinct mechanical properties. HNPMs were softer, less viscous, presenting a higher power-law than melanoma cells. Immunostaining showed that metastatic 1205LU cells expressed more p-FAK than WM793B cells. Melanoma cell migration assays showed that WM73B did not close the gap, in contrast to 1205LU cells, which closed the gap at the end of 23 h. These data seem to corroborate the high migratory behavior of 1205LU cells. Microrheology AFM applied to HNPMs and melanoma cells allowed the quantification of elasticity, viscous properties, glassy phase, and power-law properties, which have an impact in cell migration and metastasis formation. AFM study is important since it can be used as a biomarker of the different stages of the disease in melanoma.

Palmitic acid, but not other long-chain saturated fatty acids, increases S100B protein and TNF-α secretion by astrocytes.

Obesity is a health problem that involves fat accumulation in adipose and other tissues and causes cell dysfunction. Long-chain saturated fatty acids can induce and propagate inflammation, which may also contribute to the brain alterations found in individuals with obesity. Fatty acids accumulate in astrocytes in situations of blood‒brain barrier disruption, such as inflammatory conditions. Furthermore, the increase in tumor necrosis factor-alpha (TNF-α) and S100 calcium-binding protein B (S100B) secretion is considered an essential component of the inflammatory response. We hypothesize that through their action on astrocytes, long-chain saturated fatty acids mediate some of the brain alterations observed in individuals with obesity. Here, we investigate the direct effect of long-chain fatty acids on astrocytes. Primary astrocyte cultures were incubated for 24 hours with myristic, palmitic, stearic, linoleic, or α-linolenic acids (25-100 µM). All saturated fatty acids tested led to an increase in TNF-α secretion, but only palmitic acid, one of the most common fatty acids, increased S100B secretion, indicating that S100B secretion is probably not caused in response to TNF-α release. Palmitic acid also caused nuclear migration of nuclear factor kappa B. Long-chain saturated fatty acids did not alter cell viability or redox status. In conclusion, long-chain saturated fatty acids can alter astrocytic homeostasis and may contribute to brain disorders associated with obesity, such as neuroinflammation.

Transcriptomic remodeling of gastric cells by Helicobacter pylori outer membrane vesicles.

BACKGROUND: Outer membrane vesicles (OMVs) are spontaneously released by Gram-negative bacteria and influence bacteria-host interactions by acting as a delivery system for bacterial components and by interacting directly with host cells. Helicobacter pylori, a pathogenic bacterium that chronically colonizes the human stomach, also sheds OMVs, and their impact on bacterial-mediated diseases is still being elucidated. MATERIALS AND METHODS: Transcriptomic profiling of the human gastric cell line MKN74 upon challenge with H. pylori OMVs compared to control and infected cells was performed using the Ion AmpliSeq™ Transcriptome Human Gene Expression Panel to understand the gene expression changes that human gastric epithelial cells might undergo when exposed to H. pylori OMVs. RESULTS: H. pylori OMVs per se modify the gene expression profile of gastric epithelial cells, adding another layer of (gene) regulation to the already complex host-bacteria interaction. The most enriched pathways include those related to amino acid metabolism, mitogen-activated protein kinase signaling, autophagy, and ferroptosis, whereas the cell cycle, DNA replication, and DNA repair were the most downregulated. The transcriptomic changes induced by OMVs were mostly similar to those induced by the parental bacteria, likely amplifying the effects of the bacterium itself. CONCLUSIONS: Our data provide a valuable portrayal of the transcriptomic remodeling of gastric cells induced by H. pylori OMVs. It demonstrates the breadth of cellular pathways and genes affected by OMVs, most previously unreported, which can be further dissected for the underlying molecular mediators and explored to understand the pathobiology of the full spectrum of H. pylori-mediated diseases.

How S100B crosses brain barriers and why it is considered a peripheral marker of brain injury.

S100B is a 21-kDa protein that is produced and secreted by astrocytes and widely used as a marker of brain injury in clinical and experimental studies. The majority of these studies are based on measurements in blood serum, assuming an associated increase in cerebrospinal fluid and a rupture of the blood-brain barrier (BBB). Moreover, extracerebral sources of S100B are often underestimated. Herein, we will review these interpretations and discuss the routes by which S100B, produced by astrocytes, reaches the circulatory system. We discuss the concept of S100B as an alarmin and its dual activity as an inflammatory and neurotrophic molecule. Furthermore, we emphasize the lack of data supporting the idea that S100B acts as a marker of BBB rupture, and the need to include the glymphatic system in the interpretations of serum changes of S100B. The review is also dedicated to valorizing extracerebral sources of S100B, particularly adipocytes. Furthermore, S100B per se may have direct and indirect modulating roles in brain barriers: on the tight junctions that regulate paracellular transport; on the expression of its receptor, RAGE, which is involved in transcellular protein transport; and on aquaporin-4, a key protein in the glymphatic system that is responsible for the clearance of extracellular proteins from the central nervous system. We hope that the data on S100B, discussed here, will be useful and that it will translate into further health benefits in medical practice.

Astroglial S100B Secretion Is Mediated by Ca2+ Mobilization from Endoplasmic Reticulum: A Study Using Forskolin and DMSO as Secretagogues.

S100B, a homodimeric Ca2+-binding protein, is produced and secreted by astrocytes, and its extracellular levels have been used as a glial marker in brain damage and neurodegenerative and psychiatric diseases; however, its mechanism of secretion is elusive. We used primary astrocyte cultures and calcium measurements from real-time fluorescence microscopy to investigate the role of intracellular calcium in S100B secretion. In addition, the dimethyl sulfoxide (DMSO) effect on S100B was investigated in vitro and in vivo using Wistar rats. We found that DMSO, a widely used vehicle in biological assays, is a powerful S100B secretagogue, which caused a biphasic response of Ca2+ mobilization. Our data show that astroglial S100B secretion is triggered by the increase in intracellular Ca2+ and indicate that this increase is due to Ca2+ mobilization from the endoplasmic reticulum. Also, blocking plasma membrane Ca2+ channels involved in the Ca2+ replenishment of internal stores decreased S100B secretion. The DMSO-induced S100B secretion was confirmed in vivo and in ex vivo hippocampal slices. Our data support a nonclassic vesicular export of S100B modulated by Ca2+, and the results might contribute to understanding the mechanism underlying the astroglial release of S100B.

Long-term LPS systemic administration leads to memory impairment and disturbance in astrocytic homeostasis.

Dementia is the most prevalent neurodegenerative disorder, characterized by progressive loss of memory and cognitive function. Inflammation is a major aspect in the progression of brain disorders, and inflammatory events have been associated with accelerated deterioration of cognitive function. In the present work, we investigated the impact of low-grade repeated inflammation stimuli induced by lipopolysaccharide (LPS) in hippocampal function and spatial memory. Adult male Wistar rats received a weekly injection of LPS (500 ug/kg) for sixteen weeks, eliciting systemic inflammation. Animals submitted to LPS presented impaired spatial memory and neuroinflammation. While neuronal synaptic markers such as synaptophysin and PSD-95 were unaltered, critical aspects of astrocyte homeostatic functions, such as glutamate uptake and glutathione content, were reduced. Also, glucose uptake and astrocyte lactate transporters were altered, suggesting a disturbance in the astrocyte-neuron coupling. Our present work demonstrates that long-term repeated systemic inflammation can lead to memory impairment and hippocampal metabolic disorders, especially regarding astrocyte function.

Broadband Superabsorber Operating at 1500 °C Using Dielectric Bilayers.

Many technological applications in photonics require devices to function reliably under extreme conditions, including high temperatures. To this end, materials and structures with thermally stable optical properties are indispensable. State-of-the-art thermal photonic devices based on nanostructures suffer from severe surface diffusion-induced degradation, and the operational temperatures are often restricted. Here, we report on a thermo-optically stable superabsorber composed of bilayer refractory dielectric materials. The device features an average absorptivity ∼95% over >500 nm bandwidth in the near-infrared regime, with minimal temperature dependence up to 1500 °C. Our results demonstrate an alternative pathway to achieve high-temperature thermo-optically stable photonic devices.

Curcumin modulates astrocyte function under basal and inflammatory conditions.

Curcumin is a pleiotropic molecule with well-known anti-inflammatory effects. This molecule has attracted attention due to its capacity to pass the blood-brain-barrier and modulate central nervous system (CNS) cells, such as astrocytes. Astrocytes are the most numerous CNS cells, and play a pivotal role in inflammatory damage, a common feature in neurodegenerative diseases such as Alzheimer's Disease. Although the actions of curcumin have been studied extensively in peripheral cells, few studies have investigated the effect of curcumin on astrocytes under basal and inflammatory conditions. The aim of this study was to characterize the effect of curcumin on astrocytic function (glutamatergic metabolism, GFAP and S100B), and investigate a possible synergic effect with another molecule, piperine. For this purpose, we used primary cultured astrocytes; our results showed that curcumin increases GSH and GFAP content, but decreases S100B secretion under basal conditions. Under inflammatory conditions, provoked by lipopolysaccharide (LPS), curcumin and piperine reversed the LPS-induced secretion of TNF-α, and piperine reverted the LPS-induced upregulation of GFAP content. Interestingly, curcumin decreases S100B secretion even more than LPS. These results highlight important context-dependent effects of curcumin and piperine on astrocytes. Although we did not observe synergic effects of co-treatment with curcumin and piperine, their effects were complementary, as piperine modulated GFAP content under inflammatory conditions, and curcumin modulated S100B secretion. Both curcumin and piperine had important anti-inflammatory actions in astrocytes. We herein provide new insights into the actions of curcumin in the CNS that may aid in the search for new molecular targets and possible treatments for neurological diseases.

Scalable Superabsorbers and Color Filters Based on Earth-Abundant Materials.

Optical materials based on unconventional plasmonic metals (e.g., magnesium) have lately driven rising research interest for the quest of possibilities in nanophotonic applications. Several favorable attributes of Mg, such as earth abundancy, lightweight, biocompatibility/biodegradability, and its active reactions with water or hydrogen, have underpinned its emergence as an alternative nanophotonic material. Here, we experimentally demonstrate a thin film-based optical device composed exclusively of earth-abundant and complementary metal-oxide semiconductor (CMOS)-compatible materials (i.e., Mg, a-Si, and SiO2). The devices can exhibit a spectrally selective and tunable near-unity resonant absorption with an ultrathin a-Si absorbing layer due to the strong interference effect in this high-index and lossy film. Alternatively, they can generate diverse reflective colors by appropriate tuning of the a-Si and SiO2 layer thicknesses, including all the primary colors for RGB (red, green, blue) and CMY (cyan, magenta, yellow) color spaces. In addition, the reflective hues of the devices can be notably altered in a zero power-consumption fashion by immersing them in water due to the resulted dissolution of the Mg back-reflection layer. These compelling features in combination with the lithography-free and scalable fabrication steps may promise their adoption in various photonic applications including solar energy harvesting, optical information security, optical modulation, and filtering as well as structure reuse and recycling.

Machine Learning Enables Prediction of Halide Perovskites' Optical Behavior with >90% Accuracy.

The composition-dependent degradation of hybrid organic-inorganic perovskites (HOIPs) due to environmental stressors still precludes their commercialization. It is very difficult to quantify their behavior upon exposure to each stressor by exclusively using trial-and-error methods due to the high-dimensional parameter space involved. We implement machine learning (ML) models using high-throughput, in situ photoluminescence (PL) to predict the response of Cs y FA1-y Pb(Br x I1-x )3 while exposed to relative humidity cycles. We quantitatively compare three ML models while generating forecasts of environment-dependent PL responses: linear regression, echo state network, and seasonal autoregressive integrated moving average with exogenous regressor algorithms. We achieve accuracy of >90% for the latter, while tracking PL changes over a 50 h window. Samples with 17% of Cs content consistently showed a PL increase as a function of cycle. Our precise time-series forecasts can be extended to other HOIP families, illustrating the potential of data-centric approaches to accelerate material development for clean-energy devices.

High-intensity functional training with an adequate and carbohydrate restricted hypocaloric diet promotes weight loss and cardiometabolic improvements

INTRODUCTION: Excess body weight and its comorbidities represent a major public health issue. Interventions based on diet and exercise have not only been shown to promote weight loss, but also improve overall health, including cardiovascular health. OBJECTIVE: This study aimed to evaluate the effects of a 12-week hypocaloric low-carbohydrate (CHO) diet coupled with high-intensity functional training (HIFT) on the cardiometabolic risk of overweight adults. METHODS: This is a randomized controlled trial. A total of 31 overweight adults participated in this study, divided into two groups based on the dietary intervention: reduced-CHO (R-CHO, ≤130 g/day; n=15) and adequate-CHO (A-CHO, >130 g/day; n=16). The cardiometabolic risk was assessed using lipidaemic, insulinemia, and glycaemic parameters. A two-way ANOVA with Bonferroni post hoc test was utilized to evaluate the effects of the intervention. A p-value < 0.05 was considered statistically significant. RESULTS: Participants from both groups displayed decreased low-density lipoprotein, very-low-density lipoprotein, total cholesterol, and triacylglycerol concentrations, as well as the number of risk factors for the metabolic disease after 12 weeks. The high-density lipoprotein (HDL) cholesterol concentration of both groups increased after 12 weeks, however, the result of the intragroup analysis revealed that a significant increase was only observed in the participants from the A-CHO group. CONCLUSION: Reduced or adequate CHO intake was both found to be effective in reducing cardiometabolic risk. However, improvements in HDL and final cardiometabolic classification risk indicated that CHO adequacy in the diet might be a better strategy associated with caloric restriction and HIFT.

Upper airway angle and glottic height: a prospective cohort to evaluate two new features for airway prediction.

BACKGROUND: Predicting difficult direct laryngoscopies remains challenging and improvements are needed in preoperative airway assessment. We conceived two new tests (the upper airway angle and the glottic height) and assessed their association with difficult direct laryngoscopies as well as their predictive performance. METHODS: A prospective cohort was conducted with 211 patients undergoing general anesthesia for surgical procedures. We assessed the association between difficult laryngoscopies and modified Mallampati Test (MMT), Upper Lip Bite Test (ULBT), Mandibular Length (ML), Neck Circumference (NC), Mouth Opening (MO), Sternomental Distance (SMD), Thyromental Distance (TMD), Upper Airway Angle (UAA), and Glottic Height (GH). We also estimated their predictive values. RESULTS: Difficult laryngoscopy was presented by 12 patients (5.7%). Six tests were significantly associated with difficult laryngoscopies and their area under the ROC curve, and 95% CIs were as follows: UAA = 88.82 (81.86-95.78); GH = 86.43 (72.67-100); ML = 83.75 (72.77-94.74); NC = 79.17 (64.98-93.36); MO = 65.58 (45.13-86.02); and MMT = 77.89 (68.37-87.41). CONCLUSION: We have found two new features (the UAA and the GH) to be significantly associated with the occurrence of difficult direct laryngoscopies. They also presented the best predictive performance amongst the nine evaluated tests in our cohort of patients. We cannot ensure, however, these tests to be superior to other regularly used bedside tests based on our estimated 95% CIs.

Optical Tunability and Characterization of Mg-Al, Mg-Ti, and Mg-Ni Alloy Hydrides for Dynamic Color Switching Devices.

Mg shows great potential as a metal hydride for switchable optical response and hydrogen detection due to its ability to stably incorporate significant amounts of hydrogen into its lattice. However, this thermodynamic stability makes hydrogen removal difficult. By alloying Mg with secondary elements, the hydrogenation kinetics can be increased. Here, we report the dynamic optical, loading, and stress properties of three Mg alloy systems (Mg-Al, Mg-Ti, and Mg-Ni) and present several novel phenomena and three distinct device designs that can be achieved with them. We find that these materials all have large deviations in refractive index when exposed to H2 gas, with a wide range of potential properties in the hydride state. The magnitude and sign of the optical property change for each of the alloys are similar, but the differences have dramatic effects on device design. We show that Mg-Ti alloys perform well as both switchable windows and broadband switchable light absorbers, where Mg0.87Ti0.13 and Mg0.85Ti0.15 can achieve a 40% transmission change as a switchable window and a 55% absorption change as a switchable solar absorber. We also show how different alloys can be used for dynamically tunable color filters, where both the reflected and transmitted colors depend on the hydrogenation state. We demonstrate how small changes in the alloy composition (e.g., with Mg-Ni) can lead to dramatically different color responses upon hydrogenation (red-shifting vs blue-shifting of the resonance). Our results establish the potential for these Mg alloys in a variety of applications relating to hydrogen storage, detection, and optical devices, which are necessary for a future hydrogen economy.

Upper airway angle and glottic height: a prospective cohort to evaluate two new features for airway prediction

Abstract Background: Predicting difficult direct laryngoscopies remains challenging and improvements are needed in preoperative airway assessment. We conceived two new tests (the upper airway angle and the glottic height) and assessed their association with difficult direct laryngoscopies as well as their predictive performance. Methods: A prospective cohort was conducted with 211 patients undergoing general anesthesia for surgical procedures. We assessed the association between difficult laryngoscopies and modified Mallampati Test (MMT), Upper Lip Bite Test (ULBT), Mandibular Length (ML), Neck Circumference (NC), Mouth Opening (MO), Sternomental Distance (SMD), Thyromental Distance (TMD), Upper Airway Angle (UAA), and Glottic Height (GH). We also estimated their predictive values. Results: Difficult laryngoscopy was presented by 12 patients (5.7%). Six tests were significantly associated with difficult laryngoscopies and their area under the ROC curve, and 95% CIs were as follows: UAA = 88.82 (81.86-95.78); GH = 86.43 (72.67-100); ML = 83.75 (72.77-94.74); NC = 79.17 (64.98-93.36); MO = 65.58 (45.13-86.02); and MMT = 77.89 (68.37-87.41). Conclusion: We have found two new features (the UAA and the GH) to be significantly associated with the occurrence of difficult direct laryngoscopies. They also presented the best predictive performance amongst the nine evaluated tests in our cohort of patients. We cannot ensure, however, these tests to be superior to other regularly used bedside tests based on our estimated 95% CIs.

Refractory Metals and Oxides for High-Temperature Structural Color Filters.

Refractory metals have recently garnered significant interest as options for photonic applications due to their superior high-temperature stability and versatile optical properties. However, most previous studies only consider their room-temperature optical properties when analyzing these materials' behavior as optical components. Here, we demonstrate structural color pixels based on three refractory metals (Ru, Ta, and W) for high-temperature applications. We quantify their optical behavior in an oxygenated environment and determine their dielectric functions after heating up to 600 °C. We use in situ oxidation, a fundamental chemical reaction, to form nanometer-scale metal oxide thin-film bilayers on each refractory metal. We fully characterize the behavior of the newly formed thin-film interference structures, which exhibit vibrant color changes upon high-temperature treatment. Finally, we present optical simulations showing the full range of hues achievable with a simple two-layer metal oxide/metal reflector structure. All of these materials have melting points >1100 °C, with the Ta-based structure offering high-temperature stability, and the Ru- and W-based options providing an alternative for reversible color filters, at high temperatures in inert or vacuum environments. Our approach is uniquely suitable for high-temperature photonics, where the oxides can be used as conformal coatings to produce a wide variety of colors across a large portion of the color gamut.

Is Mallampati classification a good screening test? A prospective cohort evaluating the predictive values of Mallampati test at different thresholds

Abstract Background There is currently some discussion over the actual usefulness of performing preoperative upper airway assessment to predict difficult airways. In this field, modified Mallampati test (MMT) is a widespread tool used for prediction of difficult airways showing only a feeble predictive performance as a diagnostic test. We therefore aimed at evaluating if MMT test would perform better when used as a screening test rather than diagnostic. Methods An accuracy prospective study was conducted with 570 patients undergoing general anesthesia for surgical procedures. We collected preoperatively data on sex, age, weight, height, body mass index (BMI), ASA physical status, and MMT. The main outcome was difficult laryngoscopy defined as Cormack and Lahane classes 3 or 4. Bivariate analyses were performed to build three different predictive models with their ROC curves. Results Difficult laryngoscopy was reported in 36 patients (6.32%). Sex, ASA physical status, and MMT were associated with difficult laryngoscopy, while body mass index (BMI) was not. The MMT cut-off with the highest odds ratio was the class II, which also presented significantly higher sensitivity (94.44%). The balanced accuracy was 67.11% (95% CI: 62.78-71.44%) for the cut-off of class II and 71.68% (95% CI: 63.83-79.54) for the class III. Conclusion MMT seems to be more clinically useful when the class II is employed as the threshold for possible difficult laryngoscopies. At this cut-off, MMT shows the considerable highest sensitivity plus the highest odds ratio, prioritizing thus the anticipation of difficult laryngoscopies.

Quantitative Predictions of Moisture-Driven Photoemission Dynamics in Metal Halide Perovskites via Machine Learning.

Metal halide perovskite (MHP) photovoltaics may become a viable alternative to standard Si-based technologies, but the current lack of long-term stability precludes their commercial adoption. Exposure to standard operational stressors (light, temperature, bias, oxygen, and water) often instigate optical and electronic dynamics, calling for a systematic investigation into MHP photophysical processes and the development of quantitative models for their prediction. We resolve the moisture-driven light emission dynamics for both methylammonium lead tribromide and triiodide thin films as a function of relative humidity (rH). With the humidity and photoluminescence time series, we train recurrent neural networks and establish their ability to quantitatively predict the path of future light emission with 18% error over 4 h. Together, our in situ rH-PL measurements and machine learning forecasting models provide a framework for the rational design of future stable perovskite devices and, thus, a faster transition toward commercial applications.

Is Mallampati classification a good screening test? A prospective cohort evaluating the predictive values of Mallampati test at different thresholds.

BACKGROUND: There is currently some discussion over the actual usefulness of performing preoperative upper airway assessment to predict difficult airways. In this field, modified Mallampati test (MMT) is a widespread tool used for prediction of difficult airways showing only a feeble predictive performance as a diagnostic test. We therefore aimed at evaluating if MMT test would perform better when used as a screening test rather than diagnostic. METHODS: An accuracy prospective study was conducted with 570 patients undergoing general anesthesia for surgical procedures. We collected preoperatively data on sex, age, weight, height, body mass index (BMI), ASA physical status, and MMT. The main outcome was difficult laryngoscopy defined as Cormack and Lahane classes 3 or 4. Bivariate analyses were performed to build three different predictive models with their ROC curves. RESULTS: Difficult laryngoscopy was reported in 36 patients (6.32%). Sex, ASA physical status, and MMT were associated with difficult laryngoscopy, while body mass index (BMI) was not. The MMT cut-off with the highest odds ratio was the class II, which also presented significantly higher sensitivity (94.44%). The balanced accuracy was 67.11% (95% CI: 62.78...71.44%) for the cut-off of class II and 71.68% (95% CI: 63.83...79.54) for the class III. CONCLUSION: MMT seems to be more clinically useful when the class II is employed as the threshold for possible difficult laryngoscopies. At this cut-off, MMT shows the considerable highest sensitivity plus the highest odds ratio, prioritizing thus the anticipation of difficult laryngoscopies.