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Functional muscle quality, as assessed through the muscle quality index (MQI), represents a contemporary method to measure the capacity to generate force. Despite its potential, the prognostic significance of MQI remains uncertain in various clinical conditions, particularly among patients following acute myocardial infarction (AMI). In light of this, our study sought to evaluate the prognostic relevance of MQI concerning major adverse cardiovascular events (MACE) in patients following AMI. This is a secondary analysis of a prospective cohort study that included subjects aged ≥20 years from a Cardiovascular Unit Hospital. Functional muscle quality was estimated using MQI, defined as the ratio of handgrip strength (HGS) to muscle mass (MM) derived from bioelectrical impedance analysis. The outcomes included prolonged length of hospital stay, new adverse cardiovascular events (AMI, stroke and hospital readmission for unstable angina), and cardiovascular mortality. A composite score comprising all adverse events over the 1-year follow-up was calculated and defined as MACE. This study included 163 patients, with a median age of 61 years (IQ: 54–69 years), and the majority consisted of males (76.1%). Individual components of the functional muscle quality (HGS and MM) were not associated with any of the adverse outcomes. Only MQI was associated mortality over the 1-year follow-up. For each increase in MQI, the hazard of mortality decreases: adjusted HR: 0.08 (95% CI 0.01–0.84). Functional muscle quality assessed by the MQI may be a valuable clinical predictor of 1-year cardiovascular mortality in patients hospitalized post-AMI. [Display omitted] • Muscle quality is an independent predictor of mortality in patients post-AMI. • Isolated parameters of muscle quality had less predictive capacity. • Muscle quality index enhances the prognostic assessment of patients post-AMI. [ABSTRACT FROM AUTHOR]

Copyright of Brazilian Journal of Pulmonology / Jornal Brasileiro de Pneumologia is the property of Sociedade Brasileira de Pneumologia e Tisiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The aim of this review is to present the state of the art regarding obstetric violence in Brazil. The most commonly used terms are “obstetric violence,” “disrespect and abuse,” and “mistreatment”. Concerning measurement, the most widely used instrument is based on the definition of “mistreatment,” still in its early stages of evaluation and lacking adaptation to Brazil. The prevalence of obstetric violence varies widely in national studies due to methodological factors and the type of postpartum women considered. Regarding risk factors, adolescent or women over 35, non-white, with low education levels, users of the public health system (SUS), those who had vaginal birth or abortion, are at higher risk. Hierarchical relationships between the healthcare team and the family are also relevant, as well as inadequate hospital structures, bed shortages, and insufficient healthcare professionals, which contribute to obstetric violence. The consequences of this violence include an increased risk of postpartum depression and PTSD, reduced likelihood of attending postpartum and childcare consultations, and difficulties in exclusive breastfeeding. Interventions to mitigate obstetric violence should consider women’s empowerment, healthcare professionals’ training, monitoring obstetric violence, and legal support. [ABSTRACT FROM AUTHOR]

This study aimed to determine the effects of economic growth and tourism, as well as company-specific factors, on the business performance of the hospitality industry, through an empirical analysis with panel data, between 2011 and 2021, of 1299 hotels based in Portugal with the main economic activity classification 55 - Accommodation. The variables under study included financial performance indicators such as return on assets (ROA), return on equity (ROE), financial performance measured by a CP SCORE variable and characterization variables such as age, size, legal form and the region in which the hotels are based. The methodology used panel regression tests and the results suggest that macroeconomic factors may be partially responsible for a small part of the variation in firm performance. Economic growth has a positive influence on ROA and competitiveness and tourism growth on the profitability variables ROA and ROE. Age and size influence economic and financial performance and there are differences between firms' performance according to legal form and region. [ABSTRACT FROM AUTHOR]

This study aimed to analyze the role of nurses in hospital management in the face of COVID-19. The study had a qualitative, descriptive, and exploratory approach. The setting was a hospital that was completely transformed to care for patients with COVID-19. At the time of data collection, ten nurses managed the services, and all participated in the semi-structured interview. After thematic analysis, the data were presented in three categories, representing the elements of Donabedian’s triad: structure, process, and result. Category 1 highlighted the hospital structure reconfiguration based on material and people management; category 2 addressed the work process restructuring to achieve goals with safety and quality; and category 3 focused on nurses’ experiences in describing the results achieved and expected. The analysis highlighted the importance of teamwork, involvement, and adaptation of managers in the face of the challenges of a new and life-threatening disease, scarce resources, and the complexity of human relationships in the crisis. In transformational leadership, these nurses encouraged behavior change, professional growth, and resilience. [ABSTRACT FROM AUTHOR]

Transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve (BAV) stenosis is technically challenging and is burdened by an increased risk of paravalvular regurgitation (PVR). The aim of this study was to identify the incidence, predictors, and clinical outcomes of PVR after TAVR in Sievers type 1 BAV stenosis. Consecutive patients with Sievers type 1 BAV stenosis undergoing TAVR with current-generation transcatheter heart valves (THVs) in 24 international centers were enrolled. PVR was graded as none/trace, mild, moderate, and severe according to echocardiographic criteria. The endpoint of major adverse events (MAEs), defined as a composite of all-cause death, stroke, or hospitalization for heart failure, was assessed at the last available follow-up. A total of 946 patients were enrolled. PVR occurred in 423 patients (44.7%)—mild, moderate, and severe in 387 (40.9%), 32 (3.4%), and 4 (0.4%) patients, respectively. Independent predictors of moderate or severe PVR were a larger virtual raphe ring perimeter (adjusted OR: 1.07; 95% CI: 1.02-1.13), severe annular or left ventricular outflow tract calcification (adjusted OR: 5.21; 95% CI: 1.45-18.77), a self-expanding valve (adjusted OR: 9.01; 95% CI: 2.09-38.86), and intentional supra-annular THV positioning (adjusted OR: 3.31; 95% CI: 1.04-10.54). At a median follow-up of 1.3 years (Q1-Q3: 0.5-2.4 years), moderate or severe PVR was associated with an increased risk of MAEs (adjusted HR: 2.52; 95% CI: 1.24-5.09). After TAVR with current-generation THVs in Sievers type 1 BAV stenosis, moderate or severe PVR occurred in about 4% of cases and was associated with an increased risk of MAEs during follow-up. [Display omitted] [ABSTRACT FROM AUTHOR]

Copyright of Biota Neotropica (Edicao em Iingles) is the property of Biota Neotropica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Hypophosphatemia may cause serious complications. Depending on its severity and duration, signs and symptoms range from fatigue to life-threatening events, like severe rhabdomyolysis and mental status changes. Long-term consequences include osteomalacia. Hypophosphatemia may be secondary to the use of parental iron, mostly associated with ferric carboxymaltose (FCM), with an incidence of around 45% to 70%. We describe three cases of hypophosphatemia in patients with chronic iron deficiency anemia, requiring repeated FCM infusions. The patients’ presentation to the Rheumatology department included musculoskeletal symptoms of severe hypophosphatemia and long-term hypophosphatemic osteomalacia, with fractures. We aim to raise awareness for ferric carboxymaltose-induced hypophosphatemia, an entity increasingly described in the literature that can be responsible for severe disability or potentially life-threatening adverse events. [ABSTRACT FROM AUTHOR]

Although it is widely recognized that muscle quality significantly influences adverse outcomes in patients with cancer, the precise definition of muscle quality remains elusive. The muscle quality index (MQI), also known as muscle-specific strength, is a relatively recent functional concept of muscle quality. It is obtained through the ratio of muscle strength to muscle mass, but its predictive value in patients with cancer remains unknown. In this study, we explored the prognostic significance of MQI in patients with cancer. Furthermore, we introduce and assess the prognostic potential of a novel muscle quality metric: the strength-to-muscle-radiodensity index (SMRi). A secondary analysis was conducted on a prospective cohort study. CT scans were opportunistically used to assess body composition parameters, including skeletal muscle mass (SM in cm2) and muscle radiodensity (SMD in HU) at the third lumbar vertebra (L3). Handgrip strength (HGS) was measured. MQI CT was calculated using the ratio of HGS to SM (cm2). SMRi was calculated as the ratio of HGS to SMD (HU). For analysis purposes, low MQI CT and SMRi were defined using two approaches: statistical cutoffs associated with survival, and median-based distribution data. A total of 250 patients were included (52.8% females, 52% adults, 20–90 years). Gastrointestinal tumors and stage III-IV were the most frequent diagnosis and stages. SMRi and MQI CT were strongly positively correlated (ρ = 0.71 P < 0.001). Individual components of MQI CT and SMRi were also positively correlated. Patients with both low MQI CT and SMRi had shorter survival (log-rank P = 0.023 and P = 0.003, respectively). When applying median distribution cutoffs, SMRi emerged as the most accurate predictor of mortality (HR adjusted 3.18, 95% CI 1.50 to 6.75, C-index: 0.71), when compared to MQI CT (HR adjusted 1.49, 95% CI 0.77 to 2.87, C-index: 0.68). This study introduces the concept and potential prognostic significance of the SMRi. The physiological and clinical implications of this new index warrant further investigation across a spectrum of diseases, including cancer. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the features of rare oral and maxillofacial benign and malignant tumors of fibroblastic, myofibroblastic and fibrohistiocytic origin in an attempt to contribute to the diagnosis of these tumors. The sample consisted of 16 cases of benign fibrohistiocytic (BFH) tumor, myofibroma (MF), solitary fibrous tumor (SFT), fibrosarcoma (FS), dermatofibrosarcoma protuberans (DFSP), and myofibroblastic sarcoma (MFS), obtained from a laboratory of oral pathology. They were submitted to morphological, histochemical (Masson's trichrome), and immunohistochemical (α-SMA, vimentin, desmin, CD34, Bcl-2, S100, CD68, CD99, and Ki-67) analysis. Morphological analysis revealed variable features in the tumors studied. Masson's trichrome resulted in blue staining in most cases. Regarding the immunohistochemical features, all cases were positive for vimentin and negative for desmin. The BFH tumors exhibited positive staining for CD68 and S100, while MFs were positive for α-SMA and SFTs were positive for CD34, CD99 and Bcl-2. With respect to malignant tumors, DFSP was positive for CD34 and Bcl-2 and MFS was positive for α-SMA and Bcl-2, while FS was negative for most of the antibodies analyzed. A higher proliferation index (Ki-67) was observed in malignant tumors. Considering their similarity, the use of auxiliary techniques might help in the differential diagnosis of these tumors. [ABSTRACT FROM AUTHOR]

Parrot bornaviruses are responsible for proventricular dilatation disease (PDD) in psittacines. This study aimed to determine the occurrence and factors associated with Parrot bornaviruses infection in psittacines kept in captivity in a state in the southern region of Brazil. A cross-sectional study was carried out with 192 birds from two facilities (A and B) in 2019, using choanal, esophageal, and cloacal swabs and feathers, totaling 768 samples subjected to reverse-transcription polymerase chain reaction (RT-PCR), for the matrix (M) protein gene with a final product of 350 base pairs (bp). Genetic sequencing of three positive samples was performed by the Sanger method. In the study, the overall virus occurrence was 35.9% (69/192), with 40.4% (42/104) in Facility A and 30.7% (27/88) in Facility B. Sequencing analysis of the samples revealed the presence of Parrot bornavirus 2 (PaBV-2) in both facilities. Swab samples from the choanal (40/69), esophageal (30/69), cloacal (35/69), and feather (15/69) tested positive, facilitating the molecular diagnosis of Parrot bornaviruses. The results indicated that there is no single ideal sample type for antemortem molecular diagnosis of this virus. Simultaneously testing all four samples at the same time point yielded more diagnoses than testing any single sample among the four. Most of the 29 sampled psittacine species were native, and 46.9% of the birds (90/192) consisted of endangered species. Among the psittacines that tested positive, 88.4% (61/69) were clinically healthy, and 8.7% (6/69) exhibited clinical or behavioral signs, including behavioral changes, alterations in feathering, and changes in body score at the time of collection. This study showcases the application of minimally invasive sampling for diagnosing Parrot bornaviruses, enabling sample collection when the birds are restrained for clinical evaluation. This approach facilitates a prompt and effective antemortem diagnosis, thereby serving as an efficient screening method for parrots kept in captivity. [ABSTRACT FROM AUTHOR]

The present study presents a hybrid approach to the evaluation of decision-making in the context of sustainable development, combining the methods of Multicriteria Decision Analysis (MCDA) Combined Compromise Solution (CoCoSo) and Simple Aggregation of Preferences Expressed by Ordinal Vectors – Principal Components (SAPEVO-PC). The objective was to create a ranking of 153 countries, considering 14 essential criteria in the environmental, social, and economic dimensions. The methodology employed allows an integrated analysis of these criteria, reflecting the concept of Triple Bottom Line. The results revealed Japan, Sweden, and Finland as the best-positioned countries, indicating the effectiveness of their sustainable policies and practices. The hybrid approach of the above methods offered a robust tool for complex analysis and decision-making with a relatively large number of alternatives and criteria. [ABSTRACT FROM AUTHOR]

In recent years, we can observe the growth in the number of investors in the financial market. This work seeks to improve the decision-making process in real estate investment funds (Brazilian REITs). To this end, a literature review was carried out in the Scopus database using bibliometrix to analyze the applications of the multicriteria decision aid (MCDA) in the environment of Brazilian REITs, as a result, it was possible to analyze a greater approach to studies on the toma in Australia, the United Kingdom, the United States, and China. The study was promising because it opens new possibilities of approach and opportunities to cover applications, seeking to explore and use MCDA methods to provide support at all stages of the decision-making process. The literature review was used as a basis for structuring the problem and defining the application of the hybrid PSI-CoCoSo method for ordering Brazilian REITs in the corporate slabs sector traded on the São Paulo stock exchange (B3), the criterion was to address funds that have at least one million reais in daily trading on the stock exchange. As a result, the hybrid method proved to be effective in the ranking process, providing robust results on the application and evaluation of Brazilian REITs. [ABSTRACT FROM AUTHOR]

Military development is increasingly related to strategic independence and technological advantages, representing an important factor in countries' scientific, technological, and economic development. In this context, the present work proposes a methodology for evaluating the world's military power based on the integration between Multi-Criteria Decision-Making (MCDM) and Machine Learning. To this end, data from the military, economic, and strategic spheres of 140 countries were analyzed and evaluated considering 12 quantitative variables. Considering the large volume of data to be analyzed and establishing a ranking of countries, the Principal Component Analysis (PCA), an unsupervised Machine Learning technique, was used. PCA allowed the analysis of 140 countries, identifying three factors representing the collective behavior of the 12 original variables, providing a world ranking of military power. The results were compared with specialized rankings on the subject and proved robust and reliable. As a contribution to the academy and society, the authors highlighted that this work fills the gap regarding the application of PCA in military problems to classify the observations, emphasized that the proposed methodology can be replicated in the most diverse problems and serve as input in other MCDM and data science techniques. In addition, the multidisciplinary of PCA allows the technique to support the decision-making process in the most diverse areas of knowledge that involve data analysis in tactical, operational, and strategic problems. [ABSTRACT FROM AUTHOR]

The rapid globalization of the world economy has required companies to become increasingly competitive. One of the factors that contribute to reducing operational costs and, consequently, helps to improve company performance is inventory management and is mainly based on demand forecasting. This represents a key factor in the management of different areas of organizations, being fundamental in managing the logistics chain, especially in inventory management, customer service levels and purchasing planning. This research project aims to test the applicability of the ARIMA, exponential smoothing and Holt-winters models for forecasting demand for spare items in a company in the steel sector. The data used in this work were extracted from the SAP material management module software. The total base available was 327.924 registered items and 42.548 were analyzed as they had a consumption history from Jan/2012 to Dec/2022. A process of classifying the consumption history was carried out as Regular, erratic, intermittent and irregular. To run the prediction models, the RStudio software was used. To measure the performance of the prediction models, the MAE metric was used. The objective of the work was achieved and it was identified that the best demand forecast model was the Hot winter with trend and seasonality model. [ABSTRACT FROM AUTHOR]

This paper introduces a computational framework based on the SAPEVO-M method to enhance decision-making processes in complex scenarios. By integrating technological advancements with the SAPEVO-M methodology, the framework facilitates a more efficient, accurate analysis based on multi-criteria decision-making problems. The paper presents a literature background of the methodology and its axiomatic structure, highlighting its capability for decision-making for a group of stakeholders, thus offering favorable improvements as a technological aid for decision-making analysis. The results demonstrate the potential of the framework, providing decision-makers with robust and reliable insights, and making it an invaluable tool in fields requiring complex decision analysis. This study not only contributes a novel and free computational approach to the decision-making literature but also paves the way for future research and development, applying the axiomatic methodology for problem-solving in diverse areas of science, searching for increase and transparency concerning decision-making processes worldwide. [ABSTRACT FROM AUTHOR]

The present work and its applications are based on the necessity for the Brazilian Public Administration, in general, to comply with the constitutional principles established in Article 37 of the current Federal Constitution of Brazil. The primary focus is to address the principles of transparency and efficiency, which are central to this study and supported by the Transparency Law (LC nº 131/2009) and the Access to Information Law (Law nº 12,527/2011). The analysis will explore intrinsic elements of the CONFEA/CREA system to process and analyze data related to airfare, daily allowances, and accommodation expenses of the Regional Council of Engineering, Agronomy and Geosciences of the State of São Paulo – Brazil (CREA/SP). The objective is to propose compliance solutions linked to Data Science and Operational Research to standardize the aforementioned Councils in promoting transparency. Technological enhancements are suggested to improve the transparency of public acts, aiming to maximize efficiency. To achieve greater administrative and operational efficiency and effectiveness for Local Authorities, the Gaussian AHP Method is proposed. Key outcomes include improved information on the transparency portal, enhanced data accessibility, clarity, and completeness, increased analytical capacity for management and supervision, and greater visibility of administrative actions. These efforts aim to foster better public management practices and enhance decision-making precision through the application of Multi-Criteria Decision Support methods. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The LIfestyle for BRAin Health (LIBRA) index yields a dementia risk score based on modifiable lifestyle factors and is validated in Western samples. We investigated whether the association between LIBRA scores and incident dementia is moderated by geographical location or sociodemographic characteristics. METHODS: We combined data from 21 prospective cohorts across six continents (N = 31,680) and conducted cohort‐specific Cox proportional hazard regression analyses in a two‐step individual participant data meta‐analysis. RESULTS: A one‐standard‐deviation increase in LIBRA score was associated with a 21% higher risk for dementia. The association was stronger for Asian cohorts compared to European cohorts, and for individuals aged ≤75 years (vs older), though only within the first 5 years of follow‐up. No interactions with sex, education, or socioeconomic position were observed. DISCUSSION: Modifiable risk and protective factors appear relevant for dementia risk reduction across diverse geographical and sociodemographic groups. Highlights: A two‐step individual participant data meta‐analysis was conducted.This was done at a global scale using data from 21 ethno‐regionally diverse cohorts.The association between a modifiable dementia risk score and dementia was examined.The association was modified by geographical region and age at baseline.Yet, modifiable dementia risk and protective factors appear relevant in all investigated groups and regions. [ABSTRACT FROM AUTHOR]

• The first meta-analysis evaluating AI's diagnostic performance in detecting IED. • A minority of models validate their performance on external datasets. • Models validated with resampling methods outperformed those using external datasets. • Creating well-defined, multi-centric prospective labeled datasets is a priority. Interictal epileptiform discharges (IEDs) in electroencephalograms (EEGs) are an important biomarker for epilepsy. Currently, the gold standard for IED detection is the visual analysis performed by experts. However, this process is expert-biased, and time-consuming. Developing fast, accurate, and robust detection methods for IEDs based on EEG may facilitate epilepsy diagnosis. We aim to assess the performance of deep learning (DL) and classic machine learning (ML) algorithms in classifying EEG segments into IED and non-IED categories, as well as distinguishing whether the entire EEG contains IED or not. We systematically searched PubMed, Embase, and Web of Science following PRISMA guidelines. We excluded studies that only performed the detection of IEDs instead of binary segment classification. Risk of Bias was evaluated with Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Meta-analysis with the overall area under the Summary Receiver Operating Characteristic (SROC), sensitivity, and specificity as effect measures, was performed with R software. A total of 23 studies, comprising 3,629 patients, were eligible for synthesis. Eighteen models performed discharge-level classification, and 6 whole-EEG classification. For the IED-level classification, 3 models were validated in an external dataset with more than 50 patients and achieved a sensitivity of 84.9 % (95 % CI: 82.3–87.2) and a specificity of 68.7 % (95 % CI: 7.9–98.2). Five studies reported model performance using both internal validation (cross-validation) and external datasets. The meta-analysis revealed higher performance for internal validation, with 90.4 % sensitivity and 99.6 % specificity, compared to external validation, which showed 78.1 % sensitivity and 80.1 % specificity. Meta-analysis showed higher performance for models validated with resampling methods compared to those using external datasets. Only a minority of models use more robust validation techniques, which often leads to overfitting. [ABSTRACT FROM AUTHOR]

* OBJECTIVES: To (1) investigate whether different labels for neck pain after a motor vehicle crash (MVC) influenced recovery expectations and management beliefs, (2) explore reasons for low recovery expectations and greater likelihood for lodging a claim, and (3) explore the moderating effect of neck pain history and sociodemographic characteristics. * DESIGN: Online randomized experiment with nested qualitative content analysis. * METHODS: We randomized 2229 participants from the general population (mean age: 46.7 ± 17.5 years; 72.4% females; 66% with previous or current neck pain; 10% with an MVC experience) to read 1 of 5 scenarios describing a patient with neck pain after an MVC, each was labeled as whiplash injury, whiplash-associated disorder, posttraumatic neck pain, neck pain, or neck strain. The primary outcome was recovery expectations, rated on a 0- to 10-point scale. * RESULTS: Participants allocated to whiplashassociated disorder or neck pain had lower recovery expectations than those allocated to neck strain (adjusted mean difference [95% confidence interval]: -0.5 [-0.9 to -0.1] for both comparisons). Whiplash-associated disorder led to more recovery uncertainty, while neck pain led to greater doubt about the health care provider. Most secondary outcomes showed significant but small differences. Participants allocated to neck strain were less inclined to claim than those allocated to whiplash-associated disorder or whiplash injury due to less perceived need for financial support. Neck pain history moderated labeling effects on recovery expectations; household income moderated the claim intention. * CONCLUSIONS: Labels for neck pain after an MVC influenced recovery expectations and management preferences. The clinical relevance of the small effects was unclear. [ABSTRACT FROM AUTHOR]

In this study we retrospectively reviewed our clinic's treatment of unilateral condylar hyperactivity (UCH). We used computer-guided proportional condylectomy, which was conducted both through preauricular and intraoral approaches, then analysed the advantages and disadvantages of the two techniques. A computer-guided treatment algorithm is also presented. We enrolled 42 patients diagnosed with clinical asymmetry, with or without associated dentofacial deformities, which had been confirmed by single photon emission computed tomography (SPECT) to be UCH. These patients underwent proportional condylectomy: 26 of them had isolated proportional condylectomy, while 16 had proportional condylectomy with concomitant orthognathic surgery. The intraoral approach demonstrated a capacity and precision that was nearly equivalent to the extraoral approach. This mitigates the significant surgical risks associated with the extraoral approach, but it is important to acknowledge the learning curve associated with the intraoral approach. Utilising virtual surgical planning (VSP) and custom cutting guides is essential. [ABSTRACT FROM AUTHOR]

Urothelial cancer is the second most common cancer, and cause of cancer death, related to the genitourinary tract. The goals of imaging for pretreatment staging of urothelial cancer are to evaluate for both local and distant spread of the cancer and assessing for synchronous sites of urothelial cancer in the upper tracts and bladder. For pretreatment staging of urothelial carcinoma, patients can be stratified into one of three groups: 1) nonmuscle invasive bladder cancer; 2) muscle invasive bladder cancer; and 3) upper urinary tract urothelial carcinoma. This document is a review of the current literature for urothelial cancer and resulting recommendations for pretreatment staging imaging. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Acute scrotum is a medical emergency that requires prompt accurate diagnosis to appropriately triage potentially surgical conditions. Numerous differential diagnoses with overlapping clinical presentations make this a diagnostic challenge. Ultrasound is the established first-line imaging modality for acute scrotal disease and can be used to diagnose most scrotal disorders promptly and with high accuracy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation. [ABSTRACT FROM AUTHOR]

Pulmonary hypertension (PH) is a rare and severe condition characterized by increased pressure in the pulmonary circulation, often resulting in right ventricular failure and death. The autonomic nervous system (ANS) plays a crucial role in the cardiovascular and pulmonary controls. Dysfunction of ANS has been implicated in the pathogenesis of cardiopulmonary diseases. Conversely, dysfunctions in ANS can arise from these diseases, impacting cardiac and pulmonary autonomic functions and contributing to disease progression. The complex interaction between ANS dysfunction and PH plays a crucial role in the disease progression, making it essential to explore interventions that modulate ANS, such as physical exercise, to improve the treatment and prognosis of patients with PH. This review addresses autonomic dysfunctions found in PH and their implications for the cardiopulmonary system. Furthermore, we discuss how physical exercise, a significant modulator of ANS, may contribute to the prognosis of PH. Drawing from evidence of aerobic and resistance exercise training in patients and experimental models of PH, potential cardiovascular benefits of exercise are presented. Finally, we highlight emerging therapeutic targets and perspectives to better cope with the complex condition. A comprehensive understanding of the interaction between ANS and PH, coupled with targeted physical exercise interventions, may pave the way for innovative therapeutic strategies and significantly improve the treatment and prognosis of vulnerable patients. [ABSTRACT FROM AUTHOR]

Background Chronic non-specific low back pain (CNSLBP) lacks identifiable anatomical pathology and effective pharmacological treatment. Alternative approaches in homeopathy, specifically clinical homeopathy, utilize ultra-diluted (potentized) biological products. In Brazil, standardized biotherapics from sheep tissues, particularly fifty-millesimal (LM) potencies of sheep Lumbar Vertebra , have shown promise in alleviating CNSLBP. Objectives Our objective is to present the study protocol of a clinical trial that will assess the efficacy and safety of the biotherapic Lumbar Vertebra LM2 in the short-term management of CNSLBP and to estimate its therapeutic duration. Methods A randomized, double-blind, crossover, placebo-controlled clinical trial spanning 8 weeks per participant was designed. Participants will include 120 individuals (aged 20 to 60 years) with clinically diagnosed CNSLBP by the study's physiotherapist. Exclusion criteria are radicular pain, signs of radiculopathy, specific lumbar spine disorders, pregnancy, or puerperium (up to 60 days after delivery). The medical intervention includes participants being randomly assigned to one of two treatment sequences: homeopathy–placebo or placebo–homeopathy. The treatments will consist of Lumbar Vertebra LM2 oral solution, topical cream, and indistinguishable placebos. Each treatment period will span 2 weeks, with a 4-week washout interval between them. Primary outcome is the assessment of changes in self-reported pain levels using the numeric rating scale (NRS) score, analyzed with a random effects model across both treatment periods. Secondary outcomes are assessment of changes in self-reported disability levels using the Oswestry Disability Index (ODI), analyzed with a random effects model across both treatment periods, and pain and disability variations, evaluated by the NRS score and ODI respectively, after the first and second treatment periods. Adverse events will be assessed at weeks 2 and 8. Pain medications will be used concomitantly. Adherence will be evaluated by the weight of medication returned/standard weight. Discussion The BIOVERT (Bioactive Vertebra) trial protocol is designed to investigate a homeopathic strategy for short-term CNSLBP treatment. Favorable outcomes for homeopathy could prompt subsequent studies evaluating the long-term effectiveness of LM potencies of Lumbar Vertebra for CNSLBP. Trial Registration UMIN Clinical Trials Registry – ID: UMIN000051957 [ABSTRACT FROM AUTHOR]

• Pain Self-Efficacy Questionnaire (PSEQ)-2 did not show suitable reliability and structural validity. • Chronic Pain Self-Efficacy Scale short-form did not confirm >75% of the hypotheses for the construct validity. • All the pain self-efficacy scales showed acceptable criterion validity and internal consistency. • Responsiveness was suitable for PSEQ-10, PSEQ-4, CPSS long-form:function self-efficacy, and CPSS-LF:coping with symptoms self-efficacy. • PSEQ-10 was the unique scale that fit all the criteria for good measurement properties. To compare the quality of the measurement properties of Pain Self-Efficacy Questionnaire (PSEQ)-10, PSEQ-4, PSEQ-2, Chronic Pain Self-Efficacy Scale (CPSS) long-form, and CPSS short-form (CPSS-SF) in patients with chronic low back pain (CLBP). Cross-sectional and longitudinal studies (measurement properties). Outpatient rehabilitation. Participants (N=245) with nonspecific CLBP (18-60y, 63% women) were enrolled in this study. Not applicable. Pain self-efficacy questionnaires were administered on 3 occasions: baseline assessment, 1 week after the first assessment (reliability), and after an 8-week exercise program (responsiveness). The intraclass correlation coefficient (ICC) and Cronbach α were used to assess reliability and internal consistency, respectively. Pearson correlation and confirmatory factor analyses were used to assess construct validity. The area under the curve and hypothesis testing were used to assess responsiveness. No difference was observed for all the questionnaires regarding internal consistency (Cronbach α>.7), criterion validity (r >.88), and reliability (ICC>.7). The scales confirmed >75% of the hypotheses for the construct validity, except for CPSS-SF. PSEQ-2 did not meet the criterion for structural validity. PSEQ-10 met all the criteria for good measurement properties according to Consensus-Based Standards for the Selection of Health Measurement Instruments. It was not possible to calculate structural validity for PSEQ-2, CPSS-SF did not meet the criterion for suitable hypothesis testing for construct validity, and all the questionnaires did not show suitable measurement error, except for the PSEQ-10. Hence, the PSEQ-10 was the unique scale that met all the criteria for good measurement properties for assessing pain self-efficacy in CLBP. [ABSTRACT FROM AUTHOR]

During the COVID-19 pandemic, there was a shortage of filtering facepiece respirators (FFR), leading to prolonged use and reuse of FFRs. FFRs were collected in 3 hospitals after extended use (up to 15 or 30 days). We assessed the physical characteristics and filtration levels of worn FFRs, before sterilization. Respirators that achieved at least 94% filtration of aerosol particles, nasal clip still attached, had no tears, had preserved elastic bands, and had no dirt were randomized to receive or not receive cleaning before being submitted to hydrogen peroxide plasma gas sterilization. A total of 1,055 FFRs were collected. Over 85% of them exhibited secured nose clips, preserved strap elasticity, and no tears. However, more than 78% of samples contained dirt, leaving only 101 (19.6%) eligible to undergo sterilization. After sterilization, none of the FFRs in either group achieved minimum filtration, although 72% without cleaning and 80% with cleaning had filtration between 90.0% and 93.9%. A large proportion of FFRs were ineligible for sterilization due to factors unrelated to health care (eg, dirt from makeup). Prolonged reuse of FFRs significantly reduced aerosol filtration efficiency. Eligible FFRs did not maintain 94% filtration after sterilization with or without cleaning. [Display omitted] • Use of makeup may make FRRs ineligible for sterilization. • Prolonged reuse for 15 or 30 days reduced aerosol filtration efficiency. • Facepiece respirators did not maintain 94% filtration after sterilization. [ABSTRACT FROM AUTHOR]

Endovascular repair of aortic dissections may be complicated by inadequate sealing zones, persistent false lumen perfusion, and limited space for catheter manipulation and target artery incorporation. The aim of this study was to describe the indications, technical success, and early outcomes of transcatheter electrosurgical septotomy (TES) during endovascular repair of aortic dissections. We reviewed the clinical data of consecutive patients treated by endovascular repair of aortic dissections with adjunctive TES in two centers between 2021 and 2023. End points were technical success, defined by successful septotomy without dislodgment of the lamella or target artery occlusion, and 30-day rates of major adverse events (MAEs). Among 197 patients treated by endovascular repair for aortic dissections, 36 patients (18%) (median age, 61.5 years (interquartile range, 55.0-72.5 years; 83% male) underwent adjunctive TES for acute (n = 3 [8%]), subacute (n = 1 [3%]), or chronic postdissection aneurysms (n = 32 [89%]). Indications for TES were severe true lumen (TL) compression (≤16 mm) in 28 patients (78%), target vessel origin from false lumen in 19 (53%), creation of suitable landing zone in 12 (33%), and organ/limb malperfusion in four (11%). Endovascular repair included fenestrated-branched endovascular aortic repair (EVAR) in 18 patients (50%), thoracic EVAR/EVAR/PETTICOAT in 11 (31%), and arch branch repair in 7 (19%). All patients had dissections extending through zones 5 to 7, and 28 patients (78%) underwent TES across the renal-mesenteric segment. Technical success of TES was 92% (33/36) for all patients and 97% (32/33) among those with subacute or chronic postdissection aneurysms. There were three technical failures, including two patients with acute dissections with inadvertent superior mesenteric artery dissection in one patient and distal dislodgement of the dissection lamella in two patients. There were no arterial disruptions. The mean postseptotomy aortic lumen increased from 13.2 ± 4.8 mm to 28.4 ± 6.8 mm (P <.001). All 18 patients treated by fenestrated-branched EVAR had successful incorporation of 78 target arteries. There was one early death (3%) from stroke, and three patients (8%) had major adverse events. After a median follow-up of 8 months (interquartile range, 4.5-13.5 months), 13 patients (36%) had secondary interventions, and two (6%) died from non-aortic-related events. There were no other complications associated with TES. TES is an adjunctive technique that may optimize sealing zones and luminal aortic diameter during endovascular repair of subacute and chronic postdissection. Although no arterial disruptions or target vessel loss occurred, patients with acute dissections are prone to technical failures related to dislodgement of the lamella. [ABSTRACT FROM AUTHOR]

Short distances between the lowest visceral/renal artery and the aortic bifurcation are technically challenging during complex endovascular aortic aneurysm repair (EVAR), particularly after previous infrarenal repair. Traditionally, inverted limb bifurcated devices have been used in addition to fenestrated-branched (FB) endografts, but short overlap, difficult cannulation, and potential crushing of bridging stents are limitations for their use. This study reviews the early experience of patient-specific company manufactured devices (PS-CMDs) with a unibody bifurcated FB design for complex EVAR. Consecutive complex EVAR procedures over a 34-month period with unibody bifurcated FB-devices as part of physician-sponsored investigational device exemption studies at two institutions were reviewed. Unibody bifurcated FB designs included FB bifurcated or fenestrated inverted limb devices. End points included technical success, survival, frequency of type I or III endoleaks, limb occlusion, and secondary interventions. Among 168 patients undergoing complex EVAR, 33 patients (19.6%; 78.7% male; mean age, 77 years) received unibody bifurcated FB PS-CMDs. FB bifurcated and fenestrated inverted limb devices were used in 31 (93.9%) and 2 (6.06%) patients, respectively. The median maximum aneurysm diameter was 61 mm (interquartile range [IQR], 55-69 mm). Prior EVAR was reported by 29 patients (87.9%), of whom 2 (6.06%) had suprarenal stents. A short distance between the lowest renal artery and aortic bifurcation was demonstrated in 30 patients (90.9%), with median distance of 47 mm (IQR, 38-54 mm). Preloaded devices were used in 23 patients (69.7%). A total of 128 fenestrations were planned; 22 (17.2%) were preloaded with guidewires and 5 (3.9%) with catheters. The median operative time was 238 minutes (226-300 minutes), with a median fluoroscopy time of 65.5 minutes (IQR, 56.0-77.7 minutes) and a median dose area product of 147 mGy∗cm2 (IQR, 105-194 mGy∗cm2). Exclusive femoral access was used in 14 procedures (42.4%). Technical success was 100%. Target vessel primary patency was 100% at a median follow-up time of 11.7 months (IQR, 3.5-18.6 months). Two patients (6.06%) required reintervention for iliac occlusion; one patient required stenting and the other a femoral-femoral bypass. No aortic-related deaths occurred after the procedure. During follow-up, 11 type II endoleaks (33.3%) and 1 type Ib endoleak (3.03%) were detected; the latter was treated with leg extension. No type Ia or III endoleaks occurred. Complex EVAR using unibody bifurcated FB-PS-CMDs is a simple, safe, and cost-effective alternative for the treatment of patients with short distances between the renal arteries and the aortic bifurcation. Further studies are required to assess benefits and durability of unibody bifurcated FB devices. [ABSTRACT FROM AUTHOR]

This study aimed to analyze the scope, nature, and extent of the applicability of terahertz (THz) spectroscopy in dentistry. A scoping review was conducted following the 5-step methodology of Arksey and O'Malley, the PRISMA-ScR checklist, and the Evidence Synthesis Manual of the Joanna Briggs Institute. Electronic literature searches were performed in the PubMed/MEDLINE, Scopus, and Cochrane Library databases, including full-text articles with no specific publication period. The following research question was formulated: "What are the applications of THz spectroscopy in the field of dentistry?" Seventeen laboratory studies were identified, detailing oral and dental applications of THz. In restorative dentistry, 8 investigations sought to identify the properties of human and animal dental tissues and differentiate between healthy and decayed tissue. In oral pathology, 5 articles analyzed the identification of cancer cells in comparison to the identification of these cells in histological or cytological analysis. In biomaterials, 4 papers studied the changes in properties of restorative materials and effects on polymerization. While the potential for early diagnosis using THz spectroscopy in dentistry is evident, our findings underscore its limitations. The studies were exclusively conducted in vitro, emphasizing the need for innovative clinical research using intraoral devices. Bridging this gap is essential to unlock the full potential of this noninvasive technology for early diagnosis and informed clinical decision-making. [ABSTRACT FROM AUTHOR]