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Purpose.: Plantar fasciitis is the most frequent cause of heel pain. Custom-made plantar supports are a common treatment solution, while the application of kinesiology tape (KT) can be an effective measure to alleviate pain. The objective was to evaluate the effects of KT on the pain of patients with plantar fasciitis., Methods.: Randomized controlled trial including participants with plantar fasciitis. There was an experimental group ( n  = 17), whose participants underwent a KT treatment, and a control (sham tape) group ( n  = 17). The pain, measured with a visual analog scale (VAS), was the primary outcome and was assessed daily until the fifth day of wearing the tape and 24 h after removing it. Inferential statistics looked for time, group, and time per group differences with CI at 95%., Results.: The greatest between-group VAS difference was 3.5 points, and occurred at the 2-day follow-up assessment. Then, pain differences decreased over time until the last assessment point. Statistically significant time, group, and time*group differences were found with p <  0.001., Conclusion.: This study supports that KT is effective in reducing pain in the short term in patients with plantar fasciitis, and more effective than a sham intervention with tape.

Rapid flood impact assessment methods need complete and accurate flood maps to provide reliable information for disaster risk management, in particular for emergency response and recovery and reconstruction plans. With the aim of improving the rapid assessment of flood impacts, this work presents a new impact assessment method characterized by an enhanced satellite multi-sensor approach for flood mapping, which improves the characterization of the hazard. This includes a novel flood mapping method based on the new multi-temporal Modified Normalized Difference Water Index (MNDWI) that uses multi-temporal statistics computed on time-series of Sentinel-2 multi-spectral satellite images. The multi-temporal aspect of the MNDWI improves characterization of land cover over time and enhances the temporary flooded areas, which can be extracted through a thresholding technique, allowing the delineation of more precise and complete flood maps. The methodology, if implemented in cloud-based environments such as Google Earth Engine (GEE), is computationally light and robust, allowing the derivation of flood maps in matters of minutes, also for large areas. The flood mapping and impact assessment method has been applied to the seasonal flood occurred in South Sudan in 2020, using Sentinel-1, Sentinel-2 and PlanetScope satellite imagery. Flood impacts were assessed considering damages to buildings, roads, and cropland. The multi-sensor approach estimated an impact of 57.4 million USD (considering a middle-bound scenario), higher than what estimated by using Sentinel-1 data only, and Sentinel-2 data only (respectively 24% and 78% of the estimation resulting from the multi-sensor approach). This work highlights the effectiveness and importance of considering multi-source satellite data for flood mapping in a context of disaster risk management, to better inform disaster response, recovery and reconstruction plans., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Fabio Cian reports financial support was provided by The World Bank Group., (Copyright © 2024. Published by Elsevier Ltd.)

Purpose: To determine the effectiveness of current strategies oriented to increase adherence to physical therapy in subjects with knee and hip osteoarthritis (OA)., Material and Methods: A systematic review of electronic databases was conducted from inception until March 2023. Studies with experimental interventions using strategies to increase adherence to physical therapy programs in subjects with knee or hip OA were included. A meta-analysis compared the effects of such interventions with usual care for adherence-related measures (primary outcome), and functional and pain outcomes, using standardized mean differences (SMD) with a 95% confidence interval (CI). GRADE was used to determine the strength of the resultant evidence and the external validity of the findings., Results: Fifteen articles, assessing 1,818 participants, were included. The interventions included cognitive-behavior strategies, telephone calls, internet-based interventions, communication technologies, and booster sessions. A meta-analysis revealed that the experimental interventions increased adherence over usual care with a moderate effect size of SMD = 0.39 (95%CI = 0.08-0.71) and moderate certainty in this evidence., Conclusion: Overall, this review supports that the strategies to promote adherence to physical therapy in individuals with knee and hip OA are effective. However, the positive impact on adherence rates does not always translate into improved clinical outcomes.

Climacturia is defined as the leakage of urine during orgasm and it is an adverse effect of radical prostatectomy. Our goal was to determine if various preoperative MRI pelvic floor measurements were associated with the risk of climacturia following robot-assisted laparoscopic radical prostatectomy. For this purpose, we conducted a prospective study involving 57 patients who underwent robot-assisted laparoscopic radical prostatectomy. MRI measurements were analysed by 2 urologists and 2 radiologists. Follow-up was carried out at 3, 6, and 12 months using the Parra orgasmic function questionnaire. We analysed all measurements, along with other patient, surgery, and tumour characteristics, classifying patients into two groups based on the presence or absence of climacturia. A logistic regression model was applied among statistically significant variables. STROBE recommendations were taken into consideration. Shorter prostatic urethral length was associated with higher risk of climacturia at 3 months, OR = 0.83 (95%CI 0.688-0.98) (p = 0.024). Patients with climacturia at 6 months had greater median urethral width [12.66 mm, interquartile range (IQR): 11.77-13.55 vs 12.13 mm, IQR 11.08-13.18] (p = 0.02). Patients with climacturia at 12 months had a higher proportion of preoperative lower urinary tract symptoms (57.14% vs. 20%) (p = 0.026). In the logistic regression, the history of lower urinary tract symptoms was associated with a higher risk of climacturia, OR = 6.07 (95% CI 1.342-26.03) (p = 0.023). In conclusion, shorter prostatic urethral length in preoperative MRI and a history of lower urinary tract symptoms were associated with a higher risk of climacturia following robot-assisted laparoscopic radical prostatectomy., (© 2024. The Author(s), under exclusive licence to Springer Nature Limited.)

The management of nursing care regarding patients' vascular access is a priority. This study determines the contribution of the variables involved in the quality of care and maintenance of vascular access (VA) devices in admitted patients in the Valencian Community., Methods: Using the STROBE statement, an observational, cross-sectional study was conducted on 1576 VA devices. Data were collected using the INCATIV Questionnaire. We performed a multivariate analysis of the questionnaire variables., Results: In total, 50% had a good or very good assessment of the VA condition. This was positively correlated with anatomical location, dressing type, dressing date record, use of needle-free connectors (NFCs), date of last dressing change, presence of phlebitis, visibility of the insertion site and characteristics of the dressing's condition ( p < 0.001). The model indicated that the presence of phlebitis was the clearest predictor of a poor VA care assessment (OR = 20.579), followed by no visibility of the insertion site (OR = 14.209). Results also indicated that uncovered VA lumens or no NFCs used were related to a negative quality assessment., Conclusion: By managing and controlling these variables, the likelihood of providing optimal care is ensured. This enables the establishment of a standardised care approach for all nursing professionals and the building of a new quality indicator.

Background: Bandages are commonly used to relieve pain in patients with plantar fasciitis. The goal was to compare the effects of using kinesiotape versus low-dye tape in the acute phase of plantar fasciitis on pain and comfort measures., Methods: Forty individuals with plantar fasciitis were allocated to the kinesiotape or low-dye tape interventions. The patients were assessed at baseline and every 24 h until the fifth day. The primary measure was a visual analog scale of pain. The other measures were comfort, mobility, durability, personal hygiene, sweating, and allergies. The effects were compared with an ANOVA test, 95% CI., Results: Kinesiotape was more effective in reducing pain; the greater effect occurred during the first day, with a between-group difference of 2.0 (95% CI: 1.8 to 2.2). The pain differences between the treatments progressively reduced each day from the second day. Kinesiotape offered significantly higher performance than low-dye tape in mobility, comfort, and comfort in hygiene, sweating, and durability, with a large effect size d > 0.8., Conclusions: Kinesiotape could be more effective than low-dye tape in relieving pain in patients with plantar fasciitis, with a significant clinical impact on the first day of treatment. Kinesiotape can also provide higher performance in terms of comfort.

Introduction: Rehabilitation can improve outcomes after reverse shoulder arthroplasty (RSA). However, low adherence to rehabilitation and compliance rates are some of the main barriers. To address this public health issue, the goal of this research was to pilot test and evaluate the effectiveness of a chatbot to promote adherence to home rehabilitation in patients undergoing RSA., Methods: A randomized pilot trial including patients undergoing RSA and early postoperative rehabilitation was performed. The control group received standard home rehabilitation; the experimental group received the same intervention supervised with a chatbot, with automated interactions that included messages to inform, motivate, and remember the days and exercises for 12 weeks. Compliance with rehabilitation and clinical measures of shoulder function, pain, and quality of life were assessed., Results: 31 patients (17 experimental) with an average age of 70.4 (3.6) completed the intervention. Compliance was higher in the experimental group (77% vs. 65%; OR95% = 2.4 (0.5 to 11.4)). Statistically significant between-group differences with a CI of 95% were found in the QuickDASH questionnaire and self-reported quality of life. No differences were found in the rest of the measures., Conclusions: This pilot study suggests that the chatbot tool can be useful in promoting compliance with early postoperative home rehabilitation in patients undergoing RSA. Future randomized trials with adequate power are warranted to determine the clinical impact of the proposal.

Context: Suspension training devices are becoming increasingly popular. Most studies analyzed the effectiveness according to diverse measures in patients with or without conditions at any age. The characteristics of suspension training are very specific and can increase instability and; therefore, enhance balance. The goal was to determine the effects of suspension training on balance by comparing it with instability training., Design: Two-arm, randomized trial., Methods: 44 young adults, aged 22.4 years old, with no musculoskeletal condition, took part. There were 2 interventions, suspension and instability training, designed with 12 sessions in 4 weeks. The primary outcome was the Y-Balance test. Other balance outcomes were the Emery and jumping sideways tests, and platform measures while standing., Results: Suspension and instability training were effective in enhancing balance in terms of the primary outcome, the Y-Balance test, with no between-group differences. Instability training enhanced the Emery test over suspension training (P = .018), but the latter was more effective in the jumping sideways test (P = .003). Neither of the training improved static balance measures., Conclusions: Training with suspension devices is effective in enhancing dynamic balance, with similar improvements to instability training. Importantly, the magnitude of change and the frequency of responders to intervention in terms of motor coordination and keeping balance in unstable conditions appear to be sensitive to the type of training.

Background and Objectives: While suspension training devices are increasingly gaining popularity, there is limited evidence on their effects on balance, and no comprehensive assessment has been conducted. This study aimed to evaluate the effects of a 9-session suspension training program on dynamic and static balance, stability, and functional performance. Materials and Methods: A total of forty-eight healthy adults, aged between 18 and 30, participated in a 9-session suspension training program. The program included exercises targeting upper and lower body muscles as well as core muscles. Balance was comprehensively assessed using various dynamic balance tests, including the Y Balance Test (YBT) as the primary outcome, single-leg Emery test, and sideways jumping test. Static balance was evaluated through the monopedal and bipedal Romberg tests. Changes from baseline were analyzed using a one-way ANOVA test. Results : Thirty-nine participants (mean age: 21.8 years) completed the intervention. The intervention resulted in significant improvements in YBT, jumping sideways, Emery, and 30s-SST scores ( p < 0.001). Platform measures indicated enhanced monopedal stability ( p < 0.001) but did not show a significant effect on bipedal stability ( p > 0.05). Conclusions : Suspension training is a safe and feasible method for improving dynamic balance and functional performance in healthy, untrained young adults. However, it does not appear to significantly impact the ability to maintain a static posture while standing., Competing Interests: The authors declare no conflict of interest.

Background and Purpose: Clinical status of subjects with knee osteoarthritis (KOA) is influenced by a complex interaction of several biopsychosocial factors. The use of patient-reported measures (PROM) is considered the gold standard for their evaluation. However, considering that 1 in 5 subjects with KOA present with depressive symptoms, it is necessary to analyse how this psychological domain may influence the subjective perception of PROM. The objective was to study the impact that depressive symptoms have on functional outcome assessments, according to the degree of objectivity of diverse outcome measures., Methods: Cross-sectional study. Subjects with severe KOA, verified with clinical and radiological symptoms, were assessed with patient-reported (Oxford Knee Score), clinician-reported (knee range of motion), and performance-based (Timed up and go test) measures. The existence of depressive symptoms was assessed with the Yesavage scale, and participants were classified for having no-, mild- or severe-symptoms. Linear correlations (r) and one-way analysis of variance compared groups (95% CI)., Results: 244 participants were analysed, of which 75 (30.7%) had depressive symptoms. These symptoms had an inverse moderate association with Oxford Knee Score (r = -0.387). However, the correlation with the Timed up and go test was low (r = 0.176), while there was no correlation with knee ROM (r = -0.087)., Conclusions: This study supports that patient-reported questionnaires may offer biased information on the clinical status of patients with severe knee osteoarthritis who present with depressive symptoms. Consideration of such symptoms may be critical to ensure data collected to accurately reflect patients' capacities and perceptions., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Cattle brucellosis is a severe zoonosis of worldwide distribution caused by Brucella abortus and B. melitensis. In some countries with appropriate infrastructure, animal tagging and movement control, eradication was possible through efficient diagnosis and vaccination with B. abortus S19, usually combined with test-and-slaughter (T/S). Although S19 elicits anti-smooth lipopolysaccharide antibodies that may interfere in the differentiation of infected and vaccinated animals (DIVA), this issue is minimized using appropriate S19 vaccination protocols and irrelevant when high-prevalence makes mass vaccination necessary or when eradication requisites are not met. However, S19 has been broadly replaced by vaccine RB51 (a rifampin-resistant rough mutant) as it is widely accepted that is DIVA, safe and as protective as S19. These RB51 properties are critically reviewed here using the evidence accumulated in the last 35 years. Controlled experiments and field evidence shows that RB51 interferes in immunosorbent assays (iELISA, cELISA and others) and in complement fixation, issues accentuated by revaccinating animals previously immunized with RB51 or S19. Moreover, contacts with virulent brucellae elicit anti-smooth lipopolysaccharide antibodies in RB51 vaccinated animals. Thus, accepting that RB51 is truly DIVA results in extended diagnostic confusions and, when combined with T/S, unnecessary over-culling. Studies supporting the safety of RB51 are flawed and, on the contrary, there is solid evidence that RB51 is excreted in milk and abortifacient in pregnant animals, thus being released in abortions and vaginal fluids. These problems are accentuated by the RB51 virulence in humans, lack diagnostic serological tests detecting these infections and RB51 rifampicin resistance. In controlled experiments, protection by RB51 compares unfavorably with S19 and lasts less than four years with no evidence that RB51-revaccination bolsters immunity, and field studies reporting its usefulness are flawed. There is no evidence that RB51 protects cattle against B. melitensis, infection common when raised together with small ruminants. Finally, data acumulated during cattle brucellosis eradication in Spain shows that S19-T/S is far more efficacious than RB51-T/S, which does not differ from T/S alone. We conclude that the assumption that RB51 is DIVA, safe, and efficaceous results from the uncritical repetition of imperfectly examined evidence, and advise against its use., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: More than one billion of peripheral venous catheters are inserted into hospitalized patients every year. This study sought to identify the status of nursing care in vascular accesses in different hospitals and to evaluate the impact of a series of informative and formative interventions aimed at their care., Methods: Quasi-experimental, multicenter study. A total of 54 nursing professionals of 19 hospitals participated. The intervention consisted of informative talk and three training sessions related to the care and maintenance of vascular accesses and intravenous therapy in the hospital-admitted adult population. This was delivered in four years, with eight periodic cross-sectional assessments conducted before and after each intervention. To assess quality of nursing care in vascular accesses and intravenous therapy, a quality indicator called Standard Variable (VES), was developed and validated with the Delphi methodology., Results: A total of 21,108 patients, aged 64.0 years (SD 18.3), were assessed, of which 78.3% (16,516) had some type of vascular access inserted. An average of 22.1% (95% CI: 21.4-22.7) were classified as optimal. In total, 3218 nursing care professionals took part in the training activities. The VES indicator grew steadily throughout the study, raising from 7.8% to 37.6%. Changes were statistically significant between those time points in which one of the described interventions was delivered; however, there were no significant changes between time points with no intervention., Conclusions: This study supports that continuous training interventions can produce improvements in the quality of nursing care and reduce complications in patients with vascular accesses. In addition, the VES indicator was a useful and simple tool to measure quality, but the experience with its use suggests continuous research in the search for standardized indicators that objectify the evaluation and evolution of care., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Bacteria of the genus Brucella are facultative intracellular parasites that cause brucellosis, a severe animal and human disease. Recently, a group of taxonomists merged the brucellae with the primarily free-living, phylogenetically related Ochrobactrum spp. in the genus Brucella. This change, founded only on global genomic analysis and the fortuitous isolation of some opportunistic Ochrobactrum spp. from medically compromised patients, has been automatically included in culture collections and databases. We argue that clinical and environmental microbiologists should not accept this nomenclature, and we advise against its use because (i) it was presented without in-depth phylogenetic analyses and did not consider alternative taxonomic solutions; (ii) it was launched without the input of experts in brucellosis or Ochrobactrum ; (iii) it applies a non-consensus genus concept that disregards taxonomically relevant differences in structure, physiology, population structure, core-pangenome assemblies, genome structure, genomic traits, clinical features, treatment, prevention, diagnosis, genus description rules, and, above all, pathogenicity; and (iv) placing these two bacterial groups in the same genus creates risks for veterinarians, medical doctors, clinical laboratories, health authorities, and legislators who deal with brucellosis, a disease that is particularly relevant in low- and middle-income countries. Based on all this information, we urge microbiologists, bacterial collections, genomic databases, journals, and public health boards to keep the Brucella and Ochrobactrum genera separate to avoid further bewilderment and harm., Competing Interests: The authors declare no conflict of interest.

One Health is the collaborative efforts of multiple disciplines to attain optimal health for people, animals and the environment, a concept that historically owes much to the study of brucellosis, including recent political and ethical considerations. Brucellosis One Health actors include Public Health and Veterinary Services, microbiologists, medical and veterinary practitioners and breeders. Brucellosis awareness, and the correct use of diagnostic, epidemiological and prophylactic tools is essential. In brucellosis, One Health implementation faces inherited and new challenges, some aggravated by global warming and the intensification of breeding to meet growing food demands. In endemic scenarios, disease awareness, stakeholder sensitization/engagement and the need to build breeder trust are unresolved issues, all made difficult by the protean characteristics of this zoonosis. Extended infrastructural weaknesses, often accentuated by geography and climate, are critically important. Capacity-building faces misconceptions derived from an uncritical adoption of control/eradication strategies applied in countries with suitable means, and requires additional reference laboratories in endemic areas. Challenges for One Health implementation include the lack of research in species other than cattle and small ruminants, the need for a safer small ruminant vaccine, the need to fill in the infrastructure gap, the need for realistic capacity-building, the creation of reference laboratories in critical areas, and the stepwise implementation of measures not directly transposed from the so-called developed countries.

Background: Rehabilitation is essential to optimize outcomes after surgical procedures in musculoskeletal disorders. However, adherence to rehabilitation continues to be an important barrier, since compliance with the programs is not always as desired, which may have a negative impact on clinical results., Methods: Randomized controlled trial aimed at to determining the effectiveness of using a virtual assistant (i.e., chatbot) to promote adherence to home rehabilitation. Overall, seventy patients under 75, undergoing total knee replacement, who have a personal smartphone and are familiar with its use, will be assigned into the control (standard care) or the experimental (standard care plus virtual assistant) group. Adherence (primary outcome) will be assessed three months after surgery. The WOMAC questionnaire, knee pain and system usability scale will be also outcomes of interest at three months and one year. Overall, an analysis of variance will look for possible time, group and time*group interactions., Discussion: The expected result is to determine whether the use of a chatbot that interacts with the patient can increase adherence to post-surgical home physiotherapy, and result in better clinical results (functional and pain) than standard care., Trial Registration: clinicaltrials.gov id. NCT05363137., (© 2023. The Author(s).)

Importance: Menopause is a biological stage associated with increased cardiovascular morbidity and mortality due to changes in sex hormone levels., Objective: This systematic review aimed to investigate the benefits and harms of RT in menopausal and postmenopausal women., Evidence Review: We searched PubMed, Embase, CENTRAL, Scopus, and Web of Science from inception to 2021, and clinical trial registries. Randomized controlled trials (RCT) in menopausal and postmenopausal women that compared women undergoing RT programs with a control group were included. The primary outcomes were C-reactive protein level and adverse events; and, the secondary outcomes were lipid profile and waist circumference. Two reviewers independently selected the studies, extracted data, and assessed the completeness of RT programs, risk of bias, and quality of evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach (GRADE). A random-effects model was used. Statistical significance was set at P < 0.05., Findings: Twelve RCTs published from 2012 to 2020 met the inclusion criteria (n = 482). Four follow-up periods were assessed. RT caused reductions in C-reactive protein levels compared to those in the control group in postmenopausal women in the short- to long-term follow-up (mean difference, -0.47 mg/dL; 95% confidence interval, -0.66 to -0.29; P < 0.00001). Furthermore, RT may reduce C-reactive protein levels even at moderate and moderate-to-high intensity ( P < 0.0001 and P = 0.0005, respectively). Similar findings were found for lipid profiles in the short- to long-term follow-up ( P < 0.05). RT may have had little to no effect on waist circumference. The certainty of the body of evidence was assessed as very low and downgraded owing to serious study limitations, inconsistency, imprecision, and publication bias., Conclusions and Relevance: There was very low-quality evidence supporting the benefits of RT compared with control for C-reactive protein levels and lipid profile. No benefits were found for the outcome of waist circumference in postmenopausal women with different comorbidities or risk factors. Safety data were scarce. We have little confidence in the results, and the true effect is likely to be substantially different. Further well-conducted and well-reported RCTs are warranted to strengthen the evidence., Protocol Registration: PROSPERO CRD42020213125., Competing Interests: Financial disclosures/conflicts of interest: None reported., (Copyright © 2022 by The North American Menopause Society.)

To propose a fall-classification framework for patients undergoing total knee replacement (TKR). In addition, we reinforced the available evidence on fall incidence and circumstances and compared the characteristics of fallers versus. nonfallers. Retrospective and prospective data were collected from 253 subjects with severe knee osteoarthritis who were waiting for primary TKR. Falls were classified considering the location of the destabilizing force, source of destabilization and fall precipitating factor. Fall incidence and circumstances were described; the characteristics of fallers and nonfallers in terms of functional and balance performance were compared with F-tests (95% CI). The fall incidence before surgery was 40.3% (95% CI 34.2% to 46.6%). This figure decreased to 13.1% (95% CI 9.2% to 18.0%) and to 23.4% (95% CI 17.8% to 29.6%) at 6 and 12 months after surgery, respectively. Most falls were caused by destabilizations in the base of support (n = 102, 72%) and were due to extrinsic factors (n = 78, 76%) and trip patterns. Significant differences between fallers and nonfallers were found in knee extensor strength and monopodal stability in the surgical limb (p < 0.05). Falls are prevalent in patients with severe knee osteoarthritis. Symptoms and functional performance improve after surgery, and fall incidence is reduced. Most fall events originate from disruptions in the base of support and are precipitated by extrinsic factors, generally trips during walking activities., (© 2022. The Author(s).)

The purpose was to assess the effects of three interventions on bone mineral density (BMD) to prevent the onset or progression of osteoporosis in postmenopausal women. Specifically, thirty-nine postmenopausal women, diagnosed with osteopenia or osteoporosis, implemented either high-impact training (G1), the same training + calcium and vitamin D intake (G2), or walked at an intense pace + calcium and vitamin D (G3). Baseline change (BC) in BMD was estimated using the femoral neck and lumbar spine T-scores. Participants were classified as having suffered fractures and/or falls before (24-month) and during the 2-year intervention. The participants-aged 61.8 years-were allocated into G1 ( n = 9), G2 ( n = 16), and G3 ( n = 14). The groups evolved similarly over time; however, participants in G2 exhibited the largest T-score improvements with BC over 20%. G1 and G3 maintained BMD levels (BC = -7 to 13.3%; p > 0.05). Falls occurred similarly across the interventions, while the participants in G2 had the lowest percentage of fracture events ( p = 0.037). Overall, the findings suggest that regular physical exercise may be effective in maintaining or improving BMD in postmenopausal women presenting with osteopenia or osteoporosis. Due to the limited sample size, the results are preliminary and warrant future randomized trials to validate the findings.

Brucellosis is a major zoonotic disease caused by Brucella species. Historically, the disease received over fifty names until it was recognized as a single entity, illustrating its protean manifestations and intricacies, traits that generated conundrums that have remained or re-emerged since they were first described. Here, we examine confusions concerning the clinical picture, serological diagnosis, and incidence of human brucellosis. We also discuss knowledge gaps and prevalent confusions about animal brucellosis, including brucellosis control strategies, the so-called confirmatory tests, and assumptions about the primary-binding assays and DNA detection methods. We describe how doubtfully characterized vaccines have failed to control brucellosis and emphasize how the requisites of controlled safety and protection experiments are generally overlooked. Finally, we briefly discuss the experience demonstrating that S19 remains the best cattle vaccine, while RB51 fails to validate its claimed properties (protection, differentiating infected and vaccinated animals (DIVA), and safety), offering a strong argument against its current widespread use. These conundrums show that knowledge dealing with brucellosis is lost, and previous experience is overlooked or misinterpreted, as illustrated in a significant number of misguided meta-analyses. In a global context of intensifying livestock breeding, such recurrent oversights threaten to increase the impact of brucellosis.

Purpose: The effectiveness of enhanced recovery after surgery (ERAS) pathways in patients undergoing bariatric surgery remains unclear. Our objective was to determine the effect of the ERAS elements on patient outcomes following elective bariatric surgery., Materials and Methods: Prospective cohort study in adult patients undergoing elective bariatric surgery. Each participating center selected a single 3-month data collection period between October 2019 and September 2020. We assessed the 24 individual components of the ERAS pathways in all patients. We used a multivariable and multilevel logistic regression model to adjust for baseline risk factors, ERAS elements, and center differences RESULTS: We included 1419 patients. One hundred and fourteen patients (8%) developed postoperative complications. There were no differences in the incidence of overall postoperative complications between the self-designated ERAS and non-ERAS groups (54 (8.7%) vs. 60 (7.6%); OR, 1.14; 95% CI, 0.73-1.79; P = .56), neither for moderate-to-severe complications, readmissions, re-interventions, mortality, or hospital stay (2 [IQR 2-3] vs. 3 [IQR 2-4] days, 0.85; 95% CI, 0.62-1.17; P = .33) Adherence to the ERAS elements in the highest adherence quartile (Q1) was greater than 72.2%, while in the lowest adherence quartile (Q4) it was less than 55%. Patients with the highest adherence rates had shorter hospital stay (2 [IQR 2-3] vs. 3 [IQR 2-4] days, 1.54; 95% CI, 1.09-2.17; P = .015), while there were no differences in the other outcomes CONCLUSIONS: Higher adherence to ERAS Society® recommendations was associated with a shorter hospital stay without an increase in postoperative complications or readmissions., Trial Registration: ClinicalTrials.gov Identifier: NCT03864861., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The intracellular pathogens of the genus Brucella are phylogenetically close to Ochrobactrum , a diverse group of free-living bacteria with a few species occasionally infecting medically compromised patients. A group of taxonomists recently included all Ochrobactrum organisms in the genus Brucella based on global genome analyses and alleged equivalences with genera such as Mycobacterium . Here, we demonstrate that such equivalencies are incorrect because they overlook the complexities of pathogenicity. By summarizing Brucella and Ochrobactrum divergences in lifestyle, structure, physiology, population, closed versus open pangenomes, genomic traits, and pathogenicity, we show that when they are adequately understood, they are highly relevant in taxonomy and not unidimensional quantitative characters. Thus, the Ochrobactrum and Brucella differences are not limited to their assignments to different "risk-groups", a biologically (and hence, taxonomically) oversimplified description that, moreover, does not support ignoring the nomen periculosum rule, as proposed. Since the epidemiology, prophylaxis, diagnosis, and treatment are thoroughly unrelated, merging free-living Ochrobactrum organisms with highly pathogenic Brucella organisms brings evident risks for veterinarians, medical doctors, and public health authorities who confront brucellosis, a significant zoonosis worldwide. Therefore, from taxonomical and practical standpoints, the Brucella and Ochrobactrum genera must be maintained apart. Consequently, we urge researchers, culture collections, and databases to keep their canonical nomenclature.

Brucella melitensis and Brucella ovis are gram-negative pathogens of sheep that cause severe economic losses and, although B. ovis is non-zoonotic, B. melitensis is the main cause of human brucellosis. B. melitensis carries a smooth (S) lipopolysaccharide (LPS) with an N-formyl-perosamine O-polysaccharide (O-PS) that is absent in the rough LPS of B. ovis. Their control and eradication require vaccination, but B. melitensis Rev 1, the only vaccine available, triggers anti-O-PS antibodies that interfere in the S-brucellae serodiagnosis. Since eradication and serological surveillance of the zoonotic species are priorities, Rev 1 is banned once B. melitensis is eradicated or where it never existed, hampering B. ovis control and eradication. To develop a B. ovis specific vaccine, we investigated three Brucella live vaccine candidates lacking N-formyl-perosamine O-PS: Bov::CAΔwadB (CO 2 -independent B. ovis with truncated LPS core oligosaccharide); Rev1::wbdRΔwbkC (carrying N-acetylated O-PS); and H38ΔwbkF (B. melitensis rough mutant with intact LPS core). After confirming their attenuation and protection against B. ovis in mice, were tested in rams for efficacy. H38ΔwbkF yielded similar protection to Rev 1 against B. ovis but Bov::CAΔwadB and Rev1::wbdRΔwbkC conferred no or poor protection, respectively. All H38ΔwbkF vaccinated rams developed a protracted antibody response in ELISA and immunoprecipitation B. ovis diagnostic tests. In contrast, all remained negative in Rose Bengal and complement fixation tests used routinely for B. melitensis diagnosis, though some became positive in S-LPS ELISA owing to LPS core epitope reactivity. Thus, H38ΔwbkF is an interesting candidate for the immunoprophylaxis of B. ovis in B. melitensis-free areas., (© 2022. The Author(s).)

Background: The ankle plays a key role in balance, but ankle range of motion decreases with ageing., Research Question: To establish whether a talus mobilization-based manual therapy intervention may be effective for increasing range of motion and balance in older adults with limited ankle mobility due to the ageing process., Methods: Randomized clinical trial in which 42 community-dwelling older adults with limited ankle mobility were allocated to an experimental or a control group. The experimental intervention consisted of six sessions of anteroposterior talus mobilization, whereas the control intervention was a sham treatment. Baseline change in weight and non-weight bearing ankle range of motion (ROM), balance outcome in terms of the Timed up and go (mobility and dynamic balance), Single-leg stand (static balance and stability), Functional reach (margins of stability) and Romberg tests (static balance) were assessed. Analysis of variance based on a mixed-linear model of repeated measures looked for group interactions., Results: Forty participants completed the study. Participants who received six sessions of manual therapy showed greater improvements in the Timed up and go, Functional reach and Single-leg stand tests than participants who received a sham intervention (p < 0.001). Both groups presented similar performance in post-treatment static balance measures (p > 0.05)., Significance: An anteroposterior talus mobilization-based manual therapy intervention is effective for increasing ankle ROM, with a positive effect on dynamic balance, mobility and stability in community-dwelling older adults with limited ankle mobility., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Urological evaluation is essential to guarantee the success of the kidney transplant. Urologists working within a multidisciplinary team have a crucial role to detect and manage certain recipient urological conditions that could jeopardize the function and survival of the graft.The critical aspects that Urologists should consider in thepre-transplant evaluation would be:- Is renal transplantation surgical technique feasible with assumable risks based on the recipient's baseline characteristics? age, life expectancy, performance status,physical examination...- Is bladder function adequate to properly ensure the urine storage and voiding?- Is there a potentially treatable urinary flow obstruction?- Are there urological pathologies in the recipient that could lead to post-transplant complications that compromise graft survival: functional, infectious, oncological comorbidities…?- Based on the patient's cardiovascular risk factors, arteriosclerosis in the aorto-iliac territory colud put at risk thearterial anastomosis? In this chapter, we will try to explain how the pre-transplant urological evaluation should be guided according to the specific recipient characteristics. We will also explain which pre-transplant surgeries are required to avoid some risky that may compromise the recipient and graft survival after renal transplantation, as well as those should be postponed after transplantation.

Bovine brucellosis induces abortion in cows, produces important economic losses, and causes a widely distributed zoonosis. Its eradication was achieved in several countries after sustained vaccination with the live attenuated Brucella abortus S19 vaccine, in combination with the slaughtering of serologically positive animals. S19 induces antibodies against the smooth lipopolysaccharide (S-LPS), making difficult the differentiation of infected from vaccinated bovines. We developed an S19 strain constitutively expressing the green fluorescent protein (S19-GFP) coded in chromosome II. The S19-GFP displays similar biological characteristics and immunogenic and protective efficacies in mice to the parental S19 strain. S19-GFP can be distinguished from S19 and B. abortus field strains by fluorescence and multiplex PCR. Twenty-five heifers were vaccinated withS19-GFP (5×109 CFU) by the subcutaneous or conjunctival routes and some boosted with GFP seven weeks thereafter. Immunized animals were followed up for over three years and tested for anti-S-LPS antibodies by both the Rose Bengal test and a competitive ELISA. Anti-GFP antibodies were detected by an indirect ELISA and Western blotting. In most cases, anti-S-LPS antibodies preceded for several weeks those against GFP. The anti-GFP antibody response was higher in the GFP boosted than in the non-boosted animals. In all cases, the anti-GFP antibodies persisted longer, or at least as long, as those against S-LPS. The drawbacks and potential advantages of using the S19-GFP vaccine for identifying vaccinated animals in infected environments are discussed., Competing Interests: The authors have declared that no competing interests exist.

Background: Factors such as the manufacturing materials, shape or even the mechanical and thermal response of sitting Pressure Redistribution Support Surfaces (PRSS) can be potential contributors to pressure ulcers. However, few studies have compared a number of characteristics of the most frequently used devices., Objective: To compare three potential contributors to pressure ulcers in five commercial PRSS: pressure redistribution, temperature and perceived comfort., Method: Study with a cross-over randomized design in healthy volunteer participants. Data was collected in a temperature and relative humidity controlled environment. To assess thermal response, the temperature (Flir-E60) of the region of interest was captured before and after use of each PRSS for further analysis. The region of interest was the gluteal zone. To assess the pressure redistribution a pressure mat (XSensor®) was used between the 5 cushion and each study participant using a standardized method. Finally, a subjective perception questionnaire recorded comfort, adaptability and thermal sensation parameters. Data analysis levels of significance were set at 0.05., Results: A total of 22 participants completed the assessments. There were no statistically significant differences in baseline temperatures between PRSS (>0.05). Pressure redistribution analysis showed significant differences between all PRSS in all variables evaluated except in the maximum and peak pressure index al sacrum. The subjective assessment suggested no major user-perceived differences between PRSS., Conclusion: Seat cushions made of open cell polyurethane foam blocks of variable hardness and the horseshoe cushion (also open cell polyurethane foam) seem to provide a more effective pressure relief characteristic than those injected with polyurethane foam and gel in most of the studied pressure variables. However, the cushions provide similar thermal response and perceived comfort., (Copyright © 2021 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.)

Purpose: To investigate the effects of including balance training in a preoperative strengthening intervention on balance and functional outcomes in patients undergoing total knee replacement (TKR) and compare these effects to those induced by preoperative strengthening and no intervention., Methods: Eighty-two subjects scheduled for TKR were randomly allocated into the strengthening (ST, n = 28) group: a preoperative lower limb strengthening intervention; the strengthening + balance (ST + B, n = 28) group: same intervention augmented with balance training; and the control group (n = 26). The Berg Balance Scale (BBS) and the function in daily living subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS-ADL) were the primary outcomes. The secondary measures included balance and mobility, self-reported status, and knee function. The outcomes were assessed at baseline, 1 week before surgery, and 2, (primary endpoint), 6 and 52 weeks after surgery., Results: Compared with the controls, the participants in the ST and ST + B groups presented significant improvements from baseline to the end of the preoperative intervention in BBS (p = 0.005) and KOOS-ADL (p < 0.001). At 6 weeks post-surgery, the knee extensor strength values were similar in the two treatment groups and significantly higher than that in the controls. Overall, the participant outcomes in all groups stabilized at 1 year after surgery., Conclusion: A preoperative strengthening intervention, regardless of whether it is complemented with balance training, enhances strength but not balance or functional outcomes at 6 weeks after surgery. Patients are expected to present similar performance at 1 year postoperatively, but adequately statistically powered trials are needed to confirm the findings., Level of Evidence: II., Trial Registration: NCT02995668.

Objective: To determine the effectiveness of mechanical diagnosis and therapy (MDT) in patients with chronic low back pain (CLBP) compared to other traditional physical therapy interventions., Methods: Randomized controlled trials investigating the effect of MDT compared to other traditional physical therapy interventions in individuals with CLBP were considered eligible. For the purpose of this review, MDT was compared to active and passive physical therapy interventions. Independent reviewers assessed the eligibility of studies, extracted data, and assessed the risk of bias. The primary outcomes investigated were pain and disability., Results: Fourteen studies were included in the review. Of these, 11 provided data to be included in the meta-analyses. Our findings showed that MDT was no more effective in decreasing pain (standardized mean difference [SMD]=0.01, 95% confidence interval [CI]: -0.44, 0.46) and disability (SMD=0.08, 95% CI: -0.53, 0.68) than other active treatments. Similar results were found when comparing MDT to other passive treatments for pain (SMD=-0.39, 95% CI: -0.90, 0.11) and disability (SMD=-0.13, 95% CI: -0.29, 0.03)., Conclusion: There is low to moderate quality evidence that MDT is not superior than other traditional physical therapy interventions in improving pain and disability in people with CLBP., (Copyright © 2020 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Adverse effects in the sexual sphere are common in patients who have undergone radical prostatectomy (RP). Climacturia, involuntary loss of urine during orgasm, occurs in 20-40% of cases after PR. We analyse its prevalence and associated risk factors after Robotic-assisted laparoscopic radical prostatectomy (RALRP)., Objectives: We analyse the climacturia prevalence after robotic-assisted laparoscopic radical prostatectomy (RALRP) and the association with other related factors., Materials and Methods: Retrospective study of 100 patients underwent PRLAR from May 2011 to July 2014. After excluding patients who received radiotherapy after surgery (17), those who did not have sexual activity (7) and those with whom it could not be possible contacted (14), a structured telephone interview was conducted in 62 patients, investigating: presence and intensity of climacturia, orgasmic quality, incontinence and erectile dysfunction (ED). Other factors analysed included neurovascular preservation and rehabilitative treatment for ED. The statistical analysis consisted of Chi 2 test and logistic regression to evaluate associated factors., Results: The mean age was 56 vs 59 years and the mean follow-up time was 26.6 vs 20.3 months, in the group with climacturia and without climacturia, respectively. The prevalence of climacturia was 17.9% (slight leaks-82% and severe leaks-18%). In 37% of these patients occurred in all orgasms. The quality of orgasm after surgery was worse in 47%, better in 13% and equal in 40%. The quality of the orgasm worsened more frequently in the climacturia group (63% vs 37%). The urinary incontinence rate was 41%, always effort incontinence. It was more frequent in patients with climacturia (62% vs 38%). In all patients with climacturia, bilateral neurovascular bundles preservation was performed. 32% of the patients had undergone post-surgical erectile rehabilitation with oral drugs. No statistically significant differences were found between patients with or without climacturia respect to the parameters analysed., Conclusions: Climacturia rate after PRLAR in our series was 17.9%. Patients with climacturia presented worse quality orgasms and a higher incontinence rate (p> 0.05). None of the analysed parameters could be defined as predictors of climacturia., (Copyright © 2019 Asociación Española de Andrología, Medicina Sexual y Reproductiva. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Loss of knee extensor strength in individuals with knee osteoarthritis (KOA) may induce inter-limb strength asymmetries and alter functionality. The aims were to analyse whether the condition of the uninvolved knee (advanced to severe KOA or no affection) may induce different degrees of knee extensor strength asymmetry in individuals with KOA and to study whether functionality may differ in cases of unilateral or bilateral KOA., Methods: Sixty-eight subjects with advance-to-severe KOA were categorized into two groups (unilateral or bilateral KOA). The knee extensor strength ratio (KESR), and self-reported and performance-based functionality were analysed and compared. Sex and age were independent factors. One- and two-way analysis of variance assessed for significant between-group differences (95% confidence interval (CI))., Results: Participants with unilateral KOA presented with 20% knee extensor strength asymmetry. The mean difference with the bilateral KOA group in terms of Knee Extensors Strength Ratio was 0.2 (95% CI 0-0.3; P = 0.021), of the Oxford Knee Scale score was 4.2 (95% CI 3.4-5.1; P = 0.037), and of the Timed Up and Go was 1.3 s (95% CI 0.5-2.2; P > 0.05). There were significant sex and age interactions (P < 0.05)., Conclusions: Individuals with unilateral or bilateral KOA present with different degrees of knee extensor strength asymmetry. The non-affected knee seems to help to better develop functional tasks in cases of unilateral condition. The findings may help the design of tailored strengthening interventions in which each knee condition in individuals with KOA should be considered., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background : Balance limitations and foot and ankle problems are common in older adults. Objective : To determine the impact of augmented balance training with foot and ankle mobilizations (FAMs) on balance in older adults. Methods : Two-arm pilot randomized trial. Both groups underwent a 4-week conventional balance training. Additionally, the experimental group received four sessions of FAM. Balance measurement, as assessed by the Berg Balance Scale, was the primary outcome. The secondary outcome was the ankle range of movement (ROM). Outcomes were evaluated 1 day before and after intervention, and at 3 months' post-intervention (midterm). Results : Twenty-eight participants completed the study (14 control, 14 experimental). No between-group differences were observed in terms of balance. Similarly, both groups significantly improved the ankle ROM, but the effects persisted at 3 months only in the FAM group. Conclusion : Augmented balance training with FAM does not improve balance of older adults over conventional methods, but may help to correct ankle mobility limitations at midterm. As this was a pilot study, further studies with adequate sample size are warranted to validate our findings, and elucidate the dose-response relationship of FAM with improvement of balance and ROM in older adults.

Objective: The objective of our study is to stablish the scientific quality of the available information in YouTube about erectile dysfunction (ED)., Material and Methods: We searched on YouTube thrree terms ("Problemas de Erección" (PE), "Impotencia"(I) y "Disfunción Eréctil" (DE)). The sixteen first videos from each term were selected for the analysis. Two independent urologists reviewed all videos and classified all of them in scientific evidence-based (SEB) or not scientific evidence-based (NSEB) according to the current literature. In the subgroup analysis we compare: number of visits, duration, time of publication, source and type of information., Results: After excluding the repeated links and non-concordant videos between both urologists, we analysed 147 videos. The Kappa statistic was 0.89 (95% CI0.85-0.96). 37% were considered SEB and 63% were considered NSEB. The median of reproductions in the SEB group was 24.356 (96-126.410) and 44.416 for NSEB (190-10.318.642); this difference was statistically significant. The median duration was 254 seconds(46-984) for the SEB group and 228 seconds for the NSEB (23-2.880); the median time of publication was 42 (16-103) months for the SEB group and 29 (11-134) months for the other one. 83% of SEB videos were published in health networks and television programs,while 58% of NSEB were published in user blogs. The SEB videos show more information about pathophysiology,aetiology, endothelial dysfunction, diagnosis and treatment than NSEB (p<0.001)., Conclusions: 37% of the videos were consideredSEB. The NSEB videos were significantly more playedthan SEB group.

Background: Ankle range of motion declines with age, affecting mobility and postural control., Objective: The objective of this study was to investigate the effects of a talus mobilization-based intervention among healthy community-dwelling older adults presenting with limited weight-bearing ankle dorsiflexion range of motion and determine how ankle mobility evolved over the treatment., Design: This was a randomized clinical trial., Setting: This study was conducted in an outpatient clinic., Participants: Community-dwelling, older adults over 60 years of age who had limited ankle mobility participated in this study., Interventions: The experimental intervention consisted of 6 sessions of manual therapy applied in the ankle joint. The control group received the same volume of sham treatment., Measurements: The primary outcome was the weight-bearing ankle dorsiflexion range of motion as measured using the lunge test. Data were collected at 9 time points: baseline, after each session, and follow-up., Results: A total of 36 participants were analyzed. A single session of mobilization increased ankle range of motion by 8 degrees (95% confidence interval = 6 to 11). At the end of the sixth session, this effect had increased slightly to 11 degrees (95% confidence interval = 9 to 13). Significant between-group differences were found throughout the intervention., Limitations: Optimal dose and effects from follow-up evaluations for treatment volumes of fewer than 6 sessions remain unknown., Conclusions: Six sessions of a talus mobilization-based intervention in healthy community-dwelling older adults found that the greatest mobility gain in terms of the weight-bearing ankle dorsiflexion range of motion is produced after the first session. Additional sessions produce smaller improvements with a slight upward trend. Importantly, the restoration of joint mobility is enhanced over time after the end of the intervention., (© 2020 American Physical Therapy Association.)