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Chronic hyperglycemia caused by diabetes results in systemic damage to the body, and the kidney ends up being the target of tissue damage. The use of antioxidants such as alpha-lipoic acid (ALA) has been shown to improve clinical and biochemical parameters in diabetic patients as they help in the prevention of oxidative stress. The present study aimed to undertake a comparative evaluation of the renal morphology of normal and diabetes-induced Wistar rats supplemented with ALA. The experiment had 4 experimental groups (n=7): a control group and a diabetic group that were fed commercial food; an alpha-lipoic group and an alpha-lipoic diabetic group that received the ALA supplement. Diabetes was induced with a single intraperitoneal injection of alloxane monohydrate administered after fasting. After 60 days of the experiment, the kidneys were excised to study the histomorphometric and stereological parameters of the glomeruli and renal tubules and the immunohistochemical parameters with a podocyte count. In the evaluation, the ALA promoted improvement in all of the relevant parameters of the glomerular areas and attenuation of tubular lesions of diabetic animals (p

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Copyright of Online Brazilian Journal of Nursing is the property of Fundacao Euclides da Cunha de Apoio Institucional a UFF 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.)

Objective: To assess the effects of neural mobilisation on nerve function and nerve structure of patients with peripheral neuropathic pain., Methods: A systematic review with meta-analysis was conducted. Medline, Embase, CINAHL, Cochrane Library, and World Health Organization International Clinical Trials Registry Platform were searched without restrictions. Eligibility criteria included controlled trials or quasi-experimental studies comparing neural mobilisation versus sham, active or inactive control in adults with peripheral neuropathic pain. Primary outcomes were the change in peripheral nerve cross-sectional area. Secondary outcomes included nerve echogenicity, nerve excursion and nerve conduction. Random effects meta-analysis was conducted. Risk of bias was assessed with the Cochrane Collaboration tool, and certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework., Results: Eleven randomised controlled trials and four quasi-experimental studies (total sample = 722 participants) were included. Thirteen studies included participants with carpal tunnel syndrome. Two studies examined the cross-sectional area, revealing improvements (i.e., a reduction) in the cross-sectional area after the neural mobilisation. Neural mobilisation improved motor [mean difference = 2.95 (95%CI 1.67 to 4.22)] and sensory conduction velocity in short-term [mean difference = 11.74 (95%CI 7.06 to 16.43)], compared to control. Neural mobilisation did not alter distal motor or sensory latency., Conclusion: Neural mobilisation seems to improve (i.e., a reduced) the cross-sectional area (very low-quality evidence) and sensory conduction velocity (very low-quality evidence). Neural mobilisation was superior to control in improving motor conduction velocity in patients with peripheral neuropathic pain with moderate quality evidence. Distal motor or sensory latency presented similar results compared to other interventions. Our findings should be interpreted cautiously since most studies included patients with carpal tunnel syndrome., Competing Interests: The authors report no conflict of interest., (Copyright: © 2024 Bittencourt et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To develop and evaluate a new patient-reported outcome measure (PROM) to assess people's knowledge and beliefs about low back pain., Methods: This study followed the COnsensus-based Standards for the selection of health Measurement INstruments guidelines. An 18-item preliminary version of the Back pain Knowledge and beliefs Survey (BacKS) was generated based on evidence-based key messages and current clinical guidelines for low back pain. Four items were added following input from three consumers and seven experts. Focus groups (n=9) confirmed content validity. The 22-item version was completed by 258 Australian-based adults (>18 years) with self-reported low back pain. A follow-up survey was sent 1 week later. The following measurement properties were evaluated to produce, and then assess the final version of BacKS: structural validity (exploratory factor analysis); internal consistency (Cronbach's alpha); test-retest reliability (intraclass correlation coefficient); measurement error (Smallest Detectable Change); construct validity (hypothesis tested: moderate positive Pearson correlation between BacKS and Back Beliefs Questionnaire); plus, interpretability and feasibility., Results: The final BacKS comprised 20 items with a 2-factor structure (biomedical factor: 9 items, score ranging from 9 to 45, and self-care factor: 11 items, score ranging from 11 to 55). Internal consistency and reliability were adequate (>0.70) for each factor. Smallest detectable change was 4.4 (biomedical factor) and 7.0 (self-care factor). Our construct validity hypothesis was confirmed (Pearson correlation=0.53). No floor or ceiling effects were detected., Conclusion: The BacKS is a valid, reliable and feasible PROM to measure knowledge and beliefs about low back pain in clinical practice and research settings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives: To evaluate the measurement properties of Patient-reported outcome measures (PROMs) for knowledge and/or beliefs about musculoskeletal conditions., Study Design and Setting: A systematic review was performed according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines. This review was prospectively registered on PROSPERO - ID: CRD42022303111. Electronic databases, reference lists, forward citation tracking, and contact with experts were used to identify studies. Eligible studies were reports developing or assessing a measurement property of a PROM measuring musculoskeletal condition specific-knowledge and/or beliefs. We assessed the methodological quality and measurement properties of included studies. A modified Grading of Recommendations Assessment Development and Evaluation approach was used to rate the quality of evidence for each PROM., Results: The literature search was performed from inception to 11th September 2023. Sixty records were included, reporting 290 individual studies, and provided information on 25 PROMs. Five PROMs presented sufficient structural validity, three presented sufficient cross-cultural validity, ten presented sufficient reliability, three presented sufficient criterion validity, six presented sufficient hypothesis-testing, and four presented sufficient responsiveness. No PROM presented sufficient evidence for content validity, internal consistency, and measurement error. Based on the available evidence, no PROM was classified as suitable for use according to the COSMIN recommendations. Twenty-four PROMs are potentially suitable for use, and one PROM is not recommended for use., Conclusion: No PROM designed to assess knowledge and/or beliefs about musculoskeletal conditions meets the COSMIN criteria of suitable for use. Most PROMs identified in this systematic review were considered as potentially suitable for use and need further high-quality research to assess their measurement properties., Competing Interests: Declaration of competing interest There are no competing interests for any author., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Clinical practice guidelines recommend spinal manipulation for patients with low back pain. However, the effects of spinal manipulation have contradictory findings compared to placebo intervention. Therefore, this study investigated the immediate effects of lumbar spinal manipulation on pressure pain threshold (PPT) and postural stability in people with chronic low back pain (cLBP). Second, we investigated the immediate effect of lumbar spinal manipulation on pain intensity and the interference of the participant beliefs about which treatment was received in the PPT, postural stability, and pain intensity., Methods: A two-arm, randomised, placebo-controlled, double-blind trial was performed. Eighty participants with nonspecific cLPB and a minimum score of 3 on the Numeric Pain Rating Scale received one session of lumbar spinal manipulation (n = 40) or simulated lumbar spinal manipulation (n = 40). Primary outcomes were local and remote PPTs and postural stability. Secondary outcomes were pain intensity and participant's perceived treatment allocation. Between-group mean differences and their 95% confidence intervals (CIs) estimated the treatment effect. One-way analysis of covariance (ANCOVA) was performed to assess whether beliefs about which treatment was received influenced the outcomes., Results: Participants had a mean (SD) age of 34.9 (10.5) years, and 50 (62.5%) were women. Right L5 [between-group mean difference = 0.55 (95%CI 0.19 to 0.90)], left L5 [between-group mean difference = 0.45 (95%CI 0.13 to 0.76)], right L1 [between-group mean difference = 0.41 (95%CI 0.05 to 0.78)], left L1 [between-group mean difference = 0.57 (95%CI 0.15 to 0.99)], left DT [between-group mean difference = 0.35 (95%CI 0.04 to 0.65)], and right LE [between-group mean difference = 0.34 (95%CI 0.08 to 0.60)] showed superior treatment effect in the spinal manipulation group than sham. Neither intervention altered postural stability. Self-reported pain intensity showed clinically significant decreases in both groups after the intervention. A higher proportion of participants in the spinal manipulation group achieved more than two points of pain relief (spinal manipulation = 90%; sham = 60%). The participants' perceived treatment allocation did not affect the outcomes., Conclusion: One spinal manipulation session reduces lumbar pain sensitivity but does not affect postural stability compared to a sham session in individuals with cLPB. Self-reported pain intensity lowered in both groups and a higher proportion of participants in the spinal manipulation group reached clinically significant pain relief. The participant's belief in receiving the manipulation did not appear to have influenced the outcomes since the adjusted model revealed similar findings., (© 2024. The Author(s).)

Background: Computational linguistics allows an understanding of language structure and different forms of expression of patients' perceptions., Aims: The aims of this study were (i) to carry out a descriptive analysis of the discourse of people with chronic low back pain using sentiment analysis (SA) and network analysis; (ii) to verify the correlation between patients' profiles, pain intensity and disability levels with SA and network analysis; and (iii) to identify clusters in our sample according to language and SA using an unsupervised machine learning technique., Methods: We performed a secondary analysis of a qualitative study including participants with chronic non-specific low back pain. We used the data related to participants' feelings when they received the diagnosis. The SA and network analysis were performed using the Valence Aware Dictionary and sEntiment Reasoner, and the Speech Graph, respectively. Clustering was performed using the K-means algorithm., Results: In the SA, the mean composite score was -0.31 (Sd. = 0.58). Most participants presented a negative discourse (n = 41; 72%). Word Count (WC) and Largest Strongly connected Component (LSC) positively correlated with education. No statistically significant correlations were observed between pain intensity, disability levels, SA, and network analysis. Two clusters were identified in our sample., Conclusion: The SA showed that participants reported their feeling when describing the moment of the diagnosis using sentences with negative discourse. We did not find a statistically significant correlation between pain intensity, disability levels, SA, and network analysis. Education level presented positive correlation with WC and LSC., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Patellofemoral pain is a common complaint between physically active subjects. Patients with patellofemoral pain present limitations to performing daily activities. Pain could alter proprioceptive acuity and lead to movement impairment. The aim of this study was to investigate the relationship of pain and disability with proprioception acuity and physical performance in patients with patellofemoral pain., Methods: Forty-eight patients with patellofemoral pain [age 31.15 (5.91) years; 30 (62.50%) males] were recruited. Data collected included pain intensity, pain duration, disability, joint position sense (JPS) test at 20° and 60° of knee flexion, and physical performance tests (Single-Leg Triple-Hop Test and Y- Balance Test). Spearman's rank correlation coefficient (r s ) and 95% confidence intervals (CI) were computed to assess the relationship between the variables., Results: Pain intensity was correlated with Y-Balance Test posteromedial component (r s  = -0.32, 95%CI = -0.55 to -0.03, p = 0.029) and the composite score (r s  = -0.35, 95%CI = -0.58, -0.07, p = 0.015). Pain duration was correlated with Y-Balance Test posterolateral component (r s  = -0.23, 95% CI = -0.53 to -0.01, p = 0.047). Disability was correlated with Y-Balance Test posteromedial component (r s  = 0.41, 95% CI = 0.14 to 0.62, p = 0.004). Pain and disability were not correlated with JPS and the Single-Leg Triple-Hop Test., Conclusion: Pain and disability were related to Y-Balance Test but not to proprioceptive acuity and Single-Leg Triple-Hop Test in patients with patellofemoral pain., 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 © 2024 Elsevier Ltd. All rights reserved.)

The present study aimed to compare pain-related interference and pain-related distress in patients with musculoskeletal pain and differing levels of health literacy. A cross-sectional study was conducted among 243 patients with chronic musculoskeletal pain. Short Test of Functional Health Literacy in Adults classified the level of health literacy. Outcome measures included pain-related interference (pain intensity and functional limitation) and pain-related distress (psychosocial factors). Analysis of variance methods were used. One hundred twenty-three (50.62%) participants were classified as adequate, 24 (9.88%) as marginal and 96 (39.50%) as inadequate health literacy. Patients with inadequate health literacy had higher values of pain severity compared to the other groups, when controlled for age. The group adequate health literacy showed less kinesiophobia compared to their counterparts. Functional limitations and other psychosocial factors were similar among groups. Pain severity and kinesiophobia had disadvantageous findings in participants with inadequate health literacy. Still, the results of pain severity must be approached cautiously because the differences were observed when controlled for age solely., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Spinal manipulative therapy (SMT) is a guideline-recommended treatment option for spinal pain. The recommendation is based on multiple systematic reviews. However, these reviews fail to consider that clinical effects may depend on SMT "application procedures" (i.e., how and where SMT is applied). Using network meta-analyses, we aim to investigate which SMT "application procedures" have the greatest magnitude of clinical effectiveness for reducing pain and disability, for any spinal complaint, at short-term and long-term follow-up. We will compare application procedural parameters by classifying the thrust application technique and the application site (patient positioning, assisted, vertebral target, region target, Technique name, forces, and vectors, application site selection approach and rationale) against: 1. Waiting list/no treatment; 2. Sham interventions not resembling SMT (e.g., detuned ultrasound); 3. Sham interventions resembling SMT; 4. Other therapies not recommended in clinical practice guidelines; and 5. Other therapies recommended in clinical practice guidelines. Secondly, we will examine how contextual elements, including procedural fidelity (whether the SMT was delivered as planned) and clinical applicability (whether the SMT is similar to clinical practice) of the SMT., Methods: We will include randomized controlled trials (RCT) found through three search strategies, (i) exploratory, (ii) systematic, and (iii) other known sources. We define SMT as a high-velocity low-amplitude thrust or grade V mobilization. Eligibility is any RCT assessing SMT against any other type of SMT, any other active or sham intervention, or no treatment control on adult patients with pain in any spinal region. The RCTs must report on continuous pain intensity and/or disability outcomes. Two authors will independently review title and abstract screening, full-text screening, and data extraction. Spinal manipulative therapy techniques will be classified according to the technique application and choice of application sites. We will conduct a network-meta analysis using a frequentist approach and multiple subgroup and sensitivity analyses., Discussion: This will be the most extensive review of thrust SMT to date, and will allow us to estimate the importance of different SMT application procedures used in clinical practice and taught across educational settings. Thus, the results are applicable to clinical practice, educational settings, and research studies. PROSPERO registration: CRD42022375836., (© 2023. The Author(s).)

Background: Low back pain (LBP) subgroup identification and management are a research priority. The clarification of subgroup differences could assist clinicians in clinical decisions contributing to a tailored treatment., Objectives: To compare pain-related interference and pain-related psychosocial factors among subgroups of chronic low back pain (localised low back pain, peripheral neuropathic back pain, and widespread pain)., Design: Cross-sectional study., Methods: A cross-sectional study was conducted on 444 participants with chronic low back pain. Pain-related interference was investigated by the Brief Pain Inventory and Patient-Specific Functional Scale. Pain-related psychosocial factors assessment included psychosocial factors from Brief Screening Questions and maladaptive beliefs from Back Beliefs Questionnaire, self-efficacy, and expectation questions. Participants' characteristics, pain-related interference, and pain-related psychosocial factors were compared among the three groups., Results: A one-way ANCOVA presented statistically significant differences among the groups for current pain intensity [F(2,441) = 6.77, p = 0.001], pain duration [F(2,425) = 9.83, p < 0.001], pain-related interference by Brief Pain Inventory [F(2,441) = 11.97, p < 0.001], and pain-related psychosocial factors regarding symptoms of anxiety [F(2,441) = 3.85, p = 0.022], symptoms of depression [F(2,441) = 6.74, p = 0.001], social isolation [F(2,441) = 6.54, p = 0.002], catastrophising [F(2,441) = 9.72, p < 0.001], perceived stress [F(2,441) = 3.93, p = 0.020], maladaptive beliefs [F(2,441) = 6.89, p = 0.001], and expectation [F(2,441) = 6.66, p = 0.001]., Conclusion: Participants with widespread pain presented higher pain-related interference and pain-related psychosocial factors compared to the localised low back pain group. Participants with peripheral neuropathic back pain and widespread pain presented with similar characteristics., Competing Interests: Declaration of competing interest The authors have no relevant financial or non-financial interests to disclose., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Low back pain (LBP) is a global public health issue. Psychosocial factors are linked to LBP. However, there is a lack of knowledge about the relation of psychosocial factors to clinical outcomes of patients with severe LBP., Objective: To investigate the relationship between specific psychosocial factors with severe pain and functional limitation of patients with LBP., Methods: A cross-sectional study of 472 participants with LBP was conducted. Participants completed self-reported questionnaires, including psychosocial factors, characteristics of pain, and functional limitations. Two multivariable logistic regression models were performed with severe pain intensity (≥ 7 out of 10) and functional limitation (≥ 7 out of 10) (dependent variables) and 15 psychosocial factors (independent variables)., Results: One hundred twenty-five (26.5%) participants had severe LBP. Patients with catastrophising symptoms were 2.21 [95%Confidence Interval (CI): 1.30, 3.77] times more likely to have severe pain and 2.72 (95%CI: 1.75, 4.23) times more likely to have severe functional limitation than patients without catastrophising symptoms. Patients with maladaptive beliefs about rest were 2.75 (95%CI: 1.37, 5.52) times more likely to present with severe pain and 1.72 (95%CI: 1.04, 2.83) times more likely to have severe functional limitation. Patients with kinesiophobia were 3.34 (95%CI: 1.36, 8.24) times more likely to present with severe pain, and patients with social isolation were 1.98 (95%CI: 1.25, 3.14) times more likely to have severe functional limitation., Conclusion: Catastrophising, kinesiophobia, maladaptive beliefs about rest, and social isolation are related to unfavourable clinical outcomes of patients with LBP., Competing Interests: Conflict of interest There is no conflict of interest to declare., (Copyright © 2022 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Low back pain is one of the main public health concerns. Chronic low back pain (cLBP) reduces functional capacity and affects postural stability. Although health professionals widely use spinal manipulation, its immediate effect on painful sensitivity and postural stability is lacking. This study aims to verify the immediate effects of lumbar spinal manipulation on the pressure pain threshold and postural stability in individuals with cLBP., Methods: A two-arm, placebo-controlled clinical trial with parallel groups and examiner-blinded will be conducted with 80 participants with cLBP from an outpatient physical therapy department, randomly allocated at a 1:1 distribution. The experimental group will receive a lumbar spinal manipulation technique, and the placebo group will receive a simulated lumbar spinal manipulation. Both groups will receive one session of treatment and will be evaluated before and immediately after the intervention. The primary outcomes will be the pressure pain threshold and postural stability. Pain intensity and patient's expectation will be assessed as a secondary outcome. The pressure pain threshold will be assessed using a pressure algometer in 6 different anatomical regions. The evaluation of postural stability will be performed in a baropodometry exam by displacing the centre of pressure. The pain intensity will be measured using the Numeric Pain Rating Scale. A Likert scale will be used for the patient's expectation about the treatment. A two-way analysis of variance will compare the effect of the interventions between groups., Discussion: This study will provide insights regarding the immediate effects of spinal manipulation in patients with cLBP against a simulated spinal manipulation using objective outcomes and considering patients' expectations regarding the treatment., Trial Registration: Brazilian Registry of Clinical Trials RBR-3ksq2c . Registered on 13 July 2020., (© 2022. The Author(s).)

Advice to stay active is the primary management strategy for sciatica. Other conservative treatments such as neural management techniques may also contribute to sciatica recovery, but currently, the effects have not been robustly assessed. Thus, the aim of this study is to compare the effects of adding neural management to advice to stay active versus advice to stay active alone in improving pain intensity and functional limitation. Secondarily, to compare the effects of the experimental intervention in the sciatic neurodynamic, pain modulation, and psychosocial factors. A parallel-group, controlled, examiner-blinded superiority clinical trial randomised at a 1:1 allocation will be conducted in 210 participants with chronic sciatica. Patients will be recruited from outpatient physiotherapy clinics and community advertisements. The experimental group will receive neural mobilisation techniques and soft tissue mobilisation techniques for 30 minutes per session, 10 weekly sessions, plus advice to stay active on their activities of daily living, information on physical activity, imaging tests, and sciatica for 5 biweekly sessions lasting 25-30 minutes. The control group will receive advice to stay active only. The re-evaluation will be performed out after 5 weeks, 10 weeks, and 26 weeks after randomisation and primary endpoints will be pain intensity and functional limitation at 10 weeks. Secondary outcomes will include neuropathic symptoms, sciatic neurodynamic, pain modulation, and psychosocial factors. Adverse events and patient satisfaction will be assessed. Ethical approval has been granted from an Institutional Human Research Ethics Committee. Trial registration: Trial was prospectively registered in the Brazilian Registry of Clinical Trials (number: RBR-3db643c)., Competing Interests: The authors have declared that no competing interests exist.

Purpose: This study aimed to analyze the relationship between work-related lumbar posture (sitting, standing, walking, alternating posture) and LBP in workers., Methods: This is a retrospective study comprising 529 records of adult workers from a database of a private company. Predominant work-related lumbar posture was classified based on time spent in each posture. A total of 22 personal, occupational, clinical, and psychosocial covariates were evaluated. LBP symptoms in the last 12 months and during the last 7 days were the outcomes of the study. The multivariate analysis model evaluated the independent relationship between the work-related lumbar posture classification and other potential exposure factors with LBP., Results: The adjusted logistic regression model indicated that predominant walking reduced the likelihood to report LBP during the last 12 months when compared to standing (OR = 0.54; 95% CI 0.30, 0.99; p = 0.048), but there is no association between work-related postures and recent LBP. The adjusted analyses also revealed an association between LBP during the last 12 months and female sex, blue-collar task, frequently feeling tiredness, pain at any other body region previous 12 months, previous LBP, and monotonous work. Recent LBP was associated with female sex, pain at any other body region last 7 days, and previous LBP., Conclusions: Standing posture increases the likelihood to report LBP during the last 12 months when compared to walking. LBP over previous year and during the previous 7 days was associated with personal and clinical factors., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background and Objectives: Neuropathic pain is common in the general population worldwide and Brazil. The painDETECT questionnaire is a notable instrument for screening on neuropathic pain. A Brazilian version of the painDETECT is necessary to broaden the possibilities of identification of neuropathic pain in the Brazilian population for the proper diagnosis and treatment. The current study aimed to perform the translation and cross-cultural adaptation of the painDETECT into the Portuguese language of Brazil., Methods: A cross-cultural adaptation study was conducted in 11 stages according to standard procedures. Descriptive statistics were performed. The internal consistency of the questionnaire was assessed using Cronbach's Alpha test (α)., Results: Four translators, 10 experts, and 30 patients participated in the study. The expert committee adapted five out of nine items (item 2, 3, 6, 8, and 10) to the Brazilian context. The pretesting phase showed good internal consistency (α = 0.74) for the nine items, including the pain pattern and the body chart domains. The Cronbach's α of the instrument with seven descriptor items of pain was 0.83., Conclusions: The painDETECT was cross-culturally adapted into a Brazilian context and can be used to identify neuropathic components in pain of Brazilian patients., Clinical Implications: PainDETECT is available for Brazilians to identify neuropathic components in pain., (Copyright © 2021 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.)

Background: Patients with patellofemoral pain (PFP) present pain, functional limitation, and alteration in knee proprioception., Purpose: To compare the knee joint position sense and lower extremity functionality between patients with PFP and controls. Secondarily, investigate the relationship between proprioceptive acuity and physical performance., Methods: This is a matched case-control study including 48 patients with PFP and 48 healthy individuals matched by age, sex, weight, height, and limb dominance. The proprioceptive evaluation was performed using the joint position sense test (absolute error and relative error) and functionality was assessed using the Single-Leg Triple-Hop test and the Y-Balance Test. The groups were compared using the independent student's T-test. Proprioceptive acuity and physical performance correlations were determined by Pearson correlation coefficient., Results: Participants were on average 31 years old and 62.5% were men. There was no statistically difference for absolute and relative angular error between groups. Patients presented lower relative reached distance on the anterior direction of the Y-Balance Test than controls [patients=58.6 (6.6) % versus controls=61.7 (5.9) %, p=.020]. No differences between groups were found for other functional measures. Significant correlation was found between absolute angular error and anterior component at 60° (r=0.225, p=.028) and relative angular error at 60° with the posterolateral component of the Y- Balance Test (r=0.231, p=.024)., Conclusion: Proprioceptive acuity of patients with PFP was not reduced. The anterior direction of the Y-Balance Test was impaired compared to matched controls. Proprioceptive sense is related to dynamic balance but not to jump ability., 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 © 2021 Elsevier B.V. All rights reserved.)

Background: Patients' beliefs have an important influence on the clinical management of low back pain and healthcare professionals should be prepared to address these beliefs. There is still a gap in the literature about the influence of patients' perceptions of their clinical diagnosis on the severity of their pain experience and disability., Objectives: To identify the perceptions of patients with chronic non-specific low back pain regarding the influence of their clinical diagnosis on pain, beliefs, and daily life activities., Methods: Qualitative study of 70 individuals with chronic non-specific low back pain. A semi structured interview was conducted about patients' beliefs and perceptions regarding the influence of clinical diagnosis on their daily activities and pain intensity., Results: Most participants believed that higher number of different clinical diagnoses for the same individual may be associated with high pain intensity and disability for daily activities and that pain and injury are directly related. Patients beliefs were grouped into four main themes: (1) pain has multifactorial explanation in physical dimension; (2) improvement expectation is extremely low in patients with chronic pain; (3) clinical diagnosis influences pain and disability levels; (4) clinical diagnosis is extremely valued by patients., Conclusions: Patients believe that there is a strong relationship between structural changes in the lower back, pain, and daily life activities; thus, providing evidence of a strong influence of the biomedical model on their beliefs., Competing Interests: Conflicts of interest The authors report no conflicts of interest., (Copyright © 2021 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier España, S.L.U. All rights reserved.)

Study Design: Three-arm, parallel, randomized, placebo-controlled, assessor-blinded trial., Objective: To compare the immediate effect of manual therapy at the upper thoracic spine on the cardiovascular autonomic control of patients with musculoskeletal pain., Summary of Background Data: Musculoskeletal pain increases the risk of cardiovascular events. Thus, manual therapy applied to the upper thoracic region is likely efficient to improve the cardiac autonomic control., Methods: The study included 59 patients with musculoskeletal pain enrolled at an outpatient clinic. Participants were randomly assigned to spinal manipulation (n = 19), myofascial manipulation (n = 20), or placebo (n = 20) administered to the upper thoracic region. Resting heart rate variability provided indexes of the cardiac autonomic control, and the blood pressure response to the cold pressor test as a proxy of the sympathetic responsiveness to a stressor stimulus., Results: Groups were similar for baseline variables except for blood pressure. Two-way repeated-measures one-way analysis of covariance (ANCOVA) revealed that only spinal manipulation induced immediate increase of the square root of the mean squared differences of successive RR intervals (RMSSD), absolute (ms2), and normalized units (n.u.) of the high-frequency power (HF) as compared with pre-intervention evaluation, indicating an improvement in the parasympathetic activity to the heart. Normalized units of low-frequency power (LF) and the LF/HF ratio reduced after the spinal manipulation solely, suggesting a reduction of the sympathetic activity to the heart. There were no significant differences in the blood pressure responsiveness among the three treatments. There were no adverse events., Conclusion: In patients with musculoskeletal pain, spinal manipulation on the upper thoracic spine led to an immediate improvement in the resting cardiac autonomic control without an effect on the blood pressure responsiveness to a sympathoexcitatory stimulus. Myofascial manipulation or placebo did not change cardiovascular autonomic control.Level of Evidence: 2., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: The identification of central sensitization (CS) is an important aspect in the management of patients with chronic musculoskeletal pain. Several methods have been developed, including clinical indicators and psychophysical measures. However, whether clinical indicators coincide with the psychophysical test of CS-related sign and symptoms is still unknown. Therefore, the present study aimed to analyze the diagnostic accuracy of the clinical indicators in identifying CS-related sign and symptoms in patients with musculoskeletal pain., Methods: One-hundred consecutive patients with musculoskeletal pain were included. Clinical indicators (index method) based on a combination of patient self-report pain characteristics and physical examination were used to identify the phenotype of patients with musculoskeletal pain and the predominance of the CS-related sign and symptoms. Conditioned pain modulation (CPM) was assessed by the Cold Pressor Test (reference standard), which is a psychophysical test used to detect impairment of CPM. Measurements of the diagnostic accuracy were performed., Results: Twenty-seven patients presented predominance of CS-related sign and symptoms in the assessment of the clinical indicators, and 20 had impairment of CPM. Clinical indicators showed high accuracy (75.0%; 95% confidence interval = 65.3 to 83.1), high specificity (80.0%; 95% confidence interval = 69.6 to 88.1), high negative predictive value (87.7%; 95% confidence interval = 81.2 to 92.1), and a relevant positive likelihood ratio (2.8, 95% confidence interval = 1.5 to 5.0) when compared to the Cold Pressor Test., Conclusion: Clinical indicators demonstrated a valuable tool for detecting the impaired CPM, which is a remarkable feature of the CS-related sign and symptoms. Clinicians are encouraged to use the clinical indicators in the management of patients with musculoskeletal pain.

Background: The assessment of painful areas through printed body charts is a simple way for clinicians to identify patients with widespread pain in primary care. However, there is a lack in the literature about a simple and automated method designed to analyze pain drawings in body charts in clinical practice., Purpose: To test the inter- and intra-rater reliabilities and concurrent validity of software (PainMAP) for quantification of pain drawings in patients with low back pain., Methods: Thirty-eight participants (16 [42.10%] female; mean age 50.24 [11.54] years; mean body mass index 27.90 [5.42] kg/m 2 ; duration of pain of 94.35 [96.11] months) with a current episode of low back pain were recruited from a pool of physiotherapy outpatients. Participants were instructed to shade all their painful areas on a body chart using a red pen. The body charts were digitized by separate raters using smartphone cameras and twice for one rater to analyze the intra-rater reliability. Both the number of pain sites and the pain area were calculated using ImageJ software (reference method). The PainMAP software used image processing methods to automatically quantify the data from the same digitized body charts., Results: The reliability analyses revealed that PainMAP has excellent inter- and intra-rater reliabilities to quantify the number of pain sites (intraclass correlation coefficient [ICC] 2,1 : 0.998 [95% confidence interval (CI) 0.996 to 0.999]; ICC 2,1 : 0.995 [95% CI 0.991 to 0.998]) and the pain area [ICC 2,1 : 0.998 (95% CI 0.995 to 0.999); ICC 2,1 : 0.975 (95% CI 0.951 to 0.987)], respectively. The standard error of the measurement was 0.22 (4%) for the number of pain sites and 0.03 cm 2 (4%) for the pain area. The Bland-Altman analyses revealed no substantive differences between the 2 methods for the pain area (mean difference = 0.007 [95% CI -0.053 to 0.067])., Conclusion: PainMAP software is reliable and valid for quantification of the number of pain sites and the pain area in patients with low back pain., (© 2020 World Institute of Pain.)

Objective: The purpose of this study was to compare the cross-sectional area of the sciatic nerve in different positions of spinal manipulation using flexion-distraction technique., Methods: Thirty healthy participants were assessed in 6 different flexion-distraction technique positions of varying lumbar, knee, and ankle positions. Participants stood in the following 3 positions with the lumbar in the neutral position: (A) with knee extended, (B) with knee flexed, and (C) with the knee extended and ankle dorsiflexion. Participants then stood in the following 3 positions with the lumbar flexed: (D) with the knee extended, (E) with the knee flexed, and (F) with knee extended and ankle dorsiflexion. The cross-sectional area (CSA) of the sciatic nerve was measured with ultrasound imaging in transverse sections in the posterior medial region of the left thigh. The CSA values measured at each position were compared., Results: We analyzed 180 ultrasound images. The cross-sectional area of the sciatic nerve (in mm 2 ) in position B (mean; standard deviation) (59.71-17.41) presented a higher mean cross-sectional area value compared with position D (51.18-13.81; P =.005), position F (48.71-15.16; P = .004), and position C (48.37-16.35; P = .009)., Conclusion: The combination of knee extension and ankle dorsiflexion reduced the CSA of the sciatic nerve, and flexing the knee and keeping the ankle in the neutral position increased it., (Copyright © 2019. Published by Elsevier Inc.)

Outbreaks of acute Chagas disease (ACD) in northern Brazil can be caused by the ingestion of unprocessed açai pulp contaminated with Trypanosoma cruzi . The aim of this study was to determine the minimum thermal process required to inactivate T. cruzi in açai pulp. Trypomastigotes (100,000) of T. cruzi Y strain were added to 0.15 M NaCl or açai pulp and continuously mixed while being heat treated at 37 to 49°C for up to 1 h. When necessary, parasites were separated from açai pulp by forced sieving. Inocula were administrated intraperitoneally in inbred immunodeficient C.B-17-Prkdc scid /Pas Unib mice, and the recipients were monitored for parasitemia and mortality. Mice received prophylactic antibiotic therapy by using cephalexin to prevent bacterial infection from the açai pulp. T. cruzi retained its virulence in 0.15 M NaCl and açai pulp at 44 ± 0.1°C for 10 min and at 43 ± 0.1°C for 20 min, respectively, causing ACD and death in mice up to 24 days after infection. Incubation of açai pulp inoculum above 43°C for 20 min neutralized T. cruzi virulence, thereby preventing ACD and death in murine recipients. The heating of açai pulp above 43°C for 20 min is a practical and effective measure to prevent foodborne ACD caused by T. cruzi .

Background: Cancer-associated fibroblast (CAFs) are the most abundant cells in the tumor microenvironment, able to secrete growth factors and act on tumor progression. Melatonin is associated with several mechanisms of action with oncostatics and oncoprotectors effects, and also participate in the reduction of synthesis of surrounding fibroblasts and endothelial cells in breast cancer., Objective: The objectives of this study were to determine the effectiveness of melatonin in cell viability and expression of proteins involved in angiogenesis and inflammation in triplenegative mammary tumor cell line (MDA-MB-231) and in co-culture with CAFs., Method: Cell viability was measured by MTT assay and the protein expression was evaluated by Membrane Antibody Array after melatonin treatment., Results: Melatonin treatment (1 mM) for 48 hours reduced the cell viability of MDA-MB-231, CAFs and co-culture (p < 0.05). The semi-quantitative protein analysis showed that when monoculture of tumor cells were compared with co-culture of CAFs, there was a regulation of angiogenic and inflammatory proteins (p < 0.05). Melatonin treatment also leads a differential expression of angiogenic and inflammatory proteins in both monoculture and co-culture of tumor cells and CAFs (p < 0.05)., Conclusion: The influence of CAFs under the tumor microenvironment was confirmed, increasing the malignancy of the tumor. In addition, melatonin is effective in both monoculture and co-culture, regulating angiogenic and inflammatory proteins that contribute to tumor progression. This study show an overview of melatonin ability in regulating angiogenic and inflammatory proteins, and opens the way for exploration of each individual protein in further studies.

Chagas disease is a parasitic infection with high socioeconomic impact throughout Latin America. Although this severe, incurable disease can be transmitted by several routes, oral transmission is currently the most important route in the Amazon Basin. Açaí pulp has nutritional properties and is popular throughout Brazil and abroad. However, this pulp has been associated with microepidemics of acute Chagas disease (ACD) in northern Brazil, where açaí fruit is the main food supplement. In this study, we examined the in vitro survival and in vivo virulence of Trypanosoma cruzi Y strain in açaí pulp. Aliquots of in natura açaí pulp produced in Belém city in the northern Brazilian state of Pará were mixed with 10⁵ trypomastigotes. The samples were incubated at room temperature or at 4 or -20°C for various periods, and the parasites were isolated by forced sieving. The resulting eluates were examined by microscopy, and the trypomastigotes were administered intraperitoneally, orally, or by gavage to immunodeficient mice (C.B-17-Prkdc(scid)/PasUnib) that had been pretreated with antibiotics. Parasitemia was quantified by the Brener method, and mortality was recorded daily. All routes of administration resulted in ACD. A 5-day delay in the onset of parasitemia occurred with oral administration. The survival and virulence of the parasites were unaffected by prior incubation at room temperature for 24 h, at 4°C for 144 h, and at -20°C for 26 h. These results indicate that T. cruzi can survive and retain its virulence in açaí pulp under various conditions and that cooling and freezing are not suitable methods for preventing foodborne ACD.

Objective: The aim of the present study was to evaluate the inflammatory response in sites where crowns were placed supragingivally, at the level of the gingival margin and subgingivally. These were measured clinically and through the levels of interleukin-1 3 and matrix metalloproteinase-2, inflammatory mediators, before and after periodontal therapy., Methods: From 68 patients analyzed, 10 were selected for this study. The gingival crevicular fluid of the patients was collected and analyzed using standard enzyme-linked immunosorbent assay (ELISA). The clinical parameters were measured and correlated with interleukin-1beta and matrix metalloproteinase-2. Both analyses were realized before (baseline) and 2 months after non-surgical periodontal therapy. The two-way variance analysis (two-way ANOVA), Tukey-Kramer multiple comparisons test (post hoc) and Pearson parametric correlation test were performed in statistical analysis., Results: There were statistically significant differences before and after nonsurgical periodontal therapy when comparing supra- and subgingival margins for the plaque and bleeding indexes (p < 0.05). There was a tendency toward correlation between the reduction of plaque index and the reduction of interleukin-1beta levels, both for supragingival (r = 0.694, p = 0.026) and subgingival margins (r = 0.715, p = 0.020) post non-surgical periodontal therapy. The levels of matrix metalloproteinase-2 were not detectable by ELISA because they were below the detection threshold of the assay., Conclusion: Supragingival restorations appeared to be more adequate in promoting periodontal health when compared with the other possible marginal finish lines. They also presented a better response to basic periodontal treatment, according to clinical and inflammatory findings.

Hereditary persistence of fetal hemoglobin (HPFH) is characterized by increased levels of Hb F during adult life. Nondeletional forms of HPFH are characterized by single base mutations in the (A)gamma and (G)gamma promoters, resulting in an increase of Hb F ranging from 3 to 20% in heterozygotes. Many point mutations in this region have been described, including the (A)gamma -195 (C>G) mutation that causes the Brazilian type of HPFH (HPFH-B). To better understand this mechanism, we have developed HPFH-B transgenic mice. mRNA levels of human gamma-globin of -195 transgenic mice were clearly higher when compared with control transgenic mice bearing a wild type sequence of the gamma promoter. Thus, our data indicate that the -195 mutation is the unique cause of elevation of Hb F in Brazilian HPFH. These results could provide us with an opportunity to study the modifying effects of the Hb F in the phenotype of sickle cell disease and beta-thalassemia (beta-thal).

Context and Objective: Prostate biopsy is not a procedure without risk. There is concern about major complications and which antibiotics are best for routine use before these biopsies. The objective was to determine the rate of complications and the possible risk factors in prostate biopsies., Design and Setting: Prospective study, Faculdade de Medicina de Botucatu., Methods: Transrectal ultrasound (TRUS) guided prostate biopsies were carried out in 174 patients presenting either abnormality in digital rectal examinations (DRE) or levels higher than 4 ng/ml in prostate-specific antigen (PSA) tests, or both., Results: Hemorrhagic complications were the most common (75.3%), while infectious complications occurred in 19% of the cases. Hematuria was the most frequent type (56%). Urinary tract infection (UTI) occurred in 16 patients (9.2%). Sepsis was observed in three patients (1.7%). The presence of an indwelling catheter was a risk factor for infectious complications (p < 0.05). Higher numbers of biopsies correlated with hematuria, rectal bleeding and infectious complications (p < 0.05). The other conditions investigated did not correlate with post-biopsy complications., Conclusions: Post-biopsy complications were mostly self-limiting. The rate of major complications was low, thus showing that TRUS guided prostate biopsy was safe and effective. Higher numbers of fragments taken in biopsies correlated with hematuria, rectal bleeding and infectious complications. An indwelling catheter represented a risk factor for infectious complications. The use of aspirin was not an absolute contraindication for TRUS.

Unlabelled: Renal clear cell carcinoma (RCCC) is a neoplasia resistant to radio and chemotherapy, with surgical treatment being the procedure that is recognized for its curative treatment. This case report demonstrates the success of an aggressive surgical treatment for consecutive and late metachronous metastases following radical nephrectomy., Case Report: Asymptomatic 50-year old man. During a routine examination, an incidental mass was found by renal ultrasonography. He underwent right radical nephrectomy due to RCCC in June 1992. During the follow-up metastases were evidenced in cerebellum on the seventh year, and in left lung and pancreas on the eighth year following the radical nephrectomy, with all of them successfully treated by surgical excision., Comments: The surgical excision of consecutive and late metachronous metastases in different organs arising from RCCC is feasible, being a good therapeutic alternative in selected cases.

Malacoplakia is a granulomatous inflammatory disorder clinically and ultrasonographically very similar to prostatic adenocarcinoma. Symptoms and physical findings are similar to prostatism and in half of the patients the differential diagnosis includes malignancy, mainly because of the presence of a hard nodule on digital rectal examination. Additionally, cases of malacoplakia can show hypoechoic nodes on transrectal ultrasound mimicking adenocarcinoma. We report a case of malacoplakia of the prostate with emphasis on its similarities and differences with prostate adenocarcinoma.

In order to evaluate the role of underlying disease in the high mortality observed in acute renal failure (ARF) and risk factors related to the development of oliguric ARF in renal allograft recipients, two groups were selected: 34 patients with native kidneys, aged 16 and 57 years, and presenting ischemic ARF caused by cardiovascular collapse, with no signs of infection at the time of diagnosis; and 34 renal allograft recipients who developed ARF immediately after transplantation, without rejection. ARF was defined either as 30% increase of basal plasmatic creatinine in patients with native kidneys or nonnormalization of plasmatic creatinine at day 5 after transplantation in renal allograft recipients; oliguria as diuresis < or = 400 mL/24 h. There were no differences in age, male frequency, oliguria presence and duration, need for dialysis, and infection episodes for renal allograft recipients and patients with native kidneys. The development of sepsis (3% and 41%) and death rate (3% and 44%) were higher in patients with native kidneys (p < 0.01). The renal allograft recipients with both oliguric (n = 18) and nonoliguric (n = 16) ARF were evaluated and no difference was observed in the recipient's age, donor's age, cold ischemia time, time elapsed until plasmatic creatinine normalization, donor's plasmatic creatinine or urea, and mean arterial pressure. No differences were observed between the groups regarding frequency of infection episodes during ARF and frequency of death. In conclusion, renal allograft recipients presented a lower death rate and were less susceptible to sepsis. Cold ischemia time, age, and hemodynamic characteristics of the donor did not affect the development of oliguria.