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Abstract Rationale Intensive care unit-acquired weakness (ICUAW) is common in critically ill patients, characterized by muscle weakness and physical function loss. Determining risk factors for ICUAW poses challenges due to variations in assessment methods and limited generalizability of results from specific populations, the existing literature on these risk factors lacks a clear and comprehensive synthesis. Objective This overview aimed to synthesize risk factors for ICUAW, categorizing its modifiable and nonmodifiable factors. Methods An overview of systematic reviews was conducted. Six relevant databases were searched for systematic reviews. Two pairs of reviewers selected reviews following predefined criteria, where bias was evaluated. Results were qualitatively summarized and an overlap analysis was performed for meta-analyses. Results Eighteen systematic reviews were included, comprising 24 risk factors for ICUAW. Meta-analyses were performed for 15 factors, while remaining reviews provided qualitative syntheses. Twelve reviews had low risk of bias, 4 reviews were unclear, and 2 reviews exhibited high risk of bias. The extent of overlap ranged from 0 to 23% for the corrected covered area index. Nonmodifiable factors, including advanced age, female gender, and multiple organ failure, were consistently associated with ICUAW. Modifiable factors, including neuromuscular blocking agents, hyperglycemia, and corticosteroids, yielded conflicting results. Aminoglycosides, renal replacement therapy, and norepinephrine were associated with ICUAW but with high heterogeneity. Conclusions Multiple risk factors associated with ICUAW were identified, warranting consideration in prevention and treatment strategies. Some risk factors have produced conflicting results, and several remain underexplored, emphasizing the ongoing need for personalized studies encompassing all potential contributors to ICUAW development.

La cardiopatía isquémica es una afección grave causada por la falta de flujo sanguíneo y de oxígeno al corazón, siendo una de las principales causas de muerte y discapacidad en todo el mundo. Ciertos factores de riesgo predisponen a esta condición como la genética, la dieta, el sedentarismo y el tabaquismo. El enfoque principal del tratamiento enfatiza la importancia de restaurar el flujo sanguíneo al tejido afectado lo antes posible. Se describen diferentes tratamientos convencionales como la administración de oxígeno, nitratos y betabloqueadores y se explican las estrategias de reperfusión coronaria para pacientes con diferentes tipos de infarto agudo al miocardio. Se enfatiza en los diferentes tratamientos innovadores en desarrollo, como el uso de hidrogel de matriz extracelular y terapia con células madre, que muestran prometedores resultados en la mejora de la función cardíaca y de la recuperación en pacientes después de un infarto. La bioingeniería del tejido cardíaco mediante la impresión 3D, tiene la capacidad para simular ciertas características funcionales del tejido cardíaco. Se presentan resultados de estudios que exploran la posibilidad de construir tejido cardíaco artificial utilizando células madre pluripotentes inducidas y tecnología de impresión 3D, siendo esta una posible alternativa al trasplante de corazón. Se expone la evolución en el tratamiento del infarto agudo al miocardio, incluyendo enfoques en la restauración y recuperación del tejido dañado y la regeneración cardíaca, lo que sugiere un futuro prometedor en la mejora de la calidad de vida de los pacientes con cardiopatía isquémica.

Global estimates of the supply of dissolved and suspended materials to the ocean, in order to be relevant at either political or ecological scales, belie a finer-scale analysis necessary for understanding specific terrestrial-marine interactions. This is especially true for continental runoff to the marine critical zone of inland fjords and channels, where mechanisms, drivers, and predictions need to be elaborated in the context of changing land use and shifting climate forcing. In fjords in south-western Patagonia, runoff from small coastal and large continental basins (~310 x103 km2), sourced from a diverse geography and wide climatic gradient (

In the context of Big Data scenarios, the presence of extensive static datasets is not uncommon. To facilitate efficient queries on such datasets, the utilization of multiple indexes, such as the Kd-tree, becomes imperative. The current scale of managed points may, however, exceed the capacity of primary memory, posing a significant challenge. In this article we introduce cKd-tree, a compact data structure designed to represent a Kd-tree efficiently. The structure cKd-tree is essentially an encoding of the spiral code sequence of points within an implicit Kd-tree (iKd-tree) using Directly Addressable Codes (DACs). The unique feature of cKd-tree lies in its ability to perform spiral encoding and decoding of points by relying solely on knowledge of their parent points within the iKd-tree. This inherent property, combined with DACs’ direct access capability to sequence elements, enables cKd-tree to traverse and explore the tree while decoding only the nodes relevant to queries. The article details the algorithms necessary for creating and manipulating a cKd-tree, as well as algorithms for evaluating two fundamental queries over points: the point query and the range query. To assess the performance of cKd-tree, a series of experiments are conducted, comparing it with iKd-tree and $k^{2}$ -tree data structures. The evaluation metrics include compression efficiency and execution time of queries. cKd-tree achieves a compression ratio comparable to that of $k^{2}$ -tree, approximately 70%, demonstrating heightened efficiency, particularly in scenarios characterized by sparse data. Additionally, consistent with expectations, $k^{2}$ -tree exhibits superior performance in querying individual points, whereas cKd-tree outperforms in the context of aggregate data queries, such as range queries.

La investigación tuvo como objetivo analizar la relación entre la Coordinación Motora (CM) con el Índice de Masa Corporal en escolares chilenos de entre 7 y 9 años. El estudio fue observacional de corte transversal, con características descriptivas y correlacionales. Se evaluarona 180 escolares (90 mujeres de 8.4 ± 0.9 años y 90 hombres de 8.5± 0.9 años). Se midieron variables antropométricas de peso y talla. Se calculó el Índice de Masa Corporal (IMC). La coordinación motora (CM) se evaluó utilizando la batería de Körperkoordinationstest Für Kinder (KTK). Los resultados mostraron que en las mujeres el grupo Normopeso tenía un mejor desempeño en la transposición lateral que los grupos Sobrepeso y Obesidad (p˂0.05). En los hombres, el grupo Normopeso superó al grupo Obesidad en los saltos monopedales (p˂0.05). Además, al analizar las diferencias entre sexos, se determinó que las mujeres registraron mayor puntaje que los hombres en el equilibrio a la retaguardia (p

Artificial intelligence is poised to rapidly reshape many fields, including that of skin cancer screening and diagnosis, both as a disruptive and assistive technology. Together with the collection and availability of large medical data sets, artificial intelligence will become a powerful tool that can be leveraged by physicians in their diagnoses and treatment plans for patients. This comprehensive review focuses on current progress toward AI applications for patients, primary care providers, dermatologists, and dermatopathologists, explores the diverse applications of image and molecular processing for skin cancer, and highlights AI’s potential for patient self-screening and improving diagnostic accuracy for non-dermatologists. We additionally delve into the challenges and barriers to clinical implementation, paths forward for implementation and areas of active research.

Background Chronic cough is a frequent reason for seeking consultation with primary care providers. The recent widespread adoption of virtual care offers a promising alternative that can be used to optimize the assessment and management of this condition. The objective of this review was to map and identify the strategies used to assess and/or manage chronic cough virtually, and to explore their impact on cough severity and patient satisfaction with virtual care. Methods A scoping review was conducted in MEDLINE, EMBASE, and CINAHL in May 2023. Research questions were defined based on the Population, Concept, Context mnemonic, and literature search was conducted using a three-step approach. Study selection involved the steps of identification, screening, eligibility, and inclusion. A descriptive synthesis was performed, and quantitative variables were presented as absolute and relative frequencies. Results A total of 4953 studies were identified and seven met the inclusion criteria. The following mHealth and telehealth strategies were identified: diagnostic website, specialized online clinic, online speech language therapy, and remote follow-up to assess the effectiveness of in-person interventions. Results indicated that these virtual strategies can be useful to assess chronic cough, treat, and track chronic cough symptoms. Overall, patients were satisfied with the approaches. Conclusion Although literature is scarce, evidence suggests that virtual strategies for the assessment and management of chronic cough may be effective and are well-received by patients. However, further research is needed to identify the type and characteristics of virtual approaches leading to optimize and facilitate the care of patients with this condition. This will also help develop a strong body of evidence to support their incorporation into guidelines and clinical practice.

The normalization process is important to determine the best approach for normalizing electromyographic signals from respiratory muscles in healthy subjects and those with ALS. The aim of this study is to compare different methods of normalizing the sEMG signal of respiratory muscles in both healthy subjects and those with Amyotrophic Lateral Sclerosis (ALS). This cross-sectional study was conducted in 67 subjects (50 healthy and 17 with ALS). The electrical activity of the sternocleidomastoid (SCM), scalene (ESC), diaphragm (DIA), parasternal (PS), external intercostal (EI), external oblique (EO), and rectus abdominal (RA) muscles were analyzed during maximal inspiratory pressure maneuvers (MIP), maximal nasal inspiratory pressure (SNIP), maximal expiratory pressure (MEP), and maximal voluntary isometric contraction of SCM and ESC (MVICSCM/ESC) and RA (MVICRA) using surface electromyography (sEMG). In the healthy group, inspiratory and expiratory muscles displayed higher electrical activity during MVICSCM/ESC and MIVCRA maneuvers, respectively (p

AimTo determine reference values and propose prediction equations for respiratory muscle strength, maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), and endurance by means of maximal voluntary ventilation (MVV) in healthy Brazilian adults.MethodsAnthropometric data, level of physical activity, pulmonary function, and respiratory muscle strength and maximal voluntary ventilation of 243 participants (111 men and 132 women) aged 20 to 80 years were assessed at three cities in the southeast and northeast region of Brazil.ResultsMean maximal respiratory pressures and MVV were higher in men (MIP = 111.0 ± 28.0; MEP = 149.6 ± 40.3; MVV = 150.6 ± 35.2) than in women (MIP = 87.9 ± 17.6; MEP = 106.7 ± 25.2; MVV = 103.4 ± 23.2; all p < 0.05). Based on regression models, the following prediction equations were proposed for men: MIP = 137-0.57 (age), R2 = 0.13, standard error of estimate (SEE) = 26.11; MEP = 179.9-0.67 x (age), R2 = 0.08, SEE = 38.54; and MVV = 206.3-1.18 x (age), R2 = 0.36, SEE = 28.08. Prediction equations were also proposed for women: MIP = 107.3-0.4 x (age), R2 = 0.16, SEE = 16.10; MEP = 127.4-0.43 x (age), R2 = 0.08, SEE = 24.09; and MVV = 146.3-0.86 x (age), R2 = 0.42, SEE = 17.56.ConclusionReference values for MIP, MEP, and MVV were determined in healthy Brazilian adults. Results from different Brazilian regions provided adequate prediction equations considering an ethnically heterogeneous population.

Background: Given the beneficial effects of exercise in different populations and the close relationship between healthy ageing and sleep quality, our objective was to determine if physical exercise delivered through a structured program improves sleep quality in older adults. Methods: Embase, PubMed/MEDLINE, Web of Science, and Cochrane Register of Clinical Trials (CENTRAL) were searched to 15 January 2023. Studies that applied physical exercise programs in older adults were reviewed. Two independent reviewers analysed the studies, extracted the data, and assessed the quality of evidence. Results: Of the 2599 reports returned by the initial search, 13 articles reporting on 2612 patients were included in the data synthesis. The articles used interventions based on yoga (n = 5), multicomponent exercise (n = 3), walking (n = 2), cycling (n = 1), pilates (n = 1), elastic bands (n = 1), and healthy beat acupunch (n = 1). In the intervention group, we found significant improvement in Pittsburgh sleep quality index of −2.49 points (95% CI −3.84 to −1.14) in comparison to the control group (p = 0.0003) and sleep efficiency measured with objective instruments (MD 1.18%, 95% CI 0.86 to 1.50%, p < 0.0001). Conclusion: Our results found that physical exercise programs in older adults improve sleep quality and efficiency measured with objective instruments.

IntroductionObesity is a chronic medical condition that affects, among others, the cardiovascular and respiratory systems. Interventions for its treatment focus on sustained weight reduction and general health improvement, leaving respiratory management aside. Our objective was to determine the effects of inspiratory muscle training (IMT) in patients with obesity.MethodsA systematic review was performed in Embase, Cochrane Library (CENTRAL), CINAHL, Web of Science, and PubMed/MEDLINE on June 26, 2023. Randomized clinical trials (RCTs), and quasi-randomized clinical trials investigating the effects of IMT in people with obesity were included. Selected studies were screened by two independent reviewers who extracted data and assessed the quality of the evidence.ResultsThe initial search returned 705 potential studies were included. Ultimately, eight studies met the criteria for eligibility and were included in the review. IMT improves physical capacity [6-minute walk test (6MWT): 44.5 m, 95% CI: 30.5 to 58.5; p

Introduction Several systematic reviews (SRs) have been conducted to determine the effectiveness of early mobilisation in critically ill adults with heterogeneous methodology and results. Redundancy in conducting SRs, unclear justification when leading new SRs or updating, and discordant results of SRs on the same research question may generate research waste that makes it difficult for clinicians to keep up to date with the best available evidence. This meta-research aims to assess the redundancy, methodological and reporting quality, and potential reasons for discordance in the results reported by SRs conducted to determine the effectiveness of early mobilisation in critically ill adult patients.Methods and analysis A meta-research of early mobilisation SRs in critically ill adult patients will be conducted. A search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Library, Epistemonikos and other search resources will be conducted. Two independent reviewers will perform study selection, data extraction and quality appraisal. Discrepancies will be resolved by consensus or a third reviewer. The redundancy of SRs will be assessed by the degree of overlap of primary studies. In addition, the justification for conducting new SRs will be evaluated with the ‘Evidence-Based Research’ framework. The methodological quality of the SRs will be assessed with the A MeaSurement Tool to Assess systematic Reviews 2 tool, and the quality of the reports through compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. To assess the potential reasons for discordance in the results of the SRs considering divergence in results and their interpretation.Ethics and dissemination As meta-research, this study does not involve the participation of people whose rights may be violated. However, this overview will be developed rigorously and systematically to achieve valid and reliable results. The findings of this meta-research study will be presented at conferences and published in a peer-reviewed journal related to rehabilitation, critical care or research methodology.Trial registration number osf.io/kxwq9.

Background: Effective treatments for obstructive sleep apnoea (OSA) include positive pressure, weight loss, oral appliances, surgery, and exercise. Although the involvement of the respiratory muscles in OSA is evident, the effect of training them to improve clinical outcomes is not clear. We aimed to determine the effects of respiratory muscle training in patients with OSA. Methods: A systematic review was conducted in seven databases. Studies that applied respiratory muscle training in OSA patients were reviewed. Two independent reviewers analysed the studies, extracted the data and assessed the quality of evidence. Results: Of the 405 reports returned by the initial search, eight articles reporting on 210 patients were included in the data synthesis. Seven included inspiratory muscle training (IMT), and one included expiratory muscle training (EMT). Regarding IMT, we found significant improvement in Epworth sleepiness scale in −4.45 points (95%CI −7.64 to −1.27 points, p = 0.006), in Pittsburgh sleep quality index of −2.79 points (95%CI −4.19 to −1.39 points, p < 0.0001), and maximum inspiratory pressure of −29.56 cmH2O (95%CI −53.14 to −5.98 cmH2O, p = 0.01). However, the apnoea/hypopnea index and physical capacity did not show changes. We did not perform a meta-analysis of EMT due to insufficient studies. Conclusion: IMT improves sleepiness, sleep quality and inspiratory strength in patients with OSA.

BackgroundStudies exploring long COVID condition (LCC) in low- and middle-income countries are scarce. Further characterization of LCC patients experiencing activity limitations and their associated healthcare use is needed. This study aimed to describe LCC patients’ characteristics, its impact on activities, and associated healthcare use in Latin America (LATAM).ParticipantsIndividuals who (cared for someone or) had COVID-19 and could read, write, and comprehend Spanish and lived in a LATAM country were invited to complete a virtual survey. Sociodemographic characteristics, COVID-19 and LCC symptoms, activity limitations, and healthcare use.ResultsData from 2,466 people from 16 countries in LATAM were analyzed (females = 65.9%; mean age of 39.5 ± 53.3 years). 1,178 (48%) of the respondents had LCC symptoms (≥3 months). These were more likely to have COVID-19 earlier in the pandemic, were older, had no COVID vaccines, had more comorbidities, needed supplementary oxygen, and reported significantly more COVID-19 symptoms during the infectious period. 33% of the respondents visited a primary care provider, 13% went to the emergency department, 5% were hospitalized, 21% visited a specialist, and 32% consulted ≥1 therapist for LCC symptoms mainly extreme fatigue, sleep difficulties, headaches, muscle or joint pain, and shortness of breath with activity. The most consulted therapists were respiratory therapists (15%) and psychologists (14%), followed by physical therapists (13%), occupational therapists (3%), and speech pathologists (1%). One-third of LCC respondents decreased their regular activities (e.g., work, school) and 8% needed help with activities of daily living (ADLs). LCC respondents who reduced their activities reported more difficulty sleeping, chest pain with activity, depression, and problems with concentration, thinking, and memory, while those who needed help with ADLs were more likely to have difficulty walking, and shortness of breath at rest. Approximately 60% of respondents who experienced activity limitations sought a specialist and 50% consulted therapists.Conclusions and relevanceResults supported previous findings in terms of the LCC demographics, and provided insight into LCC impact on patients’ activities and healthcare services used in LATAM. This information is valuable to inform service planning and resource allocation in alignment with the needs of this population.

Introduction One of the most conflicting methodological issues when conducting an overview is the overlap of primary studies across systematic reviews (SRs). Overlap in the pooled effect estimates across SRs may lead to overly precise effect estimates in the overview. SRs that focus on exercise-related interventions are often included in overviews aimed at grouping and determining the effectiveness of various interventions for managing specific health conditions. The aim of this systematic methodological review is to describe the strategies used by authors of overviews focusing on exercise-related interventions to manage the overlap of primary studies.Methods and analysis A comprehensive search strategy has been developed for different databases and their platforms. The databases to be consulted will be MEDLINE (Ovid), Embase (Ovid), The Cochrane Database of Systematic Reviews (Cochrane Library) and Epistemonikos. Two reviewers will independently screen the records identified through the search strategy and extract the information from the included overviews. The frequency and the type of overlap management strategies of the primary studies included in the SRs will be considered as the main outcome. In addition, the recognition of the lack of use of any overlap management strategy and the congruence between planning and conducting the overview focusing on overlap management strategies will be assessed. A subgroup analysis will be carried out according to the journal impact factor, year of publication and compliance with the Preferred Reporting Items for Overviews of Reviews statement.Ethics and dissemination This study will not involve human subjects and therefore does not require ethics committee approval. However, the conduct and reporting of the findings of this review will be conducted in a rigorous, systematic and transparent manner, which relates to research ethics.The findings of this review will be presented at scientific conferences and published as one or more studies in peer-review scientific journals related to rehabilitation or research methods.

Introduction COVID-19 is an infectious disease that causes severe acute respiratory syndrome. A large variety of exercise capacity tests are used for the evaluation of post-COVID-19 patients, but the psychometric properties of these exercise tests remain undetermined in this population. This study aims to critically appraise, compare and summarise the psychometric properties (validity, reliability and responsiveness) of all physical performance tests that are used to assess exercise capacity in post-COVID-19 patients.Methods and analysis This systematic review protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols guidelines. We will include studies with hospitalised adult post-COVID-19 patients (aged 18 years or older and with a confirmed diagnosis of COVID-19). The research will cover randomised controlled trials (RCTs), quasi-RCTs and observational studies published in English and performed in the following settings: hospital, rehabilitation centre, outpatient clinic. We will search the following databases with no date restrictions: PubMed/MEDLINE, EMBASE, SciELO, Cochrane Library, CINAHL and Web of Science. Two authors will independently assess the risk of bias (using the Consensus-Based Standards for the Selection of Health Measurement Instruments Risk of bias checklist) and the certainty of evidence (using the Grading of Recommendations, Assessment, Development and Evaluations). According to the results obtained, data will be meta-analysed or reported narratively.Ethics and dissemination No ethical approval is required for this publication since it will be based on published data. Results of this review will be disseminated via peer-reviewed publications and conference presentations.PROSPERO registration number CRD42021242334.

IntroductionThe +AGIL Barcelona programme is a multicomponent care intervention for frail older adults (FOAs) living in the community. To improve the programme, it is essential to investigate the experience of all participants. Our objective was to explore the perspective of FOA and professionals about the barriers, facilitators, and improvement elements of the development of the +AGIL Barcelona programme. Qualitative descriptive approach. Were included FOA and professionals who participated in the +AGIL Barcelona programme.MethodsThree focus groups and four interviews were conducted. These were analyzed following the qualitative method of content analysis. The criteria of scientific rigor of credibility, dependence, and transferability were ensured throughout the study.ResultsThree themes and seven sub-themes were developed: facilitators (positive experience and perceived benefits), barriers (self-perceived health status, digital divide, and continuity of the programme at home), and improvements elements (programme continuity and adaptation of technology). All the participants felt satisfied, highlighting aspects such as interpersonal relationships and social contact, face-to-face sessions guided by a physiotherapist, and the functional improvement achieved. Some of the difficulties were the self-perception of frailty, the need for technological support, and continuing the exercise programme at home.ConclusionThe FOA who participated in the +AGIL Barcelona programme perceived direct benefits for their health and physical condition due to the development of self-confidence by being able to perform physical exercise despite their baseline condition, and the professionals experienced an improvement in the quality of care due to work in a multidisciplinary team.

Introdução: A prevalência da DPOC no Brasil é estimada em 15,8%, segundo o estudo Platino 1. A maioria (87,5%) de seus pacientes permanecem sem diagnóstico 2. A realização da espirometria é uma estratégia recomendada pelo documento GOLD para confirmar o diagnóstico na DPOC3. A Boehringer Ingelheim do Brasil, desde o ano de 2012, realiza gratuitamente, em parceria com secretarias municipais, estaduais e instituições de saúde, exames de espirometria de acordo com a solicitação e autorização dos serviços, associado a programas de capacitação de agentes e profissionais de saúde4-9. Dados epidemiológicos apontam que os pacientes com DPOC com tratamento iniciado nas fases leves e moderadas da doença apresentam expectativa de vida de 14 anos, enquanto pacientes inicialmente tratados com diagnóstico nos graus grave e muito grave têm expectativa de vida de 10 anos 10. O tratamento da DPOC, seja através de monoterapia com LAMA, LABA, broncodilatação dupla (LAMA/LABA) ou na terapia tripla com a adição de CI leva a um menor número de exacerbações e, consequentemente, menos internações hospitalares11-13. O custo por internação no Brasil é estimado em, pelo menos, R$ 1.552,00 reais. Objetivo: A realização mais precoce de exames de espirometria oferecidos pela parceria público-privada com a Boehringer Ingelheim do Brasil visa ao diagnóstico e tratamento mais precoce da DPOC, com potencial diminuição da taxa de exacerbações graves e, consequentemente, de internações hospitalares. Métodos: Para esta análise, foram consideradas o número de espirometrias realizadas pela parceria da Boehringer Ingelheim de 2016 a 2018 em relação aos dados epidemiológicos brasileiros descritos no estudo Platino. Resultados: No período entre 01 de janeiro de 2017 e 31 de dezembro de 2018 foram realizadas 198.370 espirometrias (47.553 em 2016, 67.201 em 2017 e 83.616 em 2018), conforme dados demonstrados na figura 1. Figura 1. Número de espirometrias realizadas pela Boehringer Ingelheim do Brasil em parceria com instituições de saúde nos anos de 2016 a 2018. Dada a prevalência aproximada de 15,8% da DPOC em adultos acima de 40 anos no Brasil, o programa de espirometrias poderia ter identificado cerca de 31.342 casos de DPOC1,2,15. Destes, potencialmente 27.424 casos poderiam ser de novos diagnósticos (87,5% destes casos), de acordo com os dados de prevalência do estudo Platino3. O programa pode ter ajudado para diagnóstico mais precoce e possível instalação mais rápida de tratamento, trazendo benefícios clínicos e econômicos. Conclusões: Com o aumento do número de espirometrias promovido pela parceria público-privada, houve um potencial benefício no diagnóstico precoce de pacientes portadores de DPOC entre os anos de 2016 a 2018 com provável impacto positivo no tratamento precoce dos pacientes, o que pode ter gerado menor número de exacerbações e internações hospitalares.

Introduction Adult and pediatric patients admitted to intensive care units (ICUs) requiring invasive ventilatory support, sedation, and muscle blockade may present neuromusculoskeletal deterioration. Different physical rehabilitation interventions have been studied to evaluate their effectiveness in improving critically ill patients’ outcomes. Given that many published systematic reviews (SRs) aims to determine the effectiveness of different types of physical rehabilitation interventions, it is necessary to group them systematically and assess the methodological quality of SRs to help clinicians make better evidence-based decisions. This overview of SRs (OoSRs) aims to map the existing evidence and to determine the effectiveness of physical rehabilitation interventions to improve neuromusculoskeletal function and other clinical outcomes in adult and pediatric critically ill patients. Methods An OoSRs of randomized and non-randomized clinical trials involving critically ill adult and pediatric patients receiving physical rehabilitation intervention will be conducted. A sensitive search of MEDLINE (Ovid), Embase (Ovid), CINAHL (EBSCOhost), Cochrane Library, Epistemonikos, and other search resources will be conducted. Two independent reviewers will conduct study selection, data extraction, and methodological quality assessment. Discrepancies will be resolved by consensus or a third reviewer. The degree of overlap of studies will be calculated using the corrected covered area. The methodological quality of the SRs will be measured using the AMSTAR-2 tool. The GRADE framework will report the certainty of evidence by selecting the "best" SR for each physical rehabilitation intervention and outcome. Discussion The findings of this overview are expected to determine the effectiveness and safety of physical rehabilitation interventions to improve neuromusculoskeletal function in adult and pediatric critically ill patients based on a wide selection of the best available evidence and to determine the knowledge gaps in this topic by mapping and assessing the methodological quality of published SRs. Registration number CRD42023389672.

Introdução: No Brasil estima-se que existam 23 mil pessoas com diagnóstico de Esclerose Sistêmica (ES)1. Cerca de 50-60% dos pacientes evolui com acometimento pulmonar e, destes, aproximadamente um terço desenvolve quadro de Fibrose Pulmonar Progressiva (FPP)2,3. É sabido que o comprometimento pulmonar gera grandes impactos na qualidade de vida de pacientes e seus cuidadores, afasta de suas atividades usuais, bem como acarreta mortalidade precoce2,3. Nesse sentido, o diagnóstico e tratamento precoce têm a possibilidade de retardar a progressão da doença e melhorar os desfechos. Importante ressaltar que mesmo em países como a Inglaterra, o tempo entre o diagnóstico e início do tratamento pode ser de até 5 anos3. Objetivos: O objetivo desse trabalho foi entender a jornada do paciente com Doença Pulmonar Intersticial (DPI) relacionada à ES, suas dificuldades, conhecimento sobre a doença e rede de apoio dentro da realidade brasileira. Método: Foi realizado levantamento através de um questionário quantitativo, individual por contato telefônico em todo país de 05 de abril a 14 de maio de 2021. A pesquisa foi conduzida pelo Instituto Data Folha, com 90 pessoas com diagnóstico de DPI. Devido à ES ser uma doença rara, as abordagens às pessoas com esse diagnóstico foram agendadas por uma equipe específica. Realizou-se checagem das entrevistas gravadas e os questionários foram submetidos a análise de consistência dos dados. Resultados: Os dados do presente estudo demonstraram que 78% dos pacientes com DPI associado a ES são do sexo feminino e que 77% desses não são economicamente ativos4 e 42% têm histórico de tabagismo passivo. Chama atenção que 1 a cada 3 pacientes passaram por cerca de 5 médicos até terem o diagnóstico e que 57% usam o Sistema Único de Saúde4. A média de início dos sintomas e o diagnóstico foi de 3 anos, para um quadro que sem tratamento a expectativa de vida pode variar entre 2-5 anos2. Dos entrevistados 69% relataram viver com limitações para atividades físicas e 33% para as atividades domésticas4.Do total de 90 pacientes, 36 relatam que tem dificuldades de acesso a medicamentos prescritos e quase 10% do total não conseguem acesso ao tratamento com menos de 1 ano4. Do total de entrevistados, 51% já são usuários de oxigênio domiciliar, sendo que 62% do grupo refere que seus sintomas progrediram com piora nos últimos dois anos e é esse o mesmo percentual de pacientes que traz como principal desafio o tempo mais longo da sua jornada ser a espera entre a suspeita diagnóstica e o início do tratamento4. Conclusão: O diagnóstico e início de tratamento precoce para pacientes com FPP associado a ES é uma oportunidade para melhora da qualidade de vida, da sobrevida e da preservação da autonomia. Atuar nessa cadeia facilitando o acesso aos recursos de saúde pode ser um modo de melhorarmos o desfecho clínico e uma política de saúde púbica visando resultados a longo prazo. Conhecer a jornada desses doentes no Brasil se faz necessário.

La crisis de representatividad política en Chile ha llevado a que la participación de jóvenes disminuya en elecciones y aumente en movimientos sociales. Estos cambios podrían afectar la forma en que perciben su capacidad para ejercer cambios mediante la política. El presente estudio transversal analiza, mediante escalas de autoreporte, las diferencias por género en la relación entre el sentido de eficacia política interna y la importancia otorgada a la participación política convencional y no convencional en una muestra de adolescentes chilenos (N = 949). Los resultados muestran que la importancia otorgada a la política convencional se asocia al sentido de eficacia política interna en hombres y mujeres, mientras que la importancia otorgada a la política no convencional solamente en mujeres. Los resultados se discuten en relación con la importancia de distintas formas de participación política en la formación de jóvenes ciudadanos políticos, en el contexto de las movilizaciones feministas.

The objective of this study was to compare the balance and functional capacity between stable chronic obstructive pulmonary disease (COPD) patients versus healthy controls using clinical tests. A comprehensive search of PubMed/MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), Embase and Web of Science was conducted from inception to 21 January 2022. Studies reporting the association between COPD status and balance or functional capacity using clinical tests were included. Two independent reviewers examined the titles and abstracts, extracted the data using a standardised form, and assessed the risk of bias of the included articles. A total of 27 studies with 2420 individuals with stable COPD were included. Overall, the risk of bias in the included studies was low to moderate. The meta-analysis showed a higher history of falls in individuals with COPD (odds ratio 1.59, 95% CI 1.25–2.02). Furthermore, an overall effect in favour of the healthy controls was observed in the Timed Up and Go (mean difference: 2.61 s, 95% CI 1.79–3.43), Berg Balance Scale (mean difference: −6.57 points, 95% CI −8.31 to −4.83), static balance tests (standardised mean difference: −1.36, 95% CI −2.10 to −0.62) and the 6-min walk test (mean difference: −148.21 m, 95% CI −219.37 to −77.39). In conclusion, individuals with stable COPD have worse balance and functional capacity compared to healthy controls. These results may guide clinicians to elaborate on therapeutic strategies focused on screening of balance and functional impairments. This is in addition to generating rehabilitation guidelines aimed at reducing the risk of falling in people with COPD.

BackgroundThe application of early mobilization (EM) in intensive care units (ICUs) has shown to improve the physical and ventilatory status of critically ill patients, even after ICU stay. This study aimed to describe the practices regarding EM in ICUs in Latin America.MethodsWe conducted an observational, cross-sectional study of professionals from all countries in Latin America. Over 3 months, professionals working in ICU units in Latin America were invited to answer the survey, which was designed by an expert committee and incorporated preliminary questions based on studies about EM recommendations.ResultsAs many as 174 health professionals from 17 countries completed the survey. The interventions carried out within each ICU were active mobilization (90.5%), passive mobilization (85.0%), manual and instrumental techniques for drainage of mucus secretion (81.8%), and positioning techniques (81%). The professionals who most participated in the rehabilitation process in ICUs were physiotherapists (98.7%), intensive care physicians (61.6%), nurses (56.1%), and respiratory therapists (43.8%). In only 36.1% of the ICUs, protocols were established to determine when a patient should begin EM. In 38.1% of the cases, the onset of EM was established by individual evaluation, and in 25.0% of the cases, it was the medical indication to start rehabilitation and EM.ConclusionThis report shows us that EM of critically ill patients is an established practice in our ICUs like in other developed countries.

BackgroundQuadriceps muscle training is a key part in the rehabilitation of chronic obstructive pulmonary disease (COPD) patients. However, exercise intensity prescription and progression with the typically used elastic bands is challenging. We aimed to evaluate neuromuscular, acute symptoms and cardiorespiratory responses (heart rate and dyspnea) during progressive elastic resistance exercise in patients with COPD.MethodsFourteen patients diagnosed with moderate-very severe COPD performed knee extensions at different elastic resistance levels (i.e., colors). The neuromuscular activity was recorded using surface electromyography for the rectus femoris, vastus lateralis and vastus medialis, together with rate of perceived exertion, perceived quadriceps fatigue, dyspnea, oxygen saturation and heart rate.ResultsFor the vastus lateralis and rectus femoris, increase of muscle activity was evident from a two-level increment when using the red color. For the vastus medialis, there were no muscle activity progressions. Dyspnea, quadriceps fatigue and especially rate of perceived exertion increased in a dose-response fashion and were correlated with the resistance level and muscle activity at the three muscles.ConclusionHeavy elastic resistance exercise is feasible in COPD patients without excessive dyspnea and a stable cardiorespiratory response. In general, at least two elastic resistance increments are needed to enhance muscle activity for the vastus lateralis and rectus femoris, while there is no increase for the vastus medialis. These results may help to individualize exercise dosing during elastic resistance training in patients with COPD.

The COVID-19 is a multiorgan disease that appeared in December 2019 in the Chinese province of Wuhan. It produces various clinical manifestations, although it mainly affects the respiratory system. Given these potentially detrimental long-term consequences of COVID-19, an appropriate assessment must be carried out to plan early rehabilitation interventions. To assess the persistent symptoms it produces, as well as exercise tolerance for a given exertion, stress testing is a feasible and cost-effective option. Therefore, the objective of this study was to provide test-retest reliability for the Chester Step Test and 1 minute Sit to Stand tests and to establish the minimum detectable change in Long-COVID patients. Method: This observational, descriptive, cross-sectional study was conducted following the STROBE guidelines. A total of 42 patients carried out, twice per partici-pant, the Chester Step and 1-Minute Sit-to-Stand (1min-STST) tests on two different days, with a five-day time lag between the initial measurement and the second measurement. Results: The Test-retest reliability for the Chester Step was excellent within session ICC (95% CI) 0.96 (0.93 to 0.98), being even better for the 1-STST, ICC (95% CI) 0.98 (0.96 to 0.99). Establishing a change of at least 16.96 steps (MDC90) or 20.15 steps (MDC95) and 1.89 stands (MDC90) or 2.71 stands (MDC95), respectively. Conclusions: The Chester Step and 1min-STST tests are reproducible and reliable tools to measure exercise tolerance in long COVID patients. The minimum detectable changes observed in the values recorded by the participants can be very useful for the evaluation of the effectiveness of interventions applied to these patients.

Impaired functional capacity is one of the most commonly reported consequences among post-COVID-19 patients. This study aimed to analyse the clinical variables related to functional capacity and exertional desaturation in post-COVID-19 patients at the time of hospital discharge. A cross-sectional study was conducted on patients recovering from COVID-19 pneumonia. The main outcomes measures were functional capacity, assessed using the 1 min sit-to-stand test (1 min STST), and exertional desaturation, defined as a drop of ≥4% in the arterial oxygen saturation. Factors used to characterise the participant outcomes included the use of a high-flow nasal cannula (HFNC), prolonged hospitalisation, occurrence of pulmonary embolism during hospitalisation, and underlying comorbidities. A total of 381 participants (mean age = 53.7 ± 13.2 years, 65.6% men) were included. Participants completed a mean of 16.9 ± 6.2 repetitions in the 1 min STST. Exertional desaturation was observed in 51% of the patients. Higher odds of exertional desaturation were found in the participants who used a HFNC (OR = 3.6; 95%CI: 1.6 to 7.8), were admitted in the hospital >10 days (OR = 4.2; 95%CI: 2.6 to 6.8), and had a pulmonary embolism (OR = 3.5; 95%CI: 2.2. to 5.3). Use of a HFNC (β = −3.4; 95%CI: −5.3 to −1.44), a hospital stay >10 days (β = −2.2; 95%CI: −3.4 to −0.9), and a history of pulmonary embolism (β = −1.4; 95%CI: −2.6 to −0.2) were also negatively associated with the 1 min STST. Most post-COVID-19 patients exhibited reduced functional capacity at the time of hospital discharge, and approximately half had exertional desaturation after the 1 min STST. The use of a HFNC, prolonged hospitalisation and pulmonary embolism were the main clinical variables associated with worse a 1 min STST performance and a higher likelihood of exertional desaturation.

Obstructive sleep apnoea (OSA) constitutes a public health problem, with various systemic consequences that can increase cardiovascular morbidity and mortality as well as increase healthcare expenditure. This review discusses the rationale and effects of using general physical exercise, oropharyngeal exercises, and respiratory muscle training as an adjunctive treatment for patients with sleep apnoea. The recommended treatment for OSA is the use of continuous positive airway pressure, which is a therapy that prevents apnoea events by keeping the airways open. In the last decade, coadjuvant treatments that aim to support weight loss (including diet and physical exercise) and oropharyngeal exercises have been proposed to lower the apnoea/hypopnoea index among patients with OSA. Based on the available evidence, health professionals could decide to incorporate these therapeutic strategies to manage patients with sleep apnoea.

The coronavirus 19 (COVID-19) pandemic has been one of the most significant challenges to public health in recent decades. The heterogeneity of government responses and the varying preparedness of health systems has determined that the pandemic's impact differs from country to country. Chile is no stranger to the challenges posed by rehabilitation in a developing country. We aimed to describe the approach to rehabilitation during the pandemic in Chile in the public health system since rehabilitation is considered a relevant health strategy from the prevention to management of complications, mitigation of sequelae, or new complications associated with COVID-19. For this, a descriptive study was conducted on the rehabilitation strategies implemented by Chile to respond to the COVID-19 pandemic. The analysis includes the context of the Chilean health system and the matrix of access to rehabilitation services in COVID-19. The Health Ministry (MINSAL) rehabilitation strategy includes five central axes: approaches, specific lines, transversal lines, intervention, and funding. Additionally, the policies were based and supported by the WHO recommendations. Intensive care unit beds were increased approximately 68%, and the primary care response was the reconversion of function depending on the epidemiological context. During the 2021–2022 period, the estimated number of people diagnosed with a post-COVID-19 condition was 80,528. With this, we can conclude that a developing country has managed to coordinate a rehabilitation policy for people with COVID-19 by generating a structure of the different health system levels. However, the effectiveness of this policy will need to be evaluated in the future.

Este estudio tiene por objetivo describir los efectos de un programa de telerrehabilitación en la funcionalidad y satisfacción usuaria de sobrevivientes de COVID-19 en un hospital público. Se trata de un estudio observacional, longitudinal y retrospectivo. Fueron compilados los antecedentes de veinte personas adultas usuarios de un hospital público de recursos limitados que habían ingresado a un programa de telerrehabilitación liderado por fisioterapeutas entre los meses de junio y octubre de 2020. Se compilaron las variables funcionales de capacidad funcional y fuerza de extremidades inferiores con la prueba Sit-to-Stand, el estado funcional evaluado con el Functional Status Scale, la fatiga evaluada con el Fatigue assessment scale y la independencia en actividades de la vida diaria (AVDs) evaluada con el Índice de Barthel. También fueron compilados las encuestas de satisfacción usuarias que contestaban los pacientes luego de finalizada la intervención. Posterior a la telerrehabilitación los pacientes mejoraron la capacidad funcional y fuerza de extremidades inferiores, el estado funcional, AVDs (p

The biogeochemical dynamics of fjords in the southeastern Pacific Ocean are strongly influenced by hydrological and oceanographic processes occurring at a seasonal scale. In this study, we describe the role of hydrographic forcing on the seasonal variability of the carbonate system of the Sub-Antarctic glacial fjord, Seno Ballena, in the Strait of Magellan (53°S). Biogeochemical variables were measured in 2018 during three seasonal hydrographic cruises (fall, winter and spring) and from a high-frequency pCO2-pH mooring for 10 months at 10 ± 1 m depth in the fjord. The hydrographic data showed that freshwater input from the glacier influenced the adjacent surface layer of the fjord and forced the development of undersaturated CO2 (< 400 μatm) and low aragonite saturation state (ΩAr < 1) water. During spring, the surface water had relatively low pCO2 (mean = 365, range: 167 - 471 μatm), high pH (mean = 8.1 on the total proton concentration scale, range: 8.0 - 8.3), and high ΩAr (mean = 1.6, range: 1.3 - 4.0). Concurrent measurements of phytoplankton biomass and nutrient conditions during spring indicated that the periods of lower pCO2 values corresponded to higher phytoplankton photosynthesis rates, resulting from autochthonous nutrient input and vertical mixing. In contrast, higher values of pCO2 (range: 365 – 433 μatm) and relatively lower values of pHT (range: 8.0 – 8.1) and ΩAr (range: 0.9 – 2.0) were recorded in cold surface waters during winter and fall. The naturally low freshwater carbonate ion concentrations diluted the carbonate ion concentrations in seawater and decreased the calcium carbonate saturation of the fjord. In spring, at 10 m depth, higher primary productivity caused a relative increase in ΩAr and pHT. Assuming global climate change will bring further glacier retreat and ocean acidification, this study represents important advances in our understanding of glacier meltwater processes on CO2 dynamics in glacier–fjord systems.

Abstract The capacity of marine organisms to adapt and/or acclimate to climate change might differ among distinct populations, depending on their local environmental history and phenotypic plasticity. Kelp forests create some of the most productive habitats in the world, but globally, many populations have been negatively impacted by multiple anthropogenic stressors. Here, we compare the physiological and molecular responses to ocean acidification (OA) and warming (OW) of two populations of the giant kelp Macrocystis pyrifera from distinct upwelling conditions (weak vs strong). Using laboratory mesocosm experiments, we found that juvenile Macrocystis sporophyte responses to OW and OA did not differ among populations: elevated temperature reduced growth while OA had no effect on growth and photosynthesis. However, we observed higher growth rates and NO3 − assimilation, and enhanced expression of metabolic-genes involved in the NO3 − and CO2 assimilation in individuals from the strong upwelling site. Our results suggest that despite no inter-population differences in response to OA and OW, intrinsic differences among populations might be related to their natural variability in CO2, NO3 − and seawater temperatures driven by coastal upwelling. Further work including additional populations and fluctuating climate change conditions rather than static values are needed to precisely determine how natural variability in environmental conditions might influence a species’ response to climate change.

Data sharing is a fundamental process for the advancement of both natural and social sciences. Starting from the idea that computers and the internet have drastically changed the world in the last decades, this paper advocates for the creation of a space where archaeologists from around the world can share information about maritime history and exchange data with colleagues. Following the principles of open access, we argue that raw data publication is necessary and significant for the development and democratization of the discipline. This study explains the fundamental aspects of the Nautical Archaeology Digital Library (NADL) and its efforts to standardize information collection for shipwrecks and related sites, so that scholars can create a community to disseminate both raw data and complete information in the field of maritime archaeology. To achieve this, our purpose is to facilitate the development of common-ground methodology and terminology that promotes an intelligible dialogue within the global community of nautical archaeologists. This paper addresses some considerations on terminology and systematization in scientific disciplines and discusses the theoretical and methodological issues linked to the process of making a template for recording shipwrecks. Furthermore, this article analyses some of the problems related to the standardization of description processes and the necessity to create a flexible system that accounts for data diversity. The third section discusses how science is greatly enhanced by publishing information in open access platforms. Highlights: • Standardization of data allows robust comparative and inter-subjective analysis of coastal and maritime projects, shipwrecks and nautical technology. • Research is strongly benefited by sharing information underlying publications and raw data generated within a project in open source platforms. • Digital databases such as NADL enhance cooperative research, as well as teaching and outreach strategies.

Two sets $A$ and $B$ , whose elements fulfill a total order on operator $\le $ , can have a binary relation $R \subseteq A \times B$ represented by the k2-tree compact data structure, which greatly improves storage space. Currently, $Count$ query is managed by either using $Range$ query or to modify the structure to have aggregate information, implying additional time or space in order to perform the query. This article presents Compact Count, which exploits the k2-tree properties to reduce the paths to be scanned to count the numbers in a range $r$ , thus ensuring an expected runtime of $O(\log _{k} r \log _{k} n)$ and storage of $O(\log _{k} r)$ with the k2-tree parameters $n$ and $k$ . Our algorithm was compared through a series of experiments that consider both synthetic data with different distributions and real data, with a solution based on the Range algorithm. Experimental results show that Compact Count is 250 to 1,000 times faster than Range on synthetic and real data, respectively, with a small additional storage cost, as expected by the theoretical analysis.

BackgroundPatients with chronic obstructive pulmonary disease (COPD) have systemic damage secondary to the primary pulmonary impairment, expressed in impaired peripheral musculature and a deficit in postural control compared to healthy subjects. This study aimed to determine the effects of rehabilitation on balance in patients with COPD.MethodsAn exhaustive search was conducted in four databases (Pubmed, Cochrane Library, EMBASE, Web of Science). Articles with a population of COPD receiving rehabilitation (therapeutic exercise, pulmonary rehabilitation, or physical therapy modalities) in an outpatient setting were included. Two independent reviewers selected and assessed the study quality. The risk of bias was assessed with the Cochrane Risk of Bias Tool for Randomized Controlled Trials.ResultsA total of eight studies involving 284 patients were included in the qualitative synthesis. The meta-analysis showed an overall result in favor of balance training for the Berg Balance Scale (mean difference 3.91 points; 95% CI: 1.51 to 6.31; P = 0.001), Timed Up and Go test (mean difference −1.58 s; 95% CI: −2.63 to −0.53; P = 0.003) and Unipedal stance test (mean difference 3.56 s, 95% CI: 2.58 to 4.54; P).ConclusionThis meta-analysis revealed that rehabilitation improve static and dynamic balance in patients with COPD.Systematic Review RegistrationPROSPERO ID: CRD42020218367.

BackgroundCongenital heart disease (CHD) entails structural defects in the morphogenesis of the heart or its main vessels. Analyzing exercise capacity of children and adolescents with CHD is important to improve their functional condition and quality of life, since it can allow timely intervention on poor prognostic factors associated with higher risk of morbidity and mortality.ObjectiveTo describe exercise capacity in children and adolescents with CHD compared with healthy controls.MethodsA systematic review was carried out. Randomized clinical trials and observational studies were included assessing exercise capacity through direct and indirect methods in children and adolescents between 5 and 17 years-old. A sensitive analysis was performed including studies with CHD repaired participants. Additionally, it was sub-analyzed by age range (< and ≥ 12 years old). Two independent reviewers analyzed the studies, extracted the data, and assessed the quality of the evidence.Results5619 articles were found and 21 were considered for the review. Eighteen articles used the direct exercise capacity measurement method by cardiopulmonary exercise test (CPET). The CHD group showed significant differences in peak oxygen consumption (VO2peak) with a value of −7.9 ml/Kg/min (95% CI: −9.9, −5.9, p = 0.00001), maximum workload (Wmax) −41.5 (95% CI: −57.9, −25.1 watts, p = 0.00001), ventilatory equivalent (VE/VCO2) slope 2.6 (95% CI: 0.3, 4.8), oxygen pulse (O2 pulse)−2.4 ml/beat (95% CI: −3.7, −1.1, p = 0.0003), and maximum heart rate (HRmax) −15 bpm (95% CI: −18, −12 bpm, p = 0.00001), compared with healthy controls. Adolescents (≥ 12 yrs) with CHD had a greater reduction in VO2peak (−10.0 ml/Kg/min (95% CI: −12.0, −5.3), p < 0.00001), Wmax (−45.5 watts (95% CI: −54.4, −36.7), p < 0.00001) and HRmax (−21 bpm (95% CI: −28, −14), p

Introduction Respiratory muscle weakness and ventilatory failure are common complications in patients with amyotrophic lateral sclerosis (ALS) and may lead to death. Respiratory physiotherapy may improve lung function in this population. This study aims to investigate the effects of respiratory physiotherapy on lung function, cough efficacy and functional status of patients with ALS.Methods and analysis A protocol was published on the International prospective register of systematic reviews (PROSPERO). The research will cover randomised controlled trials, with no language or publication date restriction, available in the following databases: MEDLINE/PubMed, EMBASE, Cochrane Library, Web of Science and Physiotherapy Evidence Database. The research question will be answered using a search strategy adapted for each database. Searches in databases will be conducted from January 2021 to December 2022. Two authors using the Cochrane risk of bias tool for randomised trials V.2 and Grading of Recommendations, Assessment, Development and Evaluations, respectively, will assess risk of bias and quality of evidence independently. According to the results obtained, data will be reported as a meta-analysis or a narrative report.Ethics and dissemination No previous ethical approval is required for this publication since data used are already published. Results of this review will be disclosed via peer-reviewed publications and conference presentations.PROSPERO registration number CRD42021251842.

The objective of this study was to evaluate different methods of predicting body weight (BW) and hot carcass weight (HCW) from biometric measurements obtained through three-dimensional images of Nellore cattle. We collected BW and HCW of 1350 male Nellore cattle (bulls and steers) from four different experiments. Three-dimensional images of each animal were obtained using the Kinect® model 1473 sensor (Microsoft Corporation, Redmond, WA, USA). Models were compared based on root mean square error estimation and concordance correlation coefficient. The predictive quality of the approaches used multiple linear regression (MLR); least absolute shrinkage and selection operator (LASSO); partial least square (PLS), and artificial neutral network (ANN) and was affected not only by the conditions (set) but also by the objective (BW vs. HCW). The most stable for BW was the ANN (Set 1: RMSEP = 19.68; CCC = 0.73; Set 2: RMSEP = 27.22; CCC = 0.66; Set 3: RMSEP = 27.23; CCC = 0.70; Set 4: RMSEP = 33.74; CCC = 0.74), which showed predictive quality regardless of the set analyzed. However, when evaluating predictive quality for HCW, the models obtained by LASSO and PLS showed greater quality over the different sets. Overall, the use of three-dimensional images was able to predict BW and HCW in Nellore cattle.

Microbial infections resistant to conventional antibiotics constitute one of the most important causes of mortality in the world. In some bacterial species, such as Escherichia coli and Staphylococcus aureus pathogens, biofilm formation can favor their antimicrobial resistance. These biofilm-forming bacteria produce a compact and protective matrix, allowing their adherence and colonization to different surfaces, and contributing to resistance, recurrence, and chronicity of the infections. Therefore, different therapeutic alternatives have been investigated to interrupt both cellular communication routes and biofilm formation. Among these, essential oils (EO) from Lippia origanoides thymol-carvacrol II chemotype (LOTC II) plants have demonstrated biological activity against different biofilm-forming pathogenic bacteria. In this work, we determined the effect of LOTC II EO on the expression of genes associated with quorum sensing (QS) communication, biofilm formation, and virulence of E. coli ATCC 25922 and S. aureus ATCC 29213. This EO was found to have high efficacy against biofilm formation, decreasing—by negative regulation—the expression of genes involved in motility (fimH), adherence and cellular aggregation (csgD), and exopolysaccharide production (pgaC) in E. coli. In addition, this effect was also determined in S. aureus where the L. origanoides EO diminished the expression of genes involved in QS communication (agrA), production of exopolysaccharides by PIA/PNG (icaA), synthesis of alpha hemolysin (hla), transcriptional regulators of the production of extracellular toxins (RNA III), QS and biofilm formation transcriptional regulators (sarA) and global regulators of biofilm formation (rbf and aur). Positive regulation was observed on the expression of genes encoding inhibitors of biofilm formation (e.g., sdiA and ariR). These findings suggest that LOTCII EO can affect biological pathways associated with QS communication, biofilm formation, and virulence of E. coli and S. aureus at subinhibitory concentrations and could be a promising candidate as a natural antibacterial alternative to conventional antibiotics.

Bacteria can communicate through quorum sensing, allowing them to develop different survival or virulence traits that lead to increased bacterial resistance against conventional antibiotic therapy. Here, fifteen essential oils (EOs) were investigated for their antimicrobial and anti-quorum-sensing activities using Chromobacterium violaceum CV026 as a model. All EOs were isolated from plant material via hydrodistillation and analyzed using GC/MS. In vitro antimicrobial activity was determined using the microdilution technique. Subinhibitory concentrations were used to determine anti-quorum-sensing activity by inhibition of violacein production. Finally, a possible mechanism of action for most bioactive EOs was determined using a metabolomic approach. Among the EOs evaluated, the EO from Lippia origanoides exhibited antimicrobial and anti-quorum activities at 0.37 and 0.15 mg/mL, respectively. Based on the experimental results, the antibiofilm activity of EO can be attributed to the blockage of tryptophan metabolism in the metabolic pathway of violacein synthesis. The metabolomic analyses made it possible to see effects mainly at the levels of tryptophan metabolism, nucleotide biosynthesis, arginine metabolism and vitamin biosynthesis. This allows us to highlight the EO of L. origanoides as a promising candidate for further studies in the design of antimicrobial compounds against bacterial resistance.

Most Candida species are opportunistic pathogens with the ability to form biofilms, which increases their resistance to antifungal drug therapies and the host immune response. Essential oils (EOs) are an alternative for developing new antimicrobial drugs, due to their broad effect on cellular viability, cell communication, and metabolism. In this work, we evaluated the antifungal and antibiofilm potential of fifty EOs on C. albicans ATCC 10231, C. parapsilosis ATCC 22019, and Candida auris CDC B11903. The EOs’ antifungal activity was measured by means of a broth microdilution technique to determine the minimum inhibitory and fungicidal concentrations (MICs/MFCs) against the different Candida spp. strains. The effects on biofilm formation were determined by a crystal violet assay using 96-well round-bottom microplates incubated for 48 h at 35 °C. The EOs from Lippia alba (Verbenaceae family) carvone-limonene chemotype and L. origanoides exhibited the highest antifungal activity against C. auris. The L. origanoides EOs also presented antifungal and antibiofilm activity against all three Candida spp., thus representing a promising alternative for developing new antifungal products focused on yeast infections, especially those related to biofilm formation, virulence factors, and antimicrobial resistance.

Background Pulmonary hypertension (PH) is a complex syndrome characterized by increased pulmonary arterial pressure and classified into five groups, according to dyspnea on exertion and systemic muscle dysfunction. These symptoms can be identified using the sit-to-stand test (STS), which indirectly evaluates exercise tolerance and lower limb muscle strength. Previous studies used the STS in PH; however, psychometric properties to understand and validate this test were not described for patients with PH. Objective To evaluate the psychometric properties (validity, reliability, and responsiveness) of different STS protocols in patients with PH. Methods and analyses This is a systematic review protocol that will include studies using STS in patients with PH. Searches will be conducted on PubMed/MEDLINE, EMBASE, SciELO, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases following PICOT mnemonic strategy and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). Rayyan software will be used for study selection. The Risk of bias will be assessed using the Consensus‐Based Standards for the Selection of Health Measurement Instruments (COSMIN) tool, while the quality of evidence will be assessed using the modified Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Two researchers will independently conduct the study, and a third researcher will be consulted in case of disagreement. The psychometric properties will be evaluated according to the COSMIN. This protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO, no. CRD42021244271). Conclusion This systematic review will attempt to identify and show the available evidence on STS for different groups of PH and report validity, reliability, and responsiveness of different protocols.

There is a wide range of sequelae affecting COVID-19 survivors, including impaired physical capacity. These sequelae can affect the quality of life and return to work of the active population. Therefore, one of the pillars of following-up is the evaluation of physical capacity, which can be assessed with field tests (such as the six-minute walk test, the one-minute standing test, the Chester step test, and the shuttle walking test) or laboratory tests (such as the cardiopulmonary exercise test). These tests can be performed in different contexts and have amply demonstrated their usefulness in the assessment of physical capacity both in post-COVID-19 patients and in other chronic respiratory, metabolic, cardiologic, or neurologic diseases. However, when traditional tests cannot be performed, physical function can be a good substitute, especially for assessing the effects of an intervention. For example, the Short Physical Performance Battery assessment and the Timed Up and Go assessment are widely accepted in older adults. Thus, the test should be chosen according to the characteristics of each subject.

Benign melanocytic nevi frequently emerge when an acquired BRAFV600E mutation triggers unchecked proliferation and subsequent arrest in melanocytes. Recent observations have challenged the role of oncogene-induced senescence in melanocytic nevus formation, necessitating investigations into alternative mechanisms for the establishment and maintenance of proliferation arrest in nevi. We compared the transcriptomes of melanocytes from healthy human skin, nevi, and melanomas arising from nevi and identified a set of microRNAs as highly expressed nevus-enriched transcripts. Two of these microRNAs—MIR211-5p and MIR328-3p—induced mitotic failure, genome duplication, and proliferation arrest in human melanocytes through convergent targeting of AURKB. We demonstrate that BRAFV600E induces a similar proliferation arrest in primary human melanocytes that is both reversible and conditional. Specifically, BRAFV600E expression stimulates either arrest or proliferation depending on the differentiation state of the melanocyte. We report genome duplication in human melanocytic nevi, reciprocal expression of AURKB and microRNAs in nevi and melanomas, and rescue of arrested human nevus cells with AURKB expression. Taken together, our data describe an alternative molecular mechanism for melanocytic nevus formation that is congruent with both experimental and clinical observations.

Background: Early surgical procedures on patients with infective endocarditis (IE) have shown a clearly benefit to reduce embolization at the central nervous system. We conducted a retrospective cohort in Mexican population to evaluate mortality and clinical outcomes in patients with IE with or without surgical intervention. Objectives: Our aim was to evaluate factors associated with mortality in patients with IE and compare both groups with and without a surgical intervention. Methods: We evaluated a retrospective cohort of patients who had been diagnosed with IE according to the Duke’s criteria at our Institution in SLP, Mexico, from January 2001 to September 2016. We compared the risk factors associated to mortality of patients with or without surgery. Our primary outcome was mortality within 6 months of follow-up after the diagnosis. Results: We included 105 patients, 51 (48.6%) were men, median age 46 [Q1 30, Q3 59] years, 36 patients (34.3%) received surgical treatment (STG), and 69 (65.7%) only medical treatment (MTG) group; 41 patients (39%) died during the study period; in the surgery group eight patients died (22%); and 33 in the MT group (47%) p = 0.049. Adjusted for APACHE II, surgery, creatinine levels and the size of vegetation, the surgery group had lower mortality than patients on MTG (HR 0.36, p = 0.047). Conclusion: As previously described in the literature, patients who underwent surgery had lower mortality than the patients who only received medical treatment; however, the Mexican population is different to other populations group, due to higher risk of diabetes mellitus (28%) versus (10%) in global risk of DM in the world and its complications and other chronic diseases as arterial systemic hypertension. Thus, surgical treatment must be elected as goal standard treatment in patient’s whit IE and presence of vegetation.

La disquinesia ciliar primaria es una enfermedad autosómica recesiva rara con compromiso del drenaje mucociliar. Entre las estrategias terapéuticas no farmacológicas más comúnmente recomendadas se encuentra las técnicas de drenaje de secreciones. Sin embargo, la evidencia del uso y efectividad de estas técnicas es reducida y generalmente se basan en evidencia extrapolada de la fibrosis quística. Este artículo revisa las recomendaciones y la evidencia disponible de la kinesiología respiratoria, principalmente las técnicas manuales e instrumentales de drenaje bronquial y el ejercicio físico en niños con disquinesia ciliar primaria.

Wet distiller grains (WDG) are a corn by-product rich in protein and fiber that can be used in feedlot diets. This study evaluated F1 Angus-Nellore bulls fed on a control diet vs. WDG (n = 25/treatment). After a period of 129 days on these feeds, the animals were slaughtered and Longissimus thoracis samples were collected for both a meat quality evaluation and gel-based proteomic analyses. A greater ribeye area (99.47 cm²) and higher carcass weight (333.6 kg) (p < 0.05) were observed in the WDG-finished cattle compared to the control (80.7 cm²; 306.3 kg). Furthermore, there were differences (p < 0.05) in the intramuscular fat between the WDG and control animals (IMF = 2.77 vs. 4.19%), which led to a significant decrease (p < 0.05) in saturated fatty acids (FA). However, no differences (p > 0.10) were observed in terms of tenderness, evaluated using Warner–Bratzler shear force (WBSF). The proteomic and bioinformatic analyses revealed substantial changes in the biological processes, molecular functions, and cellular components of the WDG-finished cattle compared to the control. Proteins related to a myriad of interconnected pathways, such as contractile and structural pathways, energy metabolism, oxidative stress and cell redox homeostasis, and transport and signaling. In this experiment, the use of WDG supplementation influenced the protein expression of several proteins, some of which are known biomarkers of beef quality (tenderness and color), as well as the protein–protein interactions that can act as the origins of increases in muscle growth and reductions in IMF deposition. However, despite the effects on the proteome, the tenderness, evaluated by WBSF, and fatty acid profile were not compromised by WDG supplementation.