Search

Lumbar pain is a very common symptom that derives from benign musculoskeletal conditions, rheumatic inflammatory diseases, neoplasms, and referred and/or nociplastic pain. A 70-year-old man with psoriatic arthritis presented with early-onset lumbosacral pain without evident red flags. Symptomatic treatment was unhelpful. Radiographic imaging showed subtle signs of a disease that could easily be missed. Magnetic resonance imaging revealed a massive prostatic malignancy with bone (sacral and iliopubic) metastasis. Awareness must be given not to disregard every lumbar pain as part of the preexisting rheumatic inflammatory disease (spondyloarthropathy in this case) or a common muscle/ligament/articular disarrangement. Persistence of pain, albeit not inflam-matory nor sharp in nature, despite adequate treatment might be just as important as an acute red flag and requires proper follow-up.

Abstract Background The existing digital healthcare solutions demand a service development approach that assesses needs, experience, and outcomes, to develop high-value digital healthcare services. The objective of this study was to develop a digital transformation of the patients’ follow-up service after cardiac surgery, based on a remote patient monitoring service that would respond to the real context challenges. Methods The study followed the Design Science Research methodology framework and incorporated concepts from the Lean startup method to start designing a minimal viable product (MVP) from the available resources. The service was implemented in a pilot study with 29 patients in 4 iterative develop-test-learn cycles, with the engagement of developers, researchers, clinical teams, and patients. Results Patients reported outcomes daily for 30 days after surgery through Internet-of-Things (IoT) devices and a mobile app. The service’s evaluation considered experience, feasibility, and effectiveness. It generated high satisfaction and high adherence among users, fewer readmissions, with an average of 7 ± 4.5 clinical actions per patient, primarily due to abnormal systolic blood pressure or wound-related issues. Conclusions We propose a 6-step methodology to design and validate a high-value digital health care service based on collaborative learning, real-time development, iterative testing, and value assessment.

We have applied first-principles calculations to investigate the structural, electronic, and optical properties of the boron nitride structure, PAI-BN, which is composed of pentagonal, hexagonal, and heptagonal rings. We have found that this structure exhibits dynamic and thermal stability and its energy is slightly higher than that obtained for hexagonal boron nitride (h-BN) monolayer. Our calculations for the electronic structure have shown that PAI-BN presents a bandgap of 2.50 eV, which is approximately half that of the h-BN bandgap, thus presenting a semiconductor behavior. Furthermore, we have found, from optical absorption results, that PAI-BN is transparent in the infrared and visible regions, absorbing only in the ultraviolet region. Therefore, based on these results, we can consider the possibility of applications of this nanostructure in electronic and optoelectronic devices.

A close interaction between basic science and applied medicine is to be expected. Therefore, it is important to measure how far apart the field of cell biology and medicine are. Our approach to estimating the distance between these fields was to compare their vocabularies and to quantify the difference in word repertoire. We compared the vocabulary of the title and abstract of articles available in PubMed in two selected high-impact journals in each field: cell biology, medicine, and translational science. Although each journal has its own editorial policy, we showed that within each field there is a small vocabulary difference between the two journals. We developed a word similarity index that can measure how much journals share a common vocabulary. We found a high similarity index between each cell biology (91%), medical (71-74%), and translational journal (65%). In contrast, the comparison between medicine and biology journals produced low correlation values (22-36%), suggesting that their vocabularies are quite dissimilar. Translational medicine journals had medium similarity values when compared to cell biology journals (52-70%) and medicine journals (27-59%). This approach was also performed in 10-year periods to evaluate the evolution of each field. Using the “onomics” strategy presented here, we observed that differences in vocabulary of basic science and medicine have been increasing over time. Since translational medicine has an intermediate vocabulary, we confirmed that translational medicine is an efficient approach to bridge this gap.

A forma como a sociedade vê a homossexualidade sofreu alterações ao longo do tempo, sendoo objetivo deste estudo perceber de que forma é vista a homossexualidade na atualidade,tendo por base diferentes variáveis: sexo, meio (rural/urbano), idade, religiosidade, contactointerpessoal LGBT, habilitações académicas e o setor profissional. Este estudo foi do tipoquasi-experimental e de caráter transversal. A amostra foi de 192 indivíduos, 97 mulheres e95 homens. Aplicou-se um questionário sociodemográfico e uma Escala Multidimensional deAtitudes Face a Lésbicas e Gays (EMAFLG). Os resultados evidenciaram valores mais elevadosnas subescalas negativas e mais baixos na subescala positiva relativas à perceção dahomossexualidade concluindo que os homens, os indivíduos que passaram a maior parte dasua vida em meio rural, as pessoas com mais idade, os indivíduos que se consideram religiosos,aqueles que não possuem contacto com LGBT, os que possuem habilitações académicasmais baixas e por fim os indivíduos que trabalham numa área do setor secundário são maishomofóbicos. Concluiu-se que existe preconceito relativamente à homossexualidade.

Purpose: To report and describe the clinical course of four pediatric traumatic macular hole (TMH) cases and respective management. Case Report: Four pediatric patients with macular hole following blunt ocular trauma underwent early pars plana vitrectomy, with consecutive hole closure. Initial visual acuity was 20/50 in 2 of the patients by the end of the follow-up. Macular hole closure was achieved in all patients with a single procedure, and anatomical success was confirmed by optical coherence tomography until the end of the follow-up. Conclusions: Although spontaneous closure of TMH is not uncommon, especially in pediatric patients, early pars plana vitrectomy seems to be a safe and effective choice in pediatric TMH management. The risk/benefit ratio of surgery seems to be better than observation.

Estudou-se a decomposição e a dinâmica de nutrientes de folhas e agulhas senescentes de Castanea sativa (CS), Pinus pinaster (PP), Pinus nigra (PN) e Pseudotsuga menziesii (PM) durante 3,1 a 3,5 anos, bem como a evolução da composição química e estrutural dos mesmos resíduos durante 391 a 518 dias, por intermédio da técnica das saquetas. Os teores de N eram mais elevados nas agulhas de PM (14,5 g kg-1) e nas folhas de CS (12,1 g kg-1) do que nas agulhas de PP (3,8 g kg-1) e PN (4,7 g kg-1) e, implicando que a razão C/N fosse menor nas primeiras (respectivamente 39,0 e 46,8) do que nas segundas (respectivamente 147,7 e 122,2). As agulhas de PM apresentavam o teor mais elevado de Ca (9,1 g kg-1) e de compostos solúveis em álcool e água (384 g kg-1, contra 95 a 160 g kg-1 nas restantes espécies), mas o teor mais baixo em holocelulose (253 g kg-1, contra ±500 g kg-1 nas restantes espécies). A razão lenhina/N era muito maior nas agulhas de PP e PN (respectivamente 71,2 e 58,3) do que nas agulhas de PM e folhas de CS (respectivamente, 20,5 e 20,3), enquanto a razão holocelulose/lenhina se situava entre o mínimo de 0,9, nas agulhas de PM, e 1,9 -2,1 para as outras espécies. A taxa de decomposição anual para todo o período de estudo, seguindo o modelo exponencial negativo, decresceu segundo a ordem CS>PN>PM>PP (0,35, -0,27, -0,19 e -0,16), com valores mais elevados no primeiro ano em CS (-0,60) e PM (-0,31). Os constituintes solúveis e a hemicelulose decresceram em geral acentuadamente com o decorrer da decomposição, enquanto a lenhina e a celulose apresentaram pequena variação, nomeadamente nas agulhas de PP e PM. As quantidades remanescentes de K, Ca e Mg decresceram durante o processo de decomposição, atingindo no final do estudo respectivamente 17 a 65%, 30 a 60 % e 18 a 59% da inicial. As quantidades remanescentes finais de N (41 a 121 %) e de P (33 a 104 %) tanto foram inferiores como superiores às iniciais. A razão C/N diminuiu acentuadamente durante a decomposição, sobretudo nas agulhas de PP e PN, com valores finais de 53,2 47,1.Decomposition of senescent leaves of Castanea sativa (CS), and needles of Pinus pinaster (PP), Pinus nigra (PN) and Pseudotsuga menziesii (PM) was studied during 3.1 to 3.5 years through weight loss and nutrient concentration evolution, using the litter bag technique, whereas the variation of chemical structural compounds was followed during 391 to 518 days. The highest contents of N were measured in PM and CS (respectively 14.5 and 12.1 g kg-1), which showed lower C/N ratio (39.0, 46.8) than PN and PP (122.2 and 147.7, respectively). Highest contents of Ca (9.1 g kg-1) and of alcohol and water soluble compounds (384 against 95 to 160 g kg-1 to other species) were measured in PM needles, which also showed the lowest contents of holocelulose (253 g kg-1 against about 500 g kg-1 in the other species). The lignin Klason/N ratio decreased according to PP>PN>PM>CS, (71.2, 58.3, 20.5 and 20.3 respectively), and the holocelulose/lignin ratio ranged from 0.9 (PM) to 1.9-2.1 in the other species. Annual decay rates, according to the negative exponential model, were ordered according to CS>PN>PM>PP (respectively -0.35, -0.27, -0.19 and -0.16), but with higher values during the first year for CS (-0.60) and PM (0.31). Soluble compounds and hemicelulose strongly decreased during the decomposition period, while lignin and cellulose amounts showed a low variability, mainly in PP and PM needles. Nutrient amounts decreased during the decomposition process, but remaining quantities for N (41 to 121 %) and P (33 to 104 %) were higher than those estimated for K, Ca and Mg (respectively 17 to 65%, 30 to 60 % and 18 to 59%). A strong decreasing of C/N ratio was observed especially for PP and PN, where reached 53.2 and 47.1.

Controlling root movement is one of the greatest challenges in orthodontic treatment with aligners, like Invisalign® aligners. Cone Beam Computed Tomography (CBCT) integration into ClinCheck®, enabling bone and root visualisation, allows a more accurate follow-up of the teeth position. This study aims to compare torque measurements of the upper central incisors with and without CBCT and relate them to the upper incisor inclination and facial biotype. In a sample of 70 teeth, torque measurements were obtained by importing images into AutoCAD® software (version 2024). The angle between the tooth’s long axis with CBCT duplicate and the tooth’s long axis without CBCT was obtained to assess the difference. Statistically significant differences between torque measurements with and without CBCT were found, as well as between these measurements and the inclination of the upper incisors. No statistically significant differences were found among the facial biotypes. The average values of 27.8° ± 3.4° and 21.5° ± 3.2° were obtained for the angle between the axes. Torque without CBCT was lower than torque with CBCT, for the same tooth. The angle between the axes had a similar mean for both teeth. CBCT integration into ClinCheck® allows for a more correct torque measurement.

The digital era is opening countless possibilities in “Sport Sciences”; “Public, Environmental, and Occupational Health”; and “Physical Therapy, Sports Therapy, and Rehabilitation” areas [...]

Zika virus (ZIKV) is an arthropod-borne virus (arbovirus) member of the Flaviviridae family, which has been associated with the development of the congenital Zika syndrome (CZS). RNA viruses, such as flaviviruses, have been reported to exert a profound impact on host microRNAs (miRNAs). Cellular miRNAs modulated by ZIKV may help identify cellular pathways of relevance to pathogenesis. Here, we screened 754 human cellular miRNAs modulated by ZIKV infection (Brazilian PE strain) in a neuroblastoma cell line. Seven miRNAs (miR-99a*, miR-126*, miR-190b, miR-361-3p, miR-522-3p, miR-299-5p, and miR-1267) were downregulated during ZIKV infection, while miR-145 was upregulated. Furthermore, 11 miRNAs were exclusively expressed in ZIKV-infected (miR-148a, miR-342-5p, miR-598, and miR-708-3p) or mock cells (miR-208, miR-329, miR-432-5p, miR-488, miR-518b, miR-520g, and miR-767-5p). Furthermore, in silico analysis indicated that some central nervous system, cellular migration, and adhesion function-related biological processes were overrepresented in the list of target genes of the miRNAs regulated in ZIKV-infected cells, especially for miR-145 and miR-148a. The induction of miR-145 and miR-148a was confirmed in postmortem brain samples from stillborn with severe CZS. Finally, we determined the expression regulation of microcephaly related genes through RNA interference pathway caused by ZIKV directly on neuron cells.

Background: The access to pediatric rheumatology (PR) services in Portugal is not well described. The primary objective of this study was to identify barriers to PR referrals and explore alternative referral patterns among family doctors and pediatricians. Methods: A web-based survey was emailed to family doctors and pediatricians practicing in Portugal to investigate issues related to access to PR care. Descriptive and comparative analyses were performed. Results: A total of 292 responses were obtained, with 24.7% from pediatricians and 75.3% from family doctors. Only 12% claimed to have received specific education on PR. Nearly 70% worked within one hour of a PR center. Twenty-eight percent had referred a patient to PR at least once, and 9.3% considered referring to PR at least once but ultimately did not. Many referred patients to other specialties, primarily pediatrics, adult rheumatology, and pediatric orthopedics. Pediatricians encountered a greater variety of rheumatic diseases. Fifty-five percent had no opinion on the support provided by PR centers, while 24% found it sufficient. Having specific training in PR, being a pediatrician, and being a specialist were associated with higher referral rates to PR. Discrepancies in regional access to PR were documented. The most highly rated measure for improving PR referrals was promoting education. Conclusion: The main barriers to PR referrals in Portugal are primarily the lack of education in PR, along with uneven national coverage and greater distances to some PR centers. Pediatricians appear to have better education, more experience, and higher referral rates to PR. The current alternatives for referral are pediatrics, adult rheumatology, and pediatric orthopedics. Addressing educational fragmentation was the most significant and rewarding inconsistency to overcome. [ABSTRACT FROM AUTHOR]

Objective: To compare the 2-year retention rate between a second tumor necrosis factor alpha inhibitor (TNFi) and secukinumab (SEK) or ustekinumab (UST), in Psoriatic Arthritis (PsA) patients with previous inadequate response to their first TNFi. Methods: Prospective longitudinal cohort study with a follow-up period of 2 years using the Nationwide Portuguese Reuma.pt database. Patients with a clinical diagnosis of PsA who also fulfill the CASPAR classification criteria, with previous treatment failure to a first-line TNFi and having started a second biotechnological drug (TNFi, SEK or UST) were included. The Cycling group was defined as switching from a first TNFi to a second TNFi, and the Swapping group as switching from a first TNFi to SEK or UST. Sociodemographic data, disease characteristics, disease activity scores and physical function at baseline and after 6, 12 and 24 months were recorded. Cox-proportional hazards regression was used to compare retention rates between Cycling and Swapping groups. To obtain a predictor model of 2-year discontinuation, a multivariable Cox regression model was performed. Results: In total, 439 patients were included, 58% were female, with a mean age (standard deviation) of 49 (12) years. Globally, 75.6% initiated a second TNFi (Cycling group), and 24.4% started SEK/UST (Swapping group). The retention rates after 6, 12 and 24 months were 72%/66%/59% in the Cycling group; and 77%/66%/59% in the Swapping group. There were no significant differences in retention rates between both strategies (HR: 1.06, 95% CI 0.72-1.16). After 2 years of follow-up, 34.4% of patients discontinued their second biologic, mainly due to inefficacy (72.8%), with no differences found between groups. Baseline treatment with glucocorticoids was the only predictor of discontinuation after 2 years of follow-up (HR:1.668, 95% CI 1.154-2.409). Conclusions: After failure of a first TNF inhibitor, Cycling and Swapping strategies result in similar retention rates suggesting that both are acceptable in the management of patients with psoriatic arthritis. [ABSTRACT FROM AUTHOR]