Aplicación del análisis de textura a partir de imágenes de RM convencional en el estudio de pacientes con lumbalgia mecánica crónica

La relación clínico-radiológica en pacientes con lumbalgia inespecífica es baja siendo difícil establecer, tras la valoración inicial del paciente, cual va a ser su pronóstico a medio plazo. La radiómica (análisis de textura) aparece como un nuevo paradigma en el análisis de la imagen médica, permitiendo cuantificar características de la misma que el ojo humano no puede discernir. El objetivo de este estudio fue determinar si el análisis de textura permite establecer el pronóstico de los pacientes que consultan por lumbalgia inespecífica. Material y métodos Se realizó un estudio observacional prospectivo en el que incluyeron individuos entre 18 y 65 años, con diagnóstico de lumbalgia inespecífica de 6 o más meses de evolución, a los que se les realizó RM convencional, siguieron tratamiento rehabilitador y acudieron a revisión tras un periodo de 6 meses. Se recogieron las variables sociodemográficas, el valor de la escala numérica del dolor (END) y el grado de discapacidad según la escala de Roland-Morris (RMQ) en ambas visitas. El proceso de análisis de la imagen de RM consistió en la segmentación de las ROI de platillos vertebrales y discos intervertebrales desde L3-L4 a L5-S1 y la musculatura paravertebral a nivel del espacio L4-L5 para, posteriormente extraer las variables de textura mediante el software Pyradiomics. Posteriormente se aplicó el algoritmo de inteligencia artificial Random Forest de clasificación con el fin de identificar aquellos individuos que al final del seguimiento mejorarían menos del 30 % en la END o puntuarían más de 4 en RMQ. En este análisis se incluyeron como variables los parámetros de textura, edad, sexo, IMC y los valores de END y RMQ. Se calcularon la sensibilidad, la especificidad y el área bajo la curva ROC. Resultados Completaron el estudio 94 pacientes, 58% mujeres, con edad media de 48,19 (DE 9,15) años. La mediana para el END inicial y final fueron de 7 y 6 respectivamente; 34,3% mejoraron el END en un 30% o más. Para el RMQ estos valores fueron 10 y 5, con una puntuación final de 4 o menor en el 39%. El modelo predictivo para clasificar a los pacientes que no mejoran su puntuación END el 30% o más ofreció una sensibilidad de 0,86, especificidad 0,57, y área bajo la curva ROC 0,71. El modelo predictivo para clasificar a los pacientes que presentan una puntuación en RMQ mayor a 4 o más ofreció una sensibilidad 0,83, especificidad 0,20, y el área bajo la curva ROC 0,52. Conclusión El análisis de textura de las imágenes de RM lumbar podría ayudar a identificar a los pacientes con mayor probabilidad de mejorar su dolor con el tratamiento rehabilitador y así poder establecer un plan terapéutico personalizado

Luxación simultánea de las articulaciones interfalángica y metacarpofalángica del pulgar

La luxación volar de la articulación metacarpofalángica del pulgar es una lesión muy rara; sólo 3 casos de luxación simultánea de las articulaciones metacarpofalángica e interfalángica del pulgar han sido publicados. Presentamos un caso de luxación combinada de las dos articulaciones del pulgar en el que se realizó un tratamiento ortopédico, con resultado satisfactorio.Thumb metacarpo-phalangeal joint palmar dislocation are a very rare injuries. Only 3 reports of intherphalangeal and metacarpo-phalangeal joints dislocations in the same thumb have been Publisher. The following is a case report of simultaneous dislocation of the MCP and IF joints in a thumb treated with a closed reduction

Root Involvement in Plant Responses to Adverse Environmental Conditions

limate change is altering the environment in which plants grow and survive. An increase in worldwide Earth surface temperatures has been already observed, together with an increase in the intensity of other abiotic stress conditions such as water deficit, high salinity, heavy metal intoxication, etc., generating harmful conditions that destabilize agricultural systems. Stress conditions deeply affect physiological, metabolic and morphological traits of plant roots, essential organs for plant survival as they provide physical anchorage to the soil, water and nutrient uptake, mechanisms for stress avoidance, specific signals to the aerial part and to the biome in the soil, etc. However, most of the work performed until now has been mainly focused on aerial organs and tissues. In this review, we summarize the current knowledge about the effects of different abiotic stress conditions on root molecular and physiological responses. First, we revise the methods used to study these responses (omics and phenotyping techniques). Then, we will outline how environmental stress conditions trigger various signals in roots for allowing plant cells to sense and activate the adaptative responses. Later, we discuss on some of the main regulatory mechanisms controlling root adaptation to stress conditions, the interplay between hormonal regulatory pathways and the global changes on gene expression and protein homeostasis. We will present recent advances on how the root system integrates all these signals to generate different physiological responses, including changes in morphology, long distance signaling and root exudation. Finally, we will discuss the new prospects and challenges in this field

International Physical Activity Questionnaire Short Form and accelerometer-assessed physical activity: concurrent validity using six cut-points in HF patients

Aims Physical activity (PA) is an important target for improving clinical outcomes in heart failure (HF) patients. Nonetheless, assessing the daily PA profile in this population is a challenging task, traditionally performed using self-report questionnaires such as the International PA Questionnaire Short Form (IPAQ-SF). This study aimed to evaluate the concurrent validity of the IPAQ-SF and accelerometer-assessed PA using six published cut-points in patients with HF and reduced or mildly reduced ejection fraction. Methods and results The concordance between the IPAQ-SF and a hip-worn accelerometer regarding daily time spent performing moderate to vigorous PA in bouts of at least 10 min was assessed in 53 participants for seven consecutive days using six different cut-points (Barnett, Dibben, Mark, Sanders, Troiano, and Vaha-Ypya). Spearman’s correlation and Bland–Altman plots were used to evaluate concurrent validity between methods. Regressions were used to study the association between patient variables, wear protocol (waking hour or 24 h), and absolute bias. The kappa index was used to evaluate the concordance between IPAQ-SF and accelerometry for classifying patients as active or non-active. All analyses were re-run using non-bouted metrics to investigate the effect of bouted versus non-bouted analysis. The IPAQ-SF and accelerometry showed low to negligible correlation (ρ = 0.12 to 0.37), depending on the cut-point used. The regression analysis showed that the absolute bias was higher in participants following the waking-hour protocol at all cut-points except Dibben’s (P ≤ 0.007). The concordance between the two methods to classify patients as active and non-active was low when using Mark (κ = 0.23) and Barnett (κ = 0.34) cut-points and poor for the remaining cut-points (κ = 0.03 to 0.18). The results of the sensitivity analysis showed negligible to low correlation using non-bouted metrics (ρ = 0.27 to 0.33). Conclusions Moderate to vigorous PA measures using IPAQ-SF and accelerometers are not equivalent, and we do not encourage researchers to use IPAQ-SF alone when assessing PA in HF patients. Moreover, applying personalized collection and processing criteria is important when assessing PA in HF patients. We recommend following the 24 h protocol and selecting cut-points calibrated in patients with cardiovascular diseases. Finally, it is necessary to develop a new tailored questionnaire that considers walking intensity and is adjusted to the current World Health Organisation recommendations, which use non-bouted metrics

Effects of high-intensity interval training on vascular function in patients with cardiovascular disease: a systematic review and meta-analysis

Background: Exercise training improves endothelial function in patients with cardiovascular disease (CVD). However, the influence of training variables remains unclear. The aim of this study was to evaluate the effect of highintensity interval training (HIIT), compared to moderate intensity training (MIT) and other exercise modalities (i.e., resistance and combined exercise), on endothelial function, assessed by arterial flow-mediated dilation (FMD) or endothelial progenitor cells (EPCs), in patients with CVD. Secondly, we investigated the influence of other training variables (i.e., HIIT protocol). Methods: The PICOS strategy was used to identify randomised and nonrandomised studies comparing the effect of HIIT and other exercise modalities (e.g., MIT) on endothelial function in patients with CVD. Electronic searches were carried out in Pubmed, Embase, and Web of Science up to November 2022. The TESTEX scale was used to evaluate the methodological quality of the included studies. Random-effects models of between-group mean difference (MD) were estimated. A positive MD indicated an effect in favour of HIIT. Heterogeneity analyses were performed by the chi-square test and I2 index. Subgroup analyses evaluated the influence of potential moderator variables. Results: Fourteen studies (13; 92.9% randomised) were included. Most of the studies trained 3 days a week for 12 weeks and performed long HIIT. No statistically significant differences were found between HIIT and MIT for improving brachial FMD in patients with coronary artery disease (CAD) and heart failure with reduced ejection fraction (HFrEF) (8 studies; MD+ = 0.91% [95% confidence interval (CI) = −0.06, 1.88]). However, subgroup analyses showed that long HIIT (i.e., > 1 min) is better than MIT for enhancing FMD (5 studies; MD+ = 1.46% [95% CI = 0.35, 2.57]), while no differences were found between short HIIT (i.e., ≤ 1 min) and MIT (3 studies; MD+ = −0.41% [95% CI = −1.64, 0.82]). Insufficient data prevented pooled analysis for EPCs, and individual studies failed to find statistically significant differences (p > .050) between HIIT and other exercise modalities in increasing EPCs. Discussion: Poor methodological quality could limit the precision of the current results and increase the inconsistency. Long HIIT is superior to MIT for improving FMD in patients with CAD or HFrEF. Future studies comparing HIIT to other exercise modalities, as well as the effect on EPCs and in HF with preserved ejection fraction are required

Effects and Optimal Dose of Exercise on Endothelial Function in Patients with Heart Failure: A Systematic Review and Meta‑Analysis

Background Exercise-based cardiac rehabilitation (CR) is considered an effective treatment for enhancing endothelial function in patients with heart failure (HF). However, recent studies have been published and the optimal “dose” of exercise required to increase the benefits of exercise-based CR programmes on endothelial function is still unknown. Objectives (a) To estimate the effect of exercise-based CR on endothelial function, assessed by flow-mediated dilation (FMD), in patients with HF; (b) to determine whether high-intensity interval training (HIIT) is better than moderate-intensity training (MIT) for improving FMD; and (c) to investigate the influence of exercise modality (i.e. resistance exercise vs. aerobic exercise and combined exercise vs. aerobic exercise) on the improvement of endothelial function. Methods Electronic searches were carried out in PubMed, Embase, and Scopus up to February 2022. Random-effects models of between-group mean differences were estimated. Heterogeneity analyses were performed by means of the chi-square test and I2 index. Subgroup analyses and meta-regressions were used to test the influence of potential moderator variables on the effect of exercise. Results We found a FMD increase of 3.09% (95% confidence interval [CI] = 2.01, 4.17) in favour of aerobic-based CR programmes compared with control groups in patients with HF and reduced ejection fraction (HFrEF). However, the results of included studies were inconsistent (p < .001; I2 = 95.2%). Higher FMD improvement was found in studies which were randomised, reported radial FMD, or performed higher number of training sessions a week. Moreover, HIIT enhanced FMD to a greater extent than MIT (2.35% [95% CI = 0.49, 4.22]) in patients with HFrEF. Insufficient data prevented pooled analyses for the effect of exercise in patients with HF and preserved ejection fraction and the influence of exercise modality on the improvement of endothelial function. Conclusion Aerobic-based CR is a non-pharmacological treatment for enhancing endothelial function in patients with HFrEF. However, higher training frequency and HIIT induce greater adaptation of endothelial function in these patients, which should betaken into consideration when designing exercise-based CR programmes. Trial registration The protocol was prospectively registered on the PROSPERO database (CRD42022304687)

Effects of high-intensity interval training on vascular function in patients with cardiovascular disease: a systematic review and meta-analysis

Background: Exercise training improves endothelial function in patients with cardiovascular disease (CVD). However, the influence of training variables remains unclear. The aim of this study was to evaluate the effect of high-intensity interval training (HIIT), compared to moderate intensity training (MIT) and other exercise modalities (i.e., resistance and combined exercise), on endothelial function, assessed by arterial flow-mediated dilation (FMD) or endothelial progenitor cells (EPCs), in patients with CVD. Secondly, we investigated the influence of other training variables (i.e., HIIT protocol).Methods: The PICOS strategy was used to identify randomised and non-randomised studies comparing the effect of HIIT and other exercise modalities (e.g., MIT) on endothelial function in patients with CVD. Electronic searches were carried out in Pubmed, Embase, and Web of Science up to November 2022. The TESTEX scale was used to evaluate the methodological quality of the included studies. Random-effects models of between-group mean difference (MD) were estimated. A positive MD indicated an effect in favour of HIIT. Heterogeneity analyses were performed by the chi-square test and I2 index. Subgroup analyses evaluated the influence of potential moderator variables.Results: Fourteen studies (13; 92.9% randomised) were included. Most of the studies trained 3 days a week for 12 weeks and performed long HIIT. No statistically significant differences were found between HIIT and MIT for improving brachial FMD in patients with coronary artery disease (CAD) and heart failure with reduced ejection fraction (HFrEF) (8 studies; MD+ = 0.91% [95% confidence interval (CI) = −0.06, 1.88]). However, subgroup analyses showed that long HIIT (i.e., &gt; 1 min) is better than MIT for enhancing FMD (5 studies; MD+ = 1.46% [95% CI = 0.35, 2.57]), while no differences were found between short HIIT (i.e., ≤ 1 min) and MIT (3 studies; MD+ = −0.41% [95% CI = −1.64, 0.82]). Insufficient data prevented pooled analysis for EPCs, and individual studies failed to find statistically significant differences (p &gt; .050) between HIIT and other exercise modalities in increasing EPCs.Discussion: Poor methodological quality could limit the precision of the current results and increase the inconsistency. Long HIIT is superior to MIT for improving FMD in patients with CAD or HFrEF. Future studies comparing HIIT to other exercise modalities, as well as the effect on EPCs and in HF with preserved ejection fraction are required.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier CRD42022358156

Morphological, physiological, and molecular scion traits are determinant for salt-stress tolerance of grafted citrus plants

IntroductionCitrus productivity has been decreasing in the last decade in the Mediterranean basin as a consequence of climate change and the high levels of salinity found in the aquifers. Citrus varieties are cultivated grafted onto a rootstock, which has been reported as responsible for plant tolerance to adverse situations. However, other important factors for stress tolerance relying in the scion have been less studied. The aim of this study was to evaluate the effect of the grafted scion on citrus tolerance to salt stress.MethodsFour different citrus rootstock/scion combinations were subjected to salt stress for 30 days, using Carrizo citrange (CC) or Citrus macrophylla (CM) as rootstocks, and Navelina orange (NA) or Oronules mandarin (OR) as scions. CM-OR was the most tolerant combination, whereas CC-NA was the most sensitive one.Results and discussionOur results support the idea that the rootstock plays an important role in salt stress tolerance, but scion is also crucial. Thus, photosynthesis and transpiration, processes regulated by abscisic acid and jasmonic acid, are determinant of plant performance. These photosynthetic parameters were not affected in plants of the salt-tolerant combination CM-OR, probably due to the lower intoxication with Cl− ions, allowing a better performance of the photosynthetic machinery under stress conditions. The different stomatal density of the two citrus scions used in this work (higher in the sensitive NA in comparison to the tolerant OR) also contributes to the different tolerance of the grafted plants to this adverse condition. Additionally, CsDTX35.1 and CsDTX35.2, genes codifying for Cl− tonoplast transporters, were exclusively overexpressed in plants of the salt-tolerant combination CM-OR, suggesting that these transporters involved in Cl− compartmentalization could be crucial for salt stress tolerance. It is concluded that to improve citrus tolerance to high salinity, it is important that scions have a versatile photosynthetic system, an adequate stomatal density, and a proper modulation of genes coding for Cl− transporters in the tonoplast

Optimising grapevine summer stress responses and hormonal balance by applying kaolin in two Portuguese Demarcated Regions

In Mediterranean-like climate areas, field-grown grapevines are typically exposed to severe environmental conditions during the summer season, which can negatively impact the sustainability of viticulture. Despite the short-term mitigation strategies available nowadays to cope with climate change, little is known regarding their effectiveness in different demarcated winegrowing regions with differing climate features. Hence, we applied a kaolin suspension (5 %) to Touriga-Franca (TF) and Touriga-Nacional (TN) grapevine varieties located in two Portuguese demarcated regions (Alentejo and Douro) with different mesoclimates to study its effect on the physiological performance, hormonal balance and ABA-related grapevine leaf gene expression during the 2017 and 2018 growing seasons. Data show that 2017 was warmer than 2018 due to the occurrence of two heatwaves in both locations, highlighting the protective effect of kaolin application under severe environmental conditions. In the first study year, at midday, kaolin enhanced water use efficiency (23 % in Douro and 13 % in Alentejo), carbon assimilation rates (PN; 72 % in Douro and 25 % in Alentejo), and the soluble sugar content of grapevine leaves, while decreasing the accumulation of plant growth regulators (ABA, IAA, and SA) during the ripening stage. The results show an up-regulation of ABA biosynthesis-related genes (VvNCED) in TF treated vines from the Douro vineyard mainly in 2017, suggesting an increased stress response under severe summer conditions. Additionally, kaolin triggered the expression of ABA-responsive genes (VvHVA22a and VvSnRK2.6) mainly in TF, indicating different varietal responses to kaolin application under fluctuating periods of summer stress

Medidas de Tromboprofilaxis en Artroplastia Total de Rodilla. Práctica habitual en la Comunidad Valenciana y revisión bibliográfica.

Antecedentes: El tromboembolismo es una complicación de la cirugía de artroplastia total de rodilla. Para su prevención disponemos de múltiples medidas físicas y farmacológicas.Objetivo:Conocer quémedidas de prevención tromboembólica son las empleadas por los cirujanos ortopédicos en cirugía protésica de rodilla primaria en diferentes centros hospitalarios de nuestra región.Método: Estudio transversal descriptivo observacional basado en encuesta dirigida a especialistas COT de 9 hospitales públicos de la Comunidad Valenciana y búsqueda bibliográfica.Resultados: Se obtuvieron 64 encuestas. Todos los cirujanos eligen HBPM durante un mes como medida de tromboprofilaxis, descartando anticoagulantes orales o aspirina. El 29% también emplea dispositivos de movilización pasiva. Conclusiones: Los cirujanos ortopédicos de la comunidad valenciana optan por HBPM conforme a las mejores evidencias. Se estima, que la incidencia de eventos tromboembólicos sintomáticos desciende del 4,3 % al 1,8% con el uso de HBPM. El empleo de dispositivos de movilización pasiva y medias de compresión no están avaladas por las evidencias. La estratificación preoperatoria del riesgo de tromboembolismo, para emplear ácido acetil salicílico asociado a bombas de presión intermitente en caso de no existir alto riesgo es una tendencia cada vez más aceptada internacionalmente