Is the straight leg raise suitable for the diagnosis of radiculopathy? analysis of diagnostic accuracy in a phase iii study

The straight leg raise test (SLR) has been proposed to detect increased nerve mechanosensitivity of the lower limbs in individuals with low back pain. However, its validity in the diagnosis of lumbosacral radiculopathy shows very variable results. The aim of this study was to analyse the diagnostic validity of the SLR including well-defined diagnostic criteria (a change in symptoms with the structural differentiation manoeuvre and the reproduction of the patient’s symptoms during the test or the asymmetries in the range of motion or symptoms location between limbs) in a sample of participants in phase III with suspicion of lumbar radiculopathy using the electrodiagnostic studies (EDX) as the reference standard. A phase III diagnostic accuracy study was designed. In total, 142 individuals with suspected lumbosacral radiculopathy referred for EDX participated in the study. Each participant was tested with EDX and SLR. SLR was considered positive using three diagnostic criteria. The sensitivity of the SLR for Criterion 3 was 89.02% (CI 81.65–96.40), the specificity was 25.00% (CI 13.21–36.79), and the positive and negative likelihood ratios were 1.19 (CI 1.01–1.40) and 0.44 (0.21–0.94), respectively. SLR showed limited validity in the diagnosis of lumbosacral radiculopathy. The incorporation of more objective diagnostic criteria (asymmetry in range of motion or localisation of symptoms) improved the diagnostic validity but the imprecision of the confidence intervals limited the interpretation of the results

Diacutaneous fibrolysis intervention in patients with mild to moderate carpal tunnel syndrome may avoid severe cases in elderly: A randomized controlled trial

Producción CientíficaBackground: Carpal Tunnel Syndrome (CTS) mainly affects adults of working age. The prevalence of severe cases is higher in elderly patients (>65 years old). Clinical guidelines recommend conservative treatment as the best option in the initial stages of CTS to avoid severe cases. Diacutaneous Fibrolysis (DF) has demonstrated to improve nerve conduction studies and mechanosensitivity. The main purpose was to quantify changes in the cross-sectional area (CSA) of the median nerve, transversal carpal ligament (TCL) thickness, numbness intensity, and the subjective assessment of clinical change after DF treatment in patients with CTS. Methods: a double-blind, randomized, placebo-controlled trial was designed. A number of 44 patients (60 wrists) with CTS were randomized to the DF group or the sham group. CSA and TCL thickness variables were registered by ultrasound. Clinical variables were assessed by the visual analogue scale and GROC scale. SPSS version 24.0 for MAC was used for statistical analysis. The group by time interaction between groups was analyzed using two-way repeated measures analysis of variance. Results: The DF group reduced CSA with a mean of 0.45 mm2 (IC 95% 0.05 to 0.86) and TCL thickness with a mean reduction of 0.4 mm (IC 95% 0.6 to 2.1) compared to the sham group (p < 0.01, p < 0,03, respectively). Additionally, the DF group decreased the numbness intensity with a mean reduction of 3.47 (IC 95% 2.50 to 4.44, p < 0.01) and showed a statistically significant improvement on the GROC scale (p < 0.01). Conclusions: DF treatment may significantly reduce CSA and TCL thickness, numbness intensity, and improved clinical perspective. DF applied in patients with mild to moderate CTS may prevent the progression of the disease as they age

Evaluation of early life experiences: The ELES scale and its clinical use

Antecedentes: la escala de Experiencias Vitales Tempranas (ELES) evalúa el recuerdo de la amenaza y subordinación percibidas durante la in-fancia en las relaciones familiares partiendo de la teoría del rango social. Se propone adaptar al español dicha escala y comprobar su estructura factorial mediante una validación cruzada y explorar sus propiedades psicométricas. Método: participaron 960 sujetos (863 de población general y 97 pacientes). Resultados: los datos confirman la estructura factorial de la versión inicial de Gilbert, Cheung, Grandfield, Campey, y Irons (2003), obteniendo tres fac-tores: sumisión, amenaza, y desvalorización, explicando un 66.31% de la varianza. La versión española de la escala ELES resultó estar compuesta por el mismo número de ítems que la original y mostró índices adecuados de validez, consistencia interna, fiabilidad retest, fiabilidad compuesta e in-varianza por género. Conclusiones: la escala de Experiencias Vitales Tempranas (ELES) puede ser de utilidad para evaluar las experiencias vitales tempra-nas, estudiar la relación entre dichas experiencias en diferentes manifesta-ciones psicopatológicas y establecer posibles modelos explicativos.Background: The Early Life Experiences Scale (ELES) evaluates the memory of threat and subordination perceived in childhood family rela-tionships based on social rank theory. This scale was adapted to Spanish, its factor structure was tested by cross-validation, and its psychometric properties were explored. Method: 960 subjects participated (863 subjects from the general population and 97 patients). Results: Data confirm the factor structure of the original version by Gilbert, Cheung, Grandfield, Campey, and Irons (2003), obtaining a similar model with three factors: submission, threat, and devaluation, which explained 66.31% of the vari-ance. The Spanish version of the ELES was comprised of the same num-ber of items as in the original study and showed adequate indices of validi-ty, internal consistency, retest and combined reliability, and invariance by gender. Conclusions: The Early Life Experiences Scale (ELES) can be a useful measure for evaluating early life experiences. Its application may be very relevant in studying the relationship between these experiences and psy-chopathological manifestations in constructing explanatory models

Dual chiral silver catalyst in the synthetic approach to the core of hepatitis C virus inhibitor GSK 625433 using enantioselective 1,3-dipolar cycloaddition of azomethine ylides and electrophilic alkenes

The asymmetric 1,3-dipolar cycloaddition of an imino ester 5 with tert-butyl acrylate is catalyzed by a dual chiral silver(I) complex formed from a chiral phosphoramidite 14 and the chiral silver(I) binolphosphate (R)-17. This reaction is selected to achieve the synthesis of enantiomerically enriched key structures to access the third generation of GSK HCV inhibitors. The scope of this dual chiral catalytic system is analyzed by employing different imino esters and dipolarophiles, and also compared with the same cycloaddition reactions performed with the chiral phosphoramidite 14·AgClO4 complex.Financial support was provided by the Spanish Ministerio de Ciencia e Innovación (MICINN) (projects CTQ2010-20387, and Consolider Ingenio 2010, CSD2007-00006), the Spanish Ministerio de Economía y Competitividad (MINECO) (projects CTQ2013-43446-P and CTQ2014-51912-REDC), the Spanish Ministerio de Economía, Industria y Competitividad, Agencia Estatal de Investigación (AEI) and Fondo Europeo de Desarrollo Regional (FEDER, EU) (projects CTQ2016-76782-P and CTQ2016-81797-REDC), the Generalitat Valenciana (PROMETEO 2009/039 and PROMETEOII/2014/017), and the University of Alicante

Los Poyos del Molinillo (Frigiliana): new site of the Bronze Age in the East Axarquía (Málaga, Andalucía)

En este trabajo damos a conocer un nuevo yacimiento descubierto recientemente en el municipio de Frigiliana. La delimitación del área denominada Los Poyos del Molinillo permitió definir la existencia de un poblado y una covacha con restos de una inhumación. El estudio de los materiales arqueológicos, que incluye cerámica, piezas metálicas o elementos de molturación, o la datación AMS obtenida, permiten adscribir el yacimiento a la Edad del Bronce y ampliar el conocimiento de esta etapa en la Axarquía oriental (Málaga, Andalucía).In this work we present a new site recently discovered in the Frigiliana municipality (Málaga). The spatial delimitation of the so called Los Poyos del Molinillo area let us define a Bronze age settlement and an inhumation burial cave. The archaeological record includes ceramic, metallic items or grinding elements, all of them belonging to the Bronze Age, as well as an AMS Radiocarbon data. This site extends the knowledge about this period in the Eastern Axarquía (Málaga, Andalucía)

Nanogels with high loading of anesthetic nanocrystals for extended duration of sciatic nerve block

The development of thermoresponsive nanogels loaded with nanocrystals of the local anesthetic bupivacaine nanocrystals (BNCs) for prolonged peripheral nerve pain relief is reported here. BNCs were prepared using the antisolvent precipitation method from the hydrophobic form of bupivacaine (bupivacaine free base). The as-prepared BNCs were used stand-alone or encapsulated in temperature-responsive poly(ethylene glycol) methyl ether methacrylate (OEGMA)-based nanogels, resulting in bupivacaine NC-loaded nanogels (BNC-nanogels) of monodisperse size. The synthesis protocol has rendered high drug loadings (i.e., 93.8 ± 1.5 and 84.8 ± 1.2 wt % for the NC and BNC-nanogels, respectively) and fast drug dissolution kinetics in the resulting composite material. In vivo tests demonstrated the efficacy of the formulation along with an extended duration of sciatic nerve block in murine models of more than 8 h with a formulation containing only 2 mg of the local anesthetic thanks to the thermoresponsive character of the polymer, which, at body temperature, becomes hydrophobic and acts as a diffusion barrier for the encapsulated drug nanocrystals. The hydrophobicity of the encapsulated bupivacaine free base probably facilitates its pass through cell membranes and also binds strongly to their hydrophobic lipid bilayer, thereby protecting molecules from diffusion to extracellular media and to the bloodstream, reducing their clearance. When using BNC-nanogels, the duration of the anesthetic blockage lasted twice as long as compared to the effect of just BNCs or a conventional bupivacaine hydrochloride solution both containing equivalent amounts of the free drug. Results of the in vivo tests showed enough sensory nerve block to potentially relieve pain, but still having mobility in the limb, which enables motor function when required. The BNC-nanogels presented minimal toxicity in the in vivo study due to their sustained drug release and excellent biocompatibility. The encapsulation of nano-sized crystals of bupivacaine provides a prolonged regional anesthesia with reduced toxicity, which could be advantageous in the management of chronic pain.The authors thank financial support from the ERC Consolidator Grant program (ERC-2013-CoG-614715, NANOHEDONISM). V.S. acknowledges the financial support from Ministerio de Ciencia, Innovación y Universidades, Programa Retos Investigación, Proyecto REF: RTI2018-099019-A-I00. CIBER-BBN is an initiative funded by the VI National R&D&i Plan 2008–2011 financed by the Instituto de Salud Carlos III with the assistance of the European Regional Development Fund. The microscopy works have been conducted in the “Laboratorio de Microscopias Avanzadas” at “Instituto de Nanociencia de Aragon─Universidad de Zaragoza”. The authors acknowledge the LMA-INA, the Histopathology Unit from CNIO (Madrid, Spain), and Cell Separation and Flow Cytometry, Cell Culture, Animal Care and Pathological Anatomy Core Units from IACS/IIS Aragon (Spain) for granting access to their instruments and expertise. The authors also acknowledge Drs. Elena Tapia, Jorge Palacio, Cristina Pastor, and Eduardo Romanos for their helpful advice and comments regarding the in vivo model. S.G.-S. and G.L. gratefully acknowledge the support from the FPI program (BES-2015-073735 and PRE2018-085769). G.M. thanks the support from the Miguel Servet Program (MS19/00092; Instituto de Salud Carlos III).Peer reviewe

Professional interventions to implement guidelines to prevent hazardous alcohol consumption by patients in primary care settings (Protocol)

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Documentación e información para mayores: actividades formación en competencias informacionales en el Centro de Mayores de Santa Engracia (Madrid)

Memoria final de un proyecto con alumnos del Grado en Información y Documentación y dos Centros de Mayores del Ayuntamiento de Madrid

A genome-wide association study follow-up suggests a possible role for PPARG in systemic sclerosis susceptibility

Introduction: A recent genome-wide association study (GWAS) comprising a French cohort of systemic sclerosis (SSc) reported several non-HLA single-nucleotide polymorphisms (SNPs) showing a nominal association in the discovery phase. We aimed to identify previously overlooked susceptibility variants by using a follow-up strategy.&lt;p&gt;&lt;/p&gt; Methods: Sixty-six non-HLA SNPs showing a P value &#60;10-4 in the discovery phase of the French SSc GWAS were analyzed in the first step of this study, performing a meta-analysis that combined data from the two published SSc GWASs. A total of 2,921 SSc patients and 6,963 healthy controls were included in this first phase. Two SNPs, PPARG rs310746 and CHRNA9 rs6832151, were selected for genotyping in the replication cohort (1,068 SSc patients and 6,762 healthy controls) based on the results of the first step. Genotyping was performed by using TaqMan SNP genotyping assays. Results: We observed nominal associations for both PPARG rs310746 (PMH = 1.90 × 10-6, OR, 1.28) and CHRNA9 rs6832151 (PMH = 4.30 × 10-6, OR, 1.17) genetic variants with SSc in the first step of our study. In the replication phase, we observed a trend of association for PPARG rs310746 (P value = 0.066; OR, 1.17). The combined overall Mantel-Haenszel meta-analysis of all the cohorts included in the present study revealed that PPARG rs310746 remained associated with SSc with a nominal non-genome-wide significant P value (PMH = 5.00 × 10-7; OR, 1.25). No evidence of association was observed for CHRNA9 rs6832151 either in the replication phase or in the overall pooled analysis.&lt;p&gt;&lt;/p&gt; Conclusion: Our results suggest a role of PPARG gene in the development of SSc