Publications by authors named "Paulo de Carvalho"

178 Publications

A new approach for interpretability and reliability in clinical risk prediction: Acute coronary syndrome scenario.

Artif Intell Med 2021 07 13;117:102113. Epub 2021 May 13.

Cardiology Department, Leiria Hospital Centre, Leiria, Portugal. Electronic address:

Introduction: The risk prediction of the occurrence of a clinical event is often based on conventional statistical procedures, through the implementation of risk score models. Recently, approaches based on more complex machine learning (ML) methods have been developed. Despite the latter usually have a better predictive performance, they obtain little approval from the physicians, as they lack interpretability and, therefore, clinical confidence. One clinical issue where both types of models have received great attention is the mortality risk prediction after acute coronary syndromes (ACS).

Objective: We intend to create a new risk assessment methodology that combines the best characteristics of both risk score and ML models. More specifically, we aim to develop a method that, besides having a good performance, offers a personalized model and outcome for each patient, presents high interpretability, and incorporates an estimation of the prediction reliability which is not usually available. By combining these features in the same approach we expect that it can boost the confidence of physicians to use such a tool in their daily activity.

Methods: In order to achieve the mentioned goals, a three-step methodology was developed: several rules were created by dichotomizing risk factors; such rules were trained with a machine learning classifier to predict the acceptance degree of each rule (the probability that the rule is correct) for each patient; that information was combined and used to compute the risk of mortality and the reliability of such prediction. The methodology was applied to a dataset of 1111 patients admitted with any type of ACS (myocardial infarction and unstable angina) in two Portuguese hospitals, to assess the 30-days all-cause mortality risk, being validated through a Monte-Carlo cross-validation technique. The performance was compared with state-of-the-art approaches: logistic regression (LR), artificial neural network (ANN), and clinical risk score model (namely the Global Registry of Acute Coronary Events - GRACE).

Results: For the scenario being analyzed, the performance of the proposed approach and the comparison models was assessed through discrimination and calibration. The ability to rank the patients was evaluated through the area under the ROC curve (AUC), and the ability to stratify the patients into low or high-risk groups was determined using the geometric mean (GM) of specificity and sensitivity, the negative predictive value (NPV) and the positive predictive value (PPV). The validation calibration curves were also inspected. The proposed approach (AUC = 81%, GM = 74%, PPV = 17%, NPV = 99%) achieved testing results identical to the standard LR model (AUC = 83%, GM = 73%, PPV = 16%, NPV=99%), but offers superior interpretability and personalization; it also significantly outperforms the GRACE risk model (AUC = 79%, GM = 47%, PPV = 13%, NPV = 98%) and the standard ANN model (AUC = 78%, GM = 70%, PPV = 13%, NPV = 98%). The calibration curve also suggests a very good generalization ability of the obtained model as it approaches the ideal curve (slope = 0.96). Finally, the reliability estimation of individual predictions presented a great correlation with the misclassifications rate.

Conclusion: We developed and described a new tool that showed great potential to guide the clinical staff in the risk assessment and decision-making process, and to obtain their wide acceptance due to its interpretability and reliability estimation properties. The methodology presented a good performance when applied to ACS events, but those properties may have a beneficial application in other clinical scenarios as well.
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http://dx.doi.org/10.1016/j.artmed.2021.102113DOI Listing
July 2021

Dural Tears During Lumbar Spinal Endoscopy: Surgeon Skill, Training, Incidence, Risk Factors, and Management.

Int J Spine Surg 2021 Apr 1;15(2):280-294. Epub 2021 Apr 1.

University of New Mexico School of Medicine, Albuquerque, New Mexico.

Background: Incidental dural tears during lumbar endoscopy can be challenging to manage. There is limited literature on their appropriate management, risk factors, and the clinical consequences of this typically uncommon complication.

Materials And Methods: To improve the statistical power of studying durotomy with lumbar endoscopy, we performed a retrospective survey study among endoscopic spine surgeons by email and chat groups on social media networks, including WhatsApp and WeChat. Descriptive and correlative statistics were done on the surgeons' recorded responses to multiple-choice questions. Surgeons were asked about their clinical experience with spinal endoscopy, training background, the types of lumbar endoscopic decompression they perform by approach, the decompression instruments they use, and incidental durotomy incidence with routine lumbar endoscopy.

Results: There were 689 dural tears in 64 470 lumbar endoscopies, resulting in an incidental durotomy incidence of 1.07%. Seventy percent of the durotomies were reported by 20.4% of the surgeons. Eliminating these 19 outlier surgeons yielded an adjusted durotomy rate of 0.32. Endoscopic stenosis decompression (54.8%; < .0001), rather than endoscopic discectomy (44.1%; 41/93), was significantly more associated with durotomy. Medium-sized dural tears (1-10 mm) were the most common (52.2%; 48/93). Small pinhole durotomies (less than 1 mm) were the second most common type (46.7%; 43/93). Rootlet herniations were seen by 46.2% (43/93) of responding surgeons. The posterior dural sac injury during the interlaminar approach (57%; 53/93) occurred more frequently than traversing nerve-root injuries (31.2%) or anterior dural sac (23.7%; 22/93). Exiting nerve-root injuries (10.8%;10/93) were less common. Over half of surgeons did not attempt any repair or closure (52.2%; 47/90). Forty percent (36/90) used sealants. Only 7.8% (7/90) of surgeons attempted an endoscopic repair or sutures (11.1%; 10/90). DuralSeal was the most commonly used brand of commercially available sealant used (42.7%; 35/82). However, other sealants such as Tisseal (15.9%; 13/82), Evicel (2.4%2/82), and additional no-brand sealants (38; 32/82) were also used. Nearly half of the patients (48.3%; 43/89) were treated with 24-48 hours of bed rest. The majority of participating surgeons (64%; 57/89) reported that the long-term outcome was unaffected. Only 18% of surgeons reported having seen the development of a postoperative cerebrospinal fluid (CSF)-fistula (18%;16/89). However, the absolute incidence of CSF fistula was only 0.025% (16/64 470). Severe radiculopathy with dysesthesia; sensory loss; and motor weakness in association with an incidental durotomy were reported by 12.4% (11/89), 3.4% (3/89), and 2.2% (2/89) of surgeons, respectively.

Conclusions: The incidence of dural tears with lumbar endoscopy is about 1%. The incidence of durotomy is higher with the use of power drills and the interlaminar approach. Stenosis decompression that typically requires the more aggressive use of these power instruments has a slightly higher incidence of dural tears than does endoscopic decompression for a herniated disc. Most dural tears are small and can be successfully managed with mechanical compression with Gelfoam and sealants. Two-thirds of patients with incidental dural tears had an entirely uneventful postoperative course. The remaining one-third of patients may develop a persistent CSF leak, radiculopathy with dysesthesia, sensory loss, or motor function loss. Patients should be educated preoperatively and reassured.

Level Of Evidence: 3.
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http://dx.doi.org/10.14444/8038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8059391PMC
April 2021

Can EEG Be Adopted as a Neuroscience Reference for Assessing Software Programmers' Cognitive Load?

Sensors (Basel) 2021 Mar 27;21(7). Epub 2021 Mar 27.

Department of Informatics Engineering, CISUC-Centre for Informatics and Systems of the University of Coimbra, University of Coimbra, P-3030-790 Coimbra, Portugal.

An emergent research area in software engineering and software reliability is the use of wearable biosensors to monitor the cognitive state of software developers during software development tasks. The goal is to gather physiologic manifestations that can be linked to error-prone scenarios related to programmers' cognitive states. In this paper we investigate whether electroencephalography (EEG) can be applied to accurately identify programmers' cognitive load associated with the comprehension of code with different complexity levels. Therefore, a controlled experiment involving 26 programmers was carried. We found that features related to Theta, Alpha, and Beta brain waves have the highest discriminative power, allowing the identification of code lines and demanding higher mental effort. The EEG results reveal evidence of mental effort saturation as code complexity increases. Conversely, the classic software complexity metrics do not accurately represent the mental effort involved in code comprehension. Finally, EEG is proposed as a reference, in particular, the combination of EEG with eye tracking information allows for an accurate identification of code lines that correspond to peaks of cognitive load, providing a reference to help in the future evaluation of the space and time accuracy of programmers' cognitive state monitored using wearable devices compatible with software development activities.
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http://dx.doi.org/10.3390/s21072338DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8037053PMC
March 2021

Perinatal Outcome of Selective Intrauterine Growth Restriction in Monochorionic Twins: Evaluation of a Retrospective Cohort in a Developing Country.

Twin Res Hum Genet 2021 02 22;24(1):37-41. Epub 2021 Mar 22.

Department of Obstetrics, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz (IFF/Fiocruz), Rio de Janeiro, Brazil.

Selective intrauterine growth restriction (sIUGR) in monochorionic twin pregnancies is associated with greater morbidity and mortality for both fetuses when compared to singleton and dichorionic pregnancies. This retrospective cohort study aimed to assess the perinatal outcomes of monochorionic twin pregnancies affected by this disorder and conducted expectantly, by analyzing the results according to the end-diastolic flow in the umbilical artery Doppler of the smaller twin (type I: persistently forward/type II: persistently absent or reversed/type III: intermittently absent or reversed). Seventy-five monochorionic diamniotic twin pregnancies with sIUGR were included in this study. sIUGR was defined by estimated fetal weight below the 3rd centile for gestational age, or below the 10th centile, when associated with at least one of the following three criteria: abdominal circumference below the 10th percentile, umbilical artery pulsatility index of the smaller twin above the 95th percentile, or estimated fetal weight discordance of 25% or more. Perinatal outcomes were analyzed from the prenatal period to hospital discharge and included perinatal death, neurological injury, retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and sepsis. The mortality rate was 1.33% in this cohort. The overall morbidity rate was lower in type I twin pregnancies. In conclusion, this study shows that sIUGR type I has lower morbidity than types II and III in expectant management.
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http://dx.doi.org/10.1017/thg.2021.7DOI Listing
February 2021

Heart rate variability analysis for the identification of the preictal interval in patients with drug-resistant epilepsy.

Sci Rep 2021 Mar 16;11(1):5987. Epub 2021 Mar 16.

University of Coimbra, Centre for Informatics and Systems of the University of Coimbra, Department of Informatics Engineering, Coimbra, Portugal.

Electrocardiogram (ECG) recordings, lasting hours before epileptic seizures, have been studied in the search for evidence of the existence of a preictal interval that follows a normal ECG trace and precedes the seizure's clinical manifestation. The preictal interval has not yet been clinically parametrized. Furthermore, the duration of this interval varies for seizures both among patients and from the same patient. In this study, we performed a heart rate variability (HRV) analysis to investigate the discriminative power of the features of HRV in the identification of the preictal interval. HRV information extracted from the linear time and frequency domains as well as from nonlinear dynamics were analysed. We inspected data from 238 temporal lobe seizures recorded from 41 patients with drug-resistant epilepsy from the EPILEPSIAE database. Unsupervised methods were applied to the HRV feature dataset, thus leading to a new perspective in preictal interval characterization. Distinguishable preictal behaviour was exhibited by 41% of the seizures and 90% of the patients. Half of the preictal intervals were identified in the 40 min before seizure onset. The results demonstrate the potential of applying clustering methods to HRV features to deepen the current understanding of the preictal state.
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http://dx.doi.org/10.1038/s41598-021-85350-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7966782PMC
March 2021

Community health workers' attitudes, practices and perceptions towards the COVID-19 pandemic in brazilian low-income communities.

Work 2021 ;68(1):3-11

Centro de Estudos Estratégicos, Fundação Oswaldo Cruz -FIOCRUZ, Rio de Janeiro, RJ, Brazil.

Background: Community Health Workers (CHW) are a category of social workers described in many countries' health systems as responsible for engaging people in their residences and communities, and other non-clinical spaces to enable access to health services, especially in low-income areas. These professionals have been exposed to numerous new risks during the COVID-19 pandemic.

Objective: This study describes how the COVID-19 pandemic is perceived by CHWs who work in poor communities or slums in Brazil.

Methods: We conducted an online survey with a random sample of 775 CHWs operating in 368 municipalities of the 26 Brazilian states. At a confidence level of 95%, results of the survey were subject to a maximum sampling error of 4%.

Results: Our data indicate that the negationist agenda increases the challenges to the performance of CHWs within low-income communities, preventing the consensus on the necessity of social distancing, business closures and other measures to face the COVID-19 pandemic.

Conclusion: The pandemic imposes unexpected challenges on the usual modes of interaction of public health officers with poor communities. This study provides evidence that these challenges have been ignored or minimized in Brazilian policy prescriptions for primary care in the face of the COVID-19 pandemic.
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http://dx.doi.org/10.3233/WOR-205000DOI Listing
February 2021

Social networks applied to Dengue, H1N1, and Zika epidemics: An integrative literature review.

Work 2020 ;67(3):721-732

Programa de Pós Graduação em Informática, Universidade Federal do Rio de Janeiro PPGI/UFRJ, Rio de Janeiro, Brazil.

Background: Health crises occur both regionally and globally. Online social networks are widely used technical resources that allow users to share large amounts of information with increasing reach and velocity. Thus, the capacity of spreading information about epidemics through social media allows members of a population and health professionals or agencies to collaborate.

Method: This study presents results obtained in an integrative review, including examples of how social media enabled collaboration in health surveillance to treat the epidemies of Dengue, Zika, and H1N1. The literature review covers studies published between 2009 and 2017.

Results: The studies reviewed indicate that social media interactions are tools for the rapid dissemination of information. These networks operate at low cost and allow information to reach audiences in need of information and who otherwise would not receive it. Social media allowed researchers to monitor evolving epidemics and obtain epidemiological data useful for decision-making in health surveillance.

Conclusions: Despite the widespread use of social networks, there are opportunities for improvement, especially in technology for treatment.
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http://dx.doi.org/10.3233/WOR-203321DOI Listing
June 2021

Evaluation of Osteoconduction of a Synthetic Hydroxyapatite/β-Tricalcium Phosphate Block Fixed in Rabbit Mandibles.

Materials (Basel) 2020 Oct 31;13(21). Epub 2020 Oct 31.

Department of Diagnosis and Surgery, Araçatuba Dental School, São Paulo State University Júlio de Mesquita Filho-UNESP, Araçatuba, SP 16 015 050, São Paulo, Brazil.

(1) Background: This study aimed to evaluate the incorporation of hydroxyapatite/β-tricalcium phosphate blocks grafted in rabbit mandibles. (2) Methods: Topographic characterization of biomaterial was performed through scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy (SEM-EDX). Ten rabbits randomly received autogenous bone graft harvested from the tibia (Autogenous Group-AG) or synthetic biomaterial manufactured in β-tricalcium phosphate (Biomaterial Group-BG) at their right and left mandibular angles. Euthanasia was performed at 30 and 60 postoperative days; (3) Results: SEM-EDX showed a surface with the formation of crystals clusters. Histological analyses in BG at 30 days showed a slower process of incorporation than AG. At 60 days, BG showed remnants of biomaterial enveloped by bone tissue in the anabolic modeling phase. Histometric analysis showed that mean values of newly formed bone-like tissue in the AG (6.56%/9.70%) were statistically higher compared to BG (3.14%/6.43%) in both periods, respectively. Immunohistochemical analysis demonstrated early bone formation and maturation in the AG with more intense osteopontin and osteocalcin staining. (4) Conclusions: The biomaterial proved to be a possible bone substitute, being incorporated into the receiving bed; however, it showed delayed bone incorporation compared to autogenous bone.
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http://dx.doi.org/10.3390/ma13214902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7662777PMC
October 2020

Does photobiomodulation therapy combined to static magnetic field (PBMT-sMF) promote ergogenic effects even when the exercised muscle group is not irradiated? A randomized, triple-blind, placebo-controlled trial.

BMC Sports Sci Med Rehabil 2020 26;12:49. Epub 2020 Aug 26.

Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Nove de Julho University, Rua Vergueiro, 235/249, São Paulo, SP 01504-001 Brazil.

Background: The direct application of photobiomodulation therapy (PBMT) using low-level laser therapy (LLLT) and light emitting diodes (LEDs) combined with a static magnetic field (sMF) (PBMT-sMF) to target tissues is shown to improve muscle performance and recovery. Studies have reported possible PBMT effects when a local distant to the target tissue is irradiated. Notably, the extent of these effects on musculoskeletal performance and the optimal site of irradiation remain unclear, although this information is clinically important since these aspects could directly affect the magnitude of the effect. Therefore, we investigated the effects of local and non-local PBMT-sMF irradiations on musculoskeletal performance and post-exercise recovery before an eccentric exercise protocol.

Methods: This randomized, triple-blind (participants, therapists and assessors), placebo-controlled trial included 30 healthy male volunteers randomly assigned to the placebo, local, and non-local groups. Active or placebo PBMT-sMF was applied to 6 sites of the quadriceps muscle of both legs. An eccentric exercise protocol was used to induce fatigue. The primary outcome was peak torque assessed by maximal voluntary contraction (MVC). The secondary outcomes were delayed onset muscle soreness (DOMS) measured by visual analogue scale (VAS), muscle injury assessed by serum creatine kinase activity (CK), and blood lactate levels. Evaluations were performed before the eccentric exercise protocol (baseline), as well as immediately after and 1, 24, 48, and 72 h upon protocol completion.

Results: Ten volunteers were randomized per group and analysed for all outcomes. Compared to the placebo and non-local groups, irradiation with PBMT-SMF led to statistically significant improvement ( < 0.05) with regard to all variables in the local group. The outcomes observed in the non-local group were similar to those in the placebo group with regard to all variables.The volunteers did not report any adverse effects.

Conclusion: Our results support the current evidence that local irradiation of all exercised muscles promotes ergogenic effects. PBMT-sMF improved performance and reduced muscle fatigue only when applied locally to muscles involved in physical activity.

Trial Registration: NCT03695458. Registered October 04th 2018.
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http://dx.doi.org/10.1186/s13102-020-00197-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7448464PMC
August 2020

Can photobiomodulation therapy be an alternative to pharmacological therapies in decreasing the progression of skeletal muscle impairments of mdx mice?

PLoS One 2020 12;15(8):e0236689. Epub 2020 Aug 12.

Department of Global Public Health and Primary Care, Physiotherapy Research Group, University of Bergen, Bergen, Norway.

Objective: To compare the effects of photobiomodulation therapy (PBMT) and pharmacological therapy (glucocorticoids and non-steroidal anti-inflammatory drugs) applied alone and in different combinations in mdx mice.

Methods: The animals were randomized and divided into seven experimental groups treated with placebo, PBMT, prednisone, non-steroidal anti-inflammatory drug (NSAIDs), PBMT plus prednisone and PBMT plus NSAID. Wild type animals were used as control. All treatments were performed during 14 consecutive weeks. Muscular morphology, protein expression of dystrophin and functional performance were assessed at the end of the last treatment.

Results: Both treatments with prednisone and PBMT applied alone or combined, were effective in preserving muscular morphology. In addition, the treatments with PBMT (p = 0.0005), PBMT plus prednisone (p = 0.0048) and PBMT plus NSAID (p = 0.0021) increased dystrophin gene expression compared to placebo-control group. However, in the functional performance the PBMT presented better results compared to glucocorticoids (p<0.0001). In contrast, the use of NSAIDs did not appear to add benefits to skeletal muscle tissue in mdx mice.

Conclusion: We believe that the promising and optimistic results about the PBMT in skeletal muscle of mdx mice may in the future contribute to this therapy to be considered a safe alternative for patients with Duchenne Muscular Dystrophy (DMD) in a washout period (between treatment periods with glucocorticoids), allowing them to remain receiving effective and safe treatment in this period, avoiding at this way periods without administration of any treatment.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236689PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7423120PMC
October 2020

Feasibility of Using Intraoperative Neuromonitoring in the Prophylaxis of Dysesthesia in Transforaminal Endoscopic Discectomies of the Lumbar Spine.

Brain Sci 2020 Aug 5;10(8). Epub 2020 Aug 5.

The Federal University of the State of Rio de Janeiro UNIRIO, Pain and Spine Minimally Invasive Surgery Service at Gaffrée Guinle University Hospital HUGG, Tijuca, Rio de Janeiro 20270-004 RJ, Brazil.

(1) Background: Postoperative nerve root injury with dysesthesia is the most frequent sequela following lumbar endoscopic transforaminal discectomy. At times, it may be accompanied by transient and rarely by permanent motor weakness. The authors hypothesized that direct compression of the exiting nerve root and its dorsal root ganglion (DRG) by manipulating the working cannula or endoscopic instruments may play a role. (2) Objective: To assess whether intraoperative neurophysiological monitoring can help prevent nerve root injury by identifying neurophysiological events during the initial placement of the endoscopic working cannula and the directly visualized video endoscopic procedure. (3) Methods: The authors performed a retrospective chart review of 65 (35 female and 30 male) patients who underwent transforaminal endoscopic decompression for failed non-operative treatment of lumbar disc herniation from 2012 to 2020. The patients' age ranged from 22 to 86 years, with an average of 51.75 years. Patients in the experimental group (32 patients) had intraoperative neurophysiological monitoring recordings using sensory evoked (SSEP), and transcranial motor evoked potentials (TCEP), those in the control group (32 patients) did not. The SSEP and TCMEP data were analyzed and correlated to the postoperative course, including dysesthesia and clinical outcomes using modified Macnab criteria, Oswestry disability index (ODI), visual analog scale (VAS) for leg and back pain. (4) Results: The surgical levels were L4/L5 in 44.6%, L5/S1 in 23.1%, and L3/L4 in 9.2%. Of the 65 patients, 56.9% (37/65) had surgery on the left, 36.9% (24/65) on the right, and the remaining 6.2% (4/65) underwent bilateral decompression. Postoperative dysesthesia occurred in 2 patients in the experimental and six patients in the control group. In the experimental neuromonitoring group, there was electrodiagnostic evidence of compression of the exiting nerve root's DRG in 24 (72.7%) of the 32 patients after initial transforaminal placement of the working cannula. A 5% or more decrease and a 50% or more decrease in amplitude of SSEPs and TCEPs recordings of the exiting nerve root were resolved by repositioning the working cannula or by pausing the root manipulation until recovery to baseline, which typically occurred within an average of 1.15 min. In 15 of the 24 patients with such latency and amplitude changes, a foraminoplasty was performed before advancing the endoscopic working cannula via the transforaminal approach into the neuroforamen to avoid an impeding nerve root injury and postoperative dysesthesia. (5) Conclusion: Neuromonitoring enabled the intraoperative diagnosis of DRG compression during the initial transforaminal placement of the endoscopic working cannula. Future studies with more statistical power will have to investigate whether employing neuromonitoring to avoid intraoperative compression of the exiting nerve root is predictive of lower postoperative dysesthesia rates in patients undergoing videoendoscopic transforaminal discectomy.
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http://dx.doi.org/10.3390/brainsci10080522DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465602PMC
August 2020

Roadmap for the development of a resilience indicator system for protection and civil defense organizations: A literature review of the evidence.

Work 2020 ;66(3):587-601

Comissão Nacional de Energia Nuclear, Instituto de Engenharia Nuclear, Cidade Universitária, Ilha do Fundão, Rio de Janeiro, Brazil.

Background: Disasters are the result of adverse events that cause human, material, environmental, and economic and social damage. To deal with disaster management, prevention, response, and recovery organizations need a system of indicators to measure their resilience.

Objective: To develop a road map to select indicators of organizational, institutional and governmental resilience to be applied to evaluate the resilience of public Protection and Civil Defense Organizations (PCDOs) of developing countries.

Method: A literature review on resilience indicators for disaster management using Scopus database, identifying and classifying the resilience indicators available in the scientific literature, to discuss the possibilities of their application in PCDOs.

Results: Resilience indicators for disaster management available in the literature have many diverse classifications and they were developed for the evaluation of communities' resilience. The literature review results also indicated that there is a lack of indicators to evaluate PCDOs' resilience.

Conclusions: Indicators of the institutional, organizational and governmental categories identified in the review, originally developed for the evaluation of communities' resilience, can be used to compose a hybrid system of resilience indicators able to measure the resilience of PCDOs.
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http://dx.doi.org/10.3233/WOR-203201DOI Listing
June 2021

Three photobiomodulation protocols in the prevention/treatment of radiotherapy-induced oral mucositis.

Photodiagnosis Photodyn Ther 2020 Sep 30;31:101906. Epub 2020 Jun 30.

Stomatology Department- A.C. Camargo Cancer Center, Sao Paulo, Brazil; Stomatology Department School of Dentistry, Sao Paulo University, Sao Paulo, Brazil. Electronic address:

Purpose: To compare three Photobiomodulation protocols to prevent/treat oral mucositis associated to radiotherapy.

Methods: Seventy-three patients with cancer in oral cavity, oropharynx, and nasopharynx, who underwent RT with dose in facial fields equal or higher than 6000 cGy were randomized into three groups (mean RT dose = 66 cGy ±4.9). Protocols of Group 1 was 660 nm, 15 mW, 3.8 J/cm2, Group 2 660 nm, 25 mW, 6.3 J/cm2 both starting on the first day of radiotherapy, and group 3 660 nm, 15 mW, 3.8 J/cm2 for therapeutic purpose. The patients of group 1 and 2 were irradiated at 40 points daily covering non-keratinizing oral mucosa. The spot size (probe's tip surface size) was 0.040 cm2 for all groups. Oral mucositis was evaluated according to both WHO and NCI scales, and pain related to oral mucositis was scored using the VAS.

Results: Patients from group 1 presented with grade II oral mucositis later than groups 2 and 3 (p < 0.001). Moreover, groups 2 and 3 also presented with a mean higher of oral mucositis grade than group 1, p < 0.001. Pain scores were lower in group 1 (p = 0.002).

Conclusions: The Photobiomodulation used in Group 1 was more effective than the protocols used in groups 2 and 3 in controlling the grade II oral mucositis intensity, and mean pain scores.
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http://dx.doi.org/10.1016/j.pdpdt.2020.101906DOI Listing
September 2020

Minimal Clinically Important Difference in Patient-Reported Outcome Measures with the Transforaminal Endoscopic Decompression for Lateral Recess and Foraminal Stenosis.

Int J Spine Surg 2020 Apr 30;14(2):254-266. Epub 2020 Apr 30.

University of New Mexico School of Medicine Department of Neurosurgery Albuquerque, New Mexico; Desert Institute for Spine Care, Phoenix, Arizona.

Background: Patient-reported outcome measures (PROMs) have become widely used to better measure patients' judgment of treatment benefits from surgical spine care. The concept of determining the minimal clinically important differences (MCIDs) of PROMs is aimed at assessing the benefits of lumbar spine care that are meaningful to the patient. The goal of this study was to validate the utility of MCIDs of the visual analog score (VAS) and Oswestry Disability Index (ODI) in patients with sciatica-type low back and leg pain due to lateral recess and foraminal stenosis who were treated with directly visualized transforaminal outpatient endoscopic decompression.

Methods: The retrospective study population consisted of 406 patients on whom PROMs were obtained preoperatively, and again postoperatively at final follow-up. Employing an anchor-based approach with a patient satisfaction index based on the modified Macnab criteria, a receiver operating characteristics (ROC) and area under the curve (AUC) analysis was performed using IBM SPSS 25.0 to define the optimal MCID in VAS and ODI with the transforaminal endoscopy using the top-left-corner criteria and the Youden index. Improvements in walking endurance were recorded as an additional parameter of patient functioning and correlated with PROMs to test for statistical significance.

Results: The patients' average age was 41.08 years, ranging from 30 to 84 years. The mean follow-up was 33.59 months, ranging from 24 to 85 months, with a standard deviation of 12.79. The MCIDs for VAS and ODI were 2.5 to 3.5 and 15 to 16.5, respectively. Patients were dichotomized as improved (377/406; 92.9%) if they reported excellent (224/406; 55.2%), good (112/406; 27.6%), and fair (41/406; 10.1%) Macnab outcomes. Patients were dichotomized as failed if they reported poor (29/406; 7.1%) Macnab outcomes. Preoperatively, only 32.5% (132/406) of patients had unlimited walking endurance compared to 77.6% (315/406) of patients postoperatively. The ROC and AUC analysis showed better accuracy with the single-integer VAS score (0.926) than with the 10-item ODI score (0.751).

Conclusions: Transforaminal outpatient endoscopic decompression for symptomatic foraminal and lateral recess stenosis is an effective surgical treatment to alleviate sciatica-type and back symptoms in 92.9% of patients. Of the PROMs analyzed, the VAS provided a more meaningful and accurate reflection of patients' interpretation of outcome with the transforaminal endoscopic spinal decompression procedure than ODI. Understanding which patient expectations drive these MCIDs may aid in replacing open surgeries for sciatica-type low back and leg pain currently preferred by traditional spine surgeons with a personalized early-staged transforaminal endoscopic hybrid decompressive/ablative procedures favored by the authors. These may prove more cost effective by focusing on significant pain generators validated with a diagnostic interventional workup instead of employing image-based indication criteria for surgery.
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http://dx.doi.org/10.14444/7034DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188088PMC
April 2020

Does the combination of photobiomodulation therapy (PBMT) and static magnetic fields (sMF) potentiate the effects of aerobic endurance training and decrease the loss of performance during detraining? A randomised, triple-blinded, placebo-controlled trial.

BMC Sports Sci Med Rehabil 2020 10;12:23. Epub 2020 Apr 10.

1Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Nove de Julho University, Rua Vergueiro, 235/249, São Paulo, SP 01504-001 Brazil.

Background: Photobiomodulation (PBMT) is a therapy that uses non-ionising forms of light, including low-level lasers and light-emitting diodes (LEDs) that may be capable of modulating cellular activity. Some biological processes may also interact with static magnetic fields (sMF), leading to modulatory effects on cells. Previous studies have verified that the combination of PBMT and sMF (PBMT/sMF) enhances the performance of individuals during aerobic training programs. The detraining period can cause losses in aerobic capacity. However, there is no evidence of the existence of any recourse that can decrease the effects of detraining. We aimed to investigate the effects of PBMT/sMF application during training and detraining to assess the effectiveness of this treatment in reducing the effects of detraining.

Methods: Sixty male volunteers were randomly allocated into four groups- participants who received PBMT/sMF during the training and detraining (PBMT/sMF + PBMT/sMF); participants who received PBMT/sMF during the training and a placebo in the detraining (PBMT/sMF + Placebo); participants who received a placebo during the training and PBMT/sMF in the detraining (Placebo+PBMT/sMF); and participants who received a placebo during the training and detraining (Placebo+Placebo). Participants performed treadmill training over 12 weeks (3 sessions/week), followed by 4 weeks of detraining. PBMT/sMF was applied using a 12-diode emitter (four 905 nm super-pulsed lasers, four 875 nm light-emitting diodes (LEDs), four 640 nm LEDs, and a 35 mT magnetic field) at 17 sites on each lower limb (dosage: 30 J per site). The data were analysed by two-way repeated measures analysis of variance (ANOVA, time vs experimental group) with post-hoc Bonferroni correction.

Results: The percentage of change in time until exhaustion and in maximum oxygen consumption was higher in the PBMT/sMF + PBMT/sMF group than in the Placebo+Placebo group at all time-points ( < 0.05). Moreover, the percentage of decrease in body fat at the 16th week was higher in the PBMT/sMF + PBMT/sMF group than in the Placebo+Placebo group ( < 0.05).

Conclusions: PBMT/sMF can potentiate the effects of aerobic endurance training and decrease performance loss after a 4-week detraining period. Thus, it may prove to be an important tool for both amateur and high-performance athletes as well as people undergoing rehabilitation.

Trial Registration: NCT03879226. Trial registered on 18 March 2019.
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http://dx.doi.org/10.1186/s13102-020-00171-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7147046PMC
April 2020

Evaluation of immediate cell viability and repair of osteotomies for implants using drills and piezosurgery. A randomized, prospective, and controlled rabbit study.

Clin Implant Dent Relat Res 2020 Jun 14;22(3):250-260. Epub 2020 Apr 14.

Bauru School of Dentistry, University of São Paulo--USP, São Paulo, Brazil.

Purpose: The objective of this study was to evaluate the immediate bone damage and bone repair after osteotomy for implants using conventional drills and drills powered by piezoelectric motor.

Materials And Methods: Twelve rabbits received a tibial osteotomy with a conventional drill (control), with a diamond like carbon drill (DLC) and with a piezoelectric drill (Piezo). The animals were euthanized immediately, 30 and 60 days postoperatively. The tibias were removed and analyzed by means of histomorphometry, immunohistochemistry and microtomography.

Results: The immediate damage to the tissue at the cavity margins was similar (P > .05). At 30 and 60 days, the amount of newly formed bone tissue was similar (P > .05). Osteocalcin was intense score at 60 days in Piezo group. Microtomography revealed that bone volume at 30 days (control 3.8; DLC 4.3; and Piezo 2.4) and 60 days (control 4.9; DLC 4.82; and Piezo 3.95) were similar. There was a significant difference in bone formation between 30 (2.4) and 60 days (3.95) for the Piezo group (P = .016).

Conclusion: The immediate effects and repair of cavities made using conventional, DLC coated, or ultrasound drills were similar.
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http://dx.doi.org/10.1111/cid.12907DOI Listing
June 2020

Virtual Reality Immersion Rescales Regulation of Interpersonal Distance in Controls but not in Autism Spectrum Disorder.

J Autism Dev Disord 2020 Dec;50(12):4317-4328

Univ Coimbra, CIBIT - Coimbra Institute for Biomedical Imaging and Translational Research, ICNAS - Institute for Nuclear Sciences Applied to Health, Coimbra, Portugal.

Interpersonal distance (IPD) is a simple social regulation metric which is altered in autism. We performed a stop-distance paradigm to evaluate IPD regulation in autism spectrum disorder (ASD) and control groups in a real versus a virtual environment mimicking in detail the real one. We found a bimodal pattern of IPDs only in ASD. Both groups showed high IPD correlations between real and virtual environments, but the significantly larger slope in the control group suggests rescaling, which was absent in ASD. We argue that loss of nuances like non-verbal communication, such as perception of subtle body gestures in the virtual environment, lead to changed regulation of IPD in controls, whilst ASD participants show similar deficits in perceiving such subtle cues in both environments.
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http://dx.doi.org/10.1007/s10803-020-04484-6DOI Listing
December 2020

Unexpected Thiocyanate Adsorption onto Ferrihydrite Under Prebiotic Chemistry Conditions.

Orig Life Evol Biosph 2020 Jun 7;50(1-2):57-76. Epub 2020 Apr 7.

Departamento de Ciências Fisiológicas, Laboratório de Fisiologia Neuroendocrina--LaFiNen, Universidade Estadual de Londrina, Londrina, PR, CEP 86 057-970, Brazil.

The most crucial role played by minerals was in the preconcentration of biomolecules or precursors of biomolecules in prebiotic seas. If this step had not occurred, molecular evolution would not have occurred. Thiocyanate is an important molecule in the formation of biomolecules as well as a catalyst for prebiotic reactions. The adsorption of thiocyanate onto ferrihydrite was carried out under pH and ion composition conditions in seawater that resembled those of prebiotic Earth. The seawater used in this work had high Mg, Ca and SO concentrations. The most important result of this work was that ferrihydrite adsorbed thiocyanateata pH value (7.2 ± 0.2) that usually does not adsorb thiocyanate. The high adsorptivity of Mg, Ca and SOonto ferrihydrite showed that seawater ions can act as carriers of thiocyanate to the ferrihydrite surface, creating a huge outer-sphere complex. Kinetic adsorption and isotherm experiments showed the best fit for the pseudo-second-order model and an activation energy of 23.8 kJ molforthe Langmuir-Freundlich model, respectively. Thermodynamic data showed positive ΔG values, which apparently contradict the adsorption isotherm data and kinetic data that was obtained. The adsorption of thiocyanate onto ferrihydrite could be explained by coupling with the exergonic SO adsorption onto ferrihydrite. The FTIR spectra showed no difference between the C≡N stretching peaks of adsorbed thiocyanate and free thiocyanate, corroborating the formation of an outer-sphere complex. All the results demonstrated the importance of the artificial seawater composition for the adsorption of thiocyanate and for understanding prebiotic chemistry.
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http://dx.doi.org/10.1007/s11084-020-09594-wDOI Listing
June 2020

Antioxidant, anti-inflammatory and healing potential of ethyl acetate fraction of Bauhinia ungulata L. (Fabaceae) on in vitro and in vivo wound model.

Mol Biol Rep 2020 Apr 1;47(4):2845-2859. Epub 2020 Apr 1.

Laboratory of Immunology, Department of Clinical Analysis and Toxicology, Faculty of Pharmacy, Universidade Federal do Ceará (UFC), Rua Capitão Francisco Pedro 1210, Fortaleza, CE, CEP 60430-370, Brazil.

The present work aimed to investigate the antioxidant, anti-inflammatory and wound healing potential of ethyl acetate fraction from Bauhinia ungulata L. (FABU) on in vitro and in vivo models. Wound healing assay using human lung adenocarcinoma A549 cell line was employed to evaluate the ability of FABU in modulating cell migration. In addition, a surgical wound model in C57BL/6 mice was used to study the healing potential of FABU incorporated into gel carbomer 940 (Carbopol®). Evaluation of lipid peroxidation, inflammatory and anti-inflammatory mediator gene expression, rate of wound closure, and histological analysis were done. FABU significantly reduced the gap area in in vitro wound healing assay, 24 h after treatment. In the animal model, FABU at 0.5% topically applied once-daily for 5 days to the surgical wounds significantly reduced the lesion area. Moreover, it significantly decreased the levels of lipid peroxidation in the lesions and decreased the relative gene expression levels of IL-1β and TNF-α in the injured region. In conclusion, our study suggests that Bauhinia ungulata can effectively promote the wound healing, probably by regulating the inflammatory environment during the early stages of the process.
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http://dx.doi.org/10.1007/s11033-020-05332-7DOI Listing
April 2020

Indication and Contraindication of Endoscopic Transforaminal Lumbar Decompression.

World Neurosurg 2021 01 19;145:631-642. Epub 2020 Mar 19.

Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico; Associate, Desert Institute for Spine Care, Phoenix, Arizona, USA.

Background: The indications and contraindications to the endoscopic transforaminal approach for lumbar spinal stenosis are not well defined.

Methods: We performed a Kaplan-Meier durability survival analysis of patients with the following types of spinal stenosis: type I, central canal; type II, lateral recess; type III, foraminal; and type IV, extraforaminal. The 304 patients comprised 140 men and 164 women, with an average age of 51.68 ± 15.78 years. The average follow-up was 45.3 years (range, 18-90 years). The primary clinical outcome measures were the Oswestry Disability Index, visual analog scale, and the modified Macnab criteria.

Results: Of 304 study patients, 70 had type I (23.0%) stenosis, 42 type II (13.7%), 151 type III (49.7%), and 41 type IV (13.5%). Excellent outcomes were obtained in 114 patients (37.5%), good in 152 (50.0%), fair in 33 (10.9%), and poor in 5 (1.6%). Kaplan-Meier durability analysis of the clinical treatment benefit with the endoscopic transforaminal decompression surgery showed statistically significance differences (P < 0.0001) on log-rank (Mantel-Cox) χ testing between the estimated median (50% percentile) survival times of type I (28 months), type II (53 months), type III (32 months), and type IV (66 months).

Conclusions: We recommend stratifying patients based on the underlying compressive disease and the skill level of the endoscopic spine surgeon to decide preoperatively whether more difficult central or complex foraminal stenotic lesions should be considered for alternative endoscopic approaches.
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http://dx.doi.org/10.1016/j.wneu.2020.03.076DOI Listing
January 2021

Regional variations in acceptance, and utilization of minimally invasive spinal surgery techniques among spine surgeons: results of a global survey.

J Spine Surg 2020 Jan;6(Suppl 1):S260-S274

University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.

Background: Regional differences in acceptance and utilization of MISST by spine surgeons may have an impact on clinical decision-making and the surgical treatment of common degenerative conditions of the lumbar spine. The purpose of this study was to analyze the acceptance and utilization of various minimally invasive spinal surgery techniques (MISST) by spinal surgeons the world over.

Methods: The authors solicited responses to an online survey sent to spine surgeons by email, and chat groups in social media networks including Facebook, WeChat, WhatsApp, and Linkedin. Surgeons were asked the following questions: (I) Do you think minimally invasive spinal surgery is considered mainstream in your area and practice setting? (II) Do you perform minimally invasive spinal surgery? (III) What type of MIS spinal surgery do you perform? (IV) If you are performing endoscopic spinal decompression surgeries, which approach do you prefer? The responses were cross-tabulated by surgeons' demographic data, and their practice area using the following five global regions: Africa & Middle East, Asia, Europe, North America, and South America. Pearson Chi-Square measures, Kappa statistics, and linear regression analysis of agreement or disagreement were performed by analyzing the distribution of variances using statistical package SPSS Version 25.0.

Results: A total of 586 surgeons accessed the survey. Analyzing the responses of 292 submitted surveys regional differences in opinion amongst spine surgeons showed that the highest percentage of surgeons in Asia (72.8%) and South America (70.2%) thought that MISST was accepted into mainstream spinal surgery in their practice area (P=0.04) versus North America (62.8%), Europe (52.8%), and Africa & Middle East region (50%). The percentage of spine surgeons employing MISST was much higher per region than the rate of surgeons who thought it was mainstream: Asia (96.7%), Europe (88.9%), South America (88.9%), and Africa & Middle East (87.5%). Surgeons in North America reported the lowest rate of MISST implementation globally (P<0.000). Spinal endoscopy (59.9%) is currently the most commonly employed MISST globally followed by mini-open approaches (55.1%), and tubular retractor systems (41.8%). The most preferred endoscopic approach to the spine is the transforaminal technique (56.2%) followed by interlaminar (41.8%), full endoscopic (35.3%), and over the top MISST (13.7%).

Conclusions: The rate of implementation of MISST into day-to-day clinical practice reported by spine surgeons was universally higher than the perceived acceptance rates of MISST into the mainstream by their peers in their practice area. The survey suggests that endoscopic spinal surgery is now the most commonly performed MISST.
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http://dx.doi.org/10.21037/jss.2019.09.31DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7063310PMC
January 2020

Surgeon motivation, and obstacles to the implementation of minimally invasive spinal surgery techniques.

J Spine Surg 2020 Jan;6(Suppl 1):S249-S259

University of New Mexico School of Medicine, Albuquerque, New Mexico.

Background: This study aimed to analyze the motivators and obstacles to the implementation of minimally invasive spinal surgery techniques (MISST) by spinal surgeons. Motivators and detractors may impact the availability of MISST to patients and drive spine surgeons' clinical decision-making in the treatment of common degenerative conditions of the lumbar spine.

Methods: The authors solicited responses to an online survey sent to spine surgeons by email, and chat groups in social media networks including Facebook, WeChat, WhatsApp, and Linkedin. Descriptive statistics were employed to count the responses and compared to the surgeon's training. Kappa statistics and linear regression analysis of agreement were performed.

Results: A total of 430 surgeons accessed the survey. The completion rate was 67.4%. A total of 292 surveys were submitted by 99 neurosurgeons (33.9%), 170 orthopaedic surgeons (58.2%), and 23 surgeons of other postgraduate training (7.9%). Personal interest (82.5%) and patient demand (48.6%) were the primary motivators for MISST implementation. High equipment (48.3%) and disposables (29.1%) cost were relevant obstacles to MISST implementation. Local workshops (47.6%) and meetings in small groups (31.8%) were listed as the primary knowledge sources. Only 12% of surgeons were fellowship trained, but 46.3% of surgeons employed MISST in over 25% of their cases.

Conclusions: The rate of implementation of MISST reported by spine surgeons was found to be high but impeded by the high cost of equipment and disposables. The primary motivators for spine surgeons' desire to implement were personal interest and patient demand.
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http://dx.doi.org/10.21037/jss.2019.08.02DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7063314PMC
January 2020

Lumbar vacuum disc, vertical instability, standalone endoscopic interbody fusion, and other treatments: an opinion based survey among minimally invasive spinal surgeons.

J Spine Surg 2020 Jan;6(Suppl 1):S165-S178

University of New Mexico School of Medicine, Albuquerque, NM, USA.

Background: A diseased lumbar intervertebral vacuum disc void of any structurally intact tissue may be vertically unstable. A primary standalone endoscopic decompression and interbody fusion surgery in the treatment of vertical instability in patients with a vacuum disc may be a more reliable treatment than decompression alone.

Methods: The authors solicited responses to an online survey sent to spine surgeons by email, and chat groups on social media networks, including Facebook, WeChat, WhatsApp, and Linkedin. Descriptive and correlative statistics were employed to count the responses and compare the surgeon's responses recorded on a Likert scale from 1 (disagree) to 10 (agree) or in multiple-choice questions. Surgeons were asked about their familiarity with the concept of vacuum disc and vertical instability and how they would treat such patients. Kappa statistics and linear regression analysis of agreement of incoming responses were performed.

Results: A total of 1,165 surgeons accessed the survey. The completion rate was 22.78. The majority surgeons were very familiar with the concept of a "vacuum disc" as a sign of end-stage lumbar degenerative disc disease and a collapsing lumbar motion segment (182/273; 66.7%; Likert score 6.53). The majority of surgeons also thought that vertical instability precedes anterolateral lumbar instability (187/273; 68.5%; Likert score 6.64) and that a vacuum disc may cause vertical instability with symptomatic dynamic foraminal & lateral recess stenosis (222/273; 81%; Likert score 7.48), mechanical back pain (201/273; 73.1%; Likert score 7.48), and may cause sciatica-type low back and leg pain (179/273; 66.3%; Likert score 6.59). The majority of surgeons indicated that vacuum phenomenon on radiographic studies is associated with vertical instability and collapse resulting in dynamic foraminal and lateral recess stenosis and should be treated surgically (199/266; 73.7%; 7 missing responses; Likert score 6.86). Preferred treatments were decompression alone without fusion (P<0.014). There was consensus in support of fusion by TLIF or PLIF with a Likert score of 6.68 (184/266; 69.2%; 7 missing responses). There was no consensus on standalone fusion.

Conclusions: Vacuum phenomenon on radiographic studies is associated with a vertical instability and collapse, resulting in dynamic foraminal and lateral recess stenosis that should be treated surgically. Preferred surgical treatments were decompression alone, decompression with interbody fusion using just bone graft, and fusion employing TLIF or PLIF. Further research into the clinical significance of lumbar vacuum disc, vertical instability and its most appropriate surgical treatments if any is necessary.
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http://dx.doi.org/10.21037/jss.2019.11.02DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7063324PMC
January 2020

Outcomes with transforaminal endoscopic versus percutaneous laser decompression for contained lumbar herniated disc: a survival analysis of treatment benefit.

J Spine Surg 2020 Jan;6(Suppl 1):S84-S99

Endoscopic Surgery, Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.

Background: Contained lumbar disc herniations frequently cause back- and leg pain. Clinical outcomes with surgical treatment may be affected by the size and location of the disc herniation. The surgical directly visualized transforaminal endoscopic decompression has gained acceptance and popularity, while the simplified percutaneous laser disc decompression has fallen out of favor in spite of its initial success as a minimally invasive intervention. In an attempt to better understand the durability of both procedures, the authors performed a comparative analysis of clinical outcomes in patients with contained lumbar disc herniations.

Methods: The study population was comprised 248 patients consisting of 162 patients in the endoscopy group (group 1) and 86 patients in the laser group (group 2). Primary outcome measures were Macnab criteria. Herniations were classified as large or small. Additional parameters of advanced degeneration of the lumbar motion segment including posterior disc- and lateral recess height of <3 mm were recorded. IBM SPSS 25.0 was used for Kaplan-Meier survival analysis and cross-tabulation of these variables with statistical testing for significant associations.

Results: The mean follow-up was 43.5 months. The serial time recorded for Kaplan-Meier analysis ranged from 1.5 to 84 months. The mean age was 53.37 years (standard deviation =14.65 years). The majority of patients had and Macnab outcomes (212/248; 85.5%) regardless of treatment. and results were achieved in another 36 patients (14.5%). There was a higher percentage of Macnab outcomes in the endoscopy group (94/162; 58.0%) than in the laser group (38/86; 44.2%) at a statistical significant level (P<0.0001). There was a statistically significantly higher percentage of and Macnab outcomes with endoscopic decompression of small paracentral herniations (97.1%; P<0.0001). Percutaneous laser decompression of large central disc herniations was not statistically better than endoscopic surgical decompression (P=0.125). Endoscopic bony and soft tissue decompression was also better than laser at alleviating symptoms in patients with reduced posterior disc- and lateral recess height with 96.7% in patients with reduced disc height of <3 mm and 94% in patients with reduced lateral recess height of <3 mm (P=0.001). Kaplan-Meier (K-M) Survival time showed longer median survival of the treatment benefit for patients who underwent visualized endoscopic surgical decompression (66.0 months) compared to median K-M survival time for percutaneous laser decompression of 17 months (P<0.0001).

Conclusions: Transforaminal endoscopic decompression for symptomatic herniated disc is an effective and durable surgical treatment to alleviate sciatica-type and back symptoms in the vast majority of patients with good long-term survival of pain relief for up to six years. Interventional percutaneous non-visualized laser decompression for the same condition may provide favorable outcomes in the short-term with soft protrusions. However, the treatment effect deteriorates much faster with a median survival of 17 months.
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http://dx.doi.org/10.21037/jss.2019.09.13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7063304PMC
January 2020

Osteopromotion Capacity of Bovine Cortical Membranes in Critical Defects of Rat Calvaria: Histological and Immunohistochemical Analysis.

Int J Biomater 2020 18;2020:6426702. Epub 2020 Feb 18.

Department of Surgery and Integrated Clinic, Araçatuba Dental School, UNESP-São Paulo State University, Araçatuba, São Paulo, Brazil.

Membranes that aid the guided bone regeneration (GBR) process have been the subject of studies of compatible biomaterials that contribute to this repair process. The present study compared different membranes used in critical-size defects of rat calvaria by assessing GBR as well as histological, histomorphometric, and immunohistochemical reactions. Forty-eight male albino Wistar rats were randomly allocated into four groups ( = 12 each), namely, C: membrane-free control group (only blood clot, negative control group); BG: porcine collagen membrane group (Bio-Gide®, positive control group); GD: bovine cortical membrane group (first experimental group); and GDF: thicker bovine cortical membrane group (second experimental group). Rats were euthanized at 30 and 60 days postoperatively. Quantitative data from the histometric analysis were submitted to two-way ANOVA and Tukey's posttest when < 0.05. Histomorphometric results of the thicker bovine cortical membrane at 30 and 60 days were promising, showing improved new bone formation values ( < 0.05), and the CD group presented similar results in both analysis periods, being surpassed only by the GDF group ( < 0.05). The immunohistochemical results were associated with the histomorphometric data. A less-thick membrane also assisted in GBR. All membranes promoted GBR, especially the positive control and experimental groups.
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http://dx.doi.org/10.1155/2020/6426702DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7049411PMC
February 2020

Preictal Time Assessment using Heart Rate Variability Features in Drug-resistant Epilepsy Patients.

Annu Int Conf IEEE Eng Med Biol Soc 2019 Jul;2019:6776-6779

Epileptic seizures are by default associated with the occurrence of EEG changes as a consequence of alterations in brain activity seconds to hours before the seizure onset. Additionally, the influence of the autonomic nervous system may also be reflected in the electrocardiogram (ECG) trace. In both biosignals (EEG and ECG), differences have been reported between normal epochs, known as interictal periods and the interval preceding seizures, preictal period. However, the existence of a preictal state indicating the transition between epileptic brain states has not yet been clinically defined. In fact, some studies report differences in preictal location and duration among patients and among seizures occurring in the same patient as well. Based on the above, a study was designed in order to investigate the existence of a preictal interval specific for each seizure, using heart rate variability (HRV) features. Time and frequency domain features (linear and non-linear) were extracted from ECG data acquired in 37 drug-resistant epilepsy patients, comprised in EPILEPSIAE database. A total of 209 seizures occurring in the temporal lobe were analysed. The existence of a transition period before the seizure onset was inspected using a linear discriminant analysis classifier. The overall best performance (88.04%±12.30% of accuracy) was obtained by combining RRMean, NN50 and SD features when discriminating the 50 min of interictal located farthest from seizure onset from the nearest preictal 50 min.
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http://dx.doi.org/10.1109/EMBC.2019.8857897DOI Listing
July 2019

Infrared Low-Level Laser Therapy (Photobiomodulation Therapy) before Intense Progressive Running Test of High-Level Soccer Players: Effects on Functional, Muscle Damage, Inflammatory, and Oxidative Stress Markers-A Randomized Controlled Trial.

Oxid Med Cell Longev 2019 16;2019:6239058. Epub 2019 Nov 16.

Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Nove de Julho University, São Paulo, SP, Brazil.

The effects of preexercise photobiomodulation therapy (PBMT) to enhance performance, accelerate recovery, and attenuate exercise-induced oxidative stress were still not fully investigated, especially in high-level athletes. The aim of this study was to evaluate the effects of PBMT (using infrared low-level laser therapy) applied before a progressive running test on functional aspects, muscle damage, and inflammatory and oxidative stress markers in high-level soccer players. A randomized, triple-blind, placebo-controlled crossover trial was performed. Twenty-two high-level male soccer players from the same team were recruited and treated with active PBMT and placebo. The order of interventions was randomized. Immediately after the application of active PBMT or placebo, the volunteers performed a standardized high-intensity progressive running test (ergospirometry test) until exhaustion. We analyzed rates of oxygen uptake (VO), time until exhaustion, and aerobic and anaerobic threshold during the intense progressive running test. Creatine kinase (CK) and lactate dehydrogenase (LDH) activities, levels of interleukin-1 (IL-1-), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-), levels of thiobarbituric acid (TBARS) and carbonylated proteins, and catalase (CAT) and superoxide dismutase (SOD) activities were measured before and five minutes after the end of the test. PBMT increased the VO (both relative and absolute values- < 0.0467 and < 0.0013, respectively), time until exhaustion ( < 0.0043), time ( < 0.0007) and volume ( < 0.0355) in which anaerobic threshold happened, and volume in which aerobic threshold happened ( < 0.0068). Moreover, PBMT decreased CK ( < 0.0001) and LDH ( < 0.0001) activities. Regarding the cytokines, PBMT decreased only IL-6 ( < 0.0001). Finally, PBMT decreased TBARS ( < 0.0001) and carbonylated protein levels ( < 0.01) and increased SOD ( < 0.0001)and CAT ( < 0.0001) activities. The findings of this study demonstrate that preexercise PBMT acts on different functional aspects and biochemical markers. Moreover, preexercise PBMT seems to play an important antioxidant effect, decreasing exercise-induced oxidative stress and consequently enhancing athletic performance and improving postexercise recovery. This trial is registered with Clinicaltrials.gov NCT03803956.
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http://dx.doi.org/10.1155/2019/6239058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6885272PMC
May 2020

Acute effects of photobiomodulation therapy and magnetic field on functional mobility in stroke survivors: a randomized, sham-controlled, triple-blind, crossover, clinical trial.

Lasers Med Sci 2020 Aug 28;35(6):1253-1262. Epub 2019 Nov 28.

Laboratory of Phototherapy and Innovative Technologies in Health (LaPIT), Nove de Julho University (UNINOVE), Sao Paulo, Brazil.

Identify the optimal energy delivered with a single application of the combination of photobiomodulation therapy (PBMT) combining different light sources (low-level laser therapy-LLLT and light emitting diode therapy-LEDT) and static magnetic field (sMF) in order to determine the acute effects on functional mobility of stroke survivors. Was conducted a randomized, placebo-controlled, crossover, triple-blind, clinical trial (RCT). Twelve patients were recruited, however ten concluded the study, they were randomly treated with four PBMT/sMF energies (sham-0 J, 10 J, 30 J, and 50 J per site irradiated), with 1-week interval washout between treatments. PBMT/sMF were administered after the pre-intervention (baseline) evaluation and the total energy delivered per site at each treatment was determined based on the results of the randomization procedure. PBMT/sMF were administered in direct contact with the skin and applied with slight pressure to nine sites on the knee extensors, six sites on the knee flexors, and two sites on the plantar flexors' muscles in both lower limbs (bilaterally). The primary outcome measure was the 6-min walk test (6MWT) and the secondary outcome was the Timed Up and Go (TUG) test. Significant improvements were found in the 6MWT test using a total energy of 30 J per site compared with sham (0 J) (p < 0.05) and compared with the baseline evaluation (p < 0.01). And in the TUG test significant improvements were also found using a total energy per site of 30 J per site compared to sham (0 J) and baseline (p < 0.05). PBMT with different light sources (laser and LEDs) and wavelengths in combination with sMF with a total energy per site of 30 J has positive acute effects on functional mobility in stroke survivors.
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http://dx.doi.org/10.1007/s10103-019-02898-yDOI Listing
August 2020

Remodeling of calvarial graft in increased atrophic maxillary thickness. A prospective clinical study.

Clin Implant Dent Relat Res 2020 Feb 20;22(1):84-90. Epub 2019 Nov 20.

Bauru School of Dentistry, University of São Paulo - USP, São Paulo, Brazil.

Purpose: This study evaluated the autogenous graft resorption rate in a calvarial block graft in the anterior region of an atrophic maxilla and compared it with the thickness of the remaining ridge.

Materials And Methods: Twelve patients were included in the study. They were submitted to cranial calotte graft surgery, and there were 40 blocks in total. The thicknesses of the ridges in the crest, middle and apical regions of the blocks were evaluated by computed tomography scan at the times: preoperative (T0), 48 hours (T1) and 6 months (T2) after the reconstructions.

Results: The resorption of the blocks from T1 to T2 was 13.4%. The greatest remodeling occurred in the alveolar bone crest (20.07%), followed by the middle portion (12.28%), and the apical region (9.5%), but the three regions did not significantly differ between times T1 and T2 (crest P = .07, middle P = .124, apical P = .131). Recipient site with the lowest thickness had the greatest resorption rates (up to 2 mm = 17.6%; from 2 to 4 mm = 17.52%) while than those with a thickness greater than 4 mm had a mean resorption of 8.81%.

Conclusions: The resorption of the grafts in this study was 13.4%. Higher resorption rates were observed in the alveolar crest areas, where the ridges were less thick.
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http://dx.doi.org/10.1111/cid.12869DOI Listing
February 2020

Predictors of perinatal outcome in early-onset fetal growth restriction: A study from an emerging economy country.

Prenat Diagn 2020 02 3;40(3):373-379. Epub 2020 Jan 3.

Clinical Research Department, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira-Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.

Objective: To identify antenatal predictors of adverse perinatal outcomes in a population of preterm fetuses with early placental insufficiency diagnosed by Doppler abnormalities.

Method: In this cross-sectional study of a cohort of singleton pregnant women diagnosed with early placental insufficiency, relationships between perinatal variables (arterial and venous Doppler, gestational age, birth weight, oligohydramnios, estimated fetal weight, and fetal weight z-scores) and major neonatal complications were analyzed by logistic regression.

Results: Two hundred sixty-five women were delivered, between 24 and 33 weeks gestation. The overall frequency of intact survival was 57.9% (n = 154). Gestational age thresholds for best prediction of survival was 27 + 6 weeks and for intact survival was 29 + 0 weeks gestation. Fetal weight and absent/reversed ductus venosus a-wave were the main predictors of survival in the regression model. When fetal weight was substituted for fetal weight z-score, ductus venosus abnormal Doppler predicted mortality and absent or reversed umbilical artery diastolic velocities predicted intact survival.

Conclusions: This study illustrates the impact of gestational age and fetal weight on perinatal outcomes in early placental insufficiency, with well-defined thresholds. Gestational age and fetal weight, or a combination of fetal weight z-scores and fetal Doppler parameters, were the best predictors of intact survival in our sample.
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http://dx.doi.org/10.1002/pd.5596DOI Listing
February 2020