Turning Points in Professional Commitment Development: The Case of Novice Nurses.

We investigated the development of professional commitment over time and its relation to work experiences of novice nurses. We used a longitudinal mixed-method approach based on weekly reported quantitative commitment scores and qualitative descriptions of experiences. Specifically, we examined turning points in commitment trajectories and analyzed qualitative characteristics of the turning point. To determine a turning point, we firstly computed a smoothed trajectory for each individual and defined each point beyond the 95% interval of this smoothed trajectory as exceptional. Secondly, we explored whether the commitment development changed after an exceptional point with regard to the slope-valence or commitment strength. The sample consisted of 18 novice nurses. Two third of them revealed at least one turning point, thus the professional commitment development of novice nurses was characterized by peaks and dips that were followed by changes in the commitment development. The analysis showed that turning points followed by positive commitment development typically were characterized by positive experiences. These experiences often concerned relatedness or competence. Turning points followed by a negative development were not consistent: they could be positive, negative, or ambiguous experiences. Many of the negative experiences concerned negative organizational issues. We concluded that there is not a simple relation between commitment development and positive or negative characteristics of an experience. The context and underlying meaning of the experiences should be taken into account to interpret the commitment changes.

Physical Activity Levels and Body Mass Index in Sport Education. Is There a Difference?

Purpose: The goals of this study were: (1) to assess students' physical activity levels in a sport education season according to the phases of the model, adjusted for body mass index; (2) to uncover the contribution of the phases of the model to the World Health Organization recommendations; (3) to understand its impact in students with overweight/obesity. Methods: A total of 42 primary education students with a mean age of 10.68 ± 0.69 years, enrolled in one year 5 (10-11 years) and one year 6 (11-12 years). Physical Education lessons of the same school agreed to participate. Students in both groups experienced a 14-lesson learning unit in team handball through the sport education. Each participant wore an ActiGraph GT3X accelerometer to measure physical activity levels, counts/minute and steps counted. Cole and Lobstein cutoff points were used to determine groups based on body mass index (thin, normal-weight, overweight/obese). Results: The results showed that the overweight/obese group achieved scores for moderate to vigorous physical activity and sedentary time that were not significantly different from the normal-weight group. According to the phases, the preseason was the most active and contributed most to the World Health Organization recommendations in all groups. Conclusions: Sport education could be considered an appropriate pedagogical framework to help overweight/obese children achieve moderate-to-vigorous physical activity and sedentary scores similar to their normal-weight classmates. Key elements of sport education include performing roles, learning work routines, and having the autonomy to choose games/tasks, all of which promote physical activity amongst all students.

The development of a set of key points to aid clinicians and researchers in designing and conducting n-of-1 trials.

INTRODUCTION: n-of-1 trials are undertaken to optimise the evaluation of health technologies in individual patients. They involve a single patient receiving treatments, both interventional and control, consecutively over set periods of time, the order of which is decided at random. Although n-of-1 trials are undertaken in medical research it could be argued they have the utility to be undertaken more frequently. We undertook the National Institute for Health Research (NIHR) commissioned DIAMOND (Development of generalisable methodology for n-of-1 trials delivery for very low volume treatments) project to develop key points to assist clinicians and researchers in designing and conducting n-of-1 trials. METHODS: The key points were developed by undertaking a stakeholder workshop, followed by a discussion within the study team and then a stakeholder dissemination and feedback event. The stakeholder workshop sought to gain the perspectives of a variety of stakeholders (including clinicians, researchers and patient representatives) on the design and use of n-of-1 trials. A discussion between the study team was held to reflect on the workshop and draft the key points. Lastly, the stakeholders from the workshop were invited to a dissemination and feedback session where the proposed key points were presented and their feedback gained. RESULTS: A set of 22 key points were developed based on the insights from the workshop and subsequent discussions. They provide guidance on when an n-of-1 trial might be a viable or appropriate study design and discuss key decisions involved in the design of n-of-1 trials, including determining an appropriate number of treatment periods and cycles, the choice of comparator, recommended approaches to randomisation and blinding, the use of washout periods and approaches to analysis. CONCLUSIONS: The key points developed in the project will support clinical researchers to understand key considerations when designing n-of-1 trials. It is hoped they will support the wider implementation of the study design.

[Understanding and enlightenment of theoretical construction of Huatuo Jiaji (EX-B 2)].

The theory of Huatuo Jiaji (EX-B 2) is the representative of the knowledge construction of ancient anatomy, reflecting the academic thought of Huatuo's school. Through deeply analyzing the classic theory of acupuncture and its cultural and historical materials, it is believed that the five-body constituents are the structural basis of Huatuo Jiaji (EX-B 2), qi and blood are the material one, while biaoben (the sites where meridian qi gathers and diffuses) and qijie (the common pathways through which meridian qi gathers) indicate its functions. Huatuo Jiaji (EX-B 2) reveals the rules of the transverse distribution of meridian points and the relevant indications, providing the theoretic foundation for acupuncture treatment. It highlights the importance of the anatomical knowledge in acupuncture effect and proposes a new idea for establishing an effective classification system of meridian points.

Association between low handgrip strength and incontinence among Chinese middle-aged and older people: A cross-sectional study.

Objective: Incontinence seriously affects the lives of middle-aged and older people. Pelvic floor muscle assessment is very important for incontinence, and handgrip strength can be used as an auxiliary diagnostic tool. Our study aims to find new cutoff points of handgrip strength as early indicators of incontinence and analyze the association between low handgrip strength and incontinence among Chinese middle-aged and older people. Methods: Participants were recruited from the 2015 China Health and Retirement Longevity Study. Receiver operating characteristic (ROC) curves were used to find the handgrip strength cutoff point. Logistic regression analysis was performed to explore other incontinence-related risk factors. Results: The study included 10,229 middle-aged and older people. Compared with normal handgrip strength participants, medium strength participants had 1.510 [men, 95% confidence interval (CI) = 1.017-2.243] and 1.792 (women, 95% CI = 1.294-2.480) times greater risk of incontinence, and low strength participants had 2.420 (men, 95% CI = 1.787-3.277) and 1.516 (women, 95% CI = 1.130-2.032) times greater risk of incontinence. Trend test results showed that the risk of incontinence increased with decreasing handgrip strength in middle-aged and older people. Conclusions: Our study suggests that handgrip strength < 31 kg in men and < 20.5 kg in women is significantly associated with higher risk of incontinence in Chinese middle-aged and older people. The risk of incontinence increases with decreasing handgrip strength. Handgrip strength should be measured in routine physical examinations in middle-aged and older people for timely assessment and intervention in incontinence.

Homotopy, symmetry, and non-Hermitian band topology.

Non-Hermitian matrices are ubiquitous in the description of nature ranging from classical dissipative systems, including optical, electrical, and mechanical metamaterials, to scattering of waves and open quantum many-body systems. Seminal line-gap and point-gap classifications of non-Hermitian systems using K-theory have deepened the understanding of many physical phenomena. However, ample systems remain beyond this description; reference points and lines do not in general distinguish whether multiple non-Hermitian bands exhibit intriguing exceptional points, spectral braids and crossings. To address this we consider two different notions: non-Hermitian band gaps and separation gaps that crucially encompass a broad class of multi-band scenarios, enabling the description of generic band structures with symmetries. With these concepts, we provide a unified and comprehensive classification of both gapped and nodal systems in the presence of physically relevant parity-time (PT) and pseudo-Hermitian symmetries using homotopy theory. This uncovers new stable topology stemming from both eigenvalues and wave functions, and remarkably also implies distinct fragile topological phases. In particular, we reveal different Abelian and non-Abelian phases inPT-symmetric systems, described by frame and braid topology. The corresponding invariants are robust to symmetry-preserving perturbations that do not induce (exceptional) degeneracy, and they also predict the deformation rules of nodal phases. We further demonstrate that spontaneousPTsymmetry breaking is captured by Chern-Euler and Chern-Stiefel-Whitney descriptions, a fingerprint of unprecedented non-Hermitian topology previously overlooked. These results open the door for theoretical and experimental exploration of a rich variety of novel topological phenomena in a wide range of physical platforms.

Rainfall seasonality dominates critical precipitation threshold for the Amazon forest in the LPJmL vegetation model.

Understanding the Amazon Rainforest's response to shifts in precipitation is paramount with regard to its sensitivity to climate change and deforestation. Studies using Dynamic Global Vegetation Models (DGVMs) typically only explore a range of socio-economically plausible pathways. In this study, we applied the state-of-the-art DGVM LPJmL to simulate the Amazon forest's response under idealized scenarios where precipitation is linearly decreased and subsequently increased between current levels and zero. Our results indicate a nonlinear but reversible relationship between vegetation Above Ground Biomass (AGB) and Mean Annual Precipitation (MAP), suggesting a threshold at a critical MAP value, below which vegetation biomass decline accelerates with decreasing MAP. We find that approaching this critical threshold is accompanied by critical slowing down, which can hence be expected to warn of accelerating biomass decline with decreasing rainfall. The critical precipitation threshold is lowest in the northwestern Amazon, whereas the eastern and southern regions may already be below their critical MAP thresholds. Overall, we identify the seasonality of precipitation and the potential evapotranspiration (PET) as the most important parameters determining the threshold value. While vegetation fires show little effect on the critical threshold and the biomass pattern in general, the ability of trees to adapt to water stress by investing in deep roots leads to increased biomass and a lower critical threshold in some areas in the eastern and southern Amazon where seasonality and PET are high. Our findings underscore the risk of Amazon forest degradation due to changes in the water cycle, and imply that regions that are currently characterized by higher water availability may exhibit heightened vulnerability to future drying.

Prevalence of Myofascial Trigger Points in Isolated Idiopathic Cervical Dystonia: A Possible Contributor to Pain, Movement and Disability.

BACKGROUND: Myofascial trigger points (TrPs) are hypersensitive points located in a tight band of muscle that, when palpated, produce not only local pain but also referred (distant) pain. The role of TrPs in patients with cervical dystonia (CD) has not been investigated. OBJECTIVE: To identify the presence of TrPs in patients with isolated idiopathic CD and their association with pain. METHODS: Thirty-one patients (74.2% women; age: 61.2 years, SD: 10.1 years) participated. TrPs were explored in the sternocleidomastoid, upper trapezius, splenius capitis, levator scapulae, anterior scalene, suboccipital, and infraspinatus muscles. Clinical features of CD were documented as well as the presence of pain. The severity of dystonia and its consequences were assessed using the Toronto Western Spasmodic Torticollis Rating Scale (TWSTRS). RESULTS: The mean number of TrPs for each patient was 12 (SD:3), with no differences between patients with pain (n = 20) and those without pain (n = 11). Active TrPs were only found in patients with pain (mean: 7.5, SD:4). Latent TrPs were found in both groups but were more prevalent (P < 0.001) in patients without pain (mean: 11, SD:3.5) than in those with pain (mean: 5, SD:3.5). The number of active TrPs or latent TrPs was positively associated with the TWSTRS disability subscale and the TWSTRS total score. The number of active, but not latent, TrPs was associated with worse scores on the TWSTRS pain subscale. CONCLUSION: Active TrPs were present in patients with CD reporting pain, while latent TrPs were present in all CD patients, irrespective of their pain status. The numbers of active/latent TrPs were associated with disability. TrPs could act as pain generators in CD and also contribute to the involuntary muscle contractions characteristic of dystonia.

Efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome.

The objective of this study was to evaluate the efficacy and factors of myofascial release therapy combined with electrical and magnetic stimulation in the treatment of chronic pelvic pain syndrome (CPPS). A total of 79 female patients diagnosed with CPPS from January 2021 to December 2022 were prospectively analyzed. Every patient received 3 weeks of treatment which included myofascial release therapy combined with electrical and magnetic stimulation. The visual analog score (VAS) of pelvic floor muscle (PFM) trigger points (TrPs) and the changes in pelvic floor surface electromyography before and after treatment were compared. Multiple linear regression was used to analyze the influencing factors of each outcome index. There were significant differences in VASs of muscle TrPs before and after treatment (P < 0.05). For the surface electromyography of PFMs, the differences in pre-baseline rest, post-baseline rest, isometric contractions for muscle endurance evaluation, and coefficient of variation were statistically significant (P < 0.05). Linear regression analysis showed that disease course (X 1), dyspareunia (X 5), and urinary incontinence (X 6) were influencing factors for the decline of pre-baseline rest (r5 = 1.067, R 2 = 0.089), post-baseline rest (r1 = 0.055, r5 = 0.99, R 2 = 0.119), VASs of ischial spine (r5 = 0.916, R 2 = 0.102), obturator internus (r5 = 0.796, r6 = -0.703, R 2 = 0.245), and pubococcygeus (r5 = 0.885, R 2 = 0.149) after treatment in the CPPS group. This study confirmed that individualized myofascial release therapy combined with electrical and magnetic stimulation has significant efficacy for patients with CPPS. At the same time, it is more effective for CPPS patients with longer course of disease, dyspareunia, and without urinary incontinence.

Extracorporeal ShockWave Treatment vs. mesotherapy in the treatment of myofascial syndromes: a clinical trial.

Numerous scientific papers have compared different treatment options in the management of myofascial pain syndrome. This study evaluated the efficacy of Extracorporeal ShockWave Treatment (ESWT) and mesotherapy in patients with Myofascial Pain Syndrome (MPS) in terms of improvement in pain, functional capacity, and quality of life. A case-control study was conducted on 54 patients, who were randomized into 2 groups: group A, consisting of 27 patients, who were treated with 5 sessions of focal ESWT on a weekly basis; and group B, consisting of 27 patients, who underwent 5 sessions of mesotherapy with Thiocolchicoside fl 4 mg/2 mL and Mepivacaine fl 10 mg/1 mL on a weekly basis. Patients were evaluated at enrollment (T0), after 5 weeks, at the end of rehabilitation treatment (T1), and at a follow- up 30 days after the end of treatment (T2), by administering rating scales (Numeric Rating Scale (NRS) - Pressure Pain Threshold (PPT) - Short Form-36 (SF-36)). The results showed that focal ESWT and Mesoterapy are two valid and effective treatment options in reducing algic symptoms and improving short- and long-term quality of life. However, the use of ESWTs, despite being mildly painful but tolerated, has been shown to be superior to mesotherapy in terms of pain reduction and increased functional capacity.

Coincidence between the distribution of myofascial trigger points and the presence of blood vessels in the gastrocnemius muscle: Implications for invasive procedures.

PURPOSE: The gastrocnemius venous system presents different anatomical variants. There have been described four locations of myofascial trigger points (MTrPs) in this muscle. However, no studies have analyzed the coincidence between vessels and MTrPs present in the gastrocnemius. Therefore, the main objective was to study the anatomical variability of the venous system by ultrasound and its coincidence with the location of the MTrPs. METHODS: A total of 100 lower limbs were studied. The gastrocnemius vessels were analyzed one by one by sector (medial, central, and lateral), quantifying the number of vessels, their distribution, and the coincidence with MTrPs. RESULTS: All muscle heads showed at least one vessel per section. A large variability was observed, from one to eight vessels per muscle head, with the most frequent number being three in the gastrocnemius medialis and two in the gastrocnemius lateralis. In all cases, the location of the vessels coincided with the MTrPs. CONCLUSIONS: The proximal gastrocnemius venous pattern is very variable between subjects in number of vessels and distribution, which has made it impossible to define a "safe" approach window for invasive procedures without ultrasound guidance. The coincidence between the clinical location of MTrPs of the gastrocnemius and the presence of vessels is total.

Energy-based corridor identification for mammals between protected areas in Iran.

Body mass plays a crucial role in determining the mass-specific energy expenditure during terrestrial locomotion across diverse animal taxa, affecting locomotion patterns. The energy landscape concept offers a framework to explore the relationship between landscape characteristics and energy expenditure, enhancing our understanding of animal movement. Although the energy landscape approach solely considers the topographic obstacles faced by animals, its suitability compared to previous methods for constructing resistance maps and delineating corridors has not been comprehensively examined. In this study, we utilized the enerscape R package to generate resistance maps in kilocalories (kcal) by incorporating digital elevation models (DEMs) and body size data (kg). We assigned body sizes ranging from 0.5 to 100 kg to encompass a wide range of small and large mammals in Iran, adjusting maximum dispersal distances accordingly from 50 to 200 km. By analyzing these scenarios, we produced four resistance maps for each body size. Next, we identified potential corridors between terrestrial protected areas in Iran using the Linkage Mapper toolkit and examined barriers and pinch-points along these paths. Our study revealed significant findings regarding the shared corridors between small and large mammals in Iran's landscape. Despite their differing body sizes and energy requirements, many corridors were found to be utilized by both small and large mammal species. For example, we identified 206 corridors for mammals weighing 500 g, which were also recognized as the least-cost paths for 100 kg mammals. Thus, embracing a comprehensive method in resistance map creation, one that incorporates species-specific traits and human infrastructure becomes imperative for accurately identifying least-cost paths and consequently pinpointing pinch points and barriers.

Robust Multi-Modal Image Registration for Image Fusion Enhancement in Infrastructure Inspection.

Efficient multi-modal image fusion plays an important role in the non-destructive evaluation (NDE) of infrastructures, where an essential challenge is the precise visualizing of defects. While automatic defect detection represents a significant advancement, the determination of the precise location of both surface and subsurface defects simultaneously is crucial. Hence, visible and infrared data fusion strategies are essential for acquiring comprehensive and complementary information to detect defects across vast structures. This paper proposes an infrared and visible image registration method based on Euclidean evaluation together with a trade-off between key-point threshold and non-maximum suppression. Moreover, we employ a multi-modal fusion strategy to investigate the robustness of our image registration results.

TRPM8 affects relative "cooling and heating" of subcellular organelles in microglia in a context-dependent manner.

Thermoregulation and thermal homeostasis at the cellular and subcellular organelle level are poorly understood events. In this work, we used BV2, a microglial cell line, and a series of thermo-sensitive subcellular organelle-specific probes to analyze the relative changes in the spatio-temporal temperatures of different subcellular organelles, both qualitatively and quantitatively. These methodologies allowed us to understand the thermal relationship of different subcellular organelles also. We modulated BV2 cells by pharmacological application of activator or inhibitor of TRPM8 ion channel (a cold-sensitive ion channel) and/or by treating the cells with LPS, a molecule that induces pathogen-associated molecular patterns (PAMPs) signaling. We demonstrate that the temperatures of individual organelles remain variable within a physiological range, yet vary in different conditions. We also demonstrate that treating BV2 cells by TRPM8 modulators and/or LPS alters the organelle temperatures in a specific and context-dependent manner. We show that TRPM8 modulation and/or LPS can alter the relationship of mitochondrial membrane potential to mitochondrial temperature. Our work suggests that mitochondrial temperature positively influences ER temperature and negatively influences Golgi temperature. Golgi temperature positively influences membrane temperature. This understanding of thermal relationships may be crucial for dissecting cellular structures, function, and stress signaling and may be relevant for different diseases.

Historic obstacles and emerging opportunities in the field of developmental metabolism - lessons from Heidelberg.

The field of developmental metabolism is experiencing a technological revolution that is opening entirely new fields of inquiry. Advances in metabolomics, small-molecule sensors, single-cell RNA sequencing and computational modeling present new opportunities for exploring cell-specific and tissue-specific metabolic networks, interorgan metabolic communication, and gene-by-metabolite interactions in time and space. Together, these advances not only present a means by which developmental biologists can tackle questions that have challenged the field for centuries, but also present young scientists with opportunities to define new areas of inquiry. These emerging frontiers of developmental metabolism were at the center of a highly interactive 2023 EMBO workshop 'Developmental metabolism: flows of energy, matter, and information'. Here, we summarize key discussions from this forum, emphasizing modern developmental biology's challenges and opportunities.

[Research on intelligent tooth segmentation method combining multiple seed region growth and boundary extension].

The segmentation of dental models is a crucial step in computer-aided diagnosis and treatment systems for oral healthcare. To address the issues of poor universality and under-segmentation in tooth segmentation techniques, an intelligent tooth segmentation method combining multiple seed region growth and boundary extension is proposed. This method utilized the distribution characteristics of negative curvature meshes in teeth to obtain new seed points and effectively adapted to the structural differences between the top and sides of teeth through differential region growth. Additionally, the boundaries of the initial segmentation were extended based on geometric features, which was effectively compensated for under-segmentation issues in region growth. Ablation experiments and comparative experiments with current state-of-the-art algorithms demonstrated that the proposed method achieved better segmentation of crowded dental models and exhibited strong algorithm universality, thus possessing the capability to meet the practical segmentation needs in oral healthcare.

Ultrasound imaging and guidance in the management of myofascial pain syndrome: a narrative review.

Myofascial pain syndrome (MPS) is a common musculoskeletal disorder characterized by muscle pain, tenderness, and trigger points. Ultrasonography has emerged as a key tool for diagnosing and treating MPS owing to its ability to provide precise, minimally invasive guidance. This review discusses the use of ultrasonography in various approaches to evaluate and manage MPS. Studies have shown that shear-wave sonoelastography can effectively assess muscle elasticity and offer insights into trapezius stiffness in patients with MPS. Ultrasound-guided interfascial hydrodissection, especially with visual feedback, has demonstrated effectiveness in treating trapezius MPS. Similarly, ultrasound-guided rhomboid interfascial plane blocks and perimysium dissection for posterior shoulder MPS have significantly reduced pain and improved quality of life. The combination of extracorporeal shockwave therapy with ultrasound-guided lidocaine injections has been particularly successful in reducing pain and stiffness in trapezius MPS. Research regarding various guided injections, including dry needling, interfascial plane blocks, and fascial hydrodissection, emphasizes the importance of ultrasonography for accuracy and safety. Additionally, ultrasound-guided delivery of local anesthetics and steroids to the quadratus lumborum muscle has shown lasting pain relief over a 6-month period. Overall, these findings highlight the pivotal role of ultrasonography in the assessment and treatment of MPS.

Correlations between the Frankfort Plane and the Presence of Myofascial Trigger Points in Posterior Cervical Musculature: An Exploratory Study.

Neck pain is a pathology with a high impact in terms of physical disability in modern society. The position of the head is related to neck pain. The Frankfort plane determines the position of the skull in space. The profile photograph of the subjects was used to determine the Frankfort plane and to study its degree of inclination. Myofascial pain syndrome is one of the most common causes of musculoskeletal pain. Trigger points are hyperirritable spots located in a palpable taut band of skeletal muscle that is painful on compression or stretch and causes a local twitch in response to snapping or palpation of the band. Objectives: The aim of this study was to analyze the relationship between the Frankfort plane and the presence of myofascial trigger points causing cervical myofascial pain. Methods: This is a cross-sectional descriptive observational study. All subjects underwent a photographic study to determine the degree of Frankfort plane inclination, and the posterior cervical musculature was palpated to find myofascial trigger points that were measured with a pressure algometer in three cervical locations on the right and left sides. Results: Our study included 47 subjects who had suffered at least one episode of cervical pain in their lifetimes. The mean age was 22.3 ± 2.9 years. Statistically significant results were found in the first right location and sports practice (p = 0.007), in the second right location and gender (p = 0.0097), in the second right location and sports practice (p = 0.0486), in the third right location and gender (p = 0.0098), and in the first, second, and third left locations and gender (p = 0.0083; p = 0.024; p = 0.0016, respectively). In the correlation between the Frankfort plane and the presence of myofascial trigger points, all locations were positive, with the first right location being statistically significant (p = 0.048). Conclusions: A positive relationship was found between the Frankfort plane and the presence of myofascial trigger points. The greater the angle of the Frankfort plane, the less the myofascial pain.

AI-Assisted Body Composition Assessment Using CT Imaging in Colorectal Cancer Patients: Predictive Capacity for Sarcopenia and Malnutrition Diagnosis.

(1) Background: The assessment of muscle mass is crucial in the nutritional evaluation of patients with colorectal cancer (CRC), as decreased muscle mass is linked to increased complications and poorer prognosis. This study aims to evaluate the utility of AI-assisted L3 CT for assessing body composition and determining low muscle mass using both the Global Leadership Initiative on Malnutrition (GLIM) criteria for malnutrition and the European Working Group on Sarcopenia in Older People (EWGSOP2) criteria for sarcopenia in CRC patients prior to surgery. Additionally, we aim to establish cutoff points for muscle mass in men and women and propose their application in these diagnostic frameworks. (2) Methods: This retrospective observational study included CRC patients assessed by the Endocrinology and Nutrition services of the Regional University Hospitals of Malaga, Virgen de la Victoria of Malaga, and Vall d'Hebrón of Barcelona from October 2018 to July 2023. A morphofunctional assessment, including anthropometry, bioimpedance analysis (BIA), and handgrip strength, was conducted to apply the GLIM criteria for malnutrition and the EWGSOP2 criteria for sarcopenia. Body composition evaluation was performed through AI-assisted analysis of CT images at the L3 level. ROC analysis was used to determine the predictive capacity of variables derived from the CT analysis regarding the diagnosis of low muscle mass and to describe cutoff points. (3) Results: A total of 586 patients were enrolled, with a mean age of 68.4 ± 10.2 years. Using the GLIM criteria, 245 patients (41.8%) were diagnosed with malnutrition. Applying the EWGSOP2 criteria, 56 patients (9.6%) were diagnosed with sarcopenia. ROC curve analysis for the skeletal muscle index (SMI) showed a strong discriminative capacity of muscle area to detect low fat-free mass index (FFMI) (AUC = 0.82, 95% CI 0.77-0.87, p < 0.001). The identified SMI cutoff for diagnosing low FFMI was 32.75 cm2/m2 (Sn 77%, Sp 64.3%; AUC = 0.79, 95% CI 0.70-0.87, p < 0.001) in women, and 39.9 cm2/m2 (Sn 77%, Sp 72.7%; AUC = 0.85, 95% CI 0.80-0.90, p < 0.001) in men. Additionally, skeletal muscle area (SMA) showed good discriminative capacity for detecting low appendicular skeletal muscle mass (ASMM) (AUC = 0.71, 95% CI 0.65-0.76, p < 0.001). The identified SMA cutoff points for diagnosing low ASMM were 83.2 cm2 (Sn 76.7%, Sp 55.3%; AUC = 0.77, 95% CI 0.69-0.84, p < 0.001) in women and 112.6 cm2 (Sn 82.3%, Sp 58.6%; AUC = 0.79, 95% CI 0.74-0.85, p < 0.001) in men. (4) Conclusions: AI-assisted body composition assessment using CT is a valuable tool in the morphofunctional evaluation of patients with colorectal cancer prior to surgery. CT provides quantitative data on muscle mass for the application of the GLIM criteria for malnutrition and the EWGSOP2 criteria for sarcopenia, with specific cutoff points established for diagnostic use.

The Management of Dietary Fiber Intake in Children With Chronic Kidney Disease - Clinical Practice Recommendations From the Pediatric Renal Nutrition Taskforce.

The benefits of dietary fiber are widely accepted. Nevertheless, a substantial proportion of children fail to meet the recommended intake of dietary fiber. Achieving adequate fiber intake is especially challenging in children with chronic kidney disease (CKD). An international team of pediatric renal dietitians and pediatric nephrologists from the Pediatric Renal Nutrition Taskforce (PRNT) has developed clinical practice recommendations (CPRs) for the dietary intake of fiber in children and adolescents with CKD. In this CPR paper, we propose a definition of fiber, provide advice on the requirements and assessment of fiber intake, and offer practical guidance on optimizing dietary fiber intake in children with CKD. In addition, given the paucity of available evidence and to achieve consensus from international experts, a Delphi survey was performed in which all the clinical practice recommendations were reviewed.