Effects of a web application based on multimedia animations to support therapeutic exercise for rotator cuff-related shoulder pain: protocol for an open-label randomised controlled trial.

INTRODUCTION: Rotator cuff-related shoulder pain (RCRSP) is the most common cause of shoulder pain. Currently, exercise is proposed as the first-line treatment for patients suffering from RCRSP. However, adherence to therapeutic exercise programmes can be poor in the long term in a home setting. The aim of this study is to evaluate the effects of adding video animations to a traditional paper-based exercise programme. METHODS AND ANALYSIS: A single-centre, randomised, open-labelled clinical trial will be conducted in a hospital in Spain. Adults aged between 18 and 80 years diagnosed with RCRSP who meet the eligibility criteria will be included. Patients (n=132) will be randomised into two groups, with both receiving paper-based exercises, and the experimental group will also be provided with video animations. The participants will receive seven face-to-face physical therapy sessions and will be asked to perform the exercises at home for 6 months. The primary outcome measure will be the Shoulder Pain and Disability Index, measured at baseline, 3 weeks, 3 months (primary analysis) and 6 months. Secondary outcomes will be the patient's pain intensity during the last week (rest, during movement and at night); expectations of improvement; satisfaction with treatment; impression of improvement; perceived usability, usefulness and satisfaction of multimedia animations; and adherence to exercises. Generalised least squares regression models with an autoregressive-moving average lag one correlation structure will be implemented, with an intention-to-treat analysis. ETHICS AND DISSEMINATION: This study has been approved by the ethics committee of Hospital Universitario Fundación Alcorcón (Madrid, Spain), reference number CI18/16. All participants will sign an informed consent. The results will be published in a peer-reviewed scientific journal. TRIAL REGISTRATION: ClinicalTrials.gov, NCT05770908.

Transcultural adaptation and psychometric validation of a Spanish-language version of the "Pelvic Girdle Questionnaire".

BACKGROUND: The Pelvic Girdle Questionnaire is the only instrument designed to assess pain and disability specifically in pregnant or postpartum women with pelvic girdle pain. The objective of this study was the adaptation to the Spanish language and analysis of the psychometric properties of the Pelvic Girdle Questionnaire. METHODS: This is a descriptive cross-sectional study divided into two phases. In the first phase, a translation and adaptation process was performed according to international guidelines. Secondly, the analysis of the properties of the Spanish version was conducted using a sample of 125 pregnant or postpartum women suffering from pelvic girdle pain. Participants completed the Spanish version along with five other measurement instruments through an online platform. Internal consistency, construct validity, test-retest reliability, the ceiling and floor effects, responsiveness and discriminatory ability of the Spanish version were analysed. RESULTS: The Spanish version of the Pelvic Girdle Questionnaire showed high internal consistency with Cronbach's alpha = 0.961, and an intraclass correlation coefficient of 0.962. The convergent validity showed high positive correlation with other questionnaires used. ROC curves showed no discriminatory capacity for number of sites of pain or pregnancy/post-partum state. CONCLUSIONS: This article presents the translation, validation and psychometric properties of the Spanish version of the Pelvic Girdle Questionnaire, that has proved to be an appropriate and valid assessment tool of disability due to pelvic girdle pain in pregnant and postpartum women.

Retinoid level dynamics during gonad recycling in the limpet Patella vulgata.

Germ cell commitment and meiosis initiation are among the multitude of physiological roles of retinoic acid (RA) in vertebrates. Acting via receptor-mediated transcription, RA induces the expression of meiotic factors, triggering meiosis. Contrasting with vertebrates, invertebrate RA metabolism is scarcely understood. Still, some physiological processes appear to be conserved. Here we set to evaluate the role of retinoids in the gonad maturation process of the marine gastropod Patella vulgata. We found that retinoid concentration in gonadal tissue, namely RA, varies between breeding and resting specimens, with maxima attained in the latter. Additionally, we isolated and quantified the expression of both the retinoic acid receptor (RAR) and the retinoid X receptor (RXR) in gonads. In view of the stability of retinoid receptor expression, we suggest that the balance of RA levels operates through the enzymatic control of synthetic and catabolic processes. Overall, the reported data are supportive for a developmental role of RA during gonadal maturation in P. vulgata, which should be addressed in other protostome lineages.

Diastasis of symphysis pubis and labor: Systematic review.

Symphysis pubis diastasis (SPD) is an infrequent complication of labor that can impair womens' general health through failure of the passive stability of the pelvic girdle. Although conservative approaches are often used to decrease symptoms and interpubic separation, notably few studies have analyzed the effect of these methods on managing the symptoms of women with SPD. The purpose of this study was to review the available literature on the conservative treatment of SPD during pregnancy and labor. A computer-based search using PubMed, PEDro, and CINAHL was performed up to November 2014. We selected all studies that considered women with SPD during pregnancy or labor and treated them with conservative methods and excluded those that included surgical intervention. Eighteen studies were selected, most of which were case reports. Although the overall results of conservative treatment were unclear because of the type and design of the obtained studies, most of the studies reported bed rest in the lateral decubitus position and a pelvic girdle as basic treatments. Additionally, the few clinical trials reported recommended additional physiotherapy, including strengthening and stabilizing exercises, to reduce SPD symptoms.

Gradation of the stress response in rainbow trout exposed to stressors of different severity: the role of brain serotonergic and dopaminergic systems.

After an intense acute stressor, fish develop a metabolic and behavioural response that usually lasts for several hours. Brain monoaminergic systems, particularly the serotonergic system, appear to play a key role in the central regulation of the stress response. However, the influence of stressor severity on brain monoaminergic systems and on the induced stress responses is yet poorly understood. We hypothesise that serotonergic system could have a direct role in the integration of sensory information during stressor exposure and in the organisation of the subsequent integrated stress response. According to our hypothesis, a low stressor intensity would induce a low response of brain serotonergic system and therefore stress responses of low magnitude and duration. To test this hypothesis, we exposed fish to handling disturbance for 5 s, 15 s or 3 min. We sampled fish at 0 (controls), 3, 15, 45 and 240 min after the start of the stress protocol. Brain levels of serotonin, dopamine and their respective main oxidative metabolites were quantified, along with plasma levels of stress markers (catecholamines, cortisol, glucose and lactate). Regarding stress markers, the 5-s and 15-s stress protocols induced similar and relatively low elevations in all parameters assessed. As expected, the 3-min protocol induced responses of a higher intensity and duration in all plasma parameters. Interestingly, the alterations of brain monoaminergic systems did not follow the same trend. The three stress protocols induced increases in the serotonergic activity in all brain regions analysed (hypothalamus, telencephalon and medulla oblongata), independently of the duration of the handling disturbance, whereas the effects on the dopaminergic system were minor and brain region-dependent. These data suggest that the brain serotonergic system, although likely involved in the recognition of the stressor stimuli, is not the only actor determining the magnitude and duration of the acute stress response in trout.

Retinoid metabolism in invertebrates: when evolution meets endocrine disruption.

Recent genomic and biochemical evidence in invertebrate species pushes back the origin of the retinoid metabolic and signaling modules to the last common ancestor of all bilaterians. However, the evolution of retinoid pathways are far from fully understood. In the majority of non-chordate invertebrate lineages, the ongoing functional characterization of retinoid-related genes (metabolism and signaling pathways), as well as the characterization of the endogenous retinoid content (precursors and active retinoids), is still incomplete. Despite limited, the available data supports the presence of biologically active retinoid pathways in invertebrates. Yet, the mechanisms controlling the spatial and temporal distribution of retinoids as well as their physiological significance share similarities and differences with vertebrates. For instance, retinol storage in the form of retinyl esters, a key feature for the maintenance of retinoid homeostatic balance in vertebrates, was only recently demonstrated in some mollusk species, suggesting that such ability is older than previously anticipated. In contrast, the enzymatic repertoire involved in this process is probably unlike that of vertebrates. The suggested ancestry of active retinoid pathways implies that many more metazoan species might be potential targets for endocrine disrupting chemicals. Here, we review the current knowledge about the occurrence and functionality of retinoid metabolic and signaling pathways in invertebrate lineages, paying special attention to the evolutionary origin of retinoid storage mechanisms. Additionally, we summarize existing information on the endocrine disruption of invertebrate retinoid modules by environmental chemicals. Research priorities in the field are highlighted.

Oral administration of melatonin counteracts several of the effects of chronic stress in rainbow trout.

To assess a possible antistress role of melatonin in fish, we orally administered melatonin to rainbow trout for 10 d and then kept the fish under normal or high stocking density conditions during the last 4 d. Food intake; biochemical parameters in plasma (cortisol, glucose, and lactate concentrations); liver (glucose and glycogen concentrations, and glycogen synthase activity); enzyme activities of amylase, lipase, and protease in foregut and midgut; and content of the hypothalamic neurotransmitters dopamine and serotonin, as well as their oxidized metabolites, 3,4-dihydroxyphenylacetic acid and 5-hydroxy-3-indoleacetic acid, were evaluated under those conditions. High stocking density conditions alone induced changes indicative of stress conditions in plasma cortisol concentrations, liver glycogenolytic potential, the activities of some digestive enzymes, and the 3,4-dihydroxyphenylacetic acid-to-dopamine and 5-hydroxy-3-indoleacetic acid-to-serotonin ratios in the hypothalamus. Melatonin treatment in nonstressed fish induced an increase in liver glycogenolytic potential, increased the activity of some digestive enzymes, and enhanced serotoninergic and dopaminergic metabolism in hypothalamus. The presence of melatonin in stressed fish resulted in a significant interaction with cortisol concentrations in plasma, glycogen content, and glycogen synthase activity in liver and dopaminergic and serotoninergic metabolism in the hypothalamus. In general, the presence of melatonin mitigated several of the effects induced by stress, supporting an antistress role for melatonin in rainbow trout.

Arginine vasotocin treatment induces a stress response and exerts a potent anorexigenic effect in rainbow trout, Oncorhynchus mykiss.

The peptide arginine vasotocin (AVT), homologous to mammalian arginine vasopressin, is involved in many aspects of fish physiology, such as osmoregulation, regulation of biological rhythms, reproduction, metabolism or responses to stress, and the modulation of social behaviours. Because a decrease in appetite is a general response to stress in fish and other vertebrates, we investigated the role of AVT as a possible food intake regulator in fish. We used i.c.v. injections for central administration of AVT to rainbow trout (Oncorhynchus mykiss). In a first experiment, we evaluated the temporal response of food intake after AVT treatment. In a second experiment, we investigated the effects of central AVT administration on the response of typical stress markers (plasma cortisol, glucose and lactate), as well as brain serotonergic, noradrenergic and dopaminergic activity. In addition, the mRNA levels of genes involved in food intake regulation [neuropetide Y, pro-opiomelanocortin (POMC), cocaine- and amphetamine-regulated transcript (CART) and corticotrophin-releasing factor (CRF)] and in CRF- (CRF-binding protein) and AVT-signalling (pro-VT and AVT receptor), were also assessed after AVT treatment. Our results showed that AVT is a potent anorexigenic factor in fish. Increases of plasma cortisol and glucose after AVT treatment strongly suggest that AVT administration induced a stress response and that AVT action was mediated by hypothalamic-pituitary-interrenal axis activation, which was also supported by the increase of the serotonergic activity in trout telencephalon and hypothalamus. The increased hypothalamic levels of POMC and CART suggest that these peptides might have a role in the anorexigenic action of AVT, whereas the involvement of CRF signalling is unclear.