Sonographic and Anatomical Evaluation of the Liver and Portal Vein Reference Values / Evaluación Ecográfica y Anatómica de los Valores de Referencia del Hígado y la Vena Porta

SUMMARY: This paper's aim is a morphometric evaluation of liver and portal vein morphometry using ultrasonography in healthy Turkish population. This study was carried out with 189 subjects (107 females, 82 males). The demographic data and the body surface area were calculated. The longitudinal axis of the liver for two lobes, diagonal axis or liver span, anteroposterior diameter of the liver and portal vein, portal vein transverse diameter, caudate lobe anteroposterior diameter, and portal vein internal diameters as well as longitudinal liver scans in an aortic plane, sagittal plane, transverse plane, and kidney axis were measured. All measurements were analyzed according to age, sex, body mass index, obesity and alcohol consumption. The mean values of the age, height, weight and body mass index were calculated as 44.39 years, 167.05 cm, 74.23 kg, and 27.06kg/m2 in females, respectively. The same values were 44.13 years, 167.70 cm, 75.93 kg and 26.71 kg/m2 in males, respectively. There was significant difference between demographic characteristics, gender, and alcohol consumption in terms of anteroposterior diameter of the liver, portal vein transverse diameter of the right side and liver transverse scan. Also, some measurements including portal vein transverse diameter, liver transverse scan and at kidney axis longitudinal scan of liver showed significant difference between the age groups. There was significant difference in diagonal axis and anteroposterior diameter of liver, portal vein internal diameter, and longitudinal liver scans of the aortic plane parameters between obesity situation. The findings obtained will provide important and useful reference values as it may determine some abnormalities related liver diseases. Also, age, sex, obesity and body mass index values can be effective in the liver and portal vein morphometry related parameters.

El objetivo de este artículo fue realizar una evaluación de la morfometría del hígado y la vena porta mediante ecografía en una población turca sana. Este estudio se llevó a cabo en 189 sujetos (107 mujeres, 82 hombres). Se calcularon los datos demográficos y la superficie corporal. Se midió eleje longitudinal del de dos lóbulos del hígado, el eje diagonal o la extensión del hígado, los diámetros anteroposterior del hígado y de la vena porta, el diámetro transversal de la vena porta, anteroposterior del lóbulo caudado y los diámetros internos de la vena porta, así como las exploraciones longitudinales del hígado en un plano aórtico. Se midieron el plano sagital, el plano transversal y el eje del riñón. Todas las mediciones se analizaron según edad, sexo, índice de masa corporal, obesidad y consumo de alcohol. Los valores medios de edad, talla, peso e índice de masa corporal se calcularon como 44,39 años, 167,05 cm, 74,23 kg y 27,06 kg/m2 en las mujeres, respectivamente. Las mismas variable fueron 44,13 años, 167,70 cm, 75,93 kg y 26,71 kg/m2. Hubo diferencias significativas entre las características demográficas, el sexo y el consumo de alcohol en términos de diámetro anteroposterior del hígado, diámetro transversal de la vena porta del lado derecho y exploración transversal del hígado. Además, algunas mediciones, incluido el diámetro transversal de la vena porta, la exploración transversal del hígado y la exploración longitudinal del hígado en el eje del riñón, mostraron diferencias significativas entre los grupos de edad. Hubo diferencias significativas en el eje diagonal y el diámetro anteroposterior del hígado, el diámetro interno de la vena porta y los parámetros de las exploraciones hepáticas longitudinales del plano aórtico entre situaciones de obesidad. Los hallazgos obtenidos proporcionarán valores de referencia importantes y útiles ya que pueden determinar algunas anomalías relacionadas con enfermedades hepáticas. Además, los valores de edad, sexo, obesidad e índice de masa corporal pueden ser eficaces en los parámetros relacionados con la morfometría del hígado y la vena porta.

Utilization of bioelectrical impedance vector analysis (BIVA) in children and adolescents without diagnosed diseases: a systematic review.

Introduction. Bioelectrical impedance vector analysis (BIVA) emerges as a technique that utilizes raw parameters of bioelectrical impedance analysis and assumes the use of a reference population for information analysis.Objective. To summarize the reference values, main studies objectives, approaches, pre-test recommendations and technical characteristics of the devices employed in studies utilizing BIVA among children and adolescents without diagnosed diseases.Methods. A systematic search was conducted in nine electronic databases (CINAHL, LILACS, PubMed, SciELO, Scopus, SPORTDiscus, Science Direct, MEDLINE, and Web of Science). Studies with different designs which allowed extracting information regarding reference values of BIVA in children and adolescents without diagnosed diseases, aged 19 years or younger, were included. The systematic review followed PRISMA procedures and was registered in PROSPERO (registration: CRD42023391069).Results. After applying the eligibility criteria, 36 studies were included. Twenty studies (55.6%) analyzed body composition using BIVA, thirteen studies (36.1%) aimed to establish reference values for BIVA, and three studies (8.3%) investigated the association of physical performance with BIVA. There was heterogeneity regarding the reference populations employed by the studies. Fifteen studies used their own sample as a reference (41.6%), four studies used the adult population as a reference (11.1%), and five studies used reference values from athletes (13.9%).Conclusion. Nutricional status and body composition were the main studies objectives. References values were not always adequate or specific for the sample and population. Furthermore, there was no pattern of pre-test recommendations among the studies.

Spatial distribution of Pb and Zn in soils under native vegetation in Southeast Brazil.

Heavy metals can play an important biological role as micronutrients but also as potentially toxic elements (PTEs). Understanding the natural concentrations of PTEs-Pb and Zn included-in soils allows for the identification and monitoring of contaminated areas and their role in environmental risk assessment. In this study, we aim to determine semi-total or natural and available concentrations of Pb and Zn in topsoils (0-20 cm depth) from 337 samples under native vegetation in the State of Minas Gerais, Brazil. Additionally, we sought to interpret the spatial geochemical variability using geostatistical techniques and quality reference values for these elements in soils were established. The semi-total concentrations were determined by flame and graphite furnace atomic absorption after microwave-assisted nitric acid digestion method. The available concentrations were extracted using the Mehlich-I extractor and determined by atomic absorption spectrometer. Spatial variability was modeled using semivariance estimators: Matheron's classic, Cressie and Hawkins' robust, and Cressie median estimators, the last two being less sensitive to extreme values. This allowed the construction of digital maps through kriging of semi-total Pb and Zn contents using the median estimator, as well as other soil properties by the robust estimator. The dominance of acidic pH and low CEC values reflects highly weathered low-fertility soils. Semi-total Pb contents ranged from 2.1 to 278 mg kg-1 (median: 9.35 mg kg-1) whereas semi-total Zn contents ranged from 2.7 to 495 mg kg-1 (median: 7.7 mg kg-1). The available Pb contents ranged from 0.1 to 6.92 mg kg-1 (median: 0.54 mg kg-1) whereas available Zn contents ranged from 0.1 to 78.2 mg kg-1 (median: 0.32 mg kg-1). The highest Pb and Zn concentrations were observed near Januária, in the northern part of the territory, probably on limestone rocks from the Bambuí group. Finally, the QRVs for Pb and Zn in natural soils were lower than their background values from other Brazilian region and below the prevention values suggested by Brazilian environmental regulations.

Reference values for the 6-min walking test in children and adolescents living in a moderate altitude region of Peru.

BACKGROUND: The assessment of cardiorespiratory fitness is important because it allows the identification of subgroups with poor health status and the targeting of effective intervention strategies to improve health. OBJECTIVE: To compare the cardiorespiratory capacity of children and adolescents living in a moderate altitude region of Peru with international studies and to develop reference values for the 6-min walk test (6MWT) according to age and sex. METHODOLOGY: A descriptive cross-sectional study of schoolchildren from a region of moderate altitude in Peru was carried out. A total of 704 schoolchildren (400 males and 304 females) with an age range of 6 to 17 years were studied. Weight, standing height, waist circumference (WC), body mass index (BMI) and tri-ponderal mass index (TMI) were evaluated. The 6MWT was assessed in a straight line over a distance of 30 m. Percentiles were created through the LMS method [L (skewness: lambda), M (median: mu) and S (coefficient of variation: Mu)]. RESULTS: There were discrepancies in cardiorespiratory fitness performance with international studies by age and sex. The schoolchildren in the study reached stability and the highest number of meters in the last two age ranges (14 to 15 years: 698.1 m and 16 to 17 years 686.3 m in males). While females (14 to 15 years: 698.1 m and 16 to 17 years: 686.3 m). The proposed percentile values show ascending values as age advances. The cut-off points adopted are: low cardiorespiratory fitness < p25, moderate p25 to p75 and high cardiorespiratory fitness p > 75. CONCLUSION: We verified that the cardiorespiratory fitness evaluated by means of the 6MWT is ascending with the course of age. Even the performance with other countries is heterogeneous at early and middle ages, stabilizing during adolescence. The proposed reference values can be used to evaluate and monitor cardiorespiratory fitness during physical education classes.

Normal values for maximal respiratory pressures in children and adolescents: A systematic review with meta-analysis.

BACKGROUND: The non-invasive assessment of maximal respiratory pressures (MRP) reflects the strength of the respiratory muscles. OBJECTIVE: To evaluate the studies which have established normative values for MRP in healthy children and adolescents and to synthesize these values through a meta-analysis. METHODS: The searches were conducted until October 2023 in the following databases: ScienceDirect, MEDLINE, CINAHL, SciELO, and Web of Science. Articles that determined normative values and/or reference equations for maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) in children and adolescents published in English, Portuguese, or Spanish regardless of the year of publication were included. Two reviewers selected titles and abstracts, in case of conflict, a third reviewer was consulted. Articles that presented sufficient data were included to conduct the meta-analysis. RESULTS: Initially, 252 studies were identified, 28 studies were included in the systematic review and 19 in the meta-analysis. The sample consisted of 5798 individuals, and the MIP and MEP values were stratified by sex and age groups of 4-11 and 12-19 years. Values from females 4-11 years were: 65.8 cmH2O for MIP and 72.8 cmH2O for MEP, and for males, 75.4 cmH2O for MIP and 84.0 cmH2O for MEP. In the 12-19 age group, values for females were 82.1 cmH2O for MIP and 90.0 cmH2O for MEP, and for males, they were 95.0 cmH2O for MIP and 105.7 cmH2O for MEP. CONCLUSIONS: This meta-analysis suggests normative values for MIP and MEP in children and adolescents based on 19 studies.

The United States reference values of the Bayley III motor scale are suitable in Suriname.

To determine if the United States reference values of the Bayley Scales of Infant and Toddler Development, version III motor scale are suitable for Surinamese infants, we assessed 151 healthy infants at 3, 12, 24 and 36 months of age. The mean fine motor, gross motor, and composite scores of the total group did not significantly differ from the US norms, although some significant but not clinically relevant differences were found (lower fine motor scores at 12 months, lower gross motor and total composite scores at 24 months, and higher scores for gross motor and composite scores at 3 months).

Setting up regional diagnostic reference levels for pediatric computed tomography in Latin America: preliminary results, challenges and the work ahead.

We established a framework for collecting radiation doses for head, chest and abdomen-pelvis computed tomography (CT) in children scanned at multiple imaging sites across Latin America with an aim towards establishing diagnostic reference levels (DRLs) and achievable doses (ADs) in pediatric CT in Latin America. Our study included 12 Latin American sites (in Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Honduras and Panama) contributing data on the four most common pediatric CT examinations (non-contrast head, non-contrast chest, post-contrast chest and post-contrast abdomen-pelvis). Sites contributed data on patients' age, sex and weight, scan factors (tube current and potential), volume CT dose index (CTDIvol) and dose length product (DLP). Data were verified, leading to the exclusion of two sites with missing or incorrect data entries. We estimated overall and site-specific 50th (AD) and 75th (diagnostic reference level [DRL]) percentile CTDIvol and DLP for each CT protocol. Non-normal data were compared using the Kruskal-Wallis test. Sites contributed data from 3,934 children (1,834 females) for different CT exams (head CT 1,568/3,934, 40%; non-contrast chest CT 945/3,934, 24%; post-contrast chest CT 581/3,934, 15%; abdomen-pelvis CT 840/3,934, 21%). There were significant statistical differences in 50th and 75th percentile CTDIvol and DLP values across the participating sites (P<0.001). The 50th and 75th percentile doses for most CT protocols were substantially higher than the corresponding doses reported from the United States of America. Our study demonstrates substantial disparities and variations in pediatric CT examinations performed in multiple sites in Latin America. We will use the collected data to improve scan protocols and perform a follow-up CT study to establish DRLs and ADs based on clinical indications.

Reference Values for Cardiorespiratory Fitness in Patients Aged 6 to 18 Years.

OBJECTIVE: To develop reference values for cardiorespiratory fitness, as quantified by peak oxygen uptake (VO2peak) and treadmill time, in patients aged 6 through 18 years referred for cardiopulmonary exercise testing (CPET). STUDY DESIGN: We reviewed a clinical pediatric CPET database for fitness data in children aged 6-18 years with no underlying heart disease. CPET was obtained via the Bruce protocol utilizing objectively confirmed maximal effort via respiratory exchange ratio. Fitness data (VO2peak and treadmill test duration) were analyzed to determine age- and sex-specific reference values for this pediatric cohort. RESULTS: Data from 2025 pediatric CPETs (53.2% female) were included in the analyses. VO2peak increased with age in males, but not females. Treadmill test duration increased with age in both males and females. Fitness was generally higher in males when compared with females in the same age groups. CONCLUSIONS: Our study provides extensive reference values for both VO2peak and total treadmill test time via the Bruce protocol for a pediatric population without known cardiac disease. Furthermore, the inclusion of objectively confirmed maximal exercise effort increases confidence in these findings compared with prior studies in this area. Clinicians performing CPET in pediatric populations can utilize these reference values to characterize test results according to representative peer data.

Valores de referencia de espirometría forzada de adultos residentes sobre o bajo 1500 m s. n. m.: revisión sistemática / Reference values of forced spirometry of adult residents above or below 1500 m.a.s.l.: systematic review

Introducción: La espirometría es una prueba de función pulmonar usada en la valoración de programas de rehabilitación para evaluar exposiciones a tóxicos y alérgenos, en estudios epidemiológicos y en el desarrollo de ecuaciones de referencia en poblaciones específicas; estos valores pueden variar de acuerdo con la altura. Objetivo: Establecer las diferencias entre los valores de referencia de espirometría forzada en población adulta residentes en alturas mayores y menores a 1500 metros sobre el nivel del mar. Métodos: Revisión sistemática, se encontraron 536 estudios, se evaluaron 66 en texto completo, 33 en calidad metodológica con las listas de chequeo Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies y Quality Assessment of Case-Control Studies; 21 estudios fueron seleccionados para la revisión y 12 surtieron metanálisis. Resultados: Se contó con 48 923 participantes de alturas entre 2,4 y 4440 m s. n. m. Hay diferencias iniciales al relacionar la altura (+/-1500 m s. n. m) con el VEF1 (hombres: DM 0,29; IC: 0,03-0,55; mujeres: DM 0,27; IC: -0,07-0,60) y los valores de referencia con el sexo: CVF (DM 1,31; IC: 1,24-1,37) y VEF1 (DM: 1,03; IC: 0,95-1,11). Se reportó alta heterogeneidad y riesgo de sesgo de publicación. Discusión: Estas diferencias se dan en función de aspectos antropométricos y fisiológicos como la aclimatación y el envejecimiento pulmonar. Los mecanismos que influyen en estos cambios son la adaptación genética, molecular, fisiológica y anatómica, que permiten compensar los efectos de la hipoxia aguda o crónica, lo cual aumenta la ventilación alveolar y los valores espirométricos. Conclusiones: Los valores de referencia de espirometría varían de acuerdo con la altura (mayores en alturas > 1500 m s. n. m) y el sexo (más elevados en hombres). Es necesario contar con evidencias más amplias y contundentes en la temática.

Introduction: Spirometry is a lung function test used in the evaluation of rehabilitation programs to evaluate exposures to toxics and allergens in epidemiological studies and in the development of reference equations in specific populations; these values may vary according to height. Objective: To establish the differences between the reference values of forced spirometry in the adult population living at altitudes greater than and less than 1,500 meters above sea level. Methods: Systematic review a total of 536 studies were found; 66 were assessed in full text and 33 were assessed for methodological quality using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies and Quality Assessment of Case-Control Studies checklists; 21 studies were selected for the review and 12 provided meta-analyses. Results: There were 48,923 participants from heights between 2.4 and 4,440 m.a.s.l. There are initial differences when relating height (+/-1,500 m.a.s.l.) with FEV1 (men: MD 0.29; CI: 0.03-0.55; women: MD 0.27; CI: -0.07-0 .60); and the reference values with gender: FVC (MD 1.31, CI: 1.24-1.37) and FEV1 (MD: 1.03, CI: 0.95-1.11). High heterogeneity and risk of publication bias are reported. Discussion: These differences occur based on anthropometric and physiological aspects such as acclimatization and lung aging. The mechanisms that influence these changes are genetic, molecular, physiological and anatomical adaptations that allow compensation for the effects of acute or chronic hypoxia, which increases alveolar ventilation and spirometric values. Conclusions: The spirometry reference values vary according to height (higher at heights >1,500 m.a.s.l.) and sex (higher in men). It is necessary to have broader and more convincing evidence on the subject.

Parâmetros de referência espaço-temporais de um sensor inercial para sujeitos brasileiros sadios / Spatial-temporal gait parameters based on a wearable inertial sensor of healthy Brazilian subjects

Gait analysis in a laboratory may be expensive, time-consuming, and restricted to a controlled environment. Validated wearable technology may be an alternative to such analysis. However, wearable technologies should demonstrate reference values of a healthy population. Objective: To establish spatio-temporal gait reference values of an accelerometer (G-Walk) in a healthy Brazilian population. Methods: This is a cross-sectional study with 124 healthy subjects evaluated with G-Walk in the 6-minute and 10-meter walk tests (6MWT and 10MWT). Gait parameters of Velocity, Cadence, Distance, and gait symmetry variables were retrieved for analysis. Clinical and demographical characteristics were also collected and tested with simple linear regression as covariables of the gait characteristics. The bootstrapped 5th percentile of the gait parameter established the reference values. If a covariable influence was found, the reference values were established by subgroup analysis according to the covariable. Results: The study analyzed 114 subjects, mostly women (67.74%), aged 39.36 (SD 12.18). Height was a covariable of cadence for the 10MWT and cadence and stride length for the 6MWT. Age and sex combined were covariables of 6MWT velocity, and sex alone was a covariable of 6MWT. All reference values for symmetry were above 89%, velocity at the 10MWT was above 1.0m/s, and distance at the 6MWT was 354m and 359.5 for females and males, respectively. Conclusions: Our study generated reference values for spatio-temporal gait analysis with G-Walk of a population of a major urban area, considering the covariables of age, height, and sex.

Análises da marcha em laboratório tem custo elevado, demandando tempo e ambiente controlado. Wearables são equipamentos portáteis que podem ser alternativas aos laboratórios. Valores de referência podem determinar parâmetros para análises de marcha de pessoas com patologias. Objetivo: Estabelecer valores de referência espaço-temporais de um acelerômetro (G-Walk) em uma população saudável. Métodos: Trata-se de um estudo transversal com indivíduos saudáveis avaliados com G-Walk nos testes de caminhada de 6 minutos e de 10 metros (TC6 e TC10). Velocidade, cadência, distância e de simetria da marcha foram analisados. Características clínicas e demográficas também foram testadas com regressão linear simples como covariáveis das características da marcha. Os valores de referência foram estabelecidos pelo quinto percentil dos parâmetros por bootstrap e na presença de covariáveis demográficas, os valores foram estabelecidos por análise de subgrupos, de acordo com a covariável. Resultados: O estudo analisou 114 sujeitos, em sua maioria mulheres (67,74%), com idade de 39,36 (DP 12,18). A altura foi uma covariável da cadência do TC10 e da cadência e comprimento da passada do TC6. Idade e sexo combinados foram covariáveis da velocidade do TC6, e o sexo foi uma covariável do TC6. Todos os valores de referência para simetria foram superiores a 89%, a velocidade no TC10 foi superior a 1,0m/s e a distância no TC6 foi de 354m e 359,5m para mulheres e homens, respectivamente. Conclusões: Nosso estudo gerou valores de referência para análise espaço-temporal da marcha com o equipamento G-Walk em uma população de uma grande área urbana, considerando as covariáveis idade, altura e sexo.

Assessing differential land use impacts on soil quality: A method based on log-response ratios and polygonal projections.

Soil quality indices (SQI) used for assessing soil degradation are often developed using additive scoring functions. However, these SQI may lack reference values for interpreting their outputs and the capacity to differentiate changes in specific variables. To overcome these limitations, this study introduces SQI using Log Response Ratios (LRR) as measures of size effects caused by land use in physical, chemical, and microbiological soil quality indicators. LRR vectors projected 2D polygons with condensed change measures along their perimeters. This method was tested in andosols within the southeastern region of Antioquia, Colombia. These soils were subjected to contrasting stages of degradation determined by the extent of A-horizon removal due to land use practices. This study shows that mining and agriculture have detrimental effects on soil organic carbon and water contents, and that size effects vary significantly between land uses (p < 0.05). Microbiological features also exhibit distinct size effects, such as populations of culturable mesophilic bacteria and fungi, microbial basal respiration, spore density of arbuscular mycorrhizal fungi (AMF), their diversity, and total glomalin-related soil proteins (p < 0.05). The SQI proposed exhibited a negative correlation with SQI computed from scoring additive functions either considering the entire dataset (R2 = 0.87) or a minimum dataset (R2 = 0.90). This approach underscores the utility of using LRR geometrical analysis to assess global soil quality differences among land uses (p < 0.01), offering a visual, quantifiable representation of the effects of each land use over specific soil quality indicators.

Multiple sclerosis functional tests and their comparability with self-administered values: A pilot study / Pruebas funcionales en esclerosis múltiple y su comparabilidad con los valores de administración autónoma: estudio piloto.

Introduction: Neurological impairment in multiple sclerosis is highly variable among patients and over time it is difficult to quantify. The Multiple Sclerosis Outcome Assessment Consortium established sensitive, cost-effective, clinically significant, and reproducible measures of different functional systems to measure outcomes in clinical trials. However, their use in clinical care routines is not widespread due to time and training constraints. Objective: To evaluate the self-administration feasibility of the timed 25-foot walking, symbol-digit-modality, and 9-peg hole tests in healthy individuals. Materials and methods: We performed a descriptive pilot study. Healthy individuals between 18 and 80 years of age were included. The Timed 25-Foot Walking Test (T25- FWT), the Symbol Digit Modality Test (SDMT), and the Nine-Hole Peg Test (9-HPT) (using the dominant and non-dominant hand) were administered by a trained physician, who also instructed the subjects about test self-administration. The correlation and agreement, between the guided and self-administered tests were assessed with Pearson and Spearman coefficients and the Bland-Altman method. Results: Thirty-eight healthy volunteers were included. The median age was 36 (range: 23-55) years old, and 55.26% were female. The correlation coefficient between guided and selfadministered tests was 0.37 for the T25-FWT (p=0.01), 0.54 for the SDMT (p<0.001), and 0.64 and 0.65 for the 9-HPT, in the dominant and non-dominant hands, respectively (p<0,001). Both forms of administration were concordant for the T25-FWT (95%CI: -1,49 to 1,43), the 9-HPT with dominant hand (95%CI: -5,23 to 4,09), the 9-HPT with non-dominant hand (95%CI: -7,75 to 7,14) and the SDMT (95% CI: -20,94 to 24,10). Conclusions: We provide a proof of concept related to the feasibility of the selfadministration of the T25-FWT, the 9-HPT, and the SDMT, as a tool to improve monitoring in routine clinical practice.

Introducción: El deterioro neurológico en la esclerosis múltiple es variable para cada paciente y su cuantificación se dificulta con el tiempo. El Multiple Sclerosis Outcome Assessment Consortium estableció medidas clínicas sensibles, costo-efectivas y reproducibles para medir los resultados de los estudios clínicos. Sin embargo, sus valores de referencia se desconocen y, en la atención habitual, su uso no está extendido por limitaciones de tiempo y entrenamiento. Objetivo: Establecer la factibilidad de la administración autónoma de las pruebas de marcha de 25 pies, símbolos y dígitos, y clavijas y nueve hoyos en individuos sanos. Materiales y métodos: Se realizó un estudio piloto descriptivo. Se incluyeron individuos sanos entre los 18 y los 80 años. Las pruebas de Timed 25-Foot Walking Test (T25-FWT) [caminata cronometrada de 25 pies], Symbol Digit Modality Test (SDMT) [símbolos y dígitos] y Nine-Hole Peg Test (9-HPT) [clavijas y nueve agujeros] fueron administradas por un médico capacitado, quien también instruyó a los sujetos sobre la administración autónoma de las pruebas. La correlación y la concordancia entre la prueba guiada y la autónoma se evaluaron con los coeficientes de Pearson y Spearman, y el análisis gráfico de Bland-Altman. Resultados: Se incluyeron 38 voluntarios sanos. La mediana de edad fue de 36 (rango: 23-55 años) y el 55,26 % eran mujeres. El coeficiente de correlación entre la prueba de administración guiada y la autónoma fue de 0,37 para la T25-FWT (p=0,01), de 0,54 para la SDMT (p<0,001) y de 0,64 y 0,65 para la 9-HPT, en las manos dominante y no dominante, respectivamente (p<0,001). Ambas formas de administración fueron concordantes para las pruebas T25-FWT (IC95%: -1,49 a 1,43), 9-HPT con la mano dominante (IC95%: -5,23 a 4,09), 9-HPT con la mano no dominante (IC95%: -7,75 a 7,14) y SDMT (IC95%: -20,94 a 24,10). Conclusiones: Los resultados de este estudio ayudan a determinar los valores de normalidad poblacional obtenidos con las pruebas T25-FWT, 9-HPT y SDMT; además, establecen la posibilidad de practicarlas de forma autónoma.

Establishing hematologic and biochemical reference intervals for the endangered Lear's macaw (Anodorhynchus leari).

BACKGROUND: The Lear's macaw, Anodorhynchus leari (Psittaciformes, Psittacidae), is an endemic species of the Caatinga region in Brazil. With only a few free-living individuals that are constantly under threat from agricultural clearance, hunting, and trapping, A. leari is classified as "endangered" by the Red Book of Endangered Brazilian Fauna and by the International Union for Conservation of Nature. At the same time, the number of individuals in captivity has been growing due to the efforts of biologists and veterinarians in zoological parks to reproduce this species. Thus, having species-specific reference intervals for hematologic and biochemical measurands is essential to assess the health status of these captive and wild birds and guarantee their reproductive success. OBJECTIVES: This study aimed to determine reference intervals for hematologic and biochemical measurands for A. leari kept in captivity in São Paulo Zoo, Brazil. METHODS: Blood samples from 32 individuals were selected based on inclusion and exclusion criteria. Only samples from adults and healthy individuals were included in this study. All statistical analyses were performed according to the American Society for Veterinary Clinical Pathology guidelines and available literature. RESULTS: Reference values and reference intervals were determined for the captive population of Anodorhynchus leari. CONCLUSIONS: This is the first study to establish reference intervals for A. leari, which can aid the veterinarian in the interpretation of laboratory test results, helping in the diagnosis, treatment, and monitoring of diseases of this endangered species of Brazilian fauna.

The impact of neonatal 17-hydroxyprogesterone cutoff determination in a public newborn screening program for congenital adrenal hyperplasia in Southern Brazil: 3 years' experience.

Congenital adrenal hyperplasia (CAH) occurs due to enzyme defects in adrenal steroidogenesis. The 21-hydroxylase deficiency accounts for 90-95% of cases, triggering accumulation of 17-hydroxyprogesterone (17-OHP). Early diagnosis through neonatal screening allows adequate treatment and reduced mortality. The purpose of the study was to determine 17-OHP cutoffs for the diagnosis of CAH in a public newborn screening program in Southern Brazil. A retrospective, descriptive, cross-sectional study was conducted to analyze 17-OHP levels in dried blood samples collected on filter paper of 317,745 newborns screened at a public newborn screening center from May 2014 to April 2017. Neonatal 17-OHP was measured in DBS samples using a time-resolved fluoroimmunoassay (GSP® kit 3305-0010; PerkinElmer). Different cutoffs were determined and stratified by birth weight. The incidence of CAH was 1:15,887 live births in the state of Rio Grande do Sul, with 20 cases of classical CAH diagnosed during the study period. Most newborns (80.73%) were white, and the prematurity rate was 9.8% in the study population. The combination of different percentiles, 98.5th for birth weight 2001-2500 g and 99.8th for the other birth weight groups, decreased false-positive results and increased specificity compared with current reference values to identify classical CAH cases. The local 17-OHP cutoffs determined were higher than those currently used by this screening program for all birth weight groups. The calculation of reference values from local population data and the combination of percentiles proved to be a valuable tool for proper diagnosis of CAH and reduction in the number of false positives.

Metal concentrations in the whole blood of farmers in southeast Brazil.

In this study, we measured Ni, Co, Cd, and Pb concentrations in the whole blood of farmers from southeast Brazil to address the factors influencing human exposure in this population. The factors included smoking, alcohol consumption, aging, body composition, gender, and feeding preferences, which were measured through carbon and nitrogen isotopic composition. We also calculated and compared the reference values (RVs) of the measured elements to evaluate ongoing exposure levels. We observed the influence of lifestyle habits on metal exposure; Cd levels were statistically higher in smokers, and alcohol consumption affected only Pb concentrations, with an association also observed with the frequency of alcohol ingestion. The metal levels were positively associated with both isotope values, indicating that feeding may be the dominant source of these elements in this population. We also observed the effect of endogenous sources measured through age, as increased Pb concentrations in both genders and higher Cd levels in older women, which is related to bone, kidney, and liver accumulation. The body mass index was negatively associated with Ni, Co, and Cd in women and positively in men. The negative associations may indicate that body fat may act as a reservoir for metals, reducing their availability in the blood in individuals with higher body mass and possibly influencing the assessment of exposure levels. The evaluated population presented elevated RVs for all elements: Ni 36, Co 3.3, Cd 16, and Pb 149 µg L-1. These values point to higher exposure in this population compared to other studies in Brazil and worldwide. These results emphasize an urgent need for monitoring programs for toxic substances in Brazil and evaluating possible health effects, given the ongoing environmental exposure associated with endogenous exposure and lifestyle habits that promote higher metal levels in this population.

Foliar Application of Selenium Associated with a Multi-Nutrient Fertilizer in Soybean: Yield, Grain Quality, and Critical Se Threshold.

Selenium uptake and its content in soybean grains are affected by Se application methods. This study evaluated the impact of Se foliar application combined with a multi-nutrient fertilizer (MNF) on soybean, establishing a Se threshold to better understand the relationship between Se content in grains and yield of two genotypes (58I60 Lança and M5917). Two trials were conducted in a 4 × 2 factorial design: four Se rates (0, 10, 40, 80 g Se ha-1) and two methods of foliar Se application (Se combined or not with MNF). Foliar fertilizers were applied twice, at phenological stages of beginning of pod development and grain filling. Grain yield increased with the application of MNF, yet Se rates increased Se contents linearly up to 80 g Se ha-1, regardless of the use of MNF. Lança and M5917 genotypes had grain Se critical thresholds of 1.0 and 3.0 mg kg-1, respectively. The application of Se favored higher contents of K, P, and S in grains of genotype Lança and higher contents of Mn and Fe in grains of genotype M5917. Our findings highlight the importance of addressing different Se fertilization strategies as well as genotypic variations when assessing the effects of Se on soybean yield and grain quality.

Pruebas funcionales en esclerosis múltiple y su comparabilidad con los valores de administración autónoma: estudio piloto / Multiple sclerosis functional tests and their comparability with self-administered values: A pilot study

Introducción. El deterioro neurológico en la esclerosis múltiple es variable para cada paciente y su cuantificación se dificulta con el tiempo. El Multiple Sclerosis Outcome Assessment Consortium estableció medidas clínicas sensibles, costo-efectivas y reproducibles para medir los resultados de los estudios clínicos. Sin embargo, sus valores de referencia se desconocen y, en la atención habitual, su uso no está extendido por limitaciones de tiempo y entrenamiento. Objetivo. Establecer la factibilidad de la administración autónoma de las pruebas de marcha de 25 pies, símbolos y dígitos, y clavijas y nueve hoyos en individuos sanos. Materiales y métodos. Se realizó un estudio piloto descriptivo. Se incluyeron individuos sanos entre los 18 y los 80 años. Las pruebas de Timed 25-Foot Walking Test (T25-FWT) [caminata cronometrada de 25 pies], Symbol Digit Modality Test (SDMT) [símbolos y dígitos] y Nine-Hole Peg Test (9-HPT) [clavijas y nueve agujeros] fueron administradas por un médico capacitado, quien también instruyó a los sujetos sobre la administración autónoma de las pruebas. La correlación y la concordancia entre la prueba guiada y la autónoma se evaluaron con los coeficientes de Pearson y Spearman, y el análisis gráfico de Bland-Altman. Resultados. Se incluyeron 38 voluntarios sanos. La mediana de edad fue de 36 (rango: 23-55 años) y el 55,26 % eran mujeres. El coeficiente de correlación entre la prueba de administración guiada y la autónoma fue de 0,37 para la T25-FWT (p=0,01), de 0,54 para la SDMT (p<0,001) y de 0,64 y 0,65 para la 9-HPT, en las manos dominante y no dominante, respectivamente (p<0,001). Ambas formas de administración fueron concordantes para las pruebas T25-FWT (IC95%: -1,49 a 1,43), 9-HPT con la mano dominante (IC95%: -5,23 a 4,09), 9-HPT con la mano no dominante (IC95%: -7,75 a 7,14) y SDMT (IC95%: -20,94 a 24,10). Conclusiones. Los resultados de este estudio ayudan a determinar los valores de normalidad poblacional obtenidos con las pruebas T25-FWT, 9-HPT y SDMT; además, establecen la posibilidad de practicarlas de forma autónoma.

Introduction. Neurological impairment in multiple sclerosis is highly variable among patients and over time it is difficult to quantify. The Multiple Sclerosis Outcome Assessment Consortium established sensitive, cost-effective, clinically significant, and reproducible measures of different functional systems to measure outcomes in clinical trials. However, their use in clinical care routines is not widespread due to time and training constraints. Objective. To evaluate the self-administration feasibility of the timed 25-foot walking, symbol-digit-modality, and 9-peg hole tests in healthy individuals. Materials and methods. We performed a descriptive pilot study. Healthy individuals between 18 and 80 years of age were included. The Timed 25-Foot Walking Test (T25- FWT), the Symbol Digit Modality Test (SDMT), and the Nine-Hole Peg Test (9-HPT) (using the dominant and non-dominant hand) were administered by a trained physician, who also instructed the subjects about test self-administration. The correlation and agreement, between the guided and self-administered tests were assessed with Pearson and Spearman coefficients and the Bland-Altman method. Results. Thirty-eight healthy volunteers were included. The median age was 36 (range: 23-55) years old, and 55.26% were female. The correlation coefficient between guided and selfadministered tests was 0.37 for the T25-FWT (p=0.01), 0.54 for the SDMT (p<0.001), and 0.64 and 0.65 for the 9-HPT, in the dominant and non-dominant hands, respectively (p<0,001). Both forms of administration were concordant for the T25-FWT (95%CI: -1,49 to 1,43), the 9-HPT with dominant hand (95%CI: -5,23 to 4,09), the 9-HPT with non-dominant hand (95%CI: -7,75 to 7,14) and the SDMT (95% CI: -20,94 to 24,10). Conclusions. We provide a proof of concept related to the feasibility of the selfadministration of the T25-FWT, the 9-HPT, and the SDMT, as a tool to improve monitoring in routine clinical practice.

Geochemical soil dynamics on a bimodal post-collisional intrusive complex.

The importance of environmental quality for global social and ecological development, including soil degradation, cannot be overstated. Trace elements dispersed in the environment due to anthropogenic or geogenic activities can result in ecotoxicological impacts, negatively influencing environmental quality. The reference values for soil quality concerning trace elements are primarily based on geological, geomorphological, and pedological patterns. However, intrinsic geological factors may diverge some concentration levels from established norms. Therefore, conducting comprehensive surveys of environmental quality reference values becomes imperative, incorporating geological, geomorphological, and pedological patterns. A deeper understanding of the distribution of these elements is also required. Multivariate analysis proves crucial in compartmentalizing the most relevant factors, particularly in regions marked by bimodal magmatism arising from post-collisional distensional processes, such as the Santa Angélica intrusive suite in southeast Brazil. This study collected soil samples from pastures and natural grasslands with minimal anthropogenic intervention at two depths. These samples underwent various chemical and physical analyses. Statistical techniques such as correlation analysis, principal component analysis, hierarchical clustering, and geostatistics were utilized to interpret the data. The analysis revealed a correlation between the clay fraction and trace elements, demonstrating that clustering is an effective methodology for ascertaining landscape distribution patterns of these components. When compared to quality reference values, it was observed that most soil content levels exceeded both global and local standards. This study suggests that the presence of barium (Ba) in the soil might be due to the isomorphic replacement of feldspathic minerals in acidic and intermediate rocks, whereas molybdenum (Mo) seems to be associated with soils in the domain of porphyritic allanite granite. However, additional research is warranted to determine the concentration factor of Mo in this scenario accurately.

Ecuación de referencia espirométrica en varones de 2 regiones del norte peruano ubicadas entre 0 a 100 metros sobre el nivel del mar: Estudio transversal

Objetivo: Determinar los valores de referencia de espirometría y formular una ecuación de predicción de valores espirométricos en población económicamente activa (PEA) de regiones con altitud 0-100 m.s.n.m. Métodos: Se seleccionaron a los participantes del estudio considerando los criterios de selección del estudio. Se recogió la información sobre las variables consideradas en el estudio: Capacidad Vital Forzada (CVF) y Volumen Espiratorio Forzado en el primer Segundo (VEF1), datos sociodemográficos y medidas antropométricas. Se dividió a la muestra en dos grupos para poder formular la ecuación de referencia y para evaluar su confiabilidad en un subgrupo de validación mediante las pruebas de correlación intraclase, T de Student para muestras pareadas y los gráficos de Bland-Altman. Resultados: Se seleccionaron 1052 participantes varones. Los rangos normales de CVF y VEF1 calculados fueron de CVF de 3.48 -5.47 y VEF1 de 2.83 - 4.41. Mediante una regresión lineal múltiple, se obtuvieron las siguientes fórmulas: CVF = 2.206 - 0.131 (Altitud Geográfica) - 0.014 (Edad) + 0.045 (Talla) y VEF1 = 1.589 - 0.08 (Altitud Geográfica) - 0.015 (Edad) + 0.033 (Talla). En los análisis de confiabilidad, se encontró una diferencia estadísticamente significativa en las medias entre los valores predichos por la ecuación y los valores reales, aunque en los gráficos de Bland-Altman no se evidenció un sesgo significativo y los coeficientes de correlación intraclase (CVF-ICC: 0.69; VEF1-ICC: 0.70) se encontraban dentro de un rango adecuado. Conclusiones: Las ecuaciones de CVF y VEF1 desarrolladas permiten predecir adecuadamente los valores espirométricos en PEA masculina de las regiones incluidas en el estudio.

Objective: Determine the spirometry reference values and formulate an equation to predict spirometric values in the economically active population (EAP) in regions with an altitude of 0-100 m.a.s.l. Materials and Methods: Study participants were selected considering the study selection criteria. Information was collected on the variables considered in the study: Forced Vital Capacity (FVC) and Forced Expiratory Volume in the first second (FEV1), sociodemographic data and anthropometric measurements. The sample was divided into 2 groups to be able to formulate the reference equation and to assess its reliability in a validation subgroup using intraclass correlation tests, Student's t-test for paired samples, and Bland-Altman plots. Results: 1052 male participants were selected. The normal ranges for FVC and FEV1 calculated were FVC 3.48 - 5.47 and FEV1 2.83 - 4.41. Using multiple linear regression, the following formulas were obtained: FVC = 2.206 - 0.131 (Geographic Altitude) - 0.014 (Age) + 0.045 (Height) and FEV1 = 1.589 - 0.08 (Geographic Altitude) - 0.015 (Age) + 0.033 (Height). In the reliability analyses, a statistically significant difference was found in the means between the values predicted by the equation and the real values, although the Bland-Altman plots did not show a significant bias and the intraclass correlation coefficients (FVC- ICC: 0.69; FEV1-ICC: 0.70) were within an adequate range. Conclusions: The developed FVC and FEV1 equations allow adequate prediction of spirometric values in male PEA of the regions included in the study.

References values and predictive factors for thyroid volume in pregnant women.

Objective: Thyroid volume varies within each population according to different clinical and biochemical factors and can change during pregnancy. The present investigation was aimed to determine the reference values for thyroid volume in pregnant women and their predictive factors. Materials and methods: A cross-sectional study was carried out with 360 healthy pregnant women. The following variables were examined: maternal age, gestational age, skin color, current smoking status, parity, use of iodinated supplements, body mass index, thyrotropin, total and free thyroid hormones, thyroglobulin, antithyroid antibodies, chorionic gonadotropin, cholesterol and triglycerides. Results: The mean thyroid volume was 5.3 ± 1.3 mL, 5.4 ± 1.6 mL and 5.6 ± 2.5 mL in the first trimester, second trimester and third trimester, respectively. The reference interval was 2.47-9.49 mL in the first trimester, 3.17-9.01 mL in the second trimester, and 3.00-12.38 mL in the third trimester. Free triiodothyronine and triglycerides were predictors of thyroid volume (corrected R2 = 0.12; p = 0.000). Conclusion: This study is the first to determine the reference values for thyroid volume and its predictive factors in pregnant women from Cuba, a Caribbean island with sustainable elimination of iodine deficiency disorders.