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- Prevalence, characteristics, and impact of spinal and lower limb recurrent pain at age 13Publication . Rodrigues, Elisa; Bessa, Isabel Moura; Brochado, Gabriela; Carvalho, Paulo; Talih, Makram; Pires, Catarina; Lucas, Raquel; Rodrigues, Elisa; Moura Bessa, IsabelTo compare spinal and lower limb pain in adolescents regarding prevalence, characteristics, causes, and impact. Methods: A descriptive cross-sectional study was conducted in 13-year-old adolescents (female n=2210; male n=2353) from the Portuguese Generation XXI birth cohort. Data were collected between 2018 and 2020 through personal interviews by applying the Luebeck Pain Questionnaire. The pain features examined in each anatomical location (back and lower limb) were recurrence, duration, frequency, intensity, perceived causes, and impact on school and leisure activities. Frequencies and the Chi-square test were used. Results: Questionnaires from 4563 adolescents were analysed, 57.9% had pain in the last three months (main pain in the spine: 11.6%; main pain in the lower limb: 29.0%). Of those, 69.4% and 62.4% reported recurrent pain in the spine and lower limb, respectively. Recurrent pain was more frequent in girls than in boys (spine: 80.0%; 57.0%; lower limb: 70.4%; 58.1% respectively). Pain lasted more than three months in most adolescents (spine: about 60%; lower limb: above 50%); frequency was similarly high in both regions and both sexes (girls: 47.0%; boys: 45.7% in the spine; girls: 45.7%; boys: 40.3% in the lower limb); intensity was rated as high by girls (spine: 45.5%; lower limb: 47.3%) and moderate by boys (spine: 42.0%; lower limb: 41.0%). The leading causes of pain were daily living activities, both for the spine (girls: 65.9%; boys: 76.5%) and the lower limb (girls: 62.2%; boys: 72.1%). Psychosocial causes were the second most common cause of spinal pain (girls: 25.0%; boys: 21.0%). Other causes of lower limb pain were traumatic (girls: 25.5%; boys: 16.6%) and physical factors (girls: 20.7%; boys: 23.8%). Absences from school (girls: 11.7%; boys: 4.8%) and restrictions of leisure activities (girls: 20.7%; boys: 25.2%) were more related to pain in the lower limb. Conclusion: More than half of the adolescents reported spinal or lower limb recurrent pain, which presents a higher frequency, higher intensity, and longer duration in the spine. However, lower limb pain led to more concurrent limitations.
- Optimized extraction protocols for bioactive antioxidants from commercial seaweeds in Portugal: A comparative study of techniquesPublication . Santos, Francisca; Soares, Cristina; Morais, Stephanie L.; Neves, Cátia; Grosso, Clara; Ramalhosa, Maria João; Vieira, Mónica; Delerue-Matos, Cristina; Domingues, Valentina F.; Vieira, MónicaThis study aimed to optimize the extraction conditions for a valuable source of antioxidants: seaweed. Therefore, ten seaweed samples were subjected to a solid–liquid extraction (SLE), where the extraction conditions (biomass (g): solvent (mL) ratio, temperature, and time) were optimized using response surface methodology (RSM). The seaweeds were also subjected to subcritical water extraction (SWE) (140 and 190 ◦C) and ultrasound-assisted extraction (UAE) (10 and 20 min). The antioxidant capacity of the extracts was determined through the ferric-reducing antioxidant power and the 2,2′ -azino-bis(3-ethylbenzothiazoline-6-sulfonic acid). The total phenolic content revealed the significance of temperature and biomass; solvent ratio parameters in the extraction process with higher conditions generally promoting the release of phenolic compounds. Furthermore, applying RSM allowed for the identification of optimal conditions and the establishment of predictive models that can be valuable in industrial-scale extraction processes. The antioxidant potency composite index (APCI) shows that SWE at 190 ◦C stands out, with E. bicyclis reaching an APCI score of 46.27%. The AGREEprep evaluation showed that UAE is the most sustainable method, achieving the highest score (0.69). The results of this study contribute to the development of efficient and standardized extraction protocols for each seaweed species, allowing for the maximum yield of antioxidants.
- Editorial comments on “Multiarray screening identifies plasma proteins associated with Th17 cell differentiation and viral defense in coincident asthma and obesity”Publication . Rufo, João Cavaleiro; Chauhan, Jitesh; Kalayci, Ömer; Eigenmann, Philippe; Cavaleiro Rufo, JoãoThe clinical associations between asthma and obesity remain poorly understood. The increasing prevalence ofboth conditions occurring may represent a modern clinical paradox. It is unclear whether reduced physical activ-ity in children with asthma leads to obesity, or if asthma-like symptoms in obese children result directly from theassociated excessive abdominal fat, impaired lung function, and heightened Th2 inflammation. Determining theetiology of both diseases and their interconnection is therefore an important research avenue.A recent study has sought to investigate this through a cross-sectional analysis of Australian children, bothwith and without asthma, examining their levels of physical activity. Interestingly, the study found no evidencethat asthma hindered physical activity.1 On the other hand, although most studies have shown obesity is linkedto a higher risk of asthma, the exact mechanism remains unclear. Many studies refer to obesity as an exacerbationfactor for asthma symptoms rather than a direct contributor to the underlying pathophysiological mechanisms ofasthma. 2 This highlights the need for continued research to untangle the complex interplay between these twoconditions.In 2019, a study investigating the associations between exposure to endocrine-disrupting chemicals andchildhood asthma identified a specific pattern of volatile organic compounds that were significantly linked to theearly onset “obese-asthma” phenotype, but not to asthma or obesity independently. 3 This suggests that asthmaand obesity may share common risk factors that trigger disease onset of both conditions during early childhood.Supporting this hypothesis, subsequent research has identified 29 genes associated with the obese-asthma phe-notypes, including GBP5 and SOCS, which further highlights the genetic underpinnings of this dual condition. 4In this issue, Manell et al. offer valuable insights by investigating novel plasma protein biomarkers specificallyassociated with the coexistence of asthma and obesity in an adolescent population. 5 The cross-sectional studyinvolved 390 children and adolescents, aged 10 to 19, who were categorized into four groups: healthy controls,individuals with asthma, individuals with obesity, and those with both obesity and asthma (OA).A proximity extension assay was used to assess the relative plasma concentrations of 113 proteins associatedwith inflammation and immune response. The study identified five plasma proteins—CCL8, IL-33, IL-17C, FGF-23,and CLEC7A—that were significantly and specifically elevated in the OA group compared to controls. However,after adjusting for age, sex, and sIgE levels, only CCL8 and CLEC7A remained significantly elevated. This suggeststhat the high levels observed for IL-33, IL-17C, and FGF-23 in the OA group may be partially attributable to atopy.Drawing on previously published evidence and considering the role of CCL8 in mucosal chemotaxis and Th2inflammation, Manell et al. propose that viral defense at mucosal barriers may play an important role in obesity-related asthma in children and adolescents. 5 While the exact pathophysiological mechanism behind CCL8 over-expression remains unclear, it is noteworthy that prior studies have confirmed no association between CCL8and atopy. 6 This, along with the evidence that CCL8 levels are regulated in obese individuals without asthma,strengthens the argument for this chemokine as a promising biomarker for obese-asthma phenotypes.Additionally, FGF-23, IL-17C, and IL-33, which are linked to mucosal host defense against viral infections andTh17 cell activation, were also regarded as potential biomarkers for concomitant asthma and obesity, though toa lesser extent. 5 Conversely, the elevated levels of CLEC7A in the OA group appear to be additive, reflecting thecombined effects of asthma and obese observed separately.
- Unlocking the functional potential of Mesembryanthemum nodiflorum: Insights into digestibility, safety and intestinal uptakePublication . Pinto, Diana; Vieira, Raquel; Teixeira, Filipa; Sut, Stefania; Vieira, Mónica; Salazar, Miguel; Delerue-Matos, Cristina; Dall’Acqua, Stefano; Rodrigues, Francisca; Vieira, MónicaMesembryanthemum nodiflorum, commonly known as slenderleaf iceplant, is an undervalued edible halophyte. The nutraceutical potential of M. nodiflorum was investigated in the current study by extracting bioactive compounds using ultrasound-assisted extraction (UAE) and assessing the influence of gastrointestinal digestion and intestinal permeability on their bioactive composition. The phenolic and flavonoid contents were the highest in the alcoholic extract, along with exceptional antioxidant/antiradical effects. The gastrointestinal digestion enhances the release and detectability of phenolic compounds and antioxidant activity, with bioaccessibility exceeding 100 %. Additionally, the extracts stimulated antioxidant enzymes and inhibited acetylcholinesterase (AChE), with alcoholic extract showing the highest inhibition (38 %). UPLC-QTOF-MS unveiled high concentrations of glycerophospholipids, tryptophan, and 5,5 ′-dihydroferulic acid. Ethanol was the most effective solvent for extracting bioactive compounds. Through an intestinal co-culture model, the intestinal digest from the alcoholic extract demonstrated notable permeation (66 % for rosmanol, 30 % for Lys-Asp-Tyr, and 15 % for tryptophan). These results highlight the bioactivity and intestinal absorption of M. nodiflorum extracts, repurposing this halophyte as a nutraceutical.
- Assessing resilience potentials in management of occupational safety and health in hospitals: Development and validation of a toolPublication . Afonso-Fernandes, J.; Barbosa, J.; Arezes, P.; Pardo-Ferreira, C.; Rubio-Romero, J.C.; Rodrigues, Matilde Alexandra; Rodrigues, MatildeA resilient Occupational Safety and Health (OSH) management system is crucial for effectively addressing potential future public emergencies, ensuring the continuous protection of workers' safety and health. Therefore, it is essential for organizations, particularly hospitals, to assess their resilient performance and employ tools that are appropriate and tailored to their specific context. This study aims to enhance the understanding of resilience potentials in OSH management within hospital settings. To this end, an assessment tool was developed based on the Resilience Assessment Grid (RAG). A Delphi study involving subject matter experts was conducted to refine the tailored RAG tool. Following this, a pilot test was administered to 404 healthcare professionals across three public hospitals, with subsequent psychometric analysis. Exploratory Factor Analysis (EFA) identified a four-dimensional structure. Goodness-of-fit indices demonstrated acceptable values, confirming the adequacy of the measurement model. Reliability testing indicated that the 29 item assessment tool is both valid and reliable. The tailored RAG tool was successfully validated, enabling the identification of strengths and weaknesses in OSH management.
- Enhancement of wound healing in diabetic mice by topical use of a peptide-ionic liquid conjugatePublication . Gomes, Ana; Leal, Ermelindo C.; Ferraz, Ricardo; Calheiros, Daniela; Silva, Jessica da; Gonçalves, Teresa; Teixeira, Inês; Carvalho, Eugénia; Gomes, Paula; Ferraz, RicardoDiabetic foot ulcers (DFU) are one of the most devastating complications of diabetes, with high impact on patient’s quality of life. In worst scenarios, DFU can lead to severe amputation or even death. DFUs are an easy target for microbial pathogens and their effective healing is hampered by the galloping increase of microbial resistance to antibiotics, including from the most prevalent pathogens in DFU, e.g. Staphylococcus aureus. As such, available antibiotics show poor efficacy in the treatment of DFU, leading to a chronic condition that is exacerbated by poor healing rates due to the persistent inflammation, poor oxygenation and low angiogenesis, leading to high risk of ischemia, among other conditions that typically affect patients with diabetes. Our group has recently designed new peptide-based strategies towards the topical treatment of DFU, whereby peptide-ionic liquid conjugates emerged as highly promising agents. One of the best such conjugates, C16-Im-PP4, results from coupling an imidazolium-based ionic liquid with intrinsic antimicrobial activity to the N-terminus of a collagen boosting peptide used in cosmetics, the pentapeptide-4. C16-Im-PP4 showed excellent in vitro properties, namely, wide-spectrum antimicrobial action and collagen-boosting effect on human dermal fibroblasts, prompting the in vivo study here reported. The peptide-ionic liquid conjugate was applied topically on wounds of mice with diabetes. The results show multitargeted actions, at a dose of 1 µg/wound including: i) anti-inflammatory; ii) antioxidant; iii) pro-collagenic; vi) pro-angiogenic; v) antimicrobial; and vi) improved wound maturation effects. Altogether, these results identify this technology as a novel topical treatment for DFU.
- Nature-based hydrogels combined with nanoparticles for bone regenerationPublication . Fernandes, Margarida; Vieira, Mónica; Peixoto, Daniela; Alves, Natália M.; Vieira, MónicaBone is a calcified tissue composed of 60% inorganic compounds, 30% organic compounds, and 10% water. Bone exhibits an intrinsic regenerative capacity, enabling it to heal after fractures or adapt during growth. However, in cases of severe injury or extensive tissue loss, this regenerative capacity becomes insufficient, often necessitating bone graft surgeries using autografts or allografts. Conventional grafting approaches present several limitations, driving the development of alternative strategies in tissue engineering. The system of hydrogel–nanoparticles (NPs) represents a new class of biomaterials designed to combine the advantages of both materials while mitigating their drawbacks. This review focuses on a combination of nature-based hydrogels with different types of nanoparticles and discusses their potential applications in bone regeneration.
- Comparative evaluation of artificial intelligence chatbots in answering electroencephalography-related questionsPublication . Proença, Soraia; Soares, Joana Isabel; Parra, Joana; Maia, Gisela; Leite, Juliana; Beniczky, Sándor; Jesus-Ribeiro, Joana; Henrique Maia, Gisela MariaAs large language models (LLMs) become more accessible, they may be used to explain challenging EEG concepts to nonspecialists. This study aimed to compare the accuracy, completeness, and readability of EEG-related responses from three LLM-based chatbots and to assess inter-rateragreement. One hundred questions, covering 10 EEG categories, were entered into ChatGPT, Copilot, and Gemini. Six raters from the clinical neurophysiology field (two physicians, two teachers, and two technicians) evaluated the responses. Accuracy was rated on a 6-point scale, completeness on a 3-point scale, and readability was assessed using the Automated Readability Index (ARI). We used a repeated-measures ANOVA for group differences in accuracy and readability, the intraclass correlation coefficient (ICC) for inter-raterreliability, and a two way ANOVA, with chatbot and raters as factors, for completeness. Total accuracy was significantly higher for ChatGPT (mean ± SD 4.54 ± .05) compared with Copilot (mean ± SD 4.11 ± .08) and Gemini (mean ± SD 4.16 ± .13) (p < .001). ChatGPT's lowest performance was in normal variants and patterns of uncertain significance (mean ± SD 3.10 ± .14), while Copilot and Gemini performed lowest in ictal EEG patterns (mean ± SD 2.93 ± .11 and 3.37 ± .24, respectively). Although inter-rater agreement for accuracy was excellent among physicians (ICC = .969) and teachers (ICC = .926), it was poor for technicians in several EEG categories. ChatGPT achieved significantly higher completeness scores than Copilot (p < .001) and Gemini (p = .01). ChatGPT text (ARI − mean ± SD 17.41 ± 2.38) was less readable than Copilot (ARI −mean ± SD 11.14 ± 2.60) (p < .001) and Gemini (ARI − mean ± SD 14.16 ± 3.33). Chatbots achieved relatively high accuracy, but not without flaws, emphasizing that the information provided requires verification. ChatGPT outperformed the other chatbots in accuracy and completeness, though at the expense of readability. The lower inter-rater agreement among technicians may reflect a gap in standardized training or practical experience, potentially impacting the consistency of EEG-related content assessment.
- Response to: Does reliability benefit from superior visualization of epileptiform discharges on inferior temporal electrodes?Publication . Batista, Carla; Soares, Joana Isabel; Coelho, Paulo; Ferreira, Simão; Rosenzweig, Ivana; Borges, Daniel Filipe; Borges, Daniel Filipe; Ferreira, SimãoWe thank Dr. Kleine for his thoughtful letter regarding our study and for highlighting both the anatomical rationale and the recognized clinical relevance of inferior-temporal electrodes. We welcome the opportunity to clarify specific numerical points and to provide the inter-reviewer agreement data he requested. Our study was intentionally designed as a prospective, blinded, within-subject technical validation comparing the IFCN-recommended 25-electrode 19-channel 10–20 International System (10–20 IS) in consecutive(IFCN-25) array with the conventional 19-channel 10–20 International System (10–20 IS) in consecutive adult EEGs. Importantly, it was not framed as a diagnostic or superiority trial: no external gold standard was applied, and both montages were treated methodologically as equivalent acquisition systems. The primary endpoint was patient-level detection of any abnormality (IEDs or focal slow activity) under blinded real-world conditions. In this reply, we address exclusively the point raised by Dr. Kleine concerning inter-reviewer agreement for temporal-lobe IEDs, providing the 2 × 2 tables and κ values requested. These analyses represent a clear subset of the broader dataset already published and are provided here for transparency.
- Assessing carbohydrate counting accuracy: Current limitations and future directionsPublication . Amorim, Débora; Miranda, Francisco; Santos, Andreia; Graça, Luís; Rodrigues, João; Rocha, Mara; Pereira, Maria Aurora; Sousa, Clementina; Felgueiras, Paula; Abreu, Carlos; Costa-Rodrigues, JoaoDiabetes mellitus is a prevalent chronic autoimmune disease with a high impact on global health, affecting millions of adults and resulting in significant morbidity and mortality. Achieving optimal blood glucose levels is crucial for diabetes management to prevent acute and long-term complications. Carbohydrate counting (CC) is widely used by patients with type 1 diabetes to adjust prandial insulin bolus doses based on estimated carbohydrate content, contributing to better glycemic control and improved quality of life. However, accurately estimating the carbohydrate content of meals remains challenging for patients, leading to errors in bolus insulin dosing. This review explores the current limitations and challenges in CC accuracy and emphasizes the importance of personalized educational programs to enhance patients’ abilities in carbohydrate estimation. Existing tools for assessing patient learning outcomes in CC are discussed, highlighting the need for individualized approaches tailored to each patient’s needs. A comprehensive review of the relevant literature was conducted to identify educational programs and assessment tools dedicated to training diabetes patients on carbohydrate counting. The research aims to provide insights into the benefits and limitations of existing tools and identifies future research directions to advance personalized CC training approaches. By adopting a personalized approach to CC education and assessment, healthcare professionals can empower patients to achieve better glycemic control and improve diabetes management. Moreover, this review identifies potential avenues for future research, paving the way for advancements in personalized CC training and assessment approaches and further enhancing diabetes management strategies.