INTRODUCTION: Clinicians increasingly use smartphone medical applications. There is no evidence to support the validity and reliability of applications used to assess the neuromusculoskeletal system. The aim of this study was to systematically review the quality of studies as well as the validity and reliability of using a smartphone as a clinical assessment tool for the neuromusculoskeletal system. Areas covered: PubMed, CINAHL and Embase were searched. A manual search was also conducted. Additionally, forward snowballing of relevant articles was performed in Scopus and Web of Science. Two reviewers independently selected the articles, extracted the data using a standardized form and assessed the articles quality based on a scoring system Expert commentary: Thirty-four articles were found eligible and were categorized into four groups: Range of Motion (ROM), posture and deformity, tremors and reflexes, and gait and mobility. Only the ROM category supported the validity and reliability of using smartphone applications as assessment tools. Regarding quality assessment scores, the articles in ROM and posture and deformity categories ranged from poor to good quality, whereas those in the tremors and reflexes and gait and mobility categories had poor quality.

PURPOSE OF REVIEW: Assessment of the musculoskeletal system requires consideration of its integrated function with the nervous system. This may be assisted by using valid and reliable methods that simulate real-life situations. Interactive virtual reality (VR) technology may introduce various auditory and visual inputs that mimic real-life scenarios. However, evidence supporting the quality and strength of evidence regarding the adequacy of its psychometric properties in assessing the musculoskeletal function has not been evaluated yet. Therefore, this study reviewed the validity and reliability of VR games and real-time feedback in assessing the musculoskeletal system.

RECENT FINDINGS: Nine studies were included in quality assessment. Based on outcome measures, studies were categorized into range of motion (ROM), balance, reaction time, and cervical motion velocity and accuracy. The majority of the studies were of moderate quality and provided evidence of VR adequate concurrent and, in some cases, known-groups validity. Also, VR showed high intra-rater reliability for most of the measured outcomes. Based on the included studies, there is a limited promising evidence that interactive VR using games or real-time feedback is highly valid and reliable in assessing ROM in asymptomatic participants and patients with chronic neck pain and radial fracture. For the remaining outcomes, evidence is limited to draw a robust conclusion. Future studies are recommended to test VR psychometric properties in different patients' population using a rigor research methodology.

OBJECTIVE: The aim of this study was to validate the classification criteria for cryoglobulinaemic vasculitis (CV).

METHODS: Twenty-three centres were involved. New patients with CV (group A) and controls, i.e. subjects with serum cryoglobulins but lacking CV based on the gold standard of clinical judgment (group B) and subjects without cryoglobulins but with clinical features that can be observed in the course of CV (group C), were studied. Positivity of serum cryoglobulins was necessary for CV classification. Sensitivity and specificity of the criteria were calculated by comparing group A vs group B. The group A vs group C comparison was done to demonstrate the possible diagnostic utility of the criteria.

RESULTS: The study included 268 patients in group A, 182 controls in group B and 193 controls in group C (small vessel vasculitis, 51.8%). The questionnaire (at least 2/3 positive answers) showed 89.0% sensitivity and 93.4% specificity; the clinical item (at least 3/4 clinical involvement) showed 75.7% sensitivity and 89.0% specificity and the laboratory item (at least 2/3 laboratory data) showed 80.2% sensitivity and 62.4% specificity. The sensitivity and specificity of the classification criteria (at least 2/3 positive items) were 89.9% and 93.5%, respectively. The comparison of group A with group C demonstrated the clinical utility of the criteria in differentiating CV from CV mimickers.

CONCLUSION: Classification criteria for CV were validated in a second, large, international study confirming good sensitivity and specificity in a complex systemic disease.

BACKGROUND: Surface ECG is a useful tool to guide mapping of focal atrial tachycardia (AT). We have previously
proposed an algorithm based on paced P wave morphology
templates by pacing from different anatomical sites in both
atria.
OBJECTIVE: Validation of this algorithm in a retrospective series of AT patients who underwent catheter ablation.
METHODS: We prospectively enrolled consecutive patients
who underwent electrophysiology study, had no heart disease
and no atrial enlargement. Atrial pacing, at twice diastolic
threshold, was carried out at different anatomical sites in
both atria. Paced P wave morphology and duration were
assessed. An algorithm was generated from the constructed
templates of each pacing site. The algorithm was applied on a
retrospective series of successfully ablated AT patients between 2006 and 2016. Overall and site-specific accuracy
were determined.
RESULTS: Derivation cohort included 65 patients (25 men,
age 37
13 years). Atrial pacing was performed in 1025 sites
in 61 patients (95%) in the right atrium and in 15 patients
(23%) in the left atrium. The validation cohort included 71
patients (28 men, age 52
19 years). AT were right atrial in
66.2%. The algorithm successfully predicted AT origin in
91.5% of patients (100% in LA and 87.2% in RA). It was off
by 1 adjacent segment in the remaining 8.5%. Site-specific
accuracies are shown in Table1.
CONCLUSION: A simple ECG algorithm based on paced
P-wave morphology templates was highly accurate in localizing sites of origin of focal atrial tachycardia particularly those
of LA origin.

Four simple, accurate, sensitive and precise spectrophotometric methods were developed and validated for simultaneous determination of Troxerutin (TXN) and Carbazochrome (CZM) in their bulk powders, laboratory prepared mixtures and pharmaceutical dosage forms. Method A is first derivative spectrophotometry (D1) where TXN and CZM were determined at 294 and 483.5 nm, respectively. Method B is first derivative of ratio spectra (DD1) where the peak amplitude at 248 for TXN and 439 nm for CZM were used for their determination. Method C is ratio subtraction (RS); in which TXN was determined at its λmax (352 nm) in the presence of CZM which was determined by D1 at 483.5 nm. While, method D is mean centering of the ratio spectra (MCR) in which the mean centered values at 300 nm and 340.0 nm were used for the two drugs in a respective order. The two compounds were simultaneously determined in the concentration ranges of 5.00–50.00 μg mL−1 and 0.5–10.0 μg mL−1 for TXN and CZM, respectively. The methods were validated according to the ICH guidelines and the results were statistically compared to the manufacturer’s method.

Four simple, accurate, sensitive and precise spectrophotometric methods were developed and validated for simultaneous determination of Troxerutin (TXN) and Carbazochrome (CZM) in their bulk powders, laboratory prepared mixtures and pharmaceutical dosage forms. Method A is first derivative spectrophotometry (D1) where TXN and CZM were determined at 294 and 483.5nm, respectively. Method B is first derivative of ratio spectra (DD1) where the peak amplitude at 248 for TXN and 439nm for CZM were used for their determination. Method C is ratio subtraction (RS); in which TXN was determined at its λmax (352nm) in the presence of CZM which was determined by D1 at 483.5nm. While, method D is mean centering of the ratio spectra (MCR) in which the mean centered values at 300nm and 340.0nm were used for the two drugs in a respective order. The two compounds were simultaneously determined in the concentration ranges of 5.00–50.00μgmL−1 and 0.5–10.0μgmL−1 for TXN and CZM, respectively. The methods were validated according to the ICH guidelines and the results were statistically compared to the manufacturer’s method.

Background: Obesity is a medical condition that may adversely affect wellbeing and leading to increased incidence of
many health problems. Abdominal obesity tends to be associated with weight gain and obesity and it is significantly
connected with different disorders like coronary heart disease and type II diabetes mellitus.This study was conducted
to investigate the efficacy of vacuum therapy as compared to abdominal exercises on abdominal obesity in overweight
and obese women.
Methods: Thirtyoverweight and obese women participated in this study with body mass index > 25 kg/m2andwaist
circumference ≥ 85 cm. Their ages ranged from 28 - 40 years old.The subjects were excluded if they have diabetes, abdominal
infection diseases or any physical limitation restricting exercise ability. They were randomly allocated into two
equal groups; group I and group II. Group I received vacuum therapy sessions (by the use of LPG device) in addition
to aerobic exercise training. Group II received abdominal exercises in addition to the same aerobic exercisesgiven to
group I. This study was extended for successive 8 weeks (3 sessions/ week). All subjects were assessed for thickness of
the abdominal skin fold, waist circumference and body mass index.
Results: The results of this study showeda significant difference between group I and group II post-interventionas regarding
to the mean values of waist circumference and abdominal skin fold thickness (p<0.05).
Conclusion: It can be concluded that aerobic exercises combined with vacuum therapy (forthree sessions/week for
successive 8 weeks) have a positive effect on women with abdominal obesity in terms of reducing waist circumference
and abdominal skin fold thickness.
Keywords: Vacuum therapy, Abdominal Exercises, Aerobic Exercises, Abdominal Obesity, Women, Obesity.