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Background:The talk test (TT) evaluates the exercise intensity by measuring speech comfort level during aerobic exercise. There are several application protocols available to assess individuals with cardiopulmonary diseases. However, the measurement properties of the TT were not systematically reviewed yet. Methods: A systematic review was developed, registered (CRD420181068930), and reported according to PRISMA Statement. Randomized clinical trials, cross-sectional studies, or series cases were identified through multiple databases and were selected if they presented concomitant speech provocation and an exercise test. Included studies were evaluated based on methodological quality (adapted New Castle-Ottawa Scale), descriptive quality (STROBE Statement), and risk of bias (COSMIN bias risk scale). Results: Ten studies were included. Seven studies presented moderate to high quality and the majority presented good scores according to the STROBE statement. Four hundred and fourteen subjects performed the TT, the majority being patients with coronary artery disease. The test validity was supported by the included studies. Talk Test reliability was considered satisfactory, although only one study presented an adequate reliability analysis. The studies found a correlation between the last positive stage of the TT with the first ventilatory threshold. Workload, oxygen uptake, and heart rate in the last positive stage of the TT were not different from the same parameters related to the first ventilatory threshold. Conclusions: The evidence indicates that the TT is suitable as an alternative tool for the assessment and prescription of exercise in individuals with cardiovascular diseases. The stage when the individual is still able to speak comfortably is suggested as the intensity for aerobic exercise prescription. As there is still no well-defined and fully explored TT protocol, caution is required when interpreting the TT results.

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Funding Acknowledgements Type of funding sources: None. Background Frailty has a high prevalence of heart failure (HF). It is believed that existing circulatory disturbance increase oxidative stress and chronic inflammation, predisposing to anabolic-catabolic imbalance. Thus, there is impairment of the efficient use of oxygen by skeletal muscles, limiting the physical-functional performance in these individuals. However, little is known about the influence of frailty on endothelial function in the elderly. Purpose To analyze the influence of frailty on endothelial function in the elderly with and without HF. Methods This was a descriptive cross-sectional study, which included individuals aged ≥60 years, with or without HF, who did not have diabetes, anemia, peripheral obstructive arterial disease and/or congenital heart disease. The Cardiovascular Health Study (CHS) frailty scale criteria were used to assess frailty (phenotype). Endothelial function at rest was evaluated by near-infrared spectroscopy ([NIRS]; slope 1, lowest tissue oxygen saturation [StO2], area under the curve [AUC] of StO2, slope 2, StO2 peak, overshoot, ΔStO2nadir_peak and Δtime nadir_peak) during arterial occlusion maneuver on the forearm. Results were grouped according to the frailty phenotype: robust, pre-frail and frail. Shapiro-Wilk test was used to assess the normality of data. Quantitative data were compared using a two-way analysis of variance plus Bonferroni post hoc test to determine the influence of the frailty or HF on endothelial function variables. A p-value <0.05 was considered statistically significant. Results Fifty-two elderly people (61% women) participated in the study, with a mean age of 70.3 ± 7.1 years. Of these, 52% (n = 27) had a diagnosis of HF. Among the sample, 35% (n = 18) were robust, 45% (n = 23) pre-frail, and 20% (n = 11) frail. Endothelial function analysis identified that there was an influence of frailty on reperfusion rate (slope 2 and ΔStO2 nadir-peak; p < 0.05) and desaturation during arterial occlusion (AUC StO2; p < 0.05) only in the HF group. Conclusion The coexistence of frailty and HF seems to impair endothelial function since frail elderly with HF had lower reperfusion rate and higher desaturation during the arterial occlusion test. Abstract Figure. Endothelial function assessment by NIRS

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Tralokinumab was approved in December 2021 in the USA for the treatment of moderate-to-severe atopic dermatitis (AD) in adults. Real-world characteristics of patients prescribed tralokinumab are not yet understood. This study aims to characterize the demographic, medical history and clinical baseline characteristics of patients prescribed tralokinumab in US dermatology practices and integrated delivery networks. A retrospective analysis of adult patients prescribed tralokinumab between February and October 2022 was conducted using electronic health record data from OMNY Health, a data platform comprising patients from US specialty and integrated delivery networks. Patients were indexed at first tralokinumab prescription and further divided into two groups for comparative analysis: biologic-naïve vs. biologic-experienced. Descriptive statistics (demographics, medical history/comorbidities and treatment history/concomitant prescriptions) were also analysed. A total of 195 tralokinumab patients were included, of which the majority were female (55%), ≥50 years old (56%) and self-identified as White race (78%). More than half (54%) were previously treated with dupilumab. Among biologic-naïve vs. biologic-experienced patients, a higher proportion was female (61% vs. 50%) and older (mean age: 54 vs. 48 years). Among the biologic-experienced subset, at baseline, the most common documented comorbidities were systemic infection (30%), skin infection (20%) and asthma (14%), while in the biologic-naïve subset, 17% had systemic infection, 14% had skin infection and 9% had asthma. Overall, commonly used AD treatments among all patients were topical corticosteroids (81%), topical calcineurin inhibitors (38%) and systemic corticosteroids (35%). Use of these medications was increased among biologic-experienced vs. biologic-naïve individuals. More dermatologists vs. nurse practitioners prescribed tralokinumab to biologic-naïve patients (43% vs. 30%); more nurse practitioners prescribed tralokinumab as second line to biologic-experienced patients compared with first line in biologic-naïve patients (15% vs. 6%). Among tralokinumab patients with available data, baseline mean AD-affected body surface area (n = 83) was 22%, and mean numeric rating scale itch score (n = 35) was 5.7 (range 0–10). Seventy-nine percent of 56 patients with available data had moderate or severe disease per investigator’s global assessment. The AD involvement of the face and hands (n = 26) was documented in 15% and 42%, respectively. A larger proportion of biologic-experienced patients had severe disease vs. their biologic-naïve counterparts (23% vs. 19%), while the opposite trend was seen with moderate disease (53% vs. 62%). This study provides early insights into the characteristics of tralokinumab patients in a real-world setting. While many characteristics were similar between biologic-naïve and biologic-experienced patients, a higher proportion of biologic-experienced patients had more clinician-assessed severe disease vs. the biologic-naïve subset. Tralokinumab was prescribed at similar rates as first- or second-line biologic therapy. The small sample size of this descriptive analysis limits generalizability of these results. Additional prospective studies are needed to observe the changes in real-world clinical outcomes in tralokinumab patients over time.

Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001. Background Cardiopulmonary exercise test (CPET) is the reference method for assessing gas exchange threshold (GET), a surrogate of the anaerobic threshold (AnT). However, muscle oxygenation has been shown as an additional tool for AnT determination, using the lower limb threshold (LLT). Besides, Talk Test (TT), a tool used to assess, prescribe, and monitor exercise intensity through speech comfort level, has shown a correlation with GET as well. Purpose To identify the AnT obtained from the traditional method from CPET (GET) and the LLT; to compare heart rate (HR) and tissue saturation index (TSI) data at AnT (GET and LLT); to compare the parameters of LLT on CPET and TT, and to correlate LLT and TT stages in cardiovascular disease (CVD) patients. Methods CVD patients underwent CPET and TT, both on a treadmill, in two distinctive days. During those tests, peripheral muscle oxygenation was assessed by the near-infrared spectroscopy method. GET (CPET) was determined by the V-slope method; LLT (CPET and TT) was determined by the visual inspection of oxyhemoglobin and deoxyhemoglobin curves. A TT protocol based on the prediction equation for the covered distance of the six-minute walk test (6MWD) was applied. TT protocol was incremental, with two-minutes stages starting at 70% of the average velocity predicted and 2% of inclination, increasing velocity in 10 percentage points (p.p.) at each stage, until the fifth stage, at which the inclination was increased in 2 p.p. until test completion. At the end of each stage, patients read a standardized paragraph and were asked about speech comfort. Shapiro-Wilk test was performed to assess data distribution. Wilcoxon test was applied to compare physiological variables (HR and TSI) at GET and LLT. Repeated measures analysis of variance (ANOVA), followed by Bonferroni post-hoc test was assessed to compare the variables at LLT and TT stages (last TT+ and first TT±). Spearman correlation coefficient was used to assess the relationship between variables. Statistical significance was set at 5%. Results 24 cardiovascular patients were included. Similar values of HR (GET vs. LLT: 102 ± 15 bpm vs. 99 ± 14 bpm, p = 0,08), and TSI (GET vs. LLT: 64,6 ± 8,2% vs. 66,4 ± 7,8%, p = 0,09) were observed during CPET. Regarding LLT at CPET and TT, there was no difference between HR (CPET vs. TT: 99 ± 14 bpm vs. 100 ± 12 bpm, p = 1,00) and TSI (CPET vs. TT: 66,4 ± 7,8% vs. 65,3 ± 4,9%, p = 1,00). Furthermore, good relationship between HR in LLT and TT stages (LLT vs. TT+: r = 0,79; LLT vs. TT±: r = 0,76; p < 0,05 for both) was found. Conclusions Our results showed similarity between LLT and GET. Besides, TT showed a similar response of muscle oxygenation and heart rate comparing to CPET, with a good correlation between LLT and TT stages. These results endorse the validity of TT as an auxiliary and low-cost tool to identify the AnT.