Biomarkers of exposure in urine of active smokers, non-smokers, and vapers.

The exposure to smoking related products has been evaluated through urine illness risk marker determination through the analysis of urine samples of smokers and vapers. Biomarkers and their metabolites such as N-acetyl-S-(2-cyanoethyl)-L-cysteine (CEMA), N-acetyl-S-(3,4-dihydroxybutyl)-L-cysteine (DHBMA), N-acetyl-S-[1-(hydroxymethyl)-2-propen-1-yl)-L-cysteine (MHBMA), N-acetyl-S-(3-hydroxypropyl)-L-cysteine (3HPMA), 2R-N-acetyl-S-(4-hydroxybutan-2-yl)-L-cysteine (HMPMA), and N-acetyl-S-(3-carboxy-2-propyl)-L-cysteine (CMEMA) together with nicotine and cotinine were identified and quantified by LC-HRMS and LC-MS/MS, and data found normalized to the creatinine level. One hundred two urine samples were collected from smokers, non-smokers, and vapers, spanning an age range from 16 to 79 years. Results obtained showed that CEMA was only detected in urine samples from smokers and MHBMA was in the same order of magnitude in all the urine samples analyzed. HMPMA was found in the urine of vapers at the same order of concentration as in non-smokers. 3HPMA in vapers was lower than in the urine of smokers, presenting an intermediate situation between smokers and non-smokers. On the other hand, DHBMA in vapers can reach similar values to those found for smokers, while CMEMA shows concentrations in the urine of vapers higher than in the case of non-smokers and traditional smokers, requiring new research to link this metabolite to the use of electronic cigarettes and possible alternative metabolomic routes. In general, this study seems to verify that traditional smoking practice constitutes a major source of carcinogenic chemicals compared with substitutive practices, although those practices are not free of potential harm.

Understanding Severe Asthma Through Small and Big Data in Spanish Hospitals: The PAGE Study.

BACKGROUND: Data on the prevalence of severe asthma (SA) are limited. Electronic health records (EHRs) offer a unique research opportunity to test machine learning (ML) tools in epidemiological studies. Our aim was to estimate the prevalence of SA among asthma patients seen in hospital asthma units, using both ML-based and traditional research methodologies. Our secondary objective was to describe patients with nonsevere asthma (NSA) and SA over a follow-up of 12 months. METHODS: PAGE is a multicenter, controlled, observational study conducted in 36 Spanish hospitals and split into 2 phases: a cross-sectional phase for estimation of the prevalence of SA and a prospective phase (3 visits in 12 months) for the follow-up and characterization of SA and NSA patients. A substudy with ML was performed in 6 hospitals. Our ML tool uses EHRead technology, which extracts clinical concepts from EHRs and standardizes them to SNOMED CT. RESULTS: The prevalence of SA among asthma patients in Spanish hospitals was 20.1%, compared with 9.7% using the ML tool. The proportion of SA phenotypes and the features of patients followed up were consistent with previous studies. The clinical predictions of patients' clinical course were unreliable, and ML found only 2 predictive models with discriminatory power to predict outcomes. CONCLUSION: This study is the first to estimate the prevalence of SA in hospitalized asthma patients and to predict patient outcomes using both standard and ML-based research techniques. Our findings offer relevant insights for further epidemiological and clinical research in SA.

Analysis of co-isogenic prion protein deficient mice reveals behavioral deficits, learning impairment, and enhanced hippocampal excitability.

BACKGROUND: Cellular prion protein (PrPC) is a cell surface GPI-anchored protein, usually known for its role in the pathogenesis of human and animal prionopathies. However, increasing knowledge about the participation of PrPC in prion pathogenesis contrasts with puzzling data regarding its natural physiological role. PrPC is expressed in a number of tissues, including at high levels in the nervous system, especially in neurons and glial cells, and while previous studies have established a neuroprotective role, conflicting evidence for a synaptic function has revealed both reduced and enhanced long-term potentiation, and variable observations on memory, learning, and behavior. Such evidence has been confounded by the absence of an appropriate knock-out mouse model to dissect the biological relevance of PrPC, with some functions recently shown to be misattributed to PrPC due to the presence of genetic artifacts in mouse models. Here we elucidate the role of PrPC in the hippocampal circuitry and its related functions, such as learning and memory, using a recently available strictly co-isogenic Prnp0/0 mouse model (PrnpZH3/ZH3). RESULTS: We performed behavioral and operant conditioning tests to evaluate memory and learning capabilities, with results showing decreased motility, impaired operant conditioning learning, and anxiety-related behavior in PrnpZH3/ZH3 animals. We also carried in vivo electrophysiological recordings on CA3-CA1 synapses in living behaving mice and monitored spontaneous neuronal firing and network formation in primary neuronal cultures of PrnpZH3/ZH3 vs wildtype mice. PrPC absence enhanced susceptibility to high-intensity stimulations and kainate-induced seizures. However, long-term potentiation (LTP) was not enhanced in the PrnpZH3/ZH3 hippocampus. In addition, we observed a delay in neuronal maturation and network formation in PrnpZH3/ZH3 cultures. CONCLUSION: Our results demonstrate that PrPC promotes neuronal network formation and connectivity. PrPC mediates synaptic function and protects the synapse from excitotoxic insults. Its deletion may underlie an epileptogenic-susceptible brain that fails to perform highly cognitive-demanding tasks such as associative learning and anxiety-like behaviors.

Presence and significance of intestinal unicellular parasites in a morbidly obese population.

BACKGROUND: Obesity is a chronic disease whose pathogenesis has been related to changes in the intestinal microbiota. Yet, the role of protozoa and other unicellular eukaryotic parasites in this microenvironment is still largely unknown. Their presence within the gut ecosystem in obese subjects warrants further study, as well as their influence on the host metabolism and comorbidities. METHODS: Herein, a single center, cross-sectional study of 104 obese individuals was performed to assess the presence of six intestinal unicellular parasites in stool using a commercially available kit, and to evaluate its relationship with the presence of abdominal symptoms, metabolic comorbidities, variations in body composition and nutritional deficiencies. RESULTS: The overall parasitic colonization rate was 51%, with Blastocystis sp., identified as the most frequent (44.2%), followed by Dientamoeba fragilis (11.5%) and Giardia intestinalis (8.7%), and significantly related to the consumption of ecological fruits and vegetables. Contrary to what previous studies pointed out, colonization with parasites species was significantly associated with fewer abdominal symptoms and depositions per day. The presence of parasites did not correlate with any nutritional deficiencies nor differences in body composition, while it did with significant lower HOMA-IR levels and a lower trend towards metabolic syndrome. CONCLUSION: Obese subjects frequently harbor unicellular enteric parasites, apparently without clinical nor nutritional harm. This evidence suggests that carrying these microorganisms, from an endocrinological perspective, has a beneficial effect, especially on insulin resistance and possibly on the development of related comorbidities.

3D Synaptic Organization of the Rat CA1 and Alterations Induced by Cocaine Self-Administration.

The hippocampus plays a key role in contextual conditioning and has been proposed as an important component of the cocaine addiction brain circuit. To gain knowledge about cocaine-induced alterations in this circuit, we used focused ion beam milling/scanning electron microscopy to reveal and quantify the three-dimensional synaptic organization of the neuropil of the stratum radiatum of the rat CA1, under normal circumstances and after cocaine-self administration (SA). Most synapses are asymmetric (excitatory), macular-shaped, and in contact with dendritic spine heads. After cocaine-SA, the size and the complexity of the shape of both asymmetric and symmetric (inhibitory) synapses increased but no changes were observed in the synaptic density. This work constitutes the first detailed report on the 3D synaptic organization in the stratum radiatum of the CA1 field of cocaine-SA rats. Our data contribute to the elucidation of the normal and altered synaptic organization of the hippocampus, which is crucial for better understanding the neurobiological mechanisms underlying cocaine addiction.

[Usefulness of chest X-rays for detecting COVID 19 pneumonia during the SARS-CoV-2 pandemic]. / Utilidad de la radiografía de tórax para la detección de neumonía COVID 19 durante la pandemia por SARS-CoV-2.

Objective: To review the prognostic usefulness of chest X-rays in selecting patients with suspected SARS-CoV-2 infection. Material and methods: This cross-sectional descriptive observational study analyzed 978 patients with suspected SARS-CoV-2 infections who underwent chest X-ray examinations in the emergency department of a tertiary hospital in March 2020. We separately analyzed demographic, clinical, and prognostic variables in two groups of patients: those in whom reverse-transcriptase polymerase chain reaction (RT-PCR) was done (n = 535) and those in whom RT-PCR was not done because of low clinical suspicion (n = 443). Results: In the group of patients with RT-PCR, the prevalence of SARS-CoV-2 was 70.4%, and the sensitivity of chest X-rays was 62.8%. In the group of patients without RT-PCR, chest X-rays were negative in 97.5%, corroborating the low clinical suspicion; these patients were discharged, and 5.6% of them reconsulted with mild forms of the disease. In the group of patients with RT-PCR, we observed no statistically significant differences in the percentage of pathologic chest X-rays between patients hospitalized in the ICU (72.9%) and in those hospitalized in other wards (68.3%) (p = 0.22). Conclusion: In the context of the pandemic, patients with low clinical suspicion and negative chest X-rays can be discharged with a low probability of reconsultation or of developing severe COVID19. In patients with RT-PCR positive for SARS-CoV-2, chest X-rays have no prognostic usefulness.

PAGE Study: Summary of a Study Protocol to Estimate the Prevalence of Severe Asthma in Spain Using Big Data Methods.

BACKGROUND AND OBJECTIVES: Background: The proposal and the initiative for the Prevalence of Severe Asthma in Hospital Units in Spain (PAGE) study came about because of the widespread implementation of electronic medical records and the limited data available on the prevalence of severe asthma in hospitals in our setting. Objectives: The primary objective was to determine the prevalence of severe asthma in the outpatient clinics of allergy and pulmonology departments in Spain. The secondary objectives were to describe the most prevalent characteristics and phenotypes of severe asthma, to evaluate the selection criteria for receiving approved biological treatments for this disease, and to estimate consumption of resources. Furthermore, digital technology and new data collection sources made it possible to reuse information stored in electronic medical records (Big Data). The study was performed using one such tool, Savana. METHODS: The PAGE study was a multicenter, nonexperimental, observational, cross-sectional study in the first phase and a prospective study in the second phase. The study was controlled and population-based, with 2-stage selection of patients by random sampling. The research was carried out in 40 hospitals selected using convenience sampling in order to ensure geographical representativeness in Spain. RESULTS: This manuscript describes the study design and protocol. CONCLUSIONS: Our study design was sufficiently robust to avoid bias and to establish the prevalence of patients with severe asthma in Spanish hospitals. It was also the first to incorporate new tools that can help in routine clinical practice and research, such as big data analysis software, and to evaluate the reliability and efficiency of these tools.

Deficits in coordinated neuronal activity and network topology are striatal hallmarks in Huntington's disease.

BACKGROUND: Network alterations underlying neurodegenerative diseases often precede symptoms and functional deficits. Thus, their early identification is central for improved prognosis. In Huntington's disease (HD), the cortico-striatal networks, involved in motor function processing, are the most compromised neural substrate. However, whether the network alterations are intrinsic of the striatum or the cortex is not fully understood. RESULTS: In order to identify early HD neural deficits, we characterized neuronal ensemble calcium activity and network topology of HD striatal and cortical cultures. We used large-scale calcium imaging combined with activity-based network inference analysis. We extracted collective activity events and inferred the topology of the neuronal network in cortical and striatal primary cultures from wild-type and R6/1 mouse model of HD. Striatal, but not cortical, HD networks displayed lower activity and a lessened ability to integrate information. GABAA receptor blockade in healthy and HD striatal cultures generated similar coordinated ensemble activity and network topology, highlighting that the excitatory component of striatal system is spared in HD. Conversely, NMDA receptor activation increased individual neuronal activity while coordinated activity became highly variable and undefined. Interestingly, by boosting NMDA activity, we rectified striatal HD network alterations. CONCLUSIONS: Overall, our integrative approach highlights striatal defective network integration capacity as a major contributor of basal ganglia dysfunction in HD and suggests that increased excitatory drive may serve as a potential intervention. In addition, our work provides a valuable tool to evaluate in vitro network recovery after treatment intervention in basal ganglia disorders.

[Medicine, epidemiology and humanism before and after COVID-19]. / Medicina, Epidemiología y Humanismo antes y después de la COVID-19.

The rapid spread of SARS-CoV-2 requires evidence to help mitigate its global harm. Generating accurate measurements of the appropriate clinical and epidemiological indicators associated with COVID-19 is a necessary step in reducing the current pandemic's burden on individuals and the population at large. These unprecedented times have presented a challenge to chronic disease epidemiologists and have required a practical approach "to do something to help during this disaster." Options include returning to clinical care or resorting to online textbooks and resources for crash courses on outbreak research. However, being aware of the magnitude of individual suffering endured by so many, including many esteemed, close colleagues, becomes a personal challenge of enormous proportions. It is envisaged that the arts and other humanities can help re-establish balance, both during the pandemic and especially after it.

The use of dynamic prevalence maps to assess the prevalence of Salmonella in broiler flocks in the Valencian Community, Spain.

The aim of this study was to design and implement a dynamic prevalence map for managing the data collected within the framework of the Salmonella spp. National control plan in broiler flocks, using a data set from the Valencian Community, Spain. Such a map would be a useful tool for veterinarians seeking to define control options. The development of the mapping tool for this study involved three main phases: data collection, data analysis and data representation. The data used were obtained from the results of the National Control Programme (based on European Commission [EC] Regulation No. 2160/2003). The Salmonella prevalence data were represented on a map of the Valencian Community, which included geographical information on flock locations to facilitate the interpretation of the results from monitoring. The average prevalence of Salmonella spp. was 2.74% from 2009 to 2013. Moreover, the proportion of broiler flocks that remained positive for the target serovars according to EC Regulation No. 2160/2003 (S. Enteritidis and/orS. Typhimurium [including monophasic S. Typhimurium]) was less than 1%. Over the five-year period of the study (2009-2013), the area of Bajo Maestrazgo had the highest level of Salmonella spp. prevalence every year, thereby validating the usefulness of this mapping tool. The aim of the study is to detect geographical 'highpressure' Salmonella zones over time and make suggestions on where efforts should be focused in this region to reduce future Salmonella spp. prevalence. Local Veterinary Services could, using the map, identify the infection pressure of Salmonella in the geographical areas where farms are located. Proximity to higher prevalences may imply an increased risk of flock contamination. Although annual data are represented, data can be presented in real time with regular frequency (daily, weekly, monthly or quarterly) or even over periods of several years. Therefore, the dynamic prevalence map provides extremely useful epidemiological information to veterinarians on the prevention of Salmonella.

L'étude présentée par les auteurs visait à concevoir et mettre en application une carte dynamique de la prévalence afin de gérer les données collectées dans le cadre du plan national de contrôle des Salmonella spp. dans les cheptels de poulets de chair à partir des informations transmises par la Communauté valencienne (Espagne). L'objectif attendu était que cette carte puisse aider les vétérinaires à définir la meilleure stratégie de lutte. La conception du logiciel de cartographie s'est faite en trois étapes, portant respectivement sur la collecte, l'analyse et la représentation des données. Les données utilisées provenaient des résultats du Programme national de lutte (basé sur le Règlement [CE] n° 2160/2003 du Parlement européen et du Conseil). Les taux de prévalence de Salmonella ont été reportés sur une carte de la Communauté valencienne, qui contenait également des informations géographiques relatives à la localisation des élevages afin de faciliter l'interprétation des résultats du suivi. De 2009 à 2013, la prévalence moyenne de Salmonella spp. était de 2,74 %. En outre, le pourcentage de cheptels de poulets de chair restant positifs au regard des sérovars visés par le Règlement CE n° 2160/2003 (S. Enteritidis et/ou S. Typhimurium [y compris la souche monophasique de S. Typhimurium]) était inférieur à 1 %. Sur les cinq années de l'étude (2009­2013), la prévalence annuelle la plus élevée de Salmonella spp. restait concentrée dans la région de Bajo Maestrazgo, ce qui confirme l'utilité de cet outil cartographique. Le but de l'étude est de pouvoir détecter les zones géographiques à « forte pression ¼ de Salmonella dans le temps afin d'orienter en conséquence les efforts de lutte dans cette région et de réduire ainsi la prévalence des Salmonella spp. à l'avenir. Grâce à cette carte, les Services vétérinaires locaux pourront connaître la pression exercée par Salmonella dans les zones géographiques où se situent les élevages. La proximité des zones à forte prévalence peut représenter un risque accru de contamination des cheptels. L'outil propose par défaut une représentation annuelle des données mais celles-ci peuvent également être présentées en temps réel à intervalles réguliers (fréquence quotidienne, hebdomadaire, mensuelle ou trimestrielle), voire même sur des périodes couvrant plusieurs années. Ainsi, la carte dynamique des prévalences fournit aux vétérinaires des informations épidémiologiques extrêmement utiles pour la prévention de Salmonella.

Los autores describen un estudio encaminado a concebir y realizar un mapa dinámico de prevalencia para explotar los datos obtenidos como parte del plan nacional de lucha contra las salmonelas en bandadas de pollos asaderos, utilizando para ello un conjunto de datos correspondientes a la Comunidad Valenciana (España). Semejante mapa ofrecería a los veterinarios una herramienta útil para definir las fórmulas idóneas de lucha. La elaboración del dispositivo de cartografía para este estudio entrañaba tres grandes fases: la de obtención, la de análisis y la de representación de los datos. Los datos utilizados derivan de los resultados obtenidos con el Programa Nacional de Control (basado en el Reglamento de la Comisión Europea [CE] Nº 2160/2003). Para facilitar la interpretación de los resultados obtenidos con la labor de vigilancia, los datos de prevalencia de salmonelas fueron representados en un mapa de la Comunidad Valenciana que contenía información geográfica sobre la localización de las bandadas. De 2009 a 2013, la prevalencia media de Salmonella spp. fue del 2,74%. Por otra parte, la proporción de bandadas de pollos asaderos que seguían siendo positivas para las serovariantes estudiadas con arreglo al Reglamento (CE)Nº 2160/2003 (S. Enteritidis y/o S. Typhimurium [incluida S. Typhimurium monofásica]) era inferior al 1%. En el quinquenio cubierto por el estudio (2009­2013), la zona del Bajo Maestrazgo registró cada año la mayor prevalencia de salmonelas, hecho que confirmó la utilidad de esta herramienta cartográfica. El estudio tiene por objetivo determinar a lo largo del tiempo las zonas geográficas de 'alta presión' de salmonelas y hacer propuestas sobre las áreas de esa región en las que convendría centrar el trabajo para reducir en el futuro la prevalencia de salmonelas. Empleando el mapa, los Servicios Veterinarios podrían determinar la presión infecciosa de salmonelas en las zonas geográficas en que se encuentran las explotaciones. Cuanto más cerca esté una explotación de zonas con niveles altos de prevalencia, mayor puede ser el riesgo de contaminación de las bandadas. Aunque en el mapa se representan datos anuales, también es posible presentarlos en tiempo real con determinada periodicidad (diaria, semanal, mensual o trimestral) o incluso cubrir periodos de varios años. El mapa dinámico de prevalencia proporciona así a los veterinarios información epidemiológica de gran utilidad para la prevención de las salmonelosis.

Asthma outcomes improve with continuous positive airway pressure for obstructive sleep apnea.

BACKGROUND: Continuous positive airway pressure (CPAP) in asthma patients with concomitant obstructive sleep apnea syndrome (OSAS) seems to have a favorable impact on asthma, but data are inconsistent due to methodological limitations of previous studies. METHODS: Prospective, multicenter study. We examined asthma outcomes after 6 months of CPAP in 99 adult asthma patients (mean age 57 years) with OSAS (respiratory disturbance index ≥20). Asthma control and quality of life were assessed with the Asthma Control Questionnaire (ACQ) and the Mini Asthma Quality of Life Questionnaire (MiniAQLQ), respectively. Data were analyzed by intention-to-treat basis. RESULTS: The mean ± SD score of the ACQ decreased from 1.39 ± 0.91 at baseline to 1.0 ± 0.78 at 6 months (P = 0.003), the percentage of patients with uncontrolled asthma from 41.4% to 17.2% (P = 0.006), and the percentage of patients with asthma attacks in the 6 months before and after treatment from 35.4% to 17.2% (P = 0.015). The score of the mAQLQ increased from 5.12 ± 1.38 to 5.63 ± 1.17 (P = 0.009). There were also significant improvements in symptoms of gastroesophageal reflux and rhinitis, bronchial reversibility, and exhaled nitric oxide values (all P < 0.05). No significant changes were observed in drug therapy for asthma or their comorbidities nor in the patients' weight. CONCLUSIONS: Asthma control (both actual and future risk), quality of life, and lung function improved after starting continuous positive airway pressure in asthmatics with moderate to severe obstructive sleep apnea syndrome.

Modular control of gait after incomplete spinal cord injury: differences between sides.

STUDY DESIGN: This is an analytical descriptive study. OBJECTIVES: The main goal of this study was to compare the modular organization of bilateral lower limb control in incomplete spinal cord injury (iSCI) patients during overground walking, using muscle synergies analysis. The secondary goal was to determine whether the similarity between the patients and control group correlate with clinical indicators of walking performance. SETTING: This study was conducted in National Hospital for Spinal Cord Injury (Toledo, Spain). METHODS: Eight iSCI patients and eight healthy subjects completed 10 walking trials at matched speed. For each trial, three-dimensional motion analysis and surface electromyography (sEMG) analysis of seven leg muscles from both limbs were performed. Muscle synergies were extracted from sEMG signals using a non-negative matrix factorization algorithm. The optimal number of synergies has been defined as the minimum number needed to obtain variability accounted for (VAF) ⩾90%. RESULTS: When compared with healthy references, iSCI patients showed fewer muscle synergies in the most affected side and, in both sides, significant differences in the composition of synergy 2. The degree of similarity of these variables with the healthy reference, together with the composition of synergy 3 of the most affected side, presented significant correlations (P<0.05) with walking performance. CONCLUSION: The analysis of muscle synergies shows potential to detect differences between the two sides in patients with iSCI. Specifically, the VAF may constitute a new neurophysiological metric to assess and monitor patients' condition throughout the gait recovery process.

The use of an antioxidant dressing on hard-to-heal wounds: a multicentre, prospective case series.

OBJECTIVE: Oxidative stress can contribute to impaired wound healing and chronic wounds. Our objective was to test the results of a new antioxidant dressing that could help stop the oxidative stress of cells in the wound bed. METHOD: A multicentre, prospective case study series was conducted in three Spanish hospitals. The RESVECH 2.0 index was used for healing assessment. Data from each patient was collected by the attending clinical researchers. Data analysis was performed using the statistical concept intention-to-treat (ITT). Descriptive results were presented as frequency and percentages for qualitative variables and mean, standard deviation (SD), range and median for quantitative variables. For analytical-inferential analyses, incidence of healing was calculated for chronic and acute wounds. Relative risk (RR) was used to establish the differences of healing between both types of wounds. Healing was represented by Kaplan-Meier survival curves, and these were compared using the log-rank test. RESULTS: A total of 31 patients with hard-to-heal wounds were recruited. During the 8-week follow-up period, nine wounds (29%) completely healed, of which seven (77.8%) were acute and two (22.2%) chronic. The remaining wounds (22) showed a significant improvement after treatment with the antioxidant dressing. RESVECH 2.0 scores decreased an average of 10.16 points over the 8-week period. CONCLUSION: The antioxidant dressing could represent an alternative in the dressing landscape for many types of acute and chronic wounds.

Can the parasitoid Necremnus tutae (Hymenoptera: Eulophidae) improve existing biological control of the tomato leafminer Tuta aboluta (Lepidoptera: Gelechiidae)?

Necremnus tutae is native to the Mediterranean region where it has been observed in greenhouses parasitizing the invasive Tuta absoluta on tomato. The objective of the present study was to determine whether augmentative releases of N. tutae can improve existing biological control of T. absoluta based on predation by Nesidicoris tenuis. Two experiments were carried out, of which the first evaluated different N. tutae release rates (1 and 2 N. tutae m-2 week-1). The parasitoid reduced plant and fruit damage, especially at the higher rate. However, such reduction was considered insufficient given the large numbers of parasitoids needed and still unacceptable level of fruit damage. The second experiment focused on combining the most efficient rate of N. tutae of those evaluated during the first experiment, with the pre- and post-planting release of N. tenuis and supplemental additions of Ephestia kuehniella eggs. Addition of N. tutae decreased leaf damage by T. absoluta regardless the release method for N. tenuis, but the pre-plant release of N. tenuis alone was sufficient to prevent fruit damage by T. absoluta. This suggested that the addition of N. tutae may not be necessary to obtain satisfactory control of T. absoluta following pre-plant application of N. tenuis, although different options for using N. tutae in commercial crops may still be possible.

Abnormal cutaneous flexor reflex activity during controlled isometric plantarflexion in human spinal cord injury spasticity syndrome.

STUDY DESIGN: Although abnormal cutaneous reflex (CR) activity has been identified during gait after incomplete spinal cord injury (SCI), this activity has not been directly compared in subjects with and without the spasticity syndrome. OBJECTIVES: Characterisation of CR activity during controlled rest and 'ramp and hold' phases of controlled plantarflexion in subjects with and without the SCI spasticity syndrome. DESIGN: Transverse descriptive study with non-parametric group analysis. SETTING: SCI rehabilitation hospital. METHODS: Tibialis Anterior (TA) reflexes were evoked by innocuous cutaneous plantar sole stimulation during rest and ramp and hold phases of plantarflexion torque in non-injured subjects (n=10) and after SCI with (n=9) and without (n=10) hypertonia and/or involuntary spasm activity. Integrated TA reflex responses were analysed as total (50-300 ms) or short (50-200 ms) and long-latency (200-300 ms) activity. RESULTS: Total and long-latency TA activity was inhibited in non-injured subjects and the SCI group without the spasticity syndrome during plantarflexion torque but not in the SCI spasticity group. Furthermore, loss of TA reflex inhibition during plantarflexion correlated with time after SCI (ρ=0.79, P=0.009). Moreover, TA reflex activity inversely correlated with maximum plantarflexion torque in the spasticity group (ρ=-0.75, P=0.02), despite similar non-reflex TA electromyographic activity during plantarflexion after SCI in subjects with (0.11, 0.08-0.13 mV) or without the spasticity syndrome (0.09, 0.07-0.12 mV). CONCLUSIONS: This reflex testing procedure supports previously published evidence for abnormal CR activity after SCI and may characterise the progressive disinhibition of TA reflex activity during controlled plantarflexion in subjects diagnosed with the spasticity syndrome.

Classification of dependence-related skin lesions: a new proposal.

A new theoretical framework on the development of pressure ulcers and other dependence-related lesions requires continued in-depth analysis of their conceptual bases. This study reports the historical background, definitions, and production mechanisms of these lesions, describing the differential pathognomonic features of pressure and/or shear ulcers, moisture-associated skin damage, and lesions from rubbing or friction. It also discusses the combined/multifactorial lesions that can be found in the clinical setting. Finally, it presents the new classification of these lesions proposed by the Spanish Pressure Ulcers and Chronic Wounds Advisory Panel.

Fontan procedure: imaging of normal post-surgical anatomy and the spectrum of cardiac and extracardiac complications.

Univentricular congenital heart diseases include a range of entities that result in a functionally single ventricular chamber. Although the only curative therapy is cardiac transplantation, there are several palliative surgical techniques that prevent ventricular volume overload, diverting part or all the systemic venous circulation into the pulmonary arteries. The modern Fontan procedure, which consists of anastomosing both the superior (SVC) and inferior vena cava (IVC) to the right pulmonary artery (RPA), is nowadays the last step before transplantation. The importance of imaging in these entities lies not only in the understanding of the new circuit established after surgical correction, but also in the early detection of the wide spectrum of cardiac and extracardiac complications that can occur due to the new physiological condition. Due to the increased survival of these patients, long-term complications are becoming more common. The main cardiac complications are atrial enlargement, ventricular dysfunction, and stenosis or thrombosis of the conduit. Pulmonary artery stenosis, pulmonary arteriovenous fistulae (PAVF), systemic-pulmonary veno venous shunts (VVS), hepatic congestion, cardiac cirrhosis, and protein-losing enteropathy are potential extracardiac complications.

Prevalence of and risk factors for pulmonary abnormalities in HIV-infected patients treated with antiretroviral therapy.

BACKGROUND: Pulmonary abnormalities are often present in patients infected with the human immunodeficiency virus (HIV). OBJECTIVES: The aim of the study was to determine the prevalence and characteristics of, and risk factors for, pulmonary abnormalities in HIV-positive patients. METHODS: A total of 275 HIV-positive patients [mean (± standard deviation) age 48.5 ± 6.6 years] were included in the study, of whom 95.6% had been receiving highly active antiretroviral therapy (HAART) for a mean (± standard deviation) duration of 11.9 ± 5.4 years. The median (interquartile range) CD4 lymphocyte count was 541 (392-813) cells/µL, and 92% of the patients had an undetectable viral load. We determined: (1) spirometry, static lung volumes, lung diffusing capacity, pulmonary gas exchange and exercise tolerance, and (2) the amount of emphysema via a computed tomography (CT) scan. RESULTS: Chronic cough and expectoration (47%) and breathlessness during exercise (33.9%) were commonly reported. Airflow limitation (AL) was present in 17.2%, low pulmonary diffusing capacity in 52.2% and emphysema in 10.5-37.7% of patients, depending on the method used for quantification. Most of these abnormalities had not been diagnosed or treated previously. Smoking exposure and previous tuberculosis were the main risk factors for AL, whereas smoking exposure and several variables related to HIV infection appeared to contribute to the risk of emphysema and low diffusing capacity. CONCLUSIONS: Despite HAART, pulmonary structural and functional abnormalities are frequent in HIV-positive patients. They are probably attributable to both environmental (smoking and tuberculosis) and HIV-related factors. Most of these abnormalities remain unnoticed and untreated. Given the relatively young age of these patients, these results anticipate a significant health problem in the next few years as, thanks to the efficacy of HAART, patients survive longer and experience the effects of aging.