Method-Dependent Epidemiological Cutoff Values for Detection of Triazole Resistance in Candida and Aspergillus Species for the Sensititre YeastOne Colorimetric Broth and Etest Agar Diffusion Methods.

Although the Sensititre Yeast-One (SYO) and Etest methods are widely utilized, interpretive criteria are not available for triazole susceptibility testing of Candida or Aspergillus species. We collected fluconazole, itraconazole, posaconazole, and voriconazole SYO and Etest MICs from 39 laboratories representing all continents for (method/agent-dependent) 11,171 Candida albicans, 215 C. dubliniensis, 4,418 C. glabrata species complex, 157 C.guilliermondii (Meyerozyma guilliermondii), 676 C. krusei (Pichia kudriavzevii), 298 C.lusitaniae (Clavispora lusitaniae), 911 C.parapsilosissensu stricto, 3,691 C.parapsilosis species complex, 36 C.metapsilosis, 110 C.orthopsilosis, 1,854 C.tropicalis, 244 Saccharomyces cerevisiae, 1,409 Aspergillus fumigatus, 389 A.flavus, 130 A.nidulans, 233 A.niger, and 302 A.terreus complex isolates. SYO/Etest MICs for 282 confirmed non-wild-type (non-WT) isolates were included: ERG11 (C. albicans), ERG11 and MRR1 (C. parapsilosis), cyp51A (A. fumigatus), and CDR2 and CDR1 overexpression (C. albicans and C. glabrata, respectively). Interlaboratory modal agreement was superior by SYO for yeast species and by the Etest for Aspergillus spp. Distributions fulfilling CLSI criteria for epidemiological cutoff value (ECV) definition were pooled, and we proposed SYO ECVs for S. cerevisiae and 9 yeast and 3 Aspergillus species and Etest ECVs for 5 yeast and 4 Aspergillus species. The posaconazole SYO ECV of 0.06 µg/ml for C. albicans and the Etest itraconazole ECV of 2 µg/ml for A. fumigatus were the best predictors of non-WT isolates. These findings support the need for method-dependent ECVs, as, overall, the SYO appears to perform better for susceptibility testing of yeast species and the Etest appears to perform better for susceptibility testing of Aspergillus spp. Further evaluations should be conducted with more Candida mutants.

Responsiveness and minimal clinically important difference of the Minnesota living with heart failure questionnaire.

BACKGROUND: The Minnesota Living with Heart Failure Questionnaire (MLHFQ) is one of the most widely used health-related quality of life questionnaires for patients with heart failure (HF). The objective of the present study was to explore the responsiveness of the MLHFQ by estimating the minimal detectable change (MDC) and the minimal clinically important difference (MCID) in Spain. METHODS: Patients hospitalized for HF in the participating hospitals completed the MLHFQ at baseline and 6 months, plus anchor questions at 6 months. To study responsiveness, patients were classified as having "improved", remained "the same" or "worsened", using anchor questions. We used the standardized effect size (SES), and standardized response mean (SRM) to measure the magnitude of the changes scores and calculate the MDC and MCID. RESULTS: Overall, 1211 patients completed the baseline and follow-up questionnaires 6 months after discharge. The mean changes in all MLHFQ domains followed a trend (P < 0.0001) with larger gains in quality of life among patients classified as "improved", smaller gains among those classified as "the same", and losses among those classified as "worsened". The SES and SRM responsiveness parameters in the "improved" group were ≥ 0.80 on nearly all scales. Among patients classified as "worsened", effect sizes were < 0.40, while among patients classified as "the same", the values ranged from 0.24 to 0.52. The MDC ranged from 7.27 to 16.96. The MCID based on patients whose response to the anchor question was "somewhat better", ranged from 3.59 to 19.14 points. CONCLUSIONS: All of these results suggest that all domains of the MLHFQ have a good sensitivity to change in the population studied.

Clinical implication of FMR1 intermediate alleles in a Spanish population.

FMR1 premutation carriers (55-200 CGGs) are at risk of developing Fragile X-associated primary ovarian insufficiency as well as Fragile X-associated tremor/ataxia syndrome. FMR1 premutation alleles are also associated with a variety of disorders, including psychiatric, developmental, and neurological problems. However, there is a major concern regarding clinical implications of smaller CGG expansions known as intermediate alleles (IA) or gray zone alleles (45-54 CGG). Although several studies have hypothesized that IA may be involved in the etiology of FMR1 premutation associated phenotypes, this association still remains unclear. The aim of this study was to provide new data on the clinical implications of IA. We reviewed a total of 17 011 individuals: 1142 with primary ovarian insufficiency, 478 with movement disorders, 14 006 with neurodevelopmental disorders and 1385 controls. Similar IA frequencies were detected in all the cases and controls (cases 1.20% vs controls 1.39%, P = .427). When comparing the allelic frequencies of IA ≥ 50CGGs, a greater, albeit not statistically significant, number of alleles were detected in all the cohorts of patients. Therefore, IA below 50 CGGs should not be considered as risk factors for FMR1 premutation-associated phenotypes, at least in our population. However, the clinical implication of IA ≥ 50CGGs remains to be further elucidated.

Effects of trimethoprim-sulfadiazine and detomidine on the function of equine Kv 11.1 channels in a two-electrode voltage-clamp (TEVC) oocyte model.

The long QT syndrome (LQTS) is a channelopathy that can lead to severe arrhythmia and sudden cardiac death. Pharmacologically induced LQTS is caused by interaction between drugs and potassium channels, especially the Kv 11.1 channel. Due to such interactions, numerous drugs have been withdrawn from the market or are administered with precautions in human medicine. However, some compounds, such as trimethoprim-sulfonamide combinations are still widely used in veterinarian medicine. Therefore, we investigate the effect of trimethoprim-sulfadiazine (TMS), trimethoprim, sulfadiazine, and detomidine on equine-specific Kv 11.1 channels. Kv 11.1 channels cloned from equine hearts were heterologously expressed in Xenopus laevis oocytes, and whole cell currents were measured by two-electrode voltage-clamp before and after drug application. TMS blocked equine Kv 11.1 current with an IC50 of 3.74 mm (95% CI: 2.95-4.73 mm) and affected the kinetics of activation and inactivation. Similar was found for trimethoprim but not for sulfadiazine, suggesting the effect is due to trimethoprim. Detomidine did not affect equine Kv 11.1 current. Thus, equine Kv 11.1 channels are also susceptible to pharmacological block, indicating that some drugs may have the potential to affect repolarization in horse. However, in vivo studies are needed to assess the potential risk of these drugs to induce equine LQTS.

Association between social support, functional status, and change in health-related quality of life and changes in anxiety and depression in colorectal cancer patients.

OBJECTIVE: The aim of this study was to explore the association between baseline social support, functional status, and change in health-related quality of life (HRQoL) in colorectal cancer patients and change in anxiety and depression measured by Hospital Anxiety and Depression Scale (HADS) at 1 year after surgery. METHODS: Consecutive patients who were due to undergo therapeutic surgery for the first time for colon or rectal cancer in 9 hospitals in Spain were eligible for the study. Patients completed the following questionnaires before surgery and 12 months afterward: 1 HRQoL instrument, the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire; a social support questionnaire, the Duke-UNC Functional Social Support Questionnaire; the Barthel Index, to assess functional status; the HADS, to assess anxiety and depression; and questions about sociodemographic information. General linear models were built to explore the association between social support, functional status, and change in HRQoL and changes in anxiety and depression 12 months after surgery. RESULTS: A total of 947 colorectal cancer patients took part in the study. Patients' functional status, social support, and change in HRQoL were associated with changes in anxiety and depression. Greater social support and improvements in physical, cognitive, and social functioning and in insomnia resulted in improvements in anxiety and depression. No functionally independent patients were associated with lesser improvements in anxiety and depression. CONCLUSIONS: Colorectal cancer patients who have more social support, are functionally independent and have higher improvements in HRQoL may have better results in anxiety and depression at 1 year after surgery, adjusting for age, gender, location, occupation, and baseline HADS scores.

The MECP2 variant c.925C>T (p.Arg309Trp) causes intellectual disability in both males and females without classic features of Rett syndrome.

Missense MECP2 variants can have various phenotypic effects ranging from a normal phenotype to typical Rett syndrome (RTT). In females, the phenotype can also be influenced by the X-inactivation pattern. In this study, we present detailed clinical descriptions of six patients with a rare base-pair substitution affecting Arg309 at the C-terminal end of the transcriptional repression domain (TRD). All patients have intellectual disability and present with some RTT features, but they do not fulfill the clinical criteria for typical or atypical RTT. Most of the patients also have mild facial dysmorphism. Intriguingly, the mother of an affected male patient is an asymptomatic carrier of this variant. It is therefore likely that the p.(Arg309Trp) variation does not necessarily lead to male lethality, and it results in a wide range of clinical features in females, probably influenced by different X-inactivation patterns in target tissues.

Association of social support, functional status, and psychological variables with changes in health-related quality of life outcomes in patients with colorectal cancer.

BACKGROUND: The aim of this study was to explore the association of social support received, and functional and psychological status of colorectal cancer patients before surgery with changes in health-related quality of life (HRQoL) outcomes measured by EORTC QLQ-C30 at 1-year post-intervention. METHODS: Consecutive patients that were because of undergo therapeutic surgery for the first time for colon or rectum cancer in nine hospitals in Spain were eligible for the study. Patients completed questionnaires before surgery and 12 months afterwards: one HRQoL instrument, the EORTC QLQ-C30; a social network and social support questionnaire, the Duke-UNC Functional Social Support Questionnaire; the Hospital Anxiety and Depression Scale, to assess anxiety and depression; and the Barthel Index, to assess functional status; as well as questions about sociodemographic information. General linear models were built to explore the association of social support, functional status, and psychological variables with changes in HRQoL 12 months after intervention. RESULTS: A total of 972 patients with colorectal cancer took part in the study. Patients' functional status, social support, and anxiety and depression were associated with changes in at least one HRQoL domain. The higher functional status, and the higher social support, the more they improved in HRQoL domains. Regarding anxiety and depression, the more anxiety and depression patients have at baseline, less they improve in HRQoL domains. CONCLUSIONS: Patients with colorectal cancer who have more social support and no psychological distress may have better results in HRQoL domains at 1 year after surgery. Copyright © 2015 John Wiley & Sons, Ltd.

Trends in the incidence of hip fracture in Gran Canaria, Canary Islands, Spain: 2007-2011 versus 1989-1993.

UNLABELLED: Hip fracture incidence in the Canaries was studied in two 5-year periods (1989-1993 and 2008-2011). The incidence in 2007-2011 was 24 % higher than in 1989, but did not differ between 2007-2011 and 1993. These findings suggest a trend to stabilize the incidence of hip fracture. INTRODUCTION: A dramatic increase in hip fractures between 1988 and 2002 was reported in Northern Spain. We performed the present study in Gran Canaria, the Canary Islands, to compare changes in the incidence of hip fracture between 1989-1993 and 2007-2011. METHODS: We recorded every osteoporotic hip fracture admitted to any hospital in Gran Canaria in the population 50 years of age or older. RESULTS: In 1989-1993, we collected 1175 hip fractures (72 % women; mean age 78.2 ± 9.9 years), and the total incidence rate was 152.1 cases/100,000 population/year. In 2007-2011, we collected 2222 hip fracture cases (71 % women; mean age 79 ± 9.8 years). The total incidence was 180.9/100,000/year. A Poisson model showed that the incidence of fractures increased by 7.1 % (95 % CI = 3.1 %; 11.8 %) each year in 1989-1993, while there was no statistically significant variation (p = 0.515) during the period 2007-2011. The incidence in 2007-2011 was 24 % higher than in 1989 (first year in the first period) but did not differ between 2007-2011 and 1993 (the last year of the first period). Incidence rates were 76.7 % (95 % CI = 63.9 %; 90.5 %) higher in women than in men, but the female/male ratio remained unchanged. The age-adjusted incidence of hip fractures increased by 7.3 % each year from 1989 to 1993. The proportions of trochanter and cervical fractures were similar in the two time periods, but the mean hospital stay was reduced from 11 days in 1989-1993 to 7 days in 2007-2011. CONCLUSIONS: These findings suggest a trend to stabilize the incidence of hip fracture in the Canary Islands due to a decrease in men, while in women, the incidence increased.

Theories and control models and motor learning: clinical applications in neuro-rehabilitation.

INTRODUCTION: In recent decades there has been a special interest in theories that could explain the regulation of motor control, and their applications. These theories are often based on models of brain function, philosophically reflecting different criteria on how movement is controlled by the brain, each being emphasised in different neural components of the movement. The concept of motor learning, regarded as the set of internal processes associated with practice and experience that produce relatively permanent changes in the ability to produce motor activities through a specific skill, is also relevant in the context of neuroscience. Thus, both motor control and learning are seen as key fields of study for health professionals in the field of neuro-rehabilitation. DEVELOPMENT: The major theories of motor control are described, which include, motor programming theory, systems theory, the theory of dynamic action, and the theory of parallel distributed processing, as well as the factors that influence motor learning and its applications in neuro-rehabilitation. CONCLUSIONS: At present there is no consensus on which theory or model defines the regulations to explain motor control. Theories of motor learning should be the basis for motor rehabilitation. The new research should apply the knowledge generated in the fields of control and motor learning in neuro-rehabilitation.

Total knee replacement; minimal clinically important differences and responders.

OBJECTIVE: To provide new data on minimally clinical important difference (MCID) and percentages of responders on pain and functional dimensions of Western Ontario and McMaster Osteoarthritis Index (WOMAC) in patients who have undergone total knee replacement (TKR). METHODS: 1-year prospective multicentre study with two different cohorts. Consecutive patients on the waiting list were recruited. There were 415 and 497 patients included. Pain and function were collected by the reverse scoring option of the WOMAC (0-100, worst to best). Transition items (five point scale) were collected at 1-year and MCID was calculated through mean change in patients somewhat better, Receiver Operating Characteristic (ROC) and two other questions about satisfaction. Analysis was performed in the whole sample and by tertiles of baseline severity. Likewise were calculated the percentages of patients who attained cut-off values. RESULTS: Global MCID for pain were about 30 in both cohorts and 32 for. By ROC these values were about 20 and 24 respectively. According to the other two transitional questions these values were for pain 27 and 20 for function. By tertiles the worst the baseline score the higher the cut-off values. Percentage of responders does not change when comparing responders to the global MCID with their own tertile MCID and were about 61% for pain and 50% for function. CONCLUSION: Due to the wide variations, MCID estimates should be calculated and used according to the baseline severity score.

Osteoporosis and metabolic syndrome according to socio-economic status, contribution of PTH, vitamin D and body weight: The Canarian Osteoporosis Poverty Study (COPS).

BACKGROUND: Poverty is associated with a great number of diseases, but the prevalence of vitamin D deficiency, secondary hyperparathyroidism and the potential association of osteoporosis, osteoporotic fractures and metabolic syndrome in this situation are less well known. OBJECTIVE: To evaluate the associations between poverty, bone density, fragility fractures and metabolic syndrome in a population of southern European postmenopausal women. Also, to assess the potential role of vitamin D and parathyroid hormone (PTH) levels in these associations. METHOD: Cross-sectional study was carried out in 1 250 postmenopausal Caucasian Spanish women. The socio-economic status of the participants was determined after a personal interview, according to the criteria of the Spanish Institute of Statistics. Participants were divided into two socio-economic levels: low (poverty) and medium or high socioeconomic level. The study protocol included a health questionnaire, a complete physical examination, lateral radiograph of the dorsal and lumbar spine and measurement of bone mineral density (BMD) at the lumbar spine (L2-L4) and proximal femur. Fasting blood was obtained to measure 25-hydroxy-vitamin D (25-OHD), intact PTH and selected biochemical variables. RESULTS: Low socio-economic status was associated with 25-OHD insufficiency, higher values of PTH, higher body weight and body mass index (BMI), lower values of BMD at the lumbar spine and a higher prevalence of fragility fractures, both vertebral and nonvertebral. Poverty was also associated with higher prevalence of metabolic syndrome, but this association was driven mainly by the higher BMI and not by poverty itself. Both vitamin D insufficiency and elevated PTH were consistently related to poverty and osteoporotic fractures. CONCLUSIONS: Poor postmenopausal women in southern Europe have a high prevalence of metabolic syndrome and osteoporotic fractures. Poverty was associated with higher BMI and metabolic syndrome on the one hand and, on the other, with 25OHD insufficiency, higher PTH levels and osteoporosis. 25OHD insufficiency and/or secondary hyperparathyroidism do not have a significant influence on the presence of metabolic syndrome in this population.

New evidence for the Ontong Java Nui hypothesis.

The formation of the Ontong Java Nui super oceanic plateau (OJN), which is based on the model that the submarine Ontong Java Plateau (OJP), Manihiki Plateau (MP), and Hikurangi Plateau (HP) were once its contiguous fragments, could have been the largest globally consequential volcanic event in Earth's history. This OJN hypothesis has been debated given the paucity of evidence, for example, the differences in crustal thickness, the compositional gap between MP and OJP basalts and the apparent older age of both plateaus relative to HP remain unresolved. Here we investigate the geochemical and 40Ar-39Ar ages of dredged rocks recovered from the OJP's eastern margin. Volcanic rocks having compositions that match the low-Ti MP basalts are reported for the first time on the OJP and new ~ 96-116 Ma and 67-68 Ma 40Ar-39Ar age data bridge the temporal gap between OJP and HP. These results provide new evidence for the Ontong Java Nui hypothesis and a framework for an integrated tectonomagmatic evolution of the OJP, MP, and HP. The isotopic data imply four mantle components in the source of OJN that are also expressed in present-day Pacific hotspots sources, indicating origin from (and longevity of) the Pacific Large Low Shear-wave Velocity Province.

Electromyographic traces of motor unit synchronization of fatigued lower limb muscles during gait.

BACKGROUND: The study of the signal in the frequency domain has shown to be a good tool to identify muscular fatigue. Previous research has shown that the low frequency band and 40 Hz frequency band increase their relative intensity with the onset of fatigue. These findings were obtained in rectus femoris, but the behaviours of other muscles of the lower limb are unknown. In this article we explored the changes in the low frequency and 40 Hz frequency band of lower limb muscles with respect to fatigue. METHODS: Thirty healthy subjects were recruited to analyse the electromyography (EMG) of biceps femoris, tibialis anterior and gastrocnemius medialis and lateralis of both legs during gait. Four two-minutes walks at a self-selected speed were recorded, the first two walks with a normal muscular function and the last two walks after a fatigue protocol. All the signals were decomposed using wavelet transformations. The signals were normalized in time and spectral intensities normalized to the sum of intensities in the frequency domain. Two frequency bands were studied in each walk: the 40-Hz (34-53 Hz) and the low frequency (< 25 Hz) bands. A ratio of the spectral intensities of those frequency bands at each walk was obtained by dividing the 40-Hz frequency band spectral intensity by the low frequency band spectral intensity. Statistical parametric mapping techniques were used to compare the ratios of the prefatigue walks against the postfatigue walks. RESULTS: The results of the Statistical Non-Parametric Mapping (SnPM) analysis of all muscles depict a higher relative spectral intensity in the low frequency band in the comparison of fatigue versus prefatigue recordings except for the right gastrocnemius lateralis. The critical thresholds F* were exceeded by multiple suprathreshold clusters with p values <0.05, showing that the low frequency band increased its relative spectral intensity in the case of fatigue. CONCLUSION: The obtained results suggest that the low frequency band increases its relative spectral intensity in all the studied muscles when fatigue onsets. This increase in relative spectral intensity may be linked to an increase in motor unit synchronization promoted by the central nervous system to ensure good motor control.

Rationale, design and methodology of TESEO study: a registry of thrombosis and neoplasia of SEOM (Spanish Society of Medical Oncology).

BACKGROUND AND RATIONALE: Thromboembolic complications are a serious, preventable and common event in cancer patients that contributes to increasing morbidity and mortality. Despite increasing knowledge on cancer-associated thrombosis (CAT), there are still several aspects of diagnosis, clinical management, treatment and prognosis with uncertainties that are under-represented in randomized clinical trials. For this reason, the Spanish Society of Medical Oncology (SEOM) launched in June 2018 a registry of CAT. METHODS/DESIGN: TESEO is an ongoing prospective, non-interventional, multicentric study in consecutive cancer patients with newly diagnosed of thromboembolic event (TEE). Eligibility criteria include being > 18 years with a histologically confirmed diagnosis of cancer and a symptomatic or incidental TEE confirmed with an imaging technique in the previous month or any time after the cancer diagnosis and signing of informed consent. The study consists of two types of integrated but independent prospective registries. Regular CAT sub-registry includes information on patient's cancer´s characteristics, anticoagulant treatment provided and outcome data. Special CAT sub-registry includes variables related to special situations of CAT that comprise patients with severe kidney failure, thrombocytopenia, high risk of bleeding related to the cancer or with coexistence of bleeding and patients who receive new treatments such a targeted therapy, antiangiogenics agents and immunotherapy. The registry considers the status of the cancer and the time to assess how the prognosis is changed based on when the thrombus occurs. Some outcomes such as rethrombosis, major bleeding, tumor progression and survival will be valued in various time intervals including 1, 3, 6 and 12 months after the even in the first year; and then every 6 months until the patient's death. RESULTS: After 18 months and with 35 centers and researchers, the registry has 1128 patients. CONCLUSION: TESEO registry will provide clinical real-world evidence for prevention, treatment and complications of CAT in different scenarios that are under-represented in randomized clinical trials.

BRCA1 5272-1G>A and BRCA2 5374delTATG are founder mutations of high relevance for genetic counselling in breast/ovarian cancer families of Spanish origin.

The distribution of BRCA1 and BRCA2 germ line mutations in breast/ovarian cancer families varies among different populations, which typically present a wide spectrum of unique mutations. Splicing mutation 5272-1G>A of BRCA1 and frameshift mutation 5374delTATG of BRCA2 are highly prevalent mutations in Castilla-León (Spain), accounting for 18.4% and 13.6% of BRCA1 and BRCA2 positive families, respectively. To test the presence of founder effects, 9 Spanish 5272-1G>A and 13 5374delTATG families were genotyped with polymorphic markers linked to BRCA1 or BRCA2. All the 5272-1G>A families shared a common haplotype in eight markers (1.1 Mb region) and the mutation age was estimated in 15 generations (approximately 380 years). A conserved haplotype associated to 5374delTATG was observed in four markers (0.82 Mb). The mutation occurred approximately 48 generations ago (approximately 1200 years). Each mutation likely arose from a common ancestor that could be traced to a small area of Castilla-León and expanded to other Spanish regions. They can have a significant impact on the clinical management of asymptomatic carriers as well as on the genetic screening strategy to be followed in populations with Spanish ancestries.

Negative electrorheological behavior in suspensions of inorganic particles.

An investigation is described on the electric-field-induced structures in colloidal dispersions. Both rheological determinations and direct microscopic observations are used with that aim. The starting point of this study is the so-called electrorheological (ER) effect, consisting of the mechanical reinforcing of a fluid or suspension due to formation of chains of molecules or particles after being polarized by the action of the field. One macroscopic manifestation of this phenomenon is the transformation of the fluid from a typically Newtonian behavior to a viscoelastic material, with finite yield stress and high elastic modulus. The systems investigated were suspensions of elongated goethite (ß-FeOOH) particles in silicone oils with varying amounts of silica nanoparticles. The results showed the rather unusual behavior known as "negative ER effect", which can be best described by saying that the application of an electric field reduces the yield stress and the elastic modulus, that is, produces destruction of structures rather than their build up. The negative behavior is also found for suspensions of other inorganic powders, including hematite and quartz. On the contrary, the usual positive ER response is found for suspensions of cellulose and montmorillonite clay. The same happens if goethite suspensions are prepared in high volume fractions, high-viscosity fluids, or both. All of the results found are compatible with the so-called interfacial model of electrorheology: the reduction of the yield stress of goethite suspensions when the applied field is high enough is the consequence of particle migration toward the electrodes because of charge injection and subsequent electrophoresis. The migration leaves the gap between the electrodes devoid of particles and explains the decrease in yield stress. The addition of silica nanoparticles contributes to reduce the strength of this effect by hindering the charging and making it necessary to increase the field strength to observe the negative effect. The model appears to also be applicable to cellulose, although the positive response found for such particles is explained by their large size: larger diameters bring about larger attraction forces between particles, leading to a tendency to produce strong aggregates. This is likely to occur in suspensions of colloids which, because of their relatively high electrical conductivity, tend to acquire charge even in such nonpolar liquids as silicone oils.

[Treadmill training with partial body weight support in subjects with incomplete spinal cord injury: a systematic review]. / Entrenamiento en cinta rodante con soporte parcial del peso corporal en pacientes con lesión medular incompleta: revisión sistemática.

INTRODUCTION: The partial body weight supported treadmill training is a common therapeutic strategy in rehabilitation of people with spinal cord injuries. AIM: To analyze its effects on gait, balance and muscle strength in people with incomplete spinal cord injury compared to conventional treatment or overground gait training. PATIENTS AND METHODS: A compilation of clinical trials from 2007 to 2019 was carried out. We included articles that evaluate the effects of body weight supported treadmill training on gait, balance and muscle strength in subjects with incomplete spinal cord injury. RESULTS: A total of six articles were analyzed. The walking cadence, speed and resistance improved in the participants that received the intervention compared to those that were treated with conventional training. The functionality, balance and strength improved in most studies, but there were not differences between them. CONCLUSIONS: Body weight supported treadmill training improves the spatiotemporal parameters of walking and resistance in subjects with incomplete spinal cord injury, but in most variables analyzed (balance, functionality and strength) the changes are not superior to those observed after conventional training.

TITLE: Entrenamiento en cinta rodante con soporte parcial del peso corporal en pacientes con lesión medular incompleta: revisión sistemática.Introducción. El entrenamiento de la marcha sobre pasarela rodante con soporte parcial del peso corporal es una estrategia terapéutica frecuente en la rehabilitación de personas con lesión medular. Objetivo. Analizar los efectos de esta intervención en la marcha, el equilibrio y la fuerza muscular en personas con lesión medular incompleta en comparación con un tratamiento de fisioterapia convencional o con un entrenamiento de la marcha sobre suelo. Pacientes y métodos. Se realizó una recopilación de ensayos clínicos desde 2007 hasta 2019. Se incluyeron trabajos que evaluasen el entrenamiento de la marcha con soporte parcial del peso corporal en cinta rodante en pacientes con lesión medular incompleta y que analizasen la marcha, el equilibrio y la fuerza muscular. Resultados. Se analizaron seis artículos. Según los resultados de los estudios incluidos, la cadencia, la velocidad y la resistencia de marcha mejoraron en los participantes que recibieron entrenamiento sobre pasarela rodante con soporte parcial del peso corporal respecto al grupo de control. Las variables de funcionalidad, equilibrio y fuerza mejoraron en ambos los grupos de intervención. Conclusiones. El entrenamiento de la marcha con soporte parcial del peso corporal sobre cinta rodante mejora los parámetros espaciotemporales de la marcha y la resistencia de los pacientes con lesión medular incompleta, pero, en la mayoría de las variables analizadas, los cambios no son superiores a los observados tras un entrenamiento convencional.

Evolution of fungemia in an Italian region.

BACKGROUND: Fungemia represents a public health concern. Knowing aetiology and activity of the antifungals is critical for the management of bloodstream infections. Therefore, surveillance on local/international levels is desirable for a prompt administration of appropriate therapy. METHODS: Data on fungi responsible for fungemia and antifungal susceptibility profiles were collected from a laboratory-based surveillance over 2016-2017 in 12 hospitals located in Lombardia, Italy. The trend of this infection in twenty years was analysed. RESULTS: A total of 1024 episodes were evaluated. Rate of candiaemia progressively increased up to 1.46/1000 admissions. C.albicans was the most common species (52%), followed by C. parapsilosis (15%) and C glabrata (13%). As in the previous surveys the antifungal resistance is rare (echinocandins<2%, fluconazole 6%, amphotericin B 0.6%). Fungi other than Candida were responsible for 18 episodes: Cryptococcus neoformans (5 cases), Fusarium spp. (4), Magnusiomyces clavatus (3), Saccharomyces cerevisiae (3), Rhodotorula spp. (2), Exophiala dermatitidis (1). All fungi, except S.cerevisiae, were intrinsically resistant to echinocandins. Some isolates showed also elevated azole MIC. CONCLUSIONS: No particular changes in terms of species distribution and antifungal susceptibility patterns was noted. However, surveillance programs are needed to monitor trends in antifungal resistance, steer stewardship activities, orient empirical treatment.