Functionality and Quality of Life with Parkinson's Disease after Use of a Dynamic Upper Limb Orthosis: A Pilot Study.

Parkinson's disease (PD) is a chronic, neurodegenerative movement disorder, whose symptoms have a negative impact on quality of life and functionality. Although its main treatment is pharmacological, non-pharmacological aids such as the dynamic elastomeric fabric orthosis (DEFO) merit an evaluation. Our objective is to assess the DEFO in upper limb (UL) functional mobility and in the quality of life of PD patients. A total of 40 patients with PD participated in a randomized controlled crossover study, and were assigned to a control group (CG) and to an experimental group (EG). Both groups used the DEFO for two months, the experimental group the first two months of the study and the control group the last two. Motor variables were measured in the ON and OFF states at the baseline assessment and at two months. Differences from the baseline assessment were observed in some motor items of the Kinesia assessment, such as rest tremor, amplitude, rhythm or alternating movements in the ON and OFF states with and without orthosis. No differences were found in the unified Parkinson's disease rating scale (UPDRS) or the PD quality-of-life questionnaire. The DEFO improves some motor aspects of the UL in PD patients but this does not translate to the amelioration of the standard of functional and quality-of-life scales.

Deep vicariance and frequent transoceanic dispersal shape the evolutionary history of a globally distributed fern family.

PREMISE: The historical biogeography of ferns is typically expected to be dominated by long-distance dispersal due to their minuscule spores. However, few studies have inferred the historical biogeography of a large and widely distributed group of ferns to test this hypothesis. Our aims were to determine the extent to which long-distance dispersal vs. vicariance have shaped the history of the fern family Blechnaceae, to explore ecological correlates of dispersal and diversification, and to determine whether these patterns differ between the northern and southern hemispheres. METHODS: We used sequence data for three chloroplast loci to infer a time-calibrated phylogeny for 154 of 265 species of Blechnaceae, including representatives of all genera in the family. This tree was used to conduct ancestral range reconstruction and stochastic character mapping, estimate diversification rates, and identify ecological correlates of diversification. RESULTS: Blechnaceae originated in Eurasia and began diversifying in the late Cretaceous. A lineage comprising most extant diversity diversified principally in the austral Pacific region around the Paleocene-Eocene Thermal Maximum. Land connections that existed near the poles during periods of warm climates likely facilitated migration of several lineages, with subsequent climate-mediated vicariance shaping current distributions. Long-distance dispersal is frequent and asymmetrical, with New Zealand/Pacific Islands, Australia, and tropical America being major source areas. CONCLUSIONS: Ancient vicariance and extensive long-distance dispersal have shaped the history of Blechnaceae in both the northern and southern hemispheres. The exceptional diversity in austral regions appears to reflect rapid speciation in these areas; mechanisms underlying this evolutionary success remain uncertain.

Aurochs roamed along the SW coast of Andalusia (Spain) during Late Pleistocene.

In the Iberian Peninsula the fossil record of artiodactyls spans over 53 million years. During the Pleistocene, wild cattle species such as Bison and especially Bos became common. In Late Pleistocene, the aurochs (Bos primigenius) was widespread and the only bovine living along the large river valleys of southern Iberia. Although commonly found in fossil sites and especially in cave bone assemblages, the trace fossil record of aurochs was known worldwide only from the Holocene. Large bovine and roe deer/caprine tracks were found in at least five horizons of the early Late Pleistocene (MIS 5) beach and eolian deposits of Cape Trafalgar (Cadiz Province, South of Spain). The large bovine tracks are formally described as Bovinichnus uripeda igen. et isp. nov. and compared with the record of aurochs tracks, large red deer tracks and steppe bison biogeographical distribution in Iberia. Aurochs were the most likely producers of the newly described Trafalgar Trampled Surface (TTS) and some of the large artiodactyl tracks in the Matalascañas Trampled Surface, representing the oldest aurochs track record known. This new evidence, together with comparisons with the record of possible aurochs tracks in the Mid-Late Pleistocene coastal deposits from the Asperillo cliff section in Matalascañas (Huelva Province, SW Spain) and bone assemblages known in Gibraltar, point to a recurrent use of the coastal habitat by these large artiodactyls in SW Iberia.

Leyes de eutanasia en España y en el mundo: aspectos médicos / Euthanasia laws in Spain and in the world: Medical aspects

Objetivo: Comparar la ley española de eutanasia y suicidio asistido con las que existen en otros países.DiseñoRevisión sistemática de la bibliografía.Fuentes de datosSe buscaron en Medline/PubMed, EMBASE y Biblioteca Cochrane los estudios que contuvieran en su título o resumen los descriptores «eutanasia» o «suicidio asistido» y además «legislación» o «ley», entre 2002 y final de 2020.Selección de estudios La búsqueda encontró 1.647 estudios y tras su cribado se valoraron 663, de los cuales 30 se incluyeron en la revisión. Se rechazaron estudios en los que solo constaran opiniones o no aportaran datos sobre la eutanasia/suicidio asistido en los países que los tienen regulados.Extracción de datosSe registraron los criterios que regulan la aceptación o rechazo de una petición de eutanasia o suicidio asistido en España y en los demás países en que están despenalizados.ResultadosLas regulaciones de la eutanasia en el mundo pueden agruparse en tres: leyes que permiten la eutanasia y el suicidio asistido (Países Bajos, Bélgica, Canadá, algunos estados de Australia, Nueva Zelanda, España), en las que la ley solo permite el suicidio asistido (EE.UU.) y en las que se admite únicamente el suicidio asistido y en base a sentencias judiciales, sin legislación específica (Suiza, Alemania).ConclusionesAunque hay diferencias, las leyes a las que más se asemeja la ley española de eutanasia son las de Países Bajos y Bélgica, por lo que es previsible que la casuística de eutanasia y sus cifras en España se parezcan en el futuro a las de estos países.

Objective: To compare the Spanish law on euthanasia and assisted suicide with those that exist in other countries.DesignSystematic review of the bibliography.Data sourcesMedline/PubMed, EMBASE and the Cochrane Library were searched for studies that contained in their title or abstract the descriptors «euthanasia» or «assisted suicide» and also «legislation» or «law», between 2002 and the end of 2020.Study selectionThe search found 1647 studies and after screening 663 were assessed, of which 30 were included in the review. Studies that only contained opinions or did not provide data on euthanasia/assisted suicide in the countries that have them regulated were rejected.Data extractionWe registered the criteria that regulate the acceptance or rejection of a request for euthanasia or assisted suicide in Spain and in the other countries where they are decriminalized.ResultsThe euthanasia regulations in the world can be grouped into three groups: laws that allow euthanasia and assisted suicide (Netherlands, Belgium, some states of Australia, New Zealand, Spain), those in which the law only allows assisted suicide (USA) and those in which only assisted suicide is admitted and based on court decisions, without specific legislation (Switzerland, Germany).ConclusionsAlthough there are differences, the laws that the Spanish euthanasia law most closely resembles are those of the Netherlands and Belgium, so it is foreseeable that the casuistry of euthanasia and its figures in Spain will resemble that of those countries in the future.

[Euthanasia laws in Spain and in the world: Medical aspects]. / Leyes de eutanasia en España y en el mundo: aspectos médicos.

OBJECTIVE: To compare the Spanish law on euthanasia and assisted suicide with those that exist in other countries. DESIGN: Systematic review of the bibliography. DATA SOURCES: Medline/PubMed, EMBASE and the Cochrane Library were searched for studies that contained in their title or abstract the descriptors «euthanasia¼ or «assisted suicide¼ and also «legislation¼ or «law¼, between 2002 and the end of 2020. STUDY SELECTION: The search found 1647 studies and after screening 663 were assessed, of which 30 were included in the review. Studies that only contained opinions or did not provide data on euthanasia/assisted suicide in the countries that have them regulated were rejected. DATA EXTRACTION: We registered the criteria that regulate the acceptance or rejection of a request for euthanasia or assisted suicide in Spain and in the other countries where they are decriminalized. RESULTS: The euthanasia regulations in the world can be grouped into three groups: laws that allow euthanasia and assisted suicide (Netherlands, Belgium, some states of Australia, New Zealand, Spain), those in which the law only allows assisted suicide (USA) and those in which only assisted suicide is admitted and based on court decisions, without specific legislation (Switzerland, Germany). CONCLUSIONS: Although there are differences, the laws that the Spanish euthanasia law most closely resembles are those of the Netherlands and Belgium, so it is foreseeable that the casuistry of euthanasia and its figures in Spain will resemble that of those countries in the future.

First tracks of newborn straight-tusked elephants (Palaeoloxodon antiquus).

Tracks and trackways of newborns, calves and juveniles attributed to straight-tusked elephants were found in the MIS 5 site (Upper Pleistocene) known as the Matalascañas Trampled Surface (MTS) at Huelva, SW Spain. Evidence of a snapshot of social behaviour, especially parental care, can be determined from the concentration of elephant tracks and trackways, and especially from apparently contemporaneous converging trackways, of small juvenile and larger, presumably young adult female tracks. The size frequency of the tracks enabled us to infer body mass and age distribution of the animals that crossed the MTS. Comparisons of the MTS demographic frequency with the morphology of the fore- and hind limbs of extant and fossil proboscideans shed light into the reproductive ecology of the straight-tusked elephant, Palaeloxodon antiquus. The interdune pond habitat appeared to have been an important water and food resource for matriarchal herds of straight-tusked elephants and likely functioned as a reproductive habitat, with only the rare presence of adult and older males in the MTS. The preservation of this track record in across a paleosol surface, although heavily trampled by different animals, including Neanderthals, over a short time frame, permitted an exceptional view into short-term intraspecific trophic interactions occurring in the Last Interglacial coastal habitat. Therefore, it is hypothesized that Neanderthals visited MTS for hunting or scavenging on weakened or dead elephants, and more likely calves.

Impact of COVID-19 outbreak on ischemic stroke admissions and in-hospital mortality in North-West Spain.

BACKGROUND AND PURPOSE: Spain has been one of the countries heavily stricken by COVID-19. But this epidemic has not affected all regions equally. We analyzed the impact of the COVID-19 pandemic on hospital stroke admissions and in-hospital mortality in tertiary referral hospitals from North-West Spain. METHODS: Spanish multicenter retrospective observational study based on data from tertiary hospitals of the NORDICTUS network. We recorded the number of patients admitted for ischemic stroke between 30 December 2019 and 3 May 2020, the number of IVT and EVT procedures, and in-hospital mortality. RESULTS: In the study period, 2737 patients were admitted with ischemic stroke. There was a decrease in the weekly mean admitted patients during the pandemic (124 vs. 173, p<0.001). In-hospital mortality of stroke patients increased significantly (9.9% vs. 6.5%, p = 0.003), but there were no differences in the proportion of IVT (17.3% vs. 16.1%, p = 0.405) or EVT (22% vs. 23%, p = 0.504). CONCLUSION: We found a decrease in the number of ischemic stroke admissions and an increase in in-hospital mortality during the COVID-19 epidemic in this large study from North-West Spain. There were regional changes within the network, not fully explained by the severity of the pandemic in different regions.

Tremor Control Devices for Essential Tremor: A Systematic Literature Review.

Background: There is a growing interest in nonpharmacological approaches for essential tremor (ET), including tremor cancelation devices. However, the true efficacy of such devices in ET remains unclear. Methods: A systematic literature review was conducted using standardized criteria regarding efficacy and comfortability. Devices focused on design or experimental testing in which tremor was simulated in a robot were excluded. Results: Out of 324 articles initially identified, 12 articles were included. Orthoses using biomechanical loading and neuromodulation with electrical stimulation, and external tremor cancelation devices, were the main interventions used to suppress tremor. All devices were designed to control tremor of the upper limbs at different anatomical locations. Overall, an average tremor attenuation of 50-98% was reported (level of evidence III). Interference with voluntary movements and portability was described as the main drawback. Discussion: In conclusion, this review highlights the growing interest in emerging tremor control devices and the importance of assessing comfort without affecting voluntary movements. However, the level of evidence regarding the efficacy of these tremor control devices remains low. An integrated multidisciplinary combination approach of engineering, robotics, physiology, physiotherapy, and clinical assessment is needed to improve the quality of non-pharmacological interventions for ET.

Germination fitness of two temperate epiphytic ferns shifts under increasing temperatures and forest fragmentation.

Ferns are an important component of ecosystems around the world. Studies of the impacts that global changes may have on ferns are scarce, yet emerging studies indicate that some species may be particularly sensitive to climate change. The lack of research in this subject is much more aggravated in the case of epiphytes, and especially those that live under temperate climates. A mathematical model was developed for two temperate epiphytic ferns in order to predict potential impacts on spore germination kinetics, in response to different scenarios of global change, coming from increasing temperature and forest fragmentation. Our results show that an increasing temperature will have a negative impact over the populations of these temperate epiphytic ferns. Under unfragmented forests the germination percentage was comparatively less influenced than in fragmented patches. This study highlight that, in the long term, populations of the studied epiphytic temperate ferns may decline due to climate change. Overall, epiphytic fern communities will suffer changes in diversity, richness and dominance. Our study draws attention to the role of ferns in epiphytic communities of temperate forests, emphasizing the importance of considering these plants in any conservation strategy, specifically forest conservation. From a methodological point of view, the model we propose could be easily used to dynamically monitor the status of ecosystems, allowing the quick prediction of possible future scenarios, which is a crucial issue in biodiversity conservation decision-making.

Suicide in primary headaches in 48 countries: A physician-survey based study.

Aim To investigate the relationship between primary headache types and accomplished or attempted suicide in countries from all world regions. Methods Data were obtained using a questionnaire about suicide due to headache in a face-to-face interview with 203 physicians with expertise in headaches. They came from 48 countries, and from all continents. Results Primary headaches cause one suicide per 1,000,000 population each year (1% of the suicide rate due to all causes). Cluster headache and migraines account for 70-80% of them. Suicide attempts are 10 times more frequent than accomplished suicides. Cluster headache poses more risk than migraine. This risk is not often acknowledged, and is increased if there is previous psychiatric history. More than half of the physicians interviewed think it could be reduced with a more aggressive treatment of headaches. Conclusions Cluster headache and migraine are not always benign, and are the cause of the majority of suicides due to headache.

Especies arborescentes del género Blechnum (Blechnaceae: Pteridophyta) / Arborescent species of the genus Blechnum (Blechnaceae: Pteridophyta)

Although the genus Blechnum has been largely studied, problems of species characterization, nomenclature, classification and taxonomy remain unsolved. For these reasons, in this study we intend to deepen in the characterization of the arborescent group of Blechnum with a review of eight species: B. brasiliense, B. columbiense, B. cycadifolium, B. magellanicum, B. moritzianum, B. schomburgkii, B. tabulare and B. werckleanum.Type material and several collections from diverse herbaria were studied. For morphological studies we used both herbarium and fresh material collected by the authors in fieldwork between 2005 and 2010. Rhizomes, stipes, vascularization of costae, as well as several characters of the lamina, such as outline, division, venation, margin structure, epidermal patterns, stomata, presence and types of hypodermis, and mesophyll of pinnae were studied. Important aspects of the morphology of the sporophyte have been analyzed, and external characters have been correlated with internal diagnostic ones to use the most reliable external traits in keys and descriptions. Taxonomy has been updated, and corrections have been introduced to the species nomenclature and comments were included to summarize the current knowledge of the geographical distribution and ecology. The presence of B. tabulare in America is confirmed, and the taxonomy of the species is updated, since external and internal morphology indicated that other related, American and African species, such as B. spannagelii and B. madagascariense must be included under that name. Similar studies carried out on B. schomburgkii indicated that the name is a synonym of B. auratum subsp. auratum, while B. auratum subsp. columbiense is treated here as a well characterized species. Detailed study of numerous specimens allowed to characterize B. moritzianum, being the correct name to apply to the recently described B. yungense. A refreshed description of the species is presented together with a list of new, selected materials to illustrate current known geographical distribution. Expanded data on ecology, geographical distribution and affinities are given, and a key for species identification is presented.

La bibliografía sobre el género Blechnum L. es muy abundante tanto en lo que respecta a las especies neotropicales como paleotropicales. Sin embargo, aún faltan estudios anatómicos completos, una caracterización actualizada de su morfología externa e interna, taxonomía, citología y afinidades. En este estudio se revisaron ocho especies de Blechnum de hábito arborescente: B. brasiliense, B. columbiense, B. cycadifolium, B. magellanicum, B. moritzianum, B. schomburgkii, B. tabulare y B. werckleanum. Se analizaron caracteres de rizomas, estípites y costas, división de la lámina, y venación, estructura de márgenes, modelos epidérmicos, presencia y tipos de hipodermis y mesofilo de las pinnas. Se estudió por primera vez la hipodermis, un área dermatoide adaxial presente en el mesofilo de todas las especies. Se correlacionaron caracteres externos e internos con el fin de utilizar los externos más confiables en claves y descripciones. Los estudios realizados confirmaron nuevamente la presencia de B. tabulare en América, que incluyen en su sinonimia a B. spannagelii de América tropical y B. madagascariense de África. También se concluyó que el nombre B. schomburgkii es un sinónimo de B. auratum subsp. auratum, en tanto que B. auratum subsp. columbiense se trata aquí con rango de especie. Se caracterizó a B. moritzianum, el nombre que corresponde aplicar a la recientemente descrita B. yungense. Se presentó una descripción actualizada de las especies, se resolvieron varios problemas nomenclaturales pendientes; se presentaron datos amplios sobre la ecología, distribución geográfica y afinidades entre las especies, así como una clave para determinarlas.

Placebo effect characteristics observed in a single, international, longitudinal study in Huntington's disease.

BACKGROUND: Classically, clinical trials are based on the placebo-control design. Our aim was to analyze the placebo effect in Huntington's disease. METHODS: Placebo data were obtained from an international, longitudinal, placebo-controlled trial for Huntington's disease (European Huntington's Disease Initiative Study Group). One-hundred and eighty patients were evaluated using the Unified Huntington Disease Rating Scale over 36 months. A placebo effect was defined as an improvement of at least 50% over baseline scores in the Unified Huntington Disease Rating Scale, and clinically relevant when at least 10% of the population met it. RESULTS: Only behavior showed a significant placebo effect, and the proportion of the patients with placebo effect ranged from 16% (first visit) to 41% (last visit). Nondepressed patients with better functional status were most likely to be placebo-responders over time. CONCLUSIONS: In Huntington's disease, behavior seems to be more vulnerable to placebo than overall motor function, cognition, and function

Prevalence of tics in schoolchildren in central Spain: a population-based study.

Tic disorders constitute a neurodevelopmental disorder of childhood. This study sought to determine the prevalence of tic disorders in a school-based sample. A randomized sample of 1158 schoolchildren, based on clusters (classrooms) in the province of Burgos (Spain), was identified on a stratified sampling frame combining types of educational center and setting (mainstream schools and special education), using a two-phase approach (screening and diagnosis ascertainment by a neurologist). Tics with/without impairment criterion were diagnosed according to Diagnostic and Statistical Manual of Mental Disorders criteria. In mainstream schools, tics were observed in 125/741 students (16.86%; 95% confidence interval, 14.10-19.63), and were more frequent in boys (87/448, 19.42%; 95% confidence interval, 15.64-23.19) compared with girls (38/293, 12.96%; 95% confidence interval, 8.95-16.98; P = 0.03). In special education centers, tics disorders were observed in 11/54 of children (20.37%; 95% confidence interval, 8.70-32.03). Overall, tics with impairment criteria were less frequent than tics without impairment criteria (4.65% vs 11.85%, P < 0.0001). The most frequent diagnoses involved chronic motor tics (6.07%) and Tourette syndrome (5.26%). Tic disorders are common in childhood, and the use or nonuse of impairment criteria exerts a significant impact on tic prevalence estimates.