Clinical report: Virtual reality enables comparable contrast sensitivity measurements to in-office testing (pilot study).

SIGNIFICANCE: Vision health disparities largely stem from inaccessibility to vision specialists. To improve patient access to vision tests and to expedite clinical workflows, it is important to assess the viability of virtual reality (VR) as a modality for evaluating contrast sensitivity. PURPOSE: This study aimed to assess the validity of a VR version of the Pelli-Robson contrast sensitivity test by comparing its results with those of the corresponding in-office test. METHODS: Twenty-eight participants (mean ± standard deviation age, 37.3 ± 20.5 years) with corrected vision were recruited for testing on a voluntary basis with randomized administration of the in-office test followed by the VR analog or vice versa. Nineteen participants took each test twice to assess test-retest consistency in each modality. Virtual reality tests were conducted on a commercial Pico Neo Eye 2 VR headset, which has a 4K screen resolution. The environment for both tests was controlled by the participant for location and lighting. RESULTS: Similar sensitivity scores were obtained between testing modalities in both the right (n = 28 participants; Wilcoxon match-paired signed rank [SR], p=0.7) and left eyes (n = 28 participants; Wilcoxon match-paired SR, p=0.7). In addition, similar test-retest scores were found for VR (n = 19 participants; Wilcoxon match-paired SR, p=1.0) or in-office (n = 19 participants; Wilcoxon match-paired SR, p=1.0) tests. Virtual reality Pelli-Robson results correlated well with in-office test results in variably diseased participants (n = 14 eyes from 7 participants, R2 = 0.93, p<0.0001). CONCLUSIONS: In this pilot trial, we demonstrated that VR Pelli-Robson measurements of corrected vision align with those of in-office modalities, suggesting that this may be a reliable method of implementing this test in a more interactive and accessible manner.

Transverse colon volvulus in a young patient with wandering liver.

We present the case of a 26-year-old male patient with no history of interest who consulted the emergency department due to occlusive symptoms. Urgent CT showed the presence of a transverse colonic volvulus in the context of a heterotopic liver, located in the left hypochondrium. There were no clinical or radiological signs of perforation or ischemia, so urgent endoscopic decompression was performed with subsequent elective surgery with a favorable resolution of the condition. Transverse colonic volvulus is rare (<1%) and wandering liver is an exceptional predisposing factor, with less than a hundred published cases. In these patients, endoscopic decompression carries a risk of perforation with high recurrence rates, and surgical treatment should be considered. However, in this case, in the absence of severity criteria, decompressive colonoscopy was considered an urgent treatment and subsequent elective surgery with favorable results.

Resistance to apoptosis in complicated Crohn's disease: Relevance in ileal fibrosis.

BACKGROUND AND AIMS: The stiffening of the extracellular matrix, and changes in its cellular and molecular composition, have been reported in the pathogenesis of fibrosis. We analyze the mechanisms that perpetuate ileal fibrosis in surgical resections of complicated Crohn's disease patients. METHODS: Ileal resections were obtained from affected and non-affected tissue of stenotic or penetrating Crohn's disease behavior. Ilea from non-IBD patients were used as control tissue. All samples underwent RNA sequencing. Human small intestinal fibroblasts were treated for 48 h with IL-1ß, TFGß1, PDGFB or TNF-α. Resistance to apoptosis was analysed by RT-PCR, western blot and immunohistochemistry in ileal tissue and by RT-PCR and FACS in cultured cells. RESULTS: Growth factor-driven signaling pathways and increased RAS GTPase activity were up-regulated in affected ilea in which we found expression of both the antiapoptotic molecule MCL1 and the transcription factor ETS1 in submucosal fibroblasts, and a senescence-associated secretory phenotype. In cultured intestinal fibroblasts, PDGFB induced an ETS1-mediated resistance to apoptosis that was associated with the induction of both of TGFB1 and IL1B, a cytokine that replicated the expression of SASP detected in ileal tissue. ETS1 drove fibroblast polarization between inflammatory and fibrogenic phenotypes in IL1ß-treated cells. CONCLUSIONS: Our data show resistance to apoptosis in complicated ileal CD, and demonstrate that PDGFB induce an ETS1-mediated resistance to apoptosis associated with an inflammatory and fibrogenic pattern of expression in intestinal fibroblasts. Results point to PDGFRB, IL1R1 or MCL1 as potential targets against ileal fibrosis.

Reactive transport model for bentonites in COMSOL multiphysics: Benchmark and validation exercise.

At present, the deep geological repository concept for spent nuclear fuel is considered the most reliable and safe technique for the permanent disposal of this type of waste. One of the many safety elements used is an engineered barrier made of compacted bentonite. This material allows the encapsulated waste to be isolated from the host rock. Therefore, there is great interest in a detailed study of the behavior of bentonites to different changes in the composition of the surrounding groundwater. In this context, this work presents a new reactive transport model for bentonites implemented in the COMSOL Multiphysics platform. The model contemplates a non-simplistic geochemical system composed of 42 species and 4 minerals. Reactive transport involves the diffusive-dispersive-advective processes defined by the Nernst Planck equations for two overlapping modeling levels (macro- and microstructural) to simulate the behavior of double-porosity media. The uniqueness of this model is that the system of equations used to calculate the chemical speciation problem and the advective-diffusive-dispersive transport can be integrally solved in COMSOL. The model has been satisfactorily verified and validated using the benchmark exercise consisting of the simulation of the multicomponent advective-diffusive column experiment conducted on a compacted bentonite core extracted from a field experiment (LOT project) in the Äspö Hardrock laboratory (Sweden).

Incidence and Risk Factors for Development of Cardiac Toxicity in Adult Patients with Newly Diagnosed Acute Myeloid Leukemia.

The incidence of cardiac morbimortality in acute myeloid leukemia (AML) is not well known. We aim to estimate the cumulative incidence (CI) of cardiac events in AML patients and to identify risk factors for their occurrence. Among 571 newly diagnosed AML patients, 26 (4.6%) developed fatal cardiac events, and among 525 treated patients, 19 (3.6%) experienced fatal cardiac events (CI: 2% at 6 months; 6.7% at 9 years). Prior heart disease was associated with the development of fatal cardiac events (hazard ratio (HR) = 6.9). The CI of non-fatal cardiac events was 43.7% at 6 months and 56.9% at 9 years. Age ≥ 65 (HR = 2.2), relevant cardiac antecedents (HR = 1.4), and non-intensive chemotherapy (HR = 1.8) were associated with non-fatal cardiac events. The 9-year CI of grade 1-2 QTcF prolongation was 11.2%, grade 3 was 2.7%, and no patient had grade 4-5 events. The 9-year CI of grade 1-2 cardiac failure was 1.3%, grade 3-4 was 15%, and grade 5 was 2.1%; of grade 1-2, arrhythmia was 1.9%, grade 3-4 was 9.1%, and grade 5 was 1%. Among 285 intensive therapy patients, median overall survival decreased in those experiencing grade 3-4 cardiac events (p < 0.001). We observed a high incidence of cardiac toxicity associated with significant mortality in AML.

Usefulness of V˙O2 Kinetics and Biomechanical Parameters as Predictors of Athlete's Performance in 800 m Running Race.

Incremental tests to exhaustion have been usually employed as the "gold standard" to establish the fitness level of athletes. However, during real competition in many sport disciplines, exertion is not characterized by an increasing effort until failure. The purpose of this preliminary study was to add new evidence regarding the usability of parameters obtained from an on-field testing in 800 m running athletes. V˙O2 kinetics (mean, amplitude, phase time, and phase start time) and biomechanical parameters (velocity, stride frequency, and stride length) were analyzed in eight athletes during a maximal 800 m running race test. Our results showed that only the peak of blood lactate concentration after the 800 m test was correlated with the race time (p = 0.047). The race time was positively associated with both the phase duration and phase start time (all p-values < 0.05). Conversely, race time was negatively correlated with velocity, stride frequency, and amplitude (p-values < 0.05). Our results reveal that jointly studying the V˙O2 kinetics and biomechanical parameters during a maximal 800 m running race test is a useful tool to predict the athlete's upcoming performance and improve the planning and control of the training process of 800 m running athletes.

Combining Soil Vapor Extraction and Electrokinetics for the Removal of Hexachlorocyclohexanes from Soil.

This paper focuses on the evaluation of the mobility of four hexachlorocyclohexane (HCH) isomers by soil vapor extraction (SVE) coupled with direct electrokinetic (EK) treatment without adding flushing fluids. SVE was found to be very efficient and remove nearly 70 % of the four HCH in the 15-days of the tests. The application of electrokinetics produced the transport of HCH to the cathode by different electrochemical processes, which were satisfactorily modelled with a 1-D transport equation. The increase in the electric field led to an increase in the transport of pollutants, although 15 days was found to be a very short time for an efficient transportation of the pollutants to the nearness of the cathode. Loss of water content in the vicinity of the cathode warns about the necessity of using electrokinetic flushing technologies instead of simple direct electrokinetics. Thus, results point out that direct electrokinetic treatment without adding flushing fluids produced low current intensities and ohmic heating that contributes negatively to the performance of the SVE process. No relevant differences were found among the removal of the four isomers, neither in SVE nor in EK processes.

Las Topográfias Médicas: una aportación de la Medicina Rural a la Salud Pública / Medical Topographies: A Contribution of Rural Medicine to Public Health

Las Topografías Médicas (TM) o Geografías Médicas, son un género de la literatura médica, cuyos orígenes pueden encontrarse en el tratado de Hipócrates, Sobre los aires, aguas y lugares. El objetivo básico de las TM fue simplemente describir la salud de la población de un lugar determinado, aunque pronto ampliaron su campo de acción, para investigar la influencia del entorno físico y social en las enfermedades que padece la población en zonas geográficas o localidades. El inicio de su desarrollo tiene lugar en el contexto de la Medicina de la Ilustración, y adquirirán su mayoría de edad durante el siglo xix y las primeras décadas del siglo xx, para finalizar su producción en los años setenta del pasado siglo. Las Reales Academias de Medicina tuvieron una importancia decisiva en el desarrollo de las TM, proponiendo una metodología y un contenido homogéneo para la redacción de las mismas y estableciendo premios anuales para las obras galardonadas, lo que permitió mejorar su calidad y homogeneidad. El texto de las TM incluía generalmente un esbozo histórico de la población, la geografía de la zona, la descripción de la flora y de la fauna, con frecuencia de forma muy detalladas, el estudio del clima, de las vías públicas y las viviendas, la descripción de las enfermedades más frecuentes y epidemias, así como la demografía y situación socioeconómica de la población, entre otros. ... En el presente artículo se describe la evolución histórica de las TM, sus contenidos principales, su distribución por autonomías y años, y algunos personajes ilustres relacionados con ellas; aportándose alguna iconografía y copias de los documentos más interesantes por su valor médico o artístico. (AU)

Medical Topographies (TM) or Medical Geographies, are a genre of medical literature, whose origins can be found in Hippocrates’ treatise, On Airs, Waters and Places. The initial objective of TM was simply to describe the health of the population of given place, although they soon expanded their field of action to investigate the influence of the physical and social environment on the diseases suffered by the population in geographical areas or localities. The beginning of their development took place in the context of Enlightenment Medicine, and they came of age during the 19th century and the first decades of the 20th century, ending their production in the seventies of the last century. The Royal Academies of Medicine had a decisive importance in the development of TM, proposing a methodology and homogeneous content for their writing and establishing annual prizes for the award-winning works, which allowed them to improve their quality and homogeneity. The text of the TM generally included a historical outline of the population, the geography of the area, the description of the flora and fauna, often in very detailed form, the study of the climate, public roads and homes, the description of the most frequent diseases and epidemics, as well as the demographics and socio-economic situation of the population, among others. ... This article describes the historical evolution of the TM, its main contents, its distribution by autonomies and years, and some illustrious people related to them, providing some iconography and copies of the most interesting documents due to their medical or artistic value. (AU)

Virtual Reality Hemifield Measurements for Corrective Surgery Eligibility in Ptosis Patients: A Pilot Clinical Trial.

Purpose: We developed an accelerated virtual reality (VR) suprathreshold hemifield perimetry algorithm, the median cut hemifield test (MCHT). This study examines the ability of the MCHT to determine ptosis severity and its reversibility with an artificial improvement by eyelid taping on an HTC Vive Pro Eye VR headset and the Humphrey visual field analyzer (HVFA) to assess the capabilities of emerging technologies in evaluating ptosis. Methods: In a single visit, the MCHT was administered along with the HVFA 30-2 on ptotic untaped and taped eyelids in a randomized order. The primary end points were a superior field visibility comparison with severity of VF loss and VF improvement after taping for MCHT and HVFA. Secondary end points included evaluating patients' Likert-scaled survey responses on the comfort, speed, and overall experience with both testing modalities. Results: VR's MCHT superior field degrees visible correlated well for severe category margin to reflex distance (r = 0.78) compared with HVFA's (r = -0.21). The MCHT also demonstrated noninferiority (83.3% agreement; P = 1) against HVFA for detection of 30% or more superior visual field improvement after taping, warranting a corrective surgical intervention. In comparing hemi-VF in untaped eyes, both tests demonstrated relative obstruction to the field when comparing normal controls to severe ptosis (HVFA P < 0.05; MCHT P < 0.001), which proved sufficient to demonstrate percent improvement with taping. The secondary end point of patient satisfaction favored VR vision testing presentation mode in terms of comfort (P < 0.01), speed (P < 0.001), and overall experience (P < 0.01). Conclusions: This pilot trial supports the use of MCHT for the quantitative measurement of visual field loss owing to ptosis and the reversibility of ptosis that is tested when conducting a presurgical evaluation. We believe the adoption of MCHT testing in oculoplastic clinics could decrease patient burden and accelerate time to corrective treatment. Translational Relevance: In this study, we look at vision field outputs in patients with ptosis to evaluate its severity and improvement with eyelid taping on a low-profile VR-based technology and compare it with HVFA. Our results demonstrate that alternative, portable technologies such as VR can be used to grade the degree of ptosis and determine whether ptosis surgery could provide a significant superior visual field improvement of 30% or more, all while ensuring a more comfortable experience and faster testing time.

Enhancing soil vapor extraction with EKSF for the removal of HCHs.

This paper evaluates the combination of electrokinetic soil flushing (EKSF) with soil vapor extraction (SVE) for the removal of four hexachlorocyclohexane (HCH) isomers contained in a real matrix. Results demonstrate that the combination of EKSF and SVE can be positive, but it is required the application of high electric fields (3 V cm-1) in order to promote a higher temperature in the system, which improves the volatilization of the HCH contained in the system. Electrokinetic transport is also enhanced with the application of higher electric gradients, but these transport processes are slower than the volatilization processes, which are the primary in this system. Hence collection of species in the electrolyte wells is negligible as compared to the compound dragged with air by the SVE but the temperature increase demonstrates a good performance. Combination of EKSF with SVE can efficiently exhaust the four HCH isomers reaching a removal of more than 90% after 15 days of treatment (20% more than values attained by SVE) but it is required the application of high electric fields to promote a higher temperature in the system (to improve the volatilization) and EK transport (to improve the dragging). 1-D transport model can be easily used to estimate the average pore water velocity and the effective diffusion of each compound under the different experimental conditions tested.

De la Higiene a la Salud pública. Apuntes para la historia / From Hygiene to Public Health. Notes for history

La Higiene ha sido motivo de preocupación para el hombre desde la más remota antigüedad, focalizándose en las enfermedades infecciosas, que fueron siempre un verdadero azote para el ser humano. Sólo en los últimos siglos ha derivado en la moderna Salud Pública, al incorporar los programas frente al resto de patologías e incorporar elementos de desarrollo y promoción de la salud. En la edad antigua, destacan las figuras de Moisés (siglo XIV a. de C.), Licurgo (siglo VII a C) e Hipócrates (siglo V a. de C.) que, desde distintas perspectivas, fueron desarrollando la Higiene y contribuyeron a su avance. El Imperio Romano supo incorporar el conocimiento de todas las naciones conquistadas, por lo que conoció un esplendor nunca visto en materia de organización social y sanitaria que. Sin embargo, sufrió un serio retroceso en el 313 de nuestra era con el Edicto de Milán y la visión resignada de la enfermedad y de la muerte que aportaba el cristianismo. La Edad Media, supone un largo periodo de oscurantismo, donde prácticas como la quiromancia, la influencia de los astros o las panaceas, entre otras, estuvieron muy arraigadas en la sociedad de la época. La invasión musulmana, aportó de nuevo a España un gran desarrollo de la Higiene y de las ciencias, al confluir en ella el saber grecolatino, hebreo y oriental. Es un periodo de terribles epidemias, como las de lepra y la de la peste de 1346, en la que falleció alrededor de la cuarta parte de la población de Europa. El descubrimiento de América supuso un incremento extraordinario del comercio y de los viajes, y la invención de la imprenta permitió una gran difusión del conocimiento. Al principio de la Edad Moderna, el Renacimiento supone un periodo brillante en la historia de España, con gran desarrollo de las ciencias y de la Medicina, la cual experimenta grandes avances en la Anatomía, al tiempo que Fracastoro funda la Epidemiología moderna.(AU)

Hygiene has been a matter of concern for mankind since ancient times, with its focus mainly on infectious diseases, which have always been a true scourge for human beings. Only in recent centuries has it derived in modern Public Health, by incorporating programs against other pathologies and incorporating elements of development and health promotion In ancient times, the figures of Moses (14th century BC), Licurgo (4th century BC) and Hippocrates (5th century BC) stand out, who, from different perspectives, developed the hygiene and contributed to its advancement. The Roman Empire knew how to incorpórate the knowledge of all the conquered nations, and as a consequence knew a splendor never seen before in terms of social and healthorganization. However, it suffered a serious setback in 313 AD. C. with the Edict of Milan and Christianity’s compliant view of illness and death. The Middle Ages, supposes a long period of obscurantism, where practices such as palmistry, the influence of the stars or panaceasamong others, were deeply rooted in the society of the time. The Muslim invasion once again brought to Spain a great development of hygiene and science, as Greco-Latin, Hebrew and Oriental knowledge converged in it. It is a period of terrible epidemics, such as leprosy and the plague of 1346, in which around a quarter of the population of Europe died. The discovery of America meant an extraordinary increase in trade and travel, and the invention of the printing press allowed for a great spread of knowledge. At the beginning of the Modern Age, the Renaissance represents a brilliant period in the history of Spain, with great development ofscience and Medicine, which experienced great advances in anatomy, at the time that Fracastoro founded modern epidemiology. Some private hygiene works are published, only intended for high society or the nobility. The 17th and 18th centuries brought exceptional progress to the medical sciences.(AU)

What is Happening in the United States? How Social Classes Influence the Political Life of the Country and its Health and Quality of Life.

This article analyses the political changes that have been occurring in the United States (including the elections for the presidency of the country) and their consequences for the health and quality of life of the population. A major thesis of this article is that there is a need to analyse, besides race and gender, other categories of power - such as social class - in order to understand what happens in the country. While the class structure of the United States is similar to that of major Western European countries, the political context is very different. The US political context has resulted in the very limited power of its working class, which explains the scarcity of labor, political and social rights in the country, such as universal access to health care.

Why Asian Countries are Controlling the Pandemic Better Than the United States and Western Europe.

The coronavirus pandemic has shed light on the detrimental impact of neoliberal policies on public health and well-being and as a result, there have been calls for increases in public spending to rectify the lack of public health services. However, neoliberal right-wing parties have dismissed such calls, pointing instead to Asian countries as examples in successfully controlling the pandemic without high public health spending, attributing this to the entrepreneurial orientation of their governments, as opposed to their public services. This article refutes this idea, instead charting the reasons that Asian countries have better controlled the pandemic including prior experience of pandemics, cultural factors, and various successful public health policies. The article concludes by looking at the example of Trump and demonstrating the inadequacies of the business model for dealing with the coronavirus pandemic.

A worksheet-based tool to implement reactive transport models in COMSOL Multiphysics.

The increasing needs for modelling of reactive transport phenomena in different areas of environmental modelling have led to the development of many numerical codes. However, many of them suffer from a lack of flexibility, which hinders the adaptation of the codes to new problems. Moreover, in many cases, changes can be done by a very reduced group of people, and often by a single person, the main developer. Implementation platforms based on multiphysics modelling removes these barriers, although until now within that programming environments has been only possible the coupling of geochemical codes to transport equations using operator splitting techniques. This paper presents the EE4MGM tool, a MS Excel worksheet, provided in supplementary material, for the edition and complete implementation of reactive transport models in COMSOL. The tool automatically generates the code needed to solve the desired reactive transport problem by selecting only which species make up the geochemical system. This way, the numerical model will be completely adapted to the idealisation to be applied, being able to choose easily and effortlessly from a wide range of different levels of conceptual complexity. The organization of data input and the equation libraries obtained for the implementation in the multiphysics COMSOL environment are first described. Afterwards, two examples, in one and two-dimensional domains, to check the utility of the tool are presented.

The Consequences of Neoliberalism in the Current Pandemic.

This article analyzes how the neoliberal policies, such as the politics of austerity (with considerable cuts to social policy expenditures including medical care and public health services) and the privatization of health services, imposed by many governments on both sides of the North Atlantic, considerably weakened the capacity of the response to the coronavirus pandemic in Italy, Spain, and the United States.

What Should Be the Objective of an Emancipatory Project?

This article covers a very central issue in the discussions of the implications of exploitation for the health, quality of life, and well-being of populations. Essentially, the objective of any emancipatory project should be the elimination of any form of exploitation, whether of class, gender, race, nation, or the environment. This article explores the interrelatedness between different types of exploitation and demonstrates how all forms of exploitation are impacted by the political context within which they exist. It compares the levels of class and gender exploitation (as well as environmental exploitation) in countries governed by different political traditions, underlining the enormous importance this political context has in shaping not only each form of exploitation but how they are related. The article concludes that those countries which have an ideological project that connects all these different projects of liberation have less exploitation of each type of discrimination.

WNT2b Activates Epithelial-mesenchymal Transition Through FZD4: Relevance in Penetrating Crohn´s Disease.

BACKGROUND AND AIMS: Epithelial-mesenchymal transition [EMT] has been related to fibrosis and fistula formation, common complications associated with Crohn´s disease [CD]. The WNT signalling pathway mediates EMT, and specific WNT/FZD interactions have been related to the activation of this process in several diseases. We aim to analyse the relevance of EMT and WNT ligands and receptors in the penetrating behaviour of CD. METHODS: Intestinal surgical resections were obtained from control and CD patients with a stenotic or penetrating behaviour. Fibrosis was determined by the histological analysis of collagen deposition and EMT by confocal microscopy. The expression of WNT ligands, inhibitors, and FZD receptors was analysed by RT-PCR, WB, IH, and IF studies. The effects of WNT2b and the role of FZD4 in EMT were analysed in HT29 epithelial cells. RESULTS: Fibrosis and expression of EMT markers were detected in samples from CD patients irrespective of the clinical behaviour. However, an increased colocalisation of E-CADHERIN and VIMENTIN, an increased number of cells expressing WNT2b, and a higher expression of FZD4 and WNT2b/FZD4 interaction, were detected in intestinal tissue from the penetrating compared with the stenotic CD behaviour. WNT2b induced EMT in HT29 cells through FZD4 activation. CONCLUSIONS: An increased EMT, associated with increased WNT2b/FZD4 interaction, was detected in intestinal tissue from CD patients with a penetrating behaviour. WNT2b, through FZD4 activation, induces EMT in vitro which points to a novel pharmacological target to prevent intestinal penetrating complications of CD.