Changing the Mandibular Position in Rowing: A Brief Report of a World-Class Rower.

We investigated the acute biophysical responses of changing the mandibular position during a rowing incremental protocol. A World-class 37-year-old male rower performed two 7 × 3 min ergometer rowing trials, once with no intraoral splint (control) and the other with a mandibular forward repositioning splint (splint condition). Ventilatory, kinematics and body electromyography were evaluated and compared between trials (paired samples t-test, p ≤ 0.05). Under the splint condition, oxygen uptake was lower, particularly at higher exercise intensities (67.3 ± 2.3 vs. 70.9 ± 1.5 mL·kg-1·min-1), and ventilation increased during specific rowing protocol steps (1st-4th and 6th). Wearing the splint condition led to changes in rowing technique, including a slower rowing frequency ([18-30] vs. [19-32] cycles·min-1) and a longer propulsive movement ([1.58-1.52] vs. [1.56-1.50] m) than the control condition. The splint condition also had a faster propulsive phase and a prolonged recovery period than the control condition. The splint reduced peak and mean upper body muscle activation, contrasting with an increase in lower body muscle activity, and generated an energetic benefit by reducing exercise cost and increasing rowing economy compared to the control condition. Changing the mandibular position benefited a World-class rower, supporting the potential of wearing an intraoral splint in high-level sports, particularly in rowing.

Kinematical Effects of a Mandibular Advancement Occlusal Splint on Running until Exhaustion at Severe Intensity.

The effects of occlusal splints on sport performance have already been studied, although their biomechanical impacts are often overlooked. We investigated the kinematical changes during running until exhaustion at severe intensity while wearing a mandibular advancement occlusal splint. Twelve trained runners completed (i) an incremental protocol on a track to determine their velocity corresponding to maximal oxygen uptake and (ii) two trials of square wave transition exercises at their velocity corresponding to maximal oxygen until exhaustion, wearing two occlusal splints (without and with mandibular advancement). Running kinematics were compared within laps performed during the square wave transition exercises and between splint conditions. The mandibular advancement occlusal splint increased the running distance covered (~1663 ± 402 vs. 1540 ± 397 m, p = 0.03), along with a noticeable lap effect in decreasing stride frequency (p = 0.04) and increasing stride length (p = 0.03) and duty factor (p < 0.001). No spatiotemporal differences were observed between splints, except for improved balance foot contact times in the mandibular advancement condition. An increased knee flexion angle at initial contact (p = 0.017) was noted along laps in the non-advancement condition, despite the fact that no differences between splints were found. Running patterns mainly shifted within laps rather than between conditions, indicating that a mandibular advancement occlusal splint had a trivial kinematical effect.

Continuous monitoring after laparoscopic Roux-En-Y gastric bypass: a pathway to ambulatory care surgery - a pilot study.

Same-day discharge (SDD) after Laparoscopic Roux-En-Y Gastric Bypass (LRYGB) faces resistance due to possible undetected postoperative complications. These present with changes in vital signs, which continuous remote monitoring devices can detect. This study compared continuous vital signs monitoring using the Isansys Patient Status Engine™ with standard nursing vital signs measurements to assess the device's reliability in postoperative surveillance of patients undergoing LRYGB. We conducted a pilot study including patients who underwent LRYGB. During their hospital stay, patients were continuously monitored using the Isansys Patient Status Engine™ with Lifetouch™, Lifetemp™, and Nonin Pulse Oximeter™ sensors. The heart rate (HR), body temperature, and oxygen saturation (SpO2) collected by the device were compared with standard nursing assessments. Thirteen patients with a mean body mass index of 41.5 ± 4.4 kg/m2 were included. No major complications occurred. The median HR assessed by standard and continuous monitoring did not significantly differ (75.5 [69-88] vs. 77 [66-91] bpm, p = 0.995), nor did the mean values of SpO2 (94.7 ± 2.0 vs. 93.7 ± 1.8%, p = 0,057). A significant difference was observed in median body temperature between the nursing staff and the monitoring device (36.3 [36.1-36.7] vs. 36.1 [34.5-36.6] degrees Celsius, p = 0.012), with a tendency for lower temperature measurements by the device. In conclusion, this is the first study on continuous postoperative surveillance using the Isansys Patient Status Engine™ monitoring device for LRYGB patients. Our results introduce a novel tool for more efficient surgery. Prospective randomized experimental studies are warranted to evaluate this method's efficacy and safety.

Ventilatory and Perceived Ergogenic Effects of Mandibular Forward Repositioning During Running at Maximal Oxygen Uptake Intensity.

ABSTRACT: Cardoso, F, Costa, MJ, Colaço, P, Vilas-Boas, JP, Pinho, JC, Pyne, DB, and Fernandes, RJ. Ventilatory and perceived ergogenic effects of mandibular forward repositioning during running at maximal oxygen uptake intensity. J Strength Cond Res XX(X): 000-000, 2024-Wearing an intraoral dental splint may enhance ventilatory function and exercise performance. Nineteen runners performed on a 400-m outdoor track: (a) an incremental protocol to assess the velocity at maximal oxygen uptake (vV̇o2max) and (b) 2 square wave bouts wearing 2 intraoral splints (with and without mandibular forward repositioning). The time until exhaustion at vV̇o2max (TLimv V̇o2max), ventilatory variables, oxygen uptake (V̇o2) kinetics, energetic profiling, perceived exertion and kinematics, were all measured. Ventilatory data were assessed breath-by-breath and perceived exertion evaluated using the Borg 6-20-point scale at the end of TLimv V̇o2max bouts. Images were recorded by video cameras (120 Hz) and kinematic measures retrieved using Kinovea. A paired t test was computed for comparison of splints (p ≤ 0.05). With (vs. without) mandibular forward repositioning, runners increased their TLimv V̇o2max by ∼6% (p = 0.03), coupled with higher ventilation (151 ± 22 vs. 147 ± 23 L·min-1, p = 0.04), end-tidal oxygen tension (114.3 ± 3.7 vs. 112.9 ± 3.9 mm Hg, p = 0.003), and lower inspiratory time (0.526 ± 0.083 vs. 0.540 ± 0.090 seconds, p = 0.02), despite similar V̇o2 kinetics (e.g., 49.0 ± 8.7 vs. 47.7 ± 8.6 ml∙kg∙min-1 of fast component amplitude) being observed. The energy expenditure was ∼8% higher (p = 0.03) with the mandible forward, coupled with lower perceived exertion scores (p = 0.04). Mandibular forward repositioning was effective in acutely improving running performance at vV̇o2max with ergogenic effects on ventilatory and perceived variables.

Peritoneal interposition flap reduces symptomatic lymphocele following transperitoneal robot-assisted radical prostatectomy and pelvic lymph node dissection: An updated meta-analysis.

Background: Robot-assisted radical prostatectomy with intraoperative pelvic lymph node dissection is the criterion standard for surgical treatment of nonmetastatic intermediate- and high-risk prostate cancer. However, this method is associated with symptomatic lymphocele (SLC), which is an important morbidity factor. To overcome this complication, several modifications of the technique have been developed, including the peritoneal interposition flap (PIF). We performed an updated systematic review and meta-analysis to investigate the efficacy and safety of this technique for preventing SLC and lymphocele (LC) formation. Materials and methods: Searches were performed using databases and references from included studies and previous systematic reviews. Only randomized controlled trials and nonrandomized cohorts were included. Primary outcomes were the incidence of SLC and LC formation, and safety outcomes were defined as operation time, estimated blood loss, length of hospital stay, and urinary incontinence. Quality assessment was performed using the Newcastle-Ottawa Scale and Cochrane Collaboration's tool. Pooled treatment effects were estimated using odds ratios with 95% confidence intervals (CIs) for binary endpoints. Heterogeneity was examined using Cochran's Q test and I 2 statistics; p values < 0.10 and I 2 > 25% were considered significant for heterogeneity. We used Mantel-Haenszel fixed-effect models in the analyses with low heterogeneity. Otherwise, the DerSimonian and Laird random-effects model was used. Results: The initial search yielded 510 results. After the removal of duplicate records and application of the exclusion criterion, 9 studies were fully reviewed for eligibility. Three randomized controlled trials and 5 retrospective cohorts met all the inclusion criteria, comprising 2261 patients, of whom 1073 (47.4%) underwent PIF. Six studies reported a significant reduction in SLC in the PIF group, and 3 of the 4 studies reported LC formation yielded significant results in preventing this complication. The incidence of SLC and LC formation in a follow-up of ≥3 months was significantly different between the PIF and no PIF group (odds ratio, 0.34 [95% CI, 0.16­0.74; p = 0.006] and 0.48 [95% CI, 0.31­0.74; p = 0.0008]), respectively. The safety outcomes did not differ significantly between the 2 groups. Conclusions: These results suggest that PIF is an effective and safe technique for preventing LC and SLC in patients undergoing transperitoneal robot-assisted radical prostatectomy and pelvic lymph node dissection.

Unfavorable neurological long-term outcome despite eTICI 3 - What are the predictors?

PURPOSE: Interventional stroke therapy has become standard treatment for patients with acute ischemic strokes. Complete reperfusion (eTICI 3) portrays the best possible technical outcome. The purpose of this study was to determine possible predictors for an unfavorable neurological long-term outcome (mRS 3-6) despite achieving the best possible treatment success. METHODS: We evaluated 122 patients with stroke in the anterior circulation and complete reperfusion after mechanical thrombectomy (MT) between May 2010 and March 2020. We performed a binary logistic regression analysis with patient baseline data, stroke severity, comorbidities, premedication and treatment information as independent variables. RESULTS: 50 of the 122 patients included in our study showed a poor clinical outcome after 90 days (41 %). Multivariable logistic regression analysis showed that older age (p = 0.033), higher admission NIHSS (p=0.009), lower admission ASPECTS (p=0.005), a pre-existing cardiovascular disease (p=0.017), and multiple passes for complete reperfusion (p=0.030) had an independent impact on unfavorable outcome. CONCLUSIONS: Older age, higher NIHSS upon admission, lower ASPECTS upon admission, cardiovascular comorbidities and multiple passes for complete reperfusion are predictors for poor neurological long-term outcome despite complete reperfusion.

Pre-stroke Functional Status in Patients Undergoing Mechanical Thrombectomy: How Relevant Are False Estimations in the Emergency Setting?

PURPOSE: The modified Rankin scale (mRS) is frequently used in the emergency setting to estimate pre-stroke functional status in stroke patients who are candidates to acute revascularization therapies (ps-mRS). We aimed to describe the agreement between pre-stroke mRS evaluated in the emergency department (ED-ps-mRS) and pre-stroke mRS evaluated comprehensively post-admission (PA-ps-mRS). METHODS: Retrospective study of consecutive ischemic stroke patients undergoing mechanical thrombectomy, with available ED-ps-mRS and PA-ps-mRS. ED-ps-mRS was evaluated by the treating neurologist and documented in the emergency stroke treatment protocol. PA-ps-mRS was retrospectively evaluated with information registered in the clinical record. Collection of baseline characteristics and 3­month outcomes. Patients with ED-overestimated pre-stroke functional status (ED ps-mRS ≤ 2 and PA-ps-mRS ≥ 3) were compared to correct low and high ED-ps-mRS groups. RESULTS: We included 409 patients (median age 77 years, 50% female, median NIHSS 14). Concordance of dichotomized ED-ps-mRS and PA-ps-mRS (0-2 vs. 3-5) was found in 81.4% (Cohen's kappa = 0.476, p < 0.001). ED-overestimated pre-stroke functional status was found in 69 patients (17%). Patients with ED-overestimated pre-stroke functional status were older (p < 0.001), more frequently presented diabetes (p < 0.001), previous stroke (p = 0.014) and less frequently presented 3­month functional independence (p < 0.001) compared to patients with correct low ED-ps-mRS. No differences in pre-stroke baseline characteristics between overestimated and correct high ED-ps-mRS was found. CONCLUSION: Disagreement between dichotomized ED-ps-mRS and PA-ps-mRS (0-2 vs. 3-5) occurred in 1/5 of patients. Overestimation of pre-stroke functional status may falsely reduce the expected proportion of patients achieving favourable 3­month functional outcomes.

Identification of a Orthohantavirus strain by clinical metagenomics in Brazil.

We describe a case of a 33-year-old male presented with fever, myalgia, nausea, and asthenia for six days. The patient lived in a rural area. Initial hypotheses included arbovirus infection, viral hepatitis, and Lyme disease. Reverse transcriptase polymerase chain reaction (RT-PCR) tests for Dengue, Zika, and Chikungunya resulted negative. We were able to recover complete S, L, and M segments of virus in the Orthohantavirus genome.

Quantifier processing and semantic flexibility in patients with aphasia.

Processing of quantifiers such as "many" and "few" relies on number knowledge, linguistic abilities, and working memory. Negative quantifiers (e.g., "few," "less than half") induce higher processing costs than their positive counterparts. Furthermore, the meaning of some quantifiers is flexible and thus adaptable. Importantly, in neurotypical individuals, changing the meaning of one quantifier also leads to a generalized change in meaning for its polar opposite (e.g., the change of the meaning of "many" leads to the change of that of "few"). Here, we extended this research to patients with fluent and non-fluent aphasia after stroke. In two experiments, participants heard sentences of the type "Many/few of the circles are yellow/blue," each followed by a picture with different quantities of blue and yellow circles. The participants judged whether the sentence adequately described the picture. Each experiment consisted of three blocks: a baseline block to assess the participants' criteria for both quantifiers, a training block to shift the criteria for "many," and a test block, identical to the baseline to capture any changes in quantifier semantics. In Experiment 1, the change of the meaning of "many" was induced by using adaptation to small numbers (20-50%) of circles of the named color. In Experiment 2, explicit feedback was given in the training block after each response to rate proportions of 40% (or higher) as "many," whereas 40% is normally rather rated as "few." The objective was to determine whether people with fluent or non-fluent aphasia were able to process quantifiers appropriately and whether generalized semantic flexibility was present after brain damage. Sixteen out of 21 patients were able to perform the task. People with fluent aphasia showed the expected polarity effect in the reaction times and shifted their criteria for "many" with generalization to the untrained quantifier "few." This effect, however, was only obtained after explicit feedback (Experiment 2) but not by mere adaptation (Experiment 1). In contrast, people with non-fluent aphasia did not change the quantifier semantics in either experiment. This study contributes to gaining new insights into quantifier processing and semantic flexibility in people with aphasia and general underlying processing mechanisms.

Mortality in sea lions is associated with the introduction of the H5N1 clade 2.3.4.4b virus in Brazil October 2023: whole genome sequencing and phylogenetic analysis.

Clade 2.3.4.4b highly pathogenic avian influenza (HPAI) H5N1 virus was detected in the South American sea lions found dead in Santa Catarina, Brazil, in October 2023. Whole genome sequencing and comparative phylogenetic analysis were conducted to investigate the origin, genetic diversity, and zoonotic potentials of the H5N1 viruses. The H5N1 viruses belonged to the genotype B3.2 of clade 2.3.4.4b H5N1 virus, which was identified in North America and disseminated to South America. They have acquired new amino acid substitutions related to mammalian host affinity. Our study provides insights into the genetic landscape of HPAI H5N1 viruses in Brazil, highlighting the continuous evolutionary processes contributing to their possible adaptation to mammalian hosts.

Metagenomic next-generation sequencing in patients with fever of unknown origin: A comprehensive systematic literature review and meta-analysis.

Metagenomic Next-Generation Sequencing (mNGS) holds promise in diagnosing fever of unknown origin (FUO) by detecting diverse pathogens. We systematically reviewed the literature to evaluate mNGS's accuracy, clinical efficacy, and limitations in FUO diagnosis. Nine studies revealed mNGS's positivity rate ranging from 66.7% to 93.5% for bacterial bloodstream infections and systemic infections. Meta-analysis of three studies involving 857 patients, including 354 with FUO, showed a sensitivity of 0.91 (95% CI: 0.87-0.93) and specificity of 0.64 (95% CI: 0.58-0.70). Despite lower specificity, mNGS demonstrated a higher Diagnostic Odds Ratio (DOR) of 17.0 (95% CI: 4.5-63.4) compared to conventional microbiological tests (CMTs) at 4.7 (95% CI: 2.9-7.6). While mNGS offers high sensitivity but low specificity in identifying causative pathogens for FUO, its superior DOR suggests potential for more accurate diagnoses and targeted interventions. Further research is warranted to optimize its clinical application in FUO management.

Blood-Based Frailty Index in Patients with Acute Ischemic Stroke Undergoing Endovascular Treatment.

INTRODUCTION: Frailty is a syndrome depicting the vulnerability of multiple physiological systems to stressors. Frailty measures, such as Hospital Frailty Risk Score (HFRS), can be used to identify frailty and predict outcomes more reliably. Our aim was to analyze a blood-based frailty index (FI-B) at admission for prediction outcomes of patients with acute ischemic stroke (AIS) undergoing endovascular treatment (EVT). METHODS: We conducted a retrospective study of consecutive AIS patients undergoing EVT in a single tertiary center during a period of 5 years. A set of eighteen blood parameters at admission were collected and nine of these were utilized to calculate FI-B. We analyzed the relationship between FI-B and HFRS. We examined the baseline characteristics of the study population based on FI-B-tertiles. Multivariable regression models were employed to ascertain the association between FI-B and in-hospital mortality, 3-month mortality and 3-month functional outcome. RESULTS: The final study population comprised 489 patients, with a median age of 75.6 years, 49.5% of patients were male. The FI-B exhibited a weak positive correlation with HFRS (rho = 0.113, p = 0.016). Patients in higher FI-B-tertiles were older and more frequently presented with pre-stroke functional dependence and comorbidities. Moreover, an increasing FI-B was independently associated with increased likelihood of in-hospital mortality (adjusted odds ratio [aOR] = 1.29, 95% confidence interval [95% CI] = 1.14-1.47), 3-month mortality (aOR = 1.26, 95% CI = 1.11-1.43), and of increasing 3-month functional disability measured by utility-weighted modified Rankin Scale (common aOR = 0.84, 95% CI = 0.76-0.93). CONCLUSION: A frailty index based on blood values at admission was able to identify frailty in AIS patients undergoing EVT and was an independent predictor of short- and medium-term outcome after stroke.

Disclosing the virome of Aedes, Anopheles and Culex female mosquitoes, Alto Pantanal of Mato Grosso, Brazil, 2019.

Using Illumina NextSeq sequencing and bioinformatics, we identified and characterized thirty-three viral sequences of unsegmented and multipartite viral families in Aedes spp., Culex sp. and Anopheles darlingi female mosquito pools from Porto São Luiz and Pirizal, Alto Pantanal. Seventeen sequences belong to unsegmented viral families, twelve represent putative novel insect-specific viruses (ISVs) within families Chuviridae (3/33; partial genomes) and coding-complete sequences of Xinmoviridae (1/33), Rhabdoviridae (2/33) and Metaviridae (6/33); and five coding-complete sequences of already-known ISVs. Notably, two putative novel rhabdoviruses, Corixo rhabdovirus 1 and 2, were phylogenetically related to Coxipo dielmovirus, but separated from other Alpharhabdovirinae genera, sharing Anopheles spp. as host. Regarding multipartite families, sixteen segments of different putative novel viruses were identified (13 coding-complete segments) within Durnavirales (4/33), Elliovirales (1/33), Hareavirales (3/33) and Reovirales (8/33) orders. Overall, this study describes twenty-eight (28/33) putative novel ISVs and five (5/33) already described viruses using metagenomics approach.

Non-hemorrhagic imaging markers of cerebral amyloid angiopathy in memory clinic patients.

INTRODUCTION: The Boston criteria v2.0 for cerebral amyloid angiopathy (CAA) incorporated non-hemorrhagic imaging markers. Their prevalence and significance in patients with cognitive impairment remain uncertain. METHODS: We studied 622 memory clinic patients with available magnetic resonance imaging (MRI) and cerebrospinal fluid (CSF) biomarkers. Two raters assessed non-hemorrhagic markers, and we explored their association with clinical characteristics through multivariate analyses. RESULTS: Most patients had mild cognitive impairment; median age was 71 years and 50% were female. Using the v2.0 criteria, possible or probable CAA increased from 75 to 383 patients. Sixty-eight percent of the sample had non-hemorrhagic CAA markers, which were independently associated with age (odds ratio [OR] = 1.04, 95% confidence interval [CI] = 1.01-1.07), female sex (OR = 1.68, 95% CI = 1.11-2.54), and hemorrhagic CAA markers (OR = 2.11, 95% CI = 1.02-4.35). DISCUSSION: Two-thirds of patients from a memory clinic cohort had non-hemorrhagic CAA markers, increasing the number of patients meeting the v2.0 CAA criteria. Longitudinal approaches should explore the implications of these markers, particularly the hemorrhagic risk in this population. HIGHLIGHTS: The updated Boston criteria for cerebral amyloid angiopathy (CAA) now include non-hemorrhagic markers. The prevalence of non-hemorrhagic CAA markers in memory clinic patients is unknown. Two-thirds of patients in our memory clinic presented non-hemorrhagic CAA markers. The presence of these markers was associated with age, female sex, and hemorrhagic CAA markers. The hemorrhagic risk of patients presenting these type of markers remains unclear.

Swallowing muscle mass contributes to post-stroke dysphagia in ischemic stroke patients undergoing mechanical thrombectomy.

BACKGROUND: Neurogenic dysphagia is a frequent complication of stroke and is associated with aspiration pneumonia and poor outcomes. Although ischaemic lesion location and size are major determinants of the presence and severity of post-stroke dysphagia, little is known about the contribution of other acute stroke-unrelated factors. We aimed to analyse the impact of swallowing and non-swallowing muscles measurements on swallowing function after large vessel occlusion stroke. METHODS: This retrospective study was based on a prospective registry of consecutive ischaemic stroke patients. Patients who underwent mechanical thrombectomy between July 2021 and June 2022 and received a flexible endoscopic evaluation of swallowing (FEES) within 5 days after admission were included. Demographic, anthropometric, clinical, and imaging data were collected from the registry. The cross-sectional areas (CSA) of selected swallowing muscles (as a surrogate marker for swallowing muscle mass) and of cervical non-swallowing muscles were measured in computed tomography. Skeletal muscle index (SMI) was calculated and used as a surrogate marker for whole body muscle mass. FEES parameters, namely, Functional Oral Intake Scale (FOIS, as a surrogate marker for dysphagia presence and severity), penetration aspiration scale, and the presence of moderate-to-severe pharyngeal residues were collected from the clinical records. Univariate and multivariate ordinal and logistic regression analyses were performed to analyse if total CSA of swallowing muscles and SMI were associated with FEES parameters. RESULTS: The final study population consisted of 137 patients, 59 were female (43.1%), median age was 74 years (interquartile range 62-83), median baseline National Institutes of Health Stroke Scale score was 12 (interquartile range 7-16), 16 patients had a vertebrobasilar occlusion (11.7%), and successful recanalization was achieved in 127 patients (92.7%). Both total CSA of swallowing muscles and SMI were significantly correlated with age (rho = -0.391, P < 0.001 and rho = -0.525, P < 0.001, respectively). Total CSA of the swallowing muscles was independently associated with FOIS (common adjusted odds ratio = 1.08, 95% confidence interval = 1.01-1.16, P = 0.029), and with the presence of moderate-to-severe pharyngeal residues for puree consistencies (adjusted odds ratio = 0.90, 95% confidence interval = 0.81-0.99, P = 0.036). We found no independent association of SMI with any of the FEES parameters. CONCLUSIONS: Baseline swallowing muscle mass contributes to the pathophysiology of post-stroke dysphagia. Decreasing swallowing muscle mass is independently associated with increasing severity of early post-stroke dysphagia and with increased likelihood of moderate-to-severe pharyngeal residues.

Evidence of reassortment of avian influenza A (H2) viruses in Brazilian shorebirds.

Influenza A viruses of the H2 subtype represent a zoonotic and pandemic threat to humans due to a lack of widespread specific immunity. Although A(H2) viruses that circulate in wild bird reservoirs are distinct from the 1957 pandemic A(H2N2) viruses, there is concern that they could impact animal and public health. There is limited information on AIVs in Latin America, and next to nothing about H2 subtypes in Brazil. In the present study, we report the occurrence and genomic sequences of two influenza A viruses isolated from wild-caught white-rumped sandpipers (Calidris fuscicollis). One virus, identified as A(H2N1), was isolated from a bird captured in Restinga de Jurubatiba National Park (PNRJ, Rio de Janeiro), while the other, identified as A(H2N2), was isolated from a bird captured in Lagoa do Peixe National Park (PNLP, Rio Grande do Sul). DNA sequencing and phylogenetic analysis of the obtained sequences revealed that each virus belonged to distinct subtypes. Furthermore, the phylogenetic analysis indicated that the genomic sequence of the A(H2N1) virus isolated from PNRJ was most closely related to other A(H2N1) viruses isolated from North American birds. On the other hand, the A(H2N2) virus genome recovered from the PNLP-captured bird exhibited a more diverse origin, with some sequences closely related to viruses from Iceland and North America, and others showing similarity to virus sequences recovered from birds in South America. Viral genes of diverse origins were identified in one of the viruses, indicating local reassortment. This suggests that the extreme South of Brazil may serve as an environment conducive to reassortment between avian influenza virus lineages from North and South America, potentially contributing to an increase in overall viral diversity.

Success rates of intensive aphasia therapy: real-world data from 448 patients between 2003 and 2020.

BACKGROUND: Aphasia is a devastating consequence after stroke, affecting millions of patients each year. Studies have shown that intensive speech and language therapy (SLT) is effective in the chronic phase of aphasia. Leveraging a large single-center cohort of persons with aphasia (PWA) including patients also in the subacute phase, we assessed treatment effects of intensive aphasia therapy in a real-world setting. METHODS: Data were collected at the Aachen aphasia ward in Germany between 2003 and 2020. Immediate treatment responses across different language domains were assessed with the Aachen Aphasia Test (AAT) using single-case psychometrics, conducted before and after 6-7 weeks of intensive SLT (10 h per week, median (IQR) dosage = 68 (61-76)). We adjusted for spontaneous recovery in subacute patients. Differential treatment effects between subgroups of chronicity and predictors of therapy response were investigated. RESULTS: A total of 448 PWA were included (29% female, median (IQR) age = 54 (46-62) years, median (IQR) time post-onset = 11 (6-20) months) with 12% in the early subacute, 15% in the late subacute and 74% in the chronic phase of aphasia. The immediate responder rate was 59%. Significant improvements in all AAT subtests und subscales were observed hinting at broad effectiveness across language domains. The degree of therapy-induced improvement did not differ between the chronicity groups. Time post-onset, dosage of therapy and aphasia severity at the beginning of treatment were predictors of immediate treatment response. DISCUSSION: Intensive therapy protocols for aphasia after stroke are yielding substantial responder rates in a routine clinical setting including a wide range of patients.