The formation of the thumb requires direct modulation of Gli3 transcription by Hoxa13.

In the tetrapod limb, the digits (fingers or toes) are the elements most subject to morphological diversification in response to functional adaptations. However, despite their functional importance, the mechanisms controlling digit morphology remain poorly understood. Here we have focused on understanding the special morphology of the thumb (digit 1), the acquisition of which was an important adaptation of the human hand. To this end, we have studied the limbs of the Hoxa13 mouse mutant that specifically fail to form digit 1. We show that, consistent with the role of Hoxa13 in Hoxd transcriptional regulation, the expression of Hoxd13 in Hoxa13 mutant limbs does not extend into the presumptive digit 1 territory, which is therefore devoid of distal Hox transcripts, a circumstance that can explain its agenesis. The loss of Hoxd13 expression, exclusively in digit 1 territory, correlates with increased Gli3 repressor activity, a Hoxd negative regulator, resulting from increased Gli3 transcription that, in turn, is due to the release from the negative modulation exerted by Hox13 paralogs on Gli3 regulatory sequences. Our results indicate that Hoxa13 acts hierarchically to initiate the formation of digit 1 by reducing Gli3 transcription and by enabling expansion of the 5'Hoxd second expression phase, thereby establishing anterior-posterior asymmetry in the handplate. Our work uncovers a mutual antagonism between Gli3 and Hox13 paralogs that has important implications for Hox and Gli3 gene regulation in the context of development and evolution.

Improving psychiatric medication use through the Michigan e-psychopharmacology course for nurse practitioners: A pre-post/follow-up study.

PURPOSE: Increasing demands for mental health treatment represent a key opportunity for nurse practitioners (NPs) to provide more psychiatric medication treatment (psychopharmacology). Given this need, NPs could benefit from opportunities to enhance knowledge and skills in psychopharmacology. DESIGN AND METHODS: A novel videoconference course was developed and tested, with 6 weekly sessions taught by a facilitator and a speaker, evaluated by multiple outcomes. FINDINGS: Course feasibility and evidence of improved NP confidence and performance in psychopharmacology were both demonstrated. PRACTICE IMPLICATIONS: Continuing education providers should consider adopting this model for effective and accessible NP psychopharmacology education, potentially expanding NP mental healthcare delivery.

Characteristics of febrile urinary tract infections in older male adults.

BACKGROUND: Urinary tract infections (UTI) are among the most frequent bacterial infections in older adults. The aim of the study was to analyse the existence of differences in clinical features, microbiological data and risk of infection by multidrug-resistant organisms (MDRO) between older and non-older men with febrile UTI (FUTI). METHODS: This was an ambispective observational study involving older males with a FUTI attended in the Emergency Department. Variables collected included age, comorbidity, diagnostic of healthcare-associated (HCA)-FUTI, clinical manifestations, hospitalization, mortality, and microbiological data. RESULTS: Five hundred fifty-two males with a FUTI, 329 (59.6%) of whom were older adults, were included. Older males had a higher frequency of HCA-FUTI (p <  0.001), increased Charlson scores (p <  0.001), had received previous antimicrobial treatment more frequently (p <  0.001) and had less lower urinary tract symptoms (p <  0.001). Older patients showed a lower frequency of FUTI caused by E. coli (p <  0.001) and a higher rate of those due to Enterobacter spp. (p = 0.003) and P. aeruginosa (p = 0.033). Resistance rates to cefuroxime (p = 0.038), gentamicin (p = 0.043), and fluoroquinolones (p <  0.001) in E. coli isolates and the prevalence of extended-spectrum beta-lactamase and AmpC producing E. coli and Klebsiella spp. strains (p = 0.041) and MDRO (p <  0.001) were increased in older males. Inadequate empirical antimicrobial treatment (p = 0.004), frequency of hospitalization (p <  0.001), and all cause in-hospital mortality (p = 0.007) were higher among older patients. In the multivariate analysis, being admitted from an long term care facility (OR 2.4; 95% CI: 1.06-5.9), having a urinary tract abnormality (OR 2.2; 95% CI: 1.2-3.8) and previous antimicrobial treatment (OR 3.2; 95% CI: 1.9-5.4) were associated to FUTI caused by MDRO. CONCLUSIONS: Older male adults with a FUTI have different clinical characteristics, present specific microbiological features, and antimicrobial resistance rates. In the multivariate analysis being an older male was not associated with an increased risk of FUTI caused by MDRO.

Prevalence and risk factors for fosfomycin resistance among Escherichia coli strains isolated from males with community febrile urinary tract infection / Prevalencia y factores de riesgo de resistencia a fosfomicina en cepas de Escherichia coli aisladas de hombres con infección del tracto urinario febril comunitaria

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Role of Hox genes in regulating digit patterning.

The distal part of the tetrapod limb, the autopod, is characterized by the presence of digits. The digits display a wide diversity of shapes and number reflecting selection pressure for functional adaptation. Despite extensive study, the different aspects of digit patterning, as well as the factors and mechanisms involved are not completely understood. Here, we review the evidence implicating Hox proteins in digit patterning and the interaction between Hox genes and the Sonic hedgehog/Gli3 pathway, the other major regulator of digit number and identity. Currently, it is well accepted that a self-organizing Turing-type mechanism underlies digit patterning, this being understood as the establishment of an iterative arrangement of digit/interdigit in the hand plate. We also discuss the involvement of 5' Hox genes in regulating digit spacing in the digital plate and therefore the number of digits formed in this self-organizing system.

Influencia de la implantación de un servicio de nutrición en el control de factores de riesgo cardiovascular en una población trabajadora / Influence of the implantation of a service of nutrition in the control of factors of cardiovascular risk in a hard-working population

Introducción: Las enfermedades cardiovasculares (ECV) siguen siendo la primera causa de muerte en España. La obesidad como uno de los mayores factores de riesgo, es la enfermedad metabólica más prevalente del mundo desarrollado. Así pues, en nuestro estudio hemos comprobado cómo influye la incorporación de un servicio de nutrición en una empresa del sector industrial, tras la recogida de parámetros antropométricos a un grupo de trabajadores observamos la evolución de dichos parámetros, después de la implantación de un programa de ejercicio físico diario, y estableciendo pautas de evaluación y seguimiento en el ámbito sanitario, con el fin de evaluar si hay mejoras en los parámetros antropométricos, consiguiendo una reducción en los factores de riesgo cardiovascular. Objetivos: Analizar la implantación de un servicio de nutrición en la empresa para la reducción de los factores de ECV en los trabajadores. Metodología: Se trata de un estudio de investigación observacional longitudinal retrospectivo, con análisis de los parámetros antropométricos relacionados con la ECV obtenidos durante el seguimiento en el servicio de nutrición durante 6 meses. Resultados: Aparecen diferencias significativas al analizar algunas variables relacionadas con el RCV entre la medición basal y a la medición a los 6 meses, como el peso (t-student, P=0.002), IMC (t-student, P=0.002) y metabolismo basal (t-student, P=0.000). Discusión: La introducción de un programa de nutrición y ejercicio en una empresa del sector industrial ofrece una reducción de los factores de riesgo cardiovascular (RCV), siendo el entorno donde pasamos gran cantidad de nuestro tiempo, y facilitando la accesibilidad y adherencia al programa. Conclusiones: Tras el análisis de los resultados se deduce que la intervención realizada ha conseguido una disminución significativa de los diferentes parámetros relacionados con el RCV (AU)

Introduction: The cardiovascular diseases (CVD) continue being the first reason of death in Spain. The obesity like one of the major factors of risk, it is the metabolic disease more prevalente of the developed world. This way so, in our study we have verified how it influences the incorporation of a service of nutrition in a company of the industrial sector, after the withdrawal of health-releated variables to a roup of workers we observe the evolution of the above mentioned parameters, after the implantation of a program of physical daily exercise, and establishing guidelines of evaluation and follow-up, in order to evaluate if there are improvements in the health variables, obtaining a reduction in the factors of cardiovascular risk. Objective: To analyze the implantation of a service of nutrition in the company or the reduction of CVD’s factors in the workers. Methodology: Observacional longitudinally retrospectively, with analysis of the health variables related to the CVD obtained during the follow-up in the service of nutrition for 6 months. Results: significant differences appear on having analyzed some variables related to the CV risk between the basal measurement and to the measurement to 6 months, as the weight (t-student, P=0.002), BMI (t-student, P=0.002) and basal metabolism (t-student, P=0.000). Discussion: The introduction of a program of nutrition and exercise in a company of the industrial sector offers a reduction of the factors of cardiovascular risk (CVR), being the environment where we spend great quantity of our time, and facilitating the accessibility and adherence to the program. Conclusions: After the analysis of the results there is deduced that the realized intervention has obtained a significant decrease of the different parameters related to the CVR (AU)

Glenohumeral osteoarthritis: overview, therapy, and rehabilitation.

PURPOSE: Glenohumeral osteoarthritis (GHOA) is a common cause of pain and functional disability of the shoulder. Despite the limited evidence, there are several options for the treatment of this pathology. The aim of this article is to provide current information on the characteristics of the disease and the pathophysiology, evidence based on medical and surgical treatments with emphasis on the rehabilitation process. METHODS: It was performed with an extensive literature review, mainly clinical practice guidelines, randomized controlled trials, reviews, focusing on the rehabilitation management. RESULTS: There are few clinical practice guidelines that address GHOA as a pathology with unique characteristics. Evidence based treatment recommendations are mostly supported by low-quality evidence and experts' opinions, with few high levels of evidence studies guiding treatment decisions. CONCLUSIONS: Despite the lack of good quality evidence, rehabilitation programs have proven to be efficient and reliable, and this revision provides information and recommendations in this field. Implication of Rehabilitation Glenohumeral osteoarthritis is a common cause of pain and functional disability of the shoulder There are few clinical practice guidelines that address Glenohumeral Osteoarthritis as a pathology with unique characteristics, and recommendations for rehabilitation and therapeutic exercise are poor The paper provides current information on the characteristics of the disease, its rehabilitation process, and could be of interest for rehabilitation professionals to direct their practices in this field.

Proposal and Evaluation of a Telerehabilitation Platform Designed for Patients With Partial Rotator Cuff Tears: A Preliminary Study.

OBJECTIVE: To propose and evaluate the effectiveness of a telerehabilitation platform designed for patients with rotator cuff (RC) tears. METHODS: During the first study phase, a virtual service platform that included information on RC tear pathology, joint care, and a series of instructions regarding therapeutic exercise was designed and created. Subsequently, in the clinical phase, a quasi-experimental study was performed. The platform was tested on patients and evaluated at baseline and at 1, 2, 3, and 6 months with respect to their pain levels and functionality on the Constant-Murley (CM) scale. RESULTS: Eleven patients were included, 5 women and 6 men, with a median age of 55 years (range, 42-68 years). Pain diminished from a baseline value of 64 mm (range, 40-80 mm) to 16 mm (range, 0-30 mm) at 6 months (p<0.001). Points on the CM scale rose from a baseline value of 54 points (range, 51-66 points) to 85 points (range, 70-100 points) at 6 months (p=0.001). Functionality in daily living and work activities, movement, and strength exhibited significant changes at 6 months (p<0.05). CONCLUSION: Significant changes were observed in pain and functionality in this group of participants who used a telerehabilitation platform. To the best of our knowledge, this is the first study that included a specific program for RC tears.

Knee muscle strength correlates with joint cartilage T2 relaxation time in young participants with risk factors for osteoarthritis.

The objective of this study is to correlate T2 relaxation time (T2RT), measured by magnetic resonance imaging (MRI) with quadriceps and hamstring strength in young participants with risk factors for knee osteoarthritis (OA). A descriptive cross-sectional study was conducted with participants between 20 and 40 years of age, without diagnosis of knee OA. Their T2 relaxation time was measured through MRI, and their muscle strength (MS) was measured with an isokinetic dynamometer. Seventy-one participants were recruited, with an average age of 28.3 ± 5.5 years; 39 (55 %) were females. Negative correlations were found between T2RT and quadriceps peak torque (QPT) in males in the femur r = -0.46 (p = 0.01), tibia r = -0.49 (p = 0.02), and patella r = -0.44 (p = 0.01). In women, correlations were found among the femur r = -0.43 (p = 0.01), tibia r = -0.61 (p = 0.01), and patella r = -0.32 (p = 0.05) and among hamstring peak torque (HPT), in the femur r = -0.46 (p = 0.01), hamstring total work (HTW) r = -0.42 (p = 0.03), and tibia r = -0.33 (p = 0.04). Linear regression models showed good capacity to predict T2RT through QPT in both genders. The present study shows that early changes in femoral, tibial, and patellar cartilage are significantly correlated with MS, mainly QPT, and that these early changes might be explained by MS, which could play an important role in pre-clinical phases of the disease.

Water-based Tai Chi: theoretical benefits in musculoskeletal diseases. Current evidence.

Tai Chi is a low-impact and moderate intensity exercise that has shown positive effects in patients with musculoskeletal disorders. Recently have been developed clinical studies on the benefits of Tai Chi techniques combined with hydrotherapy. Both types of treatment include physical training of balance, mobility, strength, coordination and sensory input that could complement each other. This report aims to present the current evidence about the benefits of the combination of water based Tai Chi in musculoskeletal diseases in order to establish whether the combined intervention is better than Tai Chi or hydrotherapy alone.

Steel barrier: legal implications from a gender equal opportunity perspective / Barreras de acero: implicaciones legales desde una perspectiva de género e igualdad de oportunidades

In recent decades, legal Acts, norms, and regulations have proliferated in order to ensure equal opportunities for women and men in multiple contexts, including public and private organizations. Nevertheless, there is sufficient evidence to suggest that, to date, real and legal equality do not match. The current context of the global economy suggests that there may now be a new barrier, related to the fact that women have been partially excluded from positions abroad which would facilitate the acquisition of professional and personal skills which are essential in the present century. This new inequality in access to senior management seems to be in contradiction with the different pressures and initiatives put in place to achieve equality of opportunities between women and men, protected in our national and international laws. In this paper, the main causes excluding women from international assignments, and consequently from senior management, are reviewed, highlighting the motivational and legal aftereffects that this trend may have (AU)

En las últimas décadas han proliferado diversas disposiciones legales y normativas con el objetivo de garantizar la igualdad de oportunidades entre mujeres y hombres en múltiples contextos, entre ellos el que atañe a las organizaciones públicas y privadas. Pese a ello, existe suficiente evidencia de que la igualdad real no se acerca, hasta la fecha, a la legal. El contexto actual de economía globalizada sugiere que puede aparecer una nueva barrera, al quedar la mujer excluida parcialmente de puestos en el extranjero que le facilitan la adquisición de capacidades profesionales y personales imprescindibles en el siglo actual. Esta nueva desigualdad en el acceso a puestos de alta dirección no parece responder a las distintas presiones e iniciativas por conseguir la igualdad de oportunidades entre hombres y mujeres, protegida en nuestro ordenamiento jurídico nacional e internacional. En este trabajo revisamos las principales causas que alejan a la mujer de los puestos internacionales y, en consecuencia, de la alta dirección, resaltando las derivaciones motivacionales y legales que dicha tendencia pudiese tener (AU)

Sepsis fulminante por Capnocytophaga canimorsus: diagnóstico por espectrometría de masas con analizador de tiempo de vuelo y desorción/ionización láser / Fulminant sepsis due to Capnocytophaga canimorsus: Diagnosis by matrix-assisted laser desorption/ionization-time of flight mass spectrometry

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"Self-regulation," a new facet of Hox genes' function.

BACKGROUND: Precise temporal and spatial expression of the clustered Hox genes is essential for patterning the developing embryo. Temporal activation of Hox genes was shown to be cluster-autonomous. However, gene clustering appears dispensable for spatial colinear expression. Generally, a set of Hox genes expressed in a group of cells instructs these cells about their fate such that the differential expression of Hox genes results in morphological diversity. The spatial colinearity is considered to rely both on local and long-range cis regulation. RESULTS: Here, we report on the global deregulation of HoxA and HoxD expression patterns upon inactivation of a subset of HOXA and HOXD proteins. CONCLUSIONS: Our data suggest the existence of a "self-regulation" mechanism, a process by which HOX proteins establish and/or maintain the spatial domains of the Hox gene family and we propose that the functionally dominant HOX proteins could contribute to generating the spatial parameters of Hox expression in a given tissue, i.e., HOX controlling the establishment of the ultimate HOX code.

Decoupling the function of Hox and Shh in developing limb reveals multiple inputs of Hox genes on limb growth.

Limb development relies on an exquisite coordination between growth and patterning, but the underlying mechanisms remain elusive. Anterior-posterior and proximal-distal specification initiates in early limb bud concomitantly with the proliferative expansion of limb cells. Previous studies have shown that limb bud growth initially relies on fibroblast growth factors (FGFs) produced in the apical ectodermal ridge (AER-FGFs), the maintenance of which relies on a positive-feedback loop involving sonic hedgehog (Shh) and the BMP antagonist gremlin 1 (Grem1). The positive cross-regulation between Shh and the HoxA and HoxD clustered genes identified an indirect effect of Hox genes on the maintenance of AER-FGFs but the respective function of Shh and Hox genes in this process remains unknown. Here, by uncoupling Hox and Shh function, we show that HoxA and HoxD genes are required for proper AER-FGFs expression, independently of their function in controlling Shh expression. In addition, we provide evidence that the Hox-dependent control of AER-FGF expression is achieved through the regulation of key mesenchymal signals, namely Grem1 and Fgf10, ensuring proper epithelial-mesenchymal interactions. Notably, HoxA and HoxD genes contribute to both the initial activation of Grem1 and the subsequent anterior expansion of its expression domain. We propose that the intricate interactions between Hox genes and the FGF and Shh signaling pathways act as a molecular network that ensures proper limb bud growth and patterning, probably contributing to the coordination of these two processes.

[Total hip arthroplasty in patients with cerebral vascular event. Case report]. / Artroplastia total de cadera primaria en paciente con evento vascular cerebral. Reporte de un caso.

INTRODUCTION: Associated neurological disorders pose a challenge hip joint reconstruction. The imbalance and poor muscle tone predispose to dislocation and loosening of the prosthesis. CLINICAL CASE: The following is the case of a 67 years old patient with a hemorrhagic cerebral vascular event with a secondary left hemiparesis. Ten years later had a femoral neck fracture on the affected side. Initially she was treated with conservative management resulting in pain and discapacity, valued with WOMAC scale as 12 points. Two years later was treated with total hip arthroplasty with large diameter femoral head. We present the follow up of 41 months, asymptomatic, walking using a cane and a WOMAC score of 41, with no signs of radiological loosening or dislocation. CONCLUSIONS: There is no experience documented in neurological disorders associated with hip diseases that requires a total hip arthroplasty. Loosening of the implants, dislocation and heterotopic ossification has been described as complications of the procedure. Large heads in total hip arthroplasty and a correct surgical technique associated with a multidisciplinary management in patients with neurological disorders offers an opportunity as a treatment in patient with hip disorders.

A mediation model of individual differences in attitudes toward affirmative actions for women.

A mediation model of the relation between gender and attitudes toward affirmative action in favor of working women was tested. Four mediation variables were considered: perceived unfairness in the situation of working women, perceived threat to the non-designated group (men), self-esteem, and gender self-concept (masculinity and femininity). 192 women and 128 men, with differing occupations, participated. Gender affects individuals' attitudes toward affirmative actions for women, mediated by perceived unfairness in the situation of working women, perceived threat to the non-designated group, and feminine self-concept. Implications for research and practice are discussed.