Automatic detection and classification of disease in citrus fruit and leaves using a customized CNN based model / Detección y clasificación automática de enfermedades en frutas y hojas de cítricos utilizando un modelo basado en CNN personalizado

India's commercial advancement and development depend heavily on agriculture. A common fruit grown in tropical settings is citrus. A professional judgment is required while analyzing an illness because different diseases have slight variati ons in their symptoms. In order to recognize and classify diseases in citrus fruits and leaves, a customized CNN - based approach that links CNN with LSTM was developed in this research. By using a CNN - based method, it is possible to automatically differenti ate from healthier fruits and leaves and those that have diseases such fruit blight, fruit greening, fruit scab, and melanoses. In terms of performance, the proposed approach achieves 96% accuracy, 98% sensitivity, 96% Recall, and an F1 - score of 92% for ci trus fruit and leave identification and classification and the proposed method was compared with KNN, SVM, and CNN and concluded that the proposed CNN - based model is more accurate and effective at identifying illnesses in citrus fruits and leaves.

El avance y desarrollo comercial de India dependen en gran medida de la agricultura. Un tipo de fruta comunmente cultivada en en tornos tropicales es el cítrico. Se requiere un juicio profesional al analizar una enfermedad porque diferentes enfermedades tienen ligeras variaciones en sus síntomas. Para reconocer y clasificar enfermedades en frutas y hojas de cítricos, se desarrolló e n esta investigación un enfoque personalizado basado en CNN que vincula CNN con LSTM. Al utilizar un método basado en CNN, es posible diferenciar automáticamente entre frutas y hojas más saludables y aquellas que tienen enfermedades como la plaga de frutas , el verdor de frutas, la sarna de frutas y las melanosis. En términos de desempeño, el enfoque propuesto alcanza una precisión del 96%, una sensibilidad del 98%, una recuperación del 96% y una puntuación F1 del 92% para la identificación y clasificación d e frutas y hojas de cítricos, y el método propuesto se comparó con KNN, SVM y CNN y se concluyó que el modelo basado en CNN propuesto es más preciso y efectivo para identificar enfermedades en frutas y hojas de cítricos.

Effect of Long-term Peripheral Nerve Stimulation on Neuro-Muscular Complex Morphologic Recovery in Experiment / Efecto de la Estimulación del Nervio Periférico a Largo Plazo sobre la Recuperación Morfológica del Complejo Neuromuscular en Experimento

SUMMARY: Peripheral nerve injury is an extremely important medical and socio-economic problem. It is far from a solution, despite on rapid development of technologies. To study the effect of long-term electrical stimulation of peripheral nerves, we used a domestically produced electrical stimulation system, which is approved for clinical use. The study was performed on 28 rabbits. Control of regeneration was carried out after 3 month with morphologic techniques. The use of long-term electrostimulation technology leads to an improvement in the results of the recovery of the nerve trunk after an injury, both directly at the site of damage, when stimulation begins in the early period, and indirectly, after the nerve fibers reach the effector muscle.

La lesión de los nervios periféricos es un problema médico y socioeconómico extremadamente importante. Sin embargo, y a pesar del rápido desarrollo de las tecnologías, aún no tiene solución. Para estudiar el efecto de la estimulación eléctrica a largo plazo de los nervios periféricos, utilizamos un sistema de estimulación eléctrica de producción nacional, que está aprobado para uso clínico. El estudio se realizó en 28 conejos. El control de la regeneración se realizó a los 3 meses con técnicas morfológicas. El uso de tecnología de electro estimulación a largo plazo conduce a una mejora en los resultados de la recuperación del tronco nervioso después de una lesión, tanto directamente en el lugar del daño, cuando la estimulación comienza en el período temprano, como indirectamente, después de que las fibras nerviosas alcanzan el músculo efector.

Research progress of long-term efficacy after implantation of implantable collamer lens V4c / 国际眼科杂志(Guoji Yanke Zazhi)

With the rapid development of science and technology and the wide application of electronic products, the number of patients with high myopia is gradually increasing. Meanwhile, owing to the continuous optimization of surgical skils and the continuous advancement in materials of posterior chamber intraocular lens and manufacturing processes, implantable collamer lens(ICL)V4c implantation has gradually become one of the main surgeries for the treatment of high myopia. In the rapid era of social information, people pay more attention to the long-term efficacy after ICL V4c implantation, they not only want clear vision, but also the pursuit of visual comfort and durability. Therefore, this paper will specifically discuss the research progress of the post-implantation efficacy of ICL V4c with at least 2 a of follow-up observation within 3 a, aiming to review the latest research progress on the long-term efficacy of ICL V4c implantation from the three dimensions of visual quality, safety, efficacy and stability and possible surgical complications after ICL V4c implantation.

The value of NLR in predicting the efficacy of preoperative nimotuzumab combined with neoadjuvant chemotherapy for local advanced oral squamous cell carcinoma / 口腔疾病防治

Objective@#To investigate the value of the peripheral blood neutrophil to lymphocyte ratio (NLR) before nimotuzumab combined with neoadjuvant chemotherapy in predicting the short-term efficacy of neoadjuvant therapy for advanced oral squamous cell carcinoma (OSCC).@*Methods@#With the approval of the Ethics Committee and the informed consent of the patients, 59 patients with stage Ⅲ and Ⅳ OSCC who were admitted to the Oral and Maxillofacial Surgery Department of the First Hospital of Shanxi Medical University from September 2020 to June 2023 were enrolled. All the patients had complete clinical data, were pathologically diagnosed with squamous cell carcinoma, and received preoperative and received preoperative nimotuzumab + TP (docetaxel + cisplatin) neoadjuvant chemotherapy. The clinical data were analyzed, and the neutrophil and lymphocyte counts in peripheral blood were collected before and after nimotuzumab combined with neoadjuvant chemotherapy. The NLR was calculated, and the threshold value was calculated using the receiver operating characteristic (ROC) curve. Patients were divided into a high NLR group and a low NLR group according to the NLR threshold before nimotuzumab combined with neoadjuvant chemotherapy with TP. The clinical efficacy after nimotuzumab combined with neoadjuvant chemotherapy with TP was evaluated according to the evaluation criteria for solid tumor efficacy, and the correlation between the NLR and recent neoadjuvant therapy efficacy was analyzed. Immunohistochemical staining was used to detect the expression of epidermal growth factor receptor (EGFR) in OSCC tissues before and after nimotuzumab combined with neoadjuvant chemotherapy with TP and to analyze whether the expression of EGFR differed among the different NLR groups.@*Results@#A total of 59 patients with advanced OSCC were included. According to the ROC curve, the NLR threshold was 2.377, and the patients were divided into a <2.377 group (low NLR group), with 24 patients, and a>2.377 group (high NLR group), with 35 patients. The short-term neoadjuvant therapy effect was significantly greater in the lower NLR group than in the higher NLR group (P<0.05); EGFR expression in both the low NLR group and the high NLR group decreased after nimotuzumab combined with neoadjuvant chemotherapy with TP, and the decrease in the low NLR group was significantly greater than that in the high NLR group (P<0.05).@*Conclusion@#A low NLR before nimotuzumab combined with neoadjuvant chemotherapy with TP is associated with better neoadjuvant therapy outcomes, and such patients are more likely to benefit from preoperative nimotuzumab combined with neoadjuvant chemotherapy.

Obstacles and approaches for the implementation of external long-term prescription dispensing for chronic diseases / 中国药房

The policy of long-term prescription for chronic diseases in China is gradually being improved and implemented， and external long-term prescription dispensing is being encouraged. The long-term prescription policy runs through the links of drug supply， equipment， use and policy， involving government departments such as medical security and health， as well as stakeholders such as patients， medical institutions and designated detail pharmacies. There are still some problems in the external dispensing of long-term prescriptions， such as the disunity of drug catalogue and the need for coordination among regulatory parties in the policy link； the need to improve the participation enthusiasm and service ability in the equipment link； the increased difficulty of prescription management， the need to improve the circulation platform in the use link. The promotion of external long-term prescription policy requires health insurance， medical service， and the medicine industry co-development， multi-party participation， and policy coordination. Among them， the “dual channel” policy， the policy of centralized medicine procurement， and the pharmacy included in outpatient overall management policy have all played a positive role in promoting the implementation of external long-term prescription dispensing for chronic diseases. It is necessary to improve supporting policies and implement regulatory responsibilities in the policy link， promote drug classification and service capabilities in the equipment link， improve the electronic prescription circulation platform， and strengthen prescription management in use link， so as to promote the implementation of external long-term prescription dispensing.

Short-term knee function after total knee arthroplasty and related factors / 中国康复理论与实践

ObjectiveTo investigate the short-term knee function recovery of patients undergoing total knee arthroplasty (TKA) after discharge and analyze its related factors. MethodsFrom December, 2022 to April, 2023, 140 adult patients who underwent TKA in Nanjing Drum Tower Hospital and being about to be discharged were selected as the survey subjects using convenient sampling. Potential influencing factors were selected based on a literature review. They were investigated with general information questionnaire, Rehabilitation Exercise Compliance Scale, Self-Efficacy Scale for Rehabilitation Exercise (SER), Visual Analog Scale for pain (VAS), and joint range of motion measurements before discharge, and were investigated with the Hospital for Special Surgery Knee Score (HSS) one month after discharge. ResultsA total of 130 patients finished follow-up. One month after discharge, the HSS score ranged from 40 to 82, with an average of (70.89±6.26). Multiple linear regression analysis revealed that Body Mass Index (B = -0.423, 95%CI -0.622 to -0.224, P < 0.001), pre-discharge VAS (B = -1.016, 95%CI -1.198 to -0.113, P = 0.028), rehabilitation exercise compliance (B = 0.267, 95%CI 0.121 to 0.413, P < 0.001), SER (B = 0.478, 95%CI 0.315 to 0.642, P < 0.001), and knee joint flexion contracture angle (B = -0.251, 95%CI -0.414 to -0.088, P = 0.003) could influence HSS score one month after discharge (R2 = 0.615, F =17.106, P < 0.001). ConclusionPatients after TKA have recovered well in short time after discharge, however, there is still significant room for improvement. Clinical healthcare providers should design and implement appropriate interventions based on related factors to improve the function.

miR-429-3p mediates memory decline by targeting MKP-1 to reduce surface GluA1-containing AMPA receptors in a mouse model of Alzheimer's disease

Alzheimer's disease (AD) is a leading cause of dementia in the elderly. Mitogen-activated protein kinase phosphatase 1 (MKP-1) plays a neuroprotective role in AD. However, the molecular mechanisms underlying the effects of MKP-1 on AD have not been extensively studied. MicroRNAs (miRNAs) regulate gene expression at the post-transcriptional level, thereby repressing mRNA translation. Here, we reported that the microRNA-429-3p (miR-429-3p) was significantly increased in the brain of APP23/PS45 AD model mice and N2AAPP AD model cells. We further found that miR-429-3p could downregulate MKP-1 expression by directly binding to its 3'-untranslated region (3' UTR). Inhibition of miR-429-3p by its antagomir (A-miR-429) restored the expression of MKP-1 to a control level and consequently reduced the amyloidogenic processing of APP and Aβ accumulation. More importantly, intranasal administration of A-miR-429 successfully ameliorated the deficits of hippocampal CA1 long-term potentiation and spatial learning and memory in AD model mice by suppressing extracellular signal-regulated kinase (ERK1/2)-mediated GluA1 hyperphosphorylation at Ser831 site, thereby increasing the surface expression of GluA1-containing α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs). Together, these results demonstrate that inhibiting miR-429-3p to upregulate MKP-1 effectively improves cognitive and synaptic functions in AD model mice, suggesting that miR-429/MKP-1 pathway may be a novel therapeutic target for AD treatment.

Long-term auditory monitoring in children with Alport syndrome based on different degrees of renal injury / 临床耳鼻咽喉头颈外科杂志

Objective:To investigate long-term auditory changes and characteristics of Alport syndrome（AS） patients with different degrees of renal injury. Methods:Retrospectively analyzing clinical data of patients diagnosed AS from January 2007 to September 2022, including renal pathology, genetic detection and hearing examination. A long-term follow-up focusing on hearing and renal function was conducted. Results:This study included 70 AS patients, of which 33（25 males, 8 females, aged 3.4-27.8 years） were followed up, resulting in a loss rate of 52.9%.The follow-up period ranged from 1.1to 15.8 years, with 16 patients followed-up for over 10 years. During the follow-up, 10 patients presenting with hearing abnormalities at the time of diagnosis of AS had progressive hearing loss, and 3 patients with new hearing abnormalities were followed up, which appeared at 5-6 years of disease course. All of which were sensorineural deafness. While only 3 patients with hearing abnormalities among 13 patients received hearing aid intervention. Of these patients,7 developed end-stage renal disease（ESRD）, predominantly males （6/7）. The rate of long-term hearing loss was significantly different between ESRD group and non-ESRD group（P=0.013）. There was no correlation between the progression of renal disease and long-term hearing level（P>0.05）. kidney biopsies from 28 patients revealed varying degrees of podocyte lesion and uneven thickness of basement membrane. The severity of podocyte lesion was correlated with the rate of long-term hearing loss（P=0.048）, and there was no correlation with the severity of hearing loss（P>0.05）. Among 11 cases, theCOL4A5mutationwas most common （8 out of 11）, but there was no significant correlation between the mutation type and hearing phenotype（P>0.05）. Conclusion:AS patients exhibit progressive hearing loss with significant heterogeneity over the long-term.. THearing loss is more likely to occur 5-6 years into the disease course. Hearing abnormalities are closely related to renal disease status, kidney tissue pathology, and gene mutations, emphasizing the need for vigilant long-term hearing follow-up and early intervention.

Construção e validação de conteúdo de instrumento de autoavaliação da qualidade do cuidado em instituição de longa permanência para pessoas idosas / Development and content validation for a self-assessment instrument of care quality in long-term care facilities for older adults

Resumo Objetivo Desenvolver e realizar a validação de conteúdo de um instrumento de autoavaliação da qualidade do cuidado em Instituições de Longa Permanência para Idosos (ILPI), denominado QualificaILPI. Método Estudo metodológico realizado entre março e dezembro de 2021. O instrumento foi desenvolvido com base em modelo multidimensional de qualidade, legislação brasileira e pesquisa bibliográfica e contém padrões de qualidade para autoavaliação das ILPI nas dimensões: ambiente, lar, cuidado, envolvimento familiar e da comunidade, equipe de trabalho e gestão. Cada padrão é descrito e seguido por uma escala, com parâmetros para classificar o nível de qualidade da ILPI em incipiente, intermediário, consolidado. A Técnica Delphi modificada foi empregada para validação por um comitê de 10 especialistas quanto a pertinência do padrão para avaliação da qualidade da ILPI, da adequação dos objetivos e da escala de avaliação, clareza, podendo fazer comentários. O padrão foi mantido quando houve 75% de concordância entre os especialistas. O instrumento foi também avaliado pelo público-alvo, constituído por coordenadores de 10 ILPI, selecionadas por conveniência. Resultados No primeiro ciclo de avaliação, foram excluídos três padrões e dois novos foram criados. No segundo, alterou-se a dimensão de um padrão e dois padrões foram unidos. Ao final, permaneceram 29 padrões divididos em seis dimensões. O público-alvo, gestores de ILPI, sugeriu alterações na redação de alguns padrões. Houve consenso de 80% ou superior em todos os padrões. Conclusão O QualificaILPI poderá contribuir para o monitoramento das ILPI favorecendo a melhoria do cuidado ofertado aos residentes.

Abstract Objective To develop and validate the content of a self-assessment instrument for the quality of care in Long-Term Care Facilities for Older Adults (Instituições de Longa Permanência para Idosos - ILPIs), named QualificaILPI. Method A methodological study conducted between March and December 2021. The instrument was developed based on a multidimensional quality model, Brazilian legislation, and literature research. It contains quality standards for self-assessment of ILPIs in the dimensions of environment, home, care, family and community involvement, work team, and management. Each standard is described and followed by a scale with parameters to classify the level of ILPI quality as incipient, intermediate, or consolidated. The modified Delphi Technique was employed for validation by a committee of 10 experts regarding the relevance of the standard for ILPI quality assessment, the appropriateness of objectives, the evaluation scale, and clarity, allowing for comments. The standard was retained when there was 75% agreement among the experts. The instrument was also evaluated by the target audience, consisting of coordinators from 10 ILPIs selected for convenience. Results In the first assessment cycle, three standards were excluded, and two new ones were created. In the second cycle, the dimension of one standard was changed, and two standards were combined. In the end, 29 standards remained, divided into six dimensions. The target audience, ILPI managers, suggested changes in the wording of some standards. There was a consensus of 80% or higher for all standards. Conclusion QualificaILPI has the potential to contribute to monitoring ILPIs, promoting the improvement of care offered to residents.

Institutional care in four Latin American countries: the importance of fostering public information and evaluation strategies / Atención en centros de cuidados a largo plazo en cuatro países de América Latina: importancia de fomentar la información pública y las estrategias de evaluación / Cuidados institucionais em quatro países da América Latina: a importância de promover informações públicas e estratégias de avaliação

ABSTRACT More than 8 million older people in Latin America depend on long-term care (LTC), accounting for 12% of people aged ≥ 60 years and almost 27% of those aged ≥ 80. It is crucial to develop sustainable strategies for providing LTC in the area, including institutional care. This special report aims to characterize institutional LTC in four countries (Brazil, Chile, Costa Rica and Mexico), using available information systems, and to identify the strategies adopted to support institutional care in these countries. This narrative review used nationwide, open-access, public data sources to gather demographic estimates and information about institutional LTC coverage and the availability of open-access data for the proportion of people with LTC needs, the number of LTC facilities and the number of residents living in them. These countries have a larger share of older people than the average in Latin America but fewer LTC facilities than required by the demand. National surveys lack standardization in defining disability, LTC and dependency on care. Information about institutional care is mainly fragmented and does not regularly include LTC facilities, their residents and workers. Data are crucial to inform evidence-based decisions to favor prioritization and to support advances in promoting policies around institutional LTC in Latin America. Although information about institutional care in the region is fragmented and insufficient, this paper profiles the four selected countries. It highlights the need for a better structure for data-driven LTC information systems. The lack of information emphasizes the urgency of the need to focus on and encourage research into this topic.

RESUMEN En América Latina, más de 8 millones de personas mayores dependen de los cuidados a largo plazo (CLP), lo que representa el 12% de las personas de 60 años o más y casi el 27% de las de 80 años o más Resulta crucial elaborar estrategias sostenibles para la prestación de CLP en la región, incluida la atención en centros de CLP. Este artículo especial tiene como finalidad determinar las características de la atención prestada en centros de CLP en cuatro países (Brasil, Chile, Costa Rica y México), utilizando los sistemas de información disponibles, así como determinar cuáles son las estrategias adoptadas en estos países para brindar apoyo a la atención en centros de CLP. En esta revisión descriptiva se utilizaron fuentes de datos públicas, de libre acceso y de ámbito nacional para recopilar estimaciones demográficas e información sobre la cobertura de la atención en centros de CLP, así como sobre la disponibilidad de datos de libre acceso acerca de la proporción de personas con necesidades de CLP, el número de centros de CLP y su correspondiente número de residentes. Estos países tienen una proporción de personas mayores superior a la media de América Latina, pero menos centros de CLP de los necesarios para cubrir la demanda. En las encuestas nacionales no hay una definición estandarizada de la discapacidad, los cuidados a largo plazo y la dependencia. La mayor parte de la información sobre la atención en centros de CLP está fragmentada y no incluye datos periódicos sobre los centros de CLP existentes, sus residentes o sus trabajadores. Estos datos son cruciales para fundamentar decisiones basadas en la evidencia destinadas a propiciar la priorización y brindar apoyo a los avances en la promoción de políticas en materia de centros de CLP en América Latina. Aunque la información sobre la atención en centros de CLP en la región es fragmentaria e insuficiente, en este artículo se presenta el perfil de los cuatro países seleccionados. Se resalta la necesidad de mejorar la estructura de los sistemas de información sobre CLP basados en datos. Esta falta de información pone de relieve la necesidad urgente de centrarse en este tema y fomentar la investigación al respecto.

RESUMO Na América Latina, mais de 8 milhões de pessoas idosas dependem de cuidados de longa duração (CLD), o que representa 12% das pessoas com mais de 60 anos e quase 27% das pessoas com mais de 80 anos. É fundamental criar estratégias sustentáveis para oferecer CLD na região, inclusive cuidados institucionais. O objetivo deste relatório especial é caracterizar CLD institucionais em quatro países (Brasil, Chile, Costa Rica e México), usando os sistemas de informação disponíveis, e identificar as estratégias adotadas para apoiar os cuidados institucionais nesses países. Esta revisão narrativa usou dados públicos de acesso aberto de âmbito nacional para coletar estimativas demográficas e informações sobre a cobertura de CLD institucionais e a disponibilidade de dados de acesso aberto sobre a porcentagem de pessoas com necessidades de CLD, o número de instituições de CLD e o número de residentes nessas instituições. Esses países têm uma parcela maior de pessoas idosas do que a média da América Latina, mas menos instituições de CLD do que a demanda exige. Falta padronização na definição de incapacidade, CLD e dependência de cuidados nas pesquisas nacionais. Em sua maior parte, as informações sobre cuidados institucionais são fragmentadas e não incluem instituições de CLD, seus residentes e trabalhadores de maneira regular. É essencial usar dados para guiar decisões baseadas em evidências a fim de favorecer a priorização e apoiar avanços que promovam políticas para CLD institucionais na América Latina. Embora as informações sobre cuidados institucionais na região sejam fragmentadas e insuficientes, este documento traça o perfil dos quatro países selecionados, destacando a necessidade de uma estrutura melhor para sistemas de informações de CLD orientados por dados. A falta de informações ressalta a urgência de aumentar o foco no tópico e encorajar pesquisas sobre o assunto.

A Delphi survey-based development and validation of cognitive-communication assessment tool for Indian preschoolers

ABSTRACT Purpose To address the need for a standardized assessment tool for assessing cognitive-communication abilities among Indian preschoolers, the current study aimed at describing a Delphi based development and validation process for developing one such tool. The objectives of the research were to conceptualize and construct the tool, validate its content, and assess its feasibility through pilot testing. Methods The study followed a Delphi approach to develop and validate the tool across four phases i.e. conceptualization; construction; content validation; and pilot testing. The first three phases were performed with a panel of six experts including speech-language pathologists and preschool teachers while the pilot testing was done with 20 typically developing preschoolers. A literature review was also conducted with the Delphi rounds to support the developmental process. Results The first two rounds of the Delphi aided in the construction of a culturally and linguistically suitable story-based cognitive-communication assessment tool with the memory (free recall, recognition, and literary recall) and executive function (reasoning, inhibition, and switching) related tasks relevant for preschoolers. The content validation of the tool was continued with the experts till the revisions were satisfactory and yielded an optimum Content Validity Index. The pilot test of the finalized version confirmed its feasibility and appropriateness to assess developmental changes in the cognitive-communication abilities of preschoolers. Conclusion The study describes the Delphi-based conceptualization, construction, content validation, and feasibility check of a tool to assess cognitive-communication skills in preschool children.

The "Phase Down" of Dental Amalgam Restorations - What are the Criteria for Replacement and Indication?

ABSTRACT Objective: To guide professionals about the criteria for replacing amalgam restorations and inform them about the new guidelines regarding the use/indication of this (amalgam) material after the Minamata Convention - COP-4. Material and Methods: The articles were selected from the databases (PubMed, Scielo, Bireme), and relevant articles on the subject between the years 2003-2021 were selected. Recently, social media have been flooded with dental treatments that aim to perform restorations only with composite resins or other types of esthetic material and completely replace all dental amalgam restorations, irrespective of their time in place, size, and functionality. Results: Although improperly, it has been noted that this information reaches patients, and they are led to believe in the inaccurate data that is passed on, such as, for example, (that amalgam leads to) permanent contamination by mercury, causing systemic problems and the loss of the tooth. Conclusion: The "phase down" of amalgam in research and teaching has previously been observed in several countries worldwide; however, its use is still necessary given particular circumstances, which, theoretically, make it a material with exact indication.

Short-term effectiveness of arthroscopic repair via modified subacromial viewing portal in treatment of Lafosse Ⅰ subscapularis tendon tears / 中国修复重建外科杂志

OBJECTIVE@#To investigate short-term effectiveness of arthroscopic repair via modified subacromial viewing portal (hereinafter referred to as modified viewing portal) in treatment of LafosseⅠsubscapularis tendon tears.@*METHODS@#A clinical data of 52 patients with LafosseⅠsubscapularis tendon tears, who underwent the arthroscopic repair via modified viewing portal between October 2020 and November 2022 and met the selective criteria, was retrospectively analyzed. There were 15 males and 37 females with an average age of 63.4 years (range, 41-76 years). Twelve patients had trauma history and the other 40 patients had no obvious inducement. The main clinical symptom was shoulder pain and the hug resistance tests were positive in all patients. The interval between symptom onset and admission ranged from 3 to 26 months (mean, 7.2 months). The shoulder pain and function were evaluated by visual analogue scale (VAS) score, American Shoulder and Elbow Surgeons (ASES) score, and University of California Los Angeles (UCLA) score before operation and at 12 months after operation. The shoulder range of motion (ROM) of forward flexion, abduction, and external rotation and the internal rotation strength were measured before operation and at 3 and 12 months after operation. MRI was performed at 3-6 months after operation to assess the tendon healing and the structural integrity and tension of reattached tendon. Patient's satisfactions were calculated at last follow-up.@*RESULTS@#All incisions healed by first intention, no complication such as incision infection or nerve injury occurred. All patients were followed up 12-37 months (mean, 18.5 months). The VAS, UCLA, and ASES scores at 12 months after operation significantly improved when compared with those before operation ( P<0.05). The ROMs of abduction and forward flexion and the internal rotation strength at 3 and 12 months significantly improved when compared with those before operation ( P<0.05); and the ROMs at 12 months significantly improved compared to that at 3 months ( P<0.05). However, there was no significant difference ( P>0.05) in the ROM of external rotation at 3 months compared to that before operation; but the ROM at 12 months significantly improved compared to that before operation and at 3 months after operation ( P<0.05). Thirty-one patients underwent MRI at 3-6 months, of which 28 patients possessed intact structural integrity, good tendon tension and tendon healing; 3 patients underwent tendon re-tear. At last follow-up, 41 patients (78.8%) were very satisfied with the effectiveness, 7 were satisfied (13.5%), and 4 were dissatisfied (7.7%).@*CONCLUSION@#Arthroscopic repair via modified viewing portal for Lafosse Ⅰsubscapularis tendon tears, which can achieve the satisfactory visualization and working space, can obtain good short-term effectiveness with low overall re-tear risk.

Desarrollo del dolor fetal y neonatal / Development of fetal and neonatal pain

Resumen: El dolor es el principal síntoma reportado a nivel mundial, es la principal causa de sufrimiento humano. Se considera que para que un individuo sienta dolor deben estar presentes: nociceptores, neurotransmisores del dolor, vías que llevan el estímulo al cerebro, el tálamo y conexión con la corteza. Por un tiempo se consideró que en esta etapa no se contaba con la madurez suficiente del sistema nervioso para sentir dolor; sin embargo, en la actualidad hay evidencia de que el feto presenta dolor; y su presencia altera el desarrollo del sistema nervioso. La presente revisión proporciona una visión actualizada de la ontogenia del dolor fetal y neonatal.

Abstract: Pain is the main symptom reported worldwide, it is the main cause of human suffering. It is considered that for an individual to feel pain, the following must be present: nociceptors, pain neurotransmitters, pathways that carry the stimulus to the brain, the thalamus and connection with the cortex. For a time it was considered that at this stage the nervous system was not mature enough to feel pain, however, there is currently evidence that the fetus has pain; and its presence alters the development of the nervous system. This review provides an updated view of the ontogeny of fetal and neonatal pain.

Tratamiento endovascular de aneurismas con anatomía aórtica compleja / Endovascular treatment of aneurysms with complex aortic anatomy

RESUMEN Introducción: la anatomía arterial es la principal limitante para el abordaje aórtico endovascular estándar. Presentamos nuestra experiencia para la reparación endovascular de aneurismas aórticos complejos. Material y métodos: estudio observacional retrospectivo en pacientes con aneurismas complejos (yuxta/pararrenales y toracoabdominales) tratados en forma consecutiva mediante: endoprótesis fenestradas (FEVAR), ramificadas (BEVAR), con EndoAnchors (ESAR), o en chimenea (ChEVAR). La decisión de la técnica fue determinada con base en la anatomía arterial. Resultados: se evaluaron los últimos 50 procedimientos (6 mujeres; edad promedio 71,3 años; diámetro 69,6mm; 3 pacientes con aneurismas complicados), de los cuales 22 recibieron FEVAR (2,8 fenestraciones / paciente), 11 BEVAR, 11 ESAR y 6 ChEVAR (1,8 chimeneas /paciente). La tasa de éxito técnico fue del 100% (ausencia de endoleak I o III con permeabilidad adecuada de los vasos viscerales). A 30 días 3 pacientes fallecieron (6%). Durante el seguimiento, 5 pacientes presentaron oclusión de la arteria renal, repermeabilizada en 4. Cuatro pacientes desarrollaron un endoleak tipo IA (3 ESAR secundarios y un ChEVAR), un paciente un endoleak IC y un cuarto uno IIIB (22%, 3 de los 11 ESAR, ninguno de los FEVAR industriales). En el análisis de supervivencia, la supervivencia global fue del 88,6% al año, y libre de reoperación del 86,5%. Conclusiones: se trata de la primera publicación en nuestro medio que muestra un enfoque global del paciente con un aneurisma de aorta complejo, de acuerdo con sus características anatómicas. Estas tecnologías ya desempeñan un papel primario en el tratamiento de estos pacientes.

ABSTRACT Background: Arterial anatomy is the main limiting factor for standard endovascular aortic (EVAR) approach. We present our experience for endovascular repair of complex aortic aneurysms. Material and Methods: This is a retrospective observational study in patients with complex aneurysms (juxta/pararenal and thoracoabdominal) treated consecutively with: fenestrated (FEVAR), branched (BEVAR), EndoAnchors (ESAR), or chimney (ChEVAR) stents. The decision of the technique was determined based on the arterial anatomy. Results: The last 50 procedures were evaluated (6 women; mean age 71.3 years; diameter 69.6 mm; and 3 patients with complicated aneurysms), among whom 22 received FEVAR (2.8 fenestrated stents/patient), 11 BEVAR, 11 ESAR and 6 ChEVAR (1.8 chimney stents/patient). Technical success rate was 100% (absence of type I or III endoleak with adequate patency of the visceral vessels). Three patients died within the first 30 days (6%). During follow-up, 5 patients presented with renal artery occlusion, treated successfully in 4 cases. Four patients developed type IA endoleak (3 secondary ESAR and one ChEVAR), one patient IC endoleak and almost a quarter of cases type IIIB endoleak (22%, 3 out of 11 patients receiving ESAR, none of the industrial FEVAR group). In survival analysis, overall survival analysis was 88.6% at one year, and 86.5% of cases were free from reoperation. Conclusions: This is the first publication in our setting that shows a global approach to the patient with complex aortic aneurysm, according to the anatomical characteristics. These technologies already play a primary role in the treatment of these patients.

Acousto-optic stimuli to promote coherent 40-Hz frequency entrainment effect / Estímulos acústico-ópticos para promover efeito de arrastamento de frequência coerente de 40 Hz

Abstract Background Research has shown that a fundamental frequency of 40 Hz in continuous neural oscillation is indicative of normal brain activity; in Alzheimer disease (AD) patients, these oscillations either disappear or are significantly interrupted. Research has also indicated that the degenerative impacts of AD in mice were mitigated by the synchronization of 40-Hz acousto-optic stimulation (AOS). Objective To examine the impact of employing a 40-Hz AOS intervention on the induction of a substantial 40-Hz frequency entrainment and improvement in working memory performance among a sample of young individuals in good health. We conduct an analysis of event-related potentials (ERPs) derived from electroencephalogram (EEG) data following the presentation of AOS. Methods We recruited 20 healthy volunteers (median age: 25 years; 8 female subjects). Following the administration of various stimuli, including no stimuli, 40-Hz AOS, pink noise, and 40Hz acoustic stimuli (AS), the participants were required to complete a working memory task. A total of 62 electrodes were used to record EEG data, which was subsequently analyzed to investigate the impact of AOS on the activity of working memory. We also aimed to determine if AOS lead to a more pronounced 40-Hz frequency entrainment. Results Following the administration of AOS, a notable enhancement in the 40-Hz power of pertinent cerebral areas was observed, accompanied by a substantial improvement in the performance of the subjects on working memory tests subsequent to the stimulation. Conclusion The findings unequivocally establish the efficacy of using AOS to enhance the 40-Hz power and working memory.

Resumo Antecedentes A pesquisa mostrou que uma frequência fundamental de 40 Hz em oscilação neural contínua é indicativa de atividade cerebral normal. Em pacientes com doença de Alzheimer (DA), essas oscilações desaparecem ou são significativamente interrompidas. A pesquisa também indicou que os impactos degenerativos da DA em camundongos foram mitigados pela sincronização da estimulação acústico-óptica (EAO) de 40 Hz. Objetivo Examinar o impacto do emprego de uma intervenção EAO de 40 Hz na indução de um arrastamento substancial de frequência de 40 Hz e na melhoria do desempenho da memória de trabalho entre uma amostra de jovens com boa saúde. Conduzimos uma análise de potenciais relacionados a eventos (PREs) derivados de dados de eletroencefalograma (EEG) após a apresentação de EAO. Métodos Recrutamos 20 voluntários saudáveis (idade média: 25 anos; 8 mulheres). Após a administração de vários estímulos, incluindo nenhum estímulo, EAO de 40 Hz, ruído rosa e estímulos acústicos (EA) de 40 Hz, os participantes foram obrigados a completar uma tarefa de memória de trabalho. Um total de 62 eletrodos foram utilizados para registrar dados de EEG, que foram posteriormente analisados. para investigar o impacto do AOS na atividade da memória de trabalho. Também pretendemos determinar se o AOS leva a um arrastamento de frequência de 40 Hz mais pronunciado. Resultados Após a administração de AOS, foi observado um aumento notável na potência de 40 Hz de áreas cerebrais pertinentes, acompanhado por uma melhoria substancial no desempenho dos sujeitos em testes de memória de trabalho subsequentes à estimulação. Conclusão Os resultados estabelecem inequivocamente a eficácia do uso do AOS para melhorar a potência de 40 Hz e a memória de trabalho.

Colonización genitourinaria por Streptococcus agalactiae y perfil de sensibilidad en mujeres gestantes

Introducción: Streptococcus agalactiae, también conocido como estreptococo beta-hemolítico del grupo B de Lancefield, adquiere relevancia durante el embarazo debido a la posibilidad de transmisión al recién nacido. Las normas internacionales sugieren realizar tamizaje vagino-anal entre las 35 y 37 semanas de gestación. Objetivo: Determinar prevalencia de colonización por Streptococcus agalactiae en muestras cérvico-vaginales de embarazadas entre 35 y 37 semanas, y en urocultivos de gestantes de cualquier edad gestacional ingresadas en el hospital ginecobstetrico provincial, así como su perfil de sensibilidad. Materiales y métodos: Se realizó un estudio observacional, descriptivo y exploratorio, de corte transversal, entre enero y agosto de 2021, en el Hospital Provincial Docente Ginecobstétrico José Ramón López Tabrane, de la ciudad de Matanzas. El universo estuvo conformado por todas las gestantes de cualquier trimestre a las que se les realizó urocultivo, y estudio microbiológico cérvico-vaginal entre las 35 y 37 semanas de gestación, cumplidos previamente criterios de inclusión. Resultados: El 18,61 % presentó cultivos positivos para Streptococcus agalactiae. Predominó la presencia de positividad en gestantes no diabéticas; se encontró un 18,75 % de urocultivos positivos. Predominaron los aislamientos sensibles a eritromicina y clindamicina, con un 63 %, seguidos de la resistencia inducible a clindamicina (MLSBi), con un 19 %. Conclusiones: El diagnóstico microbiológico de Streptococcus agalactiae en gestantes, es de vital importancia para la prevención de sepsis puerperal y neonatal. A pesar de que los resultados de este estudio muestran perfiles de sensibilidad adecuados, su monitorización permanente garantizaría el diagnóstico precoz de cepas resistentes, dado el ligero incremento del fenotipo (MLSBi) identificado.

Introduction: Streptococcus agalactiae, also known as Lancefield's group B beta-hemolytic streptococcus, acquires relevance during pregnancy due to the possibility of transmission to the newborn. International standards suggest performing vaginal-anal screening between 35 and 37 weeks of gestation. Objective: to determine the prevalence of colonization by Streptococcus agalactiae, in cervical-vaginal samples of pregnant women between 35 and 37 weeks, and in urine cultures of pregnant women of any gestational age admitted to the provincial gyneco-obstetric hospital, as well as their sensitivity profile. Materials and methods: an observational, descriptive and exploratory cross-sectional study was performed, between January and August 2021, at the Provincial Teaching Gyneco-obstetric Hospital Jose Ramon Lopez Tabrane of Matanzas. The universe was made up by all pregnant women of any trimester who underwent a urine culture, and a cervical-vaginal microbiologic study between 35 and 37 gestation weeks, previously meeting inclusion criteria. Results: 18.61% presented positive cultures for Streptococcus agalactiae. The presence of positivity predominated in non-diabetic women. 18.75 % of positive urine cultures were found. Erythromycin and clindamycin-sensitive isolates predominated (MLSBi), with 63%, followed by inducible resistance to clindamycin, with 19%. Conclusions: the microbiological diagnosis of Streptococcus agalactiae in pregnant women is of vital importance to prevent puerperal and neonatal sepsis. Although the results of this study show adequate sensitivity profiles, its permanent monitoring would warrantee the early diagnosis of resistant strains, given the slight increase of the phenotype (MLSBi) identified.

Avaliação das Instituições de Longa Permanência para Idosos no Brasil: um panorama das desigualdades regionais / Evaluation of Long-Term Institutions for Older People in Brazil: an overview of regional inequalities

Resumo O objetivo deste artigo é avaliar as Instituições de Longa Permanência para Idosos (ILPI) brasileiras, segundo o Modelo Teórico Multidimensional Integrado de Qualidade e Atendimento (MIQA), e comparar o desempenho alcançado entre as regiões do país. Estudo ecológico descritivo realizado com dados secundários públicos das ILPI participantes do Censo do Sistema Único da Assistência Social de 2018. Uma Matriz de Avaliação foi construída a partir das variáveis do Censo e do Modelo Teórico MIQA. Parâmetros de qualidade foram empregados para classificar o desempenho das instituições para cada indicador em "incipiente", "em desenvolvimento" ou "desejável. O índice de disparidade foi obtido para cada indicador. Foram analisadas 1.665 instituições. Observaram-se diferenças nos percentuais de ILPI com desempenho "desejável" entre as regiões brasileiras, e a necessidade de aprimoramento na maioria das ILPI em relação à proporção de cuidadores de pessoas idosas, a composição da equipe multiprofissional, a acessibilidade e a oferta de ações de promoção de saúde. Verificou-se a necessidade de apoio governamental para a supressão dos critérios de diferenciações excludentes e para a expansão dos serviços para superar as superlotações.

Abstract This article aims to evaluate the Brazilian Long-Term Institutions for Older People (LTIE), according to the Integrated Multidimensional Theoretical Model of Quality and Service (MIQA), and compare the performance achieved between the regions of the country. Descriptive ecological study carried out with public secondary data from the LTIE participating in the 2018 Census of the Unified Social Assistance System. An Evaluation Matrix was constructed from the Census variables and the MIQA Theoretical Model. Quality parameters were used to classify the institutions' performance for each indicator as "incipient", "developing" or "desirable". The disparity index was obtained for each indicator. 1,665 institutions were analyzed. Differences were observed in the percentages of LTIE with "desirable" performance between Brazilian regions, and the need for improvement in most LTIE in relation to the proportion of caregivers of older people, the composition of the multidisciplinary team, accessibility and supply of health promotion actions. There was a need for government support for the suppression of exclusionary differentiation criteria and for the expansion of services to overcome overcrowding.

Seguimiento a largo plazo de pacientes traqueostomizados post injuria cerebral adquirida grave / Long-term follow-up of tracheostomized patients post severe acquired brain injury

Resumen Introducción: Alrededor del 50% de los pacientes hos pitalizados por injuria cerebral adquirida grave requie ren traqueostomía y cuidados a largo plazo. El objetivo principal de este estudio fue describir la evolución de enfermos con injuria cerebral adquirida grave (ICAg) traqueostomizados que ingresaron a rehabilitación. Se cundariamente se estudió el fracaso de la decanulación y la supervivencia a los 12 meses del alta. Métodos: estudio cuantitativo observacional prospec tivo de centro único. Se incorporó al estudio, de forma prospectiva y consecutiva, usuarios mayores de 18 años, traqueostomizados posterior a ICAg ingresados a un cen tro de rehabilitación entre abril de 2018 y marzo de 2020. Resultados: se incluyeron para el análisis 50 pacien tes. La estancia en el centro fue de 203 (RIQ 93-320) días. Al alta de la institución, 32 (64%) pacientes pudieron ser decanulados exitosamente. El tiempo transcurrido desde el ingreso al centro hasta la decanulación fue de 49 (12-172) días. No se observó fracaso de la decanula ción. La mortalidad a los 12 meses de seguimiento fue de 32%, cinco (16%) de los 32 pacientes que pudieron ser decanulados y 11 (61%) de los 18 que no lograron la decanulación fallecieron dentro de los 12 meses de seguimiento. La relación entre la decanulación y la mortalidad a los 12 meses de seguimiento resultó esta dísticamente significativa (p = 0.002). Discusión: La supervivencia global fue relativamente elevada, el proceso de decanulación resulta relevante ya que puede tener impacto en la supervivencia a largo plazo.

Abstract Introduction: About 50% of patients hospitalized for severe acquired brain injury require tracheostomy, and many of them need long-term care. The main objective of this study was to describe the evolution of patients with severe acquired brain injury (sABI) tracheotomized who entered rehabilitation. Secondarily, mortality re lated to the success or failure of decannulation and survival at 12 months of discharge were studied. Methods: A single-center prospective observational quantitative study. Users over 18 years of age were recruited prospectively and consecutively, tracheosto mized after sABI, and admitted to a rehabilitation center between April 2018 and March 2020. Results: Fifty patients were included for analysis. The stay in the center was 203 (RIQ 93-320) days. At discharge to the institution, 32 (64%) patients managed to be successfully decannulated. The median number of days from admission to the center to decannulation was 49 (12-172). No decannulation failure was observed. Mortality at 12 months follow-up was 32%, five (16%) of the 32 patients who managed to be decannulated, and 11 (61%) of 18 who failed to achieve decannulation died within 12 months of follow-up. The relationship between decannulation success and mortality at 12 months of follow-up was statistically significant (p= 0.002). Discussion: Addressing the decannulation process early and properly guided is relevant as it may impact long-term survival.

The impact of SARS-CoV-2 infection on term placentae

Background: Coronavirus 2019 infection (COVID 19) is an ongoing pandemic caused by pathogenic RNA viruses called severe acute respiratory syndrome coronavirus-2 (SARS-COV-2). It has affected people of all ages, with high morbidity and mortality among the elderly and immunocompromised population. Limited information is available on the effects of COVID-19 infection on pregnancy. Aim: To describe the histopathological changes in the placental tissue of SARS-CoV-2 infected term mothers with no comorbidities and to correlate with neonatal outcome. Materials and Methods: This observational study was conducted in the Department of Pathology, KMCH institute of health sciences and research, Coimbatore from May 1, 2020 to November 30, 2020 for 6 months. Placental tissues of all COVID-19-positive term mothers with no comorbidities were included in this study. Histopathological examination of placentae was carried out and clinical data of mothers and newborn babies were obtained from medical records. Results: Histopathological examination of 64 placental tissue of COVID-19 mothers showed predominantly the features of fetal vascular malperfusion like stem villi vasculature thrombus, villous congestion, and avascular villi. No significant correlation was obtained in comparison with parity and symptomatic status of the mothers. However, histopathological changes were more prominent among symptomatic patients. The newborn babies born to these mothers showed no adverse outcome. Conclusion: This study concluded that though COVID-19 infection in normal term pregnant women was associated with increased prevalence of features of fetal vascular malperfusion, there was no significant morbidity in the health status of both COVID-19 mothers and their neonates.