Una herramienta de intervención eficaz en el adulto mayor institucionalizado

Introducción: El proceso de envejecimiento afecta el equilibrio y la movilidad de los adultos mayores institucionalizados, los cuales pueden adquirir independencia funcional gracias al ejercicio. Objetivo: Determinar el efecto de un programa de ejercicios anticaídas y desempeño físico funcional de los adultos mayores institucionalizados. Métodos: Se realizó un estudio de casos múltiples, de tipo preexperimental, prospectivo y longitudinal; además, un muestreo no probabilístico de 12 adultos mayores institucionalizados con registro de caídas durante 2015. La medición de equilibrio y desempeño físico se hizo antes y después de la aplicación del programa de ejercicios. Los datos se analizaron con el programa SPSS 22.0 y la prueba Shapiro-Wilk determinó la normalidad de las variables. Los test T de student y Wilcoxon verificaron el nivel de significancia y estadístico. D de Cohen midió la magnitud del efecto sobre la aplicación clínica. Para las características sociodemográficas y clínicas se utilizó un análisis bivariado exploratorio; y los análisis multivariados emplearon ANOVA y estadístico ETA 2. Resultados: Se determinaron cambios estadísticamente significativos en equilibrio y frecuencia de caídas con p = 0,05 y 0,008; y magnitudes del efecto grande d = 2,150 y d = 1,16, respectivamente. Las características sociodemográficas y clínicas no intervinieron en el efecto del programa sobre el equilibrio y el desempeño físico funcional. Conclusiones: La aplicación del programa anticaídas mejoró el equilibrio y disminuyó las caídas en adultos mayores institucionalizados.

Introduction: The aging process affects the balance and mobility of older adults living in an institution, who can acquire functional independence thanks to exercise. Objective: To determine the effect of a program of anti-fall exercises and functional physical performance of older adults living in an institution. Methods: A multi-case, pre-experimental, prospective and longitudinal study was carried out in a non-probabilistic sampling of 12 older adults living in an institution with a record of falls during 2015. Balance and physical performance were measured before and after the use of this program of exercises. The data was analyzed with SPSS 22.0 program and Shapiro-Wilk test determined the normality of the variables. Student's and Wilcoxon's T tests verified the level of significance and statistics. Cohen's D measured the magnitude of the effect on clinical application. For sociodemographic and clinical characteristics, an exploratory bivariate analysis was used, and the multivariate analyzes used ANOVA and ETA 2 statistic. Results: Statistically significant changes in balance and frequency of falls were determined with p = 0.05 and 0.008; and large effect sizes d = 2.150 and d = 1.16, respectively. Sociodemographic and clinical characteristics did not intervene in the effect of the program on balance and functional physical performance. Conclusions: The use of the anti-fall program improved balance and decreased falls in older adults living in an institution.

An ecological model of dropout intention in university students during the covid-19 pandemic

Objective: To analyse the drop out intention of university students after six months of home confinement during the covid-19 pandemic using an ecological model. Method: A non-experimental cross-sectional study with an intentional sampling of 1,011 active university students during 2020. Aged between 18 and 54 years (M = 22,6; SD = 4,8; female = 438). We evaluated them with the university dropout questionnaire for students, Depression, Anxiety and Stress Scale, Fear of covid-19 Scales, covid-19 Anxiety syndrome scale, and the Satisfaction with academic changes questionnaire. We performed a descriptive and multivariate analysis of the data. Results: The model explain 28 % of drop out intention among university students during confinement by covid-19 (sensitivity = 86,8 %). Dissatisfaction with academic changes is the main predictor of the model (OR = 0,960; IC 95 % [0,950, 0,959). Other significant predictors are positive and negative interactions (i.e., in family, social, and academic environments), negative emotional symptoms, anxiety about covid-19, being older, studying at a private university, and having a family member diagnosed with covid-19. Discussions: Macrosystem changes (i.e., home confinement and online classes) during the first six months of the covid-19 pandemic modified the students' interaction with their proximal systems and new predictors of the intention to drop out emerged (e.g., anxiety about covid-19 and having a family member diagnosed with covid-19), associated with the context of confinement.

Objetivo: Analizar la intención deserción de los estudiantes universitarios tras seis meses de confinamiento en casa durante la pandemia por covid-19 a partir de un modelo ecológico. Método: Estudio transversal no experimental con un muestreo intencional de 1011 estudiantes universitarios activos durante 2020. Con edades comprendidas entre los 18 y los 54 años (M = 22,6; DE = 4,8; mujeres = 438). Los estudiantes respondieron el cuestionario de abandono universitario para estudiantes, la Escala de Depresión, Ansiedad y Estrés, la Escala de Miedo de covid-19, la Escala de Síndrome de Ansiedad de covid-19 y el cuestionario de Satisfacción con los cambios académicos. Se realizó un análisis descriptivo y multivariante de los datos. Resultados: El modelo explica el 28 % de la varianza de la intención de deserción entre los estudiantes universitarios durante el confinamiento por covid-19 (sensibilidad = 86,8 %). La insatisfacción ante los cambios académicos es el principal predictor del modelo (OR = 0,960; IC 95 % [0,950, 0,959). Otros predictores significativos son las interacciones positivas y negativas (i.e., en el entorno familiar, social y académico), los síntomas emocionales negativos, la ansiedad ante la covid-19, ser mayor, estudiar en una universidad privada y tener un familiar diagnosticado con covid-19. Conclusiones: Los cambios en el macrosistema (i.e., el confinamiento en el hogar y las clases en línea) durante los primeros seis meses de la pandemia por covid-19 modificaron la interacción de los estudiantes con sus sistemas proximales y surgieron nuevos predictores de la intención de abandono (e.g., ansiedad ante la covid-19 y tener un familiar diagnosticado con covid-19), asociados al contexto de confinamiento.

Phaco-handpiece used as a Fragmatome for managing nucleus drop

Background: Nucleus drop during cataract surgery is a dreaded complication and requires urgent vitreo?retinal intervention which is managed commonly using a fragmatome. However, a fragmatome is not readily available in routine ophthalmology set?ups because its use is very limited. On the other hand, a phaco?probe is commonly available with all surgeons and makes it cost?effective. Purpose: The purpose is to demonstrate the utility of a phaco?probe as an alternative to a fragmatome in managing nucleus drop during cataract surgery, making it cost?effective and less time?consuming and simple. Synopsis: The video shows two cases of complicated cataract surgery in which a nucleus is dropped in the vitreous cavity. The sleeve of the phaco?probe was removed, and infusion was disconnected to make it function as a fragmatome. We noted reduced lenticular repulsion from the phaco?handpiece tip as compared to the fragmatome, and no scleral burns were observed. The cases were completed by secondary placement of an intra?ocular lens in the sulcus in the same sitting. Thus, the phaco?probe can be considered to manage nucleus drop in the absence of a fragmatome. Highlights: A phaco?probe can be used as an alternative to a framgamtome, which is a cost?effective and simple technique.

Harvester’s palsy – bilateral common peroneal nerve palsy: A descriptive case report

Peroneal neuropathy is the common mononeuropathy of the lower extremities in adults. The documented etiologies for peroneal nerve injury include trauma, traction, and external compression. Fibular neck is the most common site of common peroneal nerve (CPN) injury as the nerve lies superficial and vulnerable for injury. A 50-year-old male presented with foot drop in his left leg after working in squatting position for prolonged hours along with sensory disturbance in dorsum of left foot. Clinical examination showed poor dorsiflexion in both side ankle with preserved plantar flexion. Electrophysiological findings locate the site of lesion to be CPN at the level of fibular neck. We conclude that CPN is injured due to knee flexion in farmers repeatedly squatting for long hours. Superficial peroneal nerve may be spared due to their interfascicular arrangement at the level of fibular neck placing deep peroneal nerve near the fibula making them more susceptible to compression type of injury. Peroneal nerve may be damaged at multiple sites including ankle. The condition can be reversed with conservative treatment, primarily by avoiding the precipitating position.

Efficiency of exogenous zinc sulfate application reduced fruit drop and improved antioxidant activity of 'Kinnow' mandarin fruit / A eficiência da aplicação de sulfato de zinco exógeno reduziu a queda da fruta e melhorou a atividade antioxidante da tangerina 'Kinnow'

'Kinnow' mandarin (Citrus nobilis L.× Citrus deliciosa T.) is an important marketable fruit of the world. It is mainstay of citrus industry in Pakistan, having great export potential. But out of total production of the country only 10% of the produce meets the international quality standard for export. Pre-harvest fruit drop and poor fruit quality could be associated with various issues including the plant nutrition. Most of the farmers do not pay attention to the supply of micro nutrients which are already deficient in the soil. Furthermore, their mobility within plants is also a question. Zinc (Zn) is amongst those micronutrients which affect the quality and postharvest life of the fruit and its deficiency in Pakistani soils is already reported by many researchers. Therefore, this study was carried out to evaluate the influence of pre-harvest applications of zinc sulfate (ZnSO4; 0, 0.4%, 0.6% or 0.8%) on pre-harvest fruit drop, yield and fruit quality of ‘Kinnow’ mandarin at harvest. The treatments were applied during the month of October i.e. 4 months prior to harvest. The applied Zn sprays had significant effect on yield and quality of the "Kinnow" fruit. Amongst different foliar applications of ZnSO4applied four months before harvest, 0.6% ZnSO4 significantly reduced pre-harvest fruit drop (10.08%) as compared to untreated control trees (46.45%). Similarly, the maximum number of fruits harvested per tree (627), fruit weight (192.9 g), juice percentage (42.2%), total soluble solids (9.5 °Brix), ascorbic acid content (35.5 mg 100 g-¹) and sugar contents (17.4) were also found significantly higher with 0.6% ZnSO4 treatment as compared to rest of treatments and control. Foliar application of 0.6% ZnSO4 also significantly improved total antioxidants (TAO) and total phenolic contents (TPC) in fruit. In conclusion, foliar [...].

A tangerina 'Kinnow' (Citrus nobilis L. × Citrus deliciosa T.) é uma importante fruta comercializável do mundo. É o esteio da indústria cítrica no Paquistão, com grande potencial de exportação. Mas, da produção total do país, apenas 10% da produção atendem o padrão internacional de qualidade para exportação. A queda da fruta antes da colheita e a baixa qualidade da fruta podem estar associadas a vários problemas, incluindo a nutrição da planta. A maioria dos agricultores não se preocupa com o fornecimento de micronutrientes que já são deficientes no solo. Além disso, sua mobilidade dentro das plantas também é uma questão. O zinco (Zn) está entre os micronutrientes que afetam a qualidade e a vida pós-colheita da fruta, e sua deficiência em solos paquistaneses já é relatada por diversos pesquisadores. Portanto, este estudo foi realizado para avaliar a influência da aplicação pré-colheita de sulfato de zinco (ZnSO4; 0, 0,4%, 0,6% ou 0,8%) na queda dos frutos na pré-colheita, produtividade e qualidade dos frutos da tangerina 'Kinnow' em colheita. Os tratamentos foram aplicados durante o mês de outubro, ou seja, 4 meses antes da colheita. As pulverizações de Zn aplicadas tiveram efeito significativo no rendimento e na qualidade da fruta 'Kinnow'. Entre as diferentes aplicações foliares de ZnSO4 efetuadas quatro meses antes da colheita, 0,6% de ZnSO4 reduziu significativamente a queda de frutos antes da colheita (10,08%) em comparação com as árvores de controle não tratadas (46,45%). Da mesma forma, número máximo de frutos colhidos por árvore (627), peso do fruto (192,9 g), porcentagem de suco (42,2%), sólidos solúveis totais (9,5 ° Brix), teor de ácido ascórbico (35,5 mg / 100 g-¹) e os teores de açúcar (17,4) também foram significativamente maiores com o tratamento com 0,6% de ZnSO4 em comparação com o restante dos tratamentos e o controle. A aplicação foliar de 0,6% de ZnSO4 também melhorou significativamente os [...].

Efficiency of exogenous zinc sulfate application reduced fruit drop and improved antioxidant activity of Kinnow mandarin fruit

Abstract Kinnow mandarin (Citrus nobilis L.× Citrus deliciosa T.) is an important marketable fruit of the world. It is mainstay of citrus industry in Pakistan, having great export potential. But out of total production of the country only 10% of the produce meets the international quality standard for export. Pre-harvest fruit drop and poor fruit quality could be associated with various issues including the plant nutrition. Most of the farmers do not pay attention to the supply of micro nutrients which are already deficient in the soil. Furthermore, their mobility within plants is also a question. Zinc (Zn) is amongst those micronutrients which affect the quality and postharvest life of the fruit and its deficiency in Pakistani soils is already reported by many researchers. Therefore, this study was carried out to evaluate the influence of pre-harvest applications of zinc sulfate (ZnSO4; 0, 0.4%, 0.6% or 0.8%) on pre-harvest fruit drop, yield and fruit quality of Kinnow mandarin at harvest. The treatments were applied during the month of October i.e. 4 months prior to harvest. The applied Zn sprays had significant effect on yield and quality of the Kinnow fruit. Amongst different foliar applications of ZnSO4applied four months before harvest, 0.6% ZnSO4 significantly reduced pre-harvest fruit drop (10.08%) as compared to untreated control trees (46.45%). Similarly, the maximum number of fruits harvested per tree (627), fruit weight (192.9 g), juice percentage (42.2%), total soluble solids (9.5 °Brix), ascorbic acid content (35.5 mg 100 g-1) and sugar contents (17.4) were also found significantly higher with 0.6% ZnSO4 treatment as compared to rest of treatments and control. Foliar application of 0.6% ZnSO4 also significantly improved total antioxidants (TAO) and total phenolic contents (TPC) in fruit. In conclusion, foliar spray of ZnSO4 (0.6%) four months prior to harvest reduced pre-harvest fruit drop, increase yield with improved quality of Kinnow mandarin fruit.

Resumo A tangerina Kinnow (Citrus nobilis L. × Citrus deliciosa T.) é uma importante fruta comercializável do mundo. É o esteio da indústria cítrica no Paquistão, com grande potencial de exportação. Mas, da produção total do país, apenas 10% da produção atendem o padrão internacional de qualidade para exportação. A queda da fruta antes da colheita e a baixa qualidade da fruta podem estar associadas a vários problemas, incluindo a nutrição da planta. A maioria dos agricultores não se preocupa com o fornecimento de micronutrientes que já são deficientes no solo. Além disso, sua mobilidade dentro das plantas também é uma questão. O zinco (Zn) está entre os micronutrientes que afetam a qualidade e a vida pós-colheita da fruta, e sua deficiência em solos paquistaneses já é relatada por diversos pesquisadores. Portanto, este estudo foi realizado para avaliar a influência da aplicação pré-colheita de sulfato de zinco (ZnSO4; 0, 0,4%, 0,6% ou 0,8%) na queda dos frutos na pré-colheita, produtividade e qualidade dos frutos da tangerina Kinnow em colheita. Os tratamentos foram aplicados durante o mês de outubro, ou seja, 4 meses antes da colheita. As pulverizações de Zn aplicadas tiveram efeito significativo no rendimento e na qualidade da fruta Kinnow. Entre as diferentes aplicações foliares de ZnSO4 efetuadas quatro meses antes da colheita, 0,6% de ZnSO4 reduziu significativamente a queda de frutos antes da colheita (10,08%) em comparação com as árvores de controle não tratadas (46,45%). Da mesma forma, número máximo de frutos colhidos por árvore (627), peso do fruto (192,9 g), porcentagem de suco (42,2%), sólidos solúveis totais (9,5 ° Brix), teor de ácido ascórbico (35,5 mg / 100 g-1) e os teores de açúcar (17,4) também foram significativamente maiores com o tratamento com 0,6% de ZnSO4 em comparação com o restante dos tratamentos e o controle. A aplicação foliar de 0,6% de ZnSO4 também melhorou significativamente os antioxidantes totais (TAO) e os teores fenólicos totais (TPC) nas frutas. Em conclusão, a pulverização foliar de ZnSO4 (0,6%) quatro meses antes da colheita reduziu a queda de frutos antes da colheita e aumentou o rendimento com a melhoria da qualidade da fruta tangerina Kinnow.

Combining extracorporeal shock wave treatment with proprioceptive neuromuscular facilitation can improve the lower limb motor function of stroke survivors with foot drop / 中华物理医学与康复杂志

Objective:To observe any effect of combining extracorporeal shock wave stimulation with proprioceptive neuromuscular facilitation (PNF) on the lower limb motor function of stroke survivors with foot drop.Methods:Thirty-six stroke survivors with foot drop were randomly divided into an extracorporeal shock wave group, a PNF group and a combination group, each of 12. The extracorporeal shock wave group and PNF group were given those therapies alone, while the combination group was provided with both. The extracorporeal shock wave therapy protocol was 2000 times on each muscle at an intensity of 2.5 bar and a frequency of 10Hz, twice a week for 4 weeks, while the PNF was provided at least 3 times per week for 4 weeks. Before and after the intervention, all of the participants were evaluated using the modified Ashworth scale (MAS), the 10-metre walk test (10 MWT) and the Fugl-Meyer lower limb motor function scale (FMA). Active range of the ankle joint and toe out angle were also observed.Results:After the intervention the lower limb muscle tone had decreased significantly in 8 of the PNF group members and in 9 of those in the extracorporeal shock wave group, but it has decreased significantly in all 12 members of the combination group. And the average magnitude of the improvement was also significantly greater in the combination group than in the other two groups. Moreover, significant differences were observed in the active range of the ankle joint after the treatment in the combination group, but not in the other two groups. After the intervention the average 10 MWT times and FMA scores of the PNF and combination groups had improved significantly, but not those of the extracorporeal shock wave group, but significant improvement in toe out angles was observed in all three groups, though the average improvement in the combination group was significantly greater than in the other 2 groups.Conclusion:Combining extracorporeal shock waves with PNF can effectively improve the lower limb motor function of stroke survivors with foot drop.

Analysis of Knee Joint Stress During Drop Jump Landing in Females with Generalised Joint Hypermobility / 医用生物力学

Objective To analyze the differences of von Mises stress distribution in knee cartilage and meniscus in female with generalised joint hypermobility (GJH) and healthy female during drop jump landing. Methods The kinematic and ground reaction force (GRF) characteristics of knee joint in female with GJH and healthy female at the moment of peak vertical GRF (VGRF) during loading phase of drop jump landing were collected. The knee joint reaction force was calculated via inverse dynamics, and the combined force of knee joint along long axis of the femur was applied as the load. Based on three-dimensional (3D) finite element model of a female knee joint, numerical simulations were performed separately during drop jump landing of subjects in two groups, and von Mises stresses and stress distribution of knee cartilage and meniscus were calculated. Results At the moment of peak VGRF during drop jump landing, knee flexion and valgus angles in GJH group and control group showed a statistical significance (P<0. 05). Compared with control group, knee flexion angle decreased and valgus angle increased in GJH group. During drop jump landing, GJH group bore larger stress inside the knee joint, and stress distribution in weight-bearing areas of the medial and lateral tibiofemoral compartments was uneven, while the lateral femoral cartilage lateral condyle, the anterior and middle lateral of lateral tibial cartilage, the anterior angle and body lateral margin of lateral meniscus were stress concentration sites. Conclusions For females with GJH, the stability of knee joint decreases and force lines change in jumping events, due to the increased range of motion of knee joint and relaxation of joint capsule, which increases the risk of cartilage and meniscal injury in lateral knee joint. During jumping sports, females with GJH should especially prevent knee joint injury caused by altered force lines in frontal plane of knee joint.

Development and global validation of a 1-week-old piglet head finite element model for impact simulations / 中华创伤杂志(英文版)

PURPOSE@#Child head injury under impact scenarios (e.g. falls, vehicle crashes, etc.) is an important topic in the field of injury biomechanics. The head of piglet was commonly used as the surrogate to investigate the biomechanical response and mechanisms of pediatric head injuries because of the similar cellular structures and material properties. However, up to date, piglet head models with accurate geometry and material properties, which have been validated by impact experiments, are seldom. We aim to develop such a model for future research.@*METHODS@#In this study, first, the detailed anatomical structures of the piglet head, including the skull, suture, brain, pia mater, dura mater, cerebrospinal fluid, scalp and soft tissue, were constructed based on CT scans. Then, a structured butterfly method was adopted to mesh the complex geometries of the piglet head to generate high-quality elements and each component was assigned corresponding constitutive material models. Finally, the guided drop tower tests were conducted and the force-time histories were ectracted to validate the piglet head finite element model.@*RESULTS@#Simulations were conducted on the developed finite element model under impact conditions and the simulation results were compared with the experimental data from the guided drop tower tests and the published literature. The average peak force and duration of the guide drop tower test were similar to that of the simulation, with an error below 10%. The inaccuracy was below 20%. The average peak force and duration reported in the literature were comparable to those of the simulation, with the exception of the duration for an impact energy of 11 J. The results showed that the model was capable to capture the response of the pig head.@*CONCLUSION@#This study can provide an effective tool for investigating child head injury mechanisms and protection strategies under impact loading conditions.

Advances in liquid-phase microextraction technology and its application in biological sample pretreatment / 药学学报

Liquid-phase microextraction is a novel pretreatment technique for biological samples developed on the basis of liquid-phase extraction technology, which is simple, rapid, economical, and environmentally friendly, and has been widely used in the analysis of biological matrix samples such as blood, urine, and saliva. In this paper, we review the basic principles of the main modes of liquid-phase microextraction techniques, i.e., single-drop microextraction, dispersive liquid-liquid microextraction, and hollow-fiber liquid-phase microextraction, and the progress of their applications in biological sample pretreatment by reviewing the literature in the past five years, with a view to providing technical support and reference for sample pretreatment in the fields of in vivo drug analysis, pharmacokinetic studies and new drug development.

Cotransplantation of marginal mass allogeneic islets with 3D culture-derived adult human skin cells improves glycemia in diabetic mice

Islet transplantation represents a therapeutic option for type 1 diabetes (T1D). Long-term viability of transplanted islets requires improvement. Mesenchymal stromal cells (MSCs) have been proposed as adjuvants for islet transplantation facilitating grafting and functionality. Stem cell aggregation provides physiological interactions between cells and enhances the in situ concentration of modulators of inflammation and immunity. We established a hanging-drop culture of adult human skin fibroblast-like cells as spheroids, and skin spheroid-derived cells (SphCs) were characterized. We assessed the potential of SphCs in improving islet functionality by cotransplantation with a marginal mass of allogeneic islets in an experimental diabetic mouse model and characterized the secretome of SphCs by mass spectrometry-based proteomics. SphCs were characterized as multipotent progenitors and their coculture with anti-CD3 stimulated mouse splenocytes decreased CD4+ T cell proliferation with skewed cytokine secretion through an increase in the Th2/Th1 ratio profile. SphCs-conditioned media attenuated apoptosis of islets induced by cytokine challenge in vitro and importantly, intratesticular SphCs administration did not show tumorigenicity in immune-deficient mice. Moreover, SphCs improved glycemic control when cotransplanted with a marginal mass of allogeneic islets in a diabetic mouse model without pharmacological immunosuppression. SphCs' protein secretome differed from its paired skin fibroblast-like counterpart in containing 70% of up- and downregulated proteins and biological processes that overall positively influenced islets such as cytoprotection, cellular stress, metabolism, and survival. In summary, SphCs improved the performance of transplanted allogeneic islets in an experimental T1D model, without pharmacological immunosuppression. Future research is warranted to identify SphCs-secreted factors responsible for islets' endurance.

ATYPICAL MANIFESTATIONS OF SUBACUTE SCLEROSING PANENCEPHALITIS: CASE SERIES

Subacute Sclerosing Panencephalitis (SSPE) is a rare, progressive degenerative disease of the brain caused by reactivation of aberrant measles virus. Classical symptoms of SSPE are described as behavioral changes, declining scholastic performance, myoclonic jerks etc. However, at times it presents with varied atypical manifestations, which makes diagnosis dif?cult. Hereby we report two patients with unusual manifestations of SSPE. In ?rst case, 14-year-old boy presented with recurrent falls of 9 months duration. Initially, it was 1-2 times per week, progressing over 9 months to frequency of 40-50 falls per day. In second case, 21-year-old gentleman presented with behavioral changes and memory disturbance of 1-year duration. However, his family members noticed worsening of symptoms 1 month before presentation as he started developing involuntary jerky movements involving the right upper and lower limb. In both of them electroencephalogram (EEG) was showing long interval periodic discharges and cerebrospinal ?uid was showing elevated titers of anti-measles antibody overall suggesting SSPE. Hence it needs much attention for atypical presentations and also considering SSPE in differential diagnosis of unsolved atypical neurological presentations.

Tofo gotoso gigante en presentación inusual / Giant gouty tophi in unusual presentation

La gota es una enfermedad reumática inflamatoria que se debe al depósito de cristales de urato monosódico en las articulaciones. En su evolución clínica se distingues dos formas: la fase aguda caracterizada por un proceso inflamatorio monoarticular agudo de gran sensibilidad, y la fase crónica o de mantenimiento, cuyo elemento fundamental es la acumulación de cristales de urato monosódico llamados tofos gotosos. Estos se presentan con mayor frecuencia en el dorso de los dedos, a nivel articular y en el pabellón auricular. Se presenta el caso de un paciente masculino, de 47 años, con diagnóstico de gota de 5 años de evolución y con tratamiento irregular. Este paciente presentó tofos gotosos en localizaciones infrecuentes que limitaron su capacidad funcional. Este caso demuestra la necesidad de un diagnóstico oportuno y una adecuada adherencia al tratamiento, por lo que se considera importante para la comunidad médica, especialmente los profesionales de la salud que atienden a pacientes con artropatía gotosa(AU)´

Gout is a rheumatic, inflammatory disease that is generated by the deposition of monosodium urate crystals at the joint level. Two forms can be distinguished in its clinical evolution: the acute phase characterized by an acute monoarticular inflammatory process of great sensitivity, and the chronic or maintenance phase where the fundamental element is the presence of accumulations of monosodium urate crystals called gouty tophi. These occur more frequently on the back of the fingers, at the joint level and in the auricle. This paper presents the case of a 47-year-old male patient, diagnosed with gout for 5 years and with irregular treatment, who presented gouty tophi in infrequent locations that limit the patient's functional capacity. The case is presented considering it important for the medical community; especially health professionals caring for patients with gouty arthropathy(AU)´

Hypokalemic Rhabdomyolysis — A Rare Presentation

Hypokalemia leading to Rhabdomyolysis is a potentially fatal disorder if not identified and treated early. In this case report we present a patient who had one week history of asymmetric painful Quadriparesis with neck drop and preserved reflexes. Evaluation revealed Hypokalemia with raised creatine.

Comparing the effectiveness of different postoperative counseling methods for post-keratoplasty patients

Purpose: To compare various counseling methods for improving patient education, compliance, and administration of eye drops prescribed for post?optical keratoplasty patients and assess the most efficient counseling method. Methods: A prospective, questionnaire?based pilot study was conducted among 60 post?optical keratoplasty patients who were randomly assigned into three groups for postoperative eye drop counseling, namely group (video counseling), group 2 (chart counseling), and group 3 (verbal counseling at Cornea department). The questionnaire was answered by the patients/attendants applying the eye drops on the first 3 consecutive visits. McNemar–Bowker test was used to compare responses in each group and the Kruskal–Wallis test was used to compare responses among the three groups. The Institutional Ethics Committee of Aravind Eye Hospital, Tirunelveli (Registration number ECR 816/Inst/Tn/2016) approved this study. Results: Results demonstrated improvement in various categories assessed regarding drop administration in all three groups, which assessed patients’ knowledge, attitude, and hygiene. Although all three groups showed improvements during subsequent follow?up visits, the video?counseling method was found to be an effective means of communication. Conclusion: Our study emphasizes that the nonverbal and noncontact means of communication by video demonstration would be an effective way of counseling. It can be considered in the present scenario of the pandemic as well

Neutralization assays for SARS-CoV-2: Implications for assessment of protective efficacy of COVID-19 vaccines

The WHO emergency use-listed (EUL) COVID-19 vaccines were developed against early strains of SARS-CoV-2. With the emergence of SARS-CoV-2 variants of concern (VOCs) - Alpha, Beta, Gamma, Delta and Omicron, it is necessary to assess the neutralizing activity of these vaccines against the VOCs. PubMed and preprint platforms were searched for literature on neutralizing activity of serum from WHO EUL vaccine recipients, against the VOCs, using appropriate search terms till November 30, 2021. Our search yielded 91 studies meeting the inclusion criteria. The analysis revealed a drop of 0-8.9-fold against Alpha variant, 0.3-42.4-fold against Beta variant, 0-13.8-fold against Gamma variant and 1.35-20-fold against Delta variant in neutralization titres of serum from the WHO EUL COVID-19 vaccine recipients, as compared to early SARS-CoV-2 isolates. The wide range of variability was due to differences in the choice of virus strains selected for neutralization assays (pseudovirus or live virus), timing of serum sample collection after the final dose of vaccine (day 0 to 8 months) and sample size (ranging from 5 to 470 vaccinees). The reasons for this variation have been discussed and the possible way forward to have uniformity across neutralization assays in different laboratories have been described, which will generate reliable data. Though in vitro neutralization studies are a valuable tool to estimate the performance of vaccines against the backdrop of emerging variants, the results must be interpreted with caution and corroborated with field-effectiveness studies.

Development of an Anterior Foot Drop Ankle Foot Orthosis with Adjustable Stiffness / 医用生物力学

Objective For patients with foot drop gait, to design a kind of anterior ankle foot orthosis (AFO) with adjustable stiffness, so as to restore natural gait of the ankle by limiting the patients’ unusual plantar flexion to the optimum extent. Methods The minimum orthodontic moment of 10 foot drop male patients was measured by self-made experimental equipment, which could be used to select optimum material modulus of the AFO. The relationship between elastic modulus and different filling structures and filling ratio parameters was studied by tensile test. A typical patient with foot drop was selected, and the anterior AFO fitting the shape of patient’s foot was quickly made by three-dimensional (3D) printing with foot geometric data and specific filling material, filling structure and filling rate. The kinematics and surface electromyography (sEMG) of plantar flexors were tested under barefoot and wearing two kinds of AFOs, so as to verify the effect of the AFO on plantar flexion. The effectiveness of the limitation and the degree of preservation of ankle valgus and plantar flexion were discussed. Results The minimum corrective torque required for 10 male patients with foot drop was 2.16 N·m. Compared with the rigid AFO, the range of motion (ROM) of plantar flexion and valgus increased by 67.8% and 88.6% respectively with the flexible AFO. The activation of the muscles responsible for plantar flexion (soleus, medial head of gastrocnemius and lateral head of gastrocnemius) also decreased by 38.3%, 46.6% and 55.8%. Conclusions This AFO with adjustable stiffness can be used for orthosis customization of patients with foot drop, providing more effective and long-term orthosis function and potential.

Analysis of the gait of stroke survivors with foot drop / 中华物理医学与康复杂志

Objective:To observe the clearance strategies of hemiplegic stroke survivors with foot drop.Methods:Thirty hemiplegic stroke survivors with foot drop formed the observation group and 30 healthy counterparts constituted the control group. A three-dimensional motion capture system was used to observe and compare the minimum toe clearance (MTC) and its variability between the two groups to draw the motion trajectory of the toe in the swing phase of their gaits. The gait parameters were correlated with the toe clearance.Results:The average MTC of the observation group subjects on both the hemiplegic and non-hemiplegic side (12.01±3.36 and 22.38±5.51mm) was significantly smaller than the control group′s averages. The variability of their MTCs on both sides was also significantly greater. Clearance on the hemiplegic side was significantly less and its variability was significantly greater. Among the observation group, MTC on the hemiplegic side was positively correlated with walking speed, step length, swing phase percentage, maximum angle of hip extension, maximum angle of knee flexion, maximum angle of ankle dorsiflexion, and the range of motion of the knee and ankle joints.Conclusions:Hemiplegic stroke survivors with foot drop walk unstably with little toe clearance. It is necessary to intervene at the hip, knee and ankle to improve their obstacle clearance.

Research and realization of automatic evaluation of stereotactic radiotherapy plan for early non-small cell lung cancer / 中华放射肿瘤学杂志

Objective:To realize the automatic evaluation of the target conformity, dose overflow, dose drop and other indicators in stereotactic body radiation therapy (SBRT) plan for the early non-small cell lung cancer (NSCLC) in the Eclipse planning system.Methods:Eclipse Scripting API application development interface and C# programming language were used to develop it with script plug-ins combined with independent programs. According to the requirements of the NSCLC SBRT plan in Radiation Therapy Oncology Group (RTOG) 0915 report, the automatic evaluation of related indicators was realized. A rule of equal interval sampling and double thresholds was designed during the period, which could more accurately and conveniently evaluate the dose drop outside the target area.Results:13 clinical cases of NSCLC SBRT plans were randomly selected, the method in this study and the module equipped with the Eclipse system to were utilized to evaluate and compare the results. It was concluded that the results of the two methods were in line with the clinical requirements, and the former was more efficient ( P<0.05). Conclusions:The NSCLC SBRT plan evaluation software in this article has a friendly interface. It can not only realize the automatic evaluation of target conformity, dose overflow and dose drop, but also effectively improve work efficiency and better serve the clinical and scientific research work of radiotherapy.

Re-engagement and influencing factors of patients with human immunodeficiency virus infection during anti-retroviral therapy in Yunnan Province / 中华传染病杂志

Objective:To investigate the situation of patients with human immunodeficiency virus (HIV) infection who re-engaging treatment after dropping-out during anti-retroviral therapy (ART), and the influencing factors of ART re-engagement in Yunnan Province.Methods:The total dropping-out cases of ART up to December 31, 2018, including cases of lost-of-follow-up and withdrawing medications in Yunnan Province were included. The status of drop-out and demographic data were collected from survey questionnaires and the extracted medical-visiting records from the China National Free Antiretroviral Treatment Program Database of Chinese Center for Disease Control and Prevention. Chi-square test was used in statistical analysis and logistic regression was applied in analyzing factors related with re-engagement.Results:Among the total 6 075 cases with HIV infection which were recorded with the status of drop-out during ART in Yunnan Province, 5 340(87.9%) cases were confirmed drop-out, 540(8.9%) cases were false dropping-out due to belated medical visiting records, 109(1.8%) cases provided invalid answers or had no response to survey questionnaire, and 86(1.4%) cases failed to report results. Among 5 340 confirmed drop-out cases, the findings showed that 923(17.3%) cases were tracked and successfully re-initiated ART, 2 327(43.6%) cases could not be contacted, 1 443(27.0%) cases refused ART, 100(1.9%) cases died, 39(0.7%) cases came back for treatment by self-willing, 91(1.7%) cases were detained, and 417(7.8%) cases were in other situations. Tracking the dropping-out cases were through the workers based on the health facilities including ART clinics, centers for disease control and prevention and the community-based organizations. They tracked the dropping-out cases by phone, through household visiting or face-to-face communication. Statistically significant differences were found in the proportion of patients re-engagement by gender, re-engagement age, route of infection, education level and time from entry to last loss ( χ2=6.14, 21.26, 8.24, 17.69, 12.75, respectively, all P<0.050). The logistic regression suggested that the protective factors related with the re-engagement included female (adjusted odds ratio (a OR)=1.34, 95% confidence interval ( CI) 1.12 to 1.61, P=0.002), re-engagement age≤30 year-old (a OR=1.78, 95% CI 1.25 to 2.55, P<0.001), age of 31 to 60 year-old (a OR=1.33, 95% CI 1.01 to 1.76, P=0.043), education level with primary school to high school or technical secondary school (a OR=1.56, 95% CI 1.21 to 2.01, P<0.001), the period>24 months between first initiating ART and dropping-out (a OR=1.37, 95% CI 1.11 to 1.70, P=0.004). Conclusions:The program of tracking and re-engagement for ART dropping-out patients in Yunnan Province needs multi-department participation and investing large resources, but the success rate of tracking and re-engagement is not high. The protective factors related with re-engagement are female, re-engagement age≤60 year-old, education level with primary school to high school or technical secondary school, the period>24 months between first initiating ART and dropping-out.