Metabolically defined body size and body shape phenotypes and risk of postmenopausal breast cancer in the European Prospective Investigation into Cancer and Nutrition.

BACKGROUND: Excess body fatness and hyperinsulinemia are both associated with an increased risk of postmenopausal breast cancer. However, whether women with high body fatness but normal insulin levels or those with normal body fatness and high levels of insulin are at elevated risk of breast cancer is not known. We investigated the associations of metabolically defined body size and shape phenotypes with the risk of postmenopausal breast cancer in a nested case-control study within the European Prospective Investigation into Cancer and Nutrition. METHODS: Concentrations of C-peptide-a marker for insulin secretion-were measured at inclusion prior to cancer diagnosis in serum from 610 incident postmenopausal breast cancer cases and 1130 matched controls. C-peptide concentrations among the control participants were used to define metabolically healthy (MH; in first tertile) and metabolically unhealthy (MU; >1st tertile) status. We created four metabolic health/body size phenotype categories by combining the metabolic health definitions with normal weight (NW; BMI < 25 kg/m2 , or WC < 80 cm, or WHR < 0.8) and overweight or obese (OW/OB; BMI ≥ 25 kg/m2 , or WC ≥ 80 cm, or WHR ≥ 0.8) status for each of the three anthropometric measures separately: (1) MHNW, (2) MHOW/OB, (3) MUNW, and (4) MUOW/OB. Conditional logistic regression was used to compute odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: Women classified as MUOW/OB were at higher risk of postmenopausal breast cancer compared to MHNW women considering BMI (OR = 1.58, 95% CI = 1.14-2.19) and WC (OR = 1.51, 95% CI = 1.09-2.08) cut points and there was also a suggestive increased risk for the WHR (OR = 1.29, 95% CI = 0.94-1.77) definition. Conversely, women with the MHOW/OB and MUNW were not at statistically significant elevated risk of postmenopausal breast cancer risk compared to MHNW women. CONCLUSION: These findings suggest that being overweight or obese and metabolically unhealthy raises risk of postmenopausal breast cancer while overweight or obese women with normal insulin levels are not at higher risk. Additional research should consider the combined utility of anthropometric measures with metabolic parameters in predicting breast cancer risk.

Unravelling plant diversification: Intraspecific genetic differentiation in hybridizing Anacyclus species in the western Mediterranean Basin.

PREMISE: The interfertile species Anacyclus clavatus, A. homogamos, and A. valentinus represent a plant complex coexisting in large anthropic areas of the western Mediterranean Basin with phenotypically mixed populations exhibiting a great floral variation. The goal of this study was to estimate the genetic identity of each species, to infer the role of hybridization in the observed phenotypic diversity, and to explore the effect of climate on the geographic distribution of species and genetic clusters. METHODS: We used eight nuclear microsatellites to genotype 585 individuals from 31 populations of three Anacyclus species for population genetic analyses by using clustering algorithms based on Bayesian models and ordination methods. In addition, we used ecological niche models and niche overlap analyses for both the species and genetic clusters. We used an expanded data set, including 721 individuals from 129 populations for ecological niche models of the genetic clusters. RESULTS: We found a clear correspondence between species and genetic clusters, except for A. clavatus that included up to three genetic clusters. We detected individuals with admixed genetic ancestry in A. clavatus and in mixed populations. Ecological niche models predicted similar distributions for species and genetic clusters. For the two specific genetic clusters of A. clavatus, ecological niche models predicted remarkably different areas. CONCLUSIONS: Gene flow between Anacyclus species likely explains phenotypic diversity in contact areas. In addition, we suggest that introgression could be involved in the origin of one of the two A. clavatus genetic clusters, which also showed ecological differentiation.

The Impact of Robotic Therapy on the Self-Perception of Upper Limb Function in Cervical Spinal Cord Injury: A Pilot Randomized Controlled Trial.

BACKGROUND: The aim of the present study was to evaluate the impact of robotic therapy in patients with cervical spinal cord injury (SCI), measured on the basis of the patients' self-perception of limited upper limb function and level of independence in activities of daily living. METHODS: Twenty-six patients with cervical SCI completed the treatment after being randomly assigned to the intervention or control group. The training consisted of 40 experimental sessions 1 h in duration, ideally occurring 5 days/week for 8 weeks. In addition to the conventional daily therapy (30 min), the control group received another 30 min of conventional therapy, whereas the intervention group received 30 min of robotic therapy. Patients were evaluated by means of the Capabilities of Upper Extremity Questionnaire (CUE) and Spinal Cord Independence Measure (SCIM) clinical scales. RESULTS: The improvement in the feeding item of SCIM was significantly higher in the intervention group than in the control group after the treatment (2.00 (0.91) vs. 1.18 (0.89), p = 0.03). The correlation between the CUE and SCIM scales was higher at the ending than at baseline for both groups. CONCLUSIONS: Although both groups improved, the clinical relevance related to the changes observed for both assessments was slightly higher in the intervention group than in the control group.

A rationally designed self-immolative linker enhances the synergism between a polymer-rock inhibitor conjugate and neural progenitor cells in the treatment of spinal cord injury.

Rho/ROCK signaling induced after spinal cord injury (SCI) contributes to secondary damage by promoting apoptosis, inflammation, and axon growth inhibition. The specific Rho-kinase inhibitor fasudil can contribute to functional regeneration after SCI, although inherent low stability has hampered its use. To improve the therapeutic potential of fasudil, we now describe a family of rationally-designed bioresponsive polymer-fasudil conjugates based on an understanding of the conditions after SCI, such as low pH, enhanced expression of specific proteases, and a reductive environment. Fasudil conjugated to poly-l-glutamate via a self-immolative redox-sensitive linker (PGA-SS-F) displays optimal release kinetics and, consequently, treatment with PGA-SS-F significantly induces neurite elongation and axon growth in dorsal root ganglia explants, spinal cord organotypic cultures, and neural precursor cells (NPCs). The intrathecal administration of PGA-SS-F after SCI in a rat model prevents early apoptosis and induces the expression of axonal growth- and neuroplasticity-associated markers to a higher extent than the free form of fasudil. Moreover, a combination treatment comprising the acute transplantation of NPCs pre-treated with PGA-SS-F leads to enhanced cell engraftment and reduced cyst formation after SCI. In chronic SCI, combinatory treatment increases the preservation of neuronal fibers. Overall, this synergistic combinatorial strategy may represent a potentially efficient clinical approach to SCI treatment.

[Protective and risk factors predicting caregiver psychological distress in people with advanced Parkinson's disease]. / Factores de riesgo y de protección que predicen el malestar psicológico del cuidador de personas con enfermedad de Parkinson avanzada.

INTRODUCTION AND OBJECTIVES: Neurological diseases are one of the main contemporary challenges in advanced societies. Parkinson's disease (PD) is one of the most common neurological diseases causing disability. It is a health problem associated with a decrease in personal autonomy. It causes an imbalance in family functioning, with a negative impact on quality of life. The objective was to identify risk factors associated with the psychological burden of the caregiver. SUBJECTS AND METHODS: Prospective ex post facto research conducted with a sample of 106 caregivers of persons with PD, who were administered a socio-demographic questionnaire, the NEO-FFI (personality) and COPE-28 (coping strategies) inventories, and an adaptation of the Katz index to assess involvement in care. A structured diagnostic instrument (CORE-OM) was used as a dependent variable. RESULTS: Multiple regression analysis identified high neuroticism; poor caregiver perception of health; poor caregiver perception of health; non-adaptive coping strategies; and PD disability as risk factors. In turn, adaptive coping strategies and caregiver time may act as protective factors. The resulting model explains 57.1% of the variance in caregiver psychological distress. CONCLUSIONS: These results help explain why some people adapt better than others to the burden of care. The findings highlight the importance of identifying the variables that influence the quality of care for people with this disease.

TITLE: Factores de riesgo y de protección que predicen el malestar psicológico del cuidador de personas con enfermedad de Parkinson avanzada.Introducción y objetivo. Las enfermedades neurológicas son uno de los principales retos contemporáneos en las sociedades avanzadas. La enfermedad de Parkinson (EP) es una de las enfermedades neurológicas más frecuentes que provocan discapacidad. Constituye un problema de salud, asociado a una disminución de la autonomía personal. Provoca desequilibrios en el ámbito familiar, con un impacto negativo en la calidad de vida. Esta investigación se desarrolló con el propósito de identificar factores de riesgo asociados a la carga psicológica del cuidador. Sujetos y métodos. Estudio ex post facto prospectivo realizado con una muestra de 106 cuidadores de personas con EP avanzada, a los que se les administraron un cuestionario sociodemográfico, los inventarios NEO reducido de cinco factores I (personalidad) y COPE-28 (estrategias de afrontamiento), y una adaptación del índice de Katz para evaluar el grado de implicación del cuidador. Como variable dependiente se utilizó un instrumento diagnóstico estructurado (Clinical Outcomes in Routine Evaluation, Outcome Measure). Resultados. El análisis de regresión múltiple identificó como factores de riesgo el neuroticismo alto; la mala salud percibida del cuidador; la mayor implicación en los cuidados; las estrategias de afrontamiento desadaptativas; y la discapacidad de la persona con EP. Por su parte, las estrategias de afrontamiento adaptativas y el tiempo como cuidador podrían actuar como factores de protección. El modelo resultante explica el 57,1% de la varianza del malestar psicológico del cuidador. Conclusiones. Estos resultados contribuyen a explicar por qué algunas personas se adaptan mejor que otras a la carga de los cuidados. Los hallazgos resaltan la importancia de identificar las variables que influyen en la calidad de la atención a las personas con EP avanzada.

Capillary malformation-arteriovenous malformation syndrome: a multicentre study.

BACKGROUND: Capillary malformation-arteriovenous malformation (CM-AVM) syndrome is a rare syndrome with characteristic skin lesions that are associated with fast-flow vascular malformations (FFVMs) in one-third of patients. Few case series have been described, and none in Spain. AIM: To identify the prevalence of dermatological parameters, FFVMs and associated features in a large series of patients with CM-AVM. METHODS: We conducted an observational study of patients with CM-AVM syndrome diagnosed in 15 Spanish hospitals over 3 years. The main clinical, radiological, genetic findings and associated diseases were analysed. RESULTS: In total, 64 patients were assessed. In 26.5% of cases, the diagnosis was incidental. In 75% of patients, there was one significantly larger macule, which we termed the 'herald patch'. FFVMs were detected in 34% of the patients, with 30% located on the skin, 7.8% in the brain and in 1.5% in the spine. There was a positive family history in 65% of the 64 patients. Genetic analysis was performed for RASA1 mutations in 57 patients, of whom 42 (73%) had a positive result. All 4 patients tested for EPHB4 mutations had a positive result. No tumour lesions were detected in the series, except for five infantile haemangiomas. CONCLUSIONS: Our data on clinical lesions, associated FFVM, family history and genetics are similar to those previously published in the literature. An extensive data analysis failed to demonstrate any statistically significant association between the presence of an FFVM and any clinical, familial or genetic parameter that could predict its onset, although a link between the presence of a herald patch on the midline face and the presence of a brain FFVM was observed. We did not detect any genotype-phenotype correlation.

Terapia robótica con el exoesqueleto H2 en la rehabilitación de la marcha en pacientes con lesión medular incompleta. Una experiencia clínica / Robot therapy with the H2 exoskeleton for gait rehabilitation in patients with incomplete spinal cord injry. A clinical experience

No disponible

[Robot therapy with the H2 exoskeleton for gait rehabilitation in patients with incomplete spinal cord injry. A clinical experience]. / Terapia robótica con el exoesqueleto H2 en la rehabilitación de la marcha en pacientes con lesión medular incompleta. Una experiencia clínica.

BACKGROUND AND OBJECTIVE: Robotic exoskeletons have emerged as a promising tool in gait rehabilitation in patients with a spinal cord injury. The aim of this study was to assess the clinical applicability of a new robotic exoskeleton model (Exo H2) in the rehabilitation of people with incomplete spinal cord injury. MATERIAL AND METHODS: Exo H2 exoskeleton training was performed for 15 sessions in patients with incomplete subacute spinal cord injury. We analysed the appearance of undesirable events and the patient's perception of pain, fatigue and comfort. In addition, a pilot test was carried out on the possible effectiveness of the device by analysing gait characteristics before and after treatment measured by the 10mWT, the 6mWT, the TUG, the WISCI-II, and the impact on the SCIM III scale. RESULTS: Of a group of 8 patients recruited, we were able to analyse data from 4. No undesirable effects were reported. The VAS value was 2.28±1.55 for pain, 3.75±1.55 for fatigue and 4.17±1.68 for comfort. All values improved on the WISCI-I and the TUG and almost all in the 10MWT and in the 6MWT. CONCLUSIONS: The performance of the Exo H2 exoskeleton was robust during a clinical protocol for gait rehabilitation. The treatment was safe, without undesirable effects and with good patient tolerance. These results might justify the performance of clinical trials with an adequate sample size.

The Mendelian inheritance of gynomonoecy: insights from Anacyclus hybridizing species.

PREMISE: Gynomonoecy is an infrequent sexual system in angiosperms, although widely represented within the Asteraceae family. Currently, the hypothesis of two nuclear loci controling gynomonoecy is the most accepted. However, the genic interactions are still uncertain. Anacyclus clavatus, A. homogamos, and A. valentinus differ in their sexual system and floral traits. Here, we investigate the inheritance of gynomonoecy in this model system to understand its prevalence in the family. METHODS: We selected six natural populations (two per species) for intra- and interspecific experimental crosses, and generated a total of 1123 individuals from the F1 generation, F2 , and backcrosses for sexual system characterization. The frequency of gynomonoecy observed for each cross was tested to fit different possible hypotheses of genic interaction. Additionally, the breeding system and the degree of reproductive isolation between these species were assessed. RESULTS: Complementary epistasis, in which two dominant alleles are required for trait expression, explained the frequencies of gynomonoecy observed across all generations. The heterozygosity inferred in Anacyclus valentinus, as well as its lower and variable seed set, is congruent with its hybrid origin. CONCLUSIONS: In our model system gynomonoecy is controlled by complementary epistasis of two genes. A common origin of this sexual system in Asteraceae, in which genic duplications, mutations, and hybridization between lineages played a key role, is hypothesized whereas independent evolutionary pathways and possibly diverse underlying genetic factors are suggested for gynomonoecy expression in other angiosperm families.

Dietary intake of advanced glycation end products (AGEs) and changes in body weight in European adults.

PURPOSE: Advanced glycation end products (AGEs) can be formed in foods by the reaction of reducing sugars with proteins, and have been shown to induce insulin resistance and obesity in experimental studies. We examined the association between dietary AGEs intake and changes in body weight in adults over an average of 5 years of follow-up. METHODS: A total of 255,170 participants aged 25-70 years were recruited in ten European countries (1992-2000) in the PANACEA study (Physical Activity, Nutrition, Alcohol, Cessation of smoking, Eating out of home in relation to Anthropometry), a sub-cohort of the EPIC (European Prospective Investigation into Cancer and Nutrition). Body weight was measured at recruitment and self-reported between 2 and 11 years later depending on the study center. A reference database for AGEs was used containing UPLC-MS/MS-measured Nε-(carboxymethyl)-lysine (CML), Nε-(1-carboxyethyl)-lysine (CEL), and Nδ-(5-hydro-5-methyl-4-imidazolon-2-yl)-ornithine (MG-H1) in 200 common European foods. This reference database was matched to foods and decomposed recipes obtained from country-specific validated dietary questionnaires in EPIC and intake levels of CEL, CML, and MG-H1 were estimated. Associations between dietary AGEs intake and body weight change were estimated separately for each of the three AGEs using multilevel mixed linear regression models with center as random effect and dietary AGEs intake and relevant confounders as fixed effects. RESULTS: A one-SD increment in CEL intake was associated with 0.111 kg (95% CI 0.087-0.135) additional weight gain over 5 years. The corresponding additional weight gain for CML and MG-H1 was 0.065 kg (0.041-0.089) and 0.034 kg (0.012, 0.057), respectively. The top six food groups contributing to AGEs intake, with varying proportions across the AGEs, were cereals/cereal products, meat/processed meat, cakes/biscuits, dairy, sugar and confectionary, and fish/shellfish. CONCLUSION: In this study of European adults, higher intakes of AGEs were associated with marginally greater weight gain over an average of 5 years of follow-up.

The role of plasma microseminoprotein-beta in prostate cancer: an observational nested case-control and Mendelian randomization study in the European prospective investigation into cancer and nutrition.

BACKGROUND: Microseminoprotein-beta (MSP), a protein secreted by the prostate epithelium, may have a protective role in the development of prostate cancer. The only previous prospective study found a 2% reduced prostate cancer risk per unit increase in MSP. This work investigates the association of MSP with prostate cancer risk using observational and Mendelian randomization (MR) methods. PATIENTS AND METHODS: A nested case-control study was conducted with the European Prospective Investigation into Cancer and Nutrition (EPIC) with 1871 cases and 1871 matched controls. Conditional logistic regression analysis was used to investigate the association of pre-diagnostic circulating MSP with risk of incident prostate cancer overall and by tumour subtype. EPIC-derived estimates were combined with published data to calculate an MR estimate using two-sample inverse-variance method. RESULTS: Plasma MSP concentrations were inversely associated with prostate cancer risk after adjusting for total prostate-specific antigen concentration [odds ratio (OR) highest versus lowest fourth of MSP = 0.65, 95% confidence interval (CI) 0.51-0.84, Ptrend = 0.001]. No heterogeneity in this association was observed by tumour stage or histological grade. Plasma MSP concentrations were 66% lower in rs10993994 TT compared with CC homozygotes (per allele difference in MSP: 6.09 ng/ml, 95% CI 5.56-6.61, r2=0.42). MR analyses supported a potentially causal protective association of MSP with prostate cancer risk (OR per 1 ng/ml increase in MSP for MR: 0.96, 95% CI 0.95-0.97 versus EPIC observational: 0.98, 95% CI 0.97-0.99). Limitations include lack of complete tumour subtype information and more complete information on the biological function of MSP. CONCLUSIONS: In this large prospective European study and using MR analyses, men with high circulating MSP concentration have a lower risk of prostate cancer. MSP may play a causally protective role in prostate cancer.

Association of leukocyte DNA methylation changes with dietary folate and alcohol intake in the EPIC study.

BACKGROUND: There is increasing evidence that folate, an important component of one-carbon metabolism, modulates the epigenome. Alcohol, which can disrupt folate absorption, is also known to affect the epigenome. We investigated the association of dietary folate and alcohol intake on leukocyte DNA methylation levels in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Leukocyte genome-wide DNA methylation profiles on approximately 450,000 CpG sites were acquired with Illumina HumanMethylation 450K BeadChip measured among 450 women control participants of a case-control study on breast cancer nested within the EPIC cohort. After data preprocessing using surrogate variable analysis to reduce systematic variation, associations of DNA methylation with dietary folate and alcohol intake, assessed with dietary questionnaires, were investigated using CpG site-specific linear models. Specific regions of the methylome were explored using differentially methylated region (DMR) analysis and fused lasso (FL) regressions. The DMR analysis combined results from the feature-specific analysis for a specific chromosome and using distances between features as weights whereas FL regression combined two penalties to encourage sparsity of single features and the difference between two consecutive features. RESULTS: After correction for multiple testing, intake of dietary folate was not associated with methylation level at any DNA methylation site, while weak associations were observed between alcohol intake and methylation level at CpG sites cg03199996 and cg07382687, with qval = 0.029 and qval = 0.048, respectively. Interestingly, the DMR analysis revealed a total of 24 and 90 regions associated with dietary folate and alcohol, respectively. For alcohol intake, 6 of the 15 most significant DMRs were identified through FL. CONCLUSIONS: Alcohol intake was associated with methylation levels at two CpG sites. Evidence from DMR and FL analyses indicated that dietary folate and alcohol intake may be associated with genomic regions with tumor suppressor activity such as the GSDMD and HOXA5 genes. These results were in line with the hypothesis that epigenetic mechanisms play a role in the association between folate and alcohol, although further studies are warranted to clarify the importance of these mechanisms in cancer.

Changes in dietary intake, plasma carotenoids and erythrocyte membrane fatty acids in breast cancer survivors after a lifestyle intervention: results from a single-arm trial.

BACKGROUND: The influence of nutrition on breast cancer prognosis is still inconclusive and therefore dietary interventions incorporating dietary biomarkers are needed to confirm compliance with dietary goals and clarify biological mechanisms. The present study assessed whether a lifestyle intervention in breast cancer survivors could affect dietary biomarkers of fruit and vegetables and fatty acids. METHODS: In this phase II single-arm trial, 37 overweight/obese early stage breast cancer patients completed a 12-week diet and exercise intervention. The intervention involved 1-h weekly diet sessions delivered by a dietician and 75-min bi-weekly physical activity sessions of moderate-to-high intensity led by trained monitors. Before and after the intervention, three 24-h dietary recalls were carried out to calculate nutrient intakes and, in addition, blood samples were taken to measure plasma carotenoids, vitamin E and retinol concentrations and erythrocyte membrane fatty acid (EFA) composition. Wilcoxon signed rank tests were used to assess changes in dietary and biomarkers measurements over the intervention period. RESULTS: After the intervention, there was a significant increase in the intake of dietary carotenoids (+15.1% compared to baseline) but not plasma carotenoids levels (+6.3%). Regarding the EFA levels, we observed a significant decrease in percentage of saturated fatty acids (-1.4%) and n-6 polyunsaturated fatty acids (-2.9%) and an increase in monounsaturated fatty acids (1.7%) and total and long-chain n-3 polyunsaturated fatty acids (by 13.1% and 13.7%, respectively). A favourable decrease in the ratio of long-chain n-6 to n-3 polyunsaturated fatty acids (-9.1%) was also observed. CONCLUSIONS: After a short-term diet and exercise intervention in overweight/obese breast cancer survivors, we observed significant changes in dietary nutrients and fatty acid biomarkers, suggesting positive dietary changes that could be relevant for breast cancer prognosis.

Simultaneous estimation of human and exoskeleton motion: A simplified protocol.

Adequate benchmarking procedures in the area of wearable robots is gaining importance in order to compare different devices on a quantitative basis, improve them and support the standardization and regulation procedures. Performance assessment usually focuses on the execution of locomotion tasks, and is mostly based on kinematic-related measures. Typical drawbacks of marker-based motion capture systems, gold standard for measure of human limb motion, become challenging when measuring limb kinematics, due to the concomitant presence of the robot. This work answers the question of how to reliably assess the subject's body motion by placing markers over the exoskeleton. Focusing on the ankle joint, the proposed methodology showed that it is possible to reconstruct the trajectory of the subject's joint by placing markers on the exoskeleton, although foot flexibility during walking can impact the reconstruction accuracy. More experiments are needed to confirm this hypothesis, and more subjects and walking conditions are needed to better characterize the errors of the proposed methodology, although our results are promising, indicating small errors.

Shoulder kinetics and ultrasonography changes after performing a high-intensity task in spinal cord injury subjects and healthy controls.

This corrects the article DOI: 10.1038/sc.2015.140.

Modular control of gait after incomplete spinal cord injury: differences between sides.

STUDY DESIGN: This is an analytical descriptive study. OBJECTIVES: The main goal of this study was to compare the modular organization of bilateral lower limb control in incomplete spinal cord injury (iSCI) patients during overground walking, using muscle synergies analysis. The secondary goal was to determine whether the similarity between the patients and control group correlate with clinical indicators of walking performance. SETTING: This study was conducted in National Hospital for Spinal Cord Injury (Toledo, Spain). METHODS: Eight iSCI patients and eight healthy subjects completed 10 walking trials at matched speed. For each trial, three-dimensional motion analysis and surface electromyography (sEMG) analysis of seven leg muscles from both limbs were performed. Muscle synergies were extracted from sEMG signals using a non-negative matrix factorization algorithm. The optimal number of synergies has been defined as the minimum number needed to obtain variability accounted for (VAF) ⩾90%. RESULTS: When compared with healthy references, iSCI patients showed fewer muscle synergies in the most affected side and, in both sides, significant differences in the composition of synergy 2. The degree of similarity of these variables with the healthy reference, together with the composition of synergy 3 of the most affected side, presented significant correlations (P<0.05) with walking performance. CONCLUSION: The analysis of muscle synergies shows potential to detect differences between the two sides in patients with iSCI. Specifically, the VAF may constitute a new neurophysiological metric to assess and monitor patients' condition throughout the gait recovery process.

Diagnostic reference levels and complexity indices in interventional radiology: a national programme.

OBJECTIVES: To propose national diagnostic reference levels (DRLs) for interventional radiology and to evaluate the impact of the procedural complexity on patient doses. METHODS: Eight interventional radiology units from Spanish hospitals were involved in this project. The participants agreed to undergo common quality control procedures for X-ray systems. Kerma area product (KAP) was collected from a sample of 1,649 procedures. A consensus document established the criteria to evaluate the complexity of seven types of procedures. DRLs were set as the 3rd quartile of KAP values. RESULTS: The KAP (3rd quartile) in Gy cm2 for the procedures included in the survey were: lower extremity arteriography (n = 784) 78; renal arteriography (n = 37) 107; transjugular hepatic biopsies (THB) (n = 30) 45; biliary drainage (BD) (n = 314) 30; uterine fibroid embolization (UFE) (n = 56) 214; colon endoprostheses (CE) (n = 31) 169; hepatic chemoembolization (HC) (n = 269) 303; femoropopliteal revascularization (FR) (n = 62) 119; and iliac stent (n = 66) 170. The complexity involved the increases in the following KAP factors from simple to complex procedures: THB x4; BD x13; UFE x3; CE x3; HC x5; FR x5 and IS x4. CONCLUSIONS: The evaluation of the procedure complexity in patient doses will allow the proper use of DRLs for the optimization of interventional radiology. KEY POINTS: • National DRLs for interventional procedures have been proposed given level of complexity • For clinical audits, the level of complexity should be taken into account. • An evaluation of the complexity levels of the procedure should be made.

Yala-Yala: ¿cómo fue la gastroenteritis en Badghis (Afganistán)? / Yala-Yala: how was gastroenteritis like in Badghis (Afghanistan)?

INTRODUCCIÓN: La gastroenteritis es un compañero habitual de los contingentes militares desplegados en el exterior. Sin embargo, sus características han sido poco estudiadas. Describimos las particularidades de las observadas en un contingente militar español en la provincia afgana de Badghis. No hemos encontrado estudios similares al presentado en este trabajo. OBJETIVO: describir características de cuadros de gastroenteritis observados durante una rotación de Sanidad Militar en Afganistán. Material y MÉTODOS: Estudio descriptivo transversal. Se revisaron las consultas del ROLE-1 de la base de Qala-e-Naw durante una rotación de Sanidad (mayo a julio de 2013) que cumplían criterios de gastroenteritis (aumento 2-3 veces número habitual de deposiciones diarias / 2 vómitos diarios / 1 vómito con fiebre u otros síntomas digestivos). VARIABLES: sexo, unidad, fecha inicial, síntomas (fiebre, diarrea, vómitos, localización del dolor, productos patológicos), tratamiento, hospitalización. Análisis estadístico: SPSS 17.0. RESULTADOS: 892 militares censados (94,46% varones), 135 consultan por gastroenteritis (89,4% varones), prevalencia de 15,34%. Prevalencia según sexos: 14,35% entre hombres, 28,57% entre mujeres (RR=1,99, OR=2,3867, IC95% 1,88-3,01, p = 0,007). Dolor: 54,1% (34,24% de éstos, focalizado), náuseas 53,3%, vómitos 37,8%, diarrea 93,3%, productos patológicos 1,5% y fiebre 11,1% (febrícula 15,6%). Antibioticoterapia 8,1%, hospitalización 8,9%. Distribución normal según fecha inicial, mostrando pico máximo la cuarta semana del despliegue. DISCUSIÓN: Prevalencia de gastroenteritis observada inferior a descrita en otras publicaciones. Distribución de síntomas atribuible al tipo de población, zona geográfica, medidas preventivas o pérdida de casos que no buscaron atención. Pico máximo de aparición y mayor riesgo en mujeres coincide con otros estudios. CONCLUSIÓN: Nuevos estudios más potentes deberían diseñarse para identificar las características de esta patología en otras zonas de despliegue español

INTRODUCTION: Gastroenteritis is a common companion to troops deployed overseas since forever. However, its features are not fully known and there were no similar studies during the Spanish presence in Badghis. OBJECTIVE: To describe qualities of gastroenteritis observed during one rotation of Military Health in Afghanistan. MATERIAL AND METHODS: Descriptive study reviewing all medical consultations in ROLE-1 of Qala-e-Naw during one rotation of Military Health (from May to July 2013) who met criteria for gastroenteritis (increased 2-3 times usual number of stools / 2 vomiting daily / 1 vomiting with fever or other gastrointestinal symptoms). VARIABLES: gender, unit, start date, symptoms (fever, diarrhea, vomiting, pain location, pathological products), treatment, hospitalization. Statistical analysis: SPSS 17.0. Outcomes: 892 troops registered (94.46% male), 135 consulting for gastroenteritis (89.4% male), prevalence of 15.34%. Prevalence by sex: men 14.35%, 28.57% among women (RR = 1.99, OR = 2.3867, 95% CI 1.88-3.01, p = 0.007). Pain: 54.1% (34.24% of them, focused), 53.3% nausea, vomiting 37.8%, diarrhea 93.3%, 1.5% pathological products and fever 11.1% (low fever 15.6%). Antibiotic therapy 8.1% and ROLE-1 income 8.9%. Normal distribution as start date, showing the fourth week peak deployment. DISCUSSION: Observed prevalence of gastroenteritis is less than that reported in other publications. Distribution of symptoms attributable to the type of population, geographical area, preventive measures or loss cases not sought care. Peak at the onset of the disease and increased risk in women is consistent with other studies. CONCLUSION: New, more powerful studies should be designed to identify the characteristics of this disease in other parts of Spanish deployment

Nail-patella syndrome: report of 11 pediatric cases.

BACKGROUND: Nail-patella syndrome (NPS) is an inherited disease produced by mutations in the LMX1B gene. It is characterized by fingernail dysplasia, hypoplastic or absent patella, dysplasia of the elbows and iliac horns on X-ray. It is useful to know this syndrome since some patients develop nephropathy and eye abnormalities. There are very few accurate descriptions related to this syndrome in the literature. OBJECTIVE: Describe the features of 11 patients with NPS in a paediatric hospital. METHODS: We retrospectively reviewed our clinical database of 11 patients with proven diagnosis of NPS from 1977 to 2014. Clinical and radiological features were assessed. RESULTS: Eleven children (seven male/four female) were included in the study. Mean age at the time of diagnosis was 6.54 years (range 0-11 years). Five patients had a family history of NPS. All patients had nail abnormalities (100%), the most frequent finding being hyponychia. Triangular lunulae were observed in four patients. The knee was the most commonly affected joint, aplasia or hypoplasia of the patella being the most usual findings. Only one patient presented renal involvement. The genetic study revealed three different LMX1B mutations. CONCLUSION: Nail-patella syndrome is a rare disorder. The aim of the present study is to highlight the importance of nail examination in children with skeletal dysplasias, in order to diagnose the NPS.

Effectiveness of the Virtual Reality System Toyra on Upper Limb Function in People with Tetraplegia: A Pilot Randomized Clinical Trial.

The aim of this study was to investigate the effects of a virtual reality program combined with conventional therapy in upper limb function in people with tetraplegia and to provide data about patients' satisfaction with the virtual reality system. Thirty-one people with subacute complete cervical tetraplegia participated in the study. Experimental group received 15 sessions with Toyra(®) virtual reality system for 5 weeks, 30 minutes/day, 3 days/week in addition to conventional therapy, while control group only received conventional therapy. All patients were assessed at baseline, after intervention, and at three-month follow-up with a battery of clinical, functional, and satisfaction scales. Control group showed significant improvements in the manual muscle test (p = 0,043, partial η (2) = 0,22) in the follow-up evaluation. Both groups demonstrated clinical, but nonsignificant, changes to their arm function in 4 of the 5 scales used. All patients showed a high level of satisfaction with the virtual reality system. This study showed that virtual reality added to conventional therapy produces similar results in upper limb function compared to only conventional therapy. Moreover, the gaming aspects incorporated in conventional rehabilitation appear to produce high motivation during execution of the assigned tasks. This trial is registered with EudraCT number 2015-002157-35.