Effectiveness of mirror therapy in phantom limb pain: a literature review.

INTRODUCTION: Phantom limb pain (PLP) is a type of neuropathic pain that affects the territory of an amputated limb or other surgically removed body parts. Between 60% and 90% of amputees suffer from PLP during follow-up. There are a range of therapeutic options for PLP, both pharmacological (gabapentin, amitriptyline, tricyclic antidepressants, etc) and non-pharmacological (transcutaneous electrical nerve stimulation, hypnosis, acupuncture, etc). A widely accepted hypothesis considers PLP to be the consequence of postamputation cortical reorganisation. New treatment approaches, such as mirror therapy (MT), have been developed as a result of Ramachandran's groundbreaking research in the 1990s. This review analyses the current evidence on the efficacy of MT for treating PLP. DEVELOPMENT: We performed a literature review of publications registered from 2012 to 2017 on the CINAHL, Cochrane, Scopus, and PubMed (including Medline) databases using the descriptors "phantom limb" and "mirror therapy." We identified 115 publications addressing MT in PLP. Of these, 17 (15%) contributed useful information for pooled analysis. CONCLUSIONS: MT seems to be effective in relieving PLP, reducing the intensity and duration of daily pain episodes. It is a valid, simple, and inexpensive treatment for PLP. The methodological quality of most publications in this field is very limited, highlighting the need for additional, high-quality studies to develop clinical protocols that could maximise the benefits of MT for patients with PLP.

Efectividad de la terapia de espejo en el dolor del miembro fantasma. Una revisión actual de la literatura / Effectiveness of mirror therapy in phantom limb pain: A literature review

Introducción: El dolor del miembro fantasma (DMF) es un dolor de tipo neuropático que afecta al territorio de una extremidad amputada o a otras partes del cuerpo extirpadas quirúrgicamente. El 60-90% de los amputados sufren DMF durante el seguimiento. Se han descrito opciones terapéuticas para DMF, farmacológicas (gabapentina, amitriptilina, antidepresivos tricíclicos...) y no farmacológicas (TENS, hipnosis, acupuntura...). Una hipótesis predominante considera este fenómeno consecuencia de la reorganización cortical postamputación, y, tras investigaciones innovadoras de Ramachandran en los 90, se han desarrollado nuevos enfoques de tratamiento como la terapia de espejo (TE). En la presente revisión se analiza la evidencia actual publicada sobre la eficacia de la TE para el tratamiento del DMF.DesarrolloSe realizó una revisión bibliográfica, abarcando desde 2012 a 2017, de publicaciones registradas en las bases de datos Cinahl, Cochrane, Scopus y Pubmed (incluyendo Medline). Los descriptores utilizados para la búsqueda fueron los términos Phantom Limb y Mirror Therapy. Se identificaron 115 publicaciones que abordaban TE en DMF. De estas, 17 (15%) aportaban información útil para el análisis conjunto.ConclusionesLa TE parece ser efectiva en el alivio del DMF, reduciendo la intensidad y duración de los episodios de dolor diarios. Por otra parte, constituye un método válido, sencillo y muy económico. La calidad metodológica de la mayoría de las publicaciones en este campo es muy limitada, destacando la necesidad de estudios adicionales de alta calidad para desarrollar protocolos clínicos que puedan maximizar los beneficios de TE en pacientes con DMF. (AU)

Introduction: Phantom limb pain (PLP) is a type of neuropathic pain that affects the territory of an amputated limb or other surgically removed body parts. Between 60% and 90% of amputees suffer from PLP during follow-up. There are a range of therapeutic options for PLP, both pharmacological (gabapentin, amitriptyline, tricyclic antidepressants, etc) and non-pharmacological (transcutaneous electrical nerve stimulation, hypnosis, acupuncture, etc). A widely accepted hypothesis considers PLP to be the consequence of postamputation cortical reorganisation. New treatment approaches, such as mirror therapy (MT), have been developed as a result of Ramachandran's groundbreaking research in the 1990s. This review analyses the current evidence on the efficacy of MT for treating PLP.DevelopmentWe performed a literature review of publications registered from 2012 to 2017 on the CINAHL, Cochrane, Scopus, and PubMed (including Medline) databases Using the descriptors “phantom limb‿ and “mirror therapy.‿ We identified 115 publications addressing MT in PLP. Of these, 17 (15%) contributed useful information for pooled analysis.ConclusionsMT seems to be effective in relieving PLP, reducing the intensity and duration of daily pain episodes. It is a valid, simple, and inexpensive treatment for PLP. The methodological quality of most publications in this field is very limited, highlighting the need for additional, high-quality studies to develop clinical protocols that could maximise the benefits of MT for patients with PLP. (AU)

Frailty and cognitive impairment in Parkinson's disease: a systematic review.

BACKGROUND: Frailty can lead to increased vulnerability in older people and patients with Parkinson's disease (pwPD) and worsen their health conditions. These patients can also develop cognitive function impairment. The objective is to analyze whether there is a relationship between frailty and cognitive impairment in pwPD, and to find out which instruments to use for its evaluation. METHODS: Publications were searched in PubMed, Medline, Web of Science, Cinalh, Cochrane Library, Embase, Phycinfo, and Scopus. The results were measured with the instruments that are used to assess frailty and cognitive impairment, and analyze their relationship. RESULTS: Two hundred seventy-one articles were identified, of which 12 met the inclusion criteria. All studies assessed frailty and cognitive function in pwPD. Five studies analyzed the relationship between frailty and cognitive impairment. The most used instruments were the Fried scale followed by the Clinical Frailty Scale (CFS) for frailty. Cognitive impairment was mostly evaluated with the Mini-Mental State Examination and the Montreal Cognitive Assessment. The prevalence data ranged from 20.2 to 51.5% with the Fried scale and from 35.6 to 83.9% with the CFS. Cognitive impairment was present in 15 to 45.2% of the pwPD. CONCLUSION: Analysis of the included studies shows a relationship between frailty and cognitive impairment in pwPD. There was significant variability in the application of the scales used, which influences the prevalence data. More observational and experimental studies are needed to provide more evidence on this association and to determine which is the optimal tool to identify frailty in pwPD using multidimensional scales.

[Sickle cell disease diagnosis over a decade in a pediatric hematology unit]. / Experiencia de una década en el diagnóstico de la enfermedad de células falciformes en una unidad de referencia de hematología pediátrica.

Sickle cell disease (SCD) is an autosomal recessive hemoglobinopathy. The prevalence of SCD can change especially by migrations. OBJECTIVE: To describe the characteristics of patients with SCD at diagnosis, in a referral hospital over a decade. PATIENTS AND METHOD: Retrospective study of the cli nical and laboratory characteristics of children under 15 years of age with SCD, diagnosed in the Onco-Hematology Service of the Hospital Dr. Roberto del Rio, Santiago, Chile, between April 2008 and March 2018. Sex, age, nationality, symptoms, blood count characteristics, and hemoglobin elec trophoresis results were evaluated by descriptive statistical analysis. RESULTS: Sixteen patients were included, 2 were healthy carriers so were excluded from the analysis. Of the 14 analyzed, the diagnosis was made before 2015 in 2 patients. Twelve were male, 9 were Chilean, 13 had foreign parents. Eight were less than 2 years old and 12 were symptomatic. The most frequent symptoms were limb pain and anemia. Median hemoglobin was 8.2 g/dL (6.2-12.3), in 11/14 sickle cells were observed, in 4 by metabisulfite test. In 13/14, hemoglobin electrophoresis was performed, median hemoglobin S 70.2% (28.2-87.1) and hemoglobin F 18.7% (0-32.3). Only one patient had a genetic study. Thirteen patients were still in follow-up, 84.6% of them received folic acid and amoxicillin, 53.8% required transfusions, and 69.2% started hydroxyurea. CONCLUSION: SCD has increased in Chile; therefore, a high degree of suspicion is required. The diagnosis, treatment, and follow-up of this pathology should be improved at the local level.

Effectiveness of mirror therapy in phantom limb pain: A literature review. / Efectividad de la terapia de espejo en el dolor del miembro fantasma. Una revisión actual de la literatura.

INTRODUCTION: Phantom limb pain (PLP) is a type of neuropathic pain that affects the territory of an amputated limb or other surgically removed body parts. Between 60% and 90% of amputees suffer from PLP during follow-up. There are a range of therapeutic options for PLP, both pharmacological (gabapentin, amitriptyline, tricyclic antidepressants, etc) and non-pharmacological (transcutaneous electrical nerve stimulation, hypnosis, acupuncture, etc). A widely accepted hypothesis considers PLP to be the consequence of postamputation cortical reorganisation. New treatment approaches, such as mirror therapy (MT), have been developed as a result of Ramachandran's groundbreaking research in the 1990s. This review analyses the current evidence on the efficacy of MT for treating PLP. DEVELOPMENT: We performed a literature review of publications registered from 2012 to 2017 on the CINAHL, Cochrane, Scopus, and PubMed (including Medline) databases Using the descriptors "phantom limb‿ and "mirror therapy.‿ We identified 115 publications addressing MT in PLP. Of these, 17 (15%) contributed useful information for pooled analysis. CONCLUSIONS: MT seems to be effective in relieving PLP, reducing the intensity and duration of daily pain episodes. It is a valid, simple, and inexpensive treatment for PLP. The methodological quality of most publications in this field is very limited, highlighting the need for additional, high-quality studies to develop clinical protocols that could maximise the benefits of MT for patients with PLP.

[Current status of immersive virtual reality as a tool for physical and functional rehabilitation in patients with Parkinson´s disease: systematic review]. / Estado actual de la realidad virtual inmersiva como herramienta de rehabilitación física y funcional en pacientes con enfermedad de Parkinson: revisión sistemática.

INTRODUCTION: Parkinson's disease (PD) is a complex neurodegenerative process that usually appears from the 6th decade of life and is characterized by the appearance of motor and non-motor symptoms that progress, generating functional disability and negatively impacting in quality of life. Recently, Immersive Virtual Reality (IVR) has great positive impact on health domains: as a support in psychotherapy or as a treatment of cognitive-behavioral pathologies in neurological patients. OBJECTIVE: To analyze the current published evidence in the fields of physical and functional PD rehabilitation in fully immersive environments. MATERIALS AND METHODS: A literature review, covering publications registered until December 2020 in Cinahl, Scopus, Web of Science, Sport-Discus, Dialnet and Pubmed (including Medline) was carried out. The descriptors used for the search were the terms: Parkinson disease, Virtual Reality and Exercise therapy. 140 publications were identified that addressed IVR with physical rehabilitation proposes in PD. Of these, 7 contribute useful information for pooled analysis. RESULTS: The results support the application of IVR to improve physical and functional capacities in the population with PD. Its feasibility, usability and safety suggest potential benefits in the treatment of the prevalent symptoms of the parkinsonian patient. CONCLUSIONS: Research of high methodological quality is lacking, reflecting and early stage of preclinical development. Randomized control studies with larger sample size and IVR protocols that confirm the results, while analyzing their impact on the physical and functional variables related to PD are needed.

TITLE: Estado actual de la realidad virtual inmersiva como herramienta de rehabilitación física y funcional en pacientes con enfermedad de Parkinson: revisión sistemática.Introducción. La enfermedad de Parkinson (EP) es un proceso neurodegenerativo que se caracteriza por la aparición de síntomas motores y no motores que progresan, generando discapacidad funcional e impactando negativamente en la calidad de vida del paciente. Recientemente, la realidad virtual inmersiva ha adquirido gran relevancia como apoyo al tratamiento de patologías cognitivo-conductuales del paciente neurológico. Objetivo. Analizar la evidencia actual publicada en el campo de la rehabilitación física y funcional de la EP en entornos completamente inmersivos. Materiales y métodos. Se realizó una revisión bibliográfica de publicaciones registradas en las bases de datos Medline, Cinahl, PubMed, Scopus, Web of Science, Sport-Discus y Dialnet hasta diciembre de 2020. Los descriptores utilizados para la búsqueda fueron: Parkinson disease, Virtual Reality y Exercise therapy. Tras la aplicación de los criterios de selección, del total de 140 artículos identificados, se seleccionaron siete. Resultados. Describen una experiencia segura, positiva y factible, aunque obtenidos, en su mayoría, tras la aplicación de una única sesión. Los resultados hallados en las variables vinculadas a las capacidades funcionales que se deben mejorar en la EP apoyan potenciales beneficios en el tratamiento de la sintomatología prevalente del paciente parkinsoniano. Conclusiones. Los pocos estudios existentes muestran resultados preliminares, por lo que se hacen necesarias más investigaciones de mayor calidad metodológica, mayor tamaño muestral, con un proceso de control aleatorizado y protocolos que confirmen los resultados, al tiempo que analicen su impacto en las variables físicas y funcionales vinculadas a la patología parkinsoniana.

Estado actual de la realidad virtual inmersiva como herramienta de rehabilitación física y funcional en pacientes con enfermedad de Parkinson: revisión sistemática / Current status of immersive virtual reality as a tool for physical and functional rehabilitation in patients with Parkinson´s disease: systematic review

Introducción: La enfermedad de Parkinson (EP) es un proceso neurodegenerativo que se caracteriza por la aparición de síntomas motores y no motores que progresan, generando discapacidad funcional e impactando negativamente en la calidad de vida del paciente. Recientemente, la realidad virtual inmersiva ha adquirido gran relevancia como apoyo al tratamiento de patologías cognitivo-conductuales del paciente neurológico. Objetivo: Analizar la evidencia actual publicada en el campo de la rehabilitación física y funcional de la EP en entornos completamente inmersivos. Materiales y métodos: Se realizó una revisión bibliográfica de publicaciones registradas en las bases de datos Medline, Cinahl, PubMed, Scopus, Web of Science, Sport-Discus y Dialnet hasta diciembre de 2020. Los descriptores utilizados para la búsqueda fueron: Parkinson disease, Virtual Reality y Exercise therapy. Tras la aplicación de los criterios de selección, del total de 140 artículos identificados, se seleccionaron siete.Resultados: Describen una experiencia segura, positiva y factible, aunque obtenidos, en su mayoría, tras la aplicación de una única sesión. Los resultados hallados en las variables vinculadas a las capacidades funcionales que se deben mejorar en la EP apoyan potenciales beneficios en el tratamiento de la sintomatología prevalente del paciente parkinsoniano. Conclusiones: Los pocos estudios existentes muestran resultados preliminares, por lo que se hacen necesarias más investigaciones de mayor calidad metodológica, mayor tamaño muestral, con un proceso de control aleatorizado y protocolos que confirmen los resultados, al tiempo que analicen su impacto en las variables físicas y funcionales vinculadas a la patología parkinsoniana.(AU)

Introduction: Parkinson’s disease (PD) is a complex neurodegenerative process that usually appears from the 6th decade of life and is characterized by the appearance of motor and non-motor symptoms that progress, generating functional disability and negatively impacting in quality of life. Recently, Immersive Virtual Reality (IVR) has great positive impact on health domains: as a support in psychotherapy or as a treatment of cognitive-behavioral pathologies in neurological patients. Objective: To analyze the current published evidence in the fields of physical and functional PD rehabilitation in fully immersive environments. Materials and methods: A literature review, covering publications registered until December 2020 in Cinahl, Scopus, Web of Science, Sport-Discus, Dialnet and Pubmed (including Medline) was carried out. The descriptors used for the search were the terms: Parkinson disease, Virtual Reality and Exercise therapy. 140 publications were identified that addressed IVR with physical rehabilitation proposes in PD. Of these, 7 contribute useful information for pooled analysis. Results: The results support the application of IVR to improve physical and functional capacities in the population with PD. Its feasibility, usability and safety suggest potential benefits in the treatment of the prevalent symptoms of the parkinsonian patient. Conclusions: Research of high methodological quality is lacking, reflecting and early stage of preclinical development. Randomized control studies with larger sample size and IVR protocols that confirm the results, while analyzing their impact on the physical and functional variables related to PD are needed.(AU)

Segundas resecciones anatómicas en pacientes con resección anatómica previa / Second pulmonary anatomical lung resections in patients with previous anatomical resections

Resumen Introducción: Las segundas resecciones anatómicas son cada vez más frecuentes en el tratamiento de carcinomas pulmonares sincrónicos, metacrónicos y de metástasis pulmonares de origen extrapulmonar. Objetivo: Determinar si las segundas resecciones anatómicas pulmonares se asocian con un mayor riesgo de complicaciones posoperatorias comparadas con la primera intervención. Materiales y Método: Hemos analizado todos los pacientes sometidos a una segunda resección anatómica en nuestro centro entre octubre de 2000 y febrero de 2019. Las complicaciones fueron clasificadas en mayores y menores según la clasificación estandarizada de morbilidad posoperatoria de Clavien-Dindo. Se compararon las características clínicas y demográficas de los pacientes y la ocurrencia de complicaciones mayores tras la primera y la segunda intervención quirúrgica mediante la prueba T para muestras relacionadas y la prueba exacta de McNemar para las variables cuantitativas y categóricas, respectivamente. Resultados: Setenta y cinco pacientes fueron sometidos a una segunda resección anatómica. La prevalencia de complicaciones globales y mayores tras la primera intervención fue del 26,7% y el 4% frente al 34,7% y al 6,7% tras la segunda intervención (p = 0,362 y p = 0,727, respectivamente). Las segundas resecciones pulmonares ipsilaterales se asociaron con un 16,7% de complicaciones mayores y los procedimientos consistentes en completar la neumonectomía con un 25%. Conclusión: Las segundas resecciones anatómicas pulmonares no se asocian con un mayor riesgo de complicaciones posoperatorias comparadas con la primera intervención. Sin embargo, las segundas resecciones ipsilaterales y las resecciones que impliquen completar la neumonectomía se asocian con riesgo significativamente superior de complicaciones mayores posoperatorias.

Introduction: Second anatomical resections are becoming more frequent in the treatment of synchronous, metachronous and pulmonary metastases of extrapulmonary origin. Aim: The objective of this study is to determine whether second pulmonary anatomical resections are associated with an increased risk of postoperative complications compared to the first intervention. Materials and Method: We have analyzed all patients undergoing a second anatomical resection in our center between October 2000 and February 2019. Complications were classified in major and minor according to the standardized Clavien-Dindo postoperative morbidity classification. The clinical and demographic characteristics of the patients and the occurrence of major complications after the first and second surgical intervention were compared using the T test for related samples and the McNemar exact test for quantitative and categorical variables, respectively. Results: Seventy-five patients underwent a second anatomic resection. The prevalence of global and major complications after the first intervention was 26.7% and 4% compared to 34.7% and 6.7% after the second intervention (p = 0.362 and p = 0.727, respectively). Second ipsilateral lung resections were associated with 16.7% of major complications and procedures consisting of completing pneumonectomy with 25%. Conclusion: Second lung anatomical resections are not associated with an increased risk of postoperative complications compared to the first intervention. However, second ipsilateral resections and resections that involve completing pneumonectomy are associated with a significantly higher risk of major postoperative complications.

Reduction of atmospheric emissions due to switching from fuel oil to natural gas at a power plant in a critical area in Central Mexico.

A case study was conducted to evaluate the SO2 emission reduction in a power plant in Central Mexico, as a result of the shifting of fuel oil to natural gas. Emissions of criteria pollutants, greenhouse gases, organic and inorganic toxics were estimated based on a 2010 report of hourly fuel oil consumption at the "Francisco Pérez Ríos" power plant in Tula, Mexico. For SO2, the dispersion of these emissions was assessed with the CALPUFF dispersion model. Emissions reductions of > 99% for SO2, PM and Pb, as well as reductions >50% for organic and inorganic toxics were observed when simulating the use of natural gas. Maximum annual (993 µg/m3) and monthly average SO2 concentrations were simulated during the cold-dry period (152-1063 µg/m3), and warm-dry period (239-432 µg/m3). Dispersion model results and those from Mexico City's air quality forecasting system showed that SO2 emissions from the power plant affect the north of Mexico City in the cold-dry period. The evaluation of model estimates with 24 hr SO2 measured concentrations at Tepeji del Rio suggests that the combination of observations and dispersion models are useful in assessing the reduction of SO2 emissions due to shifting in fuels. Being SO2 a major precursor of acid rain, high transported sulfate concentrations are of concern and low pH values have been reported in the south of Mexico City, indicating that secondary SO2 products emitted in the power plant can be transported to Mexico City under specific atmospheric conditions. Implications: Although the surroundings of a power plant located north of Mexico City receives most of the direct SO2 impact from fuel oil emissions, the plume is dispersed and advected to the Mexico City metropolitan area, where its secondary products may cause acid rain. The use of cleaner fuels may assure significant SO2 reductions in the plant emissions and consequent acid rain presence in nearby populated cities and should be compulsory in critical areas to comply with annual emission limits and health standards.

Anatomía radiológica de la base de cráneo y los nervios craneales parte 2: Nervios craneales / Skull base and cranial nerves radiologic anatomy part 2: Cranial nerves

Resumen: La anatomía de la base del cráneo es compleja. Numerosas estructuras neurovasculares vitales pasan a través de múltiples canales y agujeros ubicados en la base del cráneo. Con el avance de la tomografía computarizada (TC) y la resonancia magnética (RM), es posible la localización cada vez más precisa de lesiones y la evaluación de su relación con las estructuras neurovasculares adyacentes. El trayecto de los nervios craneales sigue un recorrido conocido y se transmiten a la cara y cuello por los forámenes de base de cráneo. La tomografía computada y la resonancia magnética son complementarias entre sí y, a menudo, se usan juntas para demostrar la extensión total de la enfermedad. La segunda parte de esta revisión se centra en el estudio radiológico de los nervios craneales.

Abstract: The skull base anatomy is complex. Many vital neurovascular structures course through the skull base canals and foramina. With the advancement of CT and MRI, the localization of lesions has become more precise as their relationship with adjacent neurovascular structures. There is a known course of the cranial nerves as well as their skull base exiting foramina to the head and neck. CT and MRI are complimentary modalities and are often used together to map the full extent of disease. The second article in this review focus on the radiologic study of the cranial nerves.

Variation in boldness and novelty response between rural and urban predatory birds: The Chimango Caracara, Milvago chimango as study case.

The study of traits that enable species to thrive in urban habitats is critical to a better understanding the evolution of urban ecosystems. Here, we examined variation in boldness, neophobia, and exploratory behavior in a generalist raptor, the Chimango Caracara, Milvago chimango, occurring in areas with different urbanization level. We also focused on the relationship between object exploration and neophobia in rural and urban population of this species. The results showed that birds from more urbanized habitats showed more tolerance to humans than rural raptors, without any effect of age and sex in this trait. Rural birds were also more neophobic and were slower to explore than urban raptors, though they dedicated a similar amount of time to exploring novel objects, indicating a non-correspondence between the speed to approach and contact these objects and the amount of exploration performed. Finally, we found a correlation between exploration speed and neophobia in rural birds, whereas for urban raptors this correlation was not observed. Our results show that urbanization not only influences the expression of risk-taking behaviors and novelty responses in the chimango, but can also modify the relationship between exploration and neophobia.

Aplicación de un programa de ejercicios con atención focalizada en 2 pacientes afectados por síndrome de Parkinson-plus / Application of a focused-attention exercise program in two patients affected by Parkinson-plus syndrome

Antecedentes y objetivo: El síndrome de Parkinson-Plus, también conocido como síndrome parkinsoniano atípico, es clínicamente muy heterogéneo y presenta una mala respuesta a los tratamientos farmacológicos antiparkinsonianos. Además, tiene peor pronóstico y una progresión más rápida comparado con la enfermedad de Parkinson. Dada la poca evidencia existente en la aplicación de terapia por ejercicio en este síndrome, y con la intención de ir formando un cuerpo de conocimiento sobre el uso de dichas terapias en estos pacientes, se presenta la intervención realizada en 2 pacientes. Material y métodos: Se intervino en 2 pacientes con síndrome de Parkinson-plus mediante un programa de ejercicios de atención focalizada, concebido específicamente para este colectivo y con la finalidad de atenuar o detener la vertiginosa pérdida de las capacidades físicas y mentales. Se realizaron 2 controles (pre y postintervención) y las escalas empleadas fueron la versión española del 39-item Parkinson's Disease Questionnaire y la Escala de Tinetti, así como el Mini-Mental State Exam para descartar trastorno cognitivo que impidiese seguir la sesión. Resultados y conclusiones: Se objetiva una leve mejoría en los valores absolutos de equilibrio, marcha y calidad de vida. Los hallazgos sugieren una probable utilidad del programa de ejercicios implementado, como una estrategia rehabilitadora válida, ya que podría mejorar y/o evitar la rápida pérdida de capacidades funcionales que afectan al equilibrio, la marcha y la calidad de vida. Se hacen necesarios estudios más apropiados para refrendar estas conclusiones

Background and objective: Parkinson-plus syndrome, also known as atypical Parkinsonian syndrome, is very heterogeneous clinically and responds poorly to antiparkinsonian (drug) therapies. It is characterized by worse prognosis and faster clinical progression compared to Parkinson's Disease. Evidence supporting the application of exercise therapy in this syndrome is lacking, we present here a therapeutic approach to these subjects with the aim of proposing a framework for therapists. Material and methods: Two patients with Parkinson-plus syndrome were treated through a programme of focused-attention exercises, specifically designed for this group and with the aim of decreasing or stopping the loss of physical and mental abilities. Two controls were carried out (pre and post intervention) and the scales used were the Spanish version of the 39-item Parkinson's Disease Questionnaire and the Tinetti Scale, as well as the Mini Mental State Exam to rule out cognitive disorder that would prevent the subjects following the sessions. Results and conclusions: A slight improvement was observed in the absolute values of balance, gait and quality of life. The findings suggest probable utility of the exercise programme implemented, as a valid rehabilitative strategy, since it could improve and/or prevent the rapid loss of functional capacities that affect balance, gait and quality of life. More appropriate studies are necessary to endorse these conclusions

A Bayesian extension of phylogenetic generalized least squares: Incorporating uncertainty in the comparative study of trait relationships and evolutionary rates.

Phylogenetic comparative methods use tree topology, branch lengths, and models of phenotypic change to take into account nonindependence in statistical analysis. However, these methods normally assume that trees and models are known without error. Approaches relying on evolutionary regimes also assume specific distributions of character states across a tree, which often result from ancestral state reconstructions that are subject to uncertainty. Several methods have been proposed to deal with some of these sources of uncertainty, but approaches accounting for all of them are less common. Here, we show how Bayesian statistics facilitates this task while relaxing the homogeneous rate assumption of the well-known phylogenetic generalized least squares (PGLS) framework. This Bayesian formulation allows uncertainty about phylogeny, evolutionary regimes, or other statistical parameters to be taken into account for studies as simple as testing for coevolution in two traits or as complex as testing whether bursts of phenotypic change are associated with evolutionary shifts in intertrait correlations. A mixture of validation approaches indicates that the approach has good inferential properties and predictive performance. We provide suggestions for implementation and show its usefulness by exploring the coevolution of ankle posture and forefoot proportions in Carnivora.

Vértigo posicional paroxístico benigno y su tratamiento con maniobras de reposicionamiento: revisión sistemática. Respuesta de los autores / Benign paroxysmal positional vertigo and its treatment with repositioning maneuvers: a systematic review. Author's reply

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Identification of up-regulated genes from the metal-hyperaccumulator aquatic fern Salvinia minima Baker, in response to lead exposure.

Lead (Pb) is one of the most serious environmental pollutants. The aquatic fern Salvinia minima Baker is capable to hyper-accumulate Pb in their tissues. However, the molecular mechanisms involved in its Pb accumulation and tolerance capacity are not fully understood. In order to investigate the molecular mechanisms that are activated by S. minima in response to Pb, we constructed a suppression subtractive hybridization library (SSH) in response to an exposure to 40µM of Pb(NO3)2 for 12h. 365 lead-related differentially expressed sequences tags (ESTs) were isolated and sequenced. Among these ESTs, 143 unique cDNA (97 were registered at the GenBank and 46 ESTs were not registered, because they did not meet the GenBank conditions). Those ESTs were identified and classified into 3 groups according to Blast2GO. In terms of metabolic pathways, they were grouped into 29 KEGG pathways. Among the ESTs, we identified some that might be part of the mechanism that this fern may have to deal with this metal, including abiotic-stress-related transcription factors, some that might be involved in tolerance mechanisms such as ROS scavenging, membrane protection, and those of cell homeostasis recovery. To validate the SSH library, 4 genes were randomly selected from the library and analyzed by qRT-PCR. These 4 genes were transcriptionally up-regulated in response to lead in at least one of the two tested tissues (roots and leaves). The present library is one of the few genomics approaches to study the response to metal stress in an aquatic fern, representing novel molecular information and tools to understand the molecular physiology of its Pb tolerance and hyperaccumulation capacity. Further research is required to elucidate the functions of the lead-induced genes that remain classified as unknown, to perhaps reveal novel molecular mechanisms of Pb tolerance and accumulation capacity in aquatic plants.

Vértigo posicional paroxístico benigno y su tratamiento con maniobras de reposicionamiento: revisión sistemática / Benign paroxysmal positional vertigo and its treatment with repositioning manoeuvres: a systematic review

Con el objetivo de revisar los resultados recientes obtenidos tras la aplicación de maniobras de reposicionamiento en el tratamiento del vértigo posicional paroxístico benigno (VPPB), se realizó una búsqueda de enero de 2010 a mayo de 2016 en Medline, Scopus, Web of Science, CINAHL y PubMed. Los criterios de inclusión fueron: estudios con pacientes afectados por VPPB, a los que se les realizase una maniobra de reposicionamiento, y con resultados pre- y postintervención. Se obtuvieron 17 estudios. Estos resaltan que el canal semicircular posterior es el más afectado habitualmente, que el VPPB afecta más a mujeres y durante la sexta y séptima décadas de la vida, que el principal test de valoración empleado es el de Dix-Hallpike y que la maniobra de Epley es la más usada y parece que más efectiva. Sin embargo, se precisa protocolizar las pautas diagnósticas y de tratamiento del VPPB, teniendo en cuenta que hay resoluciones espontáneas, afectación de otros canales semicirculares distintos al posterior o pueden existir contraindicaciones a determinados movimientos en algunos pacientes. Además, son necesarios estudios de mayor calidad metodológica (AU)

This study aimed to review current evidence on the results obtained after implementation of repositioning manoeuvres in the treatment of benign paroxysmal positional vertigo (BPPV). To do this, a search was made of Medline, Scopus, Web of Science, CINAHL and PubMed databases for articles published from January 2010 to May 2016. Inclusion criteria consisted of studies in patients with BPPV treated with a repositioning manoeuvre, and with pre- and postintervention results. Seventeen studies were obtained. The main results indicate that the posterior semicircular canal is usually the most affected site and that BPPV is more common in men than in women and during the sixth and seventh decades of life; the main test used is the Dix-Hallpike test and the most widely used manoeuver is the Epley manoeuvre, which seems to be the most effective. However, guidelines on the diagnosis and treatment of BPPV should be protocol-based, considering that the condition sometimes resolves spontaneously, there may be involvement of other semicircular canals, and certain movements may be contraindicated in some patients. There is a need for studies with higher methodological quality (AU)

Síndrome de Vogt-Koyanagi-Harada en niños / Vogt-Koyanagi-Harada syndrome in children

Vogt-Koyanagi-Harada (VKH) syndrome is a systemic inflammatory disease that causes chronic and bilateral granulomatous panuveitis, usually described in adults. Objectives: To describe manifestations and complications of VKH in pediatric patients. Methods: Retrospectivedescriptive study upon patients <14 years-old with VKH, attended from January 1985 to July 2010 in three different centers. Results: A total of 17 patients (34 eyes) were studied; 9 (53%) female. The mean age was 10.8 years-old. Among extraocular manifestations; neurological (71%), dermatological (29%) and auditive (24%) signs were observed. Ocular findings included optic-disc involvement (94%), anterior uveitis (79%), choroiditis (77%), serous retinal detachment (71%) and vitritis (71%). Initial visual acuity (VA) was ≤0.05 in 47% of cases and ≥0.6 in 12% of patients. 71% presented complications: glaucoma (20 eyes), sinechiae (10 eyes), maculopathy (6 eyes) cataract (5 eyes) and ptisis bulbi (1 eyes). 35% received only corticosteroids and 65% inmunosupressive drugs. After treatment, 6% had VA ≤0.05 and 59% ≥0.6. Ten patients (59%) recurred: 30% compromising posterior pole, and 50% recurred >3 times. Conclusions: VKH in children is infrequent. It presents with optic-disc involvement and complications of posterior pole. It requires a high degree of suspicion, quick evaluation and early treatment, which include inmunosupressive and extended corticosteroid therapy. Nevertheless, a high rate of recurrence is seen among this group of patients. (AU)

Repeated evolution of viviparity in phrynosomatid lizards constrained interspecific diversification in some life-history traits.

In vertebrates, viviparity has evolved independently multiple times, apparently increasing morphological diversification and speciation rates as a consequence. We tested whether the evolution of viviparity has also increased diversification of life-history traits by estimating evolutionary rates of lizards from the North American family Phrynosomatidae. Using modern phylogenetic comparative methods, we compared these rates between oviparous and viviparous species, and found no support for this hypothesis. Instead, we found higher evolutionary rates for oviparous species in some life-history traits. Our results suggest that the evolution of viviparity may have constrained rather than facilitated evolution of life histories.