Evaluation of Capillary and Other Vessel Contribution to Macular Perfusion Density Measured with Optical Coherence Tomography Angiography.

Parafoveal circulation of the superficial retinal capillary plexus is usually measured with vessel density, which determines the length of capillaries with circulation, and perfusion density, which calculates the percentage of the evaluated area that has circulation. Perfusion density also considers the circulation of vessels larger than capillaries, although the contribution of these vessels to the first is not usually evaluated. As both measurements are automatically generated by optical coherence tomography angiography devices, this paper proposes a method for estimating the contribution of vessels larger than capillaries by using a coefficient of determination between vessel and perfusion densities. This method can reveal a change in the proportion of perfusion density from vessels larger than capillaries, even when mean values do not differ. This change could reflect compensatory arterial vasodilatation as a response to capillary dropout in the initial stages of retinal vascular diseases before clinical retinopathy appears. The proposed method would allow the estimation of the changes in the composition of perfusion density without the need for other devices.

Effects of Dry Needling on Spasticity and Range of Motion: A Systematic Review.

IMPORTANCE: This systematic review summarizes existing studies on dry needling for spasticity and range of motion (ROM) and discusses its potential for use as an occupational therapy intervention. OBJECTIVE: To examine existing studies on the effects of dry needling on spasticity and ROM. DATA SOURCES: Article citations and abstracts from Scopus, Cochrane Library, PubMed, CINAHL, and a university library search. STUDY SELECTION AND DATA COLLECTION: Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in abstracting data. Peer-reviewed journal articles published in English between January 2007 and June 2019 were searched. Of 270 identified studies, 10 met the inclusion criteria. Studies were divided into categories on the basis of outcome measures (Modified Modified Ashworth Scale and ROM). Pain outcome measures were excluded because a systematic review addressing this outcome has recently been completed. FINDINGS: Strong evidence was found to support the use of dry needling to decrease spasticity and increase ROM. CONCLUSIONS AND RELEVANCE: This systematic review suggests that dry needling is an effective physical agent modality to decrease spasticity and increase ROM, both of which are potentially beneficial to functional outcomes. WHAT THIS ARTICLE ADDS: This article provides information that may be helpful in determining the appropriateness of dry needling as an occupational therapy intervention.

Factores de riesgo asociados a los resultados potencialmente insatisfactorios y a la mortalidad durante el tratamiento antituberculoso en España / Risk factors for potentially unsuccessful results and mortality during tuberculosis treatment in Spain

Fundamentos: la curación del 85% de los casos de tuberculosis (TB) es uno de los retos de los programas de control de la enfermedad. El objetivo de este trabajo fue determinar los factores que influyen en los resultados insatisfactorios y la mortalidad durante el tratamiento antituberculoso en España. Métodos: estudio retrospectivo que incluyó 5.880 casos de TB declarados en 2012. Los resultados del tratamiento se clasificaron en: satisfactorios (RS: curación y tratamiento completo), potencialmente insatisfactorios (RPI: fracaso, traslado, abandono, tratamiento prolongado, desconocido) y fallecimiento. Se analizó la asociación del RPI y mortalidad con variables clínicas y epidemiológicas, mediante regresión logística. Se ajustaron dos modelos según el origen de los casos (español/extranjero). Resultados: los RS fueron 81% en españoles y 79% en extranjeros. Los españoles presentaron una mortalidad del 8% vs al 2% en los extranjeros) y menos traslados (2% vs 6%). A nivel multivariado los factores de riesgo asociados a RPI en españoles fueron la coinfección TB-VIH (OR 1,6 IC95% 1,09-2,29) y el tratamiento previo (OR 2,4 IC95% 1,67-3,53). En las personas extranjeras fueron la coinfección TB-VIH (OR 1,7 IC95% 1,15-2,60), ser hombre (OR 1,4 IC95% 1,11-1,83) y la localización pulmonar (OR 1,6 IC95% 1,22-2,09). Los predictores de mortalidad en españoles fueron la coinfección TB-VIH (OR 2,7 IC95% 1,63-4,54), ser hombre (OR 1,4 IC95% 1,09-1,89), la localización pulmonar (OR 1,5 IC95% 1,13-1,95) y la edad (OR 8,9 IC95% 5,16-15,67 en mayores de 45 años). Y en extranjeros la coinfección TB-VIH (OR 3,2 IC95% 1,53-6,76), ser hombre (OR 2,2 IC95% 1,01-4,60) y la edad (OR 3,4 IC95% 1,81-6,48 en mayores de 45 años). Conclusiones: el porcentaje de resultados satisfactorios del tratamiento antituberculosos en España no alcanza los objetivos internacionales, especialmente en las personas extranjeras. Para disminuir los resultados insatisfactorios y la mortalidad es necesario mejorar el manejo de los sujetos coinfectados TB-VIH, los casos previamente tratados, las localizaciones pulmonares, a los hombres y a las personas de edad avanzada (AU)

Background: successful result of treatment in 85% of cases is the target of a Tuberculosis (TB) Control Programme. The aim of this study is to determine the risk factors for unsuccessful completion of treatment and deaths of TB cases in Spain. Methods: data from the National Surveillance Epidemiological Network. Retrospective study including 5,880 TB cases reported in 2012. Outcomes were classified as: successful (S: cured and treatment completed), potentially unsuccessful (PU: failed, transferred, defaulted, still on treatment and unknown) and deaths. Logistic regression analysis was used to explore the association between epidemiological and clinical factors with PU and deaths as outcome variables. Two different models for nationals and foreigners were adjusted. Results: successful outcome was 81% in nationals and 79% in foreigners. Spanish TB cases had higher mortality rates than foreigners (8% vs. 2%), and lower percentage of transfers (2% vs. 6%). At multivariate level the risk factors for PU in nationals were: HIV coinfection (OR 1.6 CI95% 1.09-2.29) and previous treatment (OR 2.4 CI95% 1.67-3.53); and HIV coinfection (OR 1.7 CI95% 1.15-2.60), male sex (OR 1.4 CI95% 1.11-1.83) and pulmonary TB (OR 1.6 CI95% 1.22-2.09) in foreigners. Risk factors for death in nationals were: HIV coinfection (OR 2.7 CI95% 1.63-4.54), male sex (OR 1.4 CI95% 1.09-1.89), pulmonary TB (OR 1.5 CI95% 1.13-1.95) and an increasing risk with age (OR 8.9 CI95% 5.16-15.67 in over 45 years group.).; and HIV coinfection (OR 3.2 CI95% 1.53-6.76), male sex (OR 2.2 CI95% 1.01-4.60) and older age(OR 3.4 CI95% 1.81-6.48 in over 45 years group.) in foreigners. Conclusion: the rate of successful treatment in Spain does not meet the international target, especially in foreigners. To reduce unsuccessful treatment and deaths it is necessary to improve management in TB-HIV coinfected cases, and those with previous treatment story, pulmonary TB, males and older age (AU)

Specific genes involved in synthesis and editing of heparan sulfate proteoglycans show altered expression patterns in breast cancer.

BACKGROUND: The expression of a specific set of genes controls the different structures of heparan sulfate proteoglycans (HSPGs), which are involved in the growth, invasion and metastatic properties of cancerous cells. The purpose of this study is to increase knowledge of HSPG alterations in breast cancer. METHODS: Twenty-three infiltrating ductal adenocarcinomas (IDCs), both metastatic and non-metastatic were studied. A transcriptomic approach to the structure of heparan sulfate (HS) chains was used, employing qPCR to analyze both the expression of the enzymes involved in their biosynthesis and editing, as well as the proteoglycan core proteins. Since some of these proteoglycans can also carry chondroitin sulfate chains, we extended the study to include the genes involved in the biosynthesis of these glycosaminoglycans. Histochemical techniques were also used to analyze tissular expression of particular genes showing significant expression differences, of potential interest. RESULTS: No significant change in transcription was detected in approximately 70% of analyzed genes. However, 13 demonstrated changes in both tumor types (40% showing more intense deregulation in the metastatic), while 5 genes showed changes only in non-metastatic tumors. Changes were related to 3 core proteins: overexpression of syndecan-1 and underexpression of glypican-3 and perlecan. HS synthesis was affected by lower levels of some 3-O-sulfotransferase transcripts, the expression of NDST4 and, only in non metastatic tumors, higher levels of extracellular sulfatases. Furthermore, the expression of chondroitin sulfate also was considerably affected, involving both the synthesis of the saccharidic chains and sulfations at all locations. However, the pro-metastatic enzyme heparanase did not exhibit significant changes in mRNA expression, although in metastatic tumors it appeared related to increased levels of the most stable form of mRNA. Finally, the expression of heparanase 2, which displays anti-metastatic features, experienced a strong deregulation in all patients analyzed. CONCLUSIONS: IDCs show alterations in the expression of HSPG genes; principally the expression and localization of proteoglycans and the sulfation patterns of glycosaminoglycan chains, depending on the metastatic nature of the tumor. In addition, the anti-proliferative molecule heparanase 2 experiences strong deregulation, thus highlighting it as a potentially interesting diagnostic factor.

Migración y ruralización del SIDA: relatos de vulnerabilidad en comunidades indígenas de México / Migration and ruralization of AIDS: reports on vulnerability of indigenous communities in Mexico

OBJETIVO: Analizar la vulnerabilidad para ITS/VIH entre mujeres Purépechas y Zapotecas unidas en concubinato con varones que practican sexo sin protección. MÉTODOS: Estudio etnográfico realizado en febrero del 2004 y en diciembre del 2005 en localidades indígenas de Michoacán y Oaxaca, Mexico. Estos son entidades con niveles altos de expulsión migratoria, rezago comunitario y casos registrados de VIH/SIDA. Se entrevistaron en profundidad a 91 personas: migrantes temporales (24), mujeres indígenas (33), autoridades locales (20) y personal de salud (14). RESULTADOS: La ruralización del ITS/VIH puede relacionarse con las prácticas de iniciación sexual femeninas pero sobre todo con el miedo del migrante a que su concubina tenga relaciones extra-conyugales en su ausencia. El embarazo y la crianza son recursos masculinos de control de las esposas. CONCLUSIONES: La migración de retorno implica formas de vulnerabilidad para las mujeres indígenas en las localidades estudiadas, cuya sexualidad tiene un remarcado carácter reproductivo. Es necesario implementar políticas de prevención para ITS/VIH dirigidas a fortalecer derechos sexuales y reproductivos de las mujeres y que tomen en cuenta aspectos de identidad sexual masculina.

OBJECTIVE: To evaluate the vulnerability for STI/HIV among Mexican indigenous women in common law marriage with men who practice sex without condom. METHODS: Ethnography study undertaken in indigenous villages of Michoacán and Oaxaca, Mexico, in February 2004 and December 2005. These rural communities are characterized by high migration rates, extreme poverty and HIV/AIDS cases. An in-depth interview was applied to transient migrants (24), indigenous women (33), local authorities (20) and health providers (14). RESULTS: Rural propagation of STI/HIV is associated to sexual female initiation and mostly to migrants' fear their concubines will have extramarital sex during their absence. Impregnating their wives and the resulting childcare is one of the men's resources for controlling their concubines. CONCLUSIONS: Return migration implies vulnerability for indigenous women in the rural communities studied whose sexuality has a strong reproductive profile. It is necessary to develop prevention campaigns against STI/HIV taking into account male sexual identities to improve women rights to sexual and reproductive health.

[Migration and ruralization of AIDS: reports on vulnerability of indigenous communities in Mexico]. / Migración y ruralización del SIDA: relatos de vulnerabilidad en comunidades indígenas de México.

OBJECTIVE: To evaluate the vulnerability for STI/HIV among Mexican indigenous women in common law marriage with men who practice sex without condom. METHODS: Ethnography study undertaken in indigenous villages of Michoacán and Oaxaca, Mexico, in February 2004 and December 2005. These rural communities are characterized by high migration rates, extreme poverty and HIV/AIDS cases. An in-depth interview was applied to transient migrants (24), indigenous women (33), local authorities (20) and health providers (14). RESULTS: Rural propagation of STI/HIV is associated to sexual female initiation and mostly to migrants' fear their concubines will have extramarital sex during their absence. Impregnating their wives and the resulting childcare is one of the men's resources for controlling their concubines. CONCLUSIONS: Return migration implies vulnerability for indigenous women in the rural communities studied whose sexuality has a strong reproductive profile. It is necessary to develop prevention campaigns against STI/HIV taking into account male sexual identities to improve women rights to sexual and reproductive health.