Assessment of pain relief after four botulinum toxin A injection cycles in patients with post-stroke lower limb spasticity: A prospective, observational study.

INTRODUCTION: Spasticity is common after a stroke and is an independent risk factor for developing pain. BotulinumtoxinA injection is the treatment of choice for focal spasticity. We examined the effect of intramuscular botulinumtoxinA on pain relief in patients in routine clinical practice who were experiencing pain as a primary complaint associated with post-stroke lower limb spasticity. METHODS: Prospective, multicentre, post-marketing observational study. The study period was 16 months. The primary effectiveness variable was the mean change from baseline on the pain 0-10 Numerical Rating Scale after four botulinumtoxinA injection cycles. Secondary endpoints included changes from baseline on the pain 0-100 Visual Analogue Scale, Goal Attainment Scale, modified Ashworth Scale, 10-Meter Walk Test, Penn Spasm Frequency Scale, and 36-item Short-Form Health Survey. RESULTS: Of 186 enrolled patients, 180 (96.8%) received botulinumtoxinA at least once. The mean (standard deviation) pain 0-10 Numerical Rating Scale score decreased significantly (p<0.0001) from 4.9 (2.2) at baseline to 2.5 (2.1) at study end, representing a 50% decrease in pain severity. Relief of pain due to spasticity was supported by improvement from baseline in all secondary variables except the 10-Meter Walk Test. Two adverse events (erysipelas and phlebitis) in one patient were considered likely to be related to botulinumtoxinA injection. CONCLUSION: BotulinumtoxinA appears to provide pain relief as an additional benefit of local treatment in patients with post-stroke lower limb spasticity for whom pain relief is a primary therapeutic goal (a Lay Abstract has been provided as Appendix A).

Semi-automatic algorithm to build finite element numerical models of the human hearing system from Micro-CT data.

Finite Element modeling has been an extended methodology to build numerical model to simulate the behavior of the hearing system. Due to the complexity of the system and the difficulties to reduce the uncertainties of the geometric data, they result in computationally expensive models, sometimes generic, representative of average geometries. It makes it difficult to validate the model with direct experimental data from the same specimen or to establish a patient-oriented modeling strategy. In the present paper, a first attempt to automatize the process of model building is made. The source information is geometrical information obtained from CT of the different elements that compose the system. Importing that data, we have designed the complete procedure to build a model including tympanic membrane, ossicular chain and cavities. The methodology includes the proper coupling of all the elements and the generation of the corresponding finite element model. The whole automatic procedure is not complete, as we need to make some human-assisted decisions; however, the model development time is reduced from 4 weeks to approximately 3 days. The goal of the modeling algorithm is to build a Finite Element Model with a limited computational cost. Several tasks as contour identification or model decimation are designed and integrated in order to follow a semi-automated process that allows generating a patient-oriented model.

The genomic profiling of high-risk smoldering myeloma patients treated with an intensive strategy unveils potential markers of resistance and progression.

Smoldering multiple myeloma (SMM) precedes multiple myeloma (MM). The risk of progression of SMM patients is not uniform, thus different progression-risk models have been developed, although they are mainly based on clinical parameters. Recently, genomic predictors of progression have been defined for untreated SMM. However, the usefulness of such markers in the context of clinical trials evaluating upfront treatment in high-risk SMM (HR SMM) has not been explored yet, precluding the identification of baseline genomic alterations leading to drug resistance. For this reason, we carried out next-generation sequencing and fluorescent in-situ hybridization studies on 57 HR and ultra-high risk (UHR) SMM patients treated in the phase II GEM-CESAR clinical trial (NCT02415413). DIS3, FAM46C, and FGFR3 mutations, as well as t(4;14) and 1q alterations, were enriched in HR SMM. TRAF3 mutations were specifically associated with UHR SMM but identified cases with improved outcomes. Importantly, novel potential predictors of treatment resistance were identified: NRAS mutations and the co-occurrence of t(4;14) plus FGFR3 mutations were associated with an increased risk of biological progression. In conclusion, we have carried out for the first time a molecular characterization of HR SMM patients treated with an intensive regimen, identifying genomic predictors of poor outcomes in this setting.

Identification of prognostic factors for survival in patients with metastatic gastric adenocarcinoma in a Mexican population.

INTRODUCTION AND AIMS: Gastric adenocarcinoma is among the high-ranking tumors, with respect to frequency and mortality, worldwide. The inflammatory process and immune system activity are associated with oncologic control. Our aim was to identify whether the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and other variables are prognostic factors for survival in patients with metastatic gastric cancer in a Mexican population. MATERIAL AND METHODS: Patients diagnosed with metastatic gastric adenocarcinoma, hospitalized within the time frame of December 2011 to 2021, were analyzed. The NLR, PLR, and albumin and hemoglobin levels obtained from blood samples were calculated. Functional status (ECOG and Karnofsky), sex, histology, and the presence of signet ring cells were also considered possible prognostic factors. Each factor's prognostic value for overall survival was determined through univariate and multivariate analyses. RESULTS: The study included 956 patients diagnosed with metastatic gastric cancer, of whom 494 (51.7%) were men and 462 (48.3%) were women. The main histologic finding was diffuse adenocarcinoma (n = 619, 64.7%), followed by intestinal adenocarcinoma (n = 293, 30.6%), and the presence of signet ring cells was found in 659 (68.9%) patients. Diagnostic laparoscopy was performed on 238 patients (24.9%) to confirm peritoneal carcinomatosis. The multivariate analysis showed that an NLR above 3.2 (HR 1.51, 95% CI 1.27-1.8; p < 0.001), albumin below 3.5 g/dl (HR 1.25, CI 1.06-1.47; p = 0.006), and an ECOG performance status of 2 or higher (HR 1.39, CI 1.10-1.76; p = 0.005) were independent factors that predicted a lower survival rate, whereas a Karnofsky score above 70% (HR 0.69, CI 0.53-0.91; p = 0.008) was associated with a better survival rate. Lastly, the PLR was not statistically significant in the multivariate analysis. CONCLUSIONS: The NLR, nutritional status assessed through albumin measurement, and functional status can act as independent prognostic survival factors in hospitalized Mexican patients diagnosed with metastatic gastric adenocarcinoma and be taken into account during therapeutic decision-making.

Performance evaluation of three versions of a convolutional neural network for object detection and segmentation using a multiclass and reduced panoramic radiograph dataset.

OBJECTIVES: To evaluate the diagnostic performance of three versions of a deep-learning convolutional neural network in terms of object detection and segmentation using a multiclass panoramic radiograph dataset. METHODS: A total of 600 orthopantomographies were randomly selected for this study and manually annotated by a single operator using an image annotation tool (COCO Annotator v.11.0.1) to establish ground truth. The annotation classes included teeth, maxilla, mandible, inferior alveolar nerve, dento- and implant-supported crowns/pontics, endodontic treatment, resin-based restorations, metallic restorations, and implants. The dataset was then divided into training, validation, and testing subsets, which were used to train versions 5, 7, and 8 of You Only Look Once (YOLO) Neural Network. Results were stored, and a posterior performance analysis was carried out by calculating the precision (P), recall (R), F1 Score, Intersection over Union (IoU), and mean average precision (mAP) at 0.5 and 0.5-0.95 thresholds. The confusion matrix and recall precision graphs were also sketched. RESULTS: YOLOv5s showed an improvement in object detection results with an average R = 0.634, P = 0.781, mAP0.5 = 0.631, and mAP0.5-0.95 = 0.392. YOLOv7m achieved the best object detection results with average R = 0.793, P = 0.779, mAP0.5 = 0.740, and mAP0.5-0.95 = 0,481. For object segmentation, YOLOv8m obtained the best average results (R = 0.589, P = 0.755, mAP0.5 = 0.591, and mAP0.5-0.95 = 0.272). CONCLUSIONS: YOLOv7m was better suited for object detection, while YOLOv8m demonstrated superior performance in object segmentation. The most frequent error in object detection was related to background classification. Conversely, in object segmentation, there is a tendency to misclassify True Positives across different dental treatment categories. CLINICAL SIGNIFICANCE: General diagnostic and treatment decisions based on panoramic radiographs can be enhanced using new artificial intelligence-based tools. Nevertheless, the reliability of these neural networks should be subjected to training and validation to ensure their generalizability.

Prurigiform Angiomatosis: A New Term for Describing the Prominent Dermal Angiomatoid Proliferation Underlying Epidermal Changes in Prurigo Nodularis/Lichen Simplex Chronicus. / Angiomatosis prurigiforme: una nueva entidad propuesta para la proliferación angiomatoide dérmica prominente subyacente a los cambios epidérmicos de prurigo nodularis/liquen simple crónico.

Vascular hyperplasia is a common finding in prurigo nodularis/lichen simplex chronicus (LSC). The term prurigiform angiomatosis was recently proposed to describe a histologic pattern characterized by prominent vascular hyperplasia in patients with LSC. The aim of this study was to identify cases of LSC with this pattern and analyze associations with clinical and pathologic features and disease course. We reviewed 54 cases of histologically confirmed LSC and detected findings consistent with prurigiform angiomatosis in 10 (18.5%). The patients (7 men, 3 women) had a mean age of 59.7 years. The lesions were pruritic and predominantly located on the extremities and trunk. The most notable histologic finding was vascular proliferation in the superficial dermis associated with a lymphocytic inflammatory infiltrate. Recognition of prurigiform angiomatosis is important as it helps not only to distinguish LSC from other entities (mainly vascular tumors) but also to detect lesions that need to be surgically excised due to poor response to topical treatment.

Compact laser modulation system for a transportable atomic gravimeter.

Nowadays, atom-based quantum sensors are leaving the laboratory towards field applications requiring compact and robust laser systems. Here we describe the realization of a compact laser system for atomic gravimetry. Starting with a single diode laser operating at 780 nm and adding only one fiber electro-optical modulator, one acousto-optical modulator and one laser amplifier we produce laser beams at all the frequencies required for a Rb-87 atomic gravimeter. Furthermore, we demonstrate that an atomic fountain configuration can also be implemented with our laser system. The modulated system reported here represents a substantial advance in the simplification of the laser source for transportable atom-based quantum sensors that can be adapted to other sensors such as atomic clocks, accelerometers, gyroscopes or magnetometers with minor modifications.

Numerical model characterization of the sound transmission mechanism in the tympanic membrane from a high-speed digital holographic experiment in transient regime.

A methodology for the development of a finite element numerical model of the tympanic membrane (TM) based on experiments carried out in the time domain on a cadaveric human temporal bone is presented. Using a high-speed digital holographic (HDH) system, acoustically-induced transient displacements of the TM surface are obtained. The procedure is capable to generate and validate the finite element model of the TM by numerical and experimental data correlation. Reverse engineering approach is used to identify key material parameters that define the mechanical response of the TM. Finally, modal numerical simulations of the specimen are performed. Results show the feasibility of the methodology to obtain an accurate model of a specific specimen and to help interpret its behaviour with additional numerical simulations. STATEMENT OF SIGNIFICANCE: Improving knowledge of the dynamic behavior of the tympanic membrane is key to understanding the sound transmission system in human hearing and advance in the treatment of its pathologies. Recently we acquired a new tool to carry out experiments in transient regime by means of digital laser holography, capable of providing a large amount of information in a controlled transient test. In this work, these data are used to develop a methodology that generates a numerical model of the tympanic membrane based on numerical-experimental correlations. It is important to be able to develop models that fit specific patients. In this work, additional modal simulations are also presented that, in addition to validating the results, provide more information on the specimen.

Eficacia de un programa de intervención en la promoción de hábitos saludables en personal militar de la Armada con sobrepeso y obesidad / Effectiveness of a Program to Promotion of Healthy Habits in Military Personnel of the Navy With Overweight and Obesity

Antecedentes y objetivos:el sobrepeso y obesidad en personal de la Armada puede provocar pérdida de aptitud para el servicio y complicaciones en la participación de misiones. El objetivo principal de este estudio pretende demostrar que una intervención basada en la promoción de hábitos saludables durante doce meses, pudo disminuir el índice de masa corporal (IMC) y mejorar parámetros bioquímicos en personal con obesidad o sobrepeso. Material y métodos:estudio cuasi-experimental, longitudinal, correlacional y comparativo (pre-test y post-test), durante doce meses, con dos grupos, intervención (GI) y control (GC). La muestra compuesta por 42 militares (n=21 por grupo), con IMC superior a 28 kg/m2. Se ejecutó en dos periodos: el primero a bordo de una fragata durante una misión; el segundo desde el final de la misión hasta completar doce meses. Se realizaron 18 sesiones personalizadas enfocadas a fomentar hábitos saludables en la dieta y favorecer la actividad física. Se monitorizaron variables antropométricas y bioquímicas en el GI. Del GC se obtuvieron los datos de IMC al inicio y final del estudio. Resultados:se produjo una disminución de la media del IMC de 33,71 kg/m2 a 30,91 kg/m2 en el GI; la adherencia fue consistente (90,5 %). A partir de los seis meses se observó un descenso en el número de participantes del GI (76,2 %) y un aumento del IMC con respecto a los valores obtenidos en la primera mitad (de 30,91 a 31,82 kg/m2). Se demostró una disminución del IMC al final de la intervención (p<0,005). Se evidencia una mejora de HDL-colesterol (p<0,04) y de triglicéridos (p<0,029) estadísticamente significativa. No se apreciaron cambios significativos en el GC. Conclusiones:el efecto de la intervención basada en la promoción de hábitos de vida saludables disminuye el IMC en personal afecto de sobrepeso y obesidad y mejora determinados parámetros bioquímicos relacionados con esta.(AU)

Antecedent and objectives: overweight and obesity in Navy personnel can cause loss of physical aptitude and complications in the development of missions. The main objective is to demonstrate that an intervention based on the promotion of healthy habits for 12 months, can reduce the Body Mass Index (BMI) and improve biochemical parameters in personnel affected by overweight or obesity. Material and Methods: quasi-experimental study, correctional, longitudinal, correctional and comparative (pre-test and post-test) for 12 months, with two groups, intervention (IG) and control (CG). The sample included 42 military personnel (n=21 per group), with a BMI higher than 28 kg/m2. It was carried out in two periods: the first period was carried out on board a frigate, taking advantage of its participation during a mission; the second since the end of the mission until completing the 12 months. 18 personalized sessions were held, focused on promoting healthy habits in both diet and promote physical activity. Anthropometric and biochemical dates were monitored in the IG. In the CG, BMI data were obtained at the beginning and end of the study. Results: During the first period, in the IG there was a decrease in BMI of 33,71 to 30,91 kg/m2 (p<0.05); Adherence is consistent (90,5 %). After 6 months a decrease in the number of participants (76,2 %) and an increase in BMI with respect to the values of the first half (from 30,91 kg/m2 to 31,82 kg/m2) were observed. A decrease in BMI was demonstrated at the end of the intervention. There is an improvement in HDL-cholesterol (p<0.04) and triglycerides (p<0.029). No significant changes were seen in GC. Conclusions: the effect of the nursing intervention based on the promulgation of healthy life habits decreases the BMI in personnel affected by overweight and obesity and improves certain biochemical parameters related to this.(AU)

Pigmentary mosaicism as a recurrent clinical manifestation in three new patients with mosaic trisomy 12 diagnosed postnatally: cases report and literature review.

BACKGROUND: To date, only twenty-one cases diagnosed postnatally with mosaic trisomy 12 have been reported. The most frequent phenotypic manifestations are developmental delay, dysmorphic facial features, congenital heart defects, digital alterations, and pigmentary disorders. In the present report, detailed clinical and genetic profiles of three unrelated new patients with mosaic trisomy 12 are described and compared with previously reported cases. CASE PRESENTATION: In the present report, we include the clinical, cytogenetic, and molecular description of three Mexican patients diagnosed postnatally with mosaic trisomy 12. At phenotypic level, the three patients present with developmental delay, dysmorphic facial features, congenital heart defects and skin pigmentary anomalies. Particularly, patient 1 showed unique eye alterations as bilateral distichiasis, triple rows of upper lashes, and digital abnormalities. In patient 2 redundant skin, severe hearing loss, and hypotonia were observed, and patient 3 presented with hypertelorism and telecanthus. Hyperpigmentation with disseminated pigmentary anomalies is a common trait in all of them. The cytogenetic study was carried out under the strict criteria of analysis, screening 50-100 metaphases from three different tissues, showing trisomy 12 mosaicism in at least one of the three different tissues analyzed. With SNParray, the presence of low-level mosaic copy number variants not previously detected by cytogenetics, and uniparental disomy of chromosome 12, was excluded. STR markers allowed to confirm the absence of uniparental disomy as well as to know the parental origin of supernumerary chromosome 12. CONCLUSIONS: The detailed clinical, cytogenetic, and molecular description of these three new patients, contributes with relevant information to delineate more accurately a group of patients that show a heterogeneous phenotype, although sharing the same chromosomal alteration. The possibility of detecting mosaic trisomy 12 is directly associated with the sensitivity of the methodology applied to reveal the low-level chromosomal mosaicism, as well as with the possibility to perform the analysis in a suitable tissue.

Accurate temperature measurement of cold atoms in cesium fountain clocks.

We introduce a new approach to determine if a cloud of cold atoms has or not a unique, well-defined temperature. In the first case, the temperature can be determined using the width of the velocity distribution. However, the temperature in a cloud of cold atoms may not be well-defined if the velocity distribution does not turn out to be Gaussian. In this case, the width of the velocity distribution cannot be associated to a unique temperature, and additional considerations exposed here should be followed to measure the temperatures of two groups of atoms forming the whole cloud. Also an uncertainty evaluation is presented.

Sudden branch macular artery avulsion during internal limiting membrane peeling for idiopathic macular hole: A case report.

INTRODUCTION AND IMPORTANCE: Macular Holes (MH) are variable thickness openings of the retina that develop in the fovea. This case presents a branch macular artery avulsion during internal limiting membrane (ILM) peeling for idiopathic macular hole management in an adult patient. The proper management of this complication along with the preventive measures is mentioned. CASE PRESENTATION: A 65-year-old woman developed a branch macular artery avulsion during ILM peeling for MH. After cataract extraction by phacoemulsification with intraocular lens implantation and pars plana vitrectomy, during ILM peeling, a multifocal bleeding along a macular artery was noted indicating its avulsion. The intraocular pressure was raised to control hemorrhage, blood remnants were passively aspirated and ILM peeling was kindly completed under adequate visualization. CLINICAL DISCUSSION: Branch macular artery avulsion is a potential complication even for experienced surgeons. Proper management of this complication involves the increase of intraocular pressure for hemostasia. If hemostasia and proper visualization are achieved, the surgery could be completed, and if it is not the case, the ILM peeling could be completed in a second procedure. This complication might be avoided by initiating the ILM peeling away from the macular vessels. CONCLUSION: Branch macular artery avulsion is an intraoperative complication that might be avoided by initiating the ILM peeling away from the macular vessels.

Investigación-Acción Participativa sobre percepciones, preocupaciones y necesidades de los profesionales de salud en una central de emergencias de Argentina: Investigación-Acción Participativa en personal de salud / Participatory Action Research on perceptions, concerns and needs of healthcare professionals in an emergency department in Argentina

Objetivo: Explorar las percepciones, preocupaciones y necesidades del personal de salud en una Central de Emergencias de Adultos (CEA) de Argentina. Métodos: Investigación o acción participativa, coordinada y ejecutada por el propio personal de la CEA, que incluyó médicos/as, personal de enfermería y administrativo/as para participar activamente en la recolección de información y en el análisis. Se utilizaron metodologías mixtas: análisis documental de quejas y reclamaciones escritas por parte de los pacientes, 10 entrevistas individuales y 2 grupos focales reflexivos con 10 integrantes del personal de salud (de diferente cargo y antigüedad, y residentes en formación). Resultados: Los tópicos emergentes fueron factores laborales que inducen al error y atentan contra el encuentro clínico centrado en la persona: la sobrecarga y la falta de tiempo, la sobreutilización de recursos por medicina defensiva y la tecnología que reemplaza el contacto físico. El personal de salud manifestó episodios de agresiones de pacientes o sus familiares, cuando las largas esperas y las insuficiencias estructurales (como falta de camas, saturación de sala de espera, incomodidad) atentan contra la paciencia y la tolerancia. A partir de esta reflexión se generaron mejoras en diversas áreas de la CEA.Conclusiones: La identificación de las problemáticas realizadas por los propios actores de la CEA resultó un método pertinente para generar un proceso de cambio de gestión colectiva, promover la reflexión y concientizar, permitir identificar áreas de mejora, diseñar estrategias y propuestas concretas (AU)

Introduction: To explore perceptions, concerns and needs of healthcare professionals in an emergency department (ED) from Argentina.Methods: Participatory action research, coordinated and carried out by ED healthcare professionals, which included physicians, nurses and administrative staff who actively en-gaged in both data collection and analysis. Mixed methodologies were used: documentary analysis of complaints and written claims by patients, 10 individual interviews, and two reflective focus groups of 10 healthcare professionals (who differed in occupation, seniority and experience, including residents in training).Results: The topics that emerged were work factors that lead to errors and threaten pa-tient-centered clinical encounters: work overload and lack of time, the overuse of resources for defensive medicine purposes and technology that replaces physical contact. Healthcare professionals reported episodes of aggression by patients or their families, when long waits and structural insufficiencies (such as lack of beds, saturation of the waiting room, discom-fort) threaten patience and tolerance. From these insights, improvements were generated in various areas of the ED.Conclusions: The identification of problems by the ED stakeholders l was a relevant ap-proach that led to a process of collective management change, promoted reflection and raised awareness, allowing the identification of areas for improvement, design strategies and concrete feasible proposals (AU)

Metazoan parasite communities of the Pacific red snapper, Lutjanus peru (Perciformes: Lutjanidae): interannual variations in parasite communities.

Metazoan parasite communities can experience temporal structural changes related to seasonal and/or local variations in several biotic and abiotic environmental factors. However, few studies have addressed this issue in tropical regions, where changes in water temperature are less extreme than in temperate regions, so the factors or processes that can generate variations in these parasite communities are as yet unclear. We quantified and analysed the parasite communities of 421 Lutjanus peru (Nichols & Murphy, 1922) collected from Acapulco Bay in Guerrero, Mexico, over a four-year period (August 2018 to April 2021), to identify any interannual variation due to local biotic and abiotic factors influenced by natural oceanographic phenomena, such as El Niño-Southern Oscillation, or La Niña. Twenty-five metazoan parasite taxa were recovered and identified: seven Digenea species; two Monogenea; one Cestoda; one Acanthocephala; four Nematoda; and ten of Crustacea (seven Copepoda and three Isopoda). The digeneans and copepods were the best represented parasite groups. The parasite communities were characterized by a high numerical dominance of helminth larvae. Species richness at the component community level (13 to 19 species) was similar to reported richness in other Lutjanus spp. The parasite communities of L. peru had a high variability in species composition, but low aggregate variability (e.g. species diversity), suggesting that structure of these communities may be quite stable over time. A clear interannual variation pattern was not observed, suggesting that parasite species of this host may respond differently to variations in environmental factors. Interannual variations were possibly caused by a combination of biotic (i.e. host feeding behaviour and body size) and local abiotic factors (influenced by climatic anomalies) which generated notable changes in the infection levels of several component species.

Frailty as a predictor of clinical problems and events that require elderly patients with heart failure to use health resources.

BACKGROUND: The clinical management of elderly patients with heart failure (HF) is not firmly established. Decision-making should be individualized depending on the biological deterioration of each patient, from aggressive management to a palliative approach. Frailty can serve as the basis for this comprehensive individualized management. Our objective was to evaluate the importance of the main clinical problems, as well as the events that required the use of health resources, based the degree of frailty, in elderly patients with HF. METHODS AND RESULTS: Retrospective observational cohort study. Frailty was defined according to the deficit accumulation construct. A total of 546 patients hospitalized for acute HF were included. The median age (Q1-Q3) was 82 (78-86) years. A total of 454 patients (83%) showed some degree of frailty: 221 (48.7%) mild, 207 (45.6%) moderate and 26 (5.7%) advanced. There was a significant tendency towards polypharmacy from no to severe frailty. Hospital events were recorded for 4 (1-6) patients with mild frailty, 4 (2-6) patients with moderate frailty and 2 ((1-4) patients with advanced frailty (p = 0.045). A total of 204 patients (37.4%) died during follow-up. The median time to death was 11.4 (4-16.8), 6.7 (3.3-11.6), 6.5 (3.4-12.2) and 4.1 (0.8-7.7) months for patients with no, mild, moderate, or advanced frailty, respectively (p = 0.006). CONCLUSIONS: Frailty due to deficit accumulation is a good predictor of clinical problems and events that require the use of health resources; therefore, it can serve as a basis for the management of HF in the elderly.