Personalized protocol and scoring scale for functional electrical stimulation of the hand: A pilot feasibility study.

BACKGROUND: Complex personalized Functional Electrical Stimulation (FES) protocols for calibrating parameters and electrode positioning have been proposed, most being time-consuming or technically cumbersome for clinical settings. Therefore, there is a need for new personalized FES protocols that generate comfortable, functional hand movements, while being feasible for clinical translation. OBJECTIVE: To develop a personalized FES protocol, comprising electrode placement and parameter selection, to generate hand opening (HO), power grasp (PW) and precision grip (PG) movements, and compare in a pilot feasibility study its performance to a non-personalized protocol based on standard FES guidelines. METHODS: Two FES protocols, one personalized (P1) and one non-personalized (P2), were used to produce hand movements in twenty-three healthy participants. FES-induced movements were assessed with a new scoring scale which comprises items for selectivity, functionality, and comfort. RESULTS: Higher FES-HSS scores were obtained with P1 for all movements: HO (p= 0.00013), PW (p= 0.00007), PG (p= 0.00460). Electrode placement time was significantly shorter for P2 (p= 0.00003). Comfort scores were similar for both protocols. CONCLUSIONS: The personalized protocol for electrode placement and parameter selection enabled functional FES-induced hand movements and presented advantages over a non-personalized protocol. This protocol warrants further investigation to confirm its suitability for developing upper-limb rehabilitation interventions with clinical translational potential.

Exhaustive pathologic work-up in sentinel lymph node biopsy for melanoma: is it necessary?

The objective of this study is to determine whether a less exhaustive pathologic work-up to detect melanoma metastasis is clinically useful and does not affect patient prognosis. The success and evolution of the sentinel lymph node (SLN) depends on histological techniques. Several exhaustive protocols of SLN analysis have been published, but are time and cost consuming, with slight increases in the rates of metastasis detection. From 281 patients with SLN biopsy, each SLN was sectioned every 2 mm and from each paraffin block, 2-3 histological sections were evaluated. The patients were divided as follows: the first group (n=185) was subjected to extensive SLN examination (eSLNe) and the second group (n=96) was not subjected to an extensive SLN examination (wSLNe). The average SLN resected was 2 (range: 1-7), evaluating one in 50.9%. The SLN metastasis detection rate was 28.5%, whereas eSLNe increased by 3.2%. During follow-up, 4/26 (17.4%) cases in the wSLNe group showed recurrence in the SLN basin. Factors associated with decreased survival in univariant analysis were recurrence, Breslow thickness, advanced clinical stage, ulceration, and SLN metastasis. eSLNe did not affect disease-specific survival. Multivariate analysis showed recurrence (hazard ratio 23.475, 95% confidence interval: 1903-4559, P<0.001) and Breslow thickness of more than 3.5 mm (hazard ratio 15.222, 95% confidence interval: 1448-3059, P<0.001) as independent risk factors for decreased survival. Our routine for SLN examination enabled an adequate rate of SLN metastasis detection and the eSLNe increased the rate of detection in 3.2%, but did not affect the survival. We did not find any benefit from performing the eSLNe in patients with Breslow thickness less than 3.5 mm.

Etiquetado nutricional de productos artesanales elaborados por pequeñas empresas del estado Mérida- Venezuela / Nutritional labels in artisan products made by small business entreprenuers in Merida state-Venezuela

En muchos países del mundo, la información que aparece en las etiquetas de los productos alimenticios forma parte de los es - fuerzos de la educación nutricional para fomentar en los consumidores cambios positivos en la conducta alimentaría. La sociedad busca sustentar a través de sus métodos el co no ci miento aplicado con tecnología, de manera tal que pue da ob te ner de dicho proceso la información útil, completa y oportuna. El impacto de la información sustentada en la evidencia científica y tecnológica sobre la masa poblacional de un producto de consumo masivo particular, induce de forma ética a la toma de decisiones. El objetivo de la presente investigación fue realizar los análisis fi sicoquímicos previo muestreo, de los productos elaborados por 13 empresas de alimentos, en el estado Mérida, comparar los resultados con las normas Covenin, a fin de ela borar el etiquetado nutricional. Estas empresas fueron en cuestadas previamente para obtener la aceptación de las mis mas en el proyecto en estudio. La ubicación geográfica de las empresas corresponde a los municipios Libertador, San tos Marquina y Campo Elías del estado Mérida. Se de terminó el % de grasa, mediante el método de Soxhlet (Co ve nin, 3821:2003); Pro - teínas por micro Kjeldahl (Covenin, 370-1986)), humedad por el método gravimétrico de desecación en estufa (AOAC, 2000); cenizas por incineración directa en lla ma (AOAC, 2000), y carbohidratos por diferencia. De los re sultados obtenidos se concluye que de 21 productos analizados, el 80% no cumple con la norma de referencia para cada producto, y un 20% está dentro de los valores exigidos por la referencia respectiva. Estos resultados se compararon en al gunos casos con la norma Covenin y en otros por la Tabla de composición de alimentos del Institu to Na cional de Nutrición.

In many countries of the world, the nutritional facts that appear in the nutritional labels of many marketed alimentary products, is part of an educational effort to promote positive changes in the nutritional habits of consumers. Our society seeks sustainability through methods that enable the administration of knowledge applied to technology, in order to obtain useful, complete and opportune information. The impact over the population of the information based in scientific evidence induces positive decision making in an ethical manner. The objectives of the present investigation were to make physical and chemical analysis previous sample recollections of the manufactured alimentary products of 13 different businesses of the state of Merida and compared the results with the COVENIN norms, and finally, elaborate the nutritional labels. These businesses were pre viously submitted to the required rules of acceptance of the investigation. These small businesses are geographically located in the municipalities of Santos Marquina, Libertador y Campo Elias of the state of Mérida. The percentage of lipid content was determined by the method Soxhlet (COVENIN, 3821:2003); Proteins by micro Kjeldahl (COVENIN, 370:1986), humidity by the gravimetric method of desiccation in estove (AOAC, 2000); ashes by direct incineration (AOAC, 2000), y carbohydrates by difference. The results obtainned, are as follows: of the 21 products analized, 80% don’t fulfil the COVENIN parameters and 20% are in the range of values of reference. Some of these results were compared with the COVENIN norms and others with the table of composition of the Institute of National Nu - trition.

Practice implications with an alcohol-free, 0.07% cetylpyridinium chloride mouthrinse.

PURPOSE: Behavioral research was conducted to ascertain the relevance of an alcohol-free, 0.07% cetylpyridinium chloride (CPC) therapeutic mouthrinse to contemporary dental practice over a 6-month usage period. METHODS: A randomized, single-blind study was conducted to assess practice-relevant compliance, acceptability and side effects associated with two mouthrinses. The target population was healthy adult mouthrinse users with a history of routine dental prophylaxis and maintenance care. Subjects were randomly assigned to a therapeutic mouthrinse with 0.07% CPC (Crest Pro-Health Rinse) or a cosmetic rinse control (Scope). Other oral hygiene was not standardized. Subjects completed a questionnaire and were examined by dental hygienists at baseline, and again after 3 and 6 months rinsing. At study completion, a dental prophylaxis was administered. RESULTS: Compliance was generally favorable, with 273 subjects (89%) completing the 6-month rinsing study. Rinsing time generally stayed the same or increased relative to baseline. Groups differed among the subset who historically used an essential oils rinse (N=137), where those assigned to the alcohol-free therapeutic rinse exhibited significantly (P= 0.02) longer rinsing times compared to subjects using the alcohol-containing cosmetic rinse. Subject evaluations were generally positive with respect to both rinses. Side effects were minimal, with no between-group differences in hygienist-rated calculus or stain accumulation, or prophylaxis time. CLINICAL SIGNIFICANCE: In a 6-month study, a high bioavailable 0.07% CPC therapeutic mouthrinse showed generally high compliance and favorable user acceptability, with similar side effects to those seen with a cosmetic mouthrinse. These findings suggest that the 0.07% CPC mouthrinse may be readily incorporated within the contemporary recall dental practice.

Niños con presión arterial elevada: seguimiento al año / Children with high blood pressure: follow-up one year after

Se realizó seguimiento de 455 niños cuya presión arterial (PA) fue anormal en un estudio de prevalencia de hipertensión arterial (HTA) realizado por los autores. Se ubicaron 310 niños. Se estandarizó el equipo y los procedimientos para la obtención de las determinaciones. El error intra e inter observador fueron no significativos. Se registró la PA. Se identificaron 228 (73,55 por ciento) niños con valores de PA por debajo del percentil (P) 90, 45 (14,51 por ciento) entre P90 y P95 y 37 (11,94 por ciento) por encima de P95. Se analizó la relación entre el diagnóstico previo y el actual de HTA, determinándose que los niños hipertensos del primer estudio tienen una probabilidad doble de permanecer con PA patológica que los que presentaron PA "normal alta" y PA elevada en un solo registro. Se relacionó el índice peso/talla (P/T) en el primer estudio con el diagnóstico actual, comprobándose que el riesgo de presentar PA patológica es 2,26 veces mayor en los niños que igualan o exceden el P 95 del índice P/T y el riesgo de no mejorar es 2,15 veces mayor. Se relacionó el índice P/T del segundo estudio con el diagnóstico actual, comprobándose que el riesgo de presentar PA patológica es 2,03 veces mayor en los que igualan o exceden el P 95 y el riesgo de no mejorar es 2,14 veces mayor. Los 25 niños con HTA del primer estudio, fueron ubicados en su totalidad: 10 permanecieron hipertensos; 3 se ubicaron entre P90 y P95 y 12 normalizaron sus cifras. Se realizaron controles médicos mensuales a 12, lo que indica un bajo índice de seguimiento de estos pacientes