Distrofia miotónica tipo 1: 13 años de experiencia en un hospital terciario. Estudio clínico y epidemiológico. Correlación genotipo-fenotipo / Myotonic dystrophy type 1: 13 years of experience at a tertiary hospital. Clinical and epidemiological study and genotype-phenotype correlation

Introducción: Se desconoce la incidencia de la distrofia miotónica tipo 1 (DM1), enfermedad con gran variedad fenotípica, en nuestra región. El objetivo de nuestro trabajo es estimar la incidencia de DM1 en nuestro centro (referencia en Aragón) e identificar las características propias de nuestra población (correlación genotipo-fenotipo). Métodos: Estudio descriptivo retrospectivo de 459 pacientes clasificados según número de repeticiones CTG en: normal (5-35), premutado (36-50), protomutado (51-80), pequeñas expansiones (81-150), intermedias (151-1.000) y grandes (> 1.000). Además, según el fenotipo mostrado, se categorizaron como: no afectos (5-50 CTG), forma leve o asintomática (51-150 CTG), clásica (151-1.000 CTG) y severa (> 1.000 CTG). Resultados: La incidencia de DM1 fue de 20,61 (IC 95%: 19,59-21,63) casos por millón de individuos-año. Se evidenció una correlación inversa entre el número de CTG y la edad al diagnóstico genético (ρ = −0,547; IC 95%: −0,610 a −0,375; p < 0,001). El CTG5 fue el alelo polimórfico más frecuente en sanos. Del total de afectos, el 28,3% presentaron la forma leve o asintomática, el 59,1% la forma clásica y el 12,6% la forma severa. El 35,1% presentaron herencia materna, el 59,4% herencia paterna y el 5,5% herencia incierta. En las formas leves la calvicie frontal en varones fue el rasgo fenotípico más prevalente, junto con miotonía y cataratas, mientras que en la clásica predominó la ptosis palpebral, la debilidad facial, las alteraciones en la voz y la pronunciación, la miotonía y la sensación de cansancio/somnolencia. Conclusiones: La incidencia de DM1 es relevante en Aragón. La revisión multidisciplinar del fenotipo de pacientes con DM1 es clave para un diagnóstico precoz y medicina personalizada.(AU)

Introduction: The incidence of myotonic dystrophy type 1 (DM1), a disease with great phenotypic variety, in our region is unknown. This study aims to estimate the incidence of DM1 at our hospital (a reference centre in Aragon, Spain) and to identify the characteristics of our population (genotype-phenotype correlation). Methods: Retrospective, descriptive study of 459 patients classified according to the number of CTG repeats, as follows: normal (5-35), premutation (36-50), protomutation (51-80), small expansions (81-150), intermediate expansions (151-1000), and large expansions (> 1000). Furthermore, according to clinical phenotype, patients were categorised as unaffected (5-50 CTG repeats), mild form or asymptomatic (51-150), classical form (151-1000), and severe form (> 1000). Results: The incidence of DM1 was 20.61 cases per million person-years (95% CI: 19.59-21.63). An inverse correlation was observed between the number of CTG repeats and the age at genetic diagnosis (ρ = −0.547; 95% CI: −0.610 to −0.375; P < .001). CTG5 was the most frequent polymorphic allele in healthy individuals. Of all patients with DM1, 28.3% presented the mild or asymptomatic form, 59.1% the classical form, and 12.6% the severe form. Inheritance was maternal in 35.1% of cases, paternal in 59.4%, and uncertain in 5.5%. In mild forms, frontal balding in men was the most prevalent phenotypic trait, as well as myotonia and cataracts, while in the classical form, ptosis, facial weakness, voice and pronunciation alterations, myotonia, and fatigue/sleepiness were most frequent. Conclusions: The incidence of DM1 in Aragon is significant. Multidisciplinary study of the phenotype of patients with DM1 is key to early diagnosis and personalised management.(AU)

Myotonic dystrophy type 1: 13 years of experience at a tertiary hospital. Clinical and epidemiological study and genotype-phenotype correlation.

INTRODUCTION: The incidence of myotonic dystrophy type 1 (DM1), a disease with great phenotypic variety, in our region is unknown. This study aims to estimate the incidence of DM1 at our hospital (a reference centre in Aragon, Spain) and to identify the characteristics of our population (genotype-phenotype correlation). METHODS: Retrospective, descriptive study of 459 patients classified according to the number of CTG repeats, as follows: normal (5-35), premutation (36-50), protomutation (51-80), small expansions (81-150), intermediate expansions (151-1000), and large expansions (> 1000). Furthermore, according to clinical phenotype, patients were categorised as unaffected (5-50 CTG repeats), mild form or asymptomatic (51-150), classical form (151-1000), and severe form (> 1000). RESULTS: The incidence of DM1 was 20.61 cases per million person-years (95% CI, 19.59-21.63). An inverse correlation was observed between the number of CTG repeats and the age at genetic diagnosis (ρ = -0.547; 95% CI, -0.610 to -0.375; P < .001). CTG5 was the most frequent polymorphic allele in healthy individuals. Of all patients with DM1, 28.3% presented the mild or asymptomatic form, 59.1% the classical form, and 12.6% the severe form. Inheritance was maternal in 35.1% of cases, paternal in 59.4%, and uncertain in 5.5%. In mild forms, frontal balding in men was the most prevalent phenotypic trait, as well as myotonia and cataracts, while in the classical form, ptosis, facial weakness, voice and pronunciation alterations, myotonia, and fatigue/sleepiness were most frequent. CONCLUSIONS: The incidence of DM1 in Aragon is significant. Multidisciplinary study of the phenotype of patients with DM1 is key to early diagnosis and personalised management.

Understanding the impact of the COVID-19-related lockdown in university workers. Identifying groups through cluster analysis.

Objective: To analyse the COVID-19-related lockdown impact on University workers, to identify groups based on this information, and to study the factors associated with each group. Study design: Cross-sectional study. Methods: A survey was conducted 3.5 weeks after COVID-19-related lockdown in University workers in Spain. Sociodemographic variables, housing, work, health conditions, levels of anxiety, stress and depression (DASS-21), and social support (MSPSS) were collected. A cluster analysis was performed to identify groups depending on the impact of the lockdown. Differences between groups were tested using Chi-square and Mann-Whitney-U tests, and associated factors with binary logistic regression. Results: We identified two groups of workers. "G1: Consequences in the daily life routine" was mainly composed of men, Research and Teaching Personnel (RTP) with more stable professional categories, higher income level, and bigger houses than people in G2. Participants in "G2: Concerns for the current and future well-being" presented worse intensity of pain than before the lockdown, more anxiety, depression, stress and less social support than people in G1. ASP (Administration and Services Personnel) had more risk of belonging to G2 than RTP (OR = 5.863). A higher number of people living at home decreased the risk of being in G2 (OR = 0.439). People with lower pain intensity had less risk of being in G2 (OR = 0.014), and this risk decreased as friends support increased (OR = 0.833). Conclusions: In G1, the consequences were immediately reflected in the stress resulting from changes in their daily work routine. In G2, the concerns were related to their professional future, with worse mental health, greater intensity of pain and less social support.

Factores psicológicos asociados a la adherencia al tratamiento analgésico en pacientes con dolor crónico: revisión sistemática de la literatura / Psychological factors associated with the adherence to analgesic treatment in patients with chronic pain: systematic review of the literature

Introducción: La falta de adherencia terapéutica es frecuente en pacientes con dolor crónico (DC) y la influencia de factores psicológicos sobre ella puede ser relevante. El objetivo del estudio es analizar los factores psicológicos relacionados con la adherencia al tratamiento analgésico en paciente con DC. Metodología: Se realizó una revisión sistemática donde se incluyeron artículos originales publicados en inglés y castellano entre junio de 2009 y junio de 2019 incluidos en Pudmed, Scopus, Web of Science y PsycINFO. Se incluyeron artículos con diseño transversal y longitudinal, llevados a cabo en una población > 18 años con dolor crónico no oncológico (DCNO) y que analizaban cualquier variable psicológica en relación con la adherencia al tratamiento analgésico. Los términos de búsqueda fueron "adherence", "compliance", "misuse", "analgesic", "chronic pain" y "psychology". La calidad de los artículos incluidos se analizó mediante la Critical Appraisal Checklist for Analytical Cross-sectional studies de Joanna Briggs Institute para los estudios transversales y Newcastle-Ottawa Quality Assessment Form for Cohort Studies para los longitudinales. Resultados: Se identificaron 1184 artículos, de los cuales 14 fueron finalmente seleccionados. La depresión fue la variable más estudiada, incluida en 11 artículos, seguida de la ansiedad, que apareció en 6. Tanto la depresión como la ansiedad se asociaron de manera constante y significativa con una menor adherencia al tratamiento analgésico, y lo mismo fue cierto en dos de los artículos que miden conjuntamente la relación de ansiedad y depresión en la adherencia analgésica (efecto negativo alto 39,1 % vs. efecto negativo bajo 8,3 %, p = 0,013). Se encontró que las estrategias de afrontamiento activas se asociaban con infrauso (OR = 1,132, IC 95 %: 1,027-1,249, p = 0,013) y las pobres estrategias de afrontamiento se relacionaron con un mal uso de los opioides (p = 0,01)...(AU)

Introduction: The lack of adherence is frequent in chronic pain (CP) patients and the influence of psychological factors may play a relevant role. The aim of this study was to analyze the psychological factors related to the adherence to analgesic treatment in patients with CP. Methodology: A systematic review was carried out, including original articles published in English and Spanish between June-2009 and June-2019 included in Pudmed, Scopus, Web of Science and PsycINFO. Articles with cross-sectional and longitudinal design were included, carried out in a population >18 years with chronic non-oncological pain (CNOP) and that analyzed any psychological variable in relation to adherence to analgesic treatment. The search terms were "adherence", "compliance", "misuse", "analgesic", "chronic pain" and "psychology". The quality of the articles included was analysed through the Critical Appraisal Checklist for Analytical Cross-sectional studies of Joanna Briggs Institute for cross-sectional studies and the Newcastle-Ottawa Quality Assessment Form for Cohort Studies for the longitudinal studies. Results: A total of 1184 articles were initially identified, and 14 were finally selected. Depression was the most studied variable, being included in 11 articles, fo­­llowed by anxiety, that appeared in 6. Both depression and anxiety were repeatedly associated with lo­­wer adhe­rence to analgesic treatment, and the same was true in two of the articles that measured jointly the relationship of anxiety and depression on analgesic adherence (high negative affect 39.1 % vs. low negative affect 8,3 %, p = 0.013). Active coping strategies were found to be associated with underuse (OR = 1.132, 95 % CI: 1.027-1.249, p = 0.013) and poor coping strategies were associated with opioid misuse (p = 0.01)...(AU)

Myotonic dystrophy type1: 13years of experience at a tertiary hospital. Clinical and epidemiological study and genotype-phenotype correlation. / Distrofia miotónica tipo1: 13años de experiencia en un hospital terciario. Estudio clínico y epidemiológico. Correlación genotipo-fenotipo.

INTRODUCTION: The incidence of myotonic dystrophy type1 (DM1), a disease with great phenotypic variety, in our region is unknown. This study aims to estimate the incidence of DM1 at our hospital (a reference centre in Aragon, Spain) and to identify the characteristics of our population (genotype-phenotype correlation). METHODS: Retrospective, descriptive study of 459 patients classified according to the number of CTG repeats, as follows: normal (5-35), premutation (36-50), protomutation (51-80), small expansions (81-150), intermediate expansions (151-1000), and large expansions (>1000). Furthermore, according to clinical phenotype, patients were categorised as unaffected (5-50 CTG repeats), mild form or asymptomatic (51-150), classical form (151-1000), and severe form (>1000). RESULTS: The incidence of DM1 was 20.61 cases per million person-years (95%CI: 19.59-21.63). An inverse correlation was observed between the number of CTG repeats and the age at genetic diagnosis (ρ=-0.547; 95%CI: -0.610 to -0.375; P<.001). CTG5 was the most frequent polymorphic allele in healthy individuals. Of all patients with DM1, 28.3% presented the mild or asymptomatic form, 59.1% the classical form, and 12.6% the severe form. Inheritance was maternal in 35.1% of cases, paternal in 59.4%, and uncertain in 5.5%. In mild forms, frontal balding in men was the most prevalent phenotypic trait, as well as myotonia and cataracts, while in the classical form, ptosis, facial weakness, voice and pronunciation alterations, myotonia, and fatigue/sleepiness were most frequent. CONCLUSIONS: The incidence of DM1 in Aragon is significant. Multidisciplinary study of the phenotype of patients with DM1 is key to early diagnosis and personalised management.

Phosphorus digestibility and bioavailability in soybean meal, spray-dried plasma protein, and meat and bone meal determined using different methods.

Three experiments were conducted to determine phosphorus (P) digestibility and bioavailability using different methods. The objective of the first experiment was to determine ileal P digestibility of soybean meal (SBM), meat and bone meal (MBM), and spray-dried plasma protein (SDPP) using a precision-fed broiler chick assay. This assay involved feeding 8 g of SBM, MBM, or SDPP to broiler chicks at 21 D of age. At 6 h after feeding, ileal digesta were collected. Ileal P digestibility of SBM, MBM, and SDPP was 64, 42, and 94%, respectively. In the second experiment, ileal P digestibility and excreta P retention of SBM, SDPP, and MBM were determined using an ad libitum fed chick assay. On day 17 of age, chicks were placed on 1 of 12 dietary treatments that consisted of diets containing increasing levels of SBM, SDPP, or MBM. On day 21, ileal digesta and excreta were collected. True ileal P digestibility and true excreta P retention estimated using regression of ileal P or excreta P output on dietary P content yielded true ileal P digestibility values for SBM, SDPP, and MBM (2 diet methods for MBM) to be 83, 98, 61, and 23%, respectively. True excreta P retention values for SBM, SDPP, and MBM (2 methods) were determined to be 51, 99, 32, and 53%, respectively. The third experiment determined bioavailability of P in SBM, SDPP, and MBM relative to KH2PO4 using a chick bone ash bioassay. Dietary treatments included a P-deficient cornstarch-dextrose-SBM diet supplemented with 2 increasing levels of P from KH2PO4, SBM, SDPP, or MBM. Bioavailability of P based on tibia ash estimated using the multiple regression slope ratio method was 36, 125, and 76% for SBM, SDPP, and MBM, respectively, relative to KH2PO4. The results of this study indicated the digestibility/relative bioavailability of the P in SDPP was very high for all 3 methods, but values for SBM and MBM varied greatly among different methods.

Effects of a high-fat-diet supplemented with probiotics and ω3-fatty acids on appetite regulatory neuropeptides and neurotransmitters in a pig model.

The pig is a valuable animal model to study obesity in humans due to the physiological similarity between humans and pigs in terms of digestive and associated metabolic processes. The dietary use of vegetal protein, probiotics and omega-3 fatty acids is recommended to control weight gain and to fight obesity-associated metabolic disorders. Likewise, there are recent reports on their beneficial effects on brain functions. The hypothalamus is the central part of the brain that regulates food intake by means of the production of food intake-regulatory hypothalamic neuropeptides, as neuropeptide Y (NPY), orexin A and pro-opiomelanocortin (POMC), and neurotransmitters, such as dopamine and serotonin. Other mesolimbic areas, such as the hippocampus, are also involved in the control of food intake. In this study, the effect of a high fat diet (HFD) alone or supplemented with these additives on brain neuropeptides and neurotransmitters was assessed in forty-three young pigs fed for 10 weeks with a control diet (T1), a high fat diet (HFD, T2), and HFD with vegetal protein supplemented with Bifidobacterium breve CECT8242 alone (T3) or in combination with omega-3 fatty acids (T4). A HFD provoked changes in regulatory neuropeptides and 3,4-dihydroxyphenylacetic acid (DOPAC) in the hypothalamus and alterations mostly in the dopaminergic system in the ventral hippocampus. Supplementation of the HFD with B. breve CECT8242, especially in combination with omega-3 fatty acids, was able to partially reverse the effects of HFD. Correlations between productive and neurochemical parameters supported these findings. These results confirm that pigs are an appropriate animal model alternative to rodents for the study of the effects of HFD on weight gain and obesity. Furthermore, they indicate the potential benefits of probiotics and omega-3 fatty acids on brain function.

Exigência de lisina digestível de frangos de corte machos de 22 a 42 dias de idade / Digestible lysine levels of male broilers from 22 to 42 days of age

O objetivo deste estudo foi determinar a exigência de lisina digestível para frangos de corte machos sob as características de desempenho, composição corporal e rendimento de carcaça dos animais, de 22 a 42 dias de idade. As dietas diferiram quanto aos níveis de lisina digestível, mantendo-se a relação dos demais aminoácidos com a lisina. Foram utilizados seis níveis de lisina digestível: 0,88%; 0,96%; 1,05%; 1,13%; 1,22%; e 1,30%. Distribuídos em 36 unidades experimentais de 36 aves cada, 1296 animais da linhagem Cobb - 500® tiveram as seguintes características de desempenho avaliadas: consumo de ração (CR), peso corporal (PC), ganho de peso (GP), conversão alimentar (CA), viabilidade criatória (VC) e índice de eficiência produtiva (IEP). Aos 42 dias de idade, foram selecionadas ao acaso cinco aves para avaliação do rendimento de carcaça, e duas para avaliação da composição corporal. A CA, o IEP e o rendimento de peito foram influenciados, sendo sua exigência de 1,30%, sugerindo que níveis maiores de lisina digestível que as recomendações utilizadas como base neste estudo (1,13%) trouxeram benefícios aos animais sobre essas características.(AU)

The objective of the present study was to evaluate the optimal levels of digestible lysine in the diet of male broilers, evaluating performance characteristics, body composition, and carcass yield of the animals in the final phase (22 to 42 days old). The diets differed in digestible lysine content, maintaining the relation among the other amino acids and lysine in accordance with the ideal protein concept. The six levels of digestible lysine in the diet were: 0.88%; 0.96%; 1.05%; 1.13%; 1.22%, and 1.30%. A total of 1296 animals were employed, distributed in 36 experimental units of 36 birds each. The determined performance characteristics corresponded to feed intake (FI), body weight (BW), weight gain (WG), feed conversion (FC), viability (VB), and productive efficiency index (PEI). At 42 days of age seven birds per experimental unit were selected at random, five for the estimation of yield and total carcass and commercial cut weight, and two for the evaluation of body composition. FC, animal breast yield and PEI weres influenced with requirements of 1.30%. With respect to nationally known recommendations regarding digestible lysine (1.13%), higher levels of the amino acid in the diet have brought benefits regarding the characteristics above.(AU)

[Use of single-electrode EEG in the evaluation of attention-deficit/hyperactivity disorder]. / Empleo del electroencefalograma de un solo electrodo en la evaluación del trastorno por déficit de atención/hiperactividad.

INTRODUCTION: Attention deficit/hyperactivity disorder (ADHD) maintains a diagnosis based on behavioral data despite its involvement in neuropsychophysiological models. The monopolar electroencephalography (EEG) record focused on differentiating children with ADHD versus controls based on a higher theta/beta ratio has been proposed as an alternative to objectify the diagnosis and guide neurofeedback-based intervention, but its results have been controversial. AIM: To analyze the viability of a single electrode to detect differences in the main cerebral rhythms and especially in theta/beta ratio, in children diagnosed with ADHD, analyzing the differences by subtype, age, sex and type of experimental task. PATIENTS AND METHODS: 92 children (range: 7-13 years) diagnosed with ADHD were evaluated in a monopolar EEG record on four experimental tasks (rest, reading, active listening and copying a figure). Seven measures on slow and fast EEG rhythms were obtained, plus theta/beta ratio. RESULTS: There were no differences by ADHD subtypes. The task of greatest cognitive demand obtained the highest wave amplitudes. Smaller participants and boys presented higher amplitudes in slow waves and in theta/beta ratio in all the experimental tasks, showing a greater tendency to attentional regulation problems. CONCLUSION: Monopolar record and theta/beta ratio are a viable alternative in the clinical setting to complement the evaluation of ADHD.

TITLE: Empleo del electroencefalograma de un solo electrodo en la evaluación del trastorno por déficit de atención/hiperactividad.Introducción. El trastorno por déficit de atención/hiperactividad (TDAH) mantiene un diagnóstico basado en datos conductuales a pesar de su implicación en modelos neuropsicofisiológicos. El registro del electroencefalograma (EEG) monopolar centrado en diferenciar a los niños con TDAH frente a los controles en función de una mayor ratio theta/beta se ha propuesto desde hace tiempo como una alternativa para objetivar el diagnóstico y guiar la intervención basada en neurofeedback, pero sus resultados han resultado controvertidos. Objetivo. Analizar la viabilidad de un único electrodo para detectar diferencias en los principales ritmos cerebrales, y especialmente en la ratio theta/beta, en niños con diagnóstico de TDAH, analizando las diferencias por subtipo, edad, sexo y tarea. Pacientes y métodos. Se evaluó a 92 niños (rango: 7-13 años) con diagnóstico de TDAH en un registro de EEG monopolar sobre cuatro tareas (reposo, lectura, escucha activa y copiar una figura). Se obtuvieron siete medidas basadas en ritmos EEG lentos y rápidos, más la ratio theta/beta. Resultados. No hubo diferencias por subtipos de TDAH. La tarea de mayor demanda cognitiva obtuvo en general las amplitudes de onda más elevadas. Los participantes más pequeños y los varones presentaron en general una ratio theta/beta y amplitudes en las ondas lentas más elevadas en todas las tareas investigadas, y mostraron una mayor tendencia a problemas de regulación atencional. Conclusión. El registro monopolar y la ratio theta/beta son una alternativa viable en el ámbito clínico, al menos para complementar la evaluación del TDAH.

[Effects of virtual reality on balance and gait in stroke: a systematic review and meta-analysis]. / Efectos de la realidad virtual sobre el equilibrio y la marcha en el ictus: revision sistematica y metaanalisis.

INTRODUCTION: Stroke is the leading cause of disability in adulthood. Recently the improvement of virtual reality technologies has been used in the rehabilitation of stroke patients. AIM: To review published research literature on the effects of the virtual reality interventions vs conventional therapy on balance and gait in stroke. PATIENTS AND METHODS: A systematic and a meta-analysis of randomized controlled trials was performed during March 2018 in the databases: PubMed, PEDro, Web of Science, Scopus, Cochrane Library and Medline at EBSCO. The selection criteria were: randomized controlled trials published in English or Spanish during the past ten years. The PEDro scale evaluated the quality of the methods used in the studies. A total of 14 clinical trials were included in the systemic review, of which 10 contributed information to the meta-analysis. RESULTS: Favourable results were found on balance (Berg Balance Scale: standardized mean difference, SMD = -1.89; 95% CI: -2.72 to -1.07; Timed Up and Go, SMD: 1.42; 95% CI: 1.03-1.81), and gait (GaitRite platform: cadence, SMD: -1.51, 95% CI: -2.05 to -0.97; step length, SMD: -1.63, 95% CI: -2.18 to -1.08; stride length, SMD: -1.63, 95% CI: -2.18 to -1.08; velocity, SMD: -1.58, 95% CI: -2.97 to -0.18). CONCLUSION: The results show the potential benefit of virtual reality interventions to recover balance and gait after stroke.

TITLE: Efectos de la realidad virtual sobre el equilibrio y la marcha en el ictus: revision sistematica y metaanalisis.Introduccion. El ictus es la mayor causa de discapacidad en los adultos. En los ultimos años, la mejora en las tecnologias de realidad virtual ha propiciado su uso para la rehabilitacion de pacientes de ictus. Objetivo. Analizar las evidencias cientificas existentes sobre la efectividad del uso de realidad virtual frente a la terapia convencional en la mejora de la marcha y el equilibrio de pacientes que han sufrido un ictus. Pacientes y metodos. Se ha realizado una revision sistematica y un metaanalisis durante marzo de 2018 en las siguientes bases de datos: PubMed, PEDro, Web of Science, Scopus, Cochrane Library y Medline via EBSCO. Los principales criterios de seleccion fueron ensayos clinicos controlados aleatorizados, publicados en ingles o español, durante los ultimos diez años (2008-2018). La calidad metodologica de los estudios se evaluo mediante la escala PEDro. Se incluyo un total de 14 ensayos clinicos aleatorizados con intervenciones de realidad virtual en la revision sistematica, 10 de ellos en el metaanalisis. Resultados. Se han obtenido resultados favorables de las intervenciones de realidad virtual sobre el equilibrio (Berg Balance Scale: diferencia de medias estandarizada, DME: ­1,89; intervalo de confianza al 95%, IC 95%: ­2,72 a ­1,07; Timed Up and Go: DME: 1,42; IC 95%: 1,03 a 1,81) y la marcha (GaitRite: cadencia, DME: ­1,51, IC 95%: ­2,05 a ­0,97; longitud del paso, DME: ­1,63, IC 95%: ­2,18 a ­1,08; longitud de la zancada, DME: ­1,63, IC 95%: ­2,18 a ­1,08; velocidad, DME: ­1,58, IC 95%: ­2,97 a ­0,18). Conclusion. Los resultados obtenidos muestran el beneficio potencial de la realidad virtual sobre la recuperacion de la marcha y equilibrio en sujetos que han sufrido ictus.

Physical therapy in Down syndrome: systematic review and meta-analysis.

BACKGROUND: Down syndrome is the most common chromosomal abnormality, with a worldwide incidence of around 0.1% in live births. It is related to several conditions in which the physical therapy could take action-preventing co-morbidities. This study aims to evaluate the effectiveness of physical therapy in Down syndrome, to know and compare the effectiveness of different physical therapy interventions in this population. METHODS: A systematic review and a meta-analysis of randomised controlled trials were conducted. The search was performed during June 2018 in the following databases: PubMed, Web of Science, Physiotherapy Evidence Database and Scopus. The studies were selected using predefined inclusion and exclusion criteria. The Physiotherapy Evidence Database scale evaluated the quality of the methods used in the studies. Subsequently, the data were extracted, and statistical analysis was performed when possible. RESULTS: A total of 27 articles were included, of which nine contributed information to the meta-analysis. Statistical analysis showed favourable results for the strength of upper and lower limbs [standardised mean difference (SMD) = 1.46; 95% confidence interval (CI): (0.77-2.15); and SMD = 2.04; 95% CI: (1.07-3.01)] and mediolateral oscillations of balance [SMD = -3.30; 95% CI: (-5.34 to -1.26)]. CONCLUSIONS: The results show the potential benefit of certain types of physical therapy interventions, specifically in strength and balance, in people with Down syndrome. There are still many aspects to clarify and new lines of research.

Phosphorus retention in corn, spray dried plasma protein, soybean meal, meat and bone meal, and canola meal using a precision-fed rooster assay.

Four experiments were conducted to evaluate the precision-fed rooster assay for determining excreta phosphorus retention values for 5 feed ingredients in which roosters were precision-fed the ingredients and excreta were collected quantitatively for 48 h. The first rooster assay determined the effects of increasing P intakes on excreta P retention values for corn. This assay involved feeding either 20 g of corn or 20 g of corn supplemented with increasing amounts of KH2PO4 to provide total P intakes of 51 to 351 mg and non-phytate P intakes of 16 to 316 mg. The excreta P retention value for corn fed alone was 75% but decreased greatly when non-phytate P intakes were 76 mg or higher for the corn diets containing added KH2PO4. The second precision-fed rooster assay involved feeding increasing amounts of spray dried plasma protein (SDPP) (5 to 20 g) which provided non-phytate P intakes of 61 to 242 mg. Excretion of P increased and excreta P retention values decreased from 94 to 60% as SDPP intake increased from 5 to 20 g. Experiment 3 determined excreta P retention values for solvent extracted dehulled soybean meal (SBM) (24 g intake) and also the effect of increasing intakes of SDPP (5 to 10 g) and meat and bone meal (MBM) (1.5 to 10 g) on their excreta P retention values. The excreta P retention value for SBM was 41%. Excreta P retention values for SDPP again decreased as P intake increased. Excreta P retention values for MBM were low (27 to 35%) at all intakes. In Experiment 4, roosters were tube-fed 8, 16, or 24 g of canola meal and excreta P retention values varied from 23 to 35% among intake levels. The results of this study indicated that excreta P retention values often varied greatly among different levels of ingredient and non-phytate phosphorus intake and suggest that the precision-fed assay may be useful for determining bioavailability of P only if non-phytate P intakes are low. In addition, the assay may not be accurate for ingredients which contain high Ca levels such as MBM.

[Scoping review on formaldehyde toxicity in occupationally exposed workers]. / Toxicidad del formaldehido en trabajadores profesionalmente expuestos. Revisión bibliográfica.

The presence of formaldehyde at workplace remains significant. Exposure to it results in local irritation of the eye, nose and upper respiratory tract mucous membranes, and it has been chronically related to a higher risk of cancer development at the paranasal sinuses, naso-oropharynx and lungs. The aim of our work has been the updating of the bibliography and the categorization of the most up to date scientific evidence of formaldehyde effects on human body. Bibliographic search on the electronic database Medline / PubMed, restricted to the last 10 years through a combination of free and controlled language.Review of 185 scientific articles, finally including 54 due to duplicity, language, and inclusion criteria. We find among the main results a major evidence regarding genotoxicity; limited, inconsistent, and contradictory evidence regarding various neoplastic pathologies; and lack of evidence regarding bronchial asthma. Further studies have to be carried out, especially longitudinal studies and greater epidemiological power, to generate new knowledge about the behavior of this toxic.

La presencia del formaldehido en el ámbito laboral sigue siendo importante. La exposición produce irritación local de mucosas oculares, nasales y del tracto respiratorio superior, y crónicamente se ha asociado con mayor riesgo de desarrollar cáncer a nivel de senos paranasales, naso-orofaringe y pulmón. Esta revisión tiene por objetivo actualizar la bibliografía y categorizar la evidencia científica más actualizada de los efectos que el formaldehido produce sobre el organismo humano. Búsqueda bibliográfica en la base de datos electrónica Medline/PubMed, limitada a los últimos 10 años mediante combinación de lenguaje libre y controlado. Se revisaron 185 artículos con inclusión final de 54 tras descartar por duplicidad, idioma y criterios de inclusión. Se observa un elevado grado de evidencia respecto a la genotoxicidad, evidencia contradictoria, inconsistente o limitada respecto a patologías neoplásicas de origen hematopoyético, laringe, naso-sinusales o de pulmón y falta de evidencia sobre la relación con el asma bronquial. Es preciso efectuar nuevos estudios, especialmente con carácter longitudinal y mayor potencia epidemiológica, para generar nuevo conocimiento sobre el comportamiento de este tóxico.

Thermally Driven Electronic Topological Transition in FeTi.

Ab initio molecular dynamics, supported by inelastic neutron scattering and nuclear resonant inelastic x-ray scattering, showed an anomalous thermal softening of the M_{5}^{-} phonon mode in B2-ordered FeTi that could not be explained by phonon-phonon interactions or electron-phonon interactions calculated at low temperatures. A computational investigation showed that the Fermi surface undergoes a novel thermally driven electronic topological transition, in which new features of the Fermi surface arise at elevated temperatures. The thermally induced electronic topological transition causes an increased electronic screening for the atom displacements in the M_{5}^{-} phonon mode and an adiabatic electron-phonon interaction with an unusual temperature dependence.

Iodine status and thyroid function among Spanish schoolchildren aged 6-7 years: the Tirokid study.

I deficiency is still a worldwide public health problem, with children being especially vulnerable. No nationwide study had been conducted to assess the I status of Spanish children, and thus an observational, multicentre and cross-sectional study was conducted in Spain to assess the I status and thyroid function in schoolchildren aged 6-7 years. The median urinary I (UI) and thyroid-stimulating hormone (TSH) levels in whole blood were used to assess the I status and thyroid function, respectively. A FFQ was used to determine the consumption of I-rich foods. A total of 1981 schoolchildren (52 % male) were included. The median UI was 173 µg/l, and 17·9 % of children showed UI<100 µg/l. The median UI was higher in males (180·8 v. 153·6 µg/l; P<0·001). Iodised salt (IS) intake at home was 69·8 %. IS consumption and intakes of ≥2 glasses of milk or 1 cup of yogurt/d were associated with significantly higher median UI. Median TSH was 0·90 mU/l and was higher in females (0·98 v. 0·83; P<0·001). In total, 0·5 % of children had known hypothyroidism (derived from the questionnaire) and 7·6 % had TSH levels above reference values. Median TSH was higher in schoolchildren with family history of hypothyroidism. I intake was adequate in Spanish schoolchildren. However, no correlation was found between TSH and median UI in any geographical area. The prevalence of TSH above reference values was high and its association with thyroid autoimmunity should be determined. Further assessment of thyroid autoimmunity in Spanish schoolchildren is desirable.

Adenovirus expressing ß2-microglobulin recovers HLA class I expression and antitumor immunity by increasing T-cell recognition.

Optimal tumor cell surface expression of human leukocyte antigen (HLA) class I molecules is essential for the presentation of tumor-associated peptides to T-lymphocytes. However, a hallmark of many types of tumor is the loss or downregulation of HLA class I expression associated with ineffective tumor antigen presentation to T cells. Frequently, HLA loss can be caused by structural alterations in genes coding for HLA class I complex, including the light chain of the complex, ß2-microglobulin (ß2m). Its best-characterized function is to interact with HLA heavy chain and stabilize the complex leading to a formation of antigen-binding cleft recognized by T-cell receptor on CD8+ T cells. Our previous study demonstrated that alterations in the ß2m gene are frequently associated with cancer immune escape leading to metastatic progression and resistance to immunotherapy. These types of defects require genetic transfer strategies to recover normal expression of HLA genes. Here we characterize a replication-deficient adenoviral vector carrying human ß2m gene, which is efficient in recovering proper tumor cell surface HLA class I expression in ß2m-negative tumor cells without compromising the antigen presentation machinery. Tumor cells transduced with ß2m induced strong activation of T cells in a peptide-specific HLA-restricted manner. Gene therapy using recombinant adenoviral vectors encoding HLA genes increases tumor antigen presentation and represents a powerful tool for modulation of tumor cell immunogenicity by restoration of missing or altered HLA genes. It should be considered as part of cancer treatment in combination with immunotherapy.

Analyzing the research in Integrative & Complementary Medicine by means of science mapping.

OBJECTIVES: The research in the Complementary and Alternative Medicine (CAM) field is analyzed according to the journals indexed in ISI Web of Science. Science Mapping Analysis (SMA) is used to provide and overview of the conceptual evolution of the CAM field. METHODS: The software SciMAT is used to detect and visualize the hidden themes and their evolution over a consecutive span of years. It combines SMA and performance analysis. Twenty one journals related to CAM were analyzed, in four consecutive periods from 1974 to 2011. RESULTS: Strategic diagrams and the thematic evolution of CAM, together with performance indicators (h-index), were obtained. The results show that CAM research has focused on seven main thematic areas: MEDICINAL-PLANTS, CHIROPRACTIC-AND-LOW-BACK-PAIN, ACUPUNCTURE-AND-PAIN, CELL-PROCESSES-AND-DISEASES, LIPID-PEROXIDATION and DIABETES-AND-INSULIN. CONCLUSION: The research output could be used by the scientific community to identify thematic areas on which interest is focused.

Successful Visna/maedi control in a highly infected ovine dairy flock using serologic segregation and management strategies.

A control system for Visna/maedi virus (VMV) infection based on serologic segregation and management strategies was applied in an infected Spanish dairy Manchega breed sheep flock (n=670) that was affected by a severe respiratory process associated to VMV. The control started in 2004 and consisted on the serological study of animals, segregation in two different flocks (seropositive and seronegative), separate management of flocks, selection of young female lambs for replacement only from seronegative ewes offspring, immediate removal of seropositive animals detected in the seronegative flock and a management tending toward the reduction and final culling of the seropositive flock. The serological control was repeated yearly or twice a year, approximately. Initial VMV seroprevalence of the undivided flock was 66.4% (January 2004) that descended to 47.3%, 12.8%, 2.2% and 0.2% between July 2004 and May 2006. Residual seroprevalence fluctuated slightly thereafter with a peak of 2.2% in April 2008. After segregation, number of animals in the seronegative flock was 378 that descended to 323 in October 2005. Since then, this number has increased steadily reaching 650 sheep in December 2011. The seropositive flock was progressively reduced by culling until its total disappearance in June 2010. This work presents the detailed results obtained in the control strategy against VMV in a single dairy sheep flock by implementing a segregation system based on serologic testing. The system is highly successful, as it reduces to residual levels VMV infection in about two years without the need of culling a high number of animals, as required by other methods. Moreover, the original size flock was been recovered within 8 years and has led to a subjective improvement of animal health and welfare in the flock. The residual seroprevalence could be eliminated at this stage by applying more sensitive molecular or other serological techniques to reach eradication.

Histological and immunohistochemical assessment of liver biopsies in morbidly obese patients.

AIMS: To study liver lesions in morbidly obese patients who underwent liver biopsy at the time of bariatric surgery to define histological lesions, especially inflammatory infiltrate, diagnostic categories and the possible influence of gender in this respect. METHODS AND RESULTS: 110 biopsies (36 males-M- and 76 females -F-) were evaluated and categorised, according to the NAS (NAFLD -non alcoholic fatty liver disease- Activity Score) system and other criteria, as non-NAFLD (15.5%, F predominance), non-alcoholic steatohepatitis (NASH) (16.5%, M predominance), non-alcoholic hepatosteatosis (NAHS) (21%, F predominance) and, the most numerous group, NASH-borderline (NASH-BORD) (47%), with three subgroups, characterised by centrozonal lesions, portal area preferential involvement or affecting both areas. The predominant form of hepatocytesteatosis was mixed with a multivesicular component that was present in most cases with fibroinflammatory portal involvement. Nuclear glycogenosomes were found in greater number of biopsies in patients in the third and sixth decades. Portal inflammation was present in a large number of cases (M predominance); the application of immunohistochemical techniques (myeloperoxidase and CD68 antibodies) to evaluate lobular inflammation revealed "surgical hepatitis" in one third of the cases, and the presence of microgranulomas (CD68+) (M predominance), which were more abundant with increasing lesion severity. CONCLUSIONS: Portal inflammation and multivesicular hepatocytesteatosis are highly prevalent in morbidly obese patients. This study identifies a new subtype of NASH-BORD characterized by centrizonal and porto-periportal area involvement and the existence of liver biopsies without steatosis. CD68+ microgranulomas constitute an unequivocal marker of lobular inflammation in surgical biopsies and of lesion severity, which is gender-related.