[Paresis of an upper extremity. Action observation and motor imagery in recovery of patients with chronic stroke]. / Paresia de una extremidad superior. Recuperación mediante observación de la acción más imaginería motora en pacientes con ictus crónico.

INTRODUCTION: Action observation (AO) and motor imagery (MI) are considered functionally equivalent forms of motor representation related to movement execution (ME). Because of their characteristics, AO and MI have been proposed as techniques to facilitate the recovery of post-stroke hemiparesis in the upper extremities. PATIENTS AND METHODS: An experimental, longitudinal, prospective, single-blinded design was undertaken. Eleven patients participated, and were randomly assigned to each study group. Both groups received 10 to 12 sessions of physical therapy. Five patients were assigned to the control treatment group, and six patients to the experimental treatment group (AO + MI). All were assessed before and after treatment for function, strength (newtons) and mobility (percentage) in the affected limb, as well as alpha desynchronisation (8-13 Hz) in the supplementary motor area, the premotor cortex and primary motor cortex while performing AO + MI tasks and action observation plus motor execution (AO + ME). RESULTS: The experimental group presented improvement in function and strength. A negative correlation was found between desynchronisation in the supplementary motor area and function, as well as a post-treatment increase in desynchronisation in the premotor cortex of the injured hemisphere in the experimental group only. CONCLUSIONS: An AO + MI-based intervention positively impacts recovery of the paretic upper extremity by stimulating the supplementary motor area, a cortex involved in movement preparation and learning. AO + MI therapy can be used as adjunctive treatment in patients with upper extremity paresis following chronic stroke.

TITLE: Paresia de una extremidad superior. Recuperación mediante observación de la acción más imaginería motora en pacientes con ictus crónico.Introducción. La observación de la acción (OA) y la imaginería motora (IM) se consideran formas de representación motora funcionalmente equivalentes, relacionadas con la ejecución del movimiento (EM). Debido a sus características, la OA y la IM se han propuesto como técnicas para facilitar la recuperación de las hemiparesias de la extremidad superior posterior a ictus. Pacientes y métodos. Se realizó un diseño experimental, longitudinal y prospectivo simple ciego. Participaron 11 pacientes, quienes fueron asignados aleatoriamente a cada grupo de estudio. Ambos grupos recibieron de 10 a 12 sesiones de terapia física. Cinco pacientes fueron asignados al grupo de tratamiento control y seis pacientes al grupo de tratamiento experimental (OA + IM). A todos se les evaluó antes y después del tratamiento para determinar la función, la fuerza (newtons) y la movilidad (porcentaje) de la extremidad afectada, así como la desincronización de alfa (8-13 Hz) en el área motora suplementaria, la corteza premotora y la corteza motora primaria durante tareas de OA + IM y observación de la acción más ejecución motora (OA + EM). Resultados. El grupo experimental presentó mejoría en la función y la fuerza. Se encontró correlación negativa entre la desincronización en el área motora suplementaria y la función, así como incremento postratamiento de la desincronización en la corteza premotora del hemisferio lesionado únicamente para el grupo experimental. Conclusiones. Una intervención basada en OA + IM impacta positivamente en la recuperación de la extremidad superior parética mediante la estimulación del área motora suplementaria, corteza involucrada en la preparación y aprendizaje del movimiento. La terapia OA + IM puede usarse como tratamiento complementario en pacientes con paresia de una extremidad superior posterior a un ictus crónico.

3D phantom for image quality assessment of mammography systems.

Objective.To present an innovative approach for the design of a 3D mammographic phantom for medical equipment quality assessment, estimation of the glandular tissue percentage in the patient's breast, and emulation of microcalcification (µC) breast lesions.Approach.Contrast-to noise ratio (CNR) measurements, as well as spatial resolution and intensity-to-glandularity calibrations under mammography conditions were performed to assess the effectiveness of the phantom. CNR measurements were applied to different groups of calcium hydroxyapatite (HA) and aluminum oxide (AO)µCs ranging from 200 to 600µm. Spatial resolution was characterized using an aluminum plate contained in the phantom and standard linear figures of merit, such as the line spread function and modulation transfer function (MTF). The intensity-to-glandularity calibration was developed using an x-ray attenuation matrix within the phantom to estimate the glandular tissue percentage in a breast with a compressed thickness of 4 cm.Main results.For the prototype studied, the minimum confidence level for detecting HAµCs is 95.4%, while for AOµCs is above 68.3%. It was also possible to determine that the MTF of the commercial mammography machine used for this study at the Nyquist frequency is 41%. Additionally, a one-to-one intensity-to-glandularity calibration was obtained and verified with Monte-Carlo simulation results.Significance.The phantom provides traditional arrangements presented in accreditation phantoms, which makes it competitive with available devices, but excelling in regarding affordability, modularity, and inlays distribution. Moreover, its design allows to be positioned in close proximity to the patient's breast during a medical screening for a simultaneous x-ray imaging, such that the features of the phantom can be used as reference values to specify characteristics of the real breast tissue, such as proportion of glandular/adipose composition and/orµC type and size lesions.

SARS-CoV-2 RNA Is Readily Detectable at Least 8 Months after Shedding in an Isolation Facility.

Environmental monitoring of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for research and public health purposes has grown exponentially throughout the coronavirus disease 2019 (COVID-19) pandemic. Monitoring wastewater for SARS-CoV-2 provides early warning signals of virus spread and information on trends in infections at a community scale. Indoor environmental monitoring (e.g., swabbing of surfaces and air filters) to identify potential outbreaks is less common, and the evidence for its utility is mixed. A significant challenge with surface and air filter monitoring in this context is the concern of "relic RNA," noninfectious RNA found in the environment that is not from recently deposited virus. Here, we report detection of SARS-CoV-2 RNA on surfaces in an isolation unit (a university dorm room) for up to 8 months after a COVID-19-positive individual vacated the space. Comparison of sequencing results from the same location over two time points indicated the presence of the entire viral genome, and sequence similarity confirmed a single source of the virus. Our findings highlight the need to develop approaches that account for relic RNA in environmental monitoring. IMPORTANCE Environmental monitoring of SARS-CoV-2 is rapidly becoming a key tool in infectious disease research and public health surveillance. Such monitoring offers a complementary and sometimes novel perspective on population-level incidence dynamics relative to that of clinical studies by potentially allowing earlier, broader, more affordable, less biased, and less invasive identification. Environmental monitoring can assist public health officials and others when deploying resources to areas of need and provides information on changes in the pandemic over time. Environmental surveillance of the genetic material of infectious agents (RNA and DNA) in wastewater became widely applied during the COVID-19 pandemic. There has been less research on other types of environmental samples, such as surfaces, which could be used to indicate that someone in a particular space was shedding virus. One challenge with surface surveillance is that the noninfectious genetic material from a pathogen (e.g., RNA from SARS-CoV-2) may be detected in the environment long after an infected individual has left the space. This study aimed to determine how long SARS-CoV-2 RNA could be detected in a room after a COVID-positive person had been housed there.

The challenge of SARS-CoV-2 environmental monitoring in schools using floors and portable HEPA filtration units: Fresh or relic RNA?

Testing surfaces in school classrooms for the presence of SARS-CoV-2, the virus that causes COVID-19, can provide public-health information that complements clinical testing. We monitored the presence of SARS-CoV-2 RNA in five schools (96 classrooms) in Davis, California (USA) by collecting weekly surface-swab samples from classroom floors and/or portable high-efficiency particulate air (HEPA) units (n = 2,341 swabs). Twenty-two surfaces tested positive, with qPCR cycle threshold (Ct) values ranging from 36.07-38.01. Intermittent repeated positives in a single room were observed for both floor and HEPA filter samples for up to 52 days, even following regular cleaning and HEPA filter replacement after a positive result. We compared the two environmental sampling strategies by testing one floor and two HEPA filter samples in 57 classrooms at Schools D and E. HEPA filter sampling yielded 3.02% and 0.41% positivity rates per filter sample collected for Schools D and E, respectively, while floor sampling yielded 0.48% and 0% positivity rates. Our results indicate that HEPA filter swabs are more sensitive than floor swabs at detecting SARS-CoV-2 RNA in interior spaces. During the study, all schools were offered weekly free COVID-19 clinical testing through Healthy Davis Together (HDT). HDT also offered on-site clinical testing in Schools D and E, and upticks in testing participation were observed following a confirmed positive environmental sample. However, no confirmed COVID-19 cases were identified among students associated with classrooms yielding positive environmental samples. The positive samples detected in this study appeared to contain relic viral RNA from individuals infected before the monitoring program started and/or RNA transported into classrooms via fomites. High-Ct positive results from environmental swabs detected in the absence of known active infections supports this conclusion. Additional research is needed to differentiate between fresh and relic SARS-CoV-2 RNA in environmental samples and to determine what types of results should trigger interventions.

The challenge of SARS-CoV-2 environmental monitoring in schools using floors and portable HEPA filtration units: Fresh or relic RNA?

Testing surfaces in school classrooms for the presence of SARS-CoV-2, the virus that causes COVID-19, can provide public-health information that complements clinical testing. We monitored the presence of SARS-CoV-2 RNA in five schools (96 classrooms) in Davis, California (USA) by collecting weekly surface-swab samples from classroom floors and/or portable high-efficiency particulate air (HEPA) units. Twenty-two surfaces tested positive, with qPCR cycle threshold (Ct) values ranging from 36.07-38.01. Intermittent repeated positives in a single room were observed for both floor and HEPA filter samples for up to 52 days, even following regular cleaning and HEPA filter replacement after a positive result. We compared the two environmental sampling strategies by testing one floor and two HEPA filter samples in 57 classrooms at Schools D and E. HEPA filter sampling yielded 3.02% and 0.41% positivity rates per filter sample collected for Schools D and E, respectively, while floor sampling yielded 0.48% and 0% positivity rates. Our results indicate that HEPA filter swabs are more sensitive than floor swabs at detecting SARS-CoV-2 RNA in interior spaces. During the study, all schools were offered weekly free COVID-19 clinical testing. On-site clinical testing was offered in Schools D and E, and upticks in testing participation were observed following a confirmed positive environmental sample. However, no confirmed COVID-19 cases were identified among students associated with classrooms yielding positive environmental samples. The positive samples detected in this study appeared to reflect relic viral RNA from individuals infected before the monitoring program started and/or RNA transported into classrooms via fomites. The high-Ct positive results from environmental swabs further suggest the absence of active infections. Additional research is needed to differentiate between fresh and relic SARS-CoV-2 RNA in environmental samples and to determine what types of results should trigger interventions.

Demographic and clinical profiles of Plasmodium falciparum and Plasmodium vivax patients at a tertiary care centre in southwestern India.

BACKGROUND: Malaria remains an important cause of morbidity and mortality in India. Though many comprehensive studies have been carried out in Africa and Southeast Asia to characterize and examine determinants of Plasmodium falciparum and Plasmodium vivax malaria pathogenesis, fewer have been conducted in India. METHODS: A prospective study of malaria-positive individuals was conducted at Goa Medical College and Hospital (GMC) from 2012 to 2015 to identify demographic, diagnostic and clinical indicators associated with P. falciparum and P. vivax infection on univariate analysis. RESULTS: Between 2012 and 2015, 74,571 febrile individuals, 6287 (8.4%) of whom were malaria positive, presented to GMC. The total number of malaria cases at GMC increased more than two-fold over four years, with both P. vivax and P. falciparum cases present year-round. Some 1116 malaria-positive individuals (mean age = 27, 91% male), 88.2% of whom were born outside of Goa and 51% of whom were construction workers, were enroled in the study. Of 1088 confirmed malaria-positive patients, 77.0% had P. vivax, 21.0% had P. falciparum and 2.0% had mixed malaria. Patients over 40 years of age and with P. falciparum infection were significantly (p < 0.001) more likely to be hospitalised than younger and P. vivax patients, respectively. While approximately equal percentages of hospitalised P. falciparum (76.6%) and P. vivax (78.9%) cases presented with at least one WHO severity indicator, a greater percentage of P. falciparum inpatients presented with at least two (43.9%, p < 0.05) and at least three (29.9%, p < 0.01) severity features. There were six deaths among the 182 hospitalised malaria positive patients, all of whom had P. falciparum. CONCLUSION: During the four year study period at GMC, the number of malaria cases increased substantially and the greatest burden of severe disease was contributed by P. falciparum.

Outstanding survival and regeneration process by the use of intelligent acellular dermal matrices and mesenchymal stem cells in a burn pig model.

A pig model with a deep large burn was used to study the regeneration process induced by mesenchymal stem cells (MSCs) and acellular pig dermal matrices, made intelligent by the combination with biodegradable nanofibers loaded with growth factors (granulocyte-macrophage colony-stimulating factor and epidermal growth factor) and coated with the anti-CD44 monoclonal antibody (intelligent acellular dermal matrices, IADMs). These IADMs are specially designed to integrate in the wound bed as new biological scaffolds as well as to specifically recruit and attach circulating and/or externally applied MSCs through the anti-CD44 antibody while delivering precise amounts of growth factors. In this way, the reparative process as well as the aesthetic and functional results were enhanced in our burn model. The animal survived, the wound was completely closed, and total regeneration of the skin was obtained without much scarring. Surprisingly, hair follicles and other skin appendages developed despite the severity and deepness of the burn. Even burned muscles and ribs seemed to have undergone a regenerative process by the end of the study. Based on these findings, we have proposed the use of IADMs and autologous, allogeneic or xenogeneic MSCs, as a new paradigm for the future treatment of large burns and probably other dermatological and cosmetic human conditions.

The next generation of burns treatment: intelligent films and matrix, controlled enzymatic debridement, and adult stem cells.

We describe a novel technology based on nanoengineered multifunctional acellular biologic scaffolds combined with wound dressings and films of the same kind. This method allows selective delivery and release of shielded biomaterials and bioactive substances to a desired wound or damaged tissue while stimulating the selective anchoring and adhesion of endogenous circulating repairing cells, such as mesenchymal stem cells, to obtain a faster and more physiologic healing process. We also present a new controlled enzymatic debridement process for more effective burned tissue scarolysis. In light of our preliminary in vitro and in vivo data, we are convinced that these approaches can include the use of other kinds of adult stem cells, such as endometrial regenerative cells, to improve the vascularization of the constructs, with great potential in the entire tissue and organ regeneration field but especially for the treatment of severely burned patients, changing the way these lesions may be treated in the future.

Filarial granuloma of the testicular tunic mimicking a testicular neoplasm: a case report.

INTRODUCTION: Any firm or solid intratesticular mass on examination and/or any hypoechoic area within the tunica albuginea on imaging is markedly suspicious for testicular cancer. Filarial involvement of the testicular tunic has not been reported previously. CASE PRESENTATION: A 32-year-old man presented with a history of noticing a swelling in his right testicle for a period of 1 month which had become painful over the 10 days before presentation. Pre-operative imaging failed to shed light on the nature of the lesions (malignant or benign). The diagnostic dilemma was explained to the patient and informed consent was obtained for an orchiectomy. The patient underwent a high inguinal orchiectomy. The histopathology revealed a filarial granuloma of the testicular tunic. CONCLUSION: While it is generally regarded that any testicular swelling, especially in a young person, should be treated as a malignancy unless proven otherwise, it is important to remember that infectious diseases such as filariasis and tuberculosis may mimic neoplasms. Careful consideration of these diagnoses must be given when dealing with testicular swellings especially in areas where the prevalence of these diseases is high.

Evaluation of a femtosecond fiber laser for two-photon fluorescence correlation spectroscopy.

This work evaluates a femtosecond fiber laser for use in two-photon fluorescence fluctuation spectroscopy. Fiber lasers present an attractive alternative to Ti:Sapphire systems because of their compact size and portability. Autocorrelation of the second harmonic generation signal from the laser demonstrates that its stability is sufficient for two-photon fluorescence correlation spectroscopy. Fluorescence correlation spectroscopy autocorrelation traces were well fit by a Gaussian-Lorentzian squared model with a beam waist near the diffraction limit for the 810 nm wavelength. A photon counting histogram collected with this system also fit nicely to a single-species model, further demonstrating the quality of the focal shape. The authors conclude that the output from the femtosecond fiber laser is sufficiently stable and has a high enough quality beam shape for fluctuation fluorescence methods, and thus represents an effective, compact, readily portable two-photon excitation source.

Bacteriología y sensibilidad antibiótica en otitis media aguda / Bacteriology and antibiotic sensitivity in acute otitis media

Introducción. La otitis media aguda es uno de losdiagnósticos más frecuentes en niños menores dedos años.Objetivos. Los objetivos de este estudio fueronconocer los microrganismos más frecuentes causantesde otitis media aguda y su sensibilidad antibiótica;y valorar la prevalencia de los agentespatógenos según la edad de los pacientes.Población, material y métodos. El trabajo se llevó acabo mediante el análisis de 249 muestras de oídomedio obtenidas por timpanocentesis en 174 niñosque asistieron al Servicio de OtorrinolaringologíaInfantil de la Clínica Universitaria Reina Fabiolacon diagnóstico de otitis media aguda en el períodocomprendido entre los años 2001 a 2004. El grupo depacientes incluyó ambos sexos (91 varones; 83 mujeres)entre las edades de 18 días y 24 meses con unpromedio de edad de 9 meses. Además, se dividieronen dos grupos: niños menores de 6 meses y niños mayores de 6 meses. Los perfiles de sensibilidad antibiótica de los agentes etiológicos más frecuentes se estudiaron de acuerdo con los principios establecidos por el ComitéNacional para Estandarizaciones de LaboratoriosClínicos (Nacional Comittee for Clinical LaboratoryStandards).Resultados. El Streptococcus pneumoniae y el Haemophilusinfluenzae surgieron como los agentes predominantes.Estos resultados fueron similares a losencontrados en previas publicaciones. El Haemophilusinfluenzae predominó en los niños menores de 6meses y el Streptococcus pneumoniae en los mayoresde esa edad. Con respecto a la sensibilidad a lapenicilina, el Streptococcus pneumoniae presentó un77,6 por ciento de sensibilidad y el Haemophilus influenzae,un 85,5 por ciento.Conclusión. El Streptococcus pneumoniae fue el germenmás frecuente en los niños mayores de 6meses y el Haemophilus influenzae en los menores de esa edad.

Bacteriología y sensibilidad antibiótica en otitis media aguda / Bacteriology and antibiotic sensitivity in acute otitis media

Introducción. La otitis media aguda es uno de losdiagnósticos más frecuentes en niños menores dedos años.Objetivos. Los objetivos de este estudio fueronconocer los microrganismos más frecuentes causantesde otitis media aguda y su sensibilidad antibiótica;y valorar la prevalencia de los agentespatógenos según la edad de los pacientes.Población, material y métodos. El trabajo se llevó acabo mediante el análisis de 249 muestras de oídomedio obtenidas por timpanocentesis en 174 niñosque asistieron al Servicio de OtorrinolaringologíaInfantil de la Clínica Universitaria Reina Fabiolacon diagnóstico de otitis media aguda en el períodocomprendido entre los años 2001 a 2004. El grupo depacientes incluyó ambos sexos (91 varones; 83 mujeres)entre las edades de 18 días y 24 meses con unpromedio de edad de 9 meses. Además, se dividieronen dos grupos: niños menores de 6 meses y niños mayores de 6 meses. Los perfiles de sensibilidad antibiótica de los agentes etiológicos más frecuentes se estudiaron de acuerdo con los principios establecidos por el ComitéNacional para Estandarizaciones de LaboratoriosClínicos (Nacional Comittee for Clinical LaboratoryStandards).Resultados. El Streptococcus pneumoniae y el Haemophilusinfluenzae surgieron como los agentes predominantes.Estos resultados fueron similares a losencontrados en previas publicaciones. El Haemophilusinfluenzae predominó en los niños menores de 6meses y el Streptococcus pneumoniae en los mayoresde esa edad. Con respecto a la sensibilidad a lapenicilina, el Streptococcus pneumoniae presentó un77,6 por ciento de sensibilidad y el Haemophilus influenzae,un 85,5 por ciento.Conclusión. El Streptococcus pneumoniae fue el germenmás frecuente en los niños mayores de 6meses y el Haemophilus influenzae en los menores de esa edad. (AU)

Bacteriología y sensibilidad antibiótica en otitis media aguda / Bacteriology and antibiotic sensitivity in acute otitis media

Introducción. La otitis media aguda es uno de losdiagnósticos más frecuentes en niños menores dedos años.Objetivos. Los objetivos de este estudio fueronconocer los microrganismos más frecuentes causantesde otitis media aguda y su sensibilidad antibiótica;y valorar la prevalencia de los agentespatógenos según la edad de los pacientes.Población, material y métodos. El trabajo se llevó acabo mediante el análisis de 249 muestras de oídomedio obtenidas por timpanocentesis en 174 niñosque asistieron al Servicio de OtorrinolaringologíaInfantil de la Clínica Universitaria Reina Fabiolacon diagnóstico de otitis media aguda en el períodocomprendido entre los años 2001 a 2004. El grupo depacientes incluyó ambos sexos (91 varones; 83 mujeres)entre las edades de 18 días y 24 meses con unpromedio de edad de 9 meses. Además, se dividieronen dos grupos: niños menores de 6 meses y niños mayores de 6 meses. Los perfiles de sensibilidad antibiótica de los agentes etiológicos más frecuentes se estudiaron de acuerdo con los principios establecidos por el ComitéNacional para Estandarizaciones de LaboratoriosClínicos (Nacional Comittee for Clinical LaboratoryStandards).Resultados. El Streptococcus pneumoniae y el Haemophilusinfluenzae surgieron como los agentes predominantes.Estos resultados fueron similares a losencontrados en previas publicaciones. El Haemophilusinfluenzae predominó en los niños menores de 6meses y el Streptococcus pneumoniae en los mayoresde esa edad. Con respecto a la sensibilidad a lapenicilina, el Streptococcus pneumoniae presentó un77,6 por ciento de sensibilidad y el Haemophilus influenzae,un 85,5 por ciento.Conclusión. El Streptococcus pneumoniae fue el germenmás frecuente en los niños mayores de 6meses y el Haemophilus influenzae en los menores de esa edad. (AU)

Two-photon microscopy with wavelength switchable fiber laser excitation.

Two-photon scanning fluorescence microscopy has become a powerful tool for imaging living cells and tissues. Most applications of two-photon microscopy employ a Ti:sapphire laser excitation source, which is not readily portable or rapidly tunable. This work explores the use of two-photon fiber laser excitation (TP-FLEX) as an excitation source for scanning two-photon microscopy. We have further demonstrated the use of a photonic crystal fiber (PCF) for facile tuning of the excitation wavelength over the range from 810 nm to 1100 nm. We generated two-photon fluorescence images at excitation wavelengths from 850 nm to 1100 nm detected on a scanning-stage microscope. By PCF wavelength tuning the dye BODIPY fl was selectively excited at 1000 nm whereas MitoTracker red was excited preferentially at 1100 nm. We discuss the potential for fiber laser sources coupled with PCF wavelength tuning as an attractive tunable excitation source for two-photon scanning fluorescence microscopy.

Effects of halfway house placement on retention of patients in substance abuse aftercare.

One hundred twenty-four male veterans were enrolled in the Birmingham VAMC Outpatient Substance Abuse Clinic (OSAC) aftercare program following inpatient treatment for alcohol, cocaine, or mixed alcohol-cocaine abuse/dependence. Forty-two of the patients were concurrently admitted to a nearby halfway house (HH) while the remaining 82 patients made community-based (CB) living arrangements. Chi-square analysis showed the two groups were matched, p > .05, in regard to age, race, marital status, presenting problem, and referral source. The CB group experienced significantly, p < .05, higher early dropout (40 vs 0%) from aftercare. Of the others engaging in treatment, the HH patients stayed in OSAC aftercare 60 days longer and had significantly, p < .01, more clinic visits. A higher proportion, p < .01, of HH patients completed each of four treatment milestones: education group, psychological testing, psychological interview, and treatment planning/update. On average, the HH patients remained in OSAC an additional 90 days after their halfway house discharge. Although not significantly different, p > .05, the frequency of HH patients receiving administrative discharge status of Treatment Complete was twice (28.2%) that of CB patients (15.1%). It is concluded that concurrent halfway house placement can aid in aftercare retention and completion.