Inertial sensors for gait monitoring and design of adaptive controllers for exoskeletons after stroke: a feasibility study.

Introduction: Tuning the control parameters is one of the main challenges in robotic gait therapy. Control strategies that vary the control parameters based on the user's performance are still scarce and do not exploit the potential of using spatiotemporal metrics. The goal of this study was to validate the feasibility of using shank-worn Inertial Measurement Units (IMUs) for clinical gait analysis after stroke and evaluate their preliminary applicability in designing an automatic and adaptive controller for a knee exoskeleton (ABLE-KS). Methods: First, we estimated the temporal (i.e., stride time, stance, and swing duration) and spatial (i.e., stride length, maximum vertical displacement, foot clearance, and circumduction) metrics in six post-stroke participants while walking on a treadmill and overground and compared these estimates with data from an optical motion tracking system. Next, we analyzed the relationships between the IMU-estimated metrics and an exoskeleton control parameter related to the peak knee flexion torque. Finally, we trained two machine learning algorithms, i.e., linear regression and neural network, to model the relationship between the exoskeleton torque and maximum vertical displacement, which was the metric that showed the strongest correlations with the data from the optical system [r = 0.84; ICC(A,1) = 0.73; ICC(C,1) = 0.81] and peak knee flexion torque (r = 0.957). Results: Offline validation of both neural network and linear regression models showed good predictions (R2 = 0.70-0.80; MAE = 0.48-0.58 Nm) of the peak torque based on the maximum vertical displacement metric for the participants with better gait function, i.e., gait speed > 0.7 m/s. For the participants with worse gait function, both models failed to provide good predictions (R2 = 0.00-0.19; MAE = 1.15-1.29 Nm) of the peak torque despite having a moderate-to-strong correlation between the spatiotemporal metric and control parameter. Discussion: Our preliminary results indicate that the stride-by-stride estimations of shank-worn IMUs show potential to design automatic and adaptive exoskeleton control strategies for people with moderate impairments in gait function due to stroke.

Local Intracoronary Fibrinolysis with Distal Occlusion: A Series of Cases Using Marinade Technique.

No-reflow phenomenon is frequent in patients with ST-segment elevation myocardial infarction (STEMI) and has proven to be a strong predictor of mortality. Local fibrinolytic infusion with distal coronary occlusion (previously described as "marinade technique") can be useful in patients with acute myocardial infarction and intraluminal thrombus refractory to aspiration enabling the local effect of the drug, directly applied inside the thrombus, while protecting the microvasculature with prolonged inflation of a distal balloon. We present the early experience of four patients with inferior acute myocardial infarction and high thrombus burden successfully treated with marinade technique in one center.

Actividad científica del claustro de profesores de Neonatología. Periodo 2015-2021 / Scientific activity of the Neonatology faculty. From 2015 to 2021

Fundamento: los escenarios docentes en centros asistenciales constituyen espacios excelentes para la generación de conocimientos y el desarrollo de la actividad científico-técnica. Objetivo: caracterizar la actividad científica de los profesores del claustro de la especialidad de Neonatología de la Facultad de Ciencias Médicas "Miguel Enríquez". Métodos: se realizó un estudio observacional, descriptivo, de corte transversal y retrospectivo de la producción científica del claustro del periodo 2015-2021. Se utilizaron métodos teóricos, y empíricos: revisión de expedientes docentes y científicos e informes técnicos. La información se procesó utilizando el paquete estadístico SPSS, versión 15.0. La relación de variables se expresó en frecuencias absolutas y relativas. Resultados: el 94,4 % del claustro era másteres en ciencias y solo el 11,1 % doctores en ciencias particulares. Más del 80 % tenía grado de especialización elevado y baja categorización investigativa. Se presentaron 174 ponencias científicas, y predominaron los eventos internacionales (37 %). Se otorgaron 40 premios y 62 reconocimientos. El 2018 fue el año más productivo. El 94,4 % había publicado. El 16,7 % participó como tutor/asesor de 10-14 tesis y 55,6 % en ninguna. Participaron activamente en tribunales estatales de especialidad, categorización docente, eventos y arbitraje de documentos en revistas nacionales y extranjeras. Conclusiones: se caracterizó la actividad científica del claustro de profesores de la especialidad de Neonatología. Se constató una adecuada formación pedagógica y académica, y satisfactoria actividad científica con reconocimiento asistencial, docente e investigativo y capacidades para publicar y formar a otros especialistas.

Background: the teaching scenarios in healthcare centers constitute excellent spaces for the generation of knowledge and the development of scientific-technical activity. Objective: to characterize the scientific activity of the faculty of the Neonatology specialty of the "Miguel Enriquez" Faculty of Medical Sciences. Methods: an observational, descriptive, cross-sectional and retrospective study of the scientific production of the faculty from 2015 to 2021 was carried out. Theoretical and empirical methods were used: review of teaching and scientific records and technical reports. The information was processed using the SPSS statistical package, version 15.0. The relationship of variables was expressed in absolute and relative values. Results: 94.4% of the faculty had master's degrees in science and only 11.1% had Ph.D.in particular sciences. More than 80% had a high degree of specialization and low investigative rank. 174 scientific papers were presented, and international events predominated (37%). 40 awards and 62 recognitions were awarded. 2018 was the most productive year. 94.4% had published. 16.7% participated as tutor/advisor of 10-14 theses and 55.6% in none. They actively participated in examining boards of specialty, professor´s ranking, events, and arbitration of documents in national and foreign journals. Conclusions: the scientific activity of the faculty of the Neonatology specialty was characterized. Adequate pedagogical and academic training was verified, as well as satisfactory scientific activity with healthcare, teaching and research recognition and capacities to publish and train other specialists.

Refractive and Visual Outcomes of a Monofocal Non-Constant Aberration Aspheric Intraocular Lens.

Purpose: To evaluate the refractive and visual outcomes following cataract surgery and implantation of a new monofocal non-constant aberration aspheric intraocular lens (IOL). Methods: Ninety eyes of 86 patients who underwent implantation the CT LUCIA 621P IOL (Carl Zeiss Meditec AG) were retrospectively analyzed in this study. Main outcome measures were refractive error and monocular corrected distance visual acuity (CDVA) and monocular uncorrected distance visual acuity (UDVA) values. Patients were evaluated at 1-month post-surgery and intra- and post-operative complications were recorded. Results: Eighty percent of the eyes showed a CDVA of 20/25 or better before surgery. The postoperative mean values of monocular distance Snellen decimal UDVA and CDVA were 0.64±0.22 and 0.89±0.13, respectively. All eyes showed the same or better difference between UDVA and CDVA. In relation to the postoperative spherical equivalent, the highest percentage of eyes, 31.11%, was for the range between -0.50 and -0.14D followed by 22.22% for the ±0.13D range. Ninety percent of the eyes were within ±1.00 D and 73.33% of eyes within ±0.50 D. The mean postoperative spherical equivalent was -0.18±0.55D. 37.78% and 76.67% of the eyes showed a value ≤0.50 D and ≤1.00D, respectively, being the mean postoperative refractive cylinder -0.81±0.50D. No adverse events were reported in whole sample intra and postoperatively. Conclusion: The present study shows that cataract surgery with an monofocal non-constant aberration aspheric IOL implantation resulted in good visual performance and refractive outcomes. This lens may be considered as a valid choice for patients in a standard-routine cataract surgery practice.

Spatial distribution patterns of tick community structure in sympatric jaguars (Panthera onca) and pumas (Puma concolor) from three ecoregions in Mexico.

We examined tick communities on wild felid hosts in three ecoregions of Mexico. We collected 186 ticks of 7 species from 10 pumas (Puma concolor) and 9 jaguars (Panthera onca). Tick community composition varied across the ecoregions, and across host species within each region. Overall, Ixodes affinis, Amblyomma ovale, and Amblyomma tenellum were the most abundant species; however, only the latter two ticks were distributed across all three ecoregions, while I. affinis, along with Ixodes spinipalpis, Amblyomma inornatum, and Amblyomma parvum were restricted to more limited geographical regions. Ixodes affinis occurred strictly in southern tropical rainforest ecoregions and was significantly more abundant in Selva Lacandona compared with the Yucatán Peninsula. Amblyomma ovale was significantly more common in the tropical dry forest in the Pacific coastal ecoregion. Amblyomma tenellum abundance tended to be higher on jaguars, while I. affinis abundance was higher on pumas. Regional distribution patterns of some tick species (e.g., I. affinis and I. spinipalpis) may be determined by off-host environmental conditions rather than host factors. In contrast, at the local scale, occurrence and abundance of some tick species (e.g., A. tenellum, A. ovale and Rhipicephalus microplus) might be driven by ecological-host factors, such as habitat use or predator-prey relationships.

Transradial Secondary Approach During Transfemoral TAVI: Usefulness of Placing a Wire Before Femoral Puncture for Management and Treatment of Vascular Complications.

Vascular complications during transcatheter aortic valve implantation (TAVI) are relatively common, and some of them related to the transfemoral secondary access. The use of the transradial access (TRA) as an alternative vascular approach for transfemoral TAVI could reduce these complications, however, the treatment of potential vascular peripheral issues from this access has been scarcely described. The advance of a wire from the TRA to the primary transfemoral access at the beginning of the procedure could help the management of eventual vascular complications. A new TRA technique during transfemoral TAVI procedures is described, reporting the results in the first forty-two patients in one center.

Percutaneous Closure of Mitral Paravalvular Leaks Generating Refractory Heart Failure in the Immediate Postoperative Period.

We present two patients with refractory heart failure due to mitral paravalvular leak (PVL) in whom percutaneous PVL closure was performed in the immediate postoperative period.

Left Bundle Branch Block after Transcatheter Aortic Valve Implantation with Edwards Sapien 3 Valve: Influence of the Valve Depth Implantation.

OBJECTIVES: The aim of this study is to determine the relation between the valve depth implantation and the new-onset left bundle branch block (LBBB) in patients treated with transcatheter aortic valve implantation (TAVI) using Edwards Sapien 3 (S3) prosthesis. BACKGROUND: LBBB is the most common conduction disturbance after TAVI. The S3 has been associated with a higher incidence of LBBB. A deep valve implant could be related to new-onset LBBB with S3. METHODS: Seventy-six consecutive patients treated with transfemoral TAVI with S3 were included. Electrocardiogram (ECG) registries were recorded at baseline, after the procedure, and before discharge. Valve depth implantation was determined in 40 patients by off-line analysis of the two/three-dimensional transeophageal echocardiogram (TEE) images, with measure of the valve stent percentage under the aortic annulus. Previous and new conduction anomalies were documented; and patient, anatomic and procedural characteristics were retrospectively analyzed. RESULTS: Complete atrioventricular block (AVB) incidence was 2.9%. LBBB after TAVI appeared in 39% of patients, being transient in almost half of the cases (permanent LBBB rate 20%). Patients with new-onset LBBB after TAVI were older, with a higher STS Score and a wider basal QRS. A deep valve position was associated with new-onset LBBB, with a ROC curve establishing a cut-off point of 34% of depth implant as risk factor for new-onset LBBB (sensitivity and specificity 0.8). CONCLUSIONS: In transfemoral TAVI with S3 prosthesis, a higher valve implantation (<34% of valve stent introduced into the ventricle) may minimize the new-onset LBBB, especially in old and high-risk patients with a wide basal QRS.

Outcomes of patients at estimated low surgical risk undergoing transcatheter aortic valve implantation with balloon-expandable prostheses.

INTRODUCTION AND OBJECTIVES: Transcatheter aortic-valve implantation (TAVI) is an accepted treatment for patients with severe aortic stenosis and high surgical risk. However, there is lack in data about TAVI in low-risk patients that are already being treated with this therapy in some clinical contexts. METHODS: A retrospective analysis of patients treated with transfemoral TAVI using Edwards Sapien prosthesis in one center was performed, classifying the patients into three groups according to the surgical risk (high/intermediate/low risk for STS score>8/4-8/<4). Clinical characteristics, procedure and follow-up outcomes were collected, comparing the results between low and high surgical risk groups. RESULTS: 89 TAVIs using Edwards balloon expandable prosthesis were performed (9 Sapien XT and 80 Sapien 3 valves were implanted). 40 patients (45%) presented a STS score<4, while 33 (37%) had a STS>8. Low-risk patients were significantly younger and had lower rates of coronary artery disease, peripheral vascular disease, pulmonary lung disease and atrial fibrillation. There were no significant differences in most of the technical variables of the procedure, apart from vascular complications and complete left bundle branch block after valve implant, which were higher in the group with STS>8. Patients of low risk presented shorter hospital stay (2,91±1,6, vs 4,8±3,9 days), with lower rates of mortality at mid- and long follow-up (death from any cause 15,2% vs 0%, p 0,04). CONCLUSIONS: TAVI in low-risk patients is safe and associated with better outcome at mid and long-term follow-up compared to high-risk patients.

Implante percutáneo transfemoral de válvula aórtica en pacientes con enfermedad arterial periférica / Transcatheter aortic valve implantation in patients with arterial peripheral vascular disease

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Percutaneous closure of a giant coronary artery fistula after surgical pericardiectomy. Review of the literature.

Coronary artery fistulae (CAF) are uncommon heart defects defined as a communication between a coronary artery and a cardiac chamber or vascular structure. They are frequently asymptomatic; nevertheless, they can produce angina, dyspnea or cardiac failure. CAF are believed to be congenital; however, isolated cases of CAF have been described as rare complications of cardiac surgery. We report the percutaneous closure of a giant CAF in an adult patient with angina and previous pericardiectomy.

Experiencia inicial en el tratamiento laparoscópico de la hernia inguinal en la ii cátedra de clínica quirúrgica, hospital de clínicas. FCM-UMA / Initial experience in laparoscopic inguinal hernioplasty in ii service of surgery, hospital de clinicas. FCM-UMA

Introducción: Las hernias inguinales representan el 75 % de todas las hernias de la pared abdominal, y con un riesgo de por vida de 27 % en hombres y 3 % en las mujeres. La reparación de estas hernias es uno de los procedimientos quirúrgicos más utilizados en el mundo. En la década de los 90, la progresiva evolución de la cirugía hacia técnicas mínimamente invasivas culmina con la aparición de la cirugía laparoscópica. Objetivo: describir nuestra experiencia en el tratamiento de las hernias inguinales por videolaparoscopia. Pacientes y métodos: Estudio observacional, descriptivo, retrospectivo, de corte transversal. Se presentan 25 casos de pacientes sometidos a el tratamiento de la hernia inguinal por el abordaje video laparoscópico (TEP-TAPP), en el periodo 2010-2015 Resultados: En este estudio tuvimos en el 100% de los casos pacientes de sexo masculino. El tiempo de evolución de la enfermedad en promedio fueron de 20 meses. Los diagnósticos pre operatorios fueron hernia inguinal izquierda no complicada en 8 pacientes, hernia inguinal derecha no complicada en 12 pacientes y hernia inguinal bilateral no complicada en 5 pacientes. Las técnicas empleadas fueron TEP (Totalmente extra peritoneal) en 5 pacientes y TAPP (Trans-Abdominal Pre-Peritoneal) en 20 pacientes. En todos los casos, el medio de fijación fue con tacker helicoidal de titanio. En promedio la estancia hospitalaria fue de 1,8 días. El tiempo quirúrgico, en promedio fue de 83 minutos. En cuanto a las complicaciones, hemos tenido 3 pacientes con complicaciones post quirúrgicas seroma, inguinodinia e infección del sitio quirúrgico. Conclusión: Actualmente, el tratamiento quirúrgico de la hernia inguinal tiene muy buenos resultados por vía laparoscopia, comparadas con las técnicas abiertas, faltando aun seguimiento de los pacientes en el tiempo para tener resultados concluyentes acerca de la eficacia de la técnica.

Introduction: Inguinal hernia are the 75% of the abdominal wall hernia, with a risk during all life of 27% in male gender and 3% in female. The treatment of this disease is one of the most common procedures in the world. At 90´s, the evolution of the minimal invasive approach ends with the laparoscopic surgery appearance. Objective: to describe our initial experience in the laparoscopic approach of inguinal hernia. Patients and method: An observational, retrospective study of 25 patients who underwent TAPP or TEP approach for hernia disease. Results: All of 25 patients were male gender. The average of disease evolution until surgery was 20 moths.Pre-ops diagnosis were: left inguinal hernia in 8 cases, right inguinal hernia in 12 cases and bilateral hernia in 5 cases. We performed TEP approach in 5 patients and 20 TAPP approach in 20 patients. The fixation was with titanium tackers in all cases. Average of discharge from hospital was 1,8 days. The surgical time average was 83 minutes. 3 patients had some morbidity, included: seroma, inguinodynia and surgical site infection Conclusion: Actually, the laparoscopic approach for the inguinal hernia treatment have very good results comparing to open approach, but we need more patients follow up to establish the efficacy of the technique.

A Rhodiola rosea root extract protects skeletal muscle cells against chemically induced oxidative stress by modulating heat shock protein 70 (HSP70) expression.

Rhodiola rosea is a perennial plant in the Crassulaceae family, recently postulated to exert its adaptogenic functions partially by modulating the expression of molecular factors such as heat shock proteins (HSP). The aim of this study was to analyze the efficacy of a Rhodiola rosea extract (Rhodiolife) in protecting murine skeletal muscle cells (C2 C12 myotubes) from chemically induced oxidative stress and to establish whether modulation of HSP70 expression is observed. C2 C12 cells treated with Rhodiolife did not experience any loss of viability (p > 0.05) at concentrations of 1-100 µg/mL for up to 24 h. In control cultures, viability decreased 25% following exposure to 2 mM H2 O2 (1 h). However, no significant decrease in viability in cells pre-treated with extract at concentrations as low as 1 µg/mL was observed. HSP70 mRNA levels were up-regulated two-fold in cell cultures treated with Rhodiolife (10 µg/mL), and expression was further enhanced by exposure to H2 O2 (six-fold, p < 0.05). HSP70 protein levels were maintained in pre-treated cell cultures compared to controls but was significantly lower (-50%) in cells lacking treatment exposed to H2 O2 . The present results indicate that Rhodiolife protects C2 C12 myotubes against peroxide-induced oxidative stress through the modulation of the molecular chaperone HSP70.

Short Exposure to High CO2 and O2 at Curing Temperature to Control Postharvest Diseases of Citrus Fruit.

Curing of citrus fruit at 30 to 37°C and 90 to 98% relative humidity for 65 to 72 h is an effective alternative to fungicides to control postharvest green and blue molds caused by Penicillium digitatum and P. italicum, respectively. However, commercial adoption is limited because treatment is long and it may harm fruit quality. In order to improve the feasibility of curing, short CO2 or O2 exposures at curing temperature were evaluated on 'Nadorcott', 'Clemenules', and 'Ortanique' mandarin fruit and 'Valencia' orange. Fruit were artificially inoculated, exposed 24 h later to air (control); CO2 at 15, 30, 50, or 95 kPa; or O2 at 30 or 45 kPa at 20 or 33°C for 8, 24, or 48 h and incubated at 20°C for 4, 7, or 15 days. Exposure at 33°C with CO2 at 15 kPa for 24 h or O2 at 30 kPa for 48 h effectively controlled both green and blue molds after 7 days of incubation at 20°C; however, control of both diseases was minimal after 15 days. To assess potential induction of disease resistance, fruit were treated as described above, then inoculated after 1, 2, or 5 days at 20°C and evaluated after 3 and 6 more days at 20°C. All of the treatments were ineffective in inducing fruit resistance. Short exposures of citrus fruit to high CO2 or O2 at curing temperatures may be part of a control program alternative to synthetic fungicides, especially for organic fruit markets.

Antimicrobial edible films and coatings for fresh and minimally processed fruits and vegetables: a review.

The use of edible films and coatings is an environmentally friendly technology that offers substantial advantages for shelf-life increase of many food products including fruits and vegetables. The development of new natural edible films and coatings with the addition of antimicrobial compounds to preserve fresh and minimally processed fruits and vegetables is a technological challenge for the industry and a very active research field worldwide. Antimicrobial agents have been successfully added to edible composite films and coatings based on polysaccharides or proteins such as starch, cellulose derivatives, chitosan, alginate, fruit puree, whey protein isolated, soy protein, egg albumen, wheat gluten, or sodium caseinate. This paper reviews the development of edible films and coatings with antimicrobial activity, typically through the incorporation of antimicrobial food additives as ingredients, the effect of these edible films on the control of target microorganisms, the influence of antimicrobial agents on mechanical and barrier properties of stand-alone edible films, and the effect of the application of antimicrobial edible coatings on the quality of fresh and fresh-cut fruits and vegetables.

Exploring new applications for Rhodiola rosea: can we improve the quality of life of patients with short-term hypothyroidism induced by hormone withdrawal?

Patients treated for differentiated thyroid cancer (DTC) are subjected to periodic surveillance that includes serum thyroglobulin measurements followed by radioiodine administrations for diagnostic and therapeutic purposes if necessary. Both procedures require adequately elevated blood levels of thyroid-stimulating hormone (TSH), which can be achieved by two approaches: parenteral administration of recombinant human TSH (rhTSH) or stopping thyroid hormone replacement until optimal levels of endogenous TSH are achieved. Although rhTSH administration does not require hormone withdrawal, it is not inexpensive and carries the risk of secondary effects. The latter option is simpler but induces a profound state of hypothyroidism, which results in physical and mental complaints that may interfere severely with the patient's activities of daily living. Rhodiola rosea is a popular plant in traditional medical systems in Eastern Europe and Asia with a reputation for stimulating the nervous system, decreasing depression, enhancing work performance, and eliminating fatigue, all features of clinical hypothyroidism. Investigators have also suggested additional benefits such as cardioprotection or even tumor growth inhibition. Here, we propose R. rosea as a viable alternative treatment for the symptoms of short-term hypothyroidism in patients with DTC who require hormone withdrawal.

Causes of intrastromal corneal ring segment explantation: clinicopathologic correlation analysis.

PURPOSE: To determine the main causes of intrastromal corneal ring segment (ICRS) explantation and the relationship with the microscopic findings on the ICRS surface. SETTING: Vissum Corporation-Instituto Oftalmológico de Alicante, Alicante, Spain. METHODS: This study evaluated ICRS that were explanted in centers in Spain from 2000 to 2008. Clinical data (reasons for explantation, date of implantation/explantation, tunnel creation technique, ICRS type) and scanning electron microscopy findings on the ICRS surface (adherent tissue-like material, cell deposits, protein) were documented. RESULTS: Intrastromal corneal ring segments were explanted from 58 eyes (47 patients). The main cause was extrusion (48.2% of explanted segments), followed by refractive failure (ie, poor refractive outcome) (37.9%), keratitis (6.8%; 3.7% culture positive), and corneal melting and perforation (6.8%). Scanning electron microscopy showed cells and cell debris on the ICRS explanted by extrusion, a clean surface on the ICRS explanted for refractive failure, and bacteria (cocci) in the case of proven infectious keratitis. CONCLUSIONS: The main cause of explantation was extrusion of the ICRS followed by refractive failure. There was a clear correlation between the cause of explantation and the microscopic findings on the ICRS. Extrusion was accompanied by inflammatory cells and cell debris on the ICRS surface. No inflammatory reaction was observed on the ICRS explanted for refractive failure.

Effect of antifungal hydroxypropyl methylcellulose-lipid edible composite coatings on Penicillium decay development and postharvest quality of cold-stored "Ortanique" mandarins.

Edible composite coatings based on hydroxypropyl methylcellulose (HPMC), hydrophobic components (beeswax and shellac), and food preservatives with antifungal properties were evaluated on "Ortanique" mandarins during long-term cold storage. Selected food preservatives included potassium sorbate (PS), sodium benzoate (SB), sodium propionate (SP), and their mixtures. Intact mandarins or mandarins artificially inoculated with the pathogens Penicillium digitatum and Penicillium italicum, the causal agents of citrus postharvest green (GM) and blue (BM) molds, respectively, were coated and stored up to 8 wk at 5 °C + 1 wk of shelf-life at 20 °C. HPMC-lipid coatings containing food preservatives controlled better GM than BM on Ortanique mandarins. SB- and SB + SP-based coatings reduced the incidence of GM by about 35% after 4 wk at 5 °C. Among all coatings, only the SB-based coating reduced the incidence of GM (about 16%) after 6 wk at 5 °C. All coatings significantly reduced disease severity of both GM and BM after 6 wk at 5 °C. Analytical and sensory fruit quality was evaluated on intact mandarins. All coatings, especially the SB + SP-based coatings, were effective to control weight loss and maintain the firmness of coated mandarins. Internal gas concentration, juice ethanol and acetaldehyde content, sensory flavor, off-flavor, and fruit appearance were not adversely affected by the application of the antifungal coatings. Further studies should focus on the modification of some physical characteristics of the coatings to improve the gloss and visual aspect of treated mandarins.