Comparison of the use of blood pressure telemonitoring versus standard medical care in the achievement of short-term therapeutic goals in blood pressure in patients with uncontrolled hypertension: An open-label clinical trial.

Background: In Mexico less than half of the treated hypertensive patients reach blood pressure (BP) targets. Most hypertensive individuals rely on the standard medical care (SMC) to achieve the BP control goals; however, the efficacy of BP telemonitoring (BPT) to achieve BP targets has been poorly studied. Aim: To compare the efficacy of BPT versus SMC to achieve BP goals in patients with uncontrolled hypertension. Methods: A two-arm, open-label clinical trial was conducted in patients ≥18 years with uncontrolled hypertension. The participants were randomized to 2 arms (BPT vs SMC) and followed for 12 weeks. For the statistical analysis, the chi-squared test and covariance were used. Results: One hundred and seventy-eight participants were included, BPT (n = 94) and SMC (n = 84), after 12 weeks of follow up, we observed a baseline-adjusted reduction in systolic BP with both BPT (-13.5 [1.3] mmHg) and the SMC (-5.9 [1.4] mmHg; p < 0.001) but a greater decrease with BPT (p < 0.001). Likewise, we found a baseline-adjusted reduction of diastolic BP with BPT (-6.9 [0.9] mmHg) and SMC (-2.7 [0.9] mmHg) (p = 0.007) with a more significant percentage change from baseline with BPT (-6.8% [1.0] vs 2.5% [1.1]; p = 0.007). In the BPT arm, a larger proportion of patients achieved the BP target versus SMC (30.5% vs 12.8%; p = 0.005). Conclusion: BPT showed a greater proportion of patients achieving office BP control goals (<140/90 mmHg), compared to standard medical care.

Galgo: a bi-objective evolutionary meta-heuristic identifies robust transcriptomic classifiers associated with patient outcome across multiple cancer types.

MOTIVATION: Statistical and machine-learning analyses of tumor transcriptomic profiles offer a powerful resource to gain deeper understanding of tumor subtypes and disease prognosis. Currently, prognostic gene-expression signatures do not exist for all cancer types, and most developed to date have been optimized for individual tumor types. In Galgo, we implement a bi-objective optimization approach that prioritizes gene signature cohesiveness and patient survival in parallel, which provides greater power to identify tumor transcriptomic phenotypes strongly associated with patient survival. RESULTS: To compare the predictive power of the signatures obtained by Galgo with previously studied subtyping methods, we used a meta-analytic approach testing a total of 35 large population-based transcriptomic biobanks of four different cancer types. Galgo-generated colorectal and lung adenocarcinoma signatures were stronger predictors of patient survival compared to published molecular classification schemes. One Galgo-generated breast cancer signature outperformed PAM50, AIMS, SCMGENE and IntClust subtyping predictors. In high-grade serous ovarian cancer, Galgo signatures obtained similar predictive power to a consensus classification method. In all cases, Galgo subtypes reflected enrichment of gene sets related to the hallmarks of the disease, which highlights the biological relevance of the partitions found. AVAILABILITY AND IMPLEMENTATION: The open-source R package is available on www.github.com/harpomaxx/galgo. SUPPLEMENTARY INFORMATION: Supplementary data are available at Bioinformatics online.

Estimación en la Intención de Agarres: Cilíndrico, Esférico y Gancho Utilizando Redes Neuronales Profundas / Estimation of Hand-Grip Intention: Cylindrical, Spherical and Hook Using Deep Neural Networks

Resumen Las amputaciones de extremidades superiores pueden producir diversos grados de incapacidad en la persona afectada, esto es exacerbado aún más, si se presenta durante un periodo de su vida laboral activa, por esta razón es de importancia social el estudio de las prótesis y algoritmos que ayuden a un mejor control de estas por parte del usuario. En esta investigación, se propone una arquitectura basada en redes neuronales recurrentes del tipo Long Short-Term Memory y redes convolucionales para la clasificación de señales electromiográficas, con aplicaciones para control de prótesis de mano. La red propuesta clasifica tres tipos de agarres realizados con la mano: cilíndrico, esférico y de gancho. El modelo propuesto al ser evaluado mostró una eficiencia (accuracy) del 89 %, en contraste con una red neuronal artificial basada en capas completamente conectadas que solo obtuvo una eficiencia del 80% en la predicción de los agarres. El presente trabajo se limita solamente a evaluar la red ante una entrada de electromiograma y no se implementó un sistema de control para la prótesis de la mano. Así, una arquitectura de redes convolucionales para el control de prótesis de mano que pueden ser entrenadas con las señales del sujeto.

Abstract Upper extremities amputations can produce different disability degrees in the amputated person, this is acerbated even more, when it happens during active working life. So, for this reason, it is of social importance the study of prostheses and algorithms that help a better control of these by the user. In this research, we propose an architecture based on recurrent neural networks, called Long Short-Term Memory, and convolutional neural networks for classification of electromyographic signals, with applications for hand prosthesis control. The proposed network classifies three types of movements made by the hand: cylindrical, spherical and hook grips. The proposed model showed an efficiency (accuracy) of 89%, in contrast to an artificial neural network based on completely connected layers that only obtained an efficiency of 80% in the prediction of the hand movements. The present work is limited to evaluate the network with an electromyogram input, the control system for hand prosthesis was not implemented. Thus, an architecture of convolutional networks for the control of hand prostheses that can be trained with the signals of the subject.

The use of female estrogenized goats as sexual stimulator of crossbred dairy males subsequently exposed to acyclic goats during two phases of the anestrous season.

This research evaluated the possible influence of exposure of male goats to estrogenized female goats ("female effect") upon males' sexual behavior [appetitive (ASB) & consummatory (CSB)], as well as the induction of reproductive activity of crossbred dairy female goats exposed to such treated males ("male effect") during the early and deep anestrous periods. Crossbred dairy adult male goats (n = 12; 24-48 mo. old) and 80 anovulatory crossbred dairy adult female goats (34-50 mo. old) were used during two experimental periods: March to April and April to May. First, males were separated into four groups (n = 3 each), roughly homogeneous regarding body weight and body condition score and randomly assigned to four experimental groups. The first two groups included males + estrogenized females, then such males were exposed to anestrous females either during March (group 1: three males; 20 females; EFEM-MAR), or during April (group 2: three males; 20 females; EFEM-APR). The second two groups were respective control groups: Males + non-treated-anestrous females, and then such males exposed to acyclic females either during March (group 3: three males; 20 females; CONT-MAR) or April (group 4: three males; 20 females; CONT-APR). Once the male-to-female contact was established, both odor (ODT) and behavior (BEHT) tests (2 d × 2 h) were performed during both anestrous periods. On day 10 after introduction of the males, in both anestrous periods, one ultrasonography scanning ("US") was performed to quantify the presence, number and size of corpus luteum (US-CL) to determine the effectiveness of the "male effect" and indicators of ovarian activity. Then, on day 45 after introduction of the males, a second US was performed to evaluate pregnancy rate (US-PREG). The EFEM-males, regardless of the phase of the anestrous cycle, had an increased (P < 0.05) odor intensity with respect to the control groups. In addition, while an increased (P < 0.05) ASB occurred in the EFEM-males, no CSB differences (P > 0.05) arose when treatments were compared, neither in March-April nor in April-May. The EFEM-males exposed to acyclic goats in March-April (i.e. early anestrous period), promoted not only the largest estrus and ovulatory responses (P < 0.05), but also the largest pregnancy rate (P < 0.05) in these previously anestrus goats, suggesting that in April-May (i.e. profound anestrous), the presence of active males was not enough to completely suppress cyclic reproductive arrest. This study generates interesting out-of-season reproductive outcomes in a goat population with a large proportion of highly seasonal dairy breeds (i.e. Alpine, Saanen and Toggenburg), augmenting the possibility to expand milk production and the economic income of goat producers across the year. Besides, this practice may serve as an interesting reproductive tool to increase the sustainability of marginal goat production systems under semiarid conditions.

Semen deposition by cervical, transcervical and intrauterine route for fixed-time artificial insemination (FTAI) in the ewe.

Semen deposition through the cervix into the uterus is a difficult technique in ewes and represents the main limiting factor for insemination in this species. The objective of this study was to evaluate the pregnancy rate achieved with a new transcervical insemination method in comparison with conventional cervical and laparoscopic intrauterine techniques. A total of 586 multiparous Corriedale ewes were synchronized for fixed time artificial insemination (FTAI) performed by cervical, transcervical, or intrauterine route at 46-50 h or 52-56 h after progesterone device removal in a 3 × 2 factorial design. Pregnancy rate was affected by the insemination technique and by the moment of FTAI (P < 0.05), without interaction (P= NS). Overall, the fertility was improved as semen deposition was deeper and insemination was delayed. For transcervical insemination, pregnancy rate was intermediate (42.3%; P= NS) between cervical and intrauterine route (36.0% and 50.2%; P < 0.05), and was greater for those ewes inseminated beyond 4 cm into the cervix (60.0% versus 35.1% for insemination beyond or within 4 cm into the cervix, respectively; P < 0.05). Semen deposition beyond 4 cm into the cervix was achieved only in 28.8% of the females receiving transcervical insemination. This method was more time-consuming than cervical or laparoscopic insemination (11.4 ± 1.6 versus 85.5 ± 7.5 and 56.8 ± 5.6 ewes inseminated per hour, respectively; P < 0.05). In summary, greater pregnancy rate using FTAI is obtained when semen is placed into the uterus, which was achieved in all females only through laparoscopy. Further improvements are required for transcervical insemination to be applied in large-scale FTAI programs in Corriedale ewes.

Exposure of sexually inactive males to estrogenized females increased the investigative and consummatory sexual behavior.

Two trials were conducted to evaluate the effect of diverse socio-sexual cues upon male sexual behavior and the reproductive performance of anestrous does (AD). Trials were conducted in northern Mexico (26°N) during the natural anestrous season (Feb-Mar) with crossbred dairy bucks. In Experiment 1, sexually inactive bucks (SIB, n=12) were randomly allotted to three groups, four males/group: a) DEE 9novelty stimulation) - daily exchange of estrogenized females (EF) 12&12h, b) NEE (no novelty stimulation) - no-exchange of EF, 24h, or c) CON (saline-treated_ -daily exchange of AF 12&12h. Sexually active bucks (SAB) from the DEE, NEE and CON groups were subsequently exposed to AD (n=72; n=24/group) and the reproductive outcomes were recorded. In Experiment 2, SAB (n=12; n=6/group) were randomly divided in: 1) B+EF - males+four-EF exposed to AF (n=36), and 2) B+NEF; males+four-saline-treated AD and exposed to AD (n=36). Prior to the onset of the experimental breeding in both experiments, the investigative (ISB), consummatory (CSB) and resting (RSB) sexual behavior of males were quantified (2h×d×2d). Sexual behaviors considered were: ISB - flehmen, ano-genital sniffing, approaches, vocalizations, kicking, penis extrusion, CSB; mount attempts and mounts, and RSB - isolation, attempted escape, aggression and distractions. While EF were an effective stimulus (P<0.05) for evoking mounting in SIB males, daily exchange of estrous does used to stimulate males promoted an enhanced response (P<0.05) in terms of both ISB and CSB. After being exposed to AD, the B+EF bucks induced an earlier estrous response (P<0.05) as compared with the B+NEF bucks. The untreated females did not induce any sexual activity in males and stimulation of ovarian function did not occur when saline treated (CON) AD were exposed to AD. Also, the B+EF group induced an enhanced increase (P<0.05) of the male ISB and CSB, inducing in turn an increase percentage onset of estrus in does that had previously been anestrus (P<0.05).

Reproductive outcomes of Alpine goats primed with progesterone and treated with human chorionic gonadotropin during the anestrus-to-estrus transition season.

This study aimed to determine the possible effects of a single injection of human chorionic gonadotropin (hCG) as a means for estrus induction in acyclic French-Alpine goats during the reproductive transition period at 25°N, 103°W. The potential effects of hCG upon ovarian function and reproductive performance of goats were also assessed. Multiparous acyclic French-Alpine goats (n = 39; 37.4 ± 8 .5 kg) were primed with 20mg progesterone (P4) 1 day prior to hCG administration. Thereafter, does were treated either with saline (hCG-0; n = 10), 50 (hCG-50; n = 9), 100 (hCG-100; n = 10), or 300 IU of hCG (hCG-300; n = 10). Ovarian structures and pregnancy were monitored by transrectal ultrasonography. In addition, after hCG application, goats were monitored twice daily (0800 and 1800 h) to detect estrus signs, with the use of aproned, sexually active bucks treated with testosterone. Goats were bred 12h after the onset of estrus. Two days after hCG administration, the number of large follicles was higher (P < 0.05) in the hCG-50 and hCG-300 groups (1.7 ± 0.1 and 1.8 ± 0.2, respectively) compared with the hCG-100 and hCG-0 groups (1.4 ± 0.2 and 1.1 ± 0.1, respectively). Although none of the hCG-0-goats depicted estrus, the estrus response from the hCG-50, hCG-100, and hCG-300 groups over the 7-d breeding period was 67%, 100%, and 90%, respectively (P > 0.05), being always accompanied by ovulation. Pregnancy rate (67, 100, and 70%), kidding rate (55%, 80%, and 70%), and litter size (1.6 ± 0.5, 1.5 ± 0.5, and 1.5 ± 0.5) for hCG-50, hCG-100, and hCG-300, respectively, did not differ among the hCG-treated does. Therefore, the combined use of P4-priming plus a 100-IU hCG injection is an effective protocol for inducing estrus in non-cycling Alpine goats during the anestrus-to-estrus transition period, which is of key importance for both goat producers and industrializers.

Parenteral infusions as culture media from a viewpoint of nosocomial bacteremia.

OBJECTIVE: To assess the growth patterns of selected organisms in common parenteral solutions, in order to ascertain implications for nosocomial bacteremia. DESIGN: A microbial suspension of approximately 300 CFU/mL was sequentially inoculated into common parenteral infusions from three different manufacturers and incubated at room temperature. Initially, 11 bacterial isolates and one Candida species from clinical specimens were studied. Eight gram-negative rods (GNR) were tested at varying pH's. Species variability was examined by testing an additional 39 isolates. RESULTS: The eight GNR grew in Ringer's lactate (RL) from two manufacturers and only two grew in dextrose 5% in water (D5/W) (Klebsiella pneumoniae and Serratia marcescens). No organism grew in saline or dextrose 5% in saline. The gram-positive cocci and Candida did not grow in any solution. No significant changes in growth were found after modifying the pH of solutions. Significant inter- and intra-species growth variability was noted. CONCLUSIONS: RL is a good culture media for GNR and D5/W is a poor culture media with the exception of some bacteria of the Tribe Klebsielleae. We recommend to follow high standards of nursing practice for administering intravenous infusions and to avoid nutrient-containing solutions for prolonged parenteral use, when possible.

[Control of pediatric nosocomial bacteremia by a program based on culturing of parenteral solutions in use]. / Control de bacteriemia nosocomial pediátrica mediante un programa de cultivo de soluciones parenterales en uso.

OBJECTIVE: As Klebsiella, Enterobacter and Serratia are capable of growth in i.v. fluids and these bacteria are commonly implicated in nosocomial bacteremia, a control strategy through microbiological surveillance of in-use parenteral solutions is proposed. MATERIAL AND METHODS: A second level general teaching hospital, serving low-income patients. Through four consecutive strategies, a continuous surveillance program of i.v. fluids sterility in pediatric wards was stablished in 1992. During the first stage all of the in-use solutions were cultured. During the second stage randomly selected samples were studied. Third stage was designed as a case-control study. The last stage included samples drawn in convenience. Positive cultures point out eventual infusion mishandling, as well as high-risk areas and patients. RESULTS: After culturing 1940 parenteral solutions, infusion contamination rates decreased from 29.6% in 1992 to 12.9% in 1997 (p < 0.001). The proportion of Gram-negative rods isolated from blood cultures went from 72.7% to 40.85% (p < 0.0001), and the nosocomial bacteremia rate dropped from 3.12 to 1.54 per 100 discharges. CONCLUSIONS: The program has enabled us to: 1) Detect and control eventual bacteremia outbreaks; 2) Assess the endemic infusion contamination rate; 3) Arouse healthcare workers awareness about infusion line precautions; 4) Have a suitable surveillance strategy according to our laboratory's workload.

Parenteral infusions bacterial contamination in a multi-institutional survey in Mexico: considerations for nosocomial mortality.

BACKGROUND: Parenteral infusions can be contaminated during administration (extrinsic contamination). A previous survey found that extrinsic contamination was not uncommon in a hospital in Mexico with lapses in aseptic techniques. To determine whether this problem exists in other similar institutions, we undertook a multi-institutional study. METHODS: We surveyed 6 hospitals (A to F) lacking an infection control committee to determine the level of extrinsic contamination. We visited each hospital and obtained samples of all the parenteral infusions in use, drawing 0.5-1 mL from the tubing injection port. Quantitative and qualitative bacterial cultures were performed. Chlorine levels of the tap water were measured. Visits were repeated until the survey was completed. RESULTS: A total of 751 infusions were cultured, of which 16 (2.13%) were contaminated. Hospital contamination rates varied from zero to 5.56%. Klebsiella pneumoniae was the most common isolate (10 cases). During the first sampling day in hospital C, the 7 infusions from the pediatric ward were found to be contaminated with a similar K pneumoniae strain. In-service education was started in this hospital. Infusion contamination was eliminated followed by a reduction in mortality rate. Overall, a higher risk for infusion contamination was noted for pediatric patients (P =.01, odds ratio = 3.28, 95% CI, 1.10-9.91) and in wards with inadequate water chlorine levels (P =. 02, odds ratio = 3.64, 95% CI, 1.08-13.51). CONCLUSIONS: If the hospitals surveyed are representative of others in developing countries, an endemic level of parenteral infusion contamination could exist in many hospitals throughout the world.