Tele-Rehabilitation Versus Local Rehabilitation Therapies Assisted by Robotic Devices: A Pilot Study with Patients

The present study aims to evaluate the advantages of a master-slave robotic rehabilitation therapy in which the patient is assisted in real-time by a therapist. We have also explored if this type of strategy is applicable in a tele-rehabilitation environment. A pilot study has been carried out involving 10 patients who have performed a point-to-point rehabilitation exercise supported by three assistance modalities: fixed assistance (without therapist interaction), local therapist assistance, and remote therapist assistance in a simulated tele-rehabiliation scenario. The rehabilitation exercise will be performed using an upper-limb rehabilitation robotic device that assists the patients through force fields. The results suggest that the assistance provided by the therapist is better adapted to patient needs than fixed assistance mode. Therefore, it maximizes the patient’s level of effort, which is an important aspect to improve the rehabilitation outcomes. We have also seen that in a tele-rehabilitation environment it is more difficult to assess when to assist the patient than locally. However, the assistance suits patients better than the fixed assistance mode.This work was funded by the Conselleria d’Educacio, Cultura i Esport of Generalitat Valenciana by the European Social Fund—Investing in your Future, through the grant ACIF 2018/214, PEJ2018-002684-A and PEJ2018-002670-A, and by the Spanish Ministry of Science and Innovation through the project PID2019-108310RB-I00

Involvement of residues of the ϕ29 terminal protein intermediate and priming domains in the formation of a stable and functional heterodimer with the replicative DNA polymerase

Bacteriophage ϕ29 genome consists of a linear double-stranded DNA with a terminal protein (TP) covalently linked to each 5′ end (TP-DNA) that together with a specific sequence constitutes the replication origins. To initiate replication, the DNA polymerase forms a heterodimer with a free TP that recognizes the origins and initiates replication using as primer the hydroxyl group of TP residue Ser232. The 3D structure of the DNA polymerase/TP heterodimer allowed the identification of TP residues that could be responsible for interaction with the DNA polymerase. Here, we examined the role of TP residues Arg158, Arg169, Glu191, Asp198, Tyr250, Glu252, Gln253 and Arg256 by in vitro analyses of mutant derivatives. The results showed that substitution of these residues had an effect on either the stability of the TP/DNA polymerase complex (R158A) or in the functional interaction of the TP at the polymerization active site (R169A, E191A, Y250A, E252A, Q253A and R256A), affecting the first steps of ϕ29 TP-DNA replication. These results allow us to propose a role for these residues in the maintenance of the equilibrium between TP-priming domain stabilization and its gradual exit from the polymerization active site of the DNA polymerase as new DNA is being synthesized

Giant anteater (Myrmecophaga tridactyla) reintroduction into Iberá Nature Reserve (Argentina): mission accomplished?

Se presentan los principales avances después de ocho años de reintroducciones de hormigueros gigantes en dos lugares de la Reserva Natural Iberá (Corrientes, Argentina). El proyecto ha manejado un total de 79 ejemplares, 75 de ellos provenientes de diferentes sectores del Chaco Seco y cuatro de ecorregionesadyacentes como Yungas y Chaco Húmedo. El 73% de los ejemplares manejados fueroncrías huérfanas nacidas en libertad, el 13% fueron adultos cautivos, 2% animales silvestres translocados, 10% animales adultos silvestres heridos y un ejemplar nacido en cautiverio. Durante la fase de cuarentena se realizaron pruebas para detectar siete patógenos, encontrando anticuerpos frente a Toxoplasma gondii en el 27% de los individuos analizados, Leptospira interrogans en el 4% y la presencia del virus del moquillo canino en el 25%. El 73% de los ejemplares sobrevivió a la fase de cuarentena y manejo intensivo. Todos los hormiguerosliberados fueron marcados con un radiotransmisor VHF y luego fueron seguidos por ese método y por cámaras trampa. De los 47 animales liberados, 11 han fallecido, 10 hembras liberadas han tenido un total de 29 crías y se estima que actualmente viven libres de 29 a 46 ejemplares en la primera población y 18 en la segunda.Desde que se dieron los primeros nacimientos, la relación entre reproducción ymortalidad ha sido positiva en cuatro años y negativa en uno. El proyecto cumple un rol doble de bienestar animal y de restauración ecológica. Los datos actuales apuntan al restablecimiento exitoso de la especie en la región.We present the main results from eight years of reintroductions of giant anteaters into Iberá Nature Reserve (Corrientes, Argentina). The project has handled 79 individuals, 75 of which came from the Dry Chaco Ecoregion, and four animals were from neighboring Yungas and Wet Chaco ecoregions. 73% of the animals were wild-born orphan cubs, 13% were captive adults, 2% adults translocated from the wild, 10% injured free-ranging adults, and one animal was captive-born. We tested for seven possible pathogens during the quarantine phase. Overall, 27% of the tested animals had antibodies against Toxoplasma gondii and 4% for Leptospira interrogans, while DNA of canine distemper virus was found in 25% of the tested animals. Reintroduced anteaters were fitted with VHF transmitters and then monitored with this method or camera traps. Out of 47 released animals, 11 have died, ten females have given birth to 29 cubs, and we estimate that there are currently 29 to 46 animals in the first population and 18 in the second one. Since the animals started breeding there have been four years with more births than deaths, and one where mortality surpassed the reproductive rate. This project fulfils a double role of ecological restoration and animal welfare. Even though releases and monitoring will be sustained for several more years, present data suggest that this previously extirpated mammal has been successfully re-established in Iberá Nature Reserve.Fil: Jiménez Pérez, Ignacio. The Conservation Land Trust; Estados UnidosFil: Delgado, Alicia. The Conservation Land Trust; Estados UnidosFil: Di Blanco, Yamil Edgardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Nordeste. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú | Universidad Nacional de Misiones. Instituto de Biología Subtropical. Instituto de Biología Subtropical - Nodo Puerto Iguazú; Argentina. Centro de Investigaciones del Bosque Atlántico; ArgentinaFil: Abuin, Rafael. The Conservation Land Trust; Estados UnidosFil: Antúnez, Berta. The Conservation Land Trust; Estados UnidosFil: Galetto, Emanuel. The Conservation Land Trust; Estados UnidosFil: Masat, Marianella. The Conservation Land Trust; Estados UnidosFil: Peña, Jorge. The Conservation Land Trust; Estados UnidosFil: Pernigotti, Rut. The Conservation Land Trust; Estados UnidosFil: Pontón, Federico. The Conservation Land Trust; Estados UnidosFil: Solís, Gustavo. The Conservation Land Trust; Estados UnidosFil: Karina Spørring. The Conservation Land Trust; Estados UnidosFil: Heinonen, Sofía. The Conservation Land Trust; Estados Unido

Reproductive desire in women with HIV infection in Spain, associated factors and motivations: A mixed-method study

Background: Antiretroviral therapy has created new expectations in the possibilities of procreation for persons living with HIV. Our objectives were to evaluate reproductive desire and to analyze the associated sociodemographic and clinical factors in HIV-infected women in the Spanish AIDS Research Network Cohort (CoRIS).Methods: A mixed qualitative-quantitative approach was designed. Women of reproductive age (18-45) included in CoRIS were interviewed by phone, and data were collected between November 2010 and June 2012 using a specifically designed questionnaire. Reproductive desire was defined as having a desire to be pregnant at present or having unprotected sex with the purpose of having children or wanting to have children in the near future.Results: Overall, 134 women were interviewed. Median age was 36 years (IQR 31-41), 55% were Spanish, and 35% were unemployed. 84% had been infected with HIV through unprotected sex, with a median time since diagnosis of 4.5 years (IQR 2.9-6.9). Reproductive desire was found in 49% of women and was associated with: 1) Age (women under 30 had higher reproductive desire than those aged 30-39; OR = 4.5, 95% CI 1.4-14.3); 2) having no children vs. already having children (OR = 3.2; 1.3-7.7 3); Being an immigrant (OR = 2.2; 1.0-5.0); and 4) Not receiving antiretroviral treatment (OR = 3.6; 1.1-12.1). The main reasons for wanting children were related to liking children and wanting to form a family. Reasons for not having children were HIV infection, older age and having children already. Half of the women had sought or received information about how to have a safe pregnancy, 87% had disclosed their serostatus to their family circle, and 39% reported having experienced discrimination due to HIV infection.Conclusions: The HIV-infected women interviewed in CoRIS have a high desire for children, and the factors associated with this desire are not fundamentally different from those of women in the general population. Maternity may even help them face a situation they still consider stigmatized and prefer not to disclose. Health-care protocols for handling HIV-positive women should incorporate specific interventions on sexual and reproductive health to help them fulfill their procreation desire and experience safe pregnanciesThe RIS cohort (CoRIS) is funded by the Instituto de Salud Carlos III through the Red Temática de Investigación Cooperativa en Sida (RIS C03/173

The Response to Biologics is Better in Patients with Severe Asthma Than in Patients with Asthma–COPD Overlap Syndrome

Although biologics have demonstrated to be effective in T2-high asthma patients, there is little experience with these drugs in asthma-COPD overlap (ACO). The aim of this study was to compare the effectiveness of biologics in these two conditions. We included 318 patients (24 ACO and 297 asthma) treated with monoclonal antibodies and followed for at least 12 months Omalizumab was the most frequently employed biologic agent both in patients with ACO and asthma. Asthma control test (ACT) scores after at least 12 months of biologic therapy were not significantly different between groups. The percentage of patients with >= 1 exacerbation and >= 1 corticosteroid burst was significantly higher in ACO patients (70.8 vs 27.3 and 83.3% vs 37.5%, respectively), whereas the percentage of controlled patients (with no exacerbations, no need for corticosteroids and ACT >= 20) was significantly lower (16.7% vs 39.7%). In conclusion, this report suggests that patients with ACO treated with biologics reach worse outcomes than asthma patients

Medical students maintain their humanistic and patient‑centred vocation throughout Medicine Degree in Spain: a study based on narratives

Narrative medicine has great educational potential in the degree of medicine. This study explores for the frst time the use of narrative medicine in relation to longitudinal evolution of medical vocation for the same group of students. In the context of the Degree in Medicine at the Universidad Autónoma de Madrid (Spain), students wrote narratives about what it meant to them to be a doctor at the beginning and end of their studies. The narratives of 338 students of the academic years 2012/13– 2017/18 and 2013/14–2018/19 were analysed and compared. Students mostly pursued a degree in medicine on account of humanistic motivations, which are reinforced throughout their degree. In contrast, up to 10% of students reference to have experienced vocational crises and sufered frustration, with up to 25% of the references pertaining to having made signifcant sacrifces. Students maintain and evolve their humanistic, patient-centred vision throughout their degree studies, despite the difculties they appear to encounter. We suggest that eforts must be made to include more humanistic perspectives in the medical degree to keep this trend, which may improve both the educational experience created in universities and the health care given to patient

CHL1 hypermethylation as a potential biomarker of poor prognosis in breast cancer

The CHL1 gene encodes a cell-adhesion molecule proposed as being a putative tumour-suppressor gene in breast cancer (BC). However, neither the underlying molecular mechanisms nor the clinical value of CHL1 downregulation in BC has been explored. The methylation status of three CpG sites in the CHL1 promoter was analysed by pyrosequencing in neoplastic biopsies from 142 patients with invasive BC and compared with that of non-neoplastic tissues. We found higher CHL1 methylation levels in breast tumours than in non-neoplastic tissues, either from mammoplasties or adjacent-to-tumour, which correlated with lower levels of protein expression in tumours measured by immunohistochemistry. A panel of five BC cell lines was treated with two epigenetic drugs, and restoration of CHL1 expression was observed, indicating in vitro dynamic epigenetic regulation. CHL1 was silenced by shRNA in immortalized but non-neoplastic mammary cells, and enhanced cell proliferation and migration, but not invasion, were found by real-time cell analysis. The prognostic value of CHL1 hypermethylation was assessed by the log-rank test and fitted in a Cox regression model. Importantly, CHL1 hypermethylation was very significantly associated with shorter progression-free survival in our BC patient series, independent of age and stage (p = 0.001). In conclusion, our results indicate that CHL1 is downregulated by hypermethylation and that this epigenetic alteration is an independent prognostic factor in BC

COYUNTURA ECONÓMICA, año 2, núm. 2, enero-abril 2020

La pandemia que atraviesa el mundo a causa del virus SARS-CoV-2 ha generado grandes cambios a escala mundial y en distintos ámbitos de la humanidad. No solo por la cuestión medico biológica, la cual nos ha impuesto, como humanidad, el reto de controlar la epidemia, sino por la crisis generada por los disminuidos sistemas de atención médica y seguridad social, y la parálisis de la economía debido a las acciones de distanciamiento social, que nos llevan a plantear si el modelo económico neoliberal —que privilegia la explotación de los recursos naturales (la principal causa de la pandemia), por encima del aprovechamiento sustentable, el negocio de la salud sobre el derecho a la misma, así como la precarización del trabajo sobre los derechos laborales— es adecuado o debemos cambiar de paradigma en este sentido. En materia económica, la actual crisis trajo la primera recesión por diseño en la historia, ya que al tratar de contener la pandemia, los gobiernos cerraron sus economías, lo que llevó a una parálisis de la producción en la mayoría de los sectores y a la disminución del consumo de varios tipos de bienes. Además, dadas sus características, la actual es una crisis económica que viene tanto del lado de la oferta (ya que la mayoría de las empresas y negocios tuvo que cerrar de manera parcial o total sus operaciones, lo cual afectó principalmente al sector de servicios y a los sectores ligados a las cadenas globales de producción) como de la demanda (al dejar de consumir ciertos bienes no indispensables, cambiar hábitos de consumo por la reducción de la movilidad, así como al afectar el ingreso de los hogares tanto por la caída de la actividad económica como con el aumento de recursos a través de programas sociales).