Blastocystis sp. en humanos: actualización y experiencia clínico-terapéutica

Blastocystis sp. es uno de los parásitos del humanomás frecuentemente identificados en el laboratorioclínico durante el estudio parasitológico de las muestrasde heces. En esta revisión se actualizan los aspectosrelativos a la diversidad genética y especificidad delhuésped, la taxonomía, caracterización molecular,formas clínicas y experiencia terapéutica en pacientesinmuno-competentes y comprometidos, sintomáticosy asintomáticos, de la consulta de la Sección deGeohelmintiasis del Instituto de Medicina Tropical dela Facultad de Medicina de la Universidad Central deVenezuela, proponiendo el secnidazol como droga deprimera elección. Se analiza la presencia de Blastocystiscomo patógeno humano o como comensal, formandoparte de la microbiota intestinal. Se considera la tendenciaactual entre los diferentes grupos de investigacióna mirar la blastocistosis como un problema de saludpública en lugar de una entidad clínica frecuente y seincluyen elementos que pudieran reforzar esta visión. Seincluyen las medidas que pudieran contribuir a prevenirla parasitosis. Dado que la investigación sobre esteparásito progresa rápidamente, se recomienda realizarrevisiones frecuentes para mantener actualizadoslos conceptos relacionados con su epidemiología,diagnóstico, tratamiento y prevención en el pacienteinmunocompetente así como en el inmunosuprimido

Acoustic voice characteristics with and without wearing a facemask

Facemasks are essential for healthcare workers but characteristics of the voice whilst wearing this personal protective equipment are not well understood. In the present study, we compared acoustic voice measures in recordings of sixteen adults producing standardised vocal tasks with and without wearing either a surgical mask or a KN95 mask. Data were analysed for mean spectral levels at 0–1 kHz and 1–8 kHz regions, an energy ratio between 0–1 and 1–8 kHz (LH1000), harmonics-to-noise ratio (HNR), smoothed cepstral peak prominence (CPPS), and vocal intensity. In connected speech there was significant attenuation of mean spectral level at 1–8 kHz region and there was no significant change in this measure at 0–1 kHz. Mean spectral levels of vowel did not change significantly in mask-wearing conditions. LH1000 for connected speech significantly increased whilst wearing either a surgical mask or KN95 mask but no significant change in this measure was found for vowel. HNR was higher in the mask-wearing conditions than the no-mask condition. CPPS and vocal intensity did not change in mask-wearing conditions. These findings implied an attenuation effects of wearing these types of masks on the voice spectra with surgical mask showing less impact than the KN95

The relationship between pitch discrimination and acoustic voice measures in a cohort of female speakers

Background. Evidence across a range of musically trained, hearing disordered and voice disordered populations present conflicting results regarding the relationship between pitch discrimination (PD) and voice quality. PD characteristics of female speakers with and without a musical training background and no selfreported voice disorder, and the relationship between PD and voice quality in this particular population, have not been investigated. Aims. To evaluate PD characteristics in a cohort of female participants without a self-reported voice disorder and the relationship between PD and acoustic voice measures. Method. One hundred fourteen female participants were studied, all of whom self-reported as being non-voice disordered. All completed the Newcastle Assessment of Pitch Discrimination which involved a two-tone PD task. Their voices were recorded producing standardized vocal tasks. Voice samples were acoustically analyzed for frequency-domain measures (fundamental frequency and its standard deviation, and harmonics-to-noise ratio) and spectral-domain measures (cepstral peak prominence and the Cepstral/Spectral Index of Dysphonia). Data were analyzed for the whole cohort and for musical and non-musical training backgrounds. Results. In the whole cohort, there were no significant correlations between PD and acoustic voice measures. PD accuracy in musically trained speakers was better than in non-trained speakers and correlated with fundamental frequency standard deviation in prolonged vowel tasks. Vocalists demonstrated superior PD accuracy and fundamental frequency standard deviation in prolonged vowels compared to instrumentalists but did not show significant correlations between PD and acoustic measures. The Newcastle Assessment of Pitch Discrimination was a reliable tool, showing moderate-good prediction value in differentiating musical background. Conclusions. There was little evidence of a relationship between PD and acoustic measures of voice quality, regardless of musical training background and superior PD accuracy among the musically trained. These data do not support ideas concerning the co-development of perception and action among individuals identified as having voice quality measures within normal ranges. Numerous measures of voice quality, including measures sensitive to pitch, did not distinguish across musically and non-musically trained individuals, despite individual differences in pitch discrimination

Autonomous self-healing pneumatic McKibben muscle based on a new hydrogel material

In this paper we present a hydrogel with self-healing capabilities and its application for the development of a Pneumatic Artificial Muscle (PAM). Unlike other hydrogels, our material can be used outside of aqueous environments and does not need any external stimulus to self-heal, which makes it an interesting alternative for the manufacturing of soft robots. First, the mechanical properties of the hydrogel and its self-healing ability are analyzed. Second, we present the development of a pneumatic muscle based on the classic McKibben design but including our material. Finally, we analyze the capabilities of our self-repairing muscles before and after being punctured. The results show a good performance of our actuators even after low healing periods (10 minutes).En este trabajo presentamos un hidrogel con capacidad de autocuración y su aplicación para el desarrollo de un músculo artificial neumático (PAM). A diferencia de otros hidrogeles, nuestro material puede utilizarse fuera de entornos acuosos y no necesita ningún estímulo externo para autocurarse, lo que hace que sea una alternativa interesante para la fabricación de robots blandos. En primer lugar, se analizan las propiedades mecánicas del hidrogel y su capacidad de autocuración de autocuración. En segundo lugar, se presenta el desarrollo de un músculo neumático basado en el diseño clásico de McKibben pero incluyendo nuestro material. Por último analizamos las capacidades de nuestros músculos autorreparadores antes y después de de ser pinchados. Los resultados muestran un buen rendimiento de nuestros actuadores incluso después de periodos de curación bajos (10 minutos)

Neutrophil infiltration regulates clock-gene expression to organize daily hepatic metabolism.

Liver metabolism follows diurnal fluctuations through the modulation of molecular clock genes. Disruption of this molecular clock can result in metabolic disease but its potential regulation by immune cells remains unexplored. Here, we demonstrated that in steady state, neutrophils infiltrated the mouse liver following a circadian pattern and regulated hepatocyte clock-genes by neutrophil elastase (NE) secretion. NE signals through c-Jun NH2-terminal kinase (JNK) inhibiting fibroblast growth factor 21 (FGF21) and activating Bmal1 expression in the hepatocyte. Interestingly, mice with neutropenia, defective neutrophil infiltration or lacking elastase were protected against steatosis correlating with lower JNK activation, reduced Bmal1 and increased FGF21 expression, together with decreased lipogenesis in the liver. Lastly, using a cohort of human samples we found a direct correlation between JNK activation, NE levels and Bmal1 expression in the liver. This study demonstrates that neutrophils contribute to the maintenance of daily hepatic homeostasis through the regulation of the NE/JNK/Bmal1 axis.BGT and MC were fellows of the FPI: Severo Ochoa CNIC program (SVP-2013–067639) and (BES-2017–079711) respectively. IN was funded by EFSD/Lilly grants (2017 and 2019), the CNIC IPP FP7 Marie Curie Programme (PCOFUND-2012–600396), EFSD Rising Star award (2019), JDC-2018-Incorporación (MIN/JDC1802). T-L was a Juan de la Cierva fellow (JCI2011–11623). C.F has a Sara Borrell contract (CD19/00078). RJD is an Investigator of the Howard Hughes Medical Institute. This work was funded by the following grants to GS: funding from the European Union’s Seventh Framework Programme (FP7/2007-2013) under grant agreement n˚ ERC 260464, EFSD/Lilly European Diabetes Research Programme Dr Sabio, 2017 Leonardo Grant for Researchers and Cultural Creators, BBVA Foundation (Investigadores-BBVA-2017) IN[17] _BBM_BAS_0066, MINECO-FEDER SAF2016-79126-R and PID2019-104399RB-I00 , EUIN201785875, Comunidad de Madrid IMMUNOTHERCAN-CM S2010/BMD-2326 and B2017/BMD-3733 and Fundación AECC AECC PROYE19047SABI and AECC: INVES20026LEIV to ML. MM was funded by ISCIII and FEDER PI16/01548 and Junta de Castilla y León GRS 1362/A/16 and INT/M/17/17 and JL-T by Junta de Castilla y León GRS 1356/A/16 and GRS 1587/A/17. The study was additionally funded by MEIC grants to ML (MINECO-FEDER-SAF2015-74112-JIN) AT-L (MINECO-FEDERSAF2014-61233-JIN), RJD: Grant DK R01 DK107220 from the National Institutes of Health. AH: (SAF2015-65607-R). The CNIC is supported by the Instituto de Salud Carlos III (ISCIII), the Ministerio de Ciencia, Innovación y Universidades (MCNU) and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (SEV-2015–0505).S

Predictive Power of the "Trigger Tool" for the detection of adverse events in general surgery: a multicenter observational validation study

Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”. Conclusions The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies

Australian children with cleft palate achieve age-appropriate speech by 5 years of age

Introduction: Children with cleft palate demonstrate atypical speech sound development, which can influence their intelligibility, literacy and learning. There is limited documentation regarding how speech sound errors change over time in cleft palate speech and the effect that these errors have upon mono versus polysyllabic word production. The objective of this study was to examine the phonetic and phonological speech skills of children with cleft palate at ages 3 and 5. Methods: A cross-sectional observational design was used. Eligible participants were aged 3 or 5 years with a repaired cleft palate. The Diagnostic Evaluation of Articulation and Phonology (DEAP) Articulation subtest and a non-standardised list of mono and polysyllabic words were administered once for each child. The Profile of Phonology (PROPH) was used to analyse each child's speech. Results: N=51 children with cleft palate participated in the study. Three-year-old children with cleft palate produced significantly more speech errors than their typically-developing peers, but no difference was apparent at 5 years. The 5-year-olds demonstrated greater phonetic and phonological accuracy than the 3-year-old children. Polysyllabic words were more affected by errors than monosyllables in the 3-year-old group only. Conclusions: Children with cleft palate are prone to phonetic and phonological speech errors in their preschool years. Most of these speech errors approximate typically-developing children by 5 years. At 3 years, word shape has an influence upon phonological speech accuracy. Speech pathology intervention is indicated to support the intelligibility of these children from their earliest stages of development.The University of Sydney Douglas and Lola Douglas Speech Pathology Scholarshi

Blastocystis sp. en humanos: actualización y experiencia clínico-terapéutica

Blastocystis sp. es uno de los parásitos del humanomás frecuentemente identificados en el laboratorioclínico durante el estudio parasitológico de las muestrasde heces. En esta revisión se actualizan los aspectosrelativos a la diversidad genética y especificidad delhuésped, la taxonomía, caracterización molecular,formas clínicas y experiencia terapéutica en pacientesinmuno-competentes y comprometidos, sintomáticosy asintomáticos, de la consulta de la Sección deGeohelmintiasis del Instituto de Medicina Tropical dela Facultad de Medicina de la Universidad Central deVenezuela, proponiendo el secnidazol como droga deprimera elección. Se analiza la presencia de Blastocystiscomo patógeno humano o como comensal, formandoparte de la microbiota intestinal. Se considera la tendenciaactual entre los diferentes grupos de investigacióna mirar la blastocistosis como un problema de saludpública en lugar de una entidad clínica frecuente y seincluyen elementos que pudieran reforzar esta visión. Seincluyen las medidas que pudieran contribuir a prevenirla parasitosis. Dado que la investigación sobre esteparásito progresa rápidamente, se recomienda realizarrevisiones frecuentes para mantener actualizadoslos conceptos relacionados con su epidemiología,diagnóstico, tratamiento y prevención en el pacienteinmunocompetente así como en el inmunosuprimido

Aerosol-generating behaviours in speech pathology clinical practice: A systematic literature review.

ObjectiveTo evaluate the evidence of aerosol generation across tasks involved in voice and speech assessment and intervention, to inform better management and to reduce transmission risk of such diseases as COVID-19 in healthcare settings and the wider community.DesignSystematic literature review.Data sources and eligibilityMedline, Embase, Scopus, Web of Science, CINAHL, PubMed Central and grey literature through ProQuest, The Centre for Evidence-Based Medicine, COVID-Evidence and speech pathology national bodies were searched up until August 13th, 2020 for articles examining the aerosol-generating activities in clinical voice and speech assessment and intervention within speech pathology.ResultsOf the 8288 results found, 39 studies were included for data extraction and analysis. Included articles were classified into one of three categories: research studies, review articles or clinical guidelines. Data extraction followed appropriate protocols depending on the classification of each article (e.g. PRISMA for review articles). Articles were assessed for risk of bias and certainty of evidence using the GRADE system. Six behaviours were identified as aerosol generating. These were classified into three categories: vegetative acts (coughing, breathing), verbal communication activities of daily living (speaking, loud voicing), and performance-based tasks (singing, sustained phonation). Certainty of evidence ranged from very low to moderate with variation in research design and variables.ConclusionsThis body of literature helped to both identify and categorise the aerosol-generating behaviours involved in speech pathology clinical practice and confirm the low level of evidence throughout the speech pathology literature pertaining to aerosol generation. As many aerosol-generating behaviours are common human behaviours, these findings can be applied across healthcare and community settings.Systematic review registrationRegistration number CRD42020186902 with PROSPERO International Prospective Register for Systematic Reviews

Active Ingredients of Voice Therapy for Muscle Tension Voice Disorders: A Retrospective Data Audit

Background: Although voice therapy is the first line treatment for muscle-tension voice disorders (MTVD), no clinical research has investigated the role of specific active ingredients. This study aimed to evaluate the efficacy of active ingredients in the treatment of MTVD. A retrospective review of a clinical voice database was conducted on 68 MTVD patients who were treated using the optimal phonation task (OPT) and sob voice quality (SVQ), as well as two different processes: task variation and negative practice (NP). Mixed-model analysis was performed on auditory–perceptual and acoustic data from voice recordings at baseline and after each technique. Active ingredients were evaluated using effect sizes. Significant overall treatment effects were observed for the treatment program. Effect sizes ranged from 0.34 (post-NP) to 0.387 (post-SVQ) for overall severity ratings. Effect sizes ranged from 0.237 (post-SVQ) to 0.445 (post-NP) for a smoothed cepstral peak prominence measure. The treatment effects did not depend upon the MTVD type (primary or secondary), treating clinicians, nor the number of sessions and days between sessions. Implementation of individual techniques that promote improved voice quality and processes that support learning resulted in improved habitual voice quality. Both voice techniques and processes can be considered as active ingredients in voice therapy