Cost-effectiveness of upper extremity dry needling in the rehabilitation of patients with stroke

Introduction: Dry needling (DN) has been shown to be effective for the treatment of upper extremity hypertonia in patients with stroke. Purpose: To evaluate the cost-effectiveness of DN in patients with stroke. Methods: A cost-effectiveness analysis was performed in a research study conducted at a Spanish public hospital where patients were classified into two groups with or without DN. Hypertonia was measured using the Modified Modified Ashworth Scale (MMAS), and quality of life (QOL) was assessed using the EuroQoL 5-dimension questionnaire. Data regarding the effects and costs of physiotherapy were presented by calculating the mean and 95% confidence interval. The health outcomes were evaluated considering the rate of responders to the treatment based on the MMAS. Spanish preference weights were used to estimate quality-adjusted life years (QALYs). The incremental cost-effectiveness ratio (ICER) and incremental cost-utility ratio (ICUR) were calculated to determine the economic value of DN. Results: Eighty patients with stroke in the subacute stage of recovery were selected to participate in this study. Based on the rate of responders, the ICER of the DN group was very low. Despite the sensitivity analysis performed, the results of the ICUR were not encouraging. Discussion: Cost-effectiveness with responder rate results were favourable for the DN group and were confirmed by the sensitivity analysis according to levels of care. In addition, our findings revealed that 4 weeks of treatment could be more cost-effective than 8 weeks. DN treatment of the upper extremity appears to be cost-effective based on the rate of responders measured using the MMAS scale. © The Author(s) 2021

Prevalencia de las complicaciones del tratamiento antiparkinsoniano: Revisión sistemática y estimación de proyecciones

Introducción. El desarrollo de la enfermedad de Parkinson (EP) presenta diferentes complicaciones derivadas de la propia enfermedad, pero también de su tratamiento. La aparición de efectos adversos con el uso de antiparkinsonianos es común y su manejo es complicado, por lo que se hace necesario determinar el impacto epidemiológico de estos problemas relacionados con los medicamentos antiparkinsonianos. Objetivo. Estimar la prevalencia de los efectos adversos del tratamiento de los síntomas motores de la EP y su posible impacto a largo plazo. Pacientes y métodos. Se realizó una revisión sistemática en bases de datos biomédicas desde el año 2004; se seleccionaron los estudios más relevantes y se identificaron las frecuencias de los efectos adversos más comunes. Se proyectaron los datos obtenidos para estimar su impacto a largo plazo. Resultados. Se identificaron 218 estudios, de los cuales 24 fueron seleccionados para la revisión. Se obtuvieron datos para 20 tipos de complicaciones del tratamiento antiparkinsoniano, entre las que se encuentran problemas cardiíacos, edemas y síntomas neuropsiquiátricos. Conclusión. Las estimaciones realizadas indican que el número de pacientes de EP y, consecuentemente, la prevalencia de los efectos adversos de los tratamientos antiparkinsonianos pueden duplicarse en el año 2050. Palabras clave. Complicaciones. Efectos adversos. Enfermedad de Parkinson. Epidemiologi´a. Revisio´n sistemática. Tratamiento antiparkinsoniano

The Koskobilo (Olazti, Navarre, Northern Iberian Peninsula) paleontological collection: New insights for the Middle and Late Pleistocene in Western Pyrenees

The destroyed site(s) of Koskobilo (Olazti, Navarre, Northern Iberian Peninsula) have yielded unique archaeo-paleontological evidence in the Western Pyrenees region. The quarry uncovered a karstic site with faunal remains in 1940, and fossils were recovered both in situ and from the quarry dump. Ten years later, while the quarry was still working, a new visit to the dump yielded a large lithic assemblage and additional fossil remains with a different taphonomic pattern, which has been interpreted as the remains coming from a different site or zone within the same karst system. Here we re-study the paleontological evidence and provide new dating on a speleothem covering a Stephanorhinus hemitoechus tooth, which has yielded a minimum date of c. 220 ka for part of the assemblage. In total, the fossil assemblage comprises 38 mammal and six avian taxa and three fish remains. The faunal evidence indicates that in 1940 a mix of taxa from both the Middle and Upper Pleistocene were recovered, and it is difficult to assign most of them to a concrete period. However, based on biochronological criteria some of the identified taxa (e.g., Ursus thibetanus, Ursus cf. deningeri, Cuon cf. priscus, Macaca sylvanus, cf. Megaceroides) could be roughly contemporaneous with the dated rhino tooth, which would provide a new window to the Middle Pleistocene of the region, with deposits from MIS 7d and/or older. Despite the difficulties in studying this collection, recovered without stratigraphic context and in a salvage operation, Koskobilo has yielded an important paleontological assemblage which helps to understand the paleoecology of the Middle Pleistocene human occupations in the Western Pyrenees

Prognostic Impact of Nutritional Status After Transcatheter Edge-to-Edge Mitral Valve Repair: The MIVNUT Registry

Background Malnutrition is associated with poor prognosis in several cardiovascular diseases. However, its prognostic impact in patients undergoing transcatheter edge-to-edge mitral valve repair (TEER) is not well known. This study sought to assess the prevalence, clinical associations, and prognostic consequences of malnutrition in patients undergoing TEER. Methods and Results A total of 892 patients undergoing TEER from the international MIVNUT (Mitral Valve Repair and Nutritional Status) registry were studied. Malnutrition status was assessed with the Controlling Nutritional Status score. The association of nutritional status with mortality was analyzed with multivariable Cox regression models, whereas the association with heart failure admission was assessed by Fine-Gray models, with death as a competing risk. According to the Controlling Nutritional Status score, 74.4% of patients with TEER had any degree of malnutrition at the time of TEER (75.1% in patients with body mass index <25?kg/m2, 72.1% in those with body mass index ?25?kg/m2). However, only 20% had moderate-severe malnutrition. TEER was successful in most of patients (94.2%). During a median follow-up of 1.6?years (interquartile range, 0.6-3.0), 267 (29.9%) patients died and 256 patients (28.7%) were admitted for heart failure after TEER. Compared with normal nutritional status moderate-severe malnutrition resulted a strong predictor of mortality (adjusted hazard ratio [HR], 2.1 [95% CI, 1.1-2.4]; P<0.001) and heart failure admission (adjusted subdistribution HR, 1.6 [95% CI, 1.1-2.4]; P=0.015). Conclusions Malnutrition is common among patients submitted to TEER, and moderate-severe malnutrition is strongly associated with increased mortality and heart failure readmission. Assessment of nutritional status in these patients may help to improve risk stratification

Long-term adherence to IFN beta-1a treatment when using rebismart1device in patients with relapsing-remitting multiple sclerosis

The effectiveness of disease-modifying drugs in the treatment of multiple sclerosis is associated with adherence. RebiSmart® electronic device provides useful information about adherence to the treatment with subcutaneous (sc) interferon (IFN) ß-1a (Rebif®). The aim of the study was to determine long-term adherence to this treatment in patients with relapsing- remitting multiple sclerosis (RRMS). This retrospective multicentre observational study analysed 258 patients with RRMS who were receiving sc IFN ß-1a (Rebif®) treatment by using RebiSmart® until replacement (36 months maximum lifetime) or treatment discontinuation. Adherence was calculated with data (injection dosage, time, and date) automatically recorded by RebiSmart®. Patients in the study had a mean age of 41 years with a female proportion of 68%. Mean EDSS score at start of treatment was 1.8 (95% CI, 1.6-1.9). Overall adherence was 92.6%(95% CI, 90.6-94.5%). A total of 30.2% of patients achieved an adherence rate of 100%, 80.6% at least 90%, and only 13.2% of patients showed a suboptimal adherence (<80%). A total of 59.9% of subjects were relapse-free after treatment initiation. Among 106 subjects (41.1%) who experienced, on average, 1.4 relapses, the majority were mild (40.6%) or moderate (47.2%). Having experienced relapses from the beginning of the treatment was the only variable significantly related to achieving an adherence of at least 80% (OR = 3.06, 1.28-7.31). Results of this study indicate that sc IFN ß-1a administration facilitated by RebiSmart® could lead to high rates of adherence to a prescribed dose regimen over 36 months

A framework for modelling the biomechanical behaviour of the human liver during breathing in real time using machine learning

Progress in biomechanical modelling of human soft tissue is the basis for the development of new clinical applications capable of improving the diagnosis and treatment of some diseases (e.g. cancer), as well as the surgical planning and guidance of some interventions. The finite element method (FEM) is one of the most popular techniques used to predict the deformation of the human soft tissue due to its high accuracy. However, FEM has an associated high computational cost, which makes it difficult its integration in real-time computer-aided surgery systems. An alternative for simulating the mechanical behaviour of human organs in real time comes from the use of machine learning (ML) techniques, which are much faster than FEM. This paper assesses the feasibility of ML methods for modelling the biomechanical behaviour of the human liver during the breathing process, which is crucial for guiding surgeons during interventions where it is critical to track this deformation (e.g. some specific kind of biopsies) or for the accurate application of radiotherapy dose to liver tumours. For this purpose, different ML regression models were investigated, including three tree-based methods (decision trees, random forests and extremely randomised trees) and other two simpler regression techniques (dummy model and linear regression). In order to build and validate the ML models, a labelled data set was constructed from modelling the deformation of eight ex-vivo human livers using FEM. The best prediction performance was obtained using extremely randomised trees, with a mean error of 0.07 mm and all the samples with an error under 1 mm. The achieved results lay the foundation for the future development of some real-time software capable of simulating the human liver deformation during the breathing process during clinical interventions.This work has been funded by the Spanish Ministry of Economy and Competitiveness (MINECO) through research projects TIN2014-52033-R and DPI2013-40859-R, both also supported by European FEDER funds. The authors acknowledge the kind collaboration of the personnel from the hospital involved in the research.Lorente, D.; Martínez-Martínez, F.; Rupérez Moreno, MJ.; Lago, MA.; Martínez-Sober, M.; Escandell-Montero, P.; Martínez-Martínez, JM.... (2017). A framework for modelling the biomechanical behaviour of the human liver during breathing in real time using machine learning. Expert Systems with Applications. 71:342-357. doi:10.1016/j.eswa.2016.11.037S3423577

Taphonomic Criteria for Identifying Iberian Lynx Dens in Quaternary Deposits

For decades, taphonomists have dedicated their efforts to assessing the nature of the massive leporid accumulations recovered at archaeological sites in the northwestern Mediterranean region. Their interest lying in the fact that the European rabbit constituted a critical part of human subsistence during the late Pleistocene and early Holocene. However, rabbits are also a key prey in the food webs of Mediterranean ecosystems and the base of the diet for several specialist predators, including the Iberian lynx (Lynx pardinus). For this reason, the origin of rabbit accumulations in northwestern Mediterranean sites has proved a veritable conundrum. Here, we present the zooarchaeological and taphonomic study of more than 3000 faunal and 140 coprolite remains recovered in layer IIIa of Cova del Gegant (Catalonia, Spain). Our analysis indicates that this layer served primarily as a den for the Iberian lynx. The lynxes modified and accumulated rabbit remains and also died at the site creating an accumulation dominated by the two taxa. However, other agents and processes, including human, intervened in the final configuration of the assemblage. Our study contributes to characterizing the Iberian lynx fossil accumulation differentiating between the faunal assemblages accumulated by lynxes and hominins

The ratio of horizontal to vertical displacement in solar oscillations estimated from combined SO/PHI and SDO/HMI observations

In order to make accurate inferences about the solar interior using helioseismology, it is essential to understand all the relevant physical effects on the observations. One effect to understand is the (complex-valued) ratio of the horizontal to vertical displacement of the p- and f-modes at the height at which they are observed. Unfortunately, it is impossible to measure this ratio directly from a single vantage point, and it has been difficult to disentangle observationally from other effects. In this paper we attempt to measure the ratio directly using 7.5 hours of simultaneous observations from the Polarimetric and Helioseismic Imager on board Solar Orbiter and the Helioseismic and Magnetic Imager on board the Solar Dynamics Observatory. While image geometry problems make it difficult to determine the exact ratio, it appears to agree well with that expected from adiabatic oscillations in a standard solar model. On the other hand it does not agree with a commonly used approximation, indicating that this approximation should not be used in helioseismic analyses. In addition, the ratio appears to be real-valued.Comment: Accepted for publication in Astronomy & Astrophysics. 8 pages, 8 figure

Intensity contrast of solar network and faculae close to the solar limb, observed from two vantage points

The brightness of faculae and network depends on the angle at which they are observed and the magnetic flux density. Close to the limb, assessment of this relationship has until now been hindered by the increasingly lower signal in magnetograms. This preliminary study aims at highlighting the potential of using simultaneous observations from different vantage points to better determine the properties of faculae close to the limb. We use data from the Solar Orbiter/Polarimetric and Helioseismic Imager (SO/PHI), and the Solar Dynamics Observatory/Helioseismic and Magnetic Imager (SDO/HMI), recorded at $\sim60^\circ$ angular separation of their lines of sight at the Sun. We use continuum intensity observed close to the limb by SO/PHI and complement it with the co-observed $B_{\rm LOS}$ from SDO/HMI, originating closer to disc centre (as seen by SDO/HMI), thus avoiding the degradation of the magnetic field signal near the limb. We derived the dependence of facular brightness in the continuum on disc position and magnetic flux density from the combined observations of SO/PHI and SDO/HMI. Compared with a single point of view, we were able to obtain contrast values reaching closer to the limb and to lower field strengths. We find the general dependence of the limb distance at which the contrast is maximum on the flux density to be at large in line with single viewpoint observations, in that the higher the flux density is, the closer the turning point lies to the limb. There is a tendency, however, for the maximum to be reached closer to the limb when determined from two vantage points. We note that due to the preliminary nature of this study, these results must be taken with caution. Our analysis shows that studies involving two viewpoints can significantly improve the detection of faculae near the solar limb and the determination of their brightness contrast relative to the quiet Sun

Coronal voids and their magnetic nature

Context: Extreme ultraviolet (EUV) observations of the quiet solar atmosphere reveal extended regions of weak emission compared to the ambient quiescent corona. The magnetic nature of these coronal features is not well understood. // Aims: We study the magnetic properties of the weakly emitting extended regions, which we name coronal voids. In particular, we aim to understand whether these voids result from a reduced heat input into the corona or if they are associated with mainly unipolar and possibly open magnetic fields, similar to coronal holes. // Methods: We defined the coronal voids via an intensity threshold of 75% of the mean quiet-Sun (QS) EUV intensity observed by the high-resolution EUV channel (HRIEUV) of the Extreme Ultraviolet Imager on Solar Orbiter. The line-of-sight magnetograms of the same solar region recorded by the High Resolution Telescope of the Polarimetric and Helioseismic Imager allowed us to compare the photospheric magnetic field beneath the coronal voids with that in other parts of the QS. // Results: The coronal voids studied here range in size from a few granules to a few supergranules and on average exhibit a reduced intensity of 67% of the mean value of the entire field of view. The magnetic flux density in the photosphere below the voids is 76% (or more) lower than in the surrounding QS. Specifically, the coronal voids show much weaker or no network structures. The detected flux imbalances fall in the range of imbalances found in QS areas of the same size. // Conclusions: We conclude that coronal voids form because of locally reduced heating of the corona due to reduced magnetic flux density in the photosphere. This makes them a distinct class of (dark) structure, different from coronal holes