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Anxiety disorders are prevalent among children and adolescents. Identifying anxiety symptoms in primary care, school, and community settings has implications for service planning, resource allocation, and prevention and treatment programming. The Generalized Anxiety Disorder 7-item (GAD-7) scale is a commonly used instrument for evaluating anxiety symptoms. Still, it has yet to be validated in vulnerable groups, such as Spanish-speaking adolescents who are at risk due to socioeconomic disadvantages.This study aimed to examine the psychometric properties of the Spanish version of the GAD-7 for adolescents in a sample of middle and high school students in Puerto Rico. Secondary data from 566 students in fifth to twelfth grade in Puerto Rico were collected as part of a school-based services program.A confirmatory factor analysis evidenced the 1-factor structure of the GAD-7, while a test of invariance supported the equality of the factor loadings across gender and school level. The scores of the GAD-7 showed positive and significant correlations with the 8-item Patient Health Questionnaire depression scale-providing evidence of convergent validity-and the reliability estimates of the GAD-7 were adequate.Thus, the GAD-7 has optimal psychometric properties in terms of construct and convergent validity and internal consistency. It is a useful instrument for assessing anxiety in Spanish speaking youth in Puerto Rico.

This work presents a design for an automatized multiposition dynamic wheelchair used to transport quadriplegic patients by reconfiguring a manual wheelchair structure. An electric actuator is attached to a four-bar mechanism fixed to each side of a wheelchair’s backrest to reach multiposition. The entire device is actuated through a PID controller. An experimental test is carried out in a simplified wheelchair structure. Finally, the structure of the wheelchair is evaluated through the Dynamic analysis and Finite Element Method under the payload computed with the most critical position reached by the mechanism.

Flow-induced vibrations occur in some of the internal components of a nuclear reactor. When specific conditions are present, these vibrations may result in excessive deformations or fatigue that can generate mechanical damage. Several boiling water reactor (BWR) of nuclear power plants (NPP) have experienced failures in the jet pump assembly due to flow-induced vibration (FIV) which could be caused by acoustic pulsations derived from recirculation pumps, vibration induced by turbulence and vibration induced by leakage at the slip joint. The purpose of this paper is to establish a viable numerical methodology to evaluate the fluid-structural interaction at the slip joint of a jet pump. In this analysis, the fluid-structural interaction was evaluated with the finite element method and finite volume method with ANSYS® code in the case of two steel plates with a divergent gap. Results show that a critical velocity could cause fluidelastic instability, if only one flow in a two-way fluid-structural interaction was considered. This is one of the phenomena that could take place at the slip joint of a jet pump assembly.

Objetivo Revisar la patología tumoral del uraco, haciendo énfasis en su clínica, los métodos diagnósticos empleados y el manejo terapéutico. Métodos Presentamos el caso de un varón de 39 años con carcinoma del uraco que simuló clínicamente un absceso umbilical. Resultados Los hallazgos en la TC fueron sospechosos de patología del uraco. El examen anatomopatológico reveló células atípicas y la PET-TC demostró extensión a pared abdominal y epiplón, requiriéndose la resección completa. Conclusiones El carcinoma del uraco es una neoplasia muy poco frecuente, que tiene su origen en el epitelio que recubre la luz del uraco, un vestigio de la alantoides que conecta la vejiga con el ombligo y normalmente involuciona en la etapa embrionaria. La clínica insidiosa hace que el diagnóstico sea tardío y el pronóstico pobre. Las pruebas de imagen tienen un papel fundamental en su sospecha, así como en la definición de la relación con la pared vesical y posible extensión local o a distancia. Una vez confirmado el diagnóstico histológicamente, está indicada la resección quirúrgica completa.

There are controversies about the optimal management of AO subtype A3 burst fractures. The most common surgical treatment consists of posterior fixation with pedicle screw and rod augmentation. Nevertheless, a loss of correction in height restoration and kyphotic reduction has been observed.The aim of this study was to assess long-term outcomes of a minimally invasive technique using a percutaneous intravertebral expandable titanium implant (PIETI).This prospective, single center, pilot study was carried out on a consecutive case series of 44 patients with acute (2 weeks) traumatic thoracolumbar fractures AO type A3. The average follow-up was 5.6 years.A single center in Castilla y Leon, SpainMETHODS: Clinical outcomes (pain intensity on visual analog scale [VAS], Oswestry Disability Index [ODI], analgesic consumption) and radiographic outcomes (anterior/mid/posterior vertebral body height, vertebral area, local kyphosis angle, traumatic regional angulation) were analyzed before surgery, at one month after surgery, and at the end of the follow-up period.At one-month postsurgery, significant improvements in VAS score and ODI score were observed. PIETI achieved significant vertebral body height restoration with median height increases of 2.9 mm/4.3 mm/2.3 mm for anterior/middle/posterior parts, respectively. Significant correction of the local kyphotic angle and improvement of the traumatic regional angulation were accomplished. All these improvements were maintained throughout the follow-up period. The only complication reported was a case of cement leakage.In our opinion, the main limitation of the study is the small number of patients. However, the sample is superior to that shown in other papers.This study showed that using a PIETI in the treatment of fractures type A3 is a safe and effective method that allows marked clinical improvement, as well as anatomical vertebral body restoration. Unlike with other treatments, results were maintained over time, allowing a better long-term clinical and functional improvement. The rate of cement leakage was lower than other reports.

The ability of bacteria and archaea to modulate metabolic process, defensive response, and pathogenic capabilities depend on their repertoire of genes and capacity to regulate the expression of them. Transcription factors (TFs) have fundamental roles in controlling these processes. TFs are proteins dedicated to favor and/or impede the activity of the RNA polymerase. In prokaryotes these proteins have been grouped into families that can be found in most of the different taxonomic divisions. In this work, the association between the expansion patterns of 111 protein regulatory families was systematically evaluated in 1351 non-redundant prokaryotic genomes. This analysis provides insights into the functional and evolutionary constraints imposed on different classes of regulatory factors in bacterial and archaeal organisms. Based on their distribution, we found a relationship between the contents of some TF families and genome size. For example, nine TF families that represent 43.7% of the complete collection of TFs are closely associated with genome size, i.e., in large genomes, members of these families are also abundant, but when a genome is small, such TF family sizes are decreased. In contrast, almost 102 families (56.3% of the collection) do not exhibit or show only a low correlation with the genome size, suggesting that a large proportion of duplication or gene loss events occur independently of the genome size and that various yet-unexplored questions about the evolution of these TF families remain. In addition, we identified a group of families that have a similar distribution pattern across Bacteria and Archaea, suggesting common functional and probable coevolution processes, and a group of families universally distributed among all the genomes. Finally, a specific association between the TF families and their additional domains was identified, suggesting that the families sense specific signals or make specific protein-protein contacts to achieve the regulatory roles.

"La hesperidina es un glucósido-flavonona encontrado en cítricos, principalmente de naranja ordinaria y cítricos del género citrus-rutacea, cabe resaltar que es un subproducto abundante de desecho en los procesos industriales del cultivo, procesamiento y producción de cítricos, el cual puede ser aprovechado generando valor agregado a este desecho. Se ha reportado que sus metabolitos protegen de la oxidación celular y pueden regular la ruta de la fosfatidil-inositol 3-cinasa, la proteína cinasa activada por mitógenos y la ruta beta-catenina, las cuales están implicadas en el desarrollo de células beta-pancreáticas, por lo que en este trabajo se adicionó la hesperidina a un proceso de diferenciación guiado por distintos factores para la obtención de células productoras de insulina a partir de las células troncales de cordón umbilical, para ofrecer una posible fuente terapéutica celular en enfermedades crónicas como la diabetes mellitus, padecimiento caracterizado por una falta de insulina funcional debido a un daño en las células beta del páncreas, esta es una enfermedad que encabeza la lista de trastornos metabólicos con una creciente mortalidad, en México representa la primera causa de muerte, por ello la incorporación de la hesperidina al proceso de diferenciación surge como una alternativa para la búsqueda y evaluación de nuevas moléculas que pudieran ampliar la posibilidad de obtener un mayor rendimiento en la producción de insulina de las células obtenidas por diferenciación in vitro. "

et al., [Background]: Degenerative disc disease often causes severe low-back pain, a public health problem with huge economic and life quality impact. Chronic cases often require surgery, which may lead to biomechanical problems and accelerated degeneration of the adjacent segments. Autologous mesenchymal stromal cells (MSC) treatments have shown feasibility, safety and strong indications of clinical efficacy. We present here a randomized, controlled trial using allogeneic MSC, which are logistically more convenient than autologous cells. [Methods]: We randomized 24 patients with chronic back pain diagnosed with lumbar disk degeneration and unresponsive to conservative treatments into 2 groups. The test group received allogeneic bone marrow MSCs by intradiscal injection of 25 × 10 cells per segment under local anesthesia. The control group received a sham infiltration of paravertebral musculature with the anesthetic. Clinical outcomes were followed up for 1 year and included evaluation of pain, disability, and quality of life. Disc quality was followed up by magnetic resonance imaging. [Results]: Feasibility and safety were confirmed and indications of clinical efficacy were identified. MSC-treated patients displayed a quick and significant improvement in algofunctional indices versus the controls. This improvement seemed restricted to a group of responders that included 40% of the cohort. Degeneration, quantified by Pfirrmann grading, improved in the MSC-treated patients and worsened in the controls. [Conclusions]: Allogeneic MSC therapy may be a valid alternative for the treatment of degenerative disc disease that is more logistically convenient than the autologous MSC treatment. The intervention is simple, does not require surgery, provides pain relief, and significantly improves disc quality., Financial support from the Red de Terapia Celular (RD12/0019/0036, RD12/0019/0001 and RD16/0011/0003), Instituto de Salud Carlos III, Ministerio de Economía y Competitividad, and the Centro en Red de Medicina Regenerativa de Castilla y León is gratefully acknowledged.

The aim of our study was to determine the presence of heterotopic ossifications (HO) in a series of patients with cervical disk arthroplasty treated with different type of prosthesis, as well as to analyze the most suitable systems for diagnosis.A retrospective study of patients with cervical disk disease treated with cervical arthroplasty between May 2005 and December 2009, was performed. Patients were divided into 3 groups, depending on the prosthesis implanted: (Group A: Baguera prosthesis, Group B: ProDisc prosthesis, and Group C: PCM prosthesis). The presence of heterotopic ossifications was evaluated with both, simple radiology and computed tomography.As a summary of the results on motion preservation, computed tomography scans showed that 63% of the cervical arthroplasties in Group A presented good mobility at the first check point (December 2010), whereas cervical arthroplasties in Group B and Group C had 74% and 65% severe motion restrictions, respectively (Grade III or Grade IV, according to McAfee classification). The differences between groups were statistically significant when comparing Groups A and B, and Groups A and C (P 0.05), but there were no differences between Groups B and C (P0.05). At the second check point (December 2014), the good mobility was just preserved in the 26% of the disk replacements (all in Group A).Our results showed that, although cervical disks provide optimal mid-term results, the incidence of HO seems to increase with time. Long term studies, with a larger sample size should be conducted to evaluate the appearance of HO and cervical motion after total disk replacement.

Pedicle screws in spinal surgery have allowed greater biomechanical stability and higher fusion rates. However, malposition is very common and may cause neurologic, vascular, and visceral injuries and compromise mechanical stability.The purpose of this study was to compare the malposition rate between intraoperative computed tomography (CT) scan assisted-navigation and free-hand fluoroscopy-guided techniques for placement of pedicle screw instrumentation.This is a prospective, randomized, observational study.A total of 114 patients were included: 58 in the assisted surgery group and 56 in the free-hand fluoroscopy-guided surgery group.Analysis of screw position was assessed using the Heary classification. Breach severity was defined according to the Gertzbein classification. Radiation doses were evaluated using thermoluminescent dosimeters, and estimates of effective and organ doses were made based on scan technical parameters.Consecutive patients with degenerative disease, who underwent surgical procedures using the free-hand, or intraoperative navigation technique for placement of transpedicular instrumentation, were included in the study.Forty-four out of 625 implanted screws were malpositioned: 11 (3.6%) in the navigated surgery group and 33 (10.3%) in the free-hand group (p.001). Screw position according to the Heary scale was Grade II (4 navigated surgery, 6 fluoroscopy guided), Grade III (3 navigated surgery, 11 fluoroscopy guided), Grade IV (4 navigated surgery, 16 fluoroscopy guided), and Grade V (1 fluoroscopy guided). There was only one symptomatic case in the conventional surgery group. Breach severity was seven Grade A and four Grade B in the navigated surgery group, and eight Grade A, 24 Grade B, and one Grade C in free-hand fluoroscopy-guided surgery group. Radiation received per patient was 5.8 mSv (4.8-7.3). The median dose received in the free-hand fluoroscopy group was 1 mGy (0.8-1.1). There was no detectable radiation level in the navigation-assisted surgery group, whereas the effective dose was 10 µGy in the free-hand fluoroscopy-guided surgery group.Malposition rate, both symptomatic and asymptomatic, in spinal surgery is reduced when using CT-guided placement of transpedicular instrumentation compared with placement under fluoroscopic guidance, with radiation values within the safety limits for health. Larger studies are needed to determine risk-benefit in these patients.

El proceso de dispersión de solutos en el seno de un medio poroso heterogéneo ha sido el objetivo de numerosas investigaciones en las últimas décadas debido tanto a las limitaciones de las ecuaciones matemáticas que lo describen como a la necesidad de describir y predecir el movimiento de contaminantes en acuíferos reales, con la complejidad derivada de los patrones espaciales de heterogeneidad reales y otras incertidumbres en el conocimiento del medio. Las técnicas de modelación actuales se centran generalmente en un único parámetro para explicar la desviación del comportamiento de un penacho de soluto frente a los resultados predichos por la ADE: la variabilidad de la conductividad hidráulica. En ningún caso se hace referencia o se tiene en cuenta la variabilidad espacial de la dispersividad. La dificultad para medir o estimar este parámetro y su enorme dependencia de la escala de la discretización numérica han limitado esta vía de investigación. Esta tesis presenta el primer intento de modelar la variabilidad local de la dispersividad basándose en un experimento de flujo y transporte de solutos en un tanque de experimentación de escala intermedia (Intermediate Scale Experiment, ISE). En esta investigación, se ha construido un medio poroso artificial inserto en un tanque de experimentación cuasi-2D, cuyos patrones de heterogeneidad estaban basados en datos de conductividad hidráulica procedente de una formación natural altamente heterogénea de características no gaussianas Controlando el potencial hidráulico a la entrada y la salida del tanque, se crearon condiciones de flujo estacionario en las que se llevaron a cabo varios ensayos de transporte de trazadores conservativos. Este tanque, construido en metacrilato, fue monitorizado con una red de transductores de presión de alta precisión y se tomaron fotografías digitales de la evolución del penacho de trazador coloreado., Sanchez Fuster, I. (2011). Modelación de parámetros físicos de la ecuación de advección-dispersión utilizando un tanque de experimentación de escala intermedia [Tesis doctoral no publicada]. Universitat Politècnica de València. doi:10.4995/Thesis/10251/14635., Palancia

This paper describes a method to calculate the systolic/diastolic indices of the blood flow that pass through an artery or vein under test. The method analyzes the Doppler and the ECG signals, associating and synchronising them in order to calculate the indices. The maximum of the R and T waves, are calculated using a continuous wavelet transform. Simultaneously, the pseudo-instantaneous mean frequency is calculated from the Doppler blood flow signal. A projection of the R and T wave mark over the pseudo-instantaneous Doppler mean frequency curve is used for computing the indices. The paper shows preliminary results from real signals obtained from a carotid artery, an humeral artery and an aortic artery, demonstrating the effectiveness of the method. Further results will be obtained through a formal experimental protocol during coronary bypass surgery.

The design and construction of an ultrasonic Doppler transducer with a fixed angle for medical application using a novel acoustic matching material are described. This transducer was constructed using an 8 MHz commercial piezoelectric ceramic (PIC255) and REXOLITE which is an excellent acoustic matching material. The objective of the present work was the design and construction of an ultrasonic transducer using REXOLITE, this transducer will be part of a Doppler blood flow measurement system, the novelty of this transducer is that it includes an internal angle (45°). The resonance frequency is around 5 MHz. The transducer must work with the associated electronics using quadrature demodulation generated for the ultrasonic Doppler blood flow signal.

Stroke is the main cause of disabilities in the world and is typically treated with intensive, hands-on physical and occupational therapy for several weeks after the initial injury. However, due to economic pressures, stroke patients are receiving less therapy and going home sooner, so the potential benefit of the therapy is not completely realized. Thus, it is important to develop rehabilitation technology that allows individuals who had suffered a stroke to practice intensive movement training without the expense of an always-present therapist. Although several robotic devices have been developed for stroke rehabilitation, these are too expensive for use at home or in small clinics.We have developed a low-cost alternative that allows stroke survivors to practice arm movement exercises at home or at the clinic, with periodic interactions with a therapist. The system integrates a virtual environment for facilitating repetitive movement training, with computer vision algorithms that track the hand of a patient, using an inexpensive camera and a conventional personal computer. This system, called Gesture Therapy, has been evaluated in a controlled clinical trial at a hospital in Mexico City, comparing it with conventional occupational therapy. The results show that both treatments improve the functionality of the affected upper extremity, with not significant difference between them. However, the patients that used the virtual environment have a greater motivation and attachment to the treatment, which in the long term are decisive for maximal recovery.

A random-efect group analysis done on functional magnetic resonance images coresponding to hand-righted stroke patients who were rehabilitated with a computer game showed in a statistical way that for those whose paretic arm is the right one their brains had 10% increase in the number of activated voxels on the left primary motor area. However when there is paresis on the left arm there is no significant increase in number of activated voxels on patients' right primary motor area: it is rather a sparse rewiring thatakes place. Nevertheles for both types of patients, other statisticaly-visualized areas presented activation as wel: pre-frontal area, suplementary motor area, and sensory motor and parietal areas. And for just few the cerebelum itself was activated. 4 men and 6 women composed the sample of in-average 50-year-old right-handed patients with more than 12 months of strokevolution: with a 50%-50% right and left paretic-arm distribution within the sample. Patients folowed rehabilitation sesions in which they played a pongame on a personal computer a padle adapted to the mouse device and fixed to the patients' paretic with some bands. Twelve 10-minute rehabilitation sesions tok place with frequency of 3 times a wek. Functional evaluation was caried out with motor paradigm focused on hand functionality. Such a paradigm consisted of instructing the patients to touch their thumb to each of their four fingersequentialy, back and forth, at a self-paced rate, having astart points two auditive stimulus for alternating 30-second periods of movement and rest events - for those who could not perform the movements because of serious paretic reasons, they were instructed to show of intention of movement. The 1-minute set of two events was repeated 5 times for a total of 360 seconds each sesion: one hand at a time per functional magnetic resonance imaging (fMRI) sesion. Imaging data was acquired on a 3.0-Tesla General electric Signa scaner with an echo planar sequence 64×64 matrix; flip angle=90; TR=3 s; TE=40 ms; FOV=24 cm; 28 continuous axial slices for each of the 10 volumes) for each sesion: right hand, left hand, before and afterehabilitation treatment. Functional-scan images were motion corected, normalized, spatialy smothed statisticaly procesed to model patient' brain performance and visualize most-likely statistical activated regions. Search of evidence clues of brain re-activation orewiring was focused on expected areas [1] 2] [3]: bilateral pre-motor cortex, bilateral superior temporal gyrus, motor and suplementary areas and contra-lateral supra- marginal gyrus. Subtracting pre-activations from post-activations, special atention was paid to brain-rewiringain (Fig. 1). Thistudy leads us consider computer game-based rehabilitation as a strong alternative traditional rehabilitation sesions for stroke patientsince there is evidence of brain functional efects [1] 3] that go along with practical results on the strength of the patients' paretic arm (measured by means of the Motricity Index, e.g. [4]). As a future work, we lok forward to asesing functional efects on stroke patients who use a low-costechnology-based virtualgame system 5] that could be afordable by those who are in trouble to show up in a hospital's rehabilitation center and neds solution that provides them with some independence (i.e. they canot spend every rehabilitation day under the therapist'supervision).

In recent years there has been a considerable increase in awareness of the impact that the quality of air, water, soil and food has on human health. Of these elements, noise pollution not only affects our health and quality of life, but also our social behavior and cognitive development. Noise can have different effects depending on its type, duration and time of occurrence, and on the sensitivity of the receiver. In particular, recent scientific research has shown that noise can have effects on health, disturbing sleep and promoting psychosomatic illnesses. Therefore, the problem of noise pollution must be addressed decisively and the risks of its effects on human health assessed.

Each year millions of people in the world survive a stroke. Movement impairments after stroke are typically treated with intensive, hands-on physical and occupational therapy for several weeks after the initial injury. However, due to economic pressures, stroke patients are receiving less therapy and going home sooner, so the potential benefit of the therapy is not completely realized. Thus, it is important to develop rehabilitation technology that allows individuals who had suffered a stroke to practice intensive movement training without the expense of an always-present therapist. We have developed a low-cost, computer vision system that allows individuals with stroke to practice arm movement exercises at home or at the clinic, with periodic interactions with a therapist. The system integrates a virtual environment for facilitating repetitive movement training, with computer vision algorithms that track the hand of a patient and obtain its 3-D coordinates, using an inexpensive camera and a conventional personal computer. The system, called “Gesture Therapy”, is being evaluated in a controlled clinical trial at a hospital in Mexico City. In this paper we describe the system and discuss the results of a first clinical evaluation.

Each year millions of people in the world survive a stroke, in the U.S. alone the figure is over 600,000 people per year. Movement impairments after stroke are typically treated with intensive, hands-on physical and occupational therapy for several weeks after the initial injury. However, due to economic pressures, stroke patients are receiving less therapy and going home sooner, so the potential benefit of the therapy is not completely realized. Thus, it is important to develop rehabilitation technology that allows individuals who had suffered a stroke to practice intensive movement training without the expense of an always-present therapist. Current solutions are too expensive, as they require a robotic system for rehabilitation. We have developed a low-cost, computer vision system that allows individuals with stroke to practice arm movement exercises at home or at the clinic, with periodic interactions with a therapist. The system integrates a web based virtual environment for facilitating repetitive movement training, with state-of-the art computer vision algorithms that track the hand of a patient and obtain its 3-D coordinates, using two inexpensive cameras and a conventional personal computer. An initial prototype of the system has been evaluated in a pilot clinical study with promising results.

BACKGROUND CONTEXT: Intraoperative monitoring (IOM) is consistently and convincingly reported to have high sensitivity and specificity for detecting neurological injury. However there is surprisingly little research or understanding in the literature to explain why some alert cases result in postoperative deficit but most do not. PURPOSE: Do interventions change the outcome following intraoperative monitoring alerts. STUDY DESIGN/SETTING: Retrospective review of 6700 cases. PATIENT SAMPLE: 110 patients with significant neuromonitoring changes intraoperatively. OUTCOME MEASURES: Neurological deficit at 1 month and 1 year. METHODS: A retrospective case review was carried out using 110 spinal surgery cases from a single institution. All had been classified as red alerts due to predefined significant IOM trace changes. They were divided into two groups depending on whether they had experienced postoperative deficit following the red alert (NNDþ) or not (NND-). A range of patient, operative, monitoring and intervention factors were collected and Chisquared and Fisher’s Exact test were used to find significant differences between the groups. RESULTS: 24 patients were NNDþ. Three factors were significant in determining which these were; patient age, blood loss and the monitoring modalities used. Interventions carried out did not differentiate NNDþ from NND-. CONCLUSIONS: There are few predictive factors in spinal surgery to define which patients will develop neurological deficit post-operative. Metalwork revision, steroids, imaging modalities used post-operatively, did not predict final neurological outcome. Patients less than 9 or with monitoring changes despite low blood loss had more chance of a real deficit post-operatively. Multi-modal monitoring was more accurate in predicting neurological deficit than SSEP alone. CONFLICTS OF INTEREST: None. FUNDING SOURCES: Research funding from Mesoblast Ltd.