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Background and rationale: Stroke is considered the most common cause of adult disability. Intensive rehabilitation protocols outperform nonintensive counterparts. The subacute stroke phase represents a potential window to recovery. Virtual reality (VR) has been shown to provide a more stimulating environment, allowing for increased patient compliance. However, the quality of current literature comparing VR with standard therapies is limited. Our aim is to measure the impact of VR versus standard therapy on the recovery of the upper limb motor function in patients with stroke in the early subacute recovery phase. Method: This is a randomized, controlled trial that will assign 262 patients to tailor-made standard rehabilitation (TMSR) or TMSR plus immersive VR device. The trial will be conducted in an urban rehabilitation clinic in the United States with expertise in the management of poststroke patients. Patients will be 18 to 70 years of age and in the early subacute period (30-90 days post ischemic stroke). The primary outcome will be the change of Fugl-Meyer Assessment—Upper Extremity (FMA-UE) score, measured at baseline and 13 weeks after randomization. The secondary outcome will be the change in the UK Functional Independence Measure and Functional Assessment Measure (UK FIM-FAM) score at the same time points. Discussion: If the use of VR in the rehabilitation of patients with stroke proves to have a significant impact on their motor recovery, it will constitute an extremely important step into decreasing the functional impairment associated with stroke and the related health care expense burden.

Background: Posterior fossa tumors account for approximately half of the central nervous system tumors in children. Major technological advances, mainly in the fields of molecular biology and neuroimaging, have modified their classification, leading to a more detailed description of these entities. Into the classic taxonomy, used for many years, new concepts have been incorporated at times eliminating or modifying former ones. Methods: A literature search was conducted in PubMed using the medical subject headings involving the five most common pediatric posterior fossa tumors: diffuse midline glioma, medulloblastoma, ependymoma, atypical teratoid/rhabdoid tumor, and pilocytic astrocytoma. Only English published articles in the past 11 years that provided technological, neuroimaging, and molecular biology insight into posterior fossa tumors in children were considered. Results: Substantial changes have been introduced in the nomenclature of pediatric posterior fossa tumors. Diffuse midline gliomas are named based on alterations in histone H3. Molecular rearrangements of medulloblastomas are more important in defining the prognosis than histological variants; therefore, these tumors are currently named based on their molecular subgroups. Posterior fossa ependymomas and atypical teratoid rhabdoid tumor classification have incorporated new groups based on different genetic profiles. Pilocytic astrocytoma has been placed in a new category that distinguishes circumscribed from diffuse entities. Conclusion: Advances in molecular biology and neuroimaging have substantially changed the way pediatric neoplasms are studied. The classical taxonomy has been modified leading to more accurate classifications that are based on the genetic alterations.

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RESUMENEn el tránsito del siglo XIX al XX, la carencia de viviendas y el hacinamiento son los rasgos más característicos de las sociedades urbanas analizadas, con un corolario de afecciones sanitarias. Tal circunstancia pudo ser paliada mediante planes de urbanismo fundamentados en aspectos higienistas. No obstante, las reformas fueron siempre a remolque de pequeños intereses económicos. La conciencia crítica de urbanistas y pensadores se enfrentó a la inercia de los políticos y a la incapacidad de algunas sociedades de vislumbrar la configuración de una ciudad moderna, a partir de las estructuras pueblerinas en que vivían inmersas. Todo ello hizo que la respuesta a esas carencias acuciantes se viese siempre demorada o mal satisfecha. Palabras clave:Reforma urbana e higienismo. ABSTRACTIn the transition from the 19th to the 20th centuries the lack of dwellings and overcrowding are the most characteristic features of the urban societies analyzed, together with a corollary of health conditions. This problem was corrected urban plans based on aspects concerning hygiene aspects. However, the reforms lagged behind small economic interests. The critical awareness of urbanists and thinkers came up against the apathy of politicians as well as the fact that some societies were unable to discern the configuration of modern towns immersed, as they were, in village-like structures. Therefore, the solution to these acute shortenings always took a long time coming or when it did, was unsatisfactory.Key words: Urban reform and hygiene aspects.La progresiva concentración de población en las ciudades es un proceso que se generaliza en toda Europa en el tránsito de los siglos XIX al XX, sobre todo en los países indus-141