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Since the inception of the transcranial magnetic stimulation (TMS) technique, it has become imperative to numerically compute the distribution of the electric field induced in the brain. Various models of the coil-brain system have been proposed for this purpose. These models yield a set of formulations and boundary conditions that can be employed to calculate the induced electric field. However, the literature on TMS simulation presents several of these formulations, leading to potential confusion regarding the interpretation and contribution of each source of electric field. The present study undertakes an extensive compilation of widely utilized formulations, boundary value problems and numerical solutions employed in TMS fields simulations, analyzing the advantages and disadvantages associated with each used formulation and numerical method. Additionally, it explores the implementation strategies employed for their numerical computation. Furthermore, this work provides numerical expressions that can be utilized for the numerical computation of TMS fields using the finite difference and finite element methods. Notably, some of these expressions are deduced within the present study. Finally, an overview of some of the most significant results obtained from numerical computation of TMS fields is presented. The aim of this work is to serve as a guide for future research endeavors concerning the numerical simulation of TMS.
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Only a few centers in the world perform pure laparoscopic right hepatectomy for adult-to-adult living donor liver transplantation. In this procedure, right lobe donation is mostly preferred in view of the higher graft volume usually needed for the recipient. In the area, laparoscopic surgery has had a minor development given the greater technical difficulty and risks for both donor and preservation of the graft. Nevertheless, last 3 years, the advances in major laparoscopic liver surgery suggest that pure laparoscopic right hepatectomy could be a feasible and safe procedure in appropriately selected donors, and mostly, when is performed by surgeons with significant experience in both laparoscopic liver surgery and liver transplantation with living donor liver grafts. This video shows the surgical technique of a pure laparoscopic right hepatectomy in a 30-year-old female volunteered for living donation to her brother.
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Chronic pancreatitis usually requires medical treatment and, in rare cases, surgical intervention. The most frequent cause of consultation is chronic pain that is difficult to manage, and therapeutic options such as endoscopy can resolve most problems without surgery. However, when these options fail, surgical management is necessary. The most common surgery is a lateral pancreatic bypass or Puestow surgery. We present the case of a 31-year-old patient with unspecific abdominal discomfort. Abdominal ultrasonography showed significant dilation of the pancreatic duct (18 mm). Abdominal magnetic resonance imaging showed an impacted stone in the head of the pancreas and pancreas divisum. Resolution with endoscopy was attempted, but the pancreatic duct could not be accessed due to impacted lithiasis. After discussion in a multidisciplinary committee, surgical treatment was recommended, and a fully laparoscopic Puestow surgery was performed.
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The structural behavior of some cutin monomers, when deposited on mica support, was extensively investigated by our research group. However, other events, such as esterification reaction (ER), are still a way to explore. In this paper, we explore possible ER that could occur when these monomers adsorb on support. Although classical molecular dynamics simulations are not able to capture reactive effects, here, we show that they become valuable strategies to analyze the initial structural configurations to predict the most favorable reaction routes. Thus, when depositing aleuritic acid (ALE), it is observed that the loss of capacity to form self-assembled (SA) systems favors different routes to occur ER. In pure ALE bilayers systems, an ER is given exclusively through the -COOH and primary -OH groups. In pure ALE monolayers systems, the ER does not happen when the system is self-assembled. However, for disorganized systems, it is able to occur by two possible routes: -COOH and primary -OH (route 1) and -COOH and secondary -OH (route 2). When palmitic acid (PAL) is added in small quantities, ALE SAMs can now form an ER. In this case, ER occurs mostly through the -COOH and secondary -OH groups. However, when the presence of PAL is dominant, ER can occur with either of both possibilities, that is, routes 1 and 2. Graphical abstract.
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El ameloblastoma es una entidad patológica benigna de origen odontogénico, de alta agresividad local, lo que ha sido un punto de controversia en la literatura científica. Se presenta un caso clínico, con ubicación en maxilar superior con diagnóstico de ameloblastoma sólido multiquístico. Se evalúa el caso, su posibilidad de tratamiento, revisando las características clínicas y anatomopatológicas de laentidad, basándose en una búsqueda bibliográfica.
Ameloblastoma is a benign pathological entity of odontogenic origin, very aggressive at a local level, which has become a controversial issuein cientific literature. A clinic case is presented, located in the superior maxilla diagnosed as a solid multicystic ameloblastoma. The case isevaluated, its ways of treatment, the clinical and anatomopathological characteristics of the entity with an intensive bibliographical researc.
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Humanos , Masculino , Pessoa de Meia-Idade , Ameloblastoma/cirurgia , Ameloblastoma/diagnóstico , Ameloblastoma/patologia , Neoplasias Maxilares/classificação , Procedimentos Cirúrgicos Bucais/métodos , Argentina , Unidade Hospitalar de Odontologia , Prótese Maxilofacial , Planejamento de Assistência ao PacienteRESUMO
Since the report of the initial outbreak of Porcine rubulavirus (PorPV) infection in pigs, only one full-length genome from 1984 (PorPV-LPMV/1984) has been characterised. To investigate the overall genetic variation, full-length gene nucleotide sequences of current PorPV isolates were obtained from different clinical cases of infected swine. Genome organisation and sequence analysis of the encoded proteins (NP, P, F, M, HN and L) revealed high sequence conservation of the NP protein and the expression of the P and V proteins in all PorPV isolates. The V protein of one isolate displayed a mutation that has been implicated to antagonise the antiviral immune responses of the host. The M protein indicated a variation in a short region that could affect the electrostatic charge and the interaction with the membrane. One PorPV isolate recovered from the lungs showed a mutation at the cleavage site (HRKKR) of the F protein that could represent an important factor to determine the tissue tropism and pathogenicity of this virus. The HN protein showed high sequence identity through the years (up to 2013). Additionally, a number of sequence motifs of very high amino acid conservation among the PorPV isolates important for polymerase activity of the L protein have been identified. In summary, genetic comparisons and phylogenetic analyses indicated that three different genetic variants of PorPV are currently spreading within the swine population, and a new generation of circulating virus with different characteristics has begun to emerge.
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Infecções por Rubulavirus/veterinária , Rubulavirus/genética , Doenças dos Suínos/virologia , Animais , DNA Complementar , Surtos de Doenças/veterinária , Genes Virais , Variação Genética , México/epidemiologia , Filogenia , RNA Viral , Rubulavirus/classificação , Infecções por Rubulavirus/epidemiologia , Infecções por Rubulavirus/virologia , Análise de Sequência de RNA , Suínos , Doenças dos Suínos/epidemiologia , Proteínas Virais/genéticaRESUMO
El oncocitoma es un tumor benigno que afecta varios órganos como tiroides, paratiroides, riñón y glándulas salivales, que consiste en la proliferación de células oncocíticas producidas por una gran hiperplasia mitocondrial. El oncocitoma representa menos del 1 por ciento de todos lostumores de las gandulas salivales. Cuando en estudios por imágenes de glándula parótida se observen múltiples pequeños nódulos con unamasa sólida o quística, el diagnóstico de oncocitoma debe ser considerado, especialmente en pacientes de sesenta o más años. El objetivo de este artículo es la presentación de un caso de oncocitoma y analizar el estado de arte de los casos reportados en la temática.
The oncocytoma is a benign neoplastic tumor that occurs in several organs, including the thyroid gland, parathyroid gland, kidneys, and salivary glands consisting of a proliferation of oncocytic cells produced by a large mitochondrial hyperplasia. The oncocytoma accounts for less than 1% of the whole salivary gland tumors.When multiple small nodules are found in the parotid gland with a large solid or cystic mass that is evident on imaging, a diagnosis of oncocytoma should be considered, particularly in patients of sixty years of age or older. The objective of this article is the presentation of a case of oncocytoma and the state of art of reported cases in this field.
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Humanos , Masculino , Idoso , Adenoma Oxífilo/cirurgia , Adenoma Oxífilo/diagnóstico por imagem , Adenoma Oxífilo/patologia , Neoplasias Parotídeas/classificação , Unidade Hospitalar de Odontologia , Diagnóstico Diferencial , Imageamento por Ressonância Magnética/métodos , Procedimentos Cirúrgicos Bucais/métodos , RecidivaRESUMO
Breast cancer is the most frequent neoplasia in women and is responsible for approximately 13.8% of deaths per year for this gender. It has been suggested that JAK2, STAT3, and NF-κB gene expression is involved in this type of cancer. The objective of the present study was to determine the effect of bistriazole in these signaling pathways in patients with breast cancer and benign mammary lesions. The inhibitory concentration 50 of bistriazole was calculated in cell cultures of patients with benign lesions, Probit = 4.6 µM with IC = 95%. The study was performed by examining 63 women who submitted to mammary biopsies. Biopsies of the mammary lesions were performed, gene expression was determined, and cells were cultured in the presence of 4.6 µM bistriazole. We found that breast cancer is related to age greater than 50 (P ≤ 0.01), being overweight (P ≤ 0.023) and having a waist circumference larger than 80 cm (P ≤ 0.01). The gene expression of JAK2, STAT3, and NF-κB was higher in groups of patients with breast cancer, while SOCS3 expression was lower. After being exposed to bistriazole, the expression of JAK2 and STAT3 decreased, and the expression of SOCS3 and NF-κB increased. In conclusion, this molecule in development has an effect on the gene expression of JAK3 and STAT3; nevertheless, the lack of change in NF-κB indicates that it is not a regulator of inflammation, and therefore, more studies should be performed.
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Antineoplásicos/farmacologia , Neoplasias da Mama/tratamento farmacológico , Expressão Gênica/efeitos dos fármacos , Propranolol/análogos & derivados , Transdução de Sinais/efeitos dos fármacos , Triazóis/farmacologia , Adulto , Neoplasias da Mama/genética , Neoplasias da Mama/patologia , Células Cultivadas , Feminino , Humanos , Inflamação/tratamento farmacológico , Inflamação/metabolismo , Concentração Inibidora 50 , Janus Quinase 2/metabolismo , Pessoa de Meia-Idade , NF-kappa B/metabolismo , Propranolol/farmacologia , Estudos Prospectivos , Fator de Transcrição STAT3/metabolismo , Proteína 3 Supressora da Sinalização de Citocinas , Proteínas Supressoras da Sinalização de Citocina/metabolismoRESUMO
En este trabajo se presenta el diseño e implementación de un electrodo capacitivo de no contacto para la detección de biopotenciales en el cuerpo humano. Se presentan los circuitos eléctricos, el criterio de selección del amplificador operacional en base al análisis de la resistencia óptima de ruido, se describe el montaje físico, se presentan las señales obtenidas con este y la evaluación de su desempeño en base a la relación señal a ruido S/N. Se muestra el desempeño de diversos amplificadores operacionales y se demuestra la versatilidad del electrodo para detectar diversos biopotenciales realizando ajustes en los valores de dos componentes eléctricos del electrodo.
In this work the design and implementation of a capacitive non-contact electrode for detecting biopotentials in the human body is presented. Electrical circuits, the selection criteria of the operational amplifier based on the analysis of the optimal noise resistance are presented, the physical assembly is described and the signals obtained and evaluation of its performance are presented based on the signal-to-noise ratio S/N. We show the performance of several operational amplifiers and it is shown the versatility of the electrode to detect several biopotentials making adjustments to the values of two electrical components of the electrode.
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We conducted an immunological assay of blood samples taken from 85 swine-specialist veterinarians attending the Congress of the Mexican Association of Swine Specialist Veterinarians in Mexico in 2011. Serum samples were assayed for Porcine rubulavirus (PorPV), Encephalomyocarditis virus (EMCV) and Leptospira spp. antibodies. Using a hemagglutination inhibition test, we registered 2.3% and 27% seropositivity for PorPV and EMCV, respectively. Using viral neutralization tests, we registered 5.8% and 47% seropositivity for PorPV and EMCV, respectively. For Leptospira spp., we registered a seropositivity of 38.8%. The variables (sex, age, years of exposure, number of visited farms, biosecurity level and region) showed no significant effect (P > 0.05) on the seropositivity for EMCV, PorPV and Leptospira spp. except for number of visited farms on HI seropositivity for EMCV (P < 0.05; odds ratio: 1.38). The data obtained provide information on the epidemiology of emerging diseases with zoonotic potential in occupational risk groups.
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Infecções por Cardiovirus/epidemiologia , Leptospirose/epidemiologia , Exposição Ocupacional , Infecções por Rubulavirus/epidemiologia , Doenças dos Suínos/epidemiologia , Adolescente , Adulto , Idoso , Animais , Anticorpos Antibacterianos/sangue , Anticorpos Antivirais/sangue , Infecções por Cardiovirus/microbiologia , Vírus da Encefalomiocardite/genética , Vírus da Encefalomiocardite/imunologia , Vírus da Encefalomiocardite/isolamento & purificação , Feminino , Humanos , Leptospira/genética , Leptospira/imunologia , Leptospira/isolamento & purificação , Leptospirose/microbiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Rubulavirus/genética , Rubulavirus/imunologia , Rubulavirus/isolamento & purificação , Infecções por Rubulavirus/microbiologia , Estudos Soroepidemiológicos , Suínos , Doenças dos Suínos/microbiologia , Médicos Veterinários , Adulto Jovem , ZoonosesRESUMO
INTRODUCTION: Critically ill patients, including obstetrical patients, face undernutrition but a reliable and cost effective study to assess their nutritional state is still missing. Our main objective was to analyze serum leptin and adiponectin concentrations in puerperal women attended in an Obstetrical Intensive Care Unit (OICU) in order to evaluate their potential role as nutritional metabolic parameter. METHODS: This was a descriptive, clinical, longitudinal and comparative study. We evaluated the anthropometric variables, clinical laboratories, daily calories and adiponectin and leptin serum levels of 16 puerperal women attended at the OICU of the Materno Perinatal Hospital "Mónica Pretelini" (HMPMP). RESULTS: For all women there was a negative correlation with Spearman test between leptin the day of discharge from the obstetrical intensive care unit and the days of stay -0.632 (p = 0.011). Considering an adiponectin/leptin ratio, the media in the first day was of 0.3 (0.07-13.6) and in the day of discharge it was of 2.4 (0.1-24.6) in overweight women. The same values for obese women were of 0.3 (0.2-0.4) and 0.5 (0.3-1.2). CONCLUSION: After an average of six days of hospitalization, leptin showed a decrement in women attended at the OICU. As expected, adiponectin increased in both groups. The adiponectin/ leptin ratio could be a useful metabolic parameter.
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Complicações na Gravidez/sangue , Adiponectina , Adolescente , Adulto , Feminino , Humanos , Unidades de Terapia Intensiva , Leptina , Masculino , Estado Nutricional , Obesidade/epidemiologia , Valor Preditivo dos Testes , Gravidez , Complicações na Gravidez/epidemiologia , Adulto JovemRESUMO
We sampled sera from 1013 non-vaccinated swine from four states in Mexico, Guanajuato, Jalisco, Michoacán and the Estado de Mexico, to analyse anti-porcine rubulavirus antibody titres against three different porcine rubulavirus isolates (PAC-4/1993, PAC-6/2001, and PAC-9/2003) using a hemagglutination inhibition assay. The results revealed that there were antigenic differences among the isolates assessed. In particular, the estimated correlation between the PAC-4/1993 and PAC-6/2001 (0.50) isolates and between the PAC-4/1993 and PAC-9/2003 isolates (0.56) displayed a moderate positive correlation. In contrast, there was a strong positive correlation between the PAC-6/2001 and PAC-9/2003 isolates (0.73). We also found that in the state of Guanajuato, PAC-4/1993 was the isolate that was most frequently identified; in Jalisco, the isolate was PAC-6/2001; and in Michoacán, the isolate was PAC-9/2003. By contrast, in the Estado de Mexico, all three isolates appeared to circulate with a low seroprevalence. In general, the analysed sera from the four states displayed a porcine rubulavirus serological prevalence ranging from 9% to 23.7%. These data indicate that there is not complete antibody cross-antigenicity among the three isolates, and the antigenic variations in the antibody response found in this study implies that the use of a monovalent vaccine would not generate complete protection against the different antigenic subtypes.
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Antígenos Virais/genética , Infecções por Rubulavirus/veterinária , Rubulavirus/genética , Doenças dos Suínos/virologia , Animais , Anticorpos Antivirais/sangue , Antígenos Virais/sangue , Variação Genética , México/epidemiologia , Rubulavirus/imunologia , Infecções por Rubulavirus/epidemiologia , Infecções por Rubulavirus/imunologia , Infecções por Rubulavirus/virologia , Estudos Soroepidemiológicos , Suínos , Doenças dos Suínos/epidemiologia , Doenças dos Suínos/imunologiaRESUMO
El tumor odontogénico queratoquístico (TOK) es una entidad patológica benigna de origen odontogénico con tendencia a la recidiva y controversial tratamiento. Cerca del 75 por ciento se presentan en zona de rama ascendente y cuerpo mandibular, mientras que en zona sinfisaria no alcanzan el 10 por ciento de los casos. Se presenta un caso clínico en zona sinfisaria con diagnóstico de TOQ. Se realiza el tratamiento y seguimiento a distancia, revisando las características clínicas y anatomopatológicas de la entidad.(AU)
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Humanos , Adulto , Feminino , Tumores Odontogênicos/cirurgia , Tumores Odontogênicos/diagnóstico por imagem , Tumores Odontogênicos/diagnóstico , Neoplasias Maxilomandibulares/classificação , Diagnóstico por Imagem/métodos , Distribuição por Idade e Sexo , Tumores Odontogênicos/epidemiologia , Cistos Odontogênicos/epidemiologia , Procedimentos Cirúrgicos BucaisRESUMO
El tumor odontogénico queratoquístico (TOK) es una entidad patológica benigna de origen odontogénico con tendencia a la recidiva y controversial tratamiento. Cerca del 75 por ciento se presentan en zona de rama ascendente y cuerpo mandibular, mientras que en zona sinfisaria no alcanzan el 10 por ciento de los casos. Se presenta un caso clínico en zona sinfisaria con diagnóstico de TOQ. Se realiza el tratamiento y seguimiento a distancia, revisando las características clínicas y anatomopatológicas de la entidad.
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Humanos , Adulto , Feminino , Neoplasias Maxilomandibulares/classificação , Tumores Odontogênicos/cirurgia , Tumores Odontogênicos/diagnóstico , Tumores Odontogênicos , Distribuição por Idade e Sexo , Diagnóstico por Imagem/métodos , Procedimentos Cirúrgicos Bucais , Cistos Odontogênicos/epidemiologia , Tumores Odontogênicos/epidemiologiaRESUMO
Las neoplasias de las glándulas salivales constituyen aproximadamente el 3 por ciento de todos los tumores de cabeza y cuello. La neoplasia más frecuente que involucra tanto a las glándulas salivales mayores como menores es el adenoma pleomorfo. Se presenta con mayor frecuencia en las glándulas parótidas. En glándulas salivales menores, el paladar es el sitio de elección. Es un tumor indoloro, de crecimiento lento. El rango de edad de aparición es entre los 30 y 50 años y es más frecuente en el sexo femenino que el masculino con una relación de 2 a 1. Presentamos un caso clínico de muy baja frecuencia de aparición en cuanto a la localización, en un paciente de sexo femenino de 67 años de edad a la que se le diagnosticó adenoma pleomorfo en la región del trígono retromolar.
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Humanos , Feminino , Idoso , Adenoma Pleomorfo/cirurgia , Adenoma Pleomorfo/diagnóstico , Dente Molar , Distribuição por Idade e Sexo , Adenoma Pleomorfo/epidemiologia , Neoplasias das Glândulas Salivares/classificação , Prognóstico , Procedimentos Cirúrgicos Bucais/métodosRESUMO
OBJECTIVE: To assess the effectiveness of an integrated community based environmental management strategy to control Aedes aegypti, the vector of dengue, compared with a routine strategy. Design Cluster randomised trial. Setting Guantanamo, Cuba. Participants 32 circumscriptions (around 2000 inhabitants each). Interventions The circumscriptions were randomly allocated to control clusters (n=16) comprising routine Aedes control programme (entomological surveillance, source reduction, selective adulticiding, and health education) and to intervention clusters (n=16) comprising the routine Aedes control programme combined with a community based environmental management approach. MAIN OUTCOME MEASURES: The primary outcome was levels of Aedes infestation: house index (number of houses positive for at least one container with immature stages of Ae aegypti per 100 inspected houses), Breteau index (number of containers positive for immature stages of Ae aegypti per 100 inspected houses), and the pupae per inhabitant statistic (number of Ae aegypti pupae per inhabitant). RESULTS: All clusters were subjected to the intended intervention; all completed the study protocol up to February 2006 and all were included in the analysis. At baseline the Aedes infestation levels were comparable between intervention and control clusters: house index 0.25% v 0.20%, pupae per inhabitant 0.44 x 10(-3) v 0.29 x 10(-3). At the end of the intervention these indices were significantly lower in the intervention clusters: rate ratio for house indices 0.49 (95% confidence interval 0.27 to 0.88) and rate ratio for pupae per inhabitant 0.27 (0.09 to 0.76). CONCLUSION: A community based environmental management embedded in a routine control programme was effective at reducing levels of Aedes infestation. Trial Registration Current Controlled Trials ISRCTN88405796.
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We report observation of the electroweak production of single top quarks in pp[over ] collisions at sqrt[s]=1.96 TeV based on 2.3 fb(-1) of data collected by the D0 detector at the Fermilab Tevatron Collider. Using events containing an isolated electron or muon and missing transverse energy, together with jets originating from the fragmentation of b quarks, we measure a cross section of sigma(pp[over ]--> tb + X, tqb + X) = 3.94 + or - 0.88 pb. The probability to measure a cross section at this value or higher in the absence of signal is 2.5 x 10(-7), corresponding to a 5.0 standard deviation significance for the observation.
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Biotechnological advances in coffee research (in vitro manipulation, multiplication, generation and development of transgenic coffee plants with specific traits like high yield and good quality) have contributed to description of the metabolic pathways involved in the response mechanisms to environmental factors like abiotic stress. Coffea arabica L. plants grow in acidic soils, and therefore aluminium (Al) toxicity is a major negative impact on crop productivity. To understand Al toxicity mechanisms in cells via the Al absorption kinetic, we isolated protoplasts from two C. arabica L. suspension cell lines: Al-sensitive (L2) and Al-tolerant (LAMt). Protoplasts of LAMt line exhibited lower Al absorption levels than protoplasts of the L2 line. Use of two fluorescent tracers (morin and calcofluor white) indicated that Al interacts with internal cell structures, such as the plasma membrane and nucleus, with differences in both cell lines. Al-tolerance in the LAMt is probably associated with the cell wall as well as intracellular structures. These data will help to better understand Al toxicity in C. arabica, and Al toxicity mechanisms in plant cells.
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Alumínio/metabolismo , Coffea/metabolismo , Protoplastos/metabolismo , Alumínio/análise , Alumínio/toxicidade , Células Cultivadas , Coffea/citologia , Coffea/efeitos dos fármacos , Protoplastos/efeitos dos fármacosRESUMO
We present a search for a narrow resonance in the inclusive diphoton final state using approximately 2.7 fb(-1) of data collected with the D0 detector at the Fermilab Tevatron pp Collider. We observe good agreement between the data and the background prediction, and set the first 95% C.L. upper limits on the production cross section times the branching ratio for decay into a pair of photons for resonance masses between 100 and 150 GeV. This search is also interpreted in the context of several models of electroweak symmetry breaking with a Higgs boson decaying into two photons.
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OBJECTIVE: To assess the effectiveness of an integrated community based environmental management strategy to control Aedes aegypti, the vector of dengue, compared with a routine strategy. DESIGN: Cluster randomised trial. SETTING: Guantanamo, Cuba. PARTICIPANTS: 32 circumscriptions (around 2000 inhabitants each). INTERVENTIONS: The circumscriptions were randomly allocated to control clusters (n=16) comprising routine Aedes control programme (entomological surveillance, source reduction, selective adulticiding, and health education) and to intervention clusters (n=16) comprising the routine Aedes control programme combined with a community based environmental management approach. MAIN OUTCOME MEASURES: The primary outcome was levels of Aedes infestation: house index (number of houses positive for at least one container with immature stages of Ae aegypti per 100 inspected houses), Breteau index (number of containers positive for immature stages of Ae aegypti per 100 inspected houses), and the pupae per inhabitant statistic (number of Ae aegypti pupae per inhabitant). RESULTS: All clusters were subjected to the intended intervention; all completed the study protocol up to February 2006 and all were included in the analysis. At baseline the Aedes infestation levels were comparable between intervention and control clusters: house index 0.25% v 0.20%, pupae per inhabitant 0.44x10(-3) v 0.29x10(-3). At the end of the intervention these indices were significantly lower in the intervention clusters: rate ratio for house indices 0.49 (95% confidence interval 0.27 to 0.88) and rate ratio for pupae per inhabitant 0.27 (0.09 to 0.76). CONCLUSION: A community based environmental management embedded in a routine control programme was effective at reducing levels of Aedes infestation. TRIAL REGISTRATION: Current Controlled Trials ISRCTN88405796.