Cortical resting motor threshold difference in asleep-awake craniotomy for motor eloquent gliomas: WHO grading influences motor pathway excitability.

Developing neurophysiological tools to predict WHO tumor grade can empower the treating teams for a better surgical decision-making process. A total of 38 patients with supratentorial diffuse gliomas underwent an asleep-awake-sedated craniotomies for tumor removal with intraoperative neuromonitoring. The resting motor threshold was calculated for different train stimulation paradigms during awake and asleep phases. Receiver operating characteristic analysis and Bayesian regression models were performed to analyze the prediction of tumor grading based on the resting motor threshold differences. Significant positive spearman correlations were observed between resting motor threshold excitability difference and WHO tumor grade for train stimulation paradigms of 5 (R = 0.54, P = 0.00063), 4 (R = 0.49, P = 0.002), 3 (R = 0.51, P = 0.001), and 2 pulses (R = 0.54, P = 0.0007). Kruskal-Wallis analysis of the median revealed a positive significant difference between the median of excitability difference and WHO tumor grade in all paradigms. Receiver operating characteristic analysis showed 3 mA difference as the best predictor of high-grade glioma across different patterns of motor pathway stimulation. Bayesian regression found that an excitability difference above 3 mA would indicate a 75.8% probability of a glioma being high grade. Our results suggest that cortical motor excitability difference between the asleep and awake phases in glioma surgery could correlate with tumor grade.

Triazole-Containing [FeFe] Hydrogenase Mimics: Synthesis and Electrocatalytic Behavior.

Through a Cu-catalyzed Huisgen cycloaddition between terminal alkynes and azides (CuAAC) reaction, azide [(µ-SCH2)2N(4-N3C6H4)Fe2(CO)6] has demonstrated to be a robust and versatile reagent able to incorporate the [(µ-SR)2Fe2(CO)6] fragment on a wide range of substrates, ranging from aromatic compounds to nucleosides, metallocenes, or redox and luminescent markers. The [FeIFeI]/[Fe0FeI] and [Fe0FeI]/[Fe0Fe0] reduction potentials of the triazole derivatives prepared are comparable to those of other aminodithiolate (adt) Fe-Fe hydrogenase mimics. The presence of the triazole linker influences the electrochemical behavior of these complexes depending on the strength of the acid employed.

Two Types of σ-Allenyl Complexes from Reactions of Silylenes and Germylenes with Chromium Fischer Alkynyl(alkoxy)carbenes.

The reactivity of amidinatotetrylenes of the type E(tBu2 bzm)R1 (E=Si, Ge; tBu2 bzm=N,N'-bis(tertbutyl)benzamidinate; R1 =alkyl or aryl) with the chromium Fischer alkynylcarbene complexes [Cr{C(OEt)C2 R2 }(CO)5 ] (R2 =Ph; ferrocenyl, Fc) has been studied. At room temperature, two different reaction pathways have been identified: (a) attack of the amidinatotetrylene to the alkynyl C2 atom (γ-attack), which leads to σ-allenyl complexes in which the original Ccarbene atom maintains its attachment to the Cr(CO)5 and OEt groups (compounds 3 E - R 1 - R 2 ), and (b) attack of the amidinatotetrylene to the Ccarbene atom (α-attack), which ends in σ-allenyl complexes in which the original Ccarbene atom is not attached to the metal atom and has been inserted into an E-N bond of the amidinatotetrylene forming an E-C-N-C-N five-membered ring (compounds 4 E - R 1 - R 2 ). It has been found that compounds 3 E - R 1 - R 2 are thermodynamically less stable than their corresponding 4 E - R 1 - R 2 isomers and that some of the former (E=Ge; R1 =CH2 SiMe3 ) can be transformed into the latter upon heating. At high temperatures (>70 °C) the reactions involving bulky amidinatotetrylenes (R1 =Mes, tBu) end in the carbene-substitution products [Cr{E(tBu2 bzm)R1 }(CO)5 ].

Reversible Carbene Insertion into a Ge-N Bond and Insights into CO and Carbene Substitution Reactions Involving Amidinatogermylenes and Fischer Carbene Complexes.

The formation of the five-membered-ring germylene complexes [M(CO)5 {Ge(tBu2 bzamC(OEt)Me)tBu}] (3M ; M=Cr, W), which occurs readily at room temperature from the germylene Ge(tBu2 bzam)tBu (1tBu ) and Fischer carbenes [M(CO)5 {C(OEt)Me}] (2M ; M=Cr, W), has been found to be reversible. Upon heating at 60 °C, complexes 3M undergo epimerization to an equilibrium mixture of 3M and 3'M . At that temperature, the chromium epimers (but not the tungsten ones) release CO to end in the mixed germylene-Fischer carbene complexes [Cr(CO)4 {C(OEt)Me}{Ge(tBu2 bzam)tBu}] (cis-4Cr and trans-4Cr ). The latter decompose at 120 °C to [Cr(CO)5 {Ge(tBu2 bzam)tBu}] (6Cr ). Because the formation of cis-4Cr and trans-4Cr from 3Cr or 3'Cr requires the presence of free 1tBu and 2Cr in the reaction solutions, the reactions of 1tBu with 2M to give 3M (and 3'M at 60 °C) should be reversible. This proposal has been proven by germylene-exchange crossover reactions in which free 1tBu and [M(CO)5 {Ge(tBu2 bzamC(OEt)Me)CH2 SiMe3 }] (5'M ; M=Cr, W) were formed when complexes 3M were treated at room temperature with the germylene Ge(tBu2 bzam)CH2 SiMe3 (1tmsm ). A clear differential behavior between N-heterocyclic carbenes (NHCs) and amidinatogermylenes (1tBu and 1tmsm ) in their reactivity against group 6 metal Fischer carbene complexes is demonstrated. The higher electron-donor capacity of amidinatogermylenes with respect to NHCs and the bias of the former to get involved in ring expansion processes are responsible for this differential behavior.

Unexpected Zwitterionic Allenyls from Silylenes and a Fischer Alkynylcarbene: A Remarkable Silylene-Promoted Rearrangement.

The silylenes Si(tBu2 bzam)R (tBu2 bzam=N,N'-bis(tertbutyl)benzamidinate; R=mesityl, CH2 SiMe3 ) attack the Ccarbene atom of the Fischer alkynyl(ethoxy)carbene complex [W(CO)5 {C(OEt)C2 Ph}] to give, after a striking rearrangement, zwitterionic σ-allenyl complexes in which the original carbene C atom forms part of the allene C3 fragment and also of a Si-C-N-C-N five-membered ring after insertion into a Si-N bond of the original amidinatosilylene. These remarkable allenyl products, which contain two stereogenic groups, are selectively formed as single diastereomers.

Sequential Reactions of Alkynes on an Iridium(III) Single Site.

Sequential insertion of terminal alkynes on IrIII cyclometalated complexes allow the formation of novel metallapolycycles in a controlled and efficient manner. ortho-Methylarylethynyl derivatives led to an unprecedented cascade combination of three fundamental processes (C-C bond formation, C(sp3 )-H activation, and reductive coupling) on a single IrIII center, in a process compatible with functionalized biomolecules and photoactive substrates. The reaction with tert-butylacetylene led to a [6,5,4]-polycycle that incorporates an iridacyclobutenylidene in its structure. The sequence is a multicomponent reaction in which the metal not only promotes the different steps but also determines their stereoselectivity. This is an elegant example of the synergy between a metal-promoting reaction and a symmetry-defined stereochemistry.

Outbreak of brainstem encephalitis associated with enterovirus-A71 in Catalonia, Spain (2016): a clinical observational study in a children's reference centre in Catalonia.

OBJECTIVES: To describe the characteristics of an outbreak of brainstem encephalitis and encephalomyelitis related to enterovirus (EV) infection in Catalonia (Spain), a setting in which these manifestations were uncommon. METHODS: Clinical and microbiological data were analysed from patients with neurological symptoms associated with EV detection admitted to a reference paediatric hospital between April and June 2016. RESULTS: Fifty-seven patients were included. Median age was 27.7 months (p25-p75 17.1-37.6). Forty-one (72%) were diagnosed with brainstem encephalitis, seven (12%) with aseptic meningitis, six (11%) with encephalitis, and three (5%) with encephalomyelitis (two out of three with cardiopulmonary failure). Fever, lethargy, and myoclonic jerks were the most common symptoms. Age younger than 12 months, higher white-blood-cell count, and higher procalcitonin levels were associated with cardiopulmonary failure. Using a PAN-EV real-time PCR, EV was detected in faeces and/or nasopharyngeal aspirate in all the patients, but it was found in cerebrospinal fluid only in patients with aseptic meningitis. EV was genotyped in 47 out of 57 and EV-A71 was identified in 40 out of 47, being the only EV type found in patients with brainstem symptoms. Most of the detected EV-A71 strains were subgenogroup C1. Intravenous immunoglobulins were used in 34 patients. Eight cases (14%) were admitted to the intensive care unit. All the patients but three, those with encephalomyelitis, showed a good clinical course and had no significant sequelae. No deaths occurred. CONCLUSIONS: The 2016 outbreak of brainstem encephalitis in Catalonia was associated with EV-A71 subgenogroup C1. Despite the clinical manifestations of serious disease, a favourable outcome was observed in the majority of patients.

First Insertions of Carbene Ligands into Ge-N and Si-N Bonds.

The insertion of carbene ligands into Ge-N (three examples) and Si-N (one example) bonds has been achieved for the first time by treating Fischer carbene complexes (M=W, Cr) with bulky amidinatotetrylenes (E=Ge, Si). These reactions, which start with a nucleophilic attack of the amidinatotetrylene heavier group 14 atom to the carbene C atom, proceed through a stereoselective insertion of the carbene fragment into an E-N bond of the amidinatotetrylene ENCN four-membered ring, leading to [M(CO)5 L] derivatives in which L belongs to a novel family of tetrylene ligands comprising an ECNCN five-membered ring.

Association between within-visit systolic blood pressure variability and development of pre-diabetes and diabetes among overweight/obese individuals.

Short-term blood pressure variability is associated with pre-diabetes/diabetes cross-sectionally, but there are no longitudinal studies evaluating this association. The objective of this study is to evaluate the association between within-visit systolic and diastolic blood pressure variability and development of pre-diabetes/diabetes longitudinally. The study was conducted among eligible participants from the San Juan Overweight Adults Longitudinal Study (SOALS), who completed the 3-year follow-up exam. Participants were Hispanics, 40-65 years of age, and free of diabetes at baseline. Within-visit systolic and diastolic blood pressure variability was defined as the maximum difference between three measures, taken a few minutes apart, of systolic and diastolic blood pressure, respectively. Diabetes progression was defined as development of pre-diabetes/diabetes over the follow-up period. We computed multivariate incidence rate ratios adjusting for baseline age, gender, smoking, physical activity, waist circumference, and hypertension status. Participants with systolic blood pressure variability ≥10 mmHg compared to those with <10 mmHg, showed higher progression to pre-diabetes/diabetes (RR = 1.77, 95% CI: 1.30-2.42). The association persisted among never smokers. Diastolic blood pressure variability ≥10 mmHg (compared to <10 mmHg) did not show an association with diabetes status progression (RR = 1.20, 95% CI: 0.71-2.01). Additional adjustment of baseline glycemia, C-reactive protein, and lipids (reported dyslipidemia or baseline HDL or triglycerides) did not change the estimates. Systolic blood pressure variability may be a novel independent risk factor and an early predictor for diabetes, which can be easily incorporated into a single routine outpatient visit at none to minimal additional cost.

An Entry to Mixed NHC-Fischer Carbene Complexes and Zwitterionic Group 6 Metal Alkenyls.

The addition of NHCs to α,ß-unsaturated Cr(0) and W(0) (Fischer) carbene complexes is strongly dependent on the electrophilicity of the carbene carbon. Electrophilic alkoxy-carbene complexes quantitatively react with NHCs to yield stable zwitterionic (racemic) Cr(0) - and W(0) -alkenyls with total regio- and E-stereoselectivity. Less electrophilic aminocarbenes react with NHCs to promote the displacement of a CO ligand and yield "mixed" NHC/Fischer biscarbenes in a process that is unprecedented in group 6 metal-carbene chemistry. In fact, the compounds prepared, are some of the scarce examples of Fischer bisylidenes reported in the literature. The electrochemistry of the zwitterionic Cr(0) - and W(0) -alkenylcomplexes made, show that these compounds have a strong reductor character, which is demonstrated in their reactions towards [Ph3 C][PF6 ]. The oxidation processes lead to new types of cationic Fischer mono- and biscarbene complexes having a charged NHC fragment in their structures, in a new example of the use of electron-transfer reactions as a method to prepare novel group 6 (Fischer) carbene complexes.

Novel artemisinin derivatives with potential usefulness against liver/colon cancer and viral hepatitis.

Antitumor and antiviral properties of the antimalaria drug artemisinin from Artemisia annua have been reported. Novel artemisinin derivatives (AD1-AD8) have been synthesized and evaluated using in vitro models of liver/colon cancer and viral hepatitis B and C. Cell viability assays after treating human cell lines from hepatoblastoma (HepG2), hepatocarcinoma (SK-HEP-1), and colon adenocarcinoma (LS174T) with AD1-AD8 for a short (6h) and long (72h) period revealed that AD5 combined low acute toxicity together with high antiproliferative effect (IC50=1-5µM). Since iron-mediated activation of peroxide bond is involved in artemisinin antimalarial activity, the effect of iron(II)-glycine sulfate (ferrosanol) and iron(III)-containing protoporphyrin IX (hemin) was investigated. Ferrosanol, but not hemin, enhanced antiproliferative activity of AD5 if the cells were preloaded with AD5, but not if both compouds were added together. Five derivatives (AD1>AD2>AD7>AD3>AD8) were able to inhibit the cytopathic effect of bovine viral diarrhoea virus (BVDV), a surrogate in vitro model of hepatitis C virus (HCV), used here to evaluate the anti-Flaviviridae activity. Moreover, AD1 and AD2 inhibited the release of BVDV-RNA to the culture medium. Co-treatment with hemin or ferrosanol resulted in enhanced anti-Flaviviridae activity of AD1. In HepG2 cells permanently infected with hepatitis B virus (HBV), AD1 and AD4, at non-toxic concentrations for the host cells were able to reduce the release of HBV-DNA to the medium. In conclusion, high pharmacological interest deserving further evaluation in animal models has been identified for novel artemisinin-related drugs potentially useful for the treatment of liver cancer and viral hepatitis B and C.

Bacterial tracheitis: a varied entity.

OBJECTIVE: The objective of the study was to highlight the different presentations of bacterial tracheitis (BT), a potential life-threatening cause of airway obstruction in children. DESIGN: Case series. METHODS: A review of medical records of 4 cases of BT who presented with differing signs and symptoms was performed. RESULTS: Clinical manifestations of 4 patients with BT are presented with corresponding endoscopic appearances of the airway. Two patients were afebrile and nontoxic, and 2 had an elevated white cell count. Three had different degrees of stridor. One had a respiratory arrest. Cultures grew Staphylococcus aureus in 2 and Moraxella catarrhalis in 1 and were mixed in 1 patient. None required intubation. All were successfully treated with antibiotics and bronchoscopic debridement of the membranes. CONCLUSIONS: Bacterial tracheitis needs a high index of suspicion because of its varied presentations. Certain forms have less severe clinical manifestations. These forms also require aggressive management as they can result in airway obstruction from membranes and edema.

Enamel thickness in the Middle Miocene great apes Anoiapithecus, Pierolapithecus and Dryopithecus.

On the basis of industrial computed tomography, relative enamel thickness (RET) is computed in three Middle Miocene (ca 11.9-11.8 Ma) hominoids from Abocador de Can Mata (Vallès-Penedès Basin, Catalonia, Spain): Pierolapithecus catalaunicus from BCV1 and Anoiapithecus brevirostris from C3-Aj, interpreted as stem hominids; and Dryopithecus fontani from C3-Ae of uncertain phylogenetic affinities. Pierolapithecus displays an average RET value of 19.5, Anoiapithecus of 18.6 and Dryopithecus of 10.6. The thick-enamelled condition of Pierolapithecus and Anoiapithecus is also characteristic of afropithecids, including the more derived kenyapithecins from the early Middle Miocene of Eurasia (Griphopithecus and Kenyapithecus). Given the presence of other dentognathic and craniofacial similarities, thick enamel may be interpreted as a symplesiomorphy of the Hominidae (the great ape and human clade), which would have been later independently modified along several lineages. Given the correlation between thick enamel and hard-object feeding, our results suggest that thick enamel might have been the fundamental adaptation that enabled the out-of-Africa dispersal of great-ape ancestors and their subsequent initial radiation throughout Eurasia. The much thinner enamel of Dryopithecus is difficult to interpret given phylogenetic uncertainties, being either a hominine synapomorphy or a convergently developed feature.

Orang-like manual adaptations in the fossil hominoid Hispanopithecus laietanus: first steps towards great ape suspensory behaviours.

Morphological and biometrical analyses of the partial hand IPS18800 of the fossil great ape Hispanopithecus laietanus (=Dryopithecus laietanus), from the Late Miocene (about 9.5Ma) of Can Llobateres (Catalonia, Spain), reveal many similarities with extant orang-utans (Pongo). These similarities are interpreted as adaptations to below-branch suspensory behaviours, including arm-swinging and clambering/postural feeding on slender arboreal supports, due to an orang-like double-locking mechanism. This is confirmed by the long and highly curved phalanges of Hispanopithecus. The short and stout metacarpals with dorsally constricted heads, together with the dorsally extended articular facets on proximal phalanges, indicate the persistence of significant degrees of palmigrady. A powerful grasping capability is indicated by the great development of basal phalangeal tubercles, the marked insertions for the flexors on phalangeal shafts and the large pits for the collateral ligaments. The morphology of the Hispanopithecus long bones of the hand indicates a unique positional repertoire, combining orthogrady with suspensory behaviours and palmigrade quadrupedalism. The retention of powerful grasping and palmigrady suggests that the last common ancestor of hominids might have been more primitive than what can be inferred on the basis of extant taxa, suggesting that pronograde behaviours are compatible with an orthograde bodyplan suitable for climbing and suspension.

Brief communication: Cranial reconstruction of Dryopithecus.

This paper presents the first three-dimensional reconstruction of the cranium of the European Miocene ape, Dryopithecus. The reconstruction is based on remains collected from Can Llobateres, Spain (CLI 18000; Dryopithecus laietanus), D. fontani (St. Gaudens), and D. brancoi (Kordos and Begun [1997] Am. J. Phys. Anthropol. 103:277-294). Previously unrecognized facial fragments from CLI 18000 were included in the reconstruction. The result shows that Dryopithecus had a relatively short face, with a rather short and well-rounded neurocranium. From the lateral perspective, the face is concave at midface, and on the cranium the temporal lines run parallel to each other without forming a sagittal crest.

Egarapithecus narcisoi, a new genus of Pliopithecidae (primates, catarrhini) from the Late Miocene of Spain.

Pliopithecid remains from the Spanish locality of Torrent de Febulines (Late Vallesian, MN 10), consisting of right and left mandibular fragments with partial tooth rows and an isolated P(3) probably belonging to the same individual, are described and assigned to Egarapithecus narcisoi gen. et sp. nov. (Pliopithecidae, Crouzeliinae). This is a highly derived species dated at around 9 Ma (Ma = 10(6) years), representing the latest appearance of the family in the European continent. Morphologically it is the most distant member from the inferred primitive pliopithecid morphotype, displaying many autapomorphies that notably accentuate those of the remaining Crouzeliinae. A cladistic analysis based on lower cheek teeth, performed in order to tentatively assess the phylogenetic relationships of Egarapithecus within the Crouzeliinae, indicates that several equally parsimonious cladograms are possible in the light of current evidence. This is due to uncertainties regarding the position of Plesiopliopithecus and Crouzelia (here considered distinct genera), as a result of missing characters and the significant degree of homoplasy apparently involved in crouzeliine dental evolution. Whether Egarapithecus is more closely related to Crouzelia or to Anapithecus (the latter hypothesis tentatively favored here) cannot be definitively resolved with the currently available material and deserves further investigation. It is clear, however, that Egarapithecus is one of the more derived and specialized members of the Pliopithecidae.

Canine reduction in the miocene hominoid Oreopithecus bambolii: behavioural and evolutionary implications.

The degree of canine size sexual dimorphism and relative canine size, which have been related to levels of agonistic behaviour amongst living anthropoid primates, together with relative molar size, are evaluated in the fossil hominoid Oreopithecus bambolii from the Late Miocene of Italy. Although Oreopithecus displays a significant degree of canine height sexual dimorphism, using allometric techniques and body mass estimates for fossil species, it is shown that Oreopithecus males are microdont (smaller postcanine as well as canine teeth than expected) when compared to most living hominoids and its putative ancestor Dryopithecus. Canine reduction in Oreopithecus includes both crown height and, especially, basal area, and most closely resembles the condition found in the pygmy chimpanzee Pan paniscus. Interestingly, it had been previously proposed that Oreopithecus displays, like pygmy chimpanzees, a paedomorphic cranial morphology resulting in a reduction of facial prognathism, which could be related to microdontia in both taxa. Independent canine reduction in several anthropoid lineages (including hominids and P. paniscus) has been related to a relaxation of the selection pressure favouring canine use as a weapon. Although changes in socio-sexual behaviour, as documented in P. paniscus, cannot be currently discarded in Oreopithecus, canine reduction could be also alternatively (although not exclusively) interpreted as an aspect of generalized microdontia. The latter is best considered an adaptive readjustment required by the paedomorphic reduction of prognathism and the resulting lack of space to accommodate the adult dentition. This mechanism of canine reduction highlights the significance of developmental constraints in evolution and had not been previously suggested for any anthropoid primate.

[Urinary incontinence in menopause]. / Incontinencia urinaria en la menopausia.

OBJECTIVE: To determine if menopause increases the risk of developing bladder hyperactivity or stress urinary incontinence. METHODS: A case control study was conducted on 111 women, 57 with bladder hyperactivity and 54 controls without hyperactivity, and 55 cases with stress urinary incontinence and 55 controls without stress urinary incontinence. The results were analyzed by multivariant logistic regression for the influence of age. RESULTS: A relationship was found between age and menopause and the risk of developing stress urinary incontinence. No relationship was found between bladder hyperactivity and age or menopause. Age was found to be a negative factor of menopause in regard to the risk of developing stress urinary incontinence. CONCLUSIONS: The risk of developing stress urinary incontinence in menopausal women decreases with age and disappears after age 52.