There Is an Inverse Correlation between Basic Motor Skills and Overweight in Schoolchildren Aged 8 to 12.

In the last three decades, childhood obesity has become a 21st century epidemic, a product of social development. The purpose of this study was to analyze the repercussions that overweight and obesity have for the basic motor skills of a group of children in primary school, as well as their interrelations. We analyzed a sample of 287 students from Spain, aged between 8 and 12 years. Anthropometric data were taken to determine their Body Mass Index (BMI). A scale of assessment of basic motor skills was used to evaluate their motor skills. The BMI data revealed that 11% of this sample was considered obese, and 26% was overweight. Children showed higher competence in locomotor skills than in object control and turn and rolling skills, for which motor competence levels were lower. Likewise, there was an inverse relationship between BMI and basic motor skills; children with obesity had the lowest levels of motor skills, and there was a significant difference regarding non-obese children (p ≤ 0.05). These results showed that overweight and obese children have lower basic motor skills, which can lead to the abandonment of physical activity and the preference for other activities that reinforce a sedentary lifestyle.

A Very Rare Case of Right Insular Lobe Langerhans Cell Histiocytosis (CD1a+) Mimicking Glioblastoma Multiforme in a Young Adult.

BACKGROUND: Langerhans cell histiocytosis (LCH) is a multisystemic dendritic cell proliferation that is relatively uncommon in adults. Central nervous system LCH outside the pituitary gland is even more uncommon. CASE DESCRIPTION: We report the case of a 42-year-old man who had complained of right-side hemicranial pain and left arm minor paresis. The symptoms were due to a right insular lobe heterogeneous-enhancing lesion associated with extensive vasogenic edema. The first diagnostic impression suggested glioblastoma multiforme or localized metastasis. The thoracic, abdominal, pelvic computed tomography scan only detected small upper lung inactive nodules suggesting silent focal LCH. A very hard lesion was almost completely removed through a pterional craniotomy approach, with no fluorescence after aminolevulinic acid infusion. The intraoperative biopsy findings ruled out glioma but could not confirm lymphoma. The definitive cerebral biopsy findings showed lymphocytes and histiocytes (CD1a+, S-1001+), with a diagnosis of intracerebral parenchymal LCH. Fractioned radiotherapy resulted in clinical and radiological remission. CONCLUSIONS: The present case is so rare it should not be used as a guide. We probably will never see a single intraparenchymal supratentorial central nervous system LCH lesion. However, we hope our report will help colleagues in the future with the thought process.

The Impact of a Phone Assistance Nursing Program on Adherence to Home Exercises and Final Outcomes in Patients Who Underwent Shoulder Instability Surgery: A Randomized Controlled Study.

PURPOSE: The purpose of this study was to assess the impact of a phone assistance nursing program as an adjunct to conventional physiotherapy to increase adherence to a home exercise program on functional outcomes of patients who underwent shoulder instability surgery. METHODS: A randomized controlled study of 70 patients allocated to a phone assistance program (study group, n = 36 patients) or conventional postoperative management (control group, n = 34 patients) was conducted. All patients in both groups received conventional rehabilitation at the outpatient clinic after surgery. In addition, patients in the study group received phone calls from a nurse (who had access to a physiotherapist) 3 days per week. During the calls these patients received a coaching session about self-care and support with the home exercise program. Evaluations were performed during a follow-up of 12 months for range of motion (ROM), pain (visual analog scale [VAS] score), Disability of the Arm, Shoulder, and Hand (DASH) score, Oxford Shoulder Instability Score (OSIS), and Rowe score. RESULTS: All scores significantly improved from preoperative to the final follow-up in both groups (p = .001). At the final follow-up, there were no significant differences between groups in VAS, DASH, or Rowe scores. However, those in the study group had significantly better OSIS (p = .013) and ROM (p = .001), particularly for anterior forward motion (p = .001). Likewise, the study group achieved full motion and function significantly faster than the control group (p = .002). The amount of rehabilitation sessions at the outpatient clinic was 1.7 times higher in the control group (p = .004) than in the study group. CONCLUSION: The phone assistance nursing program was an effective procedure to significantly improve the outcomes of conventional physiotherapy in patients who have undergone an operation for shoulder instability.

A scoring system to predict 5-year mortality in patients diagnosed with laryngeal glottic cancer.

Only one prognostic model for laryngeal cancer has been published, but it has not been properly validated and is only applicable to patients treated with radiotherapy. Consequently, we constructed, internally validated and implemented in an App (Android), a predictive model of 5-year mortality in patients with glottic cancer in a cohort study of 189 patients with glottic cancer in 2004-2016 in Spain. The main variable was time-to-death. Secondary variables were age, gender, TNM, stage, smoking, alcohol consumption, histology and treatment. A scoring system to predict mortality at 5 years was constructed, validated internally by bootstrapping and then integrated into an Android app. In all, 70 patients died (37.0%, 76 deaths per 1,000 patient-years). The predictive model had the following prognostic factors: larger tumour size, greater degree of lymph node metastasis, higher stage, smoking and alcohol consumption. The internal validation of the model through bootstrapping was satisfactory. In conclusion, a points system to predict mortality at 5 years in patients with glottic cancer has been constructed, internally validated and integrated into an Android application. External validation is suggested to make available a quick and simple tool to establish the prognosis for these patients.

A predictive model for recurrence in patients with glottic cancer implemented in a mobile application for Android.

OBJECTIVES: The existing predictive models of laryngeal cancer recurrence present limitations for clinical practice. Therefore, we constructed, internally validated and implemented in a mobile application (Android) a new model based on a points system taking into account the internationally recommended statistical methodology. MATERIALS AND METHODS: This longitudinal prospective study included 189 patients with glottic cancer in 2004-2016 in a Spanish region. The main variable was time-to-recurrence, and its potential predictors were: age, gender, TNM classification, stage, smoking, alcohol consumption, and histology. A points system was developed to predict five-year risk of recurrence based on a Cox model. This was validated internally by bootstrapping, determining discrimination (C-statistics) and calibration (smooth curves). RESULTS: A total of 77 patients presented recurrence (40.7%) in a mean follow-up period of 3.4 ±â€¯3.0 years. The factors in the model were: age, lymph node stage, alcohol consumption and stage. Discrimination and calibration were satisfactory. CONCLUSION: A points system was developed to obtain the probability of recurrence of laryngeal glottic cancer in five years, using five clinical variables. Our system should be validated externally in other geographical areas.

Prospective study of comminuted articular distal radius fractures stabilized by volar plating in the elderly.

PURPOSE: The objective was to assess the ability of the volar locking plate to maintain the radiographic parameters over the time in elderly patients with complex intra-articular distal radius fractures. METHODS: Prospective cohort of 66 consecutive patients with mean age of 68 (range 60-81) years and AO type C fractures treated with volar locking plate. Radiographic measurements were performed pre and post-operatively at each follow-up. Clinical assessment was made by Patient-Rated Wrist Evaluation scores, Disabilities of the Arm, Shoulder and Hand score, range of motion, and grip strength. RESULTS: The mean post-operative follow-up was 31 (range, 24-47) months. The most difficult parameters to restore intra-operatively were volar tilt and radial height, while radial inclination and ulnar variance were restored in a high rate of patients. There was significant loss of reduction within four post-operative months in volar tilt (p = 0.001) and radial height (p = 0.029). Mean radiographic parameters had no changes from four months to final evaluation. At final follow-up, 50.1% of the patients had all radiographic parameters restored in comparison with the noninvolved wrist, but 83.3% had all radiographic parameters within a functional range (p = 0.001). No significant relationship between radiographic and functional outcomes was found (p = 0.474). CONCLUSIONS: This study found that volar locking plate fixation for displaced intra-articular distal radius fractures in elderly patients was an effective procedure to obtain success functional outcomes. Although reduction loss in volar tilt and radial height occurred within four first months, volar plate was able to maintain fracture stabilization with radiographic parameters within functional range over the time in most patients of these elderly patients.

Intra-articular distal radius fractures in elderly patients: a randomized prospective study of casting versus volar plating.

We compared outcomes in elderly patients with intra-articular distal radius fractures treated by closed reduction and plaster immobilization or open reduction and internal fixation with a volar plate. Ninety-seven patients older than 60 years were randomly allocated to conservative (47 patients) or surgical (50 patients) treatment. Over a 2-year period, we assessed patient-rated wrist evaluation score, DASH (disability arm, shoulder and hand) questionnaire, pain, wrist range of motion, grip strength, and radiological parameters. The functional outcomes and quality of life were significantly better after volar plating fixation compared with conservative treatment. We found that restoration of the articular surface, radial inclination, and ulnar variance affected the outcomes, but the articular step-off did not. Twenty-five per cent of the patients with conservative treatment had secondary loss of reduction. We conclude that surgical plating leads to better outcomes than conservative treatment for elderly patients with intra-articular distal radius fractures. LEVEL OF EVIDENCE: I.

PERVALE-S: a new cognitive task to assess deaf people's ability to perceive basic and social emotions.

UNLABELLED: A poorly understood aspect of deaf people (DP) is how their emotional information is processed. Verbal ability is key to improve emotional knowledge in people. Nevertheless, DP are unable to distinguish intonation, intensity, and the rhythm of language due to lack of hearing. Some DP have acquired both lip-reading abilities and sign language, but others have developed only sign language. PERVALE-S was developed to assess the ability of DP to perceive both social and basic emotions. PERVALE-S presents different sets of visual images of a real deaf person expressing both basic and social emotions, according to the normative standard of emotional expressions in Spanish Sign Language. Emotional expression stimuli were presented at two different levels of intensity (1: low; and 2: high) because DP do not distinguish an object in the same way as hearing people (HP) do. Then, participants had to click on the more suitable emotional expression. PERVALE-S contains video instructions (given by a sign language interpreter) to improve DP's understanding about how to use the software. DP had to watch the videos before answering the items. To test PERVALE-S, a sample of 56 individuals was recruited (18 signers, 8 lip-readers, and 30 HP). Participants also performed a personality test (High School Personality Questionnaire adapted) and a fluid intelligence (Gf) measure (RAPM). Moreover, all deaf participants were rated by four teachers for the deaf. RESULTS: there were no significant differences between deaf and HP in performance in PERVALE-S. Confusion matrices revealed that embarrassment, envy, and jealousy were worse perceived. Age was just related to social-emotional tasks (but not in basic emotional tasks). Emotional perception ability was related mainly to warmth and consciousness, but negatively related to tension. Meanwhile, Gf was related to only social-emotional tasks. There were no gender differences.

Arabidopsis thaliana peroxidases involved in lignin biosynthesis: in silico promoter analysis and hormonal regulation.

Phytohormones such as auxins, cytokinins, and brassinosteroids, act by means of a signaling cascade of transcription factors of the families NAC, MYB, AP2 (APETALA2), MADS and class III HD (homeodomain) Zip, regulating secondary growth. When the hormonal regulation of Zinnia elegans peroxidase (ZePrx), an enzyme involved in lignin biosynthesis, was studied, it was found that this peroxidase is sensitive to a plethora of hormones which control xylem lignification. In a previous study we sought Arabidopsis thaliana homologues to ZePrx. Peroxidases 4, 52, 49 and 72 are the four peroxidases that fulfill the restrictive conditions that a peroxidase involved in lignification must have. In the present study, we focus our attention on hormonal regulation in order to establish the minimal structural and regulatory elements contained in the promoter region which an AtPrx involved in lignification must have. The results indicate that of the four peroxidases selected in our previous study, the one most likely to be homologous to ZePrx is AtPrx52. The results suggest that hormones such as auxins, cytokinins and BRs directly regulate AtPrx52, and that the AtPrx52 promoter may be the target of the set of transcription factors (NAC, MYB, AP2 and class I and III HD Zip) which are up-regulated by these hormones during secondary growth. In addition, the AtPrx52 promoter contains multiple copies of all the putative cis-elements (the ACGT box, the OCS box, the OPAQ box, the L1BX, the MYCL box and the W box) known to confer regulation by NO and H2O2.

From Zinnia to Arabidopsis: approaching the involvement of peroxidases in lignification.

Zinnia elegans constitutes one of the most useful model systems for studying xylem differentiation, which simultaneously involves secondary cell wall synthesis, cell wall lignification, and programmed cell death. Likewise, the in vitro culture system of Z. elegans has been the best characterized as the differentiation of mesophyll cells into tracheary elements allows study of the biochemistry and physiology of xylogenesis free from the complexity that heterogeneous plant tissues impose. Moreover, Z. elegans has emerged as an excellent plant model to study the involvement of peroxidases in cell wall lignification. This is due to the simplicity and duality of the lignification pattern shown by the stems and hypocotyls, and to the basic nature of the peroxidase isoenzyme. This protein is expressed not only in hypocotyls and stems but also in mesophyll cells transdifferentiating into tracheary elements. Therefore, not only does this peroxidase fulfil all the catalytic requirements to be involved in lignification overcoming all restrictions imposed by the polymerization step, but also its expression is inherent in lignification. In fact, its basic nature is not exceptional since basic peroxidases are differentially expressed during lignification in other model systems, showing unusual and unique biochemical properties such as oxidation of syringyl moieties. This review focuses on the experiments which led to a better understanding of the lignification process in Zinnia, starting with the basic knowledge about the lignin pattern in this plant, how lignification takes place, and how a sole basic peroxidase with unusual catalytic properties is involved and regulated by hormones, H2O2, and nitric oxide.

Looking for Arabidopsis thaliana peroxidases involved in lignin biosynthesis.

Monolignol polymerization into lignin is catalyzed by peroxidases or laccases. Recently, a Zinnia elegans peroxidase (ZePrx) that is considered responsible for monolignol polymerization in this plant has been molecularly and functionally characterized. Nevertheless, Arabidopsis thaliana has become an alternative model plant for studies of lignification, filling the gaps that may occur with Z. elegans. The arabidopsis genome offers the possibility of performing bioinformatic analyses and data mining that are not yet feasible with other plant species, in order to obtain preliminary evidence on the role of genes and proteins. In our search for arabidopsis homologs to the ZePrx, we performed an exhaustive in silico characterization of everything from the protein to the transcript of Arabidopsis thaliana peroxidases (AtPrxs) homologous to ZePrx, with the aim of identifying one or more peroxidases that may be involved in monolignol polymerization. Nine peroxidases (AtPrx 4, 5, 52, 68, 67, 36, 14, 49 and 72) with an E-value greater than 1e-80 with ZePrx were selected for this study. The results demonstrate that a high level of 1D, 2D and 3D homology between these AtPrxs and ZePrx are not always accompanied by the presence of the same electrostatic and mRNA properties that indicate a peroxidase is involved in lignin biosynthesis. In summary, we can confirm that the peroxidases involved in lignification are among AtPrx 4, 52, 49 and 72. Their structural and mRNA features indicate that exert their action in the cell wall similar to ZePrx.

Bioinformatic and functional characterization of the basic peroxidase 72 from Arabidopsis thaliana involved in lignin biosynthesis.

Lignins result from the oxidative polymerization of three hydroxycinnamyl (p-coumaryl, coniferyl, and sinapyl) alcohols in a reaction mediated by peroxidases. The most important of these is the cationic peroxidase from Zinnia elegans (ZePrx), an enzyme considered to be responsible for the last step of lignification in this plant. Bibliographical evidence indicates that the arabidopsis peroxidase 72 (AtPrx72), which is homolog to ZePrx, could have an important role in lignification. For this reason, we performed a bioinformatic, histochemical, photosynthetic, and phenotypical and lignin composition analysis of an arabidopsis knock-out mutant of AtPrx72 with the aim of characterizing the effects that occurred due to the absence of expression of this peroxidase from the aspects of plant physiology such as vascular development, lignification, and photosynthesis. In silico analyses indicated a high homology between AtPrx72 and ZePrx, cell wall localization and probably optimal levels of translation of AtPrx72. The histochemical study revealed a low content in syringyl units and a decrease in the amount of lignin in the atprx72 mutant plants compared to WT. The atprx72 mutant plants grew more slowly than WT plants, with both smaller rosette and principal stem, and with fewer branches and siliques than the WT plants. Lastly, chlorophyll a fluorescence revealed a significant decrease in ΦPSII and q L in atprx72 mutant plants that could be related to changes in carbon partitioning and/or utilization of redox equivalents in arabidopsis metabolism. The results suggest an important role of AtPrx72 in lignin biosynthesis. In addition, knock-out plants were able to respond and adapt to an insufficiency of lignification.

Are there any significant variations in the clinical or histological presentation of lymphoid pathologies over the course of time in Spain?

INTRODUCTION: Little data is available concerning variations in the clinical characteristics of lymphoid neoplasms at presentation. We decided to investigate whether any variations in these characteristics had occurred in Spain during the last few years. MATERIALS AND METHODS: The GOTEL group database is an archive of all new lymphoma cases, regardless of their histological subtype, diagnosed in the hospitals within the group. An analysis was made of all the records between 1 January 1999 and 1 January 2009. Though the number of hospitals submitting data has changed over the course of time, data were provided by 26 hospitals from 16 Spanish provinces. RESULTS: A total of 3651 cases of lymphoma were recorded during this period. Grouped by clinical features, 42.8% (1561 patients) had low-grade lymphoma, 30.4% (1110 patients) intermediate-grade lymphoma and 15.2% (556 patients) Hodgkin's lymphoma; 208 patients had T lymphoma (5.7%), 111 patients high-grade lymphoma (3%) and 105 patients (2.9%) suffered lymphomas that were difficult to classify. A total of 6.3% of the diagnoses (231 patients) were made prior to 1999, 29.5% between 2000 and 2001, 25.7% between 2002 and 2003, 19.7% between 2004 and 2005, 11.2% between 2006 and 2007, and there were 200 entries from 2008 to the close of the study period, corresponding to 1.5% of the complete database. The median age at diagnosis was 60 (range 7-105 years), by percentiles: 25 corresponded to 44 years old, 50 to 60 years old and 75 to 71. Distribution by gender was 53.1% male and 46.9% female. An analysis was made of all the clinical variables collected, comparing their behaviour during the different diagnostic periods. The periods, gender, ECOG, stage, LDH, ß2 microglobulin, Hodgkin's or non- Hodgkin's type neoplasm, B lymphoma vs. Hodgkin's, NK or T, nodal or extra-nodal origin, median age at diagnosis and histological type by region of origin did not show any statistically significant differences in their distribution over the course of time. CONCLUSION: In our experience, there are no significant variations in clinical presentation or histological type in lymphomas diagnosed over the course of time in Spain.

The promoter region of the Zinnia elegans basic peroxidase isoenzyme gene contains cis-elements responsive to nitric oxide and hydrogen peroxide.

NO and H2O2 are important biological messengers in plants. They are formed during xylem differentiation in Zinnia elegans and apparently play important roles during the xylogenesis. To ascertain the responsiveness of the Z. elegans peroxidase (ZePrx) to these endogenous signals, the effects of NO and H2O2 on ZePrx were studied. The results showed that ZePrx is up-regulated by NO and H2O2, as confirmed by RT-qPCR, and that its promoter contains multiple copies of all the putative cis-elements (ACGT box, OCS box, OPAQ box, L1BX, MYCL box and W box) known to confer regulation by NO and H2O2. Like other OCS elements, the OCS element of ZePrx contains the sequence TACG that is recognized by OBF5, a highly conserved bZIP transcription factor, and the 10 bp sequence, ACAaTTTTGG, which is recognized by OBP1, a Dof domain protein that binds down-stream the OCS element. Furthermore, the ZePrx OCS element is flanked by two CCAAT-like boxes, and encloses one auxin-responsive ARFAT element and two GA3-responsive Pyr boxes. Results also showed that ZePrx may be described as the first protein to be up-regulated by NO and H2O2, whose mRNA contains several short-longevity conferring elements, such as a downstream (DST) sequence analogous to the DSTs contained in the highly unstable SAUR transcripts. The presence of these regulatory elements strongly suggests that ZePrx is finely regulated, as one may expect from an enzyme that catalyzes the last irreversible step of the formation of lignins, the major irreversible sink for the photosynthetically fixed CO2.

[Zonisamide in the preventive treatment of refractory migraine]. / Zonisamida en el tratamiento preventivo de la migraña refractaria.

INTRODUCTION: Chronic migraine refractory to preventive treatment is a common clinical situation in general neurology clinics. The aim is to analyse our experience with zonisamide in the preventive treatment of patients with frequent refractory migraine. PATIENTS AND METHODS: Those patients with no response or intolerance to topiramate and at least one more preventative received zonisamide. This drug was increased 25 mg per week up to 200 mg/day. The efficacy of zonisamide was evaluated in terms of 'response' (reduction in attack frequency below 50%) at the third month of treatment. RESULTS: Our series comprises a total of 172 patients, with ages ranging from 22 to 69 years. 85% were women. The final dosage of zonisamide was 50-200 mg/day, with the 100 mg/day being the most frequently administered dose. Zonisamide was efficacious (response) in 76 (44%) patients; response being excellent in 22 (13%). MIDAS score was reduced by 43.2%. Zonisamide was not tolerated by 27% of the patients, mainly due to subjective mental slowness or digestive symptoms. CONCLUSIONS: These results, obtained in a big sample of patients refractory or intolerant to topiramate and other preventatives, indicate that, at least in conditions of daily clinical practice, zonisamide, at relatively low dosages, is an option to be considered for the preventive treatment of patients with frequent migraine.

R-CHOP-14 in patients with diffuse large B-cell lymphoma younger than 70 years: a multicentre, prospective study.

Several studies have shown that adding rituximab to CHOP (cyclophosphamide, doxorubicin, vincristine, prednisolone) or reducing the interval between chemotherapy cycles from 3 weeks to 2 weeks improves survival in patients with diffuse large B-cell lymphoma (DLBCL). These studies prompted our group (GOTEL) to evaluate prospectively in a pilot study the feasibility and efficacy of R-CHOP-14 in patients with DLBCL. Patients (<70 years) with stage II bulky or stage III or IV DLBCL and no significant comorbidities were included in the study. Rituximab was administered on day 1 before chemotherapy. R-CHOP was given every 14 days. All patients received filgrastim (5 microg/kg) from days 4 to 10. From May 2002 to August 2004, 80 patients were recruited. Median age was 53 years and 58 patients were <60 years. According to the age-adjusted international prognostic index (aaIPI), 13 patients (16%) had low-risk disease, 31 (39%) low-to-intermediate risk, 27 (34%) high-to-intermediate risk and 9 (11%) high-risk disease. Grade 3-4 neutropenia was observed in 15 patients (17.5%) and grade 3-4 infections in 13 patients (16%). After therapy, 58 patients (73%) achieved CR-CRu (95% CI: 55-90%). With a median follow-up of 26 months, progression-free survival (PFS) and overall survival (OS) at 30 months were 72% and 86%, respectively. Administration of R-CHOP-14 is feasible and effective in patients <70 years.

Miliary brain metastases presenting as rapidly progressive dementia.

We report the case of a 79-year-old woman who developed a rapidly progressive dementia (RPD) with severe memory impairment, early visual hallucinations and extrapyramidal signs. Symptoms started suddenly after hip replacement surgery following an accidental fall. Motor epileptic seizures appeared at the end of the illness. Dementia worsened gradually leading to akinetic mutism. She died five and a half months after the onset of symptoms. MRI showed cerebral atrophy but failed to detect any other lesion. Results of all laboratory tests performed were negative. After the most frequent treatable diseases were excluded, the diagnosis of dementia with Lewy bodies was initially considered. CJD was also suggested based on the rapid evolution of the disease and the positivity of 14-3-3 protein in CSF. Neuropathological examination revealed an extensive miliary metastatic dissemination from an unknown primary adenocarcinoma. Pulmonary origin was suggested according to the immunohistochemical profile. Histopathological changes of Alzheimer's disease were also observed in the cerebral cortex and hippocampus. Neither Lewy bodies nor PrP deposits were found. The sudden onset of the dementia just after the hip replacement surgery raises the possibility of a pathological fracture with secondary tumoral microembolic dissemination. Despite its rarity, this entity should be included in the differential diagnosis of RPD. This case illustrates the definite importance of neuropathological post-mortem examination in order to elucidate the different types of dementia.