Characterizing injury patterns and outcomes in hospitalized trauma patients with non-English Language Preferences.

INTRODUCTION: Patients with Non-English Language Preferences (NELP) experience challenges navigating the US healthcare system which can lead to disparate outcomes. This study sought to investigate injury patterns and outcomes in hospitalized trauma patients with NELP. METHODS: A retrospective review was performed at a trauma center from January 2019-December 2020. An institutional database of all emergency department video consultations for interpreter services was cross-referenced with the trauma registry and comparisons were made between NELP and English-preferred (EP) speaking patients. RESULTS: During the study, 257 NELP patients were hospitalized after traumatic injury. Twenty-two percent had work related injuries compared to only 3.0% in the EP cohort (p < 0.001). When propensity score matched, there were no significant differences in ICU and hospital length of stay or mortality between NELP and EP patients. DISCUSSION: Trauma patients are linguistically diverse and understanding their injury patterns and outcomes is crucial for guiding culturally and linguistically appropriate injury prevention.

[Association between single nucleotide genetic polymorphisms in ABC transporter genes with drug-resistant epilepsy in the Spanish population]. / Asociación entre los polimorfismos genéticos de nucleótido único en genes transportadores ABC con la epilepsia farmacorresistente en la población española.

INTRODUCTION: Almost a third of all patients with epilepsy (30%) fail to respond to pharmacological treatment. The presence of single nucleotide polymorphisms (SNPs) in the individual may influence the variability of the response to drug treatment. The transporter hypothesis posits that the presence of SNPs in the genes encoding ABC proteins would affect the bioavailability of antiseizure drugs at the epileptogenic focus, giving rise to refractoriness. The aim of the present study was to evaluate the association of 13 polymorphisms in the ABCB1, ABCC2, ABCC5 and ABCG2 genes with drug-resistant epilepsy (DRE) in a Spanish population. SUBJECTS AND METHODS: A case-control study was conducted involving 327 patients with epilepsy: 227 resistant to drug therapy and 100 in whom their medication enabled them to control their symptoms, according to International League Against Epilepsy criteria. In the peripheral blood leukocyte DNA that was extracted, polymorphisms in the ABC transporter genes were studied. The iPlex® Gold and Mass ARRAY technology platform was used. The allele and genotypic frequencies of the case and control groups, p-value, odds ratio and 95% confidence intervals were compared. RESULTS: The allele and genotypic frequency of the present study was similar to that reported in population-based databases. For the SNPs studied, no significant differences (p > 0.05) were found in any of the inheritance models analysed. CONCLUSIONS: Our results suggest that there is no association between the polymorphisms analysed in the ABC genes and DRE in the Spanish population. Nevertheless, further studies will confirm or refute these results.

TITLE: Asociación entre los polimorfismos genéticos de nucleótido único en genes transportadores ABC con la epilepsia farmacorresistente en la población española.Introducción. El 30% de los pacientes con epilepsia no responde al tratamiento farmacológico. La presencia de polimorfismos genéticos de nucleótido único (SNP) en el individuo puede influir en la variabilidad de respuesta al tratamiento farmacológico. La hipótesis de transportadores plantea que la presencia de SNP en los genes que codifican las proteínas ABC repercutiría en la biodisponibilidad de los fármacos anticrisis en el foco epileptógeno, lo que ocasionaría refractariedad. El objetivo del presente estudio fue evaluar la asociación de 13 polimorfismos en los genes ABCB1, ABCC2, ABCC5 y ABCG2 con la epilepsia farmacorresistente (EFR) en población española. Sujetos y métodos. Se realizó un estudio de casos y controles que incluyó a 327 pacientes con epilepsia: 227 farmacorresistentes y 100 farmacocontrolados según los criterios de la Liga Internacional contra la Epilepsia. En el ADN de leucocitos de sangre periférica extraído se estudiaron los polimorfismos en los genes transportadores ABC. Se utilizó la plataforma tecnológica iPlex® Gold y Mass ARRAY. Se compararon las frecuencias alélicas y genotípicas del grupo de casos y del de controles, el valor de p, la odds ratio y los intervalos de confianza al 95%. Resultados. La frecuencia alélica y genotípica del presente estudio fue similar a la comunicada en las bases de datos poblacionales. En los SNP estudiados no se encontraron diferencias significativas (p > 0,05) en todos los modelos de herencia analizados. Conclusiones. Nuestros resultados sugieren que no existe asociación entre los polimorfismos analizados en los genes ABC con la EFR en población española. Sin embargo, otros estudios adicionales confirmarán o descartarán estos resultados.

A study on correlations between precipitation ETCCDI and airborne pollen/fungal spore parameters in the NE Iberian Peninsula.

Precipitation is one of the meteorological variables usually involved in the aerobiological studies, which presents a complex relationship with atmospheric levels of pollen and fungal spores and the temporal characteristics of their seasons. This complexity is due in a large part to rainfall's twofold impact of having, prior to pollination, a positive influence on subsequent pollen production and of contributing, during pollination, to pollen removal from the air through a wash-out effect. To better explore this impact, we place particular emphasis on extreme rainfall by calculating the correlation between airborne pollen and fungal spore parameters and the precipitation indices that the Expert Team on Climate Change Detection and Indices (ETCCDI) proposed for characterising climate extremes. Parameters for twenty-seven pollen and fungal spore taxa measured in six aerobiological stations in the NE Iberian Peninsula have been considered. We have distinguished between annual and winter ETCCDI in order to compare the correlations between extreme rainfall and airborne pollen concentrations and to avoid the wash-out effect as far as possible. Results show a positive influence from an increase in moderately extreme winter rainfall, specifically on subsequent pollen/fungal spore production: the percentage of all possible significant correlations is higher for winter than for annual rainfall. Furthermore, while annual rainfall in this region has nearly the same number of positive as negative correlations, the positive correlations for winter rainfall are more than twice that of the negative ones. The seasonal consideration on rainfall ETCCDI made with the aim to avoid the confounding overlapping of different rainfall impacts has led to more sharpened observations of its positive and negative effects on airborne pollen and fungal spore concentrations.

A baseline study on the impact of nanoplastics on the portals of entry of xenobiotics in fish.

Mediterranean waters are particularly vulnerable to plastic pollution, with plastic particles concentrations comparable to those found in oceanic gyres. This work aimed to assess the impact of polymethylmethacrylate nanoplastics (PMMA-NPs) on the most important mucosal barriers of the gilthead seabream (Sparus aurata), a highly consumed fish species in the Mediterranean area. Fish were waterborne exposed to NPs (0.001-10 mg/L) for 24 and 96 h, and biochemical parameters associated with oxidative status (total oxidative status and total antioxidant capacity) and immune function (adenosine deaminase, ADA, acetylcholinesterase activity, AChE, and esterase activity, EA) were assessed in gills, intestine, and skin. In intestine, PMMA-NPs led to oxidative status alterations and decreased ADA and EA. In gills, PMMA-NPs induced EA decrease and AChE activity increase. Total protein values were significantly increased in skin. Overall, more alterations were observed in intestine, suggesting it may be one of the most affected tissues by exposure to NPs.

Relative absorption of silicon from different formulations of dietary supplements: a pilot randomized, double-blind, crossover post-prandial study.

The purpose of the present study was to compare the relative absorption of a new powder presentation of silicon (Si) as orthosilicic acid with maltodextrin (Orgono Powder) compared to usual Si liquid presentations as orthosilicic acid with Equisetum arvense and Rosmarinus officinalis (G5 Siliplant) and orthosilicic acid with aloe vera (G7 Aloe). All dietary supplements were administered at the same Si oral dose (21.6 mg) in a randomized, double-blind, crossover post-prandial study conducted in 5 healthy men. Urine was collected at baseline and over the 6-h post-dose period in 2 separate 3-h collections for the analysis of Si concentration, which was conducted by inductively coupled plasma optical emission spectrometry as the gold standard method. No significant differences in total urinary Si excretion were found after the intake of these 3 dietary supplements; 34.6%, 32.4% and 27.2% of the ingested Si from G7 Aloe, G5 Siliplant and Orgono Powder, respectively, was excreted in urine over the 6-h follow-up period. The 3 different oral Si formulations tested, in powder and liquid presentations, provide highly bioavailable Si and present an equivalent relative absorption in healthy humans.

Effects of Hesperidin Consumption on the Cardiovascular System in Pre- and Stage 1 Hypertensive Subjects: Targeted and Non-Targeted Metabolomic Approaches (CITRUS Study).

SCOPE: The aim of the present work is to determine new biomarkers of the biological effects of hesperidin in orange juice (OJ) applying a non-targeted metabolomics approach validated by targeted metabolomics analyses of compliance biomarkers. METHODS AND RESULTS: Plasma/serum and urine targeted (HPLC-MS/MS) and untargeted (1 H-NMR) metabolomics signatures are explored in a subsample with pre- and stage-1 hypertension subjects of the CITRUS study (N = 159). Volunteers received 500 mL day-1 of control drink, OJ, or hesperidin-enriched OJ (EOJ) for 12-weeks. A 6-h postprandrial study is performed at baseline. Targeted analyses reveals plasma and urine hesperetin 7-O-ß-d-glucuronide as the only metabolite differing between OJ and EOJ groups after 12-weeks consumption, and in urine is correlated with a decreased systolic blood pressure level. The non-targeted approach shows that after single dose and 12-weeks consumption of OJ and EOJ change several metabolites related with an anti-inflammatory and antioxidant actions, lower blood pressure levels and uremic toxins. CONCLUSIONS: Hesperetin 7-O-ß-d-glucuronide can be a candidate marker for distinguishing between the consumption of different hesperidin doses at 12-weeks consumption as well as a potential agent mediating blood pressure reduction. Moreover, changes in different endogenous metabolites can explain the mechanisms of action and the biological effects of hesperidin consumption.

Early versus late tube feeding initiation after PEG tube placement: Does time to feeding matter?

BACKGROUND: Variation exists in the timing of tube feed initiation after percutaneous endoscopic gastrostomy (PEG) tube placement. The aim of our study was to review outcomes of early tube feed (ETF) versus late tube feed (LTF) initiation after PEG tube placement. METHODS: We performed a retrospective review of all trauma patients who underwent PEG tube placement from 1/2014 to 12/2018. ETF was defined as initiation < 24 h and LTF > 24 h after placement. The primary outcome measure was feeding intolerance and secondary outcomes included post-operative complications. All statistical analyses were performed using standard statistical methods (e.g. Pearson's Chi-squared, Fisher's exact and Mann Whitney-U tests). RESULTS: There were 295 patients (164 ETF and 131 LTF) that received a PEG tube at our level 1 trauma center. There was no difference with feeding intolerance at 12 h (5% vs. 4%; p = 0.88), 24 h (1% vs. 2%; p = 1.00), and 48 h (4% vs. 4%; p = 1.00). There was no difference when comparing intolerance symptoms such as nausea and vomiting (1% vs. 2%; p = 0.79), abdominal tenderness (2% vs. 3%; p = 0.76), high gastric residuals (2% vs. 2%; p = 1.00) and aspiration (0% vs. 2%; p = 0.39). There was no difference when comparing post-operative complications (4% vs. 8%; p = 0.21). CONCLUSIONS: Early tube feeding after PEG placement is safe and equivalent to late tube feeding in the adult trauma population. Future prospective studies are warranted to establish the optimal timing for initiation of tube feeds after PEG tube placement.

Simulation with 3D Neuronavigation for Learning Cortical Bone Trajectory Screw Placement.

BACKGROUND AND OBJECTIVE: Learning a new technique in neurosurgery is a big challenge especially for trainees. In recent years, simulations and simulators got into the focus as a teaching tool. Our objective is to propose a simulator for placement of cortical bone trajectory (CBT) screws to improve results and reduce complications. METHODS: We have created a platform consisting of a sawbone navigated with a 3D fluoroscope to familiarize our trainees and consultants with CBT technique and later implement it in our department. Objective Structured Assessment of Technical Skills (OSATS) and Physician Performance Diagnostic Inventory Scale (PPDI) were obtained before and after the use of the simulator by the five participants in the study. Patients who were operated on after the implementation of the technique were retrospectively reviewed. RESULTS: During the simulation, there were 4 cases of pedicle breach out of 24 screws inserted (16.6%). After having completed simulation, participants demonstrated an improvement in OSATS and PPDI (p = 0.039 and 0.042, respectively). Analyzing the answers to the different items of the tests, participants mainly improved in the knowledge (p = 0.038), the performance (p = 0.041), and understanding of the procedure (p = 0.034). In our retrospective series, eight patients with L4-L5 instability were operated on using CBT, improving their Oswestry Disability Index (ODI) score (preoperative ODI 58.5 [SD 16.7] vs. postoperative ODI 31 [SD 13.4]; p = 0.028). One intraoperative complication due to a dural tear was observed. In the follow-up, we found a case of pseudoarthrosis and a facet joint violation, but no other complications related to misplacement, pedicle fracture, or hardware failure. CONCLUSION: The simulation we have created is useful for the implementation of CBT. In our study, consultants and trainees have valued very positively the learning obtained using the system. Moreover, simulation facilitated the learning of the technique and the understanding of surgical anatomy. We hope that simulation helps reducing complications in the future.

Multifractal structure of the monthly rainfall regime in Catalonia (NE Spain): Evaluation of the non-linear structural complexity.

The complex non-linear regime of the monthly rainfall in Catalonia (NE Spain) is analyzed by means of the reconstruction fractal theorem and the multifractal detrended fluctuation analysis algorithm. Areas with a notable degree of complex physical mechanisms are detected by using the concepts of persistence (Hurst exponent), complexity (embedding dimension), predictive uncertainty (Lyapunov exponents), loss of memory of the mechanism (Kolmogorov exponent), and the set of multifractal parameters (Hölder exponents, spectral asymmetry, spectral width, and complexity index). Besides these analyses permitting a detailed description of monthly rainfall pattern characteristics, the obtained results should also be relevant for new research studies concerning monthly amounts forecasting at a monthly scale. On one hand, the number of necessary monthly data for autoregressive processes could change with the complexity of the multifractal structure of the monthly rainfall regime. On the other hand, the discrepancies between real monthly amounts and those generated by some autoregressive algorithms could be related to some parameters of the reconstruction fractal theorem, such as the Lyapunov and Kolmogorov exponents.

Effects of hesperidin consumption on cardiovascular risk biomarkers: a systematic review of animal studies and human randomized clinical trials.

CONTEXT: The cardioprotective effects of the flavonoid hesperidin, which is present in citrus products, are controversial and unclear. This systematic review was conducted in accordance with the PRISMA 2015 guidelines. OBJECTIVE: To evaluate the current evidence from animal and human clinical studies and thus determine whether the consumption of hesperidin exerts beneficial effects on cardiovascular risk factors. DATA SOURCES: PICOS (Population, Intervention, Comparison, Outcome, and Study Design) criteria defined the research question. Searches of the PubMed and Cochrane Plus databases were conducted and studies that met the inclusion criteria and were published in English in the last 15 years were included. DATA EXTRACTION: The first author, year of publication, study design, characteristics of animals and humans, intervention groups, dose of hesperidin, route of administration, duration of the intervention, cardiovascular risk biomarkers assessed, and results observed were extracted from the included articles. RESULTS: A total of 12 animal studies and 11 randomized clinical trials met the inclusion criteria. In the animal studies, the glucose, total and LDL cholesterol, and triglyceride levels decreased with chronic flavonoid consumption. In the human studies, endothelial function improved with flavonoid consumption, whereas no conclusive results were observed for the other biomarkers. CONCLUSIONS: Animal studies have revealed that hesperidin and hesperetin consumption reduces glucose levels and various lipid profile parameters. However, a definitive conclusion cannot be drawn from the existing human clinical trials. Further research is needed to confirm whether the findings observed in animal models can also be observed in humans. SYSTEMATIC REVIEW REGISTRATION: Prospero registration number CRD42018088942.

[Is it possible to extract intracranial pressure information based on the EEG activity?] / Es posible obtener informacion de la presion intracraneal a partir de la actividad electroencefalografica?

INTRODUCTION: The capability of the electroencephalography (EEG) of recording the bioelectrical activity of the brain has made of it a fundamental tool for the evaluation of the patient's neurological condition. In recent years, moreover, it has also begun to be used in obtaining information for other kind of variables, as the ones related with the cerebral hemodynamics. AIM: To study the potential relationship between the EEG activity and the intracranial pressure (ICP) in patients suffering from traumatic brain injury and subarachnoid hemorrhage, during their stay at the intensive care unit. PATIENTS AND METHODS: Twenty-one adult patients (10 women) were included in the present observational prospective cohort study. They suffered from either traumatic brain injury or subarachnoid hemorrhage, requiring continuous EEG and ICP monitoring. In every patient, Granger causality between spectral functions of the EEG and the ICP was evaluated. Temporal windows of 10 minute were used to evaluate whether a causal relationship between those variables exist or not. In all of the cases, several days of continuous recording and assessment were performed. RESULTS: In most patients and during most of the time, Granger causality turns out to be significant in the direction from the EEG to the ICP, meaning that the EEG dynamics actually leads the ICP dynamics. CONCLUSIONS: The present work provides useful information and shed light in discovering a hidden relationship between the ICP and EEG dynamics. The potential use of this relationship could lead to develop a medical device to measure ICP in a non-invasive fashion.

TITLE: Es posible obtener informacion de la presion intracraneal a partir de la actividad electroencefalografica?Introduccion. El electroencefalograma (EEG) permite obtener informacion directa de la actividad bioelectrica del cerebro y es una herramienta fundamental para la evaluacion de la condicion neurologica del paciente. En los ultimos años ha comenzado a emplearse tambien para obtener indirectamente informacion sobre la hemodinamica cerebral y las variables que intervienen en la autorregulacion del flujo sanguineo cerebral. Objetivo. Estudiar la posible relacion entre la actividad electroencefalografica y la presion intracraneal (PIC) en pacientes con traumatismo craneoencefalico y hemorragia subaracnoidea ingresados en cuidados intensivos. Pacientes y metodos. Se incluyo a 21 pacientes (10 mujeres) mayores de 18 años con traumatismo craneoencefalico o hemorragia subaracnoidea que requerian monitorizacion de la PIC y a los que se les registro el EEG de forma continua. Se determino la causalidad de Granger entre la PIC con respecto a las variables espectrales del EEG para ventanas temporales de 10 minutos durante la estancia en cuidados intensivos. Resultados. La causalidad de Granger mostro una alta correlacion entre la PIC con las bandas del EEG. En la mayoria de los pacientes existe una causalidad de Granger significativa en la direccion del EEG hacia la PIC en gran parte del tiempo de monitorizacion, de forma que las variables del EEG precedian a la PIC. Conclusiones. El presente trabajo expone la relacion temporal subyacente entre la dinamica de la PIC y la actividad bioelectrica cerebral registrada mediante EEG en pacientes con traumatismo craneoencefalico y hemorragia subaracnoidea. El potencial uso de esta relacion podria permitir estimar la PIC de manera no invasiva.

Traumatic atlantoaxial rotatory fixation in an adult patient.

INTRODUCTION: Atlantoaxial rotational fixation (AARF) is a rare entity in adults, with only a few cases reported in the English literature and often associated with a traumatic mechanism. It is an underdiagnosed condition that must be taken into account in the initial assessment of all craniocervical trauma. Both diagnostic and therapeutic delay may be a potential cause of severe neurological damage or even death of the patient. The therapeutic management is controversial given the difficulty of achieving optimum stability and permanent reduction. METHODS AND RESULTS: A 28-year-old woman was involved in a traffic accident a week before coming to the emergency with rotation and irreducible cervical flexion from trauma and severe neck pain. CT and MRI column were performed and showed a cervical spinal AARF with transverse and alar ligaments intact and preserved atlantoaxial distance (Fielding I). The patient was treated by progressive cervical traction with 5 kg and manual reduction was completed in 24 h. Subsequently, an external immobilization was performed by cervical rigid collar for 16 weeks. The clinical course was good, with the patient regaining full mobility with cervical neck pain improvement. CONCLUSIONS: The purpose of this paper is to show a case of a young woman with a posttraumatic AARF successfully treated conservatively. This case delineates the difficulties in diagnosing this pathology, as well as the challenges encountered in its management.

Collagen and fibronectin surface modification of nanoporous anodic alumina and macroporous silicon for endothelial cell cultures.

BACKGROUND: The ability to direct the cellular response by means of biomaterial surface topography is important for biomedical applications. Substrate surface topography has been shown to be an effective cue for the regulation of cellular response. Here, the response of human aortic endothelial cells to nanoporous anodic alumina and macroporous silicon with collagen and fibronectin functionalization has been studied. METHODS: Confocal microscopy and scanning electron microscopy were employed to analyse the effects of the material and the porosity on the adhesion, morphology, and proliferation of the cells. Cell spreading and filopodia formation on macro- and nanoporous material was characterized by atomic force microscopy. We have also studied the influence of the protein on the adhesion. RESULTS: It was obtained the best results when the material is functionalized with fibronectin, regarding cells adhesion, morphology, and proliferation. CONCLUSION: These results permit to obtain chemical modified 3D structures for several biotechnology applications such as tissue engineering, organ-on-chip or regenerative medicine.

Behavioural, morphological and electrophysiological assessment of the effects of type 2 diabetes mellitus on large and small nerve fibres in Zucker diabetic fatty, Zucker lean and Wistar rats.

BACKGROUND: Peripheral neuropathy is a common complication in type 2 diabetes mellitus (T2DM). The most common presentation is in the form of a distal axonal sensory-motor polyneuropathy that involves large and small nerve fibres in variable proportion. METHODS: Zucker Diabetic Fatty (ZDF), Zucker Lean (ZL) and Wistar Han (WH) rats were used to assess the behavioural, morphological and electrophysiological effects that T2DM have on peripheral large and small nerve fibres of 6- to 40-week-old rats. RESULTS: ZDF rats presented mechanical hypersensitivity that initially worsened in parallel to the progression of diabetes and eventually reverted at later stages of the disease. The reversal from hypersensitivity to hyposensitivity paralleled a reduction in the number of intraepithelial skin nerve terminals and in the nerve fibre lengths. However, no increased levels of degeneration of dorsal root ganglion neurons were observed. Nerve conduction studies showed a reduction in sensory and motor nerve conduction velocity (CV) in hyperglycaemic ZDF rats. Microneurography showed significant alterations in several parameters of activity-dependent slowing (ADS) of mechano-insensitive C-nociceptors in ZDF rats. Surprisingly, some of these changes were also observed in ZL rats. Moreover, we found spontaneous activity in all three strains implying that C-nociceptors become hyperexcitable and spontaneously active not only in ageing hyperglycaemic ZDF rats but also in age-matched and apparently normoglycaemic ZL and WH rats fed with the same diet. CONCLUSIONS: ZDF rats presented a diabetic neuropathy involving large and small nerve fibres; additionally, ZL and WH rats also showed early small abnormalities in C-fibres, clearly detected by microneurography SIGNIFICANCE: This study provides a functional description of large and small nerve fibre function in a diabetic model that recapitulates many of the findings observed in patients suffering from type 2 diabetes mellitus.

Systematic review with meta-analysis: neuroimaging in hepatitis C chronic infection.

BACKGROUND: Chronic hepatitis C is considered a systemic disease because of extra-hepatic manifestations. Neuroimaging has been employed in hepatitis C virus-infected patients to find in vivo evidence of central nervous system alterations. AIMS: Systematic review and meta-analysis of neuroimaging research in chronic hepatitis C treatment naive patients, or patients previously treated without sustained viral response, to study structural and functional brain impact of hepatitis C. METHODS: Using PRISMA guidelines a database search was conducted from inception up until 1 May 2017 for peer-reviewed studies on structural or functional neuroimaging assessment of chronic hepatitis C patients without cirrhosis or encephalopathy, with control group. Meta-analyses were performed when possible. RESULTS: The final sample comprised 25 studies (magnetic resonance spectroscopy [N = 12], perfusion weighted imaging [N = 1], positron emission tomography [N = 3], single-photon emission computed tomography [N = 4], functional connectivity in resting state [N = 1], diffusion tensor imaging [N = 2] and structural magnetic resonance imaging [N = 2]). The whole sample was of 509 chronic hepatitis C patients, with an average age of 41.5 years old and mild liver disease. A meta-analysis of magnetic resonance spectroscopy studies showed increased levels of choline/creatine ratio (mean difference [MD] 0.12, 95% confidence interval [CI] 0.06-0.18), creatine (MD 0.85, 95% CI 0.42-1.27) and glutamate plus glutamine (MD 1.67, 95% CI 0.39-2.96) in basal ganglia and increased levels of choline/creatine ratio in centrum semiovale white matter (MD 0.13, 95% CI 0.07-0.19) in chronic hepatitis C patients compared with healthy controls. Photon emission tomography studies meta-analyses did not find significant differences in PK11195 binding potential in cortical and subcortical regions of chronic hepatitis C patients compared with controls. Correlations were observed between various neuroimaging alterations and neurocognitive impairment, fatigue and depressive symptoms in some studies. CONCLUSIONS: Patients with chronic hepatitis C exhibit cerebral metabolite alterations and structural or functional neuroimaging abnormalities, which sustain the hypothesis of hepatitis C virus involvement in brain disturbances.

[Bilateral two-stage implantation for deep brain stimulation in the treatment of bilateral idiopathic Parkinson's disease: clinical outcomes]. / Implantacion bilateral en dos tiempos para estimulacion cerebral profunda en el tratamiento de la enfermedad de Parkinson idiopatica bilateral: resultados clinicos.

AIMS: Simultaneous bilateral implantation of electrodes in the subthalamic nucleus for idiopathic Parkinson's disease (IPD) is associated with long surgery time, language disorders and post-operative confusion. Moreover, there is evidence of ipsilateral improvement after stimulation of the subthalamic nucleus. In order to optimise perioperative management a prospective study is conducted with deep brain stimulation (DBS) in the subthalamic nucleus in two consecutive unilateral procedures. PATIENTS AND METHODS: We conducted a prospective study of 41 patients with bilateral IPD, with DBS implantation in two unilateral surgical phases. Its clinical outcomes are analysed according to the Unified Parkinson's Disease Rating Scale (UPDRS), the Hoehn and Yahr, and the Schwab and England scales, together with their complications. RESULTS: The mean age was 61 ± 7 years old, 23 males. Five patients (12%) did not undergo surgery of the contralateral subthalamic nucleus due to good control. The mean on the motor UPDRS and the Hoehn and Yahr in preoperative pharmacological off was 44 ± 14 and 3, respectively, and 19 ± 8 and 1.8 at six months' follow-up. The mean improvement on the Schwab and England scale in the pre-operative period and at six months was 39%. Two patients suffered post-operative confusion, and one of them had transient dysarthria. CONCLUSIONS: Bilateral DBS in two unilateral stages was an effective option with few complications in our series of patients with IPD. 10% of the patients did not require contralateral electrodes. It would be necessary to conduct a randomised study in patients who underwent bilateral surgery in one and two stages in order to confirm these results.

TITLE: Implantacion bilateral en dos tiempos para estimulacion cerebral profunda en el tratamiento de la enfermedad de Parkinson idiopatica bilateral: resultados clinicos.Objetivo. La implantacion bilateral simultanea de electrodos en el nucleo subtalamico para la enfermedad de Parkinson idiopatica (EPI) se asocia a una duracion elevada de la intervencion, alteraciones del lenguaje y confusion posquirurgica; ademas, existe evidencia de mejoria ipsilateral tras la estimulacion del nucleo subtalamico. Para optimizar el manejo perioperatorio se realiza un estudio prospectivo con estimulacion cerebral profunda (ECP) en el nucleo subtalamico en dos procedimientos unilaterales consecutivos. Pacientes y metodos. Estudio prospectivo de 41 pacientes con EPI bilateral, con implantacion de ECP en dos fases quirurgicas unilaterales. Se analizan sus resultados clinicos segun las escalas Unified Parkinson's Disease Rating Scale (UPDRS), Hoehn y Yahr, y Schwab y England, asi como sus complicaciones. Resultados. La edad media fue de 61 ± 7 años, 23 hombres. Cinco pacientes (12%) no fueron intervenidos del nucleo subtalamico contralateral por buen control. La media en la UPDRS motora y la Hoehn y Yahr en off farmacologico preoperatorio fue de 44 ± 14 y 3, respectivamente, y de 19 ± 8 y 1,8 a los seis meses de seguimiento. La mejoria media en la escala de Schwab y England en el preoperatorio y a los seis meses fue del 39%. Dos pacientes tuvieron confusion postoperatoria, y uno, disartria transitoria. Conclusiones. La ECP bilateral en dos etapas unilaterales fue una opcion eficaz y con escasas complicaciones en nuestra serie de pacientes con EPI. El 10% de los pacientes no preciso electrodos contralaterales. Seria necesario un estudio aleatorizado en pacientes sometidos a cirugia bilateral en uno y dos tiempos para confirmar estos resultados.

[Medullar thoracic compression by tophaceous gout: presentation of a case and review of the literature]. / Compresion medular dorsal por tofos gotosos: presentacion de un caso y revision de la bibliografia.

INTRODUCTION: Spine involvement in gout is an extremely uncommon complication. Dorsalgia and quadriplegia are some manifestations that may occur, although these symptoms are seen more frequently in other more prevalent pathologies, such as spinal tumors. CASE REPORT: We present an unusual case of thoracic spinal cord compression at T10-T11 level caused by the extradural deposit of tophaceous material in a 52-year-old woman with uncontrolled chronic tophaceous gout. In addition to intensive medical treatment, the patient required surgery (hemilaminectomy and spinal decompression) and subsequent rehabilitation. Overall and neurological evolution were satisfactory.

TITLE: Compresion medular dorsal por tofos gotosos: presentacion de un caso y revision de la bibliografia.Introduccion. La afectacion de la columna vertebral en la gota es una complicacion extremadamente infrecuente. La dorsalgia y la cuadriplejia son algunas manifestaciones que se pueden presentar, aunque estos sintomas se ven con mas frecuencia en otras patologias mas prevalentes, como los tumores medulares. Caso clinico. Se presenta un caso inusual de compresion medular dorsal en D10-D11 causado por el deposito extradural de material tofaceo en una paciente de 52 años con gota tofacea cronica incontrolada. Ademas de un tratamiento medico intensivo, la paciente requirio cirugia (hemilaminectomia y descompresion medular) y rehabilitacion posterior. La evolucion general y neurologica fue satisfactoria.

[New thalamic potential associated with somatosensory evoked potentials]. / Nuevo potencial talamico asociado con potenciales evocados somatosensoriales.

INTRODUCTION: The response of the thalamus during the study with somatosensory evoked potentials (SSEP) is not sufficiently understood. CASE REPORT: A 17-year-old man undergoing surgery for deep brain stimulation in the centromedian nucleus for drug-resistant epilepsy under complete sedation. During the intervention, the responses to SSEPs of the thalamic nuclei were recorded by means of four microelectrodes. These responses can be decomposed into three types: local field potentials (LFP), low amplitude fast oscillations (LFO), and high amplitude slow oscillations (HSO). LFO are widespread in much of the registered regions. However, HSOs are located at a single point in the registry and are closely associated with LFPs. CONCLUSIONS: Although the presence of LFO has been considered as an indicator of the presence of the sensory thalamus, its wide extension by different thalamic nuclei suggests that it is an unspecific response to SSEPs. However, the restricted spatial location of HSO and their association with LFP suggest that these newly described potentials are the markers for the presence of the sensory thalamus. Their identification may prove very useful in thalamic deep brain stimulation either in awake patients or especially in those requiring sedation.

TITLE: Nuevo potencial talamico asociado con potenciales evocados somatosensoriales.Introduccion. La respuesta del talamo durante el estudio con potenciales evocados somatosensoriales (PESS) no esta suficientemente comprendida. Caso clinico. Varon de 30 años intervenido con sedacion completa mediante estimulacion cerebral profunda en el nucleo centromediano por epilepsia farmacorresistente. Durante la intervencion se registraron las respuestas de los nucleos talamicos mediante cuatro microelectrodos a los PESS. Estas respuestas se pueden descomponer en tres tipos: potenciales de campo local (PCL), oscilaciones rapidas de baja amplitud (ORB) y oscilaciones lentas de gran amplitud (OLG). Las ORB estan muy extendidas por gran parte de las regiones registradas (> 5 mm) y en los cuatro electrodos simultaneamente. Sin embargo, las OLG estan localizadas en un unico punto del registro y estan intimamente asociadas con los PCL. Ademas, el analisis de wavelets muestra un componente espectral y un tiempo de aparicion diferentes. Conclusiones. Aunque se ha considerado la presencia de ORB como indicador de la presencia del talamo sensorial, su amplia extension por diferentes nucleos talamicos sugiere que se trata de una respuesta poco especifica a los PESS. Sin embargo, la localizacion espacial restringida de los OLG y su asociacion con PCL sugiere que estos potenciales de nueva descripcion son los marcadores de la presencia del talamo sensorial. Su identificacion puede resultar muy util en estimulacion cerebral profunda talamica en pacientes despiertos y, especialmente, en los que precisen sedacion.