Comparison of the Tubular Approach and Uniportal Interlaminar Full-Endoscopic Approach in the Treatment of Lumbar Spinal Stenosis: Our 3-Year Results.

BACKGROUND: To report the long-term results of patients with lumbar spinal stenosis (LSS), for whom we applied the tubular and endoscopic approaches and previously published the short-term results. METHODS: A multicenter, prospective, randomized, double-blind study was carried out to evaluate 2 groups of patients with LSS who underwent microsurgery via a tubular retractor with a unilateral approach (T group) and bilateral spinal decompression using uniportal interlaminar endoscopic approaches (E group). Dural sac cross-sectional and spinal canal cross-sectional areas were measured with the patients' preoperative and postoperative magnetic resonance images. The visual analog scale, Oswestry Disability Index, and Japanese Orthopedic Association scores in the preoperative period and the first, second, and third years after surgery were evaluated. RESULTS: Twenty patients met the inclusion criteria for the research (T group; n = 10, E group; n = 10). The groups' visual analog scale (respectively; P = 0.315, P = 0.529, and P = 0.853), Oswestry Disability Index (respectively; P = 0.529, P = 0.739, and P = 0.912), and Japanese Orthopedic Association (respectively; P = 0.436, P =0.853, and P = 0.684) scores from the first, second, and third postoperative years were quite good compared with the preoperative period, but there was no statistically significant difference. A significant difference was found in the E group, with less blood loss (P < 0.001). CONCLUSIONS: The long-term results of the patients with LSS treated with tubular and endoscopic approaches were similar and very good. Bilateral decompression with minimally invasive spinal surgery methods can be completed with less tissue damage, complications, and blood loss with the unilateral approach.

Channeled scaffolds implanted in adult rat brain.

Scaffolds with aligned channels based on acrylate copolymers, which had previously demonstrated good compatibility with neural progenitor cells were studied as colonizable structures both in vitro with neural progenitor cells and in vivo, implanted without cells in two different locations, in the cortical plate of adult rat brains and close to the subventricular zone. In vitro, neuroprogenitors colonize the scaffold and differentiate into neurons and glia within its channels. When implanted in vivo immunohistochemical analysis by confocal microscopy for neural and endothelial cells markers demonstrated that the scaffolds maintained continuity with the surrounding neural tissue and were colonized by GFAP-positive cells and, in the case of scaffolds implanted in contact with the subventricular zone, by neurons. Local angiogenesis was evidenced in the interior of the scaffolds' pores. New axons and neural cells from the adult neural niche abundantly colonized the biomaterial's inner structure after 2 months, and minimal scar formation was manifest around the implant. These findings indicate the biocompatibility of the polymeric material with the brain tissue and open possibilities to further studies on the relevance of factors such as scaffold structure, scaffold seeding and scaffold placement for their possible use in regenerative strategies in the central nervous system. The development of neural interfaces with minimized glial scar and improved tissue compatibility of the implants may also benefit from these results. © 2012 Wiley Periodicals, Inc. J Biomed Mater Res Part A 100A:3276-3286, 2012.

Conspiración de silencio y malestar emocional en pacientes diagnósticados de glioblastoma multiforme / No disponible

Objetivo: En el ámbito de enfermedades muy graves y de mal pronóstico, continúa existiendo un importante porcentaje de familiares que, por motivos beneficentes y de protección, deciden ocultar la verdad a los enfermos que desean conocer lo que les ocurre. El objetivo es identificar la incidencia de conspiración de silencio familiar y su repercusión en los niveles de ansiedad y depresión del paciente diagnosticado de glioblastoma multiforme (GBM). Método: Los niveles de ansiedad y depresión fueron recogidos en cinco momentos del proceso de enfermedad: ingreso, después de la comunicación del diagnóstico, en el alta hospitalaria, un mes después del alta y seis meses después del alta. Las necesidades de información fueron recogidas en el momento del ingreso. Resultados: El 19,3 % de las familias, consideró que no sería conveniente comunicar al paciente lo que le ocurría a pesar de que éste quería conocer aspectos relacionados con su enfermedad. Esta conspiración repercute en los niveles de ansiedad del paciente hasta incluso un mes después del alta hospitalaria. En este momento de la enfermedad, en los pacientes donde existía pacto de silencio presentaban unos niveles psicopatológicos de ansiedad (12,71±2,28), mientras que los niveles de ansiedad de los pacientes a los que se les permitió una comunicación abierta estaban por debajo de la significación clínica (7,00±3,27). Conclusiones: Existe una alta incidencia de pacto de silencio en pacientes con GBM y su repercusión sobre el malestar emocional de los enfermos se mantiene durante un largo periodo de tiempo (AU)

Aim: For those patients suffering serious illnesses with a poor prognosis, there continues to be a significant percentage of well-meaning family members who, out of a desire to protect the patient, decide to hide the truth, even if the patient wishes to know what the real situation is. Methods: To measure the incidence of conspiracies of silence within families and their repercussions on levels of anxiety and depression of patients diagnosed Glioblastoma Multiforme (GBM). Findings: 19.3 % of the families taking part thought that it would not be appropriate to give the patient information about their disease, despite the patient stating that he or she would like to know more about their disease. This conspiracy had an impact on the anxiety levels of the patient even a month after the discharge from hospital. At this point in the disease process, those patients where there was a conspiracy of silence demonstrated psychopathological levels of anxiety (12.71±2.28), whereas the levels of anxiety for those patients who were allowed more open communication showed levels which were below clinical significance (7.00±3.27). Conclusions: The needs for information of family members and patients with GBM are different and their repercussions on emotional distress in patients can continue during a prolonged period of time (AU)

Neuroplasticidad cerebral en áreas occipitales en adolescentes ciegos / Brain neuroplasticity in occipital areas in blind teenagers

Introducción y desarrollo. La neuroplasticidad es un proceso mediante el cual las neuronas consiguen aumentar sus conexiones con otras neuronas y estabilizar dichas conexiones a consecuencia de la experiencia, el aprendizaje y la estimulación sensorial y cognitiva. Diferentes autores han documentado la existencia de un gran proceso de plasticidad cerebral hacia otras áreas sensoriales, principalmente auditivas y visuales, en sujetos ciegos. Desde el punto de vista anatómico, numerosos trabajos han encontrado diferencias significativas en el cerebro de los sujetos ciegos, principalmente en estructuras relacionadas con la visión, como consecuencia de la falta de actividad de dichas áreas, que trae consigo una menor plasticidad neuronal y consecuentemente un menor volumen estructural; también se han encontrado diferencias en el volumen de estructuras subcorticales relacionadas con la visión, como el esplenio y el istmo del cuerpo calloso. Metodología. Se estimuló táctil y pasivamente a un adolescente mediante un estimulador de 1.500 táxels. La estimulación se llevó a cabo diariamente, durante una hora, a lo largo de tres meses, y consistió en líneas verticales, horizontales y oblicuas. Los resultados obtenidos en un adolescente indican una progresión de la actividad electroencefalográfica desde áreas parietales de sensibilidad táctil hacia áreas occipitales visuales a medida que avanza la estimulación. Conclusión. Cabe plantearse si la repetición sistemática, ordenada y organizada de los estímulos táctiles en sujetos ciegos permite una mayor plasticidad cerebral, consiguiendo poco a poco colonizar otras áreas cerebrales como las occipitales, responsables de la visión humana (AU)

Introduction and development. Neuroplasticity is a process by which neurons increase their connectivity with other neurons in a stable fashion as a consequence of experience, learning and both sensitive and cognitive stimulation. Different authors have shown a huge process of brain plasticity in blind subjects towards other sensorial areas, mainly auditive and visual ones. From an anatomical standpoint many data show significant differences in blind subjects brains, mainly in visual pathways and structures as a result of lack of activity on those areas. This brings a lesser neuroplasticity and, therefore, a decrease in structural volumes. They have also found differences in subcortical structures volumes related to vision, such as splenium or corpus callosum istmus. Methodology. An adolescent was administered passive tactile stimulation with an 1,500 taxels stimulator. This was carried out daily for an hour, for three months, and stimulation consisted of vertical, horizontal and oblique lines. The results obtained in an adolescent indicate a clear progression of EEG activity from tactile sensory parietal areas to visual occipital ones as stimulation progresses. Conclusion. Therefore one can speculate if systematic and organized repetition of tactile stimuli in blind subjects leads to a greater neuroplasticity which expands towards occipital areas, largely responsible for human vision (AU)