Von Economo neurons: Cellular specialization of human limbic cortices?

Von Economo neurons (VENs) have been mentioned in the medical literature since the second half of the 19th century; however, it was not until the second decade of the 20th century that their cytomorphology was described in detail. To date, VENs have been found in limbic sectors of the frontal, temporal and insular lobes. In humans, their density seems to decrease in the caudo-rostral and ventro-dorsal direction; that is, from the anterior regions of the cingulate and insular cortices towards the frontal pole and the superior frontal gyrus. Several studies have provided similar descriptions of the shape of the VEN soma, but the size of the soma varies from one cortical region to another. There is consensus among different authors about the selective vulnerability of VENs in certain pathologies, in which a deterioration of the capacities involved in social behaviour is observed. In this review, we propose that the restriction of VENs towards the sectors linked to limbic information processing in Homo sapiens gives them a possible functional role in relation to the structures in which they are located. However, given the divergence in characteristics such as location, density, size and biochemical profile among VENs of different cortical sectors, the activities in which they participate could allow them to partake in a wide spectrum of neurological functions, including autonomic responses and executive functions.

Reversal of high-glucose-induced transcriptional and epigenetic memories through NRF2 pathway activation.

Diabetes complications such as nephropathy, retinopathy, or cardiovascular disease arise from vascular dysfunction. In this context, it has been observed that past hyperglycemic events can induce long-lasting alterations, a phenomenon termed "metabolic memory." In this study, we evaluated the genome-wide gene expression and chromatin accessibility alterations caused by transient high-glucose exposure in human endothelial cells (ECs) in vitro. We found that cells exposed to high glucose exhibited substantial gene expression changes in pathways known to be impaired in diabetes, many of which persist after glucose normalization. Chromatin accessibility analysis also revealed that transient hyperglycemia induces persistent alterations, mainly in non-promoter regions identified as enhancers with neighboring genes showing lasting alterations. Notably, activation of the NRF2 pathway through NRF2 overexpression or supplementation with the plant-derived compound sulforaphane, effectively reverses the glucose-induced transcriptional and chromatin accessibility memories in ECs. These findings underscore the enduring impact of transient hyperglycemia on ECs' transcriptomic and chromatin accessibility profiles, emphasizing the potential utility of pharmacological NRF2 pathway activation in mitigating and reversing the high-glucose-induced transcriptional and epigenetic alterations.

Needs-based novel digital curriculum for the neuromodulation training deficit: Pain Rounds.

This study reports the needs-based development, effectiveness and feasibility of a novel, comprehensive spinal cord stimulation (SCS) digital curriculum designed for pain medicine trainees. The curriculum aims to address the documented systematic variability in SCS education and empower physicians with SCS expertise, which has been linked to utilization patterns and patient outcomes. Following a needs assessment, the authors developed a three-part SCS e-learning video curriculum with baseline and postcourse knowledge tests. Best practices were used for educational video production and test-question development. The study period was from 1 February 2020 to 31 December 2020. A total of 202 US-based pain fellows across two cohorts (early-fellowship and late-fellowship) completed the baseline knowledge assessment, while 122, 96 and 88 participants completed all available post-tests for Part I (Fundamentals), Part II (Cadaver Lab) and Part III (Decision Making, The Literature and Critical Applications), respectively. Both cohorts significantly increased knowledge scores from baseline to immediate post-test in all curriculum parts (p<0.001). The early-fellowship cohort experienced a higher rate of knowledge gain for Parts I and II (p=0.045 and p=0.027, respectively). On average, participants viewed 6.4 out of 9.6 hours (67%) of video content. Self-reported prior SCS experience had low to moderate positive correlations with Part I and Part III pretest scores (r=0.25, p=0.006; r=0.37, p<0.001, respectively). Initial evidence suggests that Pain Rounds provides an innovative and effective solution to the SCS curriculum deficit. A future controlled study should examine this digital curriculum's long-term impact on SCS practice and treatment outcomes.

Functional Alterations and Cerebral Variations in Humans Exposed to Early Life Stress.

Early life stress can be caused by acute or chronic exposure to childhood events, such as emotional, physical, sexual abuse, and neglect. Early stress is associated with subsequent alterations in physical and mental health, which can extend into adolescence, adulthood, and even old age. The effects of early stress exposure include alterations in cognitive, neuropsychological, and behavioral functions, and can even lead to the development of psychiatric disorders and changes in brain anatomy. The present manuscript provides a review of the main findings on these effects reported in the scientific literature in recent decades. Early life stress is associated with the presence of psychiatric disorders, mainly mood disorders such as depression and risk of suicide, as well as with the presence of post-traumatic stress disorder. At the neuropsychological level, the involvement of different mental processes such as executive functions, abstract reasoning, certain memory modalities, and poor school-skill performance has been reported. In addition, we identified reports of alterations of different subdomains of each of these processes. Regarding neuroanatomical effects, the involvement of cortical regions, subcortical nuclei, and the subcortical white matter has been documented. Among the telencephalic regions most affected and studied are the prefrontal cortex, the hippocampus, the amygdala, and the anterior cingulate cortex. Understanding the impact of early life stress on postnatal brain development is very important for the orientation of therapeutic intervention programs and could help in the formulation and implementation of preventive measures as well as in the reorientation of research targets.

[Impact of the COVID-19 pandemic on the Colombian population according to mitigation measures. Preliminary data from epidemiological models for the period March 18 to April 18, 2020]. / Proyecciones de impacto de la pandemia COVID-19 en la población colombiana, según medidas de mitigación. Datos preliminares de modelos epidemiológicos para el periodo del 18 de marzo al 18 de abril de 2020.

INTRODUCTION: First case of COVID-19 in Colombia was diagnosed on March 6th. Two weeks later, cases have rapidly increased, leading the government to establish some mitigation measures. OBJECTIVES: The first objective is to estimate and model the number of cases, use of hospital resources and mortality by using different R0 scenarios in a 1-month scenario (from March 18 to April 18, 2020), based on the different isolation measures applied. This work also aims to model, without establishing a time horizon, the same outcomes given the assumption that eventually 70% of the population will be infected. MATERIALS AND METHODS: Data on the number of confirmed cases in the country as of March 18, 2020 (n=93) were taken as the basis for the achievement of the first objective. An initial transmission rate of R0= 2.5 and a factor of 27 for undetected infections per each confirmed case were taken as assumptions for the model. The proportion of patients who may need intensive care or other in-hospital care was based on data from the Imperial College of London. On the other hand, an age-specific mortality rate provided by the Instituto Superiore di Sanità in Italy was used for the second objective. RESULTS: Based on the 93 cases reported as of March 18, if no mitigation measures were applied, by April 18, the country would have 613 037 cases. Mitigation measures that reduce R0 by 10% generate a 50% reduction in the number of cases. However, despite halving the number of cases, there would still be a shortfall in the number of beds required and only one in two patients would have access to this resource. CONCLUSION: This model found that the mitigation measures implemented to date by the Colombian government and analyzed in this article are based on sufficient evidence and will help to slow the spread of SARS-CoV-2 in Colombia. Although a time horizon of one month was used for this model, it is plausible to believe that, if the current measures are sustained, the mitigation effect will also be sustained over time.

Gene expression and proliferation analysis in young, aged, and osteoarthritic sheep chondrocytes effect of growth factor treatment.

Cartilage is a support tissue with a poor capacity to self-repair. Its cells, chondrocytes, are responsible for synthesizing and renewing the matrix that surrounds them in a constant turnover mechanism. Autologous chondrocyte implantation (ACI) is one of the techniques that promises to be an alternative to common strategies for chondral lesions. To apply this technique, a large amount of cells must be obtained. In our work, we studied the state of cells from different cartilage (young, aged, and osteoarthritic sheep) cultured in monolayer by analyzing their proliferation rate using bromodeoxyuridine and their gene expression profile by RT-PCR. A decrease was found in expression of type II collagen and aggrecan in aged, osteoarthritic, and passaged chondrocytes. Treatment of cells with growth factors aFGF, IGF-I, TGF-beta, and OP-1 improved the proliferation rate in all cells studied and stimulated gene expression of type II collagen, aggrecan, and TGF-beta. Osteoarthritic cells showed a poor response according to matrix gene expression, while young cells responded properly, and aged chondrocytes showed a moderate response. These results suggest that the state of cartilage may affect the behavior of cultured chondrocytes.

Proyecciones de impacto de la pandemia COVID-19 en la población colombiana, según medidas de mitigación: datos preliminares de modelos epidemiológicos para el periodo del 18 de marzo al 18 de abril de 2020 / Impact of the COVID-19 pandemic on the Colombian population according to mitigation measures: preliminary data from epidemiological models for the period March 18 to April 18, 2020

RESUMEN Objetivo Este estudio tiene como primer objetivo: realizar predicciones del curso de la infección en el horizonte temporal desde marzo 18 a abril 18 del 2020, según diferentes medidas de aislamiento aplicadas. Las predicciones incluyen, población total contagiada, mortalidad y necesidad de recursos hospitalarios. Segundo objetivo: modelar la mortalidad y la necesidad de recursos hospitalarios, estratificando por edad el escenario de contagio del 70% de la población. Métodos Para el primer objetivo, nos basamos en el número de casos confirmados en el país hasta marzo 18, 2020 (n=93). Como suposiciones para el modelo, incluimos un índice de contagio R0=2,5 y el índice de casos reales por cada caso confirmado. Para la proporción de pacientes que necesitarían cuidados intensivos u otros cuidados intrahospitalarios, nos basamos en datos aportados por el Imperial College of London. Para el segundo objetivo usamos como tasa de mortalidad por edad, datos aportados por el Instituto Superiore di Sanità en Italia. Resultados Basándonos en los 93 casos reportados al 18 de marzo, si no se aplicase ninguna medida de mitigación, para el 18 de abril el país tendría un total de 613 037 casos. Medidas de mitigación que reduzcan el R0 en un 10%, generan una reducción del 50% del número de casos. Sin embargo, a pesar de reducirse los casos a la mitad, todavía habría un déficit en el número de camas requeridas y sólo uno de cada dos pacientes tendría acceso a dicho recurso. Conclusión En nuestro modelo encontramos que las medidas de mitigación que han sido implementadas hasta la fecha por el gobierno colombiano, se fundamentan en evidencia suficiente para pensar que es posible reducir significativamente el número de casos contagiados y con esto, el número de pacientes que requerirán manejo hospitalario.(AU)

ABSTRACT Introduction First case of COVID-19 in Colombia was diagnosed on March 6th. Two weeks later, cases have rapidly increased, leading the government to establish some mitigation measures. Objectives The first objective is to estimate and model the number of cases, use of hospital resources and mortality by using different R0 scenarios in a 1-month scenario (from March 18 to April 18, 2020), based on the different isolation measures applied. This work also aims to model, without establishing a time horizon, the same outcomes given the assumption that eventually 70% of the population will be infected. Materials and Methods Data on the number of confirmed cases in the country as of March 18, 2020 (n=93) were taken as the basis for the achievement of the first objective. An initial transmission rate of R0= 2.5 and a factor of 27 for undetected infections per each confirmed case were taken as assumptions for the model. The proportion of patients who may need intensive care or other in-hospital care was based on data from the Imperial College of London. On the other hand, an age-specific mortality rate provided by the Instituto Superiore di Sanità in Italy was used for the second objective. Results Based on the 93 cases reported as of March 18, if no mitigation measures were applied, by April 18, the country would have 613 037 cases. Mitigation measures that reduce R0 by 10% generate a 50% reduction in the number of cases. However, despite halving the number of cases, there would still be a shortfall in the number of beds required and only one in two patients would have access to this resource. Conclusion This model found that the mitigation measures implemented to date by the Colombian government and analyzed in this article are based on sufficient evidence and will help to slow the spread of SARS-CoV-2 in Colombia. Although a time horizon of one month was used for this model, it is plausible to believe that, if the current measures are sustained, the mitigation effect will also be sustained over time.(AU)

Exploring epistasis in candidate genes for antisocial personality disorder.

OBJECTIVE: To identify and characterize high-order gene-to-gene interactions in antisocial personality disorder (ASPD). METHODS: Participants for case-control study were selected from the inmate male population in Bellavista prison from Medellin. The study included 310 individuals with ASPD and 200 with no ASPD. Diagnoses were made according to a best-estimate procedure based on a semistructured interview (diagnostic interview for genetic studies 3.0). We genotyped some single-nucleotide polymorphisms in candidate genes with main serotonin pathway effects. The gene-gene interaction was examined using the multifactor dimensionality reduction method version 2.0.α. We assessed model sizes of 2 and 3 loci and counted the number of replicates that contained the causal loci in the final best model that was identified using 10-fold cross validation. RESULTS: We find epistatic interaction with catechol-O-methyl transferase (COMT), tryptophan hydroxylase, and 5-HTR2A (serotonin receptor) with ASPD. This data supports an important role of polymorphism in serotonin receptors and low enzyme activity of COMT for susceptibility to ASPD. CONCLUSION: This study suggests that gene interactions between genetic variants in COMT, 5-HTR2A and tryptophan hydroxylase gene would be associated with ASPD and influence the dopamine rewards pathways and modulate serotonin levels in ASPD.

La crisis del sistema de salud colombiano / The Crisis in the Colombian Healthcare System

A raíz de la propuesta de ley que cursa en el Congreso de la República y reforma el sistema de salud en nuestro país, se ha generado un movimiento nacional sin precedentes, en el cual participan todas las agremiaciones médicas. Partiendo desde los estudiantes de pregrado y posgrado de Medicina, los docentes del área de salud, la mayoría de las facultades de Medicina y las asociaciones científicas, se ha elevado un clamor general de «no a la reforma¼. Difícilmente puede verse tanta unanimidad y coincidencia en todo un gremio, solo unos pocos, encabezados por el Gobierno Nacional, persisten en intentar que salga adelante.

As a result of the proposed law in the Congress of the Republic that reforms the health system in our country, an unprecedented national movement has been generated, in which all medical associations are participating. Starting with undergraduate and postgraduate medical students, teachers in the health area, the majority of medical schools and scientific associations, a general clamor of "no to the reform" has arisen. It is difficult to see such unanimity and coincidence in an entire guild, only a few, led by the National Government, persist in trying to push it through.

El compromiso debe ser de todos / Commitment Must Be Shared

La Asociación Colombiana de Psiquiatría continúa trabajando en diferentes áreas (gremial y científica), con el objetivo de fortalecer el ejercicio profesional de sus asociados. Desde el punto de vista científico, como han podido observar, la Revista, medio de comunicación de la producción del conocimiento de los profesionales en salud mental tanto nacional como internacional, está encaminada a continuar mejorando su calidad, su producción y su visibilidad dentro y fuera del país. El esfuerzo realizado por las diferentes instancias de la Asociación en el ingreso a la Editorial Elsevier es incalculable.

The Colombian Association of Psychiatry continues to work in different areas (union and scientific), with the aim of strengthening the professional practice of its associates. From a scientific point of view, as they have been able to observe, the Journal, a means of communication for the production of knowledge of both national and international mental health professionals, is aimed at continuing to improve its quality, its production and its visibility inside and outside from the country. The effort made by the different instances of the Association in joining Editorial Elsevier is incalculable.

In vitro healing of avascular meniscal injuries with fresh and frozen plugs treated with TGF-beta1 and IGF-1 in sheep.

We studied the effect of freezing and inserting meniscal plugs in lesions generated in the avascular area of sheep menisci maintained in vitro, and whether the healing process can be improved by adding growth factors TGF-beta1 and IGF-1. Thirty six menisci obtained from healthy 3 months-old sheep were cultured in 6 well plates and holes were perforated in the avascular area. Meniscal plugs, either fresh or frozen at -20 degrees C for 1 month, were used to fill in the lesions, and then cultured in the presence or absence of TGF-beta1 or IGF-1 for 8 weeks. Samples stained with Massons trichrome were analyzed to evaluate the attachment of the plug and the cell density of the tissue. BrdU immunohistochemistry was performed to identify the proliferation of meniscal cells. Both growth factors improved considerably the cell density of implanted plugs. TGF-beta1 increased significantly the attachment of both fresh and frozen plugs, but it had no effect on meniscal cell proliferation. In contrast, IGF-1 had no effect on the attachment, but did increase significantly the number of proliferating cells in the surface of the host meniscus and the inserted plug. In conclusion, frozen plugs can survive if treated with either TGF-beta1 or IGF-1. The combination of TGF-beta1 and IGF-1 could aid in the repairing of the avascular meniscal injuries, as they are capable of promoting the attachment of tissue, and increasing the proliferation of meniscal cells.

Cell viability and protein composition in cryopreserved cartilage.

Chondrocyte survival in frozen-stored osteochondral allografts is low. We analyzed different storage conditions to determine the best for maintenance or storage for preserving cartilage. We hypothesized cell viability and extracellular protein content could be improved with better cryopreservation. Articular cartilage from nine sheep femoral condyles were stored at 4 degrees C, -80 degrees C, and -196 degrees C with and without cryopreservative agents for 1 month. We determined cell viability and performed Western blot analysis for TGF-beta, IGF-1, and MMP-2, 9, and 13. We observed decreases in viability in cartilage stored at 4 degrees C: 36.2% viability when stored without solution, 40.4% in phosphate-buffered saline, and 48.1% in culture medium. TGF-beta and IGF-1 decreased in the first week in all groups. The groups stored at -80 degrees C and -196 degrees C contained less protease in the last 2 weeks. In the groups stored at 4 degrees C in phosphate-buffered saline, we detected no increase in the levels of MMPs. Our data discourage the use of frozen cartilage because of the decrease of cell viability and elevation in MMPs. However, modifying the freezing conditions might moderate these changes and improve the state of preserved cartilage.

Aspectos neurobiológicos de la psicopatía / Neurobiological aspects of psychopathy

La psicopatía es un constructo psiquiátrico caracterizado por un patrón permanente de déficit afectivo y una falta de respeto por los derechos de los demás y por las normas sociales. El término equivale al "trastorno de personalidad antisocial" DSM-IV-TR y al "Trastorno disocial de personalidad" de la Clasificación Internacional de Enfermedades (CIE-10). Los individuos afectados comienzan a presentar características psicopáticas desde la niñez, son propensos a involucrarse en conductas criminales pero no a resocializarse con los programas penitenciarios, y reinciden con más rapidez, crueldad y violencia que los criminales no psicópatas. La etiopatogenia parece basarse en la interacción compleja de factores biológicos y psicosociales. El objetivo del presente artículo es presentar una revisión actualizada de los aspectos neurobiológicos de la psicopatía entre los cuales se encuentran los obstétricos, neuroanatómicos, neuroquímicos y genéticos.

Psychopathy is a psychiatric construct characterized by a permanent pattern of affective deficit, and a lack of respect for the rights of other people and the social norms. The term is equivalent to the "Antisocial personality disorder" of the DSMIV-TR, and to the "Dissocial personality disorder" of the CIE-10. Since childhood, the affected individuals begin to display psychopathic characteristics and they have tendency to become involved in criminal behaviors but not to resocialice themselves with penitentiary programs; they reoffend more rapidly, with more cruelty and violence than non-psychopathic criminals. Etiopathogenesis of psychopathy is based on the complex interaction of biological and psychosocial factors. The objective of the present article is to provide an updated review about the neurobiological aspects of psychopathy among them the obstetric, neuroanatomical, neurochemical and genetic

Diarrea diabética: una entidad específica / Diabetic diarrhea: a specific entity

Se expresa que el síndrome diarreico es la piedra angular para una orientación terapéutica adecuada. Se indica que en la práctica diaria ocurre con frecuencia que un diabético concurre a una consulta de atención primaria por diarreas, y éstas constituyen una complicación intercurrente durante el ingreso hospitalario. Se revisa la causa del síndrome diarreico, así como las principales manifestaciones clínicas y el tratamiento. Se concluye que ésta es una manifestación sui generis de la enfermedad, que requiere conocimiento médico actualizado para su abordaje integral

Estudio técnico sobre manejo de residuos sólidos hospitalarios de la ciudad Ntra. Sra. de la Asunción

Estudio orientado hacia el análisis de los sistemas utilizados para el manejo de aquellos desperdicios sólidos que se producen dentro de los hospitales y sanatorios existentes en la ciudad de Ntra. Sra. de la Asunción (Paraguay), Indica un servicio de recolección, transporte y disposición final (incineradores de basuras patológicas) a todos los establecimientos asistenciales, para contribuir a: evitar el riesgo de la propagación de enfermedades infecciosas; brindar una mayor protección tanto a pacientes como a empleados del establecimiento; disminuir los costos de recolección, transporte y disposición por mejor aprovechamiento de los recursos existentes. Incluye gráfico de un sistema adecuado para su manejo, así como un proyecto sobre norma sanitaria