The Burden of Narcolepsy in Adults: A Population Sampling Study Using Personal Media.

OBJECTIVE: To obtain insight in the spectrum of narcolepsy symptoms and associated burden in a large cohort of patients. METHODS: We used the Narcolepsy Monitor, a mobile app, to easily rate the presence and burden of 20 narcolepsy symptoms. Baseline measures were obtained and analyzed from 746 users aged between 18 and 75 years with a reported diagnosis of narcolepsy. RESULTS: Median age was 33.0 years (IQR 25.0-43.0), median Ullanlinna Narcolepsy Scale 19 (IQR 14.0-26.0), 78% reported using narcolepsy pharmacotherapy. Excessive daytime sleepiness (97.2%) and lack of energy were most often present (95.0%) and most often caused a high burden (79.7% and 76.1% respectively). Cognitive symptoms (concentration 93.0%, memory 91.4%) and psychiatric symptoms (mood 76.8%, anxiety/panic 76.4%) were relatively often reported to be present and burdensome. Conversely, sleep paralysis and cataplexy were least often reported as highly bothersome. Females experienced a higher burden for anxiety/panic, memory, and lack of energy. CONCLUSIONS: This study supports the notion of an elaborate narcolepsy symptom spectrum. Each symptom's contribution to the experienced burden varied, but lesser-known symptoms did significantly add to this as well. This emphasizes the need to not only focus treatment on the classical core symptoms of narcolepsy.

[Long-term results of the early endoscopic treatment of acquired tracheal-subglottic stenosis: 10 years of experience]. / Resultados a largo plazo del tratamiento endoscópico precoz de las estenosis subglóticas y traqueales adquiridas: 10 años de experiencia.

INTRODUCTION: Acquired stenosis of the airway is a common complication after endotracheal intubation. Endoscopic dilation has been accepted as the treatment of choice in cases detected precociously. Our goal is to know the current status of the patients treated in our hospital with endoscopic dilation in the last 10 years. MATERIAL AND METHODS: Retrospective cohort study of patients with subglottic and tracheal acquired stenosis (STAS) early treated endoscopically with balloon dilation at our center in the last 10 years. Bronchoscopy control at 2 weeks, a month, 3 and 6 months post-dilation were performed and later on depending on the symptoms. RESULTS: 32 patient were treated in the period considered. The median age was 4.5 (3-120) months. There were necessary 2.5 (1-5) dilations per patient. All cases were extubated in the operating room or in the following 24 hours. There were no complications during the procedure. Follow-up time was 6 (1-10) years. Only 1 of the 32 patients have had recurrence of stenosis 2 years after, it was secondary to reintubations due to new surgical interventions; which it was dilated successfully. CONCLUSIONS: Early endoscopic dilation in the acquired airway stenosis is a safe and effective long-term procedure. The results support the use of this technique as a treatment of choice in these patients.

INTRODUCCION: La estenosis adquirida de la vía aérea es una complicación frecuente tras la intubación endotraqueal. La dilatación endoscópica ha sido aceptada como tratamiento de elección en los casos detectados de forma precoz. Nuestro objetivo es conocer el estado actual de los pacientes tratados en nuestro centro mediante dilatación endoscópica en los últimos 10 años. MATERIAL Y METODOS: Estudio de cohorte retrospectivo de pacientes con estenosis subglóticas y traqueales adquiridas (ESTA) tratadas endoscópicamente mediante dilatación con balón en nuestro centro en los últimos 10 años. Se realizaron broncoscopias de control a las 2 semanas, al mes, a los 3 y 6 meses postdilatación y posteriormente en función de la clínica. RESULTADOS: Se trataron 32 pacientes de ESTA de reciente aparición en dicho periodo. La mediana de edad fue de 4,5 (3-120) meses. Fueron necesarias 2,5 (1-5) dilataciones por paciente. Todos los pacientes fueron extubados en quirófano o en las 24 horas siguientes al procedimiento. No hubo complicaciones durante los procedimientos ni durante el postoperatorio. El tiempo de seguimiento fue de 6 (1-10) años. Solo 1 de los 32 pacientes presentó recidiva de la estenosis 2 años después que fue secundaria a reintubaciones por nuevas intervenciones quirúrgicas; la cual se dilató nuevamente. CONCLUSIONES: La dilatación endoscópica precoz en las estenosis adquiridas de la vía aérea es un procedimiento seguro y eficaz a largo plazo. Los resultados avalan el uso de esta técnica como tratamiento de elección en estos pacientes.

[Intestinal complications in twin-to-twin transfusion syndrome (TTTS) treated by laser coagulation (LC)]. / Complicaciones intestinales en el síndrome de trasfusión feto fetal (STFF).

AIM OF THE STUDY: The hemodynamic imbalance due to placental vascular anastomoses in TTTS but also vascular changes generated after intrauterine treatment may lead to hypoxic-ischemic complications. Different intestinal complications in TTTS are reviewed in this paper. METHODS: Retrospective review of TTTS cases treated by laser coagulation (LC) from 2012-2015. Demographic data, fetal therapy, prenatal diagnosis (US, MRI) and perinatal outcome were recorded. We describe cases with intestinal complications and their postnatal management. Results are expressed by median and range. RESULTS: 29 monochorionic pregnancies with TTTS were treated (23 LC, 4 cord occlusions and 2 cord occlusions after LC). The diagnosis was made at 19 (16-26) weeks and 86% presented stage of Quintero ≥ II. In 70% of mothers survived at least one fetus with a median of 31 (24-37) weeks at birth. Four patients had intestinal complications (1 jejunal atresia, 2 ileal atresia, 1 perforated necrotizing enterocolitis), half of them had prenatal diagnosis. Postnatal resections of the affected segments and ostomies were performed. Intestinal transit was restored and there were no severe digestive sequelae after 21 (8-38) months of follow up. CONCLUSIONS: Different types of intestinal complications were associated with TTTS and LC. US and MRI enable prenatal diagnosis of these complications and this allows prompt decisions after birth.

INTRODUCCION: El desequilibrio hemodinámico secundario a la presencia de anastomosis vasculares placentarias en el STFF así como los cambios hemodinámicos generados durante y tras su tratamiento mediante fotocoagulación con láser (FC) puede dar lugar a complicaciones hipóxico-isquémicas en distintos sistemas. Revisamos nuestra experiencia en el tratamiento del STFF con FC y presentamos las complicaciones intestinales encontradas. MATERIAL Y METODOS: Estudio retrospectivo de casos tratados intraútero entre 2012 y 2015. Recogimos datos sociodemográficos, terapia fetal, pruebas diagnósticas prenatales (ecografía, RM) y resultados perinatales. Expresamos las medidas en medianas y rangos. RESULTADOS: Se procedió al tratamiento intraútero de 29 gestaciones monocoriales complicadas con STFF (23 FC, 4 oclusiones de cordón y 2 FC seguidas de oclusión). La edad gestacional en el procedimiento fue 19 (16-26) semanas y en el 86% de los casos se trataba de un estadio de Quintero ≥ II. El 70% de las madres tuvieron al menos 1 recién nacido vivo, con mediana de edad gestacional al parto de 31 (24-37) semanas. Presentaron problemas intestinales 4 pacientes (1 atresia yeyunal, 2 atresias ileales, 1 enterocolitis necrotizante con perforación), con sospecha prenatal diagnóstica en 2 de ellos. Postnatalmente se realizó resección del segmento afecto y ostomía. Actualmente se ha restablecido el tránsito intestinal en todos sin secuelas digestivas graves tras 21(8-38) meses de seguimiento. CONCLUSIONES: Hemos descrito distintos tipos de complicaciones intestinales asociadas al STFF y/o su tratamiento con FC. Es posible hacer el diagnóstico prenatal de dichas complicaciones mediante ecografía y RM. Su conocimiento pone al cirujano en alerta y es importante en la toma de decisiones postnatales.

Optimal short-time acquisition schemes in high angular resolution diffusion-weighted imaging.

This work investigates the possibilities of applying high-angular-resolution-diffusion-imaging- (HARDI-) based methods in a clinical setting by investigating the performance of non-Gaussian diffusion probability density function (PDF) estimation for a range of b-values and diffusion gradient direction tables. It does so at realistic SNR levels achievable in limited time on a high-performance 3T system for the whole human brain in vivo. We use both computational simulations and in vivo brain scans to quantify the angular resolution of two selected reconstruction methods: Q-ball imaging and the diffusion orientation transform. We propose a new analytical solution to the ODF derived from the DOT. Both techniques are analytical decomposition approaches that require identical acquisition and modest postprocessing times and, given the proposed modifications of the DOT, can be analyzed in a similar fashion. We find that an optimal HARDI protocol given a stringent time constraint (<10 min) combines a moderate b-value (around 2000 s/mm(2)) with a relatively low number of acquired directions (>48). Our findings generalize to other methods and additional improvements in MR acquisition techniques.

[Experimental model of amniotic band in rats: model description and initial morphological study]. / Modelo experimental de brida amniótica en ratas: descripción del modelo y estudio morfológico inicial.

PURPOSE: Our objective is to describe a new experimental model of amniotic band in rats and to show the initial morphological results. METHODS: The model was created by ligation of a hind limb with silk on day 17 of gestation; in selected fetuses ligation was withdrawn on day 19 of gestation. Fetuses were removed by cesarean section on day 21 of gestation, analyzing their weights and morphological characteristics of their hind legs. We used 10 pregnant SD rats, weighing 263 g (231-279). One hundred and thirteen fetuses were analyzed divided into 6 groups: fetuses from control rats (n=28), uterine opening and closing (n=7), band creation (n=28), band creation and subsequent removal (n=14) and not intervened fetuses of the litters in which the band was created (n=19) and that the band was created and removed (n=17). Comparisons between groups were made using parametric tests considering p<0.05 as a threshold for significance. RESULTS: Operated fetuses (band creation and band creation and removal) showed statistically significant differences in weight (mean=4.56 g and 4.4 g) and length of their hind limbs (mean=3.97 mm and 5.34 mm) compared to the rest of the groups. The rate of abortions in operated fetuses was 16.6% and the rate of amputations was 8.3%. DISCUSSION: A viable and reproducible experimental model of amniotic band is described, with potential applications in both the study of the disease and the role of fetal surgery thereon.

A method for the quantification of the pressure dependent 3D collagen configuration in the arterial adventitia.

Collagen plays an important role in the response of the arterial wall to mechanical loading and presumably has a load-bearing function preventing overdistension. Collagen configuration is important for understanding this role, in particular in mathematical models of arterial wall mechanics. In this study a new method is presented to image and quantify this configuration. Collagen in the arterial adventitia is stained with CNA35, and imaged in situ at high resolution with confocal microscopy at luminal pressures from 0 to 140mm Hg. The images are processed with a new automatic approach, utilizing techniques intended for MRI-DTI data. Collagen configuration is quantified through three parameters: the waviness, the transmural angle and the helical angle. The method is demonstrated for the case of carotid arteries of the white New Zealand rabbit. The waviness indicated a gradual straightening between 40 and 80mm Hg. The transmural angle was about zero indicating that the fibers stayed within an axial-circumferential plane at all pressures. The helical angle was characterized by a symmetrical distribution around the axial direction, indicating a double symmetrical helix. The method is the first to combine high resolution imaging with a new automatic image processing approach to quantify the 3D configuration of collagen in the adventitia as a function of pressure.

Quantitative fiber tracking in the corpus callosum and internal capsule reveals microstructural abnormalities in preterm infants at term-equivalent age.

BACKGROUND AND PURPOSE: Signal-intensity abnormalities in the PLIC and thinning of the CC are often seen in preterm infants and associated with poor outcome. DTI is able to detect subtle abnormalities. We used FT to select bundles of interest (CC and PLIC) to acquire additional information on the WMI. MATERIALS AND METHODS: One hundred twenty preterm infants born at <31 weeks' gestation with 3T DTI at TEA entered this prospective study. Quantitative information (ie, volume, length, anisotropy, and MD) was obtained from fiber bundles passing through the PLIC and CC. A general linear model was used to assess the effects of factor (sex) and variables (GA, BW, HC, PMA, and WMI) on FT-segmented parameters. RESULTS: Seventy-two CC and 85 PLIC fiber bundles were assessed. For the CC, increasing WMI and decreasing FA (P = .038), bundle volume (P < .001), and length (P = .001) were observed, whereas MD increased (P = .001). For PLIC, MD increased with increasing WMI (P = .002). Higher anisotropy and larger bundle length were observed in the left PLIC compared with the right (P = .003, P = .018). CONCLUSIONS: We have shown that in the CC bundle, anisotropy was decreased and diffusivity was increased in infants with high WMI scores. A relation of PLIC with WMI was also shown but was less pronounced. Brain maturation is affected more if birth was more premature.

Automatic Detection and Visualization of Qualitative Hemodynamic Characteristics in Cerebral Aneurysms.

Cerebral aneurysms are a pathological vessel dilatation that bear a high risk of rupture. For the understanding and evaluation of the risk of rupture, the analysis of hemodynamic information plays an important role. Besides quantitative hemodynamic information, also qualitative flow characteristics, e.g., the inflow jet and impingement zone are correlated with the risk of rupture. However, the assessment of these two characteristics is currently based on an interactive visual investigation of the flow field, obtained by computational fluid dynamics (CFD) or blood flow measurements. We present an automatic and robust detection as well as an expressive visualization of these characteristics. The detection can be used to support a comparison, e.g., of simulation results reflecting different treatment options. Our approach utilizes local streamline properties to formalize the inflow jet and impingement zone. We extract a characteristic seeding curve on the ostium, on which an inflow jet boundary contour is constructed. Based on this boundary contour we identify the impingement zone. Furthermore, we present several visualization techniques to depict both characteristics expressively. Thereby, we consider accuracy and robustness of the extracted characteristics, minimal visual clutter and occlusions. An evaluation with six domain experts confirms that our approach detects both hemodynamic characteristics reasonably.

GPU-Based Ray-Casting of Spherical Functions Applied to High Angular Resolution Diffusion Imaging.

Abstract-Any sufficiently smooth, positive, real-valued function ψ : S(2) → K+ on a sphere S(2) can be expanded by a Laplace expansion into a sum of spherical harmonics. Given the Laplace expansion coefficients, we provide a CPU and GPU-based algorithm that renders the radial graph of ψ in a fast and efficient way by ray-casting the glyph of ψ in the fragment shader of a GPU. The proposed rendering algorithm has proven highly useful in the visualization of high angular resolution diffusion imaging (HARDI) data. Our implementation of the rendering algorithm can display simultaneously thousands of glyphs depicting the local diffusivity of water. The rendering is fast enough to allow for interactive manipulation of large HARDI data sets.

Optimal acquisition schemes in high angular resolution diffusion weighted imaging.

The recent challenge in diffusion imaging is to find acquisition schemes and analysis approaches that can represent non-gaussian diffusion profiles in a clinically feasible measurement time. In this work we investigate the effect of b-value and the number of gradient vector directions on Q-ball imaging and the Diffusion Orientation Transform (DOT) in a structured way using computational simulations, hardware crossing-fiber diffusion phantoms, and in-vivo brain scans. We observe that DOT is more robust to noise and independent of the b-value and number of gradients, whereas Q-ball dramatically improves the results for higher b-values and number of gradients and at recovering larger angles of crossing. We also show that Laplace-Beltrami regularization has wide applicability and generally improves the properties of DOT. Knowledge of optimal acquisition schemes for HARDI can improve the utility of diffusion weighted MR imaging in the clinical setting for the diagnosis of white matter diseases and presurgical planning.

Prognostic value of the interpectoral lymph nodes in breast cancer. A 20-year survival study.

INTRODUCTION: The indication and extent of axillary lymph node dissection in breast cancer remains open to controversy. MATERIALS AND METHOD: In this context, a 20-year survival study has been made of 1600 breast cancer patients subjected during surgical treatment to systematic dissection of the acromiothoracic vascular pedicle together with the accompanying lymph nodes (Rotter and Grossman interpectoral lymph node groups). An anatomical study of these nodes was also conducted in 100 necropsies, with the evaluation of 200 acromiothoracic vascular pedicles. RESULTS: The interpectoral lymph nodes were anatomically present in 42% of the necropsies and in 35.1% of the patients subjected to surgery. The prognosis was much worse in cases of neoplastic infiltration of the interpectoral lymph nodes (Kaplan-Meier survival study), regardless of the influence of other prognostic factors. CONCLUSIONS: In view of the results obtained, the designation of grade N3 of the TNM classification is proposed for malignancies with positive interpectoral lymph node infiltration.

Hourglass thoracic lipoma of infancy: case report and review of the literature.

The authors present a case of lipoma in infancy. A 12-year-old boy was referred for an asymptomatic fast-growing thoracic tumor of 1-month evolution. A simple chest x-ray showed an intra- and extrathoracic mass of extrapleural localization. Ultrasound scan and computed tomography studies were performed, and the diagnosis of an hourglass lipoma was confirmed by a fine-needle aspiration biopsy. Surgical excision of the tumor was performed and the pathological study reassessed the initial diagnosis of lipoma. The thoracic lipoma is a benign disease and has a good evolution after surgery.

[Latin American psychology: a two-way start]. / Psicología latinoamericana: un comienzo bifronte.

Two main trends can be found in psychological historiography, both streaming from discipline: on one hand the Central-European trend, phenomenological and dealing with inner life, and on the other, the Anglo-American trend, empirical and pragmatic. Latin America has reflected this cultural phenomenon in an extreme shadeless manner which had a clear influence in undergraduate schools. Modern psychology tendencies, however, don't allow the continuity of such a state of matters, and this has begun to reflect in the academic atmosphere of the region.

[Psychic self-activity: history and currently of a construct]. / Autoactividad psíquica: historia y actualidad de un constructo.

The psychic self-activity is a hypothetical construct meant to describe and explain the mental processes which are not entirely generated by environmental stimuli nor by the need of eliminating internal stimuli. It emphasizes the proactive behavior led by curiousity, the exploratory urge and the psychic drive increase. Initially conceived by philosophers and the intuitive psychologists, this construct tends to disentangle from that speculative past and to focus on the empirical research.

[The places of mind]. / Los lugares de la mente.

The Sciences of the Mind have gained specific fields in the knowledge upgrading achieved by the relevant scientists and theorists. Three are the best known types of classification, the ones with religious origins excluded: the one of the Mediterranean Ancient civilization, focused on the faculties of the soul; the naturalistic approach based on the complexity levels of the matter; and the bipolar one which separates the Social Sciences from the Natural ones. The places that Man conceives for the Psychological Sciences reflect its ideological status upon the Nature of the Mind.

Los lugares de la mente / [The places of mind]

The Sciences of the Mind have gained specific fields in the knowledge upgrading achieved by the relevant scientists and theorists. Three are the best known types of classification, the ones with religious origins excluded: the one of the Mediterranean Ancient civilization, focused on the faculties of the soul; the naturalistic approach based on the complexity levels of the matter; and the bipolar one which separates the Social Sciences from the Natural ones. The places that Man conceives for the Psychological Sciences reflect its ideological status upon the Nature of the Mind.