Enhancing Fatigue Resistance in Asphalt Mixtures with a Novel Additive Derived from Recycled Polymeric Fibers from End-of-Life Tyres (ELTs).

Waste-tire textile fibers (WTTF) represent a challenge for the recycling industry since there are currently very few alternatives for their use. In this study, an evaluation of the effect of a new additive developed in two granular formats from WTTF on the fatigue behavior of asphalt mixtures was performed. For the first format of the WTTF-based additive, its effect was evaluated on hot-mix asphalt (HMA), while for the second format of the additive, the effects were evaluated on stone mastic asphalt (SMA). This second format represents an alternative that allows for the total replacement of the cellulose stabilizing additive used in the reference mix. The evaluation of fatigue damage in the mixes was performed using the four-point bending beam (4PB) test specified in European standard EN 12697-24. The test results show that the asphalt mixtures manufactured with WTTF-based additives exhibited a higher capacity to resist load cycles before failure compared to the reference mixtures. Likewise, once the asphalt mixtures were evaluated in a pavement structure by means of an empirical mechanistic analysis, the pavement structures composed of asphalt mixtures with WTTF-based additives showed significant improvements in their durability for the different load axes evaluated. For an average thickness of 15 cm of asphalt mix of a pavement-type structure, the use of the WTTF additive increases the durability of the structures by up to 129% and 112% compared to the HMA and SMA reference mixtures, respectively. These results show that both formats of the WTTF-based admixture improve the fatigue damage resistance of the HMA and SMA asphalt mixtures.

Posible Bruxismo en Calidad de Vida Relacionada con la Salud Oral en Pacientes que Tuvieron y no SARS CoV-2

La pandemia por SARS-CoV2 cambió el ritmo de vida habitual y como consecuencia tuvo influencia para el desarrollo de situaciones parafuncionales, como el posible bruxismo, generando una huella en la calidad de vida. Determinar el posible bruxismo en la calidad de vida relacionada con la salud oral (CVRSO) en pacientes que tuvieron y no SARS-Cov2 en Yucatán, México, durante junio-diciembre de 2021. estudio correlacional, descriptivo, transversal, participaron 119 sujetos del estado de Yucatán que presentaron y no SARS-CoV2 a través de la aplicación de forma virtual en la plataforma Google Forms de dos cuestionarios digitalizados: el primero para la medición del posible bruxismo elaborado y adaptado por la Dra. Celia Elena del Perpetuo Socorro Mendiburu-Zavala con base en los autores Ordóñez-Plaza et al. (2016), González-Emsoto et al. (2015) y De La Hoz-Aizpurua & Winocur (2014). Para el estudio de la CVRSO se empleó el OHIP-14 diseñado por Castrejón-Pérez et al. (2010). Utilizando pruebas estadísticas como Ji Cuadra, Kruskal-Wallis y la prueba U de Mann-Whitney para identificar factores de asociación. Resultados: con respecto a la prevalencia del posible bruxismo en sujetos con SARS-CoV2 (n=43) según la edad, los adultos maduros (36 a 59 años) y mayores (de 60 años y más), presentaron mayores porcentajes que los jóvenes (18 a 35 años). Para determinar el efecto del posible bruxismo en la CVRSO en personas que tuvieron y no SARS-CoV2 se utilizó la prueba estadística de Kruskal-Wallis, no se encontraron diferencias estadísticamente significativas entre ninguno de los grupos (c ∑ = 2.87; p = .411). El efecto del posible bruxismo en la CVRSO en personas que tuvieron y no SARS-CoV2 no tiene un efecto estadísticamente significativo. Sin embargo, el posible bruxismo altera la CVRSO y sí hay una fuerte influencia de factores como la edad y contexto cultural.

The SARS-CoV-2 pandemic changed the usual rhythm of life and therefore had an influence for the development of parafunctional situations, such as possible bruxism, generating an imprint on quality of life. To determine possible bruxism in oral health-related quality of life (OHRQoL) in patients who did and did not have SARS- CoV-2 in Yucatan, Mexico, during June-December 2021. Materials and methods: correlational, descriptive, cross- sectional study, 119 subjects from the state of Yucatan who did and did not present SARS-CoV-2 participated through the virtual application in the Google Forms platform of two digitized questionnaires: the first for the measurement of possible bruxism elaborated and adapted by Dr. Celia Elena del Perpetuo Socorro Mendiburu-Zavala based on the authors Ordóñez Plaza et al. (2016), González-Emsoto et al. (2015), and De La Hoz-Aizpurua & Winocur (2014). For the study of the OHRQoL the OHIP-14 designed by Castrejón-Pérez et al. was used. They were used statistical tests such as Ji Cuadra, Kruskal-Wallis and the Mann- Whitney U test to identify factors of association. Results: regarding the prevalence of possible bruxism in subjects with SARS-CoV-2 (n=43) according to age, mature adults (36 to 59 years) and older adults (60 years and older) presented higher percentages than young adults (18 to 35 years). To determine the effect of possible bruxism on OHRQoL in people who did and did not have SARS-CoV-2, the Kruskal- Wallis statistical test was used; no statistically significant differences were found between any of the groups (c∑ = 2.87; p = .411). the effect of possible bruxism on OHRQoL in subjects who did and did not have SARS-CoV-2 did not have a statistically significant effect. However, possible bruxism did alter OHRQoL and there was a strong influence of factors such as age and cultural context.

Effect of a New Additive Based on Textile Fibres from End-of-Life Tyres (ELT) on the Mechanical Properties of Stone Mastic Asphalt.

Stone Mastic Asphalts (SMA) are asphalt mixes with discontinuous granulometry and a high content of asphalt binder. In order to prevent draindown of the asphalt binder and ensure good performance, these mixes must be strengthened with cellulose or mineral fibres and/or polymer additives. This study was designed to evaluate the effect of a granular additive based on waste tyre textile fibres (WTTF), developed as a replacement for cellulose commercial additives in SMA mixes. Use of the WTTF-based additive will encourage the development of sustainable mixes by recycling a by-product of end-of-life tyres (ELT), which currently constitute a major environmental problem around the world. To this end, in the present experimental study we evaluated the replacement of cellulose-based commercial fibre with different percentages of WTTF-based additive (0%, 50%, 75%, 100%) in an SMA asphalt mix. The following design and performance properties were evaluated: resistance to cracking, stiffness modulus, sensitivity to moisture, and resistance to permanent deformation. The results indicated that replacing 100% of the cellulose commercial additive in the SMA mix by the WTTF-based additive allowed the mix to meet its design properties and showed good performance in the mechanical properties evaluated, with behaviour similar to that of the reference SMA mix.

Study of the Effect of the Use of Asphalt Binders Modified with Polymer Fibres from End-of-Life Tyres (ELT) on the Mechanical Properties of Hot Mix Asphalt at Different Operating Temperatures.

Processing of end-of-life tyres (ELT) produces polymer fibres (PFELT) as a by-product. PFELT currently presents a challenge to the recycling industry, due to the increasing numbers of ELT and lack of alternatives for the re-use of this material. The object of this investigation was to propose an alternative for re-using PFELT, in order to improve the performance properties of hot mix asphalt (HMA). This study enabled us to understand the relation between the addition of polymer fibre to the aggregate-binder matrix of the HMA in depth, as well as its effects on the mechanical properties of the resulting asphalt mix. To do this, we first made a physical and chemical characterization of the PFELT (TGA, SEM, polarized light, and fluorescence microscopy), establishing a modification methodology using two asphalt binders (CA-24 and CA-14) and three PFELT contents (0.1%, 0.3%, and 0.5%). The HMA was designed using the Marshall method. The mechanical performance of the HMA was evaluated in a range of operating temperatures, from -10 °C to 50 °C, observing the following properties: (1) resistance to thermal cracking; (2) stiffness modulus; (3) indirect tensile strength; and (4) resistance to permanent deformation. The results show that the addition of 0.3% and 0.5% of PFELT to the asphalt binder significantly improved the mechanical performance properties of the mixes studied, with a greater effect at high operating temperatures; the resistance to permanent deformation increased by more than 30%.

Clinical Efficacy of SARS-CoV-2 Vaccination in Hemodialysis Patients.

Introduction: The COVID-19 pandemic is a global public health problem. Patients with end-stage renal disease on hemodialysis are at a higher risk of infection and mortality than the general population. Worldwide, a vaccination campaign has been developed that has been shown to reduce severe infections and deaths in the general population. However, there are currently limited data on the clinical efficacy of vaccinations in the hemodialysis population. Methods: A national multicenter observational cohort was performed in Chile to evaluate the clinical efficacy of anti-SARS-CoV-2 vaccination in end-stage renal disease patients on chronic hemodialysis from February 2021 to August 2021. In addition, the BNT162b2 (Pfizer-BioNTech) and CoronaVac (Sinovac) vaccines were evaluated. The efficacy of vaccination in preventing SARS-CoV-2 infection, hospitalizations, and deaths associated with COVID-19 was determined. Results: A total of 12,301 patients were evaluated; 10,615 (86.3%) received a complete vaccination (2 doses), 490 (4.0%) received incomplete vaccination, and 1196 (9.7%) were not vaccinated. During follow-up, 1362 (11.0%) patients developed COVID-19, and 150 died (case fatality rate: 11.0%). The efficacy of the complete vaccination in preventing infection was 18.1% (95% confidence interval [CI]:11.8-23.8%), and prevention of death was 66.0% (95% CI:60.6-70.7%). When comparing both vaccines, BNT162b2 and CoronaVac were effective in reducing infection and deaths associated with COVID-19. Nevertheless, the BNT162b2 vaccine had higher efficacy in preventing infection (42.6% vs. 15.0%) and deaths (90.4% vs. 64.8%) compared to CoronaVac. Conclusion: The results of our study suggest that vaccination against SARS-CoV-2 in patients on chronic hemodialysis was effective in preventing infection and death associated with COVID-19.

Inclusion of the Symbol Digit Modalities Test in a revised assessment of 'no evidence of disease activity-4 (NEDA-4)' in Latin-American patients with multiple sclerosis.

BACKGROUND: In relapsing-remitting multiple sclerosis (RRMS), no evidence of disease activity-3 (NEDA-3) is defined as the absence of: (1) relapses; (2) disability progression; (3) MRI activity (new/enlarged T2 lesions and/or gadolinium-enhanced T1 lesions). NEDA-4 status is defined as meeting all NEDA-3 criteria plus having an annualized percentage brain volume change (a-PBVC) >-0.4%. In individual patients, brain volume assessment is confounded with normal aging, methodological limitations and fluid-shift related fluctuations in brain volume. Cognitive impairment has been proposed as another component that should be integrated into therapeutic algorithms for RRMS. We aim to determine the proportion of patients failing to meet NEDA-4 criteria and to appraise whether the Symbol Digit Modalities Test (SDMT) is capable of replacing a-PBVC as one of the components of NEDA-4. We hypothesize that NEDA-4 has the potential to capture the impact of DMT therapies in RRMS. METHODS: Forty-five patients were prospectively followed 1 and 2 years after their baseline assessment at the University of Chile Hospital. SIENA software was used to assess a-PBVC. RESULTS: At baseline, the patients had a mean age of 33.0 years (range 18-57), disease duration of 1.9 years (0.4-4), Expanded Disability Status Scale score of 1.3 (0-4), and 67% were female. The majority had RRMS (91% while 9% had clinically isolated syndrome (CIS)). Seventy-three percent were on the so-called first line DMTs such as interferons (53%), glatiramer acetate (13%), teriflunomide (9%), and 18% were on fingolimod. There was a serial decline in the proportion of NEDA: after 1 and 2 years of follow-up 60% and 47% met NEDA-3 status, and 38% and 27% met NEDA-4, respectively. At the last follow-up 21% remained on interferons, 47% were now on fingolimod, 4% on alemtuzumab and 2% on natalizumab. At year 1 and year 2, with the replacement of a-PBVC by SDMT, 53% and 40% of patients achieved a putative NEDA-4 status, respectively. CONCLUSION: Brain volumetric MRI has yet to be translated into clinical practice and SDMT may qualify as the fourth component of NEDA-4 definition. NEDA-4 has the potential to capture the impact of DMT therapies in RRMS earlier in the disease course of RRMS.

Prospective Assessment of No Evidence of Disease Activity-4 Status in Early Disease Stages of Multiple Sclerosis in Routine Clinical Practice.

Background: In relapsing-remitting multiple sclerosis, no evidence of disease activity-3 (NEDA-3) is defined as no relapses, no disability progression and no MRI activity. NEDA-4 status is defined as meeting all NEDA-3 criteria plus having an annualized brain volume loss (a-BVL) of ≤0.4%. Prospective real-world studies presenting data on NEDA-4 are scarce. Objective: To determine the proportion of patients failing to meet one or more NEDA-4 criteria and the contribution of each component to this failure. Methods: Forty-eight patients were followed for 12 months. Structural image evaluation, using normalization, of atrophy was used to assess a-BVL. Results: The patients had a mean age of 33.0 years (range 18-57), disease duration of 1.7 years (0.4-4) and Expanded Disability Status Scale score of 1.3 (0-4); 71% were women. All patients were on disease-modifying therapies. During follow-up, 21% of the patients had at least one relapse, 21% had disability progression, 8% had new T2 lesions, and 10% had gadolinium-enhanced lesions. Fifty-eight percent (28/48) achieved NEDA-3 status. a-BVL of >0.4% was observed in 52% (25/48). Only 29% (14/48) achieved NEDA-4 status. Conclusion: a-BVL is a good marker to detect subclinical disease activity. a-BVL is parameter to continue investigating for guiding clinical practice in relapsing-remitting multiple sclerosis.

Disease duration and disability in dysfeRlinopathy can be described by muscle imaging using heatmaps and random forests.

INTRODUCTION: The manner in which imaging patterns change over the disease course and with increasing disability in dysferlinopathy is not fully understood. METHODS: Fibroadipose infiltration of 61 muscles was scored based on whole-body MRI of 33 patients with dysferlinopathy and represented in a heatmap. We trained random forests to predict disease duration, Motor Function Measure dimension 1 (MFM-D1), and modified Rankin scale (MRS) score based on muscle scoring and selected the most important muscle for predictions. RESULTS: The heatmap delineated positive and negative fingerprints in dysferlinopathy. Disease duration was related to infiltration of infraspinatus, teres major-minor, and supraspinatus muscles. MFM-D1 decreased with higher infiltration of teres major-minor, triceps, and sartorius. MRS related to infiltration of vastus medialis, gracilis, infraspinatus, and sartorius. DISCUSSION: Dysferlinopathy shows a recognizable muscle MRI pattern. Fibroadipose infiltration in specific muscles of the thigh and the upper limb appears to be an important marker for disease progression. Muscle Nerve 59:436-444, 2019.

Deep Brain Stimulation Surgery for Parkinson Disease Coexisting With Communicating Hydrocephalus: A Case Report.

We report a successful bilateral globus pallidus internus-deep brain stimulation (GPi-DBS) for a Parkinson disease (PD) patient with idiopathic normal pressure hydrocephalus (INPH) and an unusually long anterior commissure-posterior commissure (AC-PC) line. A 54-year-old man presented with a history of 3 months of severe shuffling gait, rigidity, slow movements of the left side limbs, and difficulty managing finances. A brain MRI revealed marked ventriculomegaly (Evans index = 0.42). The patient was diagnosed with INPH and a ventriculoperitoneal shunt was placed. Cognitive impairment improved, but walking disturbances, slowness, and rigidity persisted. Then treatment with levodopa was added, and the patient experienced a sustained improvement. He was diagnosed with PD. After 7 years, the patient developed gait freezing and severe levodopa-induced dyskinesia. The patient underwent bilateral GPi-DBS. We used MRI/CT fusion techniques for anatomical indirect targeting. Indirect targeting is based on standardized stereotactic atlas and on a formula-derived method based on AC-PC landmarks. The AC-PC line was 40 mm (the usual length is between 19 and 32 mm). Intraoperative microelectrode recording was a non-expendable test, but multiple recordings were avoided to reduce the surgical risk of ventricular involvement. There was a 71% decrease in the UPDRS III score during the on-stimulation state (28 to 8). The patient's dyskinesias resolved dramatically with a UdysRS of 15 (88% improvement) during the on-stimulation condition. The observed motor benefits and the improvement of his daily activities have persisted 6 months after surgery. Deep brain stimulation surgery in PD with ventriculomegaly is a challenge. This procedure can result in a greater chance of breaching the ventricle, with risks of intraventricular hemorrhage and migration of cerebrospinal fluid into the brain parenchyma with target displacement. Furthermore, clinical judgment is paramount when recent onset of shuffling gait coexists with ventriculomegaly because the most common dilemma is differentiating between PD and INPH. For these reasons, neurologists and surgeons may refuse to operate on PD patients with ventriculomegaly. However, DBS should be considered for PD patients with motor complications when responsiveness to levodopa is demonstrated, even in the context of marked ventriculomegaly.

Prevalencia de lesiones por sobreuso en jugadores de las selecciones de rugby de Chile y Uruguay / Overuse injury prevalence in national team rugby players of Chile and Uruguay

OBJETIVO Determinar la prevalencia de lesiones por sobreuso en las selecciones de rugby adulta y juvenil de Chile y Uruguay. Objetivos secundarios: 1. Describir el impacto en el rendimiento, factores de riesgo y las diferencias entre adultos y juveniles; 2. Evaluar la definición de lesión según tiempo perdido para el estudio de las lesiones por sobreuso. METODOLOGÍA: Grupo de estudio: selecciones adultas y juveniles de rugby de Chile y Uruguay (106 jugadores). Se utilizó el Oslo Sports Trauma Research Centre Overuse Injury Questionnaire, para el registro y la evaluación de las lesiones. Se definió lesión por sobreuso como todos los problemas articulares de origen no traumático, ocurridos hasta los 7 días previos al registro. Se registró la edad, peso, talla, posición de juego y volumen de entrenamiento para el análisis de factores de riesgo. RESULTADOS: La prevalencia fue de un 31%. Solo el 6% requirió más de 24 horas de reposo deportivo. El principal factor de riesgo fue la edad (OR 1,12 IC 1,017­1,24), aumentando un 12% por cada año cumplido. Se observó una mayor prevalencia en los adultos y los juveniles presentaron un puntaje mayor de gravedad (23,2 versus 15,8 p = 0,03). CONCLUSIONES La prevalencia de lesiones por sobreuso en este grupo fue alta. El impacto en el rendimiento en la mayoría fue leve, siendo mayor en los juveniles. El principal factor de riesgo fue la edad. La definición de lesión según tiempo perdido fue insuficiente para el tamizaje de lesiones por sobreuso, pesquisando una minoría de los jugadores afectados.

OBJECTIVE: To determine the prevalence of overuse injuries in the senior and junior teams of the Chilean and Uruguayan rugby national teams. Secondary objectives: 1. Describe the impact on performance, risk factors and differences between senior players and junior players; 2. Evaluate the time lost injury definition for studies in overuse injuries. METHOD: Study group: senior and junior national rugby teams of Chile and Uruguay (106 players). The "Oslo Sports Trauma Research Centre Overuse Injury Questionnaire" was used for the registration and evaluation of overuse injuries. An overuse injury was defined as all joint problems of non-traumatic origin, which occurred up to 7 days prior to the interview. Age, weight, height, playing position and training volume were recorded for the analysis of risk factors. RESULTS: The prevalence of overuse injuries was 31%. Only 6% required more than 24 hours of rest from sports. The main risk factor was age (OR 1.12 CI 1.017 to 1.24), increasing by 12% for every year of age. A higher prevalence in senior players was noted, however, juniors had a higher severity score than adults (23.2 versus 15.8 p = 0.03). CONCLUSIONS: The prevalence of overuse injuries in this group was high. The impact on performance was mild in most players, being higher in juniors. The main risk factor was age. The time lost injury definition was insufficient for the screening of overuse injuries, only diagnosing a minority of the affected players.

Tau Platelets Correlate with Regional Brain Atrophy in Patients with Alzheimer's Disease.

BACKGROUND: Intracellular neurofibrillary tangles are part of the core pathology of Alzheimer's disease (AD), which are mainly composed of hyperphosphorylated tau protein. OBJECTIVES: The purpose of this study is to determine whether high molecular weight (HMW) or low molecular weight (LMW) tau protein levels, as well as the ratio HMW/LMW, present in platelets correlates with brain magnetic resonance imaging (MRI) structural changes in normal and cognitively impaired subjects. METHODS: We examined 53 AD patients and 37 cognitively normal subjects recruited from two Memory Clinics at the Universidad de Chile. Tau levels in platelets were determined by immunoreactivity and the MRI scans were analyzed using voxel-based morphometry in 41 AD patients. RESULTS: The HMW/LMW tau ratio was statistically different between controls and AD patients, and no associations were noted between HMW or LMW tau and MRI structures. In a multivariate analysis controlled for age and education level, the HMW/LMW tau ratio was associated with reduced volume in the left medial and right anterior cingulate gyri, right cerebellum, right thalamus (pulvinar), left frontal cortex, and right parahippocampal region. CONCLUSIONS: This exploratory study showed that HMW/LMW tau ratio is significantly higher in AD patients than control subjects, and that it is associated with specific brain regions atrophy. Determination of peripheral markers of AD pathology can help understanding the pathophysiology of neurodegeneration in AD.

Broadening the imaging phenotype of dysferlinopathy at different disease stages.

INTRODUCTION: MRI characterization of dysferlinopathy has been mostly limited to the lower limbs. We aimed to broaden the MRI description of dysferlinopathy and to correlate it with objective measures of motor dysfunction. METHODS: Sequential whole-body axial MRI was performed in 27 patients with genetically confirmed dysferlinopathy classified according to disease duration. Spearman correlations of fatty infiltration scores versus Motor Function Measure (MFM) were calculated. RESULTS: Significant fatty infiltration was symmetrically present in early stages mainly in the posterior compartments of legs and thighs, thigh adductors, pelvic girdle, and some paravertebral muscles and the subscapularis. Later, fatty infiltration involved leg and thigh anterior compartments, arms and forearms, paravertebral, and trunk muscles. MRI infiltration score correlated positively with disease duration and negatively with MFM scale. CONCLUSIONS: We expand MRI characterization of dysferlinopathy and provide evidence for use of MRI scoring combined with motor functional scales to assess the natural course of disease. Muscle Nerve, 2016 Muscle Nerve 54: 203-210, 2016.

Caracterización de parámetros clínicos y anatomopatológicos de pacientes con cáncer de próstata localmente avanzado en Hospital Barros Luco Trudeau / Characterization of clinical and pathological parameters of patients with locally advanced prostate cancer in Hospital Barros Luco Trudeaus

La estadificación clínica del Cáncer de Próstata es una evaluación de la extensión de la enfermedad mediante el uso de parámetros previos al tratamiento como tacto rectal, PSA, biopsia transrectal e imágenes radiológicas. El estadío anatomo patológico post quirúrgico comprende el análisis histopatológico de la pieza operatoria, lo que constituye una estimación más precisa de la extensión de la enfermedad y representa el método más ¬ fiable para predecir el resultado del tratamiento. De 386 pacientes sometidos a Prostatectomía entre los años 2002 y 2012 se realiza estudio retrospectivo de 48 pacientes, que presentaron compromiso extra prostático. Análisis estadístico de las variables estudiadas mediante prueba de Chi cuadrado. De 386 pacientes sometidos a Prostatectomía, el 12,4 por ciento presentó compromiso extra prostático. La edad promedio fue de 64,1 años; el PSA promedio 12,2 ng/ml. El 37,77 por ciento presentaba un tacto rectal sospechoso. El tamaño prostático promedio estimado por ecografía fue 38,2 cc. La biopsia defi¬nitiva reveló un volumen glandular promedio de 64 cc. y volumen tumoral promedio de 6,9 cc. El 72,92 por ciento fue clasi¬ficado con un score de Gleason 7. El 82 por ciento presentaba compromiso glandular bilateral. El 65,12 por ciento presentó compromiso capsular; 73,9 por ciento compromiso de bordes quirúrgicos; 23,4 por ciento compromiso unilateral y 19,1 por ciento bilateral de vesículas seminales. No fue posible establecer evidencia que permita afirmar la existencia de algún factor predictor para el compromiso capsular, de bordes quirúrgicos, de vesículas seminales, de conductos deferentes, ni permeación linfática. Se logró establecer una relación estadísticamente significativa entre niveles de PSA y probabilidad de compromiso vascular.

Clinical staging of prostate cancer is an assessment of the extent of disease by using pretreatment parameters as DRE, PSA, transrectal biopsy and scans. The postoperative pathologic stage comprises histopathological analysis of surgical piece, which is a more accurate estimate of the extent of disease and represents the most reliable method to predict the outcome of treatment. Retrospective study of 48 patients with prostate cancer who underwent radical prostatectomy between 2002 and 2012, which showed extraprostatic commitment. Statistical analysis of the variables using chi-square test. Of 386 patients undergoing prostatectomy, 12.4 percent had extraprostatic commitment. The average age was 64.1 years and the mean PSA 12.2 ng / ml. The 37.77 percent had a suspicious DRE. The average prostate size estimated by ultrasound was 38.2 cc. The ¬ final biopsy revealed an average volume of 64 cc glandular. and average tumor volume of 6.9 cc. The 72.92 percent was classified with a Gleason score 7. 82 percent had bilateral glandular involvement. The capsular involvement showed 65.12 percent, 73.9 percent commitment surgical margins, 23.4 percent and 19.1 percent unilateral commitment bilateral seminal vesicles. It was not possible to establish evidence to a rm the existence of a predictor factor for capsular involvement of surgical margins, seminal vesicle, vas deferens, or lymphatic permeation. They managed to establish a statistically significant relationship between PSA levels and probability of vascular compromise.

Clinical spectrum of Kufor-Rakeb syndrome in the Chilean kindred with ATP13A2 mutations.

We report the clinical features of the original Chilean family with Kufor-Rakeb syndrome (KRS) that led to the discovery of the ATP13A2 gene at the PARK9 locus. KRS is a rare juvenile-onset autosomal recessive disease characterized by progressive Parkinsonism, pyramidal signs, and cognitive decline in addition to vertical gaze palsy and facial-faucial-finger minimyoclonus. Neurological and neuropsychological examination during a 10-year period, videotaping, neuroimaging, and measurement of DNA methylation of the ATP13A2 promoter region were performed. The youngest 5 of 17 children of nonconsanguineous parents, carrying compound-heterozygous ATP13A2 mutations, had normal development until ages ∼10 to 12 years, when school performance deteriorated and slowness, rigidity, and frequent falls developed. Examination revealed bradykinesia, subtle postural/action tremor, cogwheel rigidity, spasticity, upward gaze palsy, smooth pursuit with saccadic intrusions, and dementia. Additional signs included facial-faucial-finger minimyoclonus, absent postural reflexes, visual/auditory hallucinations, and insomnia. Levodopa response could not be fully judged in this family. T2* magnetic resonance imaging sequences revealed marked diffuse hypointensity of the caudate (head and body) and lenticular nucleus bilaterally. Disease progression was slow including epilepsy, cachexia, and anarthria. Four affected members died after 28.5 ± 5.5 (mean ± SD) years of disease. Two heterozygous carriers, the mother and eldest sibling, showed jerky perioral muscle contractions and clumsiness of hand movements. There was no significant correlation between DNA methylation of the ATP13A2 promoter region and disease progression. The marked caudate and lenticular nucleus T2*-hypointensity suggests that KRS might belong to the family of neurodegenerative diseases associated with brain iron accumulation.