Staging Parkinson's Disease Combining Motor and Nonmotor Symptoms Correlates with Disability and Quality of Life.

INTRODUCTION: In a degenerative disorder such as Parkinson's disease (PD), it is important to establish clinical stages that allow to know the course of the disease. Our aim was to analyze whether a scale combining Hoehn and Yahr's motor stage (H&Y) and the nonmotor symptoms burden (NMSB) (assessed by the nonmotor symptoms scale (NMSS)) provides information about the disability and the patient's quality of life (QoL) with regard to a defined clinical stage. MATERIALS AND METHODS: Cross-sectional study in which 603 PD patients from the COPPADIS cohort were classified according to H&Y (1, stage I; 2, stage II; 3, stage III; 4, stage IV/V) and NMSB (A: NMSS = 0-20; B: NMSS = 21-40; C: NMSS = 41-70; D: NMSS ≥ 71) in 16 stages (HY.NMSB, from 1A to 4D). QoL was assessed with the PDQ-39SI, PQ-10, and EUROHIS-QOL8 and disability with the Schwab&England ADL (Activities of Daily Living) scale. RESULTS: A worse QoL and greater disability were observed at a higher stage of H&Y and NMSB (p < 0.0001). Combining both (HY.NMSB), patients in stages 1C and 1D and 2C and 2D had significantly worse QoL and/or less autonomy for ADL than those in stages 2A and 2B and 3A and 3B, respectively (p < 0.005; e.g., PDQ-39SI in 1D [n = 15] vs 2A [n = 101]: 28.6 ± 17.1 vs 7.9 ± 5.8; p < 0.0001). CONCLUSION: The HY.NMSB scale is simple and reflects the degree of patient involvement more accurately than the H&Y. Patients with a lower H&Y stage may be more affected if they have a greater NMS burden.

Osteoporotic patients treated with bisphosphonates do not show the increased mortality observed in those untreated.

INTRODUCTION: Osteoporosis has been said to be associated with increased mortality. On the other hand, it is debated whether treatment with bisphosphonates may reduce mortality in osteoporotic patients. To contribute to the clarification of these issues, we have studied in a prospective cohort the mortality in people without osteoporosis and in patients with osteoporosis, untreated or treated with bisphosphonates MATERIAL AND METHODS: At their inclusion in the cohort, four groups of participants were identified: (a) people without osteoporosis (group 1); (b) osteoporotic patients treated with bisphosphonates (group 2); (c) osteoporotic patients who refused to be treated (group 3); and (d) patients who met osteoporosis diagnostic criteria but were not treated because their risk of fracture was considered to be low (group 4). To compare all four groups, unadjusted Kaplan-Meier estimates of survivorship were obtained and they were compared using log-rank test. Hazard ratios were then estimated via Cox regression adjusting for the main confounders. A comparison among the osteoporotic groups was made by means of a Cox regression analysis performed using only these three groups, adjusting for propensity scores. RESULTS: Two thousand six hundred and sixty-five people were included. In the unadjusted analysis, mortality in group 3 was higher than in the other groups (p < 0.001). Taking group 1 as a reference, Cox regression analysis showed the following mortality HRs for groups 2, 3, and 4 after adjusting for confounding factors: 0.82 (0.41-1.63), 1.37 (0.90-2.10), and 0.69 (0.46-1.02). In the analysis of the osteoporotic groups with the PS generated for them, and taking group 2 as a reference, the HRs were as follows: group 3, 2.38 (1.34-4.22); group 4, 1.45 (0.61-3.43). CONCLUSION: Mortality in osteoporotic patients who refused treatment is higher than in osteoporotic patients treated with bisphosphonates. In unadjusted analysis, it was also higher than in non-osteoporotic people; however, this difference disappeared after adjustment for confounding factors.

Sleep Problems Are Related to a Worse Quality of Life and a Greater Non-Motor Symptoms Burden in Parkinson's Disease.

INTRODUCTION: The aim of the present study was to examine the frequency of self-reported sleep problems and their associated factors in a large cohort of PD patients. METHODS: PD patients and controls, recruited from 35 centers of Spain from the COPPADIS cohort were included in this cross-sectional study. Sleep problems were assessed by the Spanish version of the Parkinson's disease Sleep Scale version 1 (PDSS-1). An overall score below 82 or a score below 5 on at least 1 item was defined as sleep problems. RESULTS: The frequency of sleep problems was nearly double in PD patients compared to controls: 65.8% (448/681) vs 33.5% (65/206) (p < 0.0001). Mean total PDSS score was lower in PD patients than controls: 114.9 ± 28.8 vs 132.8 ± 16.3 (p < 0.0001). Quality of life (QoL) was worse in PD patients with sleep problems compared to those without: PDQ-39SI, 19.3 ± 14 vs 13 ± 11.6 (p < 0.0001); EUROHIS-QoL8, 3.7 ± 0.5 vs 3.9 ± 0.5 (p < 0.0001). Non-motor symptoms burden (NMSS; OR = 1.029; 95%CI 1.015-1.043; p < 0.0001) and impulse control behaviors (QUIP-RS; OR = 1.054; 95%CI 1.009-1.101; p = 0.018) were associated with sleep problems after adjustment for age, gender, disease duration, daily equivalent levodopa dose, H&Y, UPDRS-III, UPDRS-IV, PD-CRS, BDI-II, NPI, VAS-Pain, VAFS, FOGQ, and total number of non-antiparkinsonian treatments. CONCLUSION: Sleep problems were frequent in PD patients and were related to both a worse QoL and a greater non-motor symptoms burden in PD. These findings call for increased awareness of sleep problems in PD patients.

Depression is Associated with Impulse-compulsive Behaviors in Parkinson's disease.

BACKGROUND: Depression and impulse control disorders (ICDs) are both common in Parkinson's disease (PD) patients and their coexistence is frequent. Our aim was to determine the relationship between depression and impulsive-compulsive behaviors (ICBs) in a large cohort of PD patients. METHODS: PD patients recruited from 35 centers of Spain from the COPPADIS cohort from January 2016 to November 2017 were included in the study. The QUIP-RS (Questionnaire for Impulsive-Compulsive Disorders in Parkinson's Disease-Rating Scale) was used for screening ICDs (cutoff points: gambling ≥6, buying ≥8, sex≥8, eating≥7) and compulsive behaviors (CBs) (cutoff points: hobbyism-punding ≥7). Mood was assessed with the BDI-II (Beck Depression Inventory - II) and major, minor, and subthreshold depression were defined. RESULTS: Depression was more frequent in PD patients with ICBs than in those without: 66.3% (69/104) vs 47.5% (242/509); p<0.0001. Major depression was more frequent in this group as well: 22.1% [23/104] vs 14.5% [74/509]; p=0.041. Considering types of ICBs individually, depression was more frequent in patients with pathological gambling (88.9% [8/9] vs 50.2% [303/603]; p=0.021), compulsive eating behavior (65.9% [27/41] vs 49.7% [284/572]; p=0.032), and hobbyism-punding (69% [29/42] vs 49.4% [282/571]; p=0.010) than in those without, respectively. The presence of ICBs was also associated with depression (OR=1.831; 95%CI 1.048-3.201; p=0.034) after adjusting for age, sex, civil status, disease duration, equivalent daily levodopa dose, antidepressant treatment, Hoehn&Yahr stage, non-motor symptoms burden, autonomy for activities of daily living, and global perception of QoL. LIMITATIONS: Cross-sectional design. CONCLUSIONS: Depression is associated with ICBs in PD. Specifically, with pathological gambling, compulsive eating behavior, and hobbyism-punding.

Quality of life and non-motor symptoms in Parkinson's disease patients with subthreshold depression.

BACKGROUND: The role of subthreshold depression (subD) in Parkinson's Disease (PD) is not clear. The present study aimed to compare the quality of life (QoL) in PD patients with subD vs patients with no depressive disorder (nonD). Factors related to subD were identified. MATERIAL AND METHODS: PD patients and controls recruited from the COPPADIS cohort were included. SubD was defined as Judd criteria. The 39-item Parkinson's disease Questionnaire (PDQ-39) and the EUROHIS-QOL 8-item index (EUROHIS-QOL8) were used to assess QoL. RESULTS: The frequency of depressive symptoms was higher in PD patients (n = 694) than in controls (n = 207) (p < 0.0001): major depression, 16.1% vs 7.8%; minor depression, 16.7% vs 7.3%; subD, 17.4% vs 5.8%. Both health-related QoL (PDQ-39; 18.1 ±â€¯12.8 vs 11.6 ±â€¯10; p < 0.0001) and global QoL (EUROHIS-QOL8; 3.7 ±â€¯0.5 vs 4 ±â€¯0.5; p < 0.0001) were significantly worse in subD (n = 120) than nonD (n = 348) PD patients. Non-motor Symptoms Scale (NMSS) total score was higher in subD patients (45.9 ±â€¯32 vs 29.1 ±â€¯25.8;p < 0.0001). Non-motor symptoms burden (NMSS;OR = 1.019;95%CI 1.011-1.028; p < 0.0001), neuropsychiatric symptoms (NPI; OR = 1.091; 95%CI 1.045-1.139; p < 0.0001), impulse control behaviors (QUIP-RS; OR = 1.035; 95%CI 1.007-1063; p = 0.013), quality of sleep (PDSS; OR = 0.991; 95%CI 0.983-0.999; p = 0.042), and fatigue (VAFS-physical; OR = 1.185; 95%CI 1.086-1.293; p < 0.0001; VAFS-mental; OR = 1.164; 95%CI 1.058-1.280; p = 0.0001) were related to subD after adjustment to age, disease duration, daily equivalent levodopa dose, motor status (UPDRS-III), and living alone. CONCLUSIONS: SubD is a frequent problem in patients with PD and is more prevalent in these patients than in controls. QoL is worse and non-motor symptoms burden is greater in subD PD patients.

[Impact of Spanish Public Health Measures on Emergency Visits and COVID- 19 diagnosed cases during the pandemic in Madrid].

OBJECTIVE: Changes in Public Health recommendations may have changed the number of emergency visits and COVID-19 diagnosed cases in an Emergency Department in Madrid. METHODS: This retrospective case series study included all consecutive patients in a tertiary and urban ED in Madrid from 1st to 31st March. The sample was divided: NonCOVID-19, Non-investigated COVID-19, Possible COVID-19, Probable COVID-19, Confirmed COVID-19. Differences between public health periods were tested by ANOVA for each cohort, and by ANCOVA including the number of PCR tests (%) as covariate. RESULTS: A total of 7,163 (4,071 Non-COVID-19, 563 Non-investigated COVID-19, 870 Possible, 648 Probable and 1,011 Confirmed COVID-19) cases were included. Public Health measurements applied during each period showed a clear effect on the case proportion for the five cohorts. CONCLUSIONS: The variability of case definitions and diagnostic test criteria may have impact on the number of emergency visits and COVID-19 diagnosed cases in Emergency Department.

[Physical activity and nutritional and psychosocial status in non-dependent elderly]. / La actividad física y el estado nutricional y psicosocial del anciano no dependiente.

OBJECTIVE: To describe the level of physical activity (PA) of a sample of independent non-institutionalised elderly and its relationship between nutritional status and psychosocial conditions of the elderly. MATERIAL AND METHODS: A multicentre cross-sectional descriptive study carried out in Health Centres of the city of Huesca in a sample size of patients over 75 years-old. Demographic, psychosocial, nutritional, anthropometric, and PA variables were analysed. The short scale of Minnesota in Spanish (VREM) was used to measure the latter. RESULTS: The mean age was 81.58 years (±4) with a gender distribution of 51.7% women. The group were in a good health condition overall: Mild physical impairment (45%), correct mental health as regards cognition (93%) or mood (88%), favourable social status (96%), independence for activities of daily living (100%), and a good perceived quality of life (score>70 in 70%). There was a mean of 4666.2 METS-Min/14 days obtained in PA, and 10% of the participants were identified as sedentary. A statistically significant inverse relationship (P<.05) was observed between PA and functional disability, sarcopenia and body composition (waist circumference, sagittal abdominal diameter, mass index, and body fat percentage). No significant relationship was observed between PA and nutritional status and psychosocial conditions. The relationship between the nutritional status and the variables of the psychosocial sphere was significant (P<.01). CONCLUSIONS: The characteristics of the population studied in the organic, functional, psychical, and social spheres do not suggest important limitations for PA. An insignificant percentage of the elderly does not perform enough PA. There is a significant relationship between physical exercise and favourable body composition rates.

COPPADIS-2015 (COhort of Patients with PArkinson's DIsease in Spain, 2015): an ongoing global Parkinson's disease project about disease progression with more than 1000 subjects included. Results from the baseline evaluation.

BACKGROUND AND PURPOSE: In Parkinson's disease (PD), the course of the disorder is highly variable between patients. Well-designed, prospective studies for identifying PD progression biomarkers are necessary. Our aim was to show the results of baseline evaluations of an ongoing global PD project, COPPADIS-2015 (Cohort of Patients with PArkinson's DIsease in Spain, 2015). METHODS: This was an observational, descriptive, nationwide study (Spain). The recruitment period ended in October 2017. Baseline evaluation included more than 15 validated scales and complementary studies in a subgroup of participants. RESULTS: In total, 1174 subjects from 35 centres were considered valid for baseline analysis: 694 patients (62.6 ± 8.9 years old, 60.3% males), 273 caregivers (58.5 ± 11.9 years old, 31.8% males) and 207 controls (61 ± 8.3 years old, 49.5% males). The mean disease duration was 5.5 ± 4.4 years. Hoehn and Yahr stage was 1 or 2 in 90.7% of the patients whilst 33.9% and 18.1% of them presented motor fluctuations and dyskinesias, respectively. The mean Non-Motor Symptoms Scale total score was 45.4 ± 38.1, and 30.4% of the patients presented cognitive impairment, 16.1% major depression, 12.7% impulse control disorder, 7.2% compulsive behaviour, 57.2% pain and 13.2% falls. Compared to the control group, PD patients presented a significantly higher burden of non-motor symptoms and a worse quality of life. More than 300 subjects conducted complementary studies (serum biomarkers, genetic and neuroimaging). CONCLUSIONS: Parkinson's disease is a complex disorder and different non-motor symptoms are frequently present and are more prevalent than in controls. In real clinical practice it is important to ask for them.

Patient's Peak Skin Dose evaluation using Gafchromic films in interventional cardiology procedures and its correlation with other dose indicators.

OBJECTIVE: Number and complexity of interventional cardiology procedures have increased during last years and can result in patient skin dose high enough to cause deterministic skin effects. The aim of the work is to investigate the correlation between Peak Skin Dose (PSD) and the dosimetric indicators directly registered by the radiological equipment and provide the physicians a tool to identify patients at risk of deterministic effects and include them into a follow-up program. METHODS: PSD was measured in vivo using radiochromic Gafchromic XR-RV3 films, properly calibrated. DAP, Cumulative Dose at the interventional reference point (CD) and exposure time of each procedure were retrieved from the Radiation Dose Structured Reports created by an Allura Clarity Xper FD20 angiographic system. Linear correlation between PSD and both DAP and CD was investigated. RESULTS: 42 interventional cardiology procedures (16 CA and 26 PTCA) were involved in the study. The dosimetric indicators values for PTCA are generally higher than those for CA, due to the different levels of procedure complexity. Mean PSD values were (103 ±â€¯64) and (526 ±â€¯436) mGy for CA and PTCA procedures. For CA, we found strong correlation both between PSD and DAP (r = 0.753) and PSD and CD (r = 0.782). For PTCA, good correlation both for DAP (r = 0.648) and CD (r = 0.649) was found. CONCLUSIONS: DAP and CD show strong correlation with PSD measured with Gafchromic films during interventional procedures. The proposed method allows the physician to estimate patient's PSD from the dosimetric indicators that the radiological equipment display and record at the end of the procedure.

Elective neck dissection during salvage surgery after radiotherapy in patients with head and neck squamous cell carcinoma.

SUMMARY: Elective neck dissection in patients with recurrent head and neck squamous cell carcinoma (HNSCC) without evidence of neck disease (crN0) is poorly defined. A retrospective review was carried out on 165 crN0 patients treated with salvage surgery and elective neck dissection. Multivariate Cox analysis and recursive partitioning analysis were used to evaluate prognostic factors. The frequency of occult neck node metastases in the neck dissection (rpN+) was 16.4%. The risk of occult metastases for glottic rpT1-T2 recurrences was 5.9%, for glottic rpT3-T4 recurrences 13.2%, for non-glottic rpT1-T2 recurrences 16.1% and for locally advanced (rpT3-T4) non-glottic recurrences 31.1%. Patients with occult neck node metastases (rpN+) had a 5-year adjusted survival rate of 38.1%, while patients without nodal disease (rpN0) had a 5-year adjusted survival rate of 71.1% (p = 0.0001). Elective neck dissection can be omitted in crN0 patients with rT1-T2 glottic recurrence. We consider it advisable to perform elective neck dissection in all other situations.

Abnormal bone turnover in individuals with low serum alkaline phosphatase.

The clinical spectrum of hypophosphatasia (HPP) is broad and variable within families. Along severe infantile forms, adult forms with mild manifestations may be incidentally discovered by the presence of low alkaline phosphatase (ALP) activity in serum. However, it is still unclear whether individuals with persistently low levels of ALP, in the absence of overt manifestations of HPP, have subclinical abnormalities of bone remodeling or bone mass. The aim of this study was to obtain a better understanding of the skeletal phenotype of adults with low ALP by analyzing bone mineral density (BMD), bone microarchitecture (trabecular bone score, TBS), and bone turnover markers (P1NP and ß-crosslaps). We studied 42 individuals with persistently low serum ALP. They showed lower levels of P1NP (31.4 ± 13.7 versus 48.9 ± 24.4 ng/ml; p = 0.0002) and ß-crosslaps (0.21 ± 0.17 versus 0.34 ± 0.22 ng/ml, p = 0.0015) than individuals in the control group. There were no significant differences in BMD, bone mineral content, or TBS. These data suggest that individuals with hypophosphatasemia have an overall reduction of bone turnover, even in the absence of overt manifestations of HPP or low BMD. We evaluated bone mineral density (BMD), bone microarchitecture, and bone turnover markers in patients with low serum levels of alkaline phosphatase. Our results show that these patients have low bone remodeling even in the absence of BMD abnormalities, thus supporting the recommendation of avoiding antiresorptives such as bisphosphonates in these subjects.

Degradation of extracellular matrix regulates osteoblast migration: A microfluidic-based study.

Bone regeneration is strongly dependent on the capacity of cells to move in a 3D microenvironment, where a large cascade of signals is activated. To improve the understanding of this complex process and to advance in the knowledge of the role of each specific signal, it is fundamental to analyze the impact of each factor independently. Microfluidic-based cell culture is an appropriate technology to achieve this objective, because it allows recreating realistic 3D local microenvironments by taking into account the extracellular matrix, cells and chemical gradients in an independent or combined scenario. The main aim of this work is to analyze the impact of extracellular matrix properties and growth factor gradients on 3D osteoblast movement, as well as the role of cell matrix degradation. For that, we used collagen-based hydrogels, with and without crosslinkers, under different chemical gradients, and eventually inhibiting metalloproteinases to tweak matrix degradation. We found that osteoblast's 3D migratory patterns were affected by the hydrogel properties and the PDGF-BB gradient, although the strongest regulatory factor was determined by the ability of cells to remodel the matrix.

African histoplasmosis: new clinical and microbiological insights.

African histoplasmosis is defined as the fungal infection caused by Histoplasma capsulatum var. duboisii (Hcd). Studies focused on distinguishing Hcd and H. capsulatum var. capsulatum (Hcc), which coexist in Africa, are scarce or outdated, and African strains are continuously underrepresented. In this work, 13 cases of African patients with histoplasmosis diagnosed in the Spanish Mycology Reference Laboratory have been reviewed showing that 77% had disseminated disease and AIDS as underlying disease although Hcd infection has been classically considered a rare presentation in AIDS patients. Strains isolated from these patients and other clinical and reference strains were studied by assessing classical identification methods and performing a three-loci multi-locus sequence analysis (MLSA). Classical identification methods based on biochemical tests and measurement of yeast size proved to be useless in distinguishing both varieties. The MLSA defined an African cluster, with a strong statistical support, that included all strains with African origin. Finally, mating type was also determined by using molecular methods revealing an unequal mating type distribution in African strains. In conclusion, historical statements and classical identification methods were useless to distinguish between varieties, whereas molecular analyses revealed that all strains with African origin grouped together suggesting that traditional classification should be revised. Further investigation is required in order to unravel traditional concepts about Hcd infection and support results obtained in this work.

Seroplevalencia de virus sincicial respiratorio en paciente pediátricos con rinitis alérgica / Seroprevalence of the Respitatory Syncytial Virus in pediatric patients with allergic rhinitis allergic

El objetivo de este estudio fue determinar la prevalencia del Virus Sincicial Respiratorio (VSR) en pacientes pediátricos con rinitis alérgica (RA). Se incluyeron 56 pacientes mayores de 7 años y menores de 15 años, con diagnóstico de rinitis alérgica a los cuales se les tomo muestras sanguíneas sin anticoagulante, para la obtención de suero. Se determinó IgG anti VSR e IgE total por la técnica de ELISA. Los resultados muestran que 38 (68%) fueron escolares y 18 (32%) adolescentes, 14 (25%) de sexo femenino y 42 (75%) masculinos. Del total de pacientes estudiados, 52 (92,86%) resultaron positivos a la presencia de anticuerpos IgG anti VSR, observándose una prevalencia general significativa, al igual que el grupo control. Se observó mayor prevalencia (69,2%) en los escolares con respecto a los adolescentes, con predominio del sexo masculino. En los pacientes con RA seropositivos al VSR se obtuvo un incremento significativo (346,8±264,7 UL/ml) de IgE con respecto al grupo control sin RA (116,3±89,7 UL/ml). Los resultados evidencian una alta seroprevalencia de VSR en la región, principalmente en edad escolar, esta infección temprana podría ser determinante en la secreción de mediadores que contribuyen en la aparición y severidad de enfermedades respiratorias como rinitis alérgica y asma bronquial. Por lo tanto se concluye que la cuantificación de IgE total puede ser considerada como una prueba de calidad para el diagnóstico y monitoreo de la rinitis alérgica.

The objective of this study was to determine the prevalence of Respiratory Syncytial Virus (RSV) in pediatric patients with allergic rhinitis (AR). We included 56 patients older than 7 years and younger than 15, with clinical diagnosis of allergic rhinitis (AR). Blood samples were taken without anticoagulants, to obtain serum. IgG anti-RSV and total IgE were determined by the ELISA technique. The results showed that 38 (68%) were schoolchildren and 18 (32%) adolescents, 14 (25%) female and 42 (75%). Of the total number of patients studied, 52 (92.86%) were positive for the presence of IgG anti-RSV antibodies, with a significant overall prevalence, similar prevalence presented by the control group. A significant increase (346.8 ± 264.7 UL / ml) of IgE was observed in patients with RA who were seropositive for RSV compared to the control group without RA (116.3 ± 89.7 UL / ml). The results show a high seroprevalence of RSV in the region, especially in school age, this early infection could be determinant in the secretion of mediators that contribute to the appearance and severity of respiratory diseases such as allergic rhinitis and bronchial asthma. Therefore it is concluded that the quantification of total IgE can be considered as a quality test for the diagnosis and monitoring of allergic rhinitis.

Adaptation and validation of a Spanish-language version of the Frontotemporal Dementia Rating Scale (FTD-FRS). / Adaptación y validación de la Frontotemporal Dementia Rating Scale (FTD-FRS) al castellano.

INTRODUCTION: The Frontotemporal Dementia Rating Scale (FTD-FRS) is a tool designed to aid with clinical staging and assessment of the progression of frontotemporal dementia (FTD-FRS). OBJECTIVE: Present a multicentre adaptation and validation study of a Spanish version of the FRS. METHODOLOGY: The adapted version was created using 2 translation-back translation processes (English to Spanish, Spanish to English) and verified by the scale's original authors. We validated the adapted version in a sample of consecutive patients diagnosed with FTD. The procedure included evaluating internal consistency, testing unidimensionality with the Rasch model, analysing construct validity and discriminant validity, and calculating the degree of agreement between the Clinical Dementia Rating scale (CDR) and FTD-FRS for FTD cases. RESULTS: The study included 60 patients with DFT. The mean score on the FRS was 12.1 points (SD=6.5; range, 2-25) with inter-group differences (F=120.3; df=3; P<.001). Cronbach's alpha was 0.897 and principal component analysis of residuals delivered an acceptable eigenvalue for 5 contrasts (1.6-2.7) and 36.1% raw variance. FRS was correlated with the Mini-mental State Examination (r=0.572; P<.001) and functional capacity (DAD; r=0.790; P<.001). FTD-FRS also showed a significant correlation with CDR (r=-0.641; P<.001), but we did observe variability in the severity levels; cases appeared to be less severe according to the CDR than when measured with the FTD-FRS (kappa=0.055). CONCLUSIONS: This process of validating the Spanish translation of the FTD-FRS yielded satisfactory results for validity and unidimensionality (severity) in the assessment of patients with FTD.

Diverging results of areal and volumetric bone mineral density in Down syndrome.

Population with Down syndrome (DS) has lower areal BMD, in association with their smaller skeletal size. However, volumetric BMD and other indices of bone microarchitecture, such as trabecular bone score (TBS) and calcaneal ultrasound (QUS), were normal. INTRODUCTION: Patients with DS have a number of risk factors that could predispose them to osteoporosis. Several studies reported that people with DS also have lower areal bone mineral density, but differences in the skeletal size could bias the analysis. METHODS: Seventy-five patients with DS and 76 controls without intellectual disability were recruited. Controls were matched for age and sex. Bone mineral density (BMD) was measure by Dual-energy X-ray Absorptiometry (DXA), and volumetric bone mineral density (vBMD) was calculated by published formulas. Body composition was also measured by DXA. Microarchitecture was measured by TBS and QUS. Serum 25-hidroxyvitamin D (25OHD), parathyroid hormone (PTH), aminoterminal propeptide of type collagen (P1NP), and C-terminal telopeptide of type I collagen (CTX) were also determined. Physical activity was assessed by the International Physical Activity Questionnaires (IPAQ-short form). To evaluate nutritional intake, we recorded three consecutive days of food. RESULTS: DS individuals had lower height (151 ± 11 vs. 169 ± 9 cm). BMD was higher in the controls (lumbar spine (LS) 0.903 ± 0.124 g/cm2 in patients and 0.997 ± 0.115 g/cm2 in the controls; femoral neck (FN) 0.761 ± .126 g/cm2 and 0.838 ± 0.115 g/cm2, respectively). vBMD was similar in the DS group (LS 0.244 ± 0.124 g/cm3; FN 0.325 ± .0.073 g/cm3) and the controls (LS 0.255 ± 0.033 g/cm3; FN 0.309 ± 0.043 g/cm3). Microarchitecture measured by QUS was slightly better in DS, and TBS measures were similar in both groups. 25OHD, PTH, and CTX were similar in both groups. P1NP was higher in the DS group. Time spent on exercise was similar in both groups, but intensity was higher in the control group. Population with DS has correct nutrition. CONCLUSIONS: Areal BMD is reduced in DS, but it seems to be related to the smaller body and skeletal size. In fact, the estimated volumetric BMD is similar in patients with DS and in control individuals. Furthermore, people with DS have normal bone microarchitecture.

Prostatectomía simple laparascópica asistida por robot descripción de la técnica y resultados / Simple robot assisted laparoscopic prostatectomy technique description and results

Introducción: La prostatectomía simple abierta ha sido el tratamiento tradicional para el crecimiento prostático grado III sintomático. En la búsqueda de nuevas técnicas quirúrgicas menos invasivas, la cirugía robótica ha venido desempeñado un papel importante permitiendo mejorar los resultados terapéuticos en múltiples aspectos. El objetivo de este trabajo es describir la experiencia en un Hospital Público Latinoamericano de la prostatectomía simple laparoscópica asistida por robot, como alternativa de tratamiento en próstatas de gran volumen.Material y métodos. Pacientes sometidos a prostatectomía simple laparoscópica asistidas por robot mediante abordaje transperitoneal de 5 portales dispuestos en forma de W empleando la técnica de Millin.Resultados. Se realizaron 11 prostatectomías simples laparoscópicas asistidas por robot, edad promedio: 65,17±5,81 años (57-74), IMC: 26±2,06 (23,3-28,3), PSA total: 4,56±2,47 ng/ml (1,54-8,3), IPSS preoperatorio: 28,67±6,47 puntos (18-35), QoL preoperatorio: 5,33±0,82puntos (4-6), volumen prostático por ultrasonido transrectal: 94,52±18,15 (80,16-120),tiempo operatorio: 202,5±66,91 minutos (75-240), sangrado: 650±320,94cc (300-1200),complicaciones: 1 (9,09%) Clavien IIIa, tiempo de hospitalización: 3,67±1,21 días (3-6), permanencia del catéter vesical: 8,5±1,64 días (7-10). Al comparar los resultados pre y post operatorios se evidencia marcada mejoría de los síntomas urinarios obstructivos bajos (SUOB), en la calidad de vida del paciente (QoL) y de los parámetros urodinámicos. No se realizaron conversiones a cirugía abierta ni transfusiones sanguíneas.Conclusión. La prostatectomía simple laparoscópica asistida por robot es un procedimiento reproducible y seguro para el tratamiento de próstatas benignas de gran volumen con resultados quirúrgicos comparables a cualquier otro tipo de abordaje pero con las ventajas que posee la cirugía mínimamente invasiva. Palabras claves: Prostatectomía simple, cirugía robótica, Hiperplasia prostática.(AU)

Introduction: Open simple prostatectomy has being the traditional treatment for sintomatic Prostate Hiperplasia °III. In the search of new surgical techniques less invassives, the robotic surgery play an important role because let better terapeutic results in many topics. The objetive of this work is describe the initial experience in a Latinamerican Public Hospital irobot-assisted laparoscopic simple prostatectomy as an alternative treatment in high- volumen prostates.Material y Methods. Pacients under laparoscopic robot-assisted simple prostatectomy. Transperitoneal 5 ports in W form Millin technique.Results. Did it 11 laparoscopic robot-assisted. Mean age 65,17±5,81 years (57-74). ICM: 26±2,06kg/m² (23,3-28,3), PSAT: 4,56±2,47ng/ml (1,54-8,3), IPSS pre-operatory28,67±6,47 points (18-35) QoL pre-operatory: 5,33±0,82 points (4-6), ultrasound prostatevolumen 94,52±18,15 (80,16-120), surgical time 202±66,91 minutes (75-240), lost blood:650±320,94cc (300-1200), complications 1(9,09%), hospitalization time: 3,67±1,21 days (3- 6), bladder cateterization 8,5±1,64 days (7-10). When comparing the pre and post operative results marked improvement in lower urinary tract obstructive symptoms, quality of live of patients and urodynamic parameters is evident. No had convertions or transfutions around surgery.Conclusion. Robot-assisted laparoscopic simple prostatectomy is a reproducible and saved technique with surgical results similars anything other kind whit the additional ventage of minimally invasión.(AU)

Finite element simulation for the mechanical characterization of soft biological materials by atomic force microscopy.

The characterization of the mechanical properties of soft materials has been traditionally performed through uniaxial tensile tests. Nevertheless, this method cannot be applied to certain extremely soft materials, such as biological tissues or cells that cannot be properly subjected to these tests. Alternative non-destructive tests have been designed in recent years to determine the mechanical properties of soft biological tissues. One of these techniques is based on the use of atomic force microscopy (AFM) to perform nanoindentation tests. In this work, we investigated the mechanical response of soft biological materials to nanoindentation with spherical indenters using finite element simulations. We studied the responses of three different material constitutive laws (elastic, isotropic hyperelastic and anisotropic hyperelastic) under the same process and analyzed the differences thereof. Whereas linear elastic and isotropic hyperelastic materials can be studied using an axisymmetric simplification, anisotropic hyperelastic materials require three-dimensional analyses. Moreover, we established the limiting sample size required to determine the mechanical properties of soft materials while avoiding boundary effects. Finally, we compared the results obtained by simulation with an estimate obtained from Hertz theory. Hertz theory does not distinguish between the different material constitutive laws, and thus, we proposed corrections to improve the quantitative measurement of specific material properties by nanoindentation experiments.