Validity of Normative Volumetric Estimates from Open Access Software in Amnestic Mild Cognitive Impairment.

BACKGROUND: Neurodegeneration in Alzheimer's disease (AD) is typically assessed through brain MRI. Although proprietary software can provide normative estimates of regional atrophy, such tools can be cost-prohibitive for research settings. Free software for generating normative estimates has recently been released but has yet to be validated in the context of amnestic mild cognitive impairment (aMCI). OBJECTIVES: Determine whether normative morphometric estimates generated from open-source software replicate established patterns of neurodegeneration in aMCI, and whether these metrics correlate with episodic memory performance. DESIGN: Observational study of brain MRI and cognition in aging and aMCI with two identical study visits occurring approximately 1.2 years apart. SETTING: Participants were recruited from the local community and outpatient clinical settings. PARTICIPANTS: Adults ages 60-85 with aMCI (n = 25) and cognitively normal controls (CN; n = 74). A subset returned for follow-up (aMCI n = 11, CN n = 52). MEASUREMENTS: Participants completed brain MRI and two neuropsychological tests of verbal episodic memory. FreeSurfer v6.0 and Normative Morphometry Image Statistics were used to generate normative morphometric estimates for AD-relevant regions (hippocampus, parahippocampus, entorhinal cortex, amygdala) and control regions (cuneus, lingual gyrus, pericalcarine gyrus), adjusting for age, sex, head size, scanner manufacturer, and field strength. We tested for baseline group differences in ROI volumes and memory and assessed their within-group associations. We also evaluated changes in ROI volumes over time and tested whether these changes corresponded to declines in memory. RESULTS: At baseline, the aMCI group exhibited poorer memory and smaller volumes in AD-relevant regions than the CN group. There were no group differences in control region volumes. Memory was associated with volumes in AD-relevant regions in the aMCI group only. The aMCI group exhibited greater declines than the CN group in hippocampal volume (17% vs. 8% annual decline) and entorhinal volume (54% vs. 5% annual decline). Decrease in hippocampal volume was marginally associated with decline in memory for the aMCI group. CONCLUSIONS: Normative morphometric values generated from freely available software demonstrated expected patterns of group differences in AD-related volumes and associations with memory. Significant effects were localized to AD-relevant brain regions and only occurred in the aMCI group. These findings support the validity of these free tools as reliable and cost-effective alternatives to proprietary software for use in research settings.

A hybrid artificial intelligence model leverages multi-centric clinical data to improve fetal heart rate pregnancy prediction across time-lapse systems.

STUDY QUESTION: Can artificial intelligence (AI) algorithms developed to assist embryologists in evaluating embryo morphokinetics be enriched with multi-centric clinical data to better predict clinical pregnancy outcome? SUMMARY ANSWER: Training algorithms on multi-centric clinical data significantly increased AUC compared to algorithms that only analyzed the time-lapse system (TLS) videos. WHAT IS KNOWN ALREADY: Several AI-based algorithms have been developed to predict pregnancy, most of them based only on analysis of the time-lapse recording of embryo development. It remains unclear, however, whether considering numerous clinical features can improve the predictive performances of time-lapse based embryo evaluation. STUDY DESIGN, SIZE, DURATION: A dataset of 9986 embryos (95.60% known clinical pregnancy outcome, 32.47% frozen transfers) from 5226 patients from 14 European fertility centers (in two countries) recorded with three different TLS was used to train and validate the algorithms. A total of 31 clinical factors were collected. A separate test set (447 videos) was used to compare performances between embryologists and the algorithm. PARTICIPANTS/MATERIALS, SETTING, METHODS: Clinical pregnancy (defined as a pregnancy leading to a fetal heartbeat) outcome was first predicted using a 3D convolutional neural network that analyzed videos of the embryonic development up to 2 or 3 days of development (33% of the database) or up to 5 or 6 days of development (67% of the database). The output video score was then fed as input alongside clinical features to a gradient boosting algorithm that generated a second score corresponding to the hybrid model. AUC was computed across 7-fold of the validation dataset for both models. These predictions were compared to those of 13 senior embryologists made on the test dataset. MAIN RESULTS AND THE ROLE OF CHANCE: The average AUC of the hybrid model across all 7-fold was significantly higher than that of the video model (0.727 versus 0.684, respectively, P = 0.015; Wilcoxon test). A SHapley Additive exPlanations (SHAP) analysis of the hybrid model showed that the six first most important features to predict pregnancy were morphokinetics of the embryo (video score), oocyte age, total gonadotrophin dose intake, number of embryos generated, number of oocytes retrieved, and endometrium thickness. The hybrid model was shown to be superior to embryologists with respect to different metrics, including the balanced accuracy (P ≤ 0.003; Wilcoxon test). The likelihood of pregnancy was linearly linked to the hybrid score, with increasing odds ratio (maximum P-value = 0.001), demonstrating the ranking capacity of the model. Training individual hybrid models did not improve predictive performance. A clinic hold-out experiment was conducted and resulted in AUCs ranging between 0.63 and 0.73. Performance of the hybrid model did not vary between TLS or between subgroups of embryos transferred at different days of embryonic development. The hybrid model did fare better for patients older than 35 years (P < 0.001; Mann-Whitney test), and for fresh transfers (P < 0.001; Mann-Whitney test). LIMITATIONS, REASONS FOR CAUTION: Participant centers were located in two countries, thus limiting the generalization of our conclusion to wider subpopulations of patients. Not all clinical features were available for all embryos, thus limiting the performances of the hybrid model in some instances. WIDER IMPLICATIONS OF THE FINDINGS: Our study suggests that considering clinical data improves pregnancy predictive performances and that there is no need to retrain algorithms at the clinic level unless they follow strikingly different practices. This study characterizes a versatile AI algorithm with similar performance on different time-lapse microscopes and on embryos transferred at different development stages. It can also help with patients of different ages and protocols used but with varying performances, presumably because the task of predicting fetal heartbeat becomes more or less hard depending on the clinical context. This AI model can be made widely available and can help embryologists in a wide range of clinical scenarios to standardize their practices. STUDY FUNDING/COMPETING INTEREST(S): Funding for the study was provided by ImVitro with grant funding received in part from BPIFrance (Bourse French Tech Emergence (DOS0106572/00), Paris Innovation Amorçage (DOS0132841/00), and Aide au Développement DeepTech (DOS0152872/00)). A.B.-C. is a co-owner of, and holds stocks in, ImVitro SAS. A.B.-C. and F.D.M. hold a patent for 'Devices and processes for machine learning prediction of in vitro fertilization' (EP20305914.2). A.D., N.D., M.M.F., and F.D.M. are or have been employees of ImVitro and have been granted stock options. X.P.-V. has been paid as a consultant to ImVitro and has been granted stocks options of ImVitro. L.C.-D. and C.G.-S. have undertaken paid consultancy for ImVitro SAS. The remaining authors have no conflicts to declare. TRIAL REGISTRATION NUMBER: N/A.

[Birth weight and frozen embryo transfer: State of the art]. / Poids de naissance et transfert d'embryon congelé : état de l'art.

The aim of this study was to update our acknowledgment if there is a link between assisted embryo cryopreservation and epigenetics in human? Animal studies have demonstrated epigenetics consequence and especially imprinting disorders due to in vitro culture. In human, it is important to note that after frozen embryo transfer birth weight is significantly increased by 81 to 250g. But these studies cannot identify the reasons of such difference. This review strongly suggests that embryo cryopreservation is responsible for birth weight variations but mechanisms not yet elucidated. Epigenetics is probably one of these but to date, none study is able to prove it. We have to be attentive on a possible link between assisted reproductive technology (ART) and epigenetics reprogrammation.

Physical examination tests for screening and diagnosis of cervicogenic headache: A systematic review.

It has been suggested that differential diagnosis of headaches should consist of a robust subjective examination and a detailed physical examination of the cervical spine. Cervicogenic headache (CGH) is a form of headache that involves referred pain from the neck. To our knowledge, no studies have summarized the reliability and diagnostic accuracy of physical examination tests for CGH. The aim of this study was to summarize the reliability and diagnostic accuracy of physical examination tests used to diagnose CGH. A systematic review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed in four electronic databases (MEDLINE, Web of Science, Embase and Scopus). Full text reports concerning physical tests for the diagnosis of CGH which reported the clinometric properties for assessment of CGH, were included and screened for methodological quality. Quality Appraisal for Reliability Studies (QAREL) and Quality Assessment of Studies of Diagnostic Accuracy (QUADAS-2) scores were completed to assess article quality. Eight articles were retrieved for quality assessment and data extraction. Studies investigating diagnostic reliability of physical examination tests for CGH scored poorer on methodological quality (higher risk of bias) than those of diagnostic accuracy. There is sufficient evidence showing high levels of reliability and diagnostic accuracy of the selected physical examination tests for the diagnosis of CGH. The cervical flexion-rotation test (CFRT) exhibited both the highest reliability and the strongest diagnostic accuracy for the diagnosis of CGH.

Tumor miofibroblástico inflamatorio (pseudotumor inflamatorio) ocasionando abdomen agudo / Inflammatory myofibroblastic tumor as a cause of acute abdomen

Background: Inflammatory myofibroblastic tumor (IMT) is a rare disease, usually benign, although with possible progression to malignancy. The clinical features depend on its location. If the resection is completed, surgery is curative, but recurrence is possible. The diagnosis is always histopathological. Case report: We report a 20 years old female admitted for a progressive abdominal pain lasting 24 hours. The patient was subjected to an appendectomy but in the postoperative period she continued with nausea and vomiting. The patient was operated again, finding a small bowel tumor with multiple adhesions, occluding the intestinal lumen and a Meckel diverticulum. The pathological study of the tumor reported the presence of an inflammatory myofibroblastic tumor. The patient had an uneventful postoperative outcome.

Introducción: El tumor miofibroblástico inflamatorio (TMI) es una enfermedad poco frecuente, en general benigna, aunque con posible evolución a malignidad. Las características clínicas dependen del lugar en el que esté ubicado. La cirugía es curativa siempre y cuando la resección sea total; aunque no se excluye la posibilidad de recidivas. El diagnóstico siempre es histopatológico. Dadas sus características clínicas y sitios de presentación se ha denominado de distintas formas e incluso sigue siendo motivo de estudio a fin de entender completamente su fisiopatología. Caso clínico: Presentamos un caso de esta rara entidad con un cuadro clínico de un abdomen agudo.

Cistadenoma mucinoso del apéndice cecal como causa de gangrena intestinal / Appendiceal mucocele causing large bowel gangrene

Introduction: Appendiceal mucocele are lesions located in the cecum, which are found in 0.2 to 0.3 percent of appendectomies and correspond to 8-10 percent of all appendiceal tumors. Clinical case: We report a 83 years old female consulting for abdominal pain lasting 24 hours. On physical examination, signs of peritoneal irritation were found. The patient was operated, finding an appendiceal tumor that was coiled up in the mesentery with large bowel gangrene. An intestinal resection, terminal ileostomy, appendectomy and surgical lavage were performed. The pathological study of the surgical piece reported a mucinous cystadenoma.

Introducción: Los tumores del Apéndice Cecal corresponden al 0,5 por ciento de las neoplasias gastrointestinales y se encuentran entre el 0,8 por ciento y el 1 por ciento de las apendicectomías. El término Mucocele Apendicular (AM), se refiere a un grupo de lesiones localizados a nivel del ciego cuyo rango de incidencia está entre el 0,2 por ciento y el 0,3 por ciento de todas las apendicectomías, y entre el 8-10 por ciento de todos los tumores apendiculares. Las presentaciones clínicas más frecuentes son: cuadro clínico de apendicitis aguda, como hallazgo incidental como en el caso de esta paciente, o como masa abdominal en fosa ilíaca derecha. Caso clínico: Se presenta un caso de Cistade-noma Mucinoso Apendicular (CAM) encontrado como hallazgo incidental en un abdomen agudo quirúrgico con la particularidad de presentarse con una necrosis intestinal.

Pielonefritis, colecistitis y cistitis enfisematosas en paciente con diabetes mellitus descompensada / Pyelonephritis, cholecystitis, and emphysematous cystitis in a diabetic patient

Background. Emphysematous pyelonephritis is a necrotizing infection characterized by gas production that usually is located in the kidney tissue, urinary tract and retroperitoneal tissue. Gas can escape following the renal veins and accumulate in the hepatic veins and other places. E coli is the most common causative organism. Clinical case: We report a 62 years old diabetic female, admitted to the hospital with a diabetic ketoacidosis. An abdominal CT scan disclosed a left emphysematous pyelonephritis, cholecystitis and cystitis. The patient was operated, performing a left nephrectomy, cholecystectomy and placement of sub hepatic and retroperitoneal drainages. The pathological study of the surgical piece showed an acute pyelonephritis with abscess formation and chronic cholecystitis. The patient died due to a multi systemic failure.

Introducción: La Pielonefritis enfisematosa es una infección necrotizante caracterizada por la producción de gas, que habitualmente se ubica en el parénquima renal, las vías urinarias y los tejidos retroperi-toneales. Cuando el gas es abundante puede escapar siguiendo las venas renales y acumularse en las venas hepáticas, y el resto del sistema. La E. coli es el patógeno más frecuente. Caso clínico: Presentamos el caso de paciente femenina de 62 años, diabética que ingresa con sintomatología de vías urinarias diagnosticada como pielonefritis enfisematosa izquierda por tomografía y encontrando como hallazgos adicionales.

Clinical factors leading to lamotrigine prescription in bipolar outpatients: subanalysis of the SIN-DEPRES study.

BACKGROUND: The use of lamotrigine is a point of discrepancy among the diverse guidelines published on the management of bipolar disorder (BD). Evidence supporting the long-term efficacy is reasonably robust. Nonetheless, the effectiveness of lamotrigine in acute treatment is vigorously debated and it is unclear how this drug is used in routine clinical practice. This subanalysis of the SIN-DEPRES study was designed to understand the clinical profile of bipolar patients receiving lamotrigine. METHODS: In this prospective national multicenter study, 652 patients with clinically stable bipolar I and II disorder were recruited. Clinical assessments included sociodemographic and clinical data, the Modified Clinical Global Impression scale for BD (CGI-BP-M), the Hamilton Depression Rating Scale (HDRS), and prescriptions of psychotropic medications and their doses. RESULTS: By means of a logistic regression model, an association between receiving treatment with lamotrigine and the following clinical variables was found: number of past depressive episodes (O.R.=2.875, 95% CI: 1.203-6.869, p=0.018), depressive polarity of the most recent episode (O.R.=1.945, 95% CI: 1.267-2.985, p=0.002), severity in CGI-BD-M depression (O.R.=1.850, 95% CI: 1.215-2.817, p=0.004), bipolar II disorder diagnosis (O.R.=1.635, 95% CI: 1.078-2.482, p=0.021) and number of episodes per year (O.R.=1.310, 95% CI: 1.069-1.605, p=0.009). LIMITATIONS: Subanalysis of the SIN-DEPRES study with a cross-sectional design. CONCLUSIONS: The use of lamotrigine in clinical practice is in accordance with most of the guidelines, which support its use in patients with depressive predominant polarity and bipolar II disorder.

Influencia del sexo del paciente en el manejo del síndrome coronario agudo con elevación del STen los servicios de urgencias / Sex-related differences in emergency department management of acute coronary syndrome

Objetivos: Existen datos en la literatura que demuestran que existen diferencias en cuanto a la mortalidad en el síndrome coronario agudo con elevación del segmento ST(IAMEST) entre los distintos sexos, y ésta es más elevada en las mujeres. Nuestra intenciónes analizar las características específicas y la atención urgente recibida tanto extra como intrahospitalaria en función de sexo. Pacientes y métodos: Estudio longitudinal, observacional donde se incluyeron de forma consecutiva todos los pacientes asistidos en el servicio de urgencias (SU) de un hospital general por IAMEST desde marzo 2001 hasta junio 2007. El estudio es un subanálisisdel registro multicéntrico RESIM. Se analizaron datos demográficos, variables clínicas, horarios y tratamiento administrado a nivel extra e intrahospitalario. Resultados: De los 214 casos recogidos, un 74,8% (160 pacientes) eran hombres. La edad media fue de 64,4 ± 12,6 años. Las mujeres atendidas eran más mayores (71,7años DE ± 10,6) que los hombres (62 años DE ± 12,3). La diabetes mellitus fue más frecuente en las mujeres y la hipertensión arterial y el tabaquismo en los hombres. Hubodiferencias entre los siguientes tiempos: inicio de los síntomas y llegada al hospital(240,3 min en hombres vs 503,3 min en mujeres; p < 0,05), inicio de los síntomas y realización de un electrocardiiograma (ECG) (240,6 min en hombres vs 516,4 min en mujeres; p < 0,01) y llegada al hospital y realización de un ECG (6,4 min en hombres 13 min en mujeres; p < 0,01). No encontramos diferencias en el medio de transporte utilizado ni en el tratamiento administrado tanto a nivel extra como intrahospitalario. Conclusiones: Existen retrasos en la atención de mujeres que acuden al SU con IAMEST. Su consideración puede mejorar la atención prestada a estos pacientes (AU)

Background and objective: Higher mortality rates for women with acute coronary syndrome with ST elevation havebeen reported. Our aim was to analyze patient characteristics and care provided by our emergency department both before and after arrival at the hospital in order to detect sex-related differences in approach to care.Patients and methods: Longitudinal, observational study of consecutive patients with acute coronary syndrome with STelevation attended by a general hospital emergency department between March 2001 and June 2007. The study fell within the scope of work carried out by the Spanish Register of Myocardial Infarction Emergencies (RESIM). Patient characteristics, clinical variables, timing, and treatment administered before and after arrival at the hospital were analyzed. Results: Of the 214 cases registered, 160 (74.8%) were men. The mean (SD) age was 64.4 (12.6) years. The women were older (71.7 [10.6] years) than the men (62 [12.3] years). Diabetes mellitus was more common in women and hypertension and smoking more common in men. Care differed with regard to time elapsed between onset of symptoms to arrival at the hospital (men, 240.3 minutes; women, 503.3 minutes; P<.05), time elapsed between on set of symptoms and an electrocardiogram (ECG) (men, 240.6 minutes; women, 516.4 minutes; P<.01), and time elapsed between arrival at the hospital and an ECG (men, 6.4 minutes; women, 13 minutes; P<.01). There were no differences in type of transport used or in treatment given before or after arrival at the hospital.Conclusions: Care for women with acute coronary syndrome with ST elevation is subject to longer delays. Awareness ofthis may improve emergency care given to women (AU)

Vertical distribution of a soil microbial community as affected by plant ecophysiological adaptation in a desert system.

The spatial and temporal patterns of resource distribution in a desert system have been shown to influence a number of soil biota components and processes. The pattern of possible different resources supplied by two typical halophyte shrubs with different ecophysiological adaptations, Atriplex halimus and Hammada scoparia, was found to be the trigger in the present study on the microbial community temporal and spatial (vertical) scale. The uniqueness of A. halimus, a saltbush plant, is in the creation of 'islands of salinity' in its rhizosphere system and the relatively high percentage of organic matter beneath its canopy, whereas the H. scoparia shrub has a leafless stem with a relatively lower amount of organic matter accumulation beneath its canopy. Soil samples from 0 to 50 cm depths were collected at 10-cm intervals during each of the four seasons. The vertical distribution of the microbial community was measured in the vicinity of the above plant shrubs and in the open spaces between them. The results obtained from the field study demonstrated that plant ecophysiological adaptation played an important role in the temporal and spatial distribution of abiotic conditions and microbial community levels such as microbial biomass, CO(2) evolution, and colony-forming units (CFUs) of both bacteria and fungi. However, we did not find consistency in the positive effect of plant cover on the microbial community. The shrub effect was observed to have a major outcome on microbial variables not only on a temporal but also on a spatial (vertical) basis. This contributed to the understanding of the controversy regarding the difference between the shrubs.

[Validated translation to Spanish of the evaluation questionnaire of patients with restless legs syndrome.]. / Traducción validada al español de cuestionarios de evaluación de pacientes con síndrome de piernas inquietas.

Introduction. Restless legs syndrome (RLS) is a common sensory- motor condition, characterised by the irresistible need to move the legs while sitting or lying down, usually presenting late in the day, from the end of the afternoon into the night. Objective. To describe the translation process to Spanish of three different research RLS tools: the diagnosis criteria, the Practitioner Screening Questionnaire and the Basic Set of Questions for Epidemiological Studies. A procedure is proposed for the translation of these tools into other languages. Methods. The back translation method was employed. Five translators took part: two translated into their mother tongue and two into their foreign tongue, and once the translations were completed, a fifth independent translator introduced the changes using his mother tongue. Two expert analysts determined the equivalence between the original questionnaire and the translation. The clarity of the translated questionnaires was evaluated in a sample of students, who completed these themselves, and in RLS patients, for whom the doctor(s) or another authorised person filled them out. Results. The procedure undertaken varied according as to how each instrument were to be used either by health care professionals (diagnosis criteria) or to obtain information from patients (the questionnaire being directly completed by the patient directly or indirectly by a health care professional). No significant differences between the original and the translation of the practitioner screening questionnaire and the basic set of questions for epidemiological studies were found. The translators aimed to maintain concept equivalence function and validity of the original instrument were preserved in the trans lation. The same terminology was employed in the di fferent translations to make sure they were all consistent should they be used together. The Spanish version of the practitioner screening questionnaire has added terms to the first item by providing examples of sensations to ensure its understanding by patients from different parts of Spain. Conclusions. Spanish translated versions of three different questionnaires have been obtained to be used for RLS assessment in Spain, following appropriate psychometric validation. The instrument translated in the third place showed the closest equivalence with original.

Subsyndromal depressive symptoms in patients with bipolar and unipolar disorder during clinical remission.

BACKGROUND: Subsyndromal depressive symptoms seem to be quite prevalent in mood disorders although very few studies have assessed them in patients considered to be in remission by clinical and psychometric criteria. This study sought to evaluate the presence of subsyndromal depressive symptoms in bipolar and unipolar patients in clinical remission. METHODS: One-hundred seventy-six patients with DSM-IV bipolar (62 bipolar I, 58 bipolar II) or unipolar mayor depression (n=58) in clinical remission and 60 healthy subjects were assessed using several psychometric instruments including the 17 items Hamilton Depression Rating Scale (HDRS). To be considered in clinical remission patients assessed with the Clinical Impression for Bipolar Disorder-Modified (CGI-BP-M) had to be stable for 6 months and scoring 6 or less in the Young Mania Rating Scale (YMRS) and 8 or less in the HDRS. RESULTS: Both Unipolar Disorder (UD) and Bipolar Disorder (BD) patients in clinical remission presented statistically significant higher HRSD scores, than healthy subjects. The HRSD scores were statistically higher in UD patients under remission than in BD patients. The subsyndromal symptoms more strongly associated with a clinical diagnosis of either UD or BD were Depressed Mood, Somatic Anxiety, Impact on Work and Activities, Psychic Anxiety, Gastrointestinal and Somatic Symptoms, Retardation during the Interview and Genital Symptoms. CONCLUSION: Subsyndromal depressive symptoms are present in affective disorder patients, both UD and BD, who apparently are in clinical remission. Remitted unipolar patients may have more residual symptoms than bipolar patients, particularly in items related to anxiety and somatic complaints.

Proceso de adaptación al español del cuestionario Mood Disorder Questionnaire / Adaptation of the Mood Disorder Questionnaire to spanish

Introducción: En la actualidad no se dispone de un instrumento de cribado en español para identificar a los pacientes con trastorno bipolar. El Mood Disorder Questionnaire (MDQ) es un instrumento de cribado para los trastornos del estado del ánimo que no está disponible en versión española. En el presente artículo se describe el proceso de adaptación del MDQ para su uso en España. Sujetos y método: El proceso de adaptación se llevó a cabo siguiendo la metodología de traducción-retrotraducción. Los ítems que no presentaron una equivalencia perfecta con el original fueron analizados por el equipo investigador y los traductores hasta llegar a una expresión adecuada, aceptada por consenso. Posteriormente, personas bilingües realizaron una valoración del grado de equivalencia entre el original y la versión en castellano. Finalmente, se valoró la comprensión de cada uno de los ítems utilizando una muestra de 52 controles sanos y 10 pacientes con trastorno bipolar. Resultados: Los datos derivados de la traducción del cuestionario, de la valoración por parte de personas bilingües y de la prueba de comprensión en sujetos sanos fueron satisfactorios en todos los casos. Todos los ítems mostraron una equivalencia perfecta (equivalencia tipo A) o satisfactoria (equivalencia tipo B). El análisis de la comprensión de los ítems (valorado de 1 a 7) osciló entre puntuaciones medias de 6,02 ± 1,44 y 6,85 ± 0,36 puntos. Conclusiones: Estos resultados indican que la versión en español del MDQ es adecuada y bien aceptada, tanto por personas sanas como por pacientes. No obstante, faltan por estudiar las propiedades psicométricas del cuestionario en posteriores estudios

Introduction: Currently, there is no screening instrument in Spanish to detect patients with bipolar disorder. The Mood Disorder Questionnaire (MDQ) is a screening instrument for mood disorders that is not yet available in Spanish. In the present article we describe the cross-cultural adaptation process of the MDQ into the Spanish language. Subjects and method: The adaptation process was based on the forward-backward translation method. Items without perfect equivalence with the original were analyzed by the research team and translators until an agreement was reached. Subsequently, the degree of equivalence between the original and the Spanish version was evaluated by bilingual individuals. Finally, 52 healthy controls and 10 patients with bipolar disorder rated the comprehensibility of each item. Results: Data from the translation, evaluation of equivalence by bilinguals and the test of comprehension in healthy controls were satisfactory. All items showed perfect equivalence (A equivalence) or satisfactory equivalence (B equivalence). Analysis of understanding of items (scored from 1 to 7) ranged from mean scores of 6.02 ± 1.44 to 6.85 ± 0.36 points. Conclusions: These results show that the Spanish version of the MDQ is appropriate and acceptable in healthy individuals as well as in patients with bipolar disorder. Nevertheless, to complete the process of adaptation of the Spanish version, the questionnaire's psychometric properties remain to be studied

Seasonal changes in free-living amoeba species in the root canopy of Zygophyllum dumosum in the Negev Desert, Israel.

The influence of seasonality and Zygophyllum dumosum root canopy on the species diversity of free-living amoebae at two soil depths (0-10 and 10-20 cm) was studied in a Negev Desert ecosystem in Israel. Free-living amoebae were extracted and identified after cultivation in non-nutritive agar plates. A total of 90 amoeba species were identified in the soil during the study period, with the most common genera present being Hartmannella, Platyamoeba, Vahlkampfia, Acanthamoeba, and Echinamoeba. Differences between the control soil and the soil under Z. dumosum were found mainly during the dry seasons, when 97% similarity was found between the two soil layers, which could be due to the effect of the shrub on the soil microenvironment. The amoeba community exhibited more species diversity in spring (reaching a value of 34 species) than in the winter (18 species) or summer and autumn (20 species), since the community has a time lag for becoming stabilized after the dry summer and autumn. This is one of the first studies on the amoeba population in the Negev Desert and elucidates the importance and the need for taking trophic and functional groups into consideration in order to understand biomineralization processes.

Impact of Phyllocnistis citrella (Lepidoptera: Gracillariidae) on leaf area development and yield of mature citrus trees in the Mediterranean area.

Seasonal population trends and damage to citrus trees by the leafminer Phyllocnistis citrella Stainton were studied in the Valencia area of eastern Spain from 1996 to 1999. The area-wide seasonal flushing pattern of citrus trees and leafminer population trends were determined in 10 mature citrus orchards. In the 10 orchards, the annual percentage of new shoots that developed in the spring ranged from 51 to 96% for individual orchards (mean of 80%). Phyllocnistis citrella populations damaged new leaves from July to November. During this period, approximately 45% of the new leaf area was lost due to leafminer mining. In addition, at three mature citrus orchards, two 'Navelina' sweet oranges from 1996 to 1999 and one 'Clementine' mandarin (variety 'Clemenules') in 1998 and 1999, the leaf area damage, spring flushing pattern, and crop yield were determined in trees sprayed one to three times a year with abamectin (Epimeck, 0.02%) to control P. citrella and compared with nonsprayed control trees. In these three orchards, damaged leaf area in summer-fall flushes was on average 52% in nonsprayed and 8% in sprayed trees. No significant differences were found between sprayed and nonsprayed trees in the spring flushing and flowering pattern, number of fruits or fruit diameter. In Mediterranean areas, P. citrella damaged only 5-15% of the annual new leaf area of mature trees and yield was usually not affected by the pest.

Dental health for the pediatrician.

Pediatricians play an important role in promoting oral health care, and their advice regarding dental procedures or therapies may be solicited. This review is intended to provide answers for the more common questions that parents may have regarding the oral health of their children. The controversies surrounding early orthodontic therapy and mercury-containing amalgam fillings continue to be areas of contention. Why does the orthodontist want to initiate orthodontic treatment in a 7-year-old child? Is there justification for the banning of amalgam fillings, as has occurred in some countries? Also explored are the current therapies for two of the more common oral mucosal disorders: aphthous ulcers and recurrent herpes simplex labialis. These subjects have relevance not only for pediatric patients but also for adults (and for many providers) as well.

In vitro evaluation of the amebicidal activity of Buddleia cordata (Loganiaceae, H.B.K.) on several strains of Acanthamoeba.

Infectious diseases produced by free-living amoebae from the genus Acanthamoeba have been recently recognized. The need for antiamebic compounds is urgent as the occurrence of these diseases is being registered more frequently since the late sixties. We screened the aqueous and methanolic extract of a plant used by folk medicine (Buddleia cordata) against eye and skin inflammation for antiamebic activity. We tested the extracts on 29 strains of free-living amoebae, with the result that they were amebostatic for 14 and 15 strains, respectively. We obtained linarin and vanillic acid from the extracts, but only linarin was amebostatic to all the strains and vanillic acid had no activity. However, acetyl vanillic acid had similar effects on amoebae to linarin. Threshold values of these two active compounds ranged from 31.25 microg/ml to 4 mg/ml and from 31.25 microg/ml to 8 mg/ml for linarin and acetyl vanillic acid, respectively. These differences in threshold values were observed even on several strains belonging to the same species (as in the case of A. castellanii and A. polyphaga) indicating the need of susceptibility testing for each clinical isolate of free-living amoebae.

The evolutionary history of the genus Acanthamoeba and the identification of eight new 18S rRNA gene sequence types.

The 18S rRNA gene (Rns) phylogeny of Acanthamoeba is being investigated as a basis for improvements in the nomenclature and taxonomy of the genus. We previously analyzed Rns sequences from 18 isolates from morphological groups 2 and 3 and found that they fell into four distinct evolutionary lineages we called sequence types T1-T4. Here, we analyzed sequences from 53 isolates representing 16 species and including 35 new strains. Eight additional lineages (sequence types T5-T12) were identified. Four of the 12 sequence types included strains from more than one nominal species. Thus, sequence types could be equated with species in some cases or with complexes of closely related species in others. The largest complex, sequence type T4, which contained six closely related nominal species, included 24 of 25 keratitis isolates. Rns sequence variation was insufficient for full phylogenetic resolution of branching orders within this complex, but the mixing of species observed at terminal nodes confirmed that traditional classification of isolates has been inconsistent. One solution to this problem would be to equate sequence types and single species. Alternatively, additional molecular information will be required to reliably differentiate species within the complexes. Three sequence types of morphological group 1 species represented the earliest divergence in the history of the genus and, based on their genetic distinctiveness, are candidates for reclassification as one or more novel genera.