Geomorphology applied to landscape analysis for planning and management of natural spaces. Case study: Las Batuecas-S. de Francia and Quilamas natural parks, (Salamanca, Spain).

Geomorphology is fundamental to landscape analysis, as it represents the main parameter that determines the land spatial configuration and facilitates reliefs classification. The goal of this article is the elaboration of thematic maps that enable the determination of different landscape units and elaboration of quality and vulnerability synthetic maps for landscape fragility assessment prior to planning human activities. For two natural spaces, the final synthetic maps were created with direct (visual-perceptual features) and indirect (cartographic models and 3D simulations) methods from thematic maps with GIS technique. This enabled the creation of intrinsic and extrinsic landscape quality maps showing sectors needing most preservation, as well as intrinsic and extrinsic landscape fragility maps (environment response capacity or vulnerability towards human actions). The resulting map shows absorption capacity for areas of maximum and/or minimum human intervention. Sectors of high absorption capacity (minimum need for preservation) are found where the incidence of human intervention is minimum: escarpment bottoms, fitted rivers, sinuous high lands with thick vegetation coverage and valley interiors, or those areas with high landscape quality, low fragility and high absorption capacity, whose average values are found across lower hillsides of some valleys, and sectors with low absorption capacity (areas needing most preservation) found mainly in the inner parts of natural spaces: peaks and upper hillsides, synclines flanks and scattered areas. For the integral analysis of landscape, a mapping methodology has been set. It comprises a valid criterion for rational and sustainable planning, management and protection of natural spaces.

Evaluation of anxiety in Parkinson's disease with some commonly used rating scales.

This study assessed the concurrent validity of the State-Trait Anxiety Inventory (STAI), the Hospital Anxiety and Depression Scale (HADS) and the Hamilton Anxiety Scale (Ham-A) for evaluating anxiety in a group of 46 Parkinson's disease (PD) patients. The magnitude of correlations between the scales was high (all p<0.01), indicating a good concurrent validity. The item-by item analysis indicated that the main characteristics of anxiety in PD patients were 'inability to relax', 'restlessness or inability to feel calm' and 'feeling tense'. The association between anxiety, as measured by the HADS-A, with demographic characteristics or clinical features of PD was not significant, supporting existing data suggesting that anxiety in PD is not closely correlated with the severity of motor symptoms or the degree of disability. The HADS-A may be the most appropriate scale for documenting patient-reported anxiety in depression.

Cardiac risk assessment of asymptomatic patients by stress echocardiography before infrarenal aortic aneurysm surgery.

AIM: Aggressive cardiac assessment before aortic abdominal aneurysm (AAA) surgery is indicated for patients with symptomatic coronary artery disease (CAD). Assessment of intermediate and moderate risk patients is still under debate. The purpose of the study was to prospectively evaluate the effectiveness of stress echocardiography (SE) in the detection of CAD in patients undergoing AAA surgery who have no symptoms and/or signs of CAD, but who have risk factors for it. METHODS: Patients with 1 or more risk factors for CAD underwent SE. All patients with positive SE underwent coronary arteriography, and, when indicated, treatment. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for SE by comparing results to coronary arteriography. Moreover, major perioperative cardiac events were recorded. RESULTS: Ninety-one patients with AAA and risk factors for CAD were studied. SE was positive in 9 cases, including 7 presenting critical CAD on the basis of coronary arteriography. One major cardiac event (1.1%), a nonfatal myocardial infarction, occurred in 1 patient with positive SE and non-critical, single-vessel CAD. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of SE proved to be 100%, 98%, 78%, 100%, and 92%, respectively. CONCLUSIONS: Positive SE should be considered a valid method for testing high-risk patients for CAD. The low rate of major cardiac events in this series suggests that cardiac assessment by SE and selective coronary arteriography prior to AAA surgery is effective in asymptomatic patients with one or more risk factors.

Number processing and calculation--normative data from healthy adults.

Despite the high incidence of numerical deficits in neurological patients, little attention has been paid to the development of diagnostic tools. In fact, most of the published reports on acquired numerical disorders, whether single case or group studies, do not refer to standardised measures of performance providing little, if any, control data specifically collected for the examination. In this study we present data of 282 healthy controls of different age groups and educational levels in a new battery of Number Processing and Calculation (NPC). The NPC battery includes a total of 35 tasks, assessing different counting abilities, various aspects of number comprehension (such as parity and magnitude judgements), numerical transcoding, calculation, arithmetic reasoning and conceptual knowledge. Special attention is paid to the assessment of different calculation abilities, including simple fact retrieval, rule based processing, mental calculation and written calculation in all four operations. Moreover, text problem solving is assessed as well as the understanding of arithmetic principles. Thus, the NPC battery differs from the EC 301 battery proposed by Deloche et al., 1994 (Dellatolas, Deloche, Basso, & Claros-Salinas, 2001) and allows a more fine grained diagnosis which is relevant for planning targeted interventions. The battery is easy to administer and does not require special materials or equipment.

Can cerebral vasoreactivity predict cerebral tolerance to carotid clamping during carotid endarterectomy?

Cerebral vasoreactivity (CVR) was evaluated as a preoperative test in predicting cerebral tolerance to carotid clamping.A consecutive series of 115 carotid endarterectomy (CEA) cases were studied. Before surgical operation CVR was evaluated, by measuring the mean velocity of the middle cerebral artery (mv-MCA) using transcranial Doppler (TCD) at the basal condition and 20 min after intravenous administration of acetazolamide (1 g). CEA was performed under general anesthesia. TCD was used during surgery to evaluate mv-MCA and to calculate mv-MCA clamping/mv-MCA pre-clamping x100 ratio (mv-MCA%), which was used as the parameter to validate CVR.CVR did not correlate with mv-MCA% (r=0.22). There was no significant difference (P=0.09) between mean values of the non shunted subgroup and the shunted one.CVR does not seem to be suitable for evaluating cerebral tolerance to carotid clamping.

Letter and number writing in agraphia: a single-case study.

The gradual recovery of writing abilities of a patient whose processing of Arabic numerals and alphabetic script evolved differently over time is reported. Writing of multidigit numerals was achieved when writing of letters was nil. However, despite an initial advantage for numbers, the final examination disclosed fluent and correct writing of letters and words together with specific syntactic difficulties in complex Arabic numerals. The differential improvement for Arabic and alphabetic stimuli is partly explained in terms of different processing requirements rather than in terms of script-specific mechanisms only.

Writing and rewriting numerals: a dissociation within the transcoding processes.

In the present study we report the case of A.B., a patient with a specific, though not isolated, deficit in transcoding verbal to Arabic numerals. Despite perfect production of Arabic numerals in a writing to dictation task, she frequently produced syntactic errors when the input was in written verbal form (e.g., duecentotrenta [two hundred and thirty] --> 20030). In absence of problems in the verbal comprehension system, A.B.'s performance is difficult to accommodate within current models of number processing. In the attempt to interpret the present findings, we suggest that different numerical codes, i.e, spoken and written verbal numerals, activate with different efficiency the transcoding algorithm.

[Surgical management of asymptomatic carotid artery stenosis. Authors' experience, problems and prospectives]. / La chirurgia della stenosi carotidea asintomatica. Nostra esperienza, problemi e prospettive.

BACKGROUND: Some trials have demonstrated effectiveness of carotid endarterectomy (CEA) for preventing stroke in patients with severe symptomatic carotid stenosis. Although some researches, indication to surgery for asymptomatic carotid stenosis is debated up today. Based on personal experience and literature, the main problems of CEA for asymptomatic stenosis are discussed. DESIGN: Retrospective study. SETTING: Section of Vascular Surgery, University Department. PATIENTS: CEA was performed in a consecutive series of 63 cases with asymptomatic stenosis (59 patients, 40 males and 19 females, ages ranging from 46 to 80 years, mean 67.9). INTERVENTIONS: CEA was performed under general anesthesia, with primary closure of arteriotomy in 37 cases and patch angioplasty using PTFE in 24, using eversion technique in 2 cases. Pruitt-Inahara shunt was used in 10/63 cases (15.9%), according to the mean velocity of the middle cerebral artery at carotid clamping/mean velocity of the middle cerebral artery pre-clamping ratio x 100 equal to or lesser than 15%, evaluated with transcranial Doppler, or stump pressure lesser than 50 mmHg, when transcranial Doppler examination was not possible. MEASURES: Operative mortality and postoperative morbidity. RESULTS: Operative mortality plus postoperative stroke were 1.6% (1/63). Operative mortality was precisely 0.0%. Postoperative complications were two: one was a neurologic deficit (monoparesis of the arm) and the other was myocardial ischemia. CONCLUSIONS: Four main problems have been shown in CEA for asymptomatic stenosis: 1. Identification of asymptomatic stenosis: 2. Assessment of risk for stroke: 3. Role of CEA: 4. Questions about surgical treatment. For the first problem, it is important to consider possible indicators for carotid stenosis (contralateral carotid stenosis, coronary artery disease, aortic aneurysm, peripheral arterial disease, etc.). With regard to the second problem, it is important to know the natural history of the carotid stenosis, which shows a stroke rate of 1-2% per year. Regarding the third problem, the role of CEA is conditioned by: trials, patient conditions, lesion characteristics and ability of the surgeon. Further studies should identify some groups of patients (with severe carotid stenosis, dyshomogeneous plaque, progression of plaque, etc.), who can profit from CEA. Finally (fourth problem), CEA for asymptomatic carotid stenosis carries all common problems of carotid surgery (preoperative assessment, evaluation of cerebral ischemia due to carotid clamping, shunt, closure of arteriotomy, etc.). Some of these problems can receive ultimate solutions from some studies in next years.

Temporal relationships between changes in phantom limb pain intensity and changes in surface electromyogram of the residual limb.

Previous studies of relationships between surface EMG of the residual limb and phantom pain have not shown which changed first. Thus, predictive relationships could not be demonstrated. 24 male (20) and female (4) amputees between the ages of 33 and 71 who reported either burning (3), cramping (8), shocking-shooting-stabbing (6), or a combination of these descriptions of phantom pain (7) participated in one or two recording sessions. Raw surface EMG from the major muscles of the residual limb was recorded while subjects activated an event marker to indicate changes in pain. All eight subjects with cramping phantom pain reported changes in pain after the recording showed sharply demarcated increases in EMG. Subjects reporting either shocking-shooting or burning pain did not show any consistent relationships between EMG and pain. Three of the four subjects reporting experiencing both shocking-shooting and cramping phantom pain simultaneously during recordings showed changes in EMG preceding changes in pain. Sensations of cramping phantom pain were preceded by increases in muscle tension in the residual limb in almost every instance for each of our subjects showing changes in cramping phantom pain. Thus, changes in muscle tension in the residual limb are likely to either be causes or close intermediaries for the cause of cramping phantom pain but not necessarily of other common descriptors.

Personality profiles of the morbidly obese.

Personality characteristics of 150 morbidly obese patients (100 pounds or more over ideal weight) were investigated. The patients were given the Minnesota Multiphasic Personality Inventory (MMPI) and a new, self-report personality disorder inventory. The study attempted to determine whether particular personality variables could predict success or failure at weight loss six months post-surgery. Multivariate analyses of variance revealed no significant differences on any of the personality variables when the patients were divided into "good," "fair," and "poor" success categories. Rank order MMPI scale profiles and personality disorder profiles are presented and implications discussed.