Preventing Shift from Pneumocephalus During Deep Brain Stimulation Surgery: Don't Give Up the 'Fork in the Brain'.

Clinical vignette: We present the case of a patient who developed intra-operative pneumocephalus during left globus pallidus internus deep brain stimulation (DBS) placement for Parkinson's disease (PD). Microelectrode recording (MER) revealed that we were anterior and lateral to the intended target. Clinical dilemma: Clinically, we suspected brain shift from pneumocephalus. Removal of the guide-tube for readjustment of the brain target would have resulted in the introduction of movement resulting from brain shift and from displacement from the planned trajectory. Clinical solution: We elected to leave the guide-tube cannula in place and to pass the final DBS lead into a channel that was located posterior-medially from the center microelectrode pass. Gap in knowledge: Surgical techniques which can be employed to minimize brain shift in the operating room setting are critical for reduction in variation of the final DBS lead placement. Pneumocephalus after dural opening is one potential cause of brain shift. The recognition that the removal of a guide-tube cannula could worsen brain shift creates an opportunity for an intraoperative team to maintain the advantage of the 'fork' in the brain provided by the initial procedure's requirement of guide-tube placement.

Management of essential tremor deep brain stimulation-induced side effects.

Deep brain stimulation (DBS) is an effective surgical therapy for carefully selected patients with medication refractory essential tremor (ET). The most popular anatomical targets for ET DBS are the ventral intermedius nucleus (VIM) of the thalamus, the caudal zona incerta (cZI) and the posterior subthalamic area (PSA). Despite extensive knowledge in DBS programming for tremor suppression, it is not uncommon to experience stimulation induced side effects related to DBS therapy. Dysarthria, dysphagia, ataxia, and gait impairment are common stimulation induced side effects from modulation of brain tissue that surround the target of interest. In this review, we explore current evidence about the etiology of stimulation induced side effects in ET DBS and provide several evidence-based strategies to troubleshoot, reprogram and retain tremor suppression.

The Effects of Deep Brain Stimulation on Mood and Quality of Life in Parkinson's Disease: A Systematic Review and Meta-Analysis.

Deep brain stimulation (DBS) is extensively used to treat motor and non-motor symptoms in Parkinson's disease (PD). The aim of this study was to investigate the difference between subthalamic (STN) and globus pallidus internus (GPi) DBS on mood and quality of life with reference to minimal clinically important differences (MCID). A systematic literature search for articles published until November 2022 yielded 14 studies meeting the eligibility criteria, with a total of 1,088 patients undergoing STN (n=571) or GPi (n=517) stimulation. Baseline patient and clinical characteristics were comparable between the two groups. Results showed that GPi stimulation demonstrated a greater reduction in the Beck depression inventory (mean difference (MD)=1.68) than STN stimulation (MD=0.84). Hospital anxiety and depression scale showed a 2.69- and 3.48-point decrease by the GPi group in the depression and anxiety categories, respectively. The summary index (SI) of the PD questionnaire depicted a greater improvement in the GPi group from baseline (mean=41.01, 95% CI 34.89, 47.13) to follow-up (mean=30.85, 95% CI 22.08, 39.63) when compared to the STN group (baseline mean=42.43, 95% CI 34.50, 50.37; follow-up mean=34.21, 95% CI 25.43, 42.99). The emotions category also demonstrated a similar trend. However, STN stimulation showed greater reductions in motor symptoms and medication than GPi stimulation. This meta-analysis demonstrated that GPi stimulation seems to offer an advantage over STN stimulation in improving mood and quality of life in PD, but those effects must be further validated by larger studies.

Hyposmia and apathy in early, de novo Parkinson's disease: Lessons from structural brain connectivity.

INTRODUCTION: The neuroanatomical structures implicated in olfactory and emotional processing overlap significantly. Our understanding of the relationship between hyposmia and apathy, common manifestations of early Parkinson's disease (PD), is inadequate. MATERIALS AND METHODS: We analyzed data on 40 patients with early de-novo idiopathic PD enrolled within 2 years of motor symptom onset in the Parkinson's Progression Markers Initiative (PPMI) study. To be included in the analysis, patients must have smell dysfunction but no apathy at the baseline visit and had completed a diffusion MRI (dMRI) at the baseline visit and at the 48-month follow-up visit. We used the FMRIB Software Library's diffusion tool kit to measure fractional anisotropy (FA) in six regions of interest on dMRI: bilateral anterior corona radiata, left cingulum, left superior corona radiata, genu and body of the corpus callosum. We compared the FA in each region from the dMRI done at the beginning of the study with the follow up studies at 4 years. RESULTS: We found a significant decrease of FA at the bilateral anterior corona radiata, and the genu and body of the corpus callosum comparing baseline scans with follow up images at 4-years after starting the study. CONCLUSION: Structural connectivity changes associated with apathy can be seen early in PD patients with smell dysfunction.

Drugs to the Rescue: Comparison of On-Demand Therapies for OFF Symptoms in Parkinson's Disease.

Patients with Parkinson's disease often suffer from OFF symptoms disrupting their daily routines and adding to disabilities. Despite polypharmacy and adjustments to medication schedules, they often do not experience consistent relief from their motor symptoms. As the disease progresses, impaired gastric emptying may evolve, making it even more challenging for dopaminergic drugs to provide consistent results. This review focuses on a group of drugs that have the pharmacokinetic advantage of a much earlier onset of action by virtue of their non-oral routes of absorption. We compare the current marketed options: subcutaneous apomorphine, sublingual apomorphine, and inhaled levodopa. Subcutaneous apomorphine is the speediest to take effect, whereas sublingual apomorphine offers the longest clinical effect. Inhaled levodopa has the most favorable side effect profile among the three options. An inhaled form of apomorphine is currently under development, having passed safety and efficacy studies. Each of these drugs has unique characteristics for the user, including different side effect profiles and onset of action. The best choice for a patient will depend on individual needs and circumstances. In this review, we explore those nuances to allow clinicians to select the best option for their patients.

Socio-emotional strengths against psychopathology and suicidal ideation in fear of COVID-19.

Coronavirus disease (COVID-19) has caused a global health crisis. It also leads to different types of psychosocial problems in society as a result of preventive health measures and the disease itself. Among others, psychopathological symptoms and suicide behaviors have increased. The PsicorecurSOS COVID-19 online protocol was designed. At baseline, 1020 Spanish adults were assessed, during confinement, for sociodemographics, fear of COVID-19, anxious-depressive symptoms, covitality, and suicidal ideation. Reliability, descriptive, and frequency analyses were carried out, and the computer tool SPSS PROCESS was used to carry out a conditional process analysis (model 59). A total of 595 participants were included (58.30% response rate from baseline; mean age = 37.18 [SD = 13.30]; 72.44% female). Regarding suicidal ideation, 12% responded differently to "never," 19.3% exceeded the cutoff point on the anxiety scale, and 24% on the depression scale. Moderate mediation analysis explained 27% of the variance in suicidal ideation. In addition, the indirect effect of moderate mediation was significant (b = -.004, SE = .002 with the presence of covitality; and b = .01, SE = .003 absence of covitality). Sex and age did not influence the overall outcome of the model. The data from this study can serve as a starting point for generating social and health treatment initiatives based on self-examination of anxiety-depressive symptoms and increasing socio-emotional skills in order to prevent and alleviate the psychosocial effects of the pandemic.

Adjuvant medical therapy in cervical dystonia after deep brain stimulation: A retrospective analysis.

Background: There is limited information on optimization of symptomatic management of cervical dystonia (CD) after implantation of pallidal deep brain stimulation (DBS). Objectives: To describe the long-term, "real-world" management of CD patients after DBS implantation and the role of reintroduction of pharmacologic and botulinum toxin (BoNT) therapy. Methods: A retrospective analysis of patients with focal cervical or segmental craniocervical dystonia implanted with DBS was conducted. Results: Nine patients were identified with a mean follow-up of 41.7 ± 15.7 months. All patients continued adjuvant oral medication(s) to optimize symptom control post-operatively. Three stopped BoNT and four reduced BoNT dose by an average of 22%. All patients remained on at least one medication used to treat dystonia post-operatively. Conclusion: Optimal symptom control was achieved with DBS combined with either BoNT and/or medication. We suggest utilization of adjuvant therapies such as BoNT and/or medications if DBS monotherapy does not achieve optimal symptom control.

Olfaction and apathy in early idiopathic Parkinson's disease.

BACKGROUND: Apathy remains a disabling symptom in Parkinson's disease (PD) with limited therapeutic success. Processing of emotions and smell share neuroanatomical and evolutionary pathways. OBJECTIVES: To explore the association of apathy with smell dysfunction (SD) in early PD. METHODS: We analyzed patients with de-novo PD, with follow-up of at least 5 years from the Parkinson's Progression Markers Initiative. SD and apathy were defined using University of Pennsylvania Smell Identification Test and MDS-UPDRS part 1A. Odds ratios were calculated between apathy and olfaction groups. Kaplan-Meier survival analysis was grouped by presence/ absence of smell dysfunction. The Log Rank test was used to compare time to apathy. RESULTS: We found no association between presence of apathy in patients with and without SD (OR 1.01 [0.49-2.08]). There was no significant difference between PD patients with and without SD in time to apathy (p = 0.72). CONCLUSIONS: SD does not portend greater risk of apathy in PD.

Under pressure: pressure-dependent pontine compression by a dolichoectasia basilar artery, a case report.

Basilar artery dolichoectasia can lead to ischemic stroke through thrombosis of small perforating vessels of the brainstem. Here we report the case of a patient with transient paramedian pontine syndrome in the setting of a hypertensive crisis, finding a dolichoectasia basilar artery compressing on the ventral surface of the pons. The outcome was near-complete resolution of deficits after blood pressure control. We propose increased basilar artery pulse pressure as a novel mechanism of transient compression of the brainstem by a dolichoectasia artery.

Gestational Weight Gain Among Pregnant Women in the Mexico–US Border City of Tijuana, Mexico / Ganancia Excesiva de Peso Gestacional entre Mujeres Embarazadas en la Ciudad Fronteriza de Tijuana, México

Background: Excess of gestational weight gain is a risk factor for short and long term health implications for women and their offspring. The aim of this study was to assess the prevalence of excess of gestational weight gain (EGWG) among pregnant women attending the social security system, and to assess the factors associated with it. Methods: The inclusion criteria for this study were women attending immediate puerperium, older than 18yo with a single delivery, and delivery of a live, single birth, mothers who sought prenatal visits at or before the 20th week of gestation with a minimum of 8 total visits, and who had a baseline weight measure before pregnancy. Categorization of BMI was done according to WHO classification and EGWG was assessed by using the Institute of Medicine guidelines. Associations between EGWG and maternal and new- born variables were assessed by odds ratio and Chi-squared test. Results: A total of 438 women were included. The overall prevalence of EGWG was 43%, and a higher prevalence was observed in higher BMI subgroups. Significant dependence was found between EGWG and new-born weight categories and after stratification of macrosomic vs non-macrosomic delivery (OR=2.2 (CI95%=1.2-4.2). Further, an association was found between EGWG and threatened abortion (7.7%). Conclusions: A very high prevalence (43%) of EGWG with a higher likelihood of having macrocosmic new-borns was found. Additionally, an association was found between EGWG and threatened abortion.(AU)

Antecedentes: La ganancia excesiva de peso gestacional es un factor de riesgo a corto y a largo término con implicaciones para las mujeres y sus hijos. El objetivo de este estudio fue valorar la prevalencia de la ganancia excesiva de peso gestacional (GEPG) entre mujeres que se atienden en el sistema de seguridad social y valorar los factores asociados. Métodos: Los criterios de inclusión fueron mujeres que se atendieron en el puerperio inmediato, mayores de 18 años, con parto único, producto vivo, y que antes de la semana 20 de embarazo tuvieron atención pre-natal un mínimo de ocho visitas, y a quienes tenían la medición del peso previo al embarazo. Las categorías del índice de masa corporal fueron de acuerdo a los criterios de la OMS y la GEPG se estimó de acuerdo a las guías del Instituto de Medicina de los EEUU. Las asociaciones entre la GEPG y las variables maternas y las del recién nacido se realizaron por medio de la Chi cuadrada y el Odds Ratio. Resultados: Se incluyeron un total de 438 mujeres. La prevalencia de GEPG fue de 43% y se observó una mayor prevalencia en los grupos de IMC más altos. Se observó asociación significativa entre GEPG y las categorías de peso al nacimiento y después de la estratificación de producto macrosómico vs no macrosómico (OR=2.2 (CI95%=1.2-4.2). Además se observó asociación entre GEPG y amenaza de aborto (7.7%). Conclusión: Se observó una muy alta prevalencia de GEPG (43%), y una mayor probabilidad de productos macrosómicos. Asimismo, se observó una asociación entre la GEPG y la amenaza de aborto.(AU)

Energetic and structural effects of the Tanford transition on ligand recognition of bovine ß-lactoglobulin.

Bovine ß-lactoglobulin, an abundant protein in whey, is a promising nanocarrier for peroral administration of drug-like hydrophobic molecules, a process that involves transit through the different acidic conditions of the human digestive tract. Among the several pH-induced conformational rearrangements that this lipocalin undergoes, the Tanford transition is particularly relevant. This transition, which occurs with a midpoint around neutral pH, involves a conformational change of the E-F loop that regulates accessibility to the primary binding site. The effect of this transition on the ligand binding properties of this protein has scarcely been explored. In this study, we carried out an energetic and structural characterization of ß-lactoglobulin molecular recognition at pH values above and below the zone in which the Tanford transition occurs. The combined analysis of crystallographic, calorimetric, and molecular dynamics data sheds new light on the interplay between self-association, ligand binding, and the Tanford pre- and post-transition conformational states, revealing novel aspects underlying the molecular recognition mechanism of this enigmatic lipocalin.

Leptin G-2548A and Leptin Receptor Q223R Gene Polymorphisms are Differently Associated with Oxidative Process in Mexican Mestizo and Indigenous with Obesity.

Leptin levels and oxidative stress are implicated in obesity risk. Reports of association of leptin gene (LEP) and leptin receptor gene (LEPR) polymorphisms with leptin elevation are contradictory in a diverse population. Only a few studies report the linkage of obesity with biochemical markers and genetic factors. OBJECTIVE: The aim of this study was to examine whether plasma lipid peroxidation, antioxidant capability, leptin levels are associate selected LEP -2548 A/G and LEPR Q223R polymorphisms in mestizo and indigenous obesity Mexican population. METHODS: We identified and characterized 50 overweight or obese subjects and 50 healthy, normal- weight volunteers with indigenous Tepehuana or Mexican mestizo ethnicity from Durango, Mexico. LEP -2548 A/G and LEPR Q223R polymorphisms were determined by genotyping. Concentrations of leptin, antioxidant capacity (CA) and lipoperoxidation (LIPX) were determined in fast conditions on plasma with Enzyme-Linked ImmunoSorbent Assay (ELISA) in all participants. RESULTS: The highest genotype frequency was the heterozygous LEPR, which was associated with lipid peroxidation levels in normal-weight Tepehuan populations. A positive correlation was observed (r = 0.5; p <0.01) between LEP polymorphism and lipoperoxidation in normal weight Tepehuan subjects. On the other hand, the LEPR polymorphism was associated with the level of lipoperoxidation (r = 0.13; P <0.05) in mestizo populations of normal weight. CONCLUSION: It is probable that there is a synergistic effect for obesity, where the presence of oxidative stress and single nucleotide polymorphisms (SNP) of leptin and its receptor contributes to the generation of pathological subcutaneous fat of obesity, together with the environmental conditions of the populations.

Política pública en los procesos de internacionalización para programas de derecho en Colombia

Introducción. El documento es el resultado de una investigación científica que tiene por objetivo evaluar los procesos de internacionalización en los currículos de los programas de derecho del área metropolitana de Barranquilla. Objetivo. Con miras a alcanzar este objetivo, se abordan aspectos conceptuales como las dimensiones políticas y jurídicas de la internacionalización en el ámbito de la educación superior y de las ciencias jurídicas. Materiales y métodos. Con un método de carácter deductivo y una tipología de análisis hermenéutico documental. Resultados. Existe ausencia de gestión y conocimientos técnicos en los diseños de políticas públicas en internacionalización de programas de derecho. Conclusión. EAn síntesis que frente a los lineamientos de gestión de la política pública en los procesos de internacionalización de programas de derecho en Colombia, existen factores que se hace necesario colocar a tono a las instituciones de educación superior.

Introduction. This document is the result of a scientific research intended to evaluate the internationalization processes in curricula of law programs in Barranquilla metropolitan area. Objective. With the purpose of reaching this objective, conceptual aspects such as political and juridical areas of internationalization in higher education and juridical sciences are addressed. Materials and methods. With a deductive method and a documentary hermeneutic analysis typology. Results. Management and technical knowledge lack in the design of public policies in the internationalization of law programs. Conclusion. With respect to management guidelines of public policy in the internationalization processes of law programs in Colombia, there are factors which should be Set a tone a higher education institutions.

Introdução . O documento é o resultado de uma investigação científica que tem como objetivo avaliar os processos de internacionalização nos currículos dos programas de direito da área metropolitana de Barranquilla. Objetivo. Visando alcançar este objetivo, se abordam aspectos conceituais como as dimensões políticas e jurídicas da internacionalização no âmbito da educação superior e das ciências jurídicas. Materiais e métodos. Com um método de carácter dedutivo e uma tipologia de análise hermenêutico documental. Resultados. Existe ausência de gestão e conhecimentos técnicos nos desenhos de políticas públicas em internacionalização de programas de direito. Conclusão . Em síntese que frente aos alinhamentos de gestão da política pública nos processos de internacionalização de programas de direito na Colômbia, existem fatores que se faz necessário colocar à margem às instituições de educação superior.

First approach to characterize tilts through multiple pistons in the classical Ronchi test.

In this work, it is shown how a tilt can be introduced into a segmented surface through several piston terms, by using the classical Ronchi test. We have developed tilt error simulations by adding multiple constant terms to each point on the sagitta surface of a segment using ray tracing. Thereby a comparison between simulated Ronchigrams for piston and tilt has been performed for two adjacent segments, so that it is possible to appreciate the tilt and piston effects on the shape of the patterns. As a result, we show the behavior of the central maximum of the fringes in the presence of tilt and/or piston. Additionally we present evidence of introducing tilting without changing the surface shape by adding multiple pistons, and a description of how to characterize both piston and tilt using the Ronchi test.

Structure and non-structure of centrosomal proteins.

Here we perform a large-scale study of the structural properties and the expression of proteins that constitute the human Centrosome. Centrosomal proteins tend to be larger than generic human proteins (control set), since their genes contain in average more exons (20.3 versus 14.6). They are rich in predicted disordered regions, which cover 57% of their length, compared to 39% in the general human proteome. They also contain several regions that are dually predicted to be disordered and coiled-coil at the same time: 55 proteins (15%) contain disordered and coiled-coil fragments that cover more than 20% of their length. Helices prevail over strands in regions homologous to known structures (47% predicted helical residues against 17% predicted as strands), and even more in the whole centrosomal proteome (52% against 7%), while for control human proteins 34.5% of the residues are predicted as helical and 12.8% are predicted as strands. This difference is mainly due to residues predicted as disordered and helical (30% in centrosomal and 9.4% in control proteins), which may correspond to alpha-helix forming molecular recognition features (α-MoRFs). We performed expression assays for 120 full-length centrosomal proteins and 72 domain constructs that we have predicted to be globular. These full-length proteins are often insoluble: Only 39 out of 120 expressed proteins (32%) and 19 out of 72 domains (26%) were soluble. We built or retrieved structural models for 277 out of 361 human proteins whose centrosomal localization has been experimentally verified. We could not find any suitable structural template with more than 20% sequence identity for 84 centrosomal proteins (23%), for which around 74% of the residues are predicted to be disordered or coiled-coils. The three-dimensional models that we built are available at http://ub.cbm.uam.es/centrosome/models/index.php.

Improved Ronchi tester.

We used a LED in a Ronchi tester to obtain two main improvements: (i) We can choose one of two wavelength bands to illuminate and record the ronchigram, and (ii) we can change the irradiance of the illumination source according to the optical system under test and the detector array. This can be done by use of an adequate electronic circuit.

Optical alignment of segmented mirrors to the fluorescence detectors of the Pierre Auger observatory.

Segmented mirrors will be used in the telescopes of the Pierre Auger Fluorescence detector. To align the segments, we have developed four methods in which (a) the image of the stop border, (b) the image of a screen with concentric circles, and (c) the Ronchi pattern are used. In addition to these, we have developed a new method, (d), in which instead of the Ronchi ruling, we have used a circular grid. In this case we obtain a moiré pattern for each segment by means of which the experimental setup is simplified, and the sensitivity of the alignment is improved.