Identification of allele-specific KIV-2 repeats and impact on Lp(a) measurements for cardiovascular disease risk.

The abundance of Lp(a) protein holds significant implications for the risk of cardiovascular disease (CVD), which is directly impacted by the copy number (CN) of KIV-2, a 5.5 kbp sub-region. KIV-2 is highly polymorphic in the population and accurate analysis is challenging. In this study, we present the DRAGEN KIV-2 CN caller, which utilizes short reads. Data across 166 WGS show that the caller has high accuracy, compared to optical mapping and can further phase ~50% of the samples. We compared KIV-2 CN numbers to 24 previously postulated KIV-2 relevant SNVs, revealing that many are ineffective predictors of KIV-2 copy number. Population studies, including USA-based cohorts, showed distinct KIV-2 CN, distributions for European-, African-, and Hispanic-American populations and further underscored the limitations of SNV predictors. We demonstrate that the CN estimates correlate significantly with the available Lp(a) protein levels and that phasing is highly important.

Military experience in the management of pelvic fractures from OIF/OEF.

INTRODUCTION: Pelvic fractures are a common occurrence in combat trauma. However, the fracture pattern and management within the most recent conflicts, i.e. Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), have yet to be described, especially in the context of dismounted complex blast injury. Our goal was to identify the incidence, patterns of injury and management of pelvic fractures. METHODS: We conducted a retrospective review on all combat-injured patients who arrived at our military treatment hospital between November 2010 and November 2012. Basic demographics, Young-Burgess fracture pattern classification and treatment strategies were examined. RESULTS: Of 562 patients identified within the study time period, 14% (81 of 562) were found to have a pelvic fracture. The vast majority (85%) were secondary to an improvised explosive device. The average Injury Severity Score for patients with pelvic fracture was 31±12 and 70% were classified as open. Of the 228 patients with any traumatic lower extremity amputation, 23% had pelvic fractures, while 30% of patients with bilateral above-knee amputations also sustained a pelvic fracture. The most common Young-Burgess injury pattern was anteroposterior compression (APC) (57%), followed by lateral compression (LC) (36%) and vertical shear (VS) (7%). Only 2% (nine of 562) of all patients were recorded as having pelvic binders placed in the prehospital setting. 49% of patients with pelvic fracture required procedural therapy, the most common of which was placement of a pelvic external fixator (34 of 40; 85%), followed by preperitoneal packing (16 of 40; 40%) and angioembolisation (three of 40; 0.75%). 17 (42.5%) patients required combinations of these three treatment modalities, the majority of which were a combination of external fixator and preperitoneal packing. The likelihood to need procedural therapy was impacted by injury pattern, as 72% of patients with an APC injury, 100% of patients with a VS injury and 25% of patients with an LC injury required procedural therapy. CONCLUSIONS: Pelvic fractures were common concomitant injuries following blast-induced traumatic lower extremity amputations. APC was the most common pelvic fracture pattern identified. While procedural therapy was frequent, the majority of patients underwent conservative therapy. However, placement of an external fixator was the most frequently used modality. Considering angioembolisation was used in less than 1% of cases, in the forward deployed military environment, management should focus on pelvic external fixation±preperitoneal packing. Finally, prehospital pelvic binder application may be an area for further process improvement.

Study protocol for a randomized controlled trial of the NEIVATECH virtual reality system to improve visual function in children with anisometropic amblyopia.

BACKGROUND: Interest in developing alternative methods for the treatment of amblyopia has long been a topic of interest among clinicians and researchers, as prescribed occlusion and penalization therapies do not always provide an effective response and are associated with a high risk of recurrence and non-compliance. Here, we present the protocol of a small-scale RCT to evaluate the safety and clinical efficacy of a novel VR-based system designed to provide binocular vision training to children with anisometropic amblyopia. METHODS: We aim to recruit a total of 60 children with anisometropic amblyopia aged 5-17 years with no previous treatment for amblyopia other than refractive correction from the pediatric ophthalmology units of the University Clinical Hospital of Valladolid and the Vithas Medimar International Hospital of Alicante. Children who meet the eligibility criteria and consent to participate will be randomly assigned to a three-month intervention group of 18 half-hour in-office therapy sessions with the NEIVATECH system (group A) or to a parallel group receiving 2 hours of conventional patching per day at home for the same period of time (group B). Assessments of visual function will be carried out before the intervention and at 1, 2 and 3 months, with changes in distance BCVA being the primary outcome measure to be considered. Patient safety, compliance, satisfaction and acceptance to treatment will also be assessed after therapy as other valuable outcome measures. In addition, a rsfMRI scan will be performed on a subgroup of 5 patients from each group at the pre-intervention visit and at the post-intervention visit to test the effects of both therapies on neural plasticity in the visual cortex. DISCUSSION: The NEIVATECH system has been conceived as a serious game designed to provide binocular vision training to anisometropic amblyopic children by complementing the concepts of perceptual learning, dichoptic training and gamification in an immersive VR environment. We hope that this novel approach may lead to greater improvements in vision performance than those provided so far by conventional patching in anisometropic amblyopic children. TRIAL REGISTRATION: This protocol was registered with ClinicalTrials.gov ( NCT04819386 ) on 29 March 2021.

Effectiveness of rosuvastatin plus colchicine, emtricitabine/tenofovir and combinations thereof in hospitalized patients with COVID-19: a pragmatic, open-label randomized trial.

BACKGROUND: The use of rosuvastatin plus colchicine and emtricitabine/tenofovir in hospitalized patients with SARS-CoV-2 disease (COVID-19) has not been assessed. The objective of this study was to assess the effectiveness and safety of rosuvastatin plus colchicine, emtricitabine/tenofovir, and their combined use in these patients. METHODS: This was a randomized, controlled, open-label, multicentre, parallel, pragmatic study conducted in six referral hospitals in Bogotá, Colombia. The study enrolled hospitalized patients over 18 years of age with a confirmed diagnosis of COVID-19 complicated with pneumonia, not on chronic treatment with the study medications, and with no contraindications for their use. Patients were assigned 1:1:1:1. 1) emtricitabine with tenofovir disoproxil fumarate (FTC/TDF, 200/300 mg given orally for 10 days); 2) colchicine plus rosuvastatin (COLCH+ROSU, 0.5 mg and 40 mg given orally for 14 days); 3) emtricitabine with tenofovir disoproxil plus colchicine and rosuvastatin at the same doses and for the same period of time (FTC/TDF+COLCH+ROSU); or 4) the Colombian consensus standard of care, including a corticosteroid (SOC). The primary endpoint was 28-day all-cause mortality. A modified intention-to-treat analysis was used together with a usefulness analysis to determine which could be the best treatment. The trial was registered at ClinicalTrials.gov: NCT04359095. FINDINGS: Out of 994 candidates considered between August 2020 and March 2021, 649 (65.3%) patients agreed to participate and were enrolled in this study; among them, 633 (97.5%) were included in the analysis. The mean age was 55.4 years (SD ± 12.8 years), and 428 (68%) were men; 28-day mortality was significantly lower in the FTC/TDF+COLCH+ROSUV group than in the SOC group, 10.7% (17/159) vs. 17.4% (28/161) (hazard ratio [HR] 0.53; 95% CI 0.29 to 0.96). Mortality in the FTC/TDF group was 13.8% (22/160, HR 0.68, 95% CI 0.39 to 1.20) and 14.4% in the COLCH+ROSU group (22/153) (HR 0.78, 95% CI 0.44 to 1.36). A lower need for invasive mechanical ventilation was observed in the FTC/TDF+COLCH+ROSUV group than in the SOC group (risk difference [RD] - 0.08, 95% CI 0.11 to 0.04). Three patients presented severe adverse events, one severe diarrhoea in the COLCH+ROSU and one in the FTC/TDF+COLCH+ROSU group and one general exanthema in the FTC/TDF group. INTERPRETATION: The combined use of FTC/TDF+COLCH+ROSU reduces the risk of 28-day mortality and the need for invasive mechanical ventilation in hospitalized patients with pulmonary compromise from COVID-19. More randomized controlled trials are needed to compare the effectiveness and cost of treatment with this combination versus other drugs that have been shown to reduce mortality from SARS-CoV-2 infection and its usefulness in patients with chronic statin use.

Nódulos subcutáneos como manifestación de cisticercosis diseminada / Subcutaneous nodules as manifestation of disseminated cysticercosis

RESUMEN Antecedentes: La cisticercosis es una infección parasitaria causada por la TaeniaSolium. Puede presentar una forma diseminada con compromiso sistémico. Clínicamente, la cisticercosis diseminada puede debutar con la presencia de nódulos subcutáneos. Presentamos un caso de diagnóstico de cisticercosis diseminada con la presencia de nódulos subcutáneos y síntomas respiratorios como única fuente de sospecha de enfermedad. Caso: Se presenta el caso de un paciente varón de 76 años de edad procedente de una región del Centro del Perú que acude a emergencia por hemoptisis, baja de peso y astenia de un año de evolución. Presentaba además nódulos subcutáneos no dolorosos, móviles en miembros superiores, inferiores, tórax, abdomen, cuello y cara. En la biopsia se demostró la presencia de cisticercocelullosae. Fue tratado con albendazol 400mg cada 12 horas por 6 meses, con evolución favorable. Conclusión: La cisticercosis es una enfermedad prevalente en nuestro país. Su presentación diseminada, sin embargo, no es tan frecuente. El diagnóstico puede ser difícil y a veces permanecer oculto, pues la clínica varía de silente a formas graves, dependiendo del órgano afectado, que en una forma diseminada pueden ser múltiples los órganos afectados, como el caso de nuestro paciente. Se concluye que las presencias de nódulos subcutáneos deben hacernos pensar en la posibilidad de formas diseminadas de cisticercosis.

ABSTRACT: Cysticercosis is a parasitic infection caused by Taenia Solium. It can be present as a disseminated form with systemic compromise. Disseminated cysticercosis may clinically debut with the presence of subcutaneous nodules. We present a case of diagnosis of disseminated cysticercosis with the presence of subcutaneous nodules and respiratory symptoms as the only source of suspected disease. Case: We present the case of a 76-year-old male patient from a region of central Peru who came to emergency due to hemoptysis, low weight and asthenia of one year of evolution. It also presented subcutaneous nodules that were painless, mobile in upper and lower limbs, abdomen, neck and face, the biopsy demonstrated with the presence of cysticercuscelullosae. He was treated with albendazole 400mg every 12h for 6 months, with favorable evolution. Conclusion: Cysticercosis is a prevalent disease in our country. Its disseminated presentation, however, is not as frequent. Diagnosis can be difficult and sometimes remain hidden, as the clinic varies from silent to severe, depending on the affected organ, which in a disseminated form can be multiple, as in the case of our patient. We conclude that the presence of subcutaneous nodules should make us think about the possibility of disseminated forms of cysticercosis.

Total sleep deprivation impairs fear memory retrieval by decreasing the basolateral amygdala activity.

It is well known that sleep deprivation impairs fear memory processes, but little is known about the underlying mechanisms or circuits. The aim of this study was to evaluate the effects of total sleep deprivation (24 h) on contextual fear memory acquisition, consolidation, and retrieval, as well as c-Fos activity in the hippocampus and amygdala. Fear memory recall was associated with an increase in the number of c-Fos-positive cells in the hippocampal CA1 and CA3 regions and the basolateral amygdala (BLA). Total sleep deprivation before to the acquisition and during consolidation of memory impaired retrieval and blocked the associated c-Fos activity in the hippocampus and amygdala. In contrast, total sleep deprivation before memory recall also impaired retrieval, but selectively prevented the increase of c-Fos activity in the amygdala (but not in the hippocampus). Our data indicate that sleep is essential not only for acquisition and consolidation but also for the retrieval of fear memories. They also suggest a differential susceptibility of specific memory-related neural circuits (hippocampus and BLA) to the absence of sleep.

[Synaptic plasticity as a substrate of resilience]. / Plasticidad sinaptica como sustrato de la resiliencia.

INTRODUCTION: Adverse life experiences promote the development of mental illness such as depression, anxiety or schizophrenia. However, some individuals are capable to overcome adversity, achieving a physical and psychological normal development; this process is known as resilience. AIM: To discuss the neuronal substrates of resilience. DEVELOPMENT: We propose that resilience at neuronal level needs systems for representing and evaluating the context (adverse situation) in order to display an adequate behavioural output, and for reorganizing memory associated to the adverse situation in order to tell a new story using the same elements of experience; this is, a system that allows to reorganize neuronal ensembles associated to the adverse memory. In this sense, it is not coincidence that neuronal substrates involving in resilience include the reward-guided behavior system (nucleus accumbens-ventral tegmental area), the emotional system (amygdala-hippocampus), the stress system (hypothalamus-pituitary-adrenal) and the system for context evaluation, representation and discrimination (prefrontal cortex-hippocampus). We emphasize that each adverse experience shapes both the activity of the resilience neuronal system and the behavioral output. CONCLUSIONS: We propose that synaptic plasticity in structures for representing and evaluating context is the neuronal substrate of resilience. Specifically, cortico-hippocampal interactions would allow to re-build adverse experiences through the reorganization of neuronal ensembles.

TITLE: Plasticidad sinaptica como sustrato de la resiliencia.Introduccion. Las experiencias adversas facilitan el desarrollo de enfermedades mentales como la depresion, la ansiedad o la esquizofrenia. Sin embargo, algunos individuos muestran capacidades para superar la adversidad logrando un desarrollo fisico y psicologico adecuado; este proceso se conoce como resiliencia. Objetivo. Discutir cual es el sustrato neuronal de la resiliencia. Desarrollo. Se plantea que la resiliencia, neuronalmente, necesita sistemas que representen y evaluen el contexto (la situacion adversa) para dar una salida conductual adecuada, y que reorganicen la memoria de la situacion adversa para poder contar otro relato a partir de los mismos elementos de la experiencia, es decir, un sistema que permita reorganizar los ensambles neuronales de dicha memoria. En este sentido, no es casualidad que los sustratos neuronales involucrados en la resiliencia incluyan al sistema de la motivacion-accion-recompensa (nucleo accumbens-area tegmental ventral), de las emociones (amigdala-hipocampo), del estres (eje hipotalamo-hipofiso-adrenal) y de la representacion, evaluacion y discriminacion del contexto (corteza prefrontal-hipocampo). Se hace enfasis en mostrar como las experiencias adversas especificas modulan tanto la actividad del sistema neuronal de la resiliencia como la salida conductual de cada individuo. Conclusiones. Se propone que la plasticidad sinaptica en estructuras que representan y evaluan el contexto son el sustrato neuronal de la resiliencia. Especificamente, las interacciones corticohipocampicas permitirian la reestructuracion de las experiencias adversas a traves de la reorganizacion de los ensambles neuronales.

The associations between anthropometric measurements and left ventricular structure and function: the Echo-SOL Study.

OBJECTIVE: The objective of this study is to determine associations between anthropometry and echocardiographic measures of cardiac structure and function in Hispanic/Latinos. METHODS: A total of 1,824 participants from ECHO-SOL were included. We evaluated associations between echocardiographic measures of left ventricular structure and function and anthropometric measures using multivariable-adjusted linear and logistic regression models adjusting for traditional cardiovascular risk factors. RESULTS: The mean age was 56 ± 0.17 years, 57% were women. The mean body mass index (BMI) was 30 ± 9.4 kg m-2, waist circumference (WC) was 100 ± 18 cm, and waist-to-hip ratio (WHR) was 0.93 ± 0.15. Adjusted analysis showed that 5-unit increment in BMI and 5-cm increase in WC was associated with 3.4 ± 0.6 and 1.05 ± 0.05 g m-2.7 (p < 0.05 for both) higher left ventricular (LV) mass index, respectively. Similarly, 0.1-unit increment in WHR was associated with 2.0 ± 0.16 g m-2.7 higher LV mass index (p < 0.01). WHR was associated with 0.22 ± 0.08% decrease in ejection fraction (p < 0.05). Concomitantly, 5-unit increment in BMI and WC was associated with increased odds of abnormal LV geometry (odds ratio 1.40 and 1.16, p = 0.03 and <0.01, respectively); 0.1-unit increment in WHR was associated with increased odds of abnormal LV geometry (odds ratio 1.51, p < 0.01). CONCLUSIONS: Among Hispanic/Latinos, higher anthropometric measures were associated with adverse cardiac structure and function.

Análisis superficial de rugosidad (RA) en el mecanizado de Poli-Éter-Éter-Cetona (PEEK) para aplicación en implantes individualizados / Surface roughness analysis (RA) in the machining of Poly-Ether-Keton (PEEK) for tailored implants

RESUMEN El objetivo de esta investigación es determinar los valores de velocidad de corte, avance y trayectoria (estrategia de mecanizado) en el mecanizado del PEEK que permitan obtener una rugosidad (Ra) recomendada según la literatura para la adecuada diferenciación, proliferación y adhesión de células mesenquimales aplicables en implantes óseos[3,4,6,7,11]. De la revisión del estado del arte se determinó que dichos procesos celulares se obtienen cuando la rugosidad superficial Ra tiene un valor entre 1 μm a 3 μm[9,12], de igual forma, a mayor anisotropía superficial, mayor diferenciación celular se obtendrá[7,8]. Para determinar los parámetros de corte con los que se obtiene una rugosidad Ra óptima se realizó un diseño experimental de superficie de respuesta con rangos de exploración de: velocidad de corte: 60 m/min - 90 m/min y velocidad de avance: 900 mm/min - 1500 mm/min usados para ambas estrategias evaluadas: Raster y Espiral. La investigación concluyó que los parámetros de mecanizado con los cuales se obtiene una rugosidad recomendada Ra para la elaboración de implantes óseos son: velocidad de avance 1500 mm/min y velocidad de corte de 90 m/min mecanizando con una trayectoria (técnica de mecanizado) Raster, con la cual se obtiene una rugosidad Ra de 2,7 μm.

ABSTRACT The objective of this study is determinate the values of cutting speed, feed along and the machining strategy to get optimal values of roughness Ra for the machining of PEEK, polyetheretherketone, to get to get differentiation, proliferation and adhesion for mesenchymal for the development of individualized tailored prosthesis. According to literature to get those cellular process the superficial roughness must have a value Ra of 1 μm to 3 μm, also, if more anisotropic surface, more adhesion of cells. To determinate the recommended roughness Response Surface Methodology was used, the region of operability was: cutting speed 60 m/min to 90 m/min, feed along 900 mm/min to 1500 mm/min and a cutting strategy of Raster and Spiral. In this investigation the conclusion was that the cutting parameter to get the recommended roughness Ra for the elaboration of tailored prosthesis is feed along of 1500 mm/min and cutting speed of 90 m/min, machining with Raster strategy, for those parameters the roughness was of 2,7 μm.

Efecto de un tratamiento experimental de una superficie sobre la resistencia flexural en una zirconia Y-TZP / Effect of an experimental surface treatment on Y-TZP zirconia flexural strength

RESUMEN Objetivo: Analizar el efecto del microgranallado superficial como tratamiento experimental de regeneración, en la resistencia flexural y esfuerzos residuales de una Zirconia Y-TZP, una vez ha sido alterada con otros tratamientos mecánicos como microarenado y fresado. Métodos: Un total de 75 probetas de Zirconia Y-TZP fueron divididas en cinco grupos n=15 y sometidas a tratamientos de superficie así: fresado y microarenado (Grupos 2 y 4) microarenado + microgranallado y fresado + microgranallado (Grupos 3 y 5), y comparadas con un grupo control (Grupo 1), mediante Difracción de Rayos X (DRX), Microscopía electrónica de barrido (SEM), Microscopía confocal (CLSM) y sometida a falla en máquina universal de ensayos. Resultados: Los grupos de microgranallado y microarenado presentaron un aumento significativo de la resistencia flexural p=0.0082 con relación al grupo de fresado. Las mediciones mediante DRX no mostraron relación estadística con los cambios en la resistencia flexural. Significancia: Es posible que el microgranallado se considere un tratamiento para regenerar las propiedades mecánicas reducidas por fresado o arenado en la Zirconia Y-TZP.

ABSTRACT Objective: To analyze the effect of surface micro shot peening as an experimental regeneration treatment on the flexural strength and residual stresses of a Y-TZP Zirconia, once it has been altered with other mechanical treatments such as micro sandblasting and milling. Methods: A total of 75 Zirconia Y-TZP specimens were divided into five n = 15 groups and subjected to surface treatments such as: milling and micro sandblasting (Groups 2 and 4) micro sandblasting + micro shot peening; and milling + micro shot peening (Groups 3 and 5), compared to a control group (Group 1), by X-ray diffraction (XRD), scanning electron microscopy (SEM), confocal microscopy (CLSM) and subjected to failure in a universal testing machine. All the results were compared to find a statistical relationship between them using a mixed linear model and Tuckey. Results: The groups of micro shot peening and micro sandblasting presented a significant increase of the flexural strength p = 0.0082 vs the milling group. The XRD technique is not related to flexural strength measurements. Significance: It is possible that the micro shot peening be considered a treatment to regenerate the mechanical properties reduced by milling or sandblasting in Zirconia Y-TZP.

Damage control resuscitation in patients with severe traumatic hemorrhage: a practice management guideline from the Eastern Association for the Surgery of Trauma

BACKGROUND: The resuscitation of severely injured bleeding patients has evolved into a multi-modal strategy termed damage control resuscitation (DCR). This guideline evaluates several aspects of DCR including the role of massive transfusion (MT) protocols, the optimal target ratio of plasma (PLAS) and platelets (PLT) to red blood cells (RBC) during DCR, and the role of recombinant activated factor VII (rVIIa) and tranexamic acid (TXA). METHODS: Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, a subcommittee of the Practice Management Guidelines (PMG) Section of EAST conducted a systematic review using MEDLINE and EMBASE. Articles in English from1985 through 2015 were considered in evaluating four PICO questions relevant to DCR. RESULT: A total of 37 studies were identified for analysis, of which 31 met criteria for quantitative meta-analysis. In these studies, mortality decreased with use of an MT/DCR protocol vs. no protocol (OR 0.61, 95% CI 0.43-0.87, p = 0.006) and with a high ratio of PLAS:RBC and PLT:RBC (relatively more PLAS and PLT) vs. a low ratio (OR 0.60, 95% CI 0.46-0.77, p < 0.0001; OR 0.44, 95% CI 0.28-0.71, p = 0.0003). Mortality and blood product use were no different with either rVIIa vs. no rVIIa or with TXA vs. no TXA. CONCLUSION: DCR can significantly improve outcomes in severely injured bleeding patients. After a review of the best available evidence, we recommend the use of a MT/DCR protocol in hospitals that manage such patients and recommend that the protocol target a high ratio of PLAS and PLT to RBC. This is best achieved by transfusing equal amounts of RBC, PLAS, and PLT during the early, empiric phase of resuscitation. We cannot recommend for or against the use of rVIIa based on the available evidence. Finally, we conditionally recommend the in-hospital use of TXA early in the management of severely injured bleeding patients.

Combat trauma-associated invasive fungal wound infections: epidemiology and clinical classification.

The emergence of invasive fungal wound infections (IFIs) in combat casualties led to development of a combat trauma-specific IFI case definition and classification. Prospective data were collected from 1133 US military personnel injured in Afghanistan (June 2009-August 2011). The IFI rates ranged from 0·2% to 11·7% among ward and intensive care unit admissions, respectively (6·8% overall). Seventy-seven IFI cases were classified as proven/probable (n = 54) and possible/unclassifiable (n = 23) and compared in a case-case analysis. There was no difference in clinical characteristics between the proven/probable and possible/unclassifiable cases. Possible IFI cases had shorter time to diagnosis (P = 0·02) and initiation of antifungal therapy (P = 0·05) and fewer operative visits (P = 0·002) compared to proven/probable cases, but clinical outcomes were similar between the groups. Although the trauma-related IFI classification scheme did not provide prognostic information, it is an effective tool for clinical and epidemiological surveillance and research.

Oleoylethanolamide affects food intake and sleep-waking cycle through a hypothalamic modulation.

Oleoylethanolamide (OEA) is an endogenous molecule related to endocannabinoids (eCBs) that induces satiety. It binds to the peroxisome-proliferator-activated receptor alpha (PPAR alpha). PPAR alpha is involved in feeding regulation and it has been proposed to play a role in sleep modulation. The objective of the present work is to show if this molecule modifies the sleep-waking cycle through central mechanisms. We have found that the peripheral administration of OEA reduces food intake and increases waking with a concomitant reduction of rapid eye movement sleep. Additionally, this treatment produces deactivation of the lateral hypothalamus, as inferred from the c-Fos expression evaluation. Finally, intra-lateral hypothalamus injection of OEA has mirrored the effects induced by this molecule when it is peripherally administered. In conclusion, we show for the very first time that OEA can modify the sleep-waking cycle and food intake, apparently mediated by the lateral hypothalamus.

Paciente con una lesión de pie diabético de grado 5 según la escala de Wagner / A patient with a grade-5 diabetic foot lesion according to the Wagner scale

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De la restauración neuronal a la reorganización de los circuitos neuronales: una aproximación a las funciones del sueño / From neuronal recovery to the reorganisation of neuronal circuits: a review of the functions of sleep

Objetivo. Analizar datos y conceptos que se han generadoen torno a una de las funciones propuestas para el sueño: la restauraciónneuronal. Desarrollo. El sueño es un estado de concienciadiferente de la vigilia. Los mamíferos invierten una buena partede su vida en dormir; por ejemplo, los humanos dormimos una terceraparte de nuestra vida, pero ¿para qué invertir tanto tiempo enun estado donde perdemos contacto con el entorno?, ¿qué pasaríasi no durmiéramos? La privación de sueño total altera procesoscognitivos, como la memoria o la atención; si esta privación seprolonga, el sujeto se deteriora y muere. Se ha propuesto que elsueño sirve para restaurar a los organismos del desgaste ocurridodurante la vigilia y, dado que los primeros efectos de la ausenciade sueño se observan en procesos que dependen directamente delcerebro, se ha sugerido que la restauración neuronal es su principalobjetivo. En este trabajo se analizan algunos estudios sobre losefectos de la privación de sueño total en humanos y ratas, así comola relación entre el sueño y el sistema de las neurotrofinas, el cualpromueve la supervivencia y la restauración neuronal. Finalmente,se discuten teorías recientes sobre la función del sueño. Conclusiones.La restauración de las neuronas no es el fin último del sueño,sino mantener y reorganizar los circuitos neuronales, incluyendo laneoformación de sinapsis, que permiten modificar redes neuronalesexistentes, por efecto de la experiencia, y todo esto para el adecuadofuncionamiento del cerebro y su adaptación al ambiente

Aim. To analyse the data and concepts that have been produced in relation to one of the functions that have beensuggested for sleep, namely, neuronal recovery. Development. Sleep is a state of consciousness that is different to that ofarousal. Mammals devote an important part of their lives to sleeping; for example, as humans, we sleep for a third of our lives,but why do we spend so much time in a state where we lose contact with our surroundings? What would happen if we didn’tsleep? Total sleep deprivation alters cognitive processes such as memory or attention, and if this deprivation is prolonged, theindividual deteriorates and dies. It has been suggested that sleep provides the organism with time to recover from the wear andtear that occurs during the waking state and, given that the first effects of the absence of sleep are seen to affect processes thatare directly dependent on the brain, it has been claimed that its main purpose is to allow neuronal recovery. In this work weanalyse some of the studies on the effects of total sleep deprivation in humans and rats, as well as the relationship betweensleep and the neurotrophin system, which promotes neuronal survival and recovery. Finally, the latest theories about thefunction of sleep are discussed. Conclusions. Neuron recovery is not the ultimate purpose of sleep; rather it is to allow formaintenance and reorganisation of neuronal circuits, including new synapse formation, which enables existing neuronalnetworks to be modified by the effect of experience, and all this makes it possible for the brain to work properly and to adaptitself to the environment

[From neuronal recovery to the reorganisation of neuronal circuits: a review of the functions of sleep]. / De la restauración neuronal a la reorganización de los circuitos neuronales: una aproximación a las funciones del sueño.

AIM: To analyse the data and concepts that have been produced in relation to one of the functions that have been suggested for sleep, namely, neuronal recovery. DEVELOPMENT: Sleep is a state of consciousness that is different to that of arousal. Mammals devote an important part of their lives to sleeping; for example, as humans, we sleep for a third of our lives, but why do we spend so much time in a state where we lose contact with our surroundings? What would happen if we didn't sleep? Total sleep deprivation alters cognitive processes such as memory or attention, and if this deprivation is prolonged, the individual deteriorates and dies. It has been suggested that sleep provides the organism with time to recover from the wear and tear that occurs during the waking state and, given that the first effects of the absence of sleep are seen to affect processes that are directly dependent on the brain, it has been claimed that its main purpose is to allow neuronal recovery. In this work we analyse some of the studies on the effects of total sleep deprivation in humans and rats, as well as the relationship between sleep and the neurotrophin system, which promotes neuronal survival and recovery. Finally, the latest theories about the function of sleep are discussed. CONCLUSIONS: Neuron recovery is not the ultimate purpose of sleep; rather it is to allow for maintenance and reorganisation of neuronal circuits, including new synapse formation, which enables existing neuronal networks to be modified by the effect of experience, and all this makes it possible for the brain to work properly and to adapt itself to the environment.

Intra-atrial thrombus after surgical closure of patent foramen ovale.

Patent foramen ovale (PFO) represents a potential path for paradoxical embolism and is associated with cryptogenic stroke. It has been suggested that because a PFO represents a repairable lesion (by surgical or transcatheter methods), repair may be the optimal treatment to prevent recurrent stroke. This report describes a patient with recurrent neurologic and peripheral embolic events, which occurred approximately 6 months after the surgical closure of a PFO. The diagnosis of an intra-atrial thrombus with a small residual PFO was made by subsequent transesophageal echocardiography. Thrombus formation at the closure site needs to be considered in a patient with recurrent embolic events after closure of a PFO.