Ethoxysclerol injection into the posterior ligament under single puncture arthroscopy for the treatment of recurrent temporomandibular joint dislocation: a novel technique.

The pathogenesis of recurrent chronic dislocation of the temporomandibular joint has been attributed to multiple factors, such as hyperlaxity of the soft tissues or alterations in the size of the temporal eminence. When there are no bone alterations, the injection of sclerosing solutions is an effective treatment that can be performed using a blind technique or with arthroscopy. This study presents an innovative technique for injecting ethoxysclerol into the posterior ligament through single puncture arthroscopy. This approach offers a safe and effective alternative for surgeons without experience in high-complexity arthroscopy who want to ensure precise injection of the agent into the desired anatomical areas.

Quantum Information Entropy for Another Class of New Proposed Hyperbolic Potentials.

In this work, we investigate the Shannon entropy of four recently proposed hyperbolic potentials through studying position and momentum entropies. Our analysis reveals that the wave functions of the single-well potentials U0,3 exhibit greater localization compared to the double-well potentials U1,2. This difference in localization arises from the depths of the single- and double-well potentials. Specifically, we observe that the position entropy density shows higher localization for the single-well potentials, while their momentum probability density becomes more delocalized. Conversely, the double-well potentials demonstrate the opposite behavior, with position entropy density being less localized and momentum probability density showing increased localization. Notably, our study also involves examining the Bialynicki-Birula and Mycielski (BBM) inequality, where we find that the Shannon entropies still satisfy this inequality for varying depths u¯. An intriguing observation is that the sum of position and momentum entropies increases with the variable u¯ for potentials U1,2,3, while for U0, the sum decreases with u¯. Additionally, the sum of the cases U0 and U3 almost remains constant within the relative value 0.01 as u¯ increases. Our study provides valuable insights into the Shannon entropy behavior for these hyperbolic potentials, shedding light on their localization characteristics and their relation to the potential depths. Finally, we extend our analysis to the Fisher entropy F¯x and find that it increases with the depth u¯ of the potential wells but F¯p decreases with the depth.

Niveles de vitamina D en sangre materna y su relación con el consumo de pescado y los parámetros antropométricos de los recién nacidos en una cohorte de parejas madre/hijos de Sevilla / Vitamin D levels in maternal blood and its relationship with fish consumption and anthropometric parameters of newborns in a cohort of mother/child couples from Seville

Introducción: Comparar los niveles de vitamina D maternos con la zona de residencia o el consumo de pescado, así como su relación con el peso, la longitud y el perímetro craneal de los bebés. Materiales y métodos: Cohorte de 100 parejas madre-hijo (n=100) de la provincia de Sevilla (Hospital Universitario Virgen del Rocío y Hospital Universitario de Valme). En muestras de sangre materna (edad gestacional≥40 semanas) se han medido los niveles de 25(OH)D mediante quimioluminiscencia. Las medidas antropométricas de los bebés se realizaron mediante métodos estándares. Resultados: Con relación a los niveles de vitamina D, 54% presentaban valores deficientes, 26% insuficientes y 20% valores suficientes. Tras un análisis de regresión múltiple, se observa que no hay diferencia significativa entre niveles de vitamina D maternos, la longitud y el perímetro cefálico de los bebés, sin embargo, sí con el peso al nacer (p<0,05). Al aplicarse la T-Student y el test Wilcoxon, no hay relación entre niveles de vitamina D y el área de residencia ni con el consumo de pescado materno (ambos p>0,05). Conclusiones: El 80% de madres presentan valores deficientes e insuficientes de vitamina D. No hay correlación entre este parámetro y la longitud y perímetro cefálico del bebé, observándose correlación negativa con el peso al nacer. Tampoco se observa correlación entre la zona de residencia o el consumo de pescado y niveles de vitamina D en madres. Sugerimos complementos en dieta de madres gestantes y seguimiento de los niveles de vitamina D en los bebés.(AU)

Introduction: To compare maternal vitamin D levels with the area of residence or the consumption of fish, as well as its relationship with the weight, length and cranial perimeter of babies. Materials and methods: Cohort of 100 mother–child pairs (n=100) from the province of Seville (Virgen del Rocío University Hospital and Valme University Hospital). In maternal blood samples (gestational age≥40 weeks) 25(OH)D levels have been measured by chemiluminescence. Anthropometric measurements of the babies were made using standard methods. Results: Regarding vitamin D levels, 54% had deficient values, 26% insufficient and 20% sufficient values. After a multiple regression analysis, it is observed that there is no significant difference between maternal vitamin D levels, the length and the cephalic perimeter of the babies, however, there is a difference with the birth weight (P<.05). When applying the t-Student and the Wilcoxon test, there is no relationship between vitamin D levels and the area of residence or with maternal fish consumption (both P>.05). Conclusions: Eighty percent of mothers present deficient and insufficient values of vitamin D. There is no correlation between this parameter and the length and cephalic perimeter of the baby, observing a negative correlation with birth weight. No correlation was observed between the area of residence or the consumption of fish and vitamin D levels in mothers. We suggest dietary supplements for pregnant mothers and monitoring of vitamin D levels in babies.(AU)

Quantum Information Entropy for a Hyperbolic Double Well Potential in the Fractional Schrödinger Equation.

In this study, we investigate the position and momentum Shannon entropy, denoted as Sx and Sp, respectively, in the context of the fractional Schrödinger equation (FSE) for a hyperbolic double well potential (HDWP). We explore various values of the fractional derivative represented by k in our analysis. Our findings reveal intriguing behavior concerning the localization properties of the position entropy density, ρs(x), and the momentum entropy density, ρs(p), for low-lying states. Specifically, as the fractional derivative k decreases, ρs(x) becomes more localized, whereas ρs(p) becomes more delocalized. Moreover, we observe that as the derivative k decreases, the position entropy Sx decreases, while the momentum entropy Sp increases. In particular, the sum of these entropies consistently increases with decreasing fractional derivative k. It is noteworthy that, despite the increase in position Shannon entropy Sx and the decrease in momentum Shannon entropy Sp with an increase in the depth u of the HDWP, the Beckner-Bialynicki-Birula-Mycielski (BBM) inequality relation remains satisfied. Furthermore, we examine the Fisher entropy and its dependence on the depth u of the HDWP and the fractional derivative k. Our results indicate that the Fisher entropy increases as the depth u of the HDWP is increased and the fractional derivative k is decreased.

Quantum Information Entropy of Hyperbolic Potentials in Fractional Schrödinger Equation.

In this work we have studied the Shannon information entropy for two hyperbolic single-well potentials in the fractional Schrödinger equation (the fractional derivative number (0

Utilidad diagnóstica de test cognitivos breves en el cribado de deterioro cognitivo / Diagnostic performance of brief cognitive tests in cognitive impairment screening

Introducción y objetivos: Evaluar y comparar la utilidad diagnóstica (UD) para el cribado de deterioro cognitivo (DC) de los test cognitivos breves (TCB) recomendados por la Guía de práctica clínica sobre la atención integral a las personas con enfermedad de Alzheimer y otras demencias. Material y métodos: Estudio de fase iii de evaluación de pruebas diagnósticas en el que se ha incluido en Atención Primaria a sujetos con sospecha de DC. A todos se les ha aplicado Mini-Mental State Examination (Mini-Mental), Mini Examen Cognoscitivo (MEC), Short Portable Mental Status Questionnaire (SPMSQ), Memory Impairment Screen (MIS), test del reloj (TdR), Eurotest, Fototest y test de alteración de memoria (T@M). El diagnóstico de DC se ha realizado de forma independiente y cegada con respecto a los resultados de los TCB. La UD se ha evaluado mediante el área bajo la curva ROC (aROC). Resultados: Se ha incluido a 141 sujetos (86 con DC). El Eurotest y el T@M (0,91 ± 0,02 [aROC ± EE] y 0,90 ± 0,02, respectivamente), los instrumentos que requieren más tiempo (7,1 ± 1,8 [media ± DE] y 6,8 ± 2,2 min, respectivamente) tienen una UD significativamente superior a la del Mini-Mental, MEC, SPMSQ y TdR, pero no a la del MIS y Fototest (0,87 ± 0,03 ambas), requiriendo este último menos de la mitad del tiempo (2,8 ± 0,8 min). T@M y MIS solo evalúan memoria y el último no es aplicable a analfabetos. Conclusiones: Los instrumentos más recomendables para el cribado de DC en Atención Primaria son Eurotest, T@M y Fototest, siendo el último más eficiente por requerir la mitad de tiempo. (AU)

Introduction and objectives: This study aims to assess and compare the diagnostic performance of brief cognitive tests for cognitive impairment (CI) screening recommended by the Spanish guidelines for the integral care of people with Alzheimer's disease and other dementias. Material and methods: We performed a phase iii study into the accuracy of diagnostic tests, including patients with suspected CI in a primary care setting. All patients completed the Mini–Mental State Examination (MMSE), the Mini Examen Cognoscitivo (MEC), the Short Portable Mental Status Questionnaire (SPMSQ), the Memory Impairment Screen (MIS), the Clock Drawing Test (CDT), the Eurotest, the Fototest, and the Memory Alteration Test (M@T). CI was diagnosed independently by researchers blinded to scores on these tests. Diagnostic performance was evaluated by calculating the area under the receiver operating characteristic curve (AUC). Results: The study included 141 individuals (86 with CI). The Eurotest and M@T (AUC ± SE: 0.91 ± 0.02 and 0.90 ± 0.02, respectively) took longer to administer (mean [SD]: 7.1 [1.8] and 6.8 [2.2] min, respectively) and have significantly better diagnostic performance compared to the MMSE, MEC, SPMSQ, and CDT, but not compared to MIS or Fototest (both with an AUC of 0.87 ± 0.03), with the latter taking less than half as long to administer (2.8 [0.8] min). The M@T and MIS only evaluate memory, and the latter cannot be administered to illiterate people. Conclusion: The most advisable tests for CI screening in primary care are the Eurotest, M@T, and Fototest, with the latter being the most efficient as it takes half as long to administer. (AU)

Diagnostic performance of brief cognitive tests in cognitive impairment screening.

INTRODUCTION AND OBJECTIVES: This study aims to assess and compare the diagnostic performance of brief cognitive tests for cognitive impairment (CI) screening recommended by the Spanish guidelines for the integral care of people with Alzheimer's disease and other dementias. MATERIAL AND METHODS: We performed a phase iii study into the accuracy of diagnostic tests, including patients with suspected CI in a primary care setting. All patients completed the Mini-Mental State Examination (MMSE), the Mini Examen Cognoscitivo (MEC), the Short Portable Mental Status Questionnaire (SPMSQ), the Memory Impairment Screen (MIS), the Clock Drawing Test (CDT), the Eurotest, the Fototest, and the Memory Alteration Test (M@T). CI was diagnosed independently by researchers blinded to scores on these tests. Diagnostic performance was evaluated by calculating the area under the receiver operating characteristic curve (AUC). RESULTS: The study included 141 individuals (86 with CI). The Eurotest and M@T (AUC±SE: 0.91±0.02 and 0.90±0.02, respectively) took longer to administer (mean [SD]: 7.1 [1.8] and 6.8 [2.2]min, respectively) and have significantly better diagnostic performance compared to the MMSE, MEC, SPMSQ, and CDT, but not compared to MIS or Fototest (both with an AUC of 0.87±0.03), with the latter taking less than half as long to administer (2.8 [0.8]min). The M@T and MIS only evaluate memory, and the latter cannot be administered to illiterate people. CONCLUSION: The most advisable tests for CI screening in primary care are the Eurotest, M@T, and Fototest, with the latter being the most efficient as it takes half as long to administer.

Normative data for the Fototest from neurological patients with no cognitive impairment.

OBJECTIVES: To contribute normative data for the Fototest from neurological patients with no cognitive impairment, including disaggregated data on each domain of the test (naming, free recall, total recall, and naming fluency). MATERIAL AND METHODS: We performed a cross-sectional study in which neurological patients with no cognitive impairment were tested with the Fototest; we recorded total and domain scores. We performed a descriptive study of the total and domain scores, with data disaggregated by sex, age (over/under 65 years), and level of education (primary education completed/not completed; further study completed). RESULTS: We included a sample of 1055 patients, who were mainly women (57.1%), aged over 65 (60.6%), and had a low level of education (38.6% had not completed primary education). Sex, age, and level of education influence total Fototest score (34.6 ±â€¯5.3; P10: 28; P5: 27) and free recall (8.5 ±â€¯2.2; 6; 4), total recall (10.0 ±â€¯1.5; 8; 7), and naming fluency scores (18.7 ±â€¯4.9; 13; 12). For total score, the multivariate analysis revealed values of 1.5 ±â€¯0.3 (ß ±â€¯SD) for sex (female), -2.4 ±â€¯0.3 for age (>65), and -1.6 ±â€¯0.4 and 3.3 ±â€¯0.4 for incomplete primary education and completed post-primary education, respectively (completed primary study was used as a reference). CONCLUSIONS: We provide normative data for total and domain Fototest results for each of the groups defined according to sex, age, and level of education. We also provide a percentile distribution of scores. We hope that these normative data will translate into increases in efficiency in Fototest administration in the clinical setting.

Evaluación de la utilidad diagnóstica y validez discriminativa del Test del Reloj y del Mini-Cog en la detección del deterioro cognitivo / Assessment of the diagnostic accuracy and discriminative validity of the Clock Drawing and Mini-Cog tests in detecting cognitive impairment

Introducción y objetivos: El Mini-Cog es un test cognitivo muy breve de uso extendido que incluye una tarea de memoria y una evaluación simplificada del Test del Reloj (TdR). No existe una evaluación formal del Mini-Cog en español; nuestro objetivo es analizar la utilidad diagnóstica (UD) del Mini-Cog y del TdR para deterioro cognitivo (DC). Métodos: Estudio transversal en el que se han incluido de forma sistemática todos los sujetos atendidos durante un semestre en una consulta de Neurología. La UD se ha evaluado para DC (incluye sujetos con criterios NIA-AA de Mild Cognitive Impairment o demencia) por medio del área bajo la curva ROC (aROC). Se han calculado los parámetros de sensibilidad (S), especificidad (E) y cocientes de probabilidad positivo y negativo (CP+, CP−) para los distintos puntos de corte. Resultados: Se han incluido 581 sujetos (315 DC), 55,1% mujeres y 27,7% con bajo nivel educativo (< estudios primarios). La UD del Mini-Cog es superior a la del TdR (0,88 ± 0,01 (aROC ± EE) vs 0,84 ± 0,01, p < 0,01); para ambos instrumentos la UD disminuye notablemente en sujetos con bajo nivel educativo (0,74 ± 0,05 y 0,75 ± 0,05, respectivamente). El punto de corte 2/3 del Mini-Cog tiene una S de 0,90 (0,87-0,93) y una E de 0,71 (0,65-0,76) y el 5/6 del TdR una S de 0,77 (0,72-0,81) y una E de 0,80 (0,75-0,85). Conclusiones: En consulta de Neurología, el Mini-Cog tiene una UD para DC aceptable, superior a la del TdR; ninguno de ellos es un instrumento adecuado para ser utilizado en sujetos con bajo nivel educativo. (AU)

Introduction and objectives: The Mini-Cog is a very brief, widely used cognitive test that includes a memory task and a simplified assessment of the Clock Drawing Test (CDT). There is not a formal evaluation of the Mini-Cog test in Spanish. This study aims to analyse the diagnostic usefulness of the Mini-Cog and CDT for detecting cognitive impairment (CI). Methods: We performed a cross-sectional study, systematically including all patients who consulted at our neurology clinic over a 6-month period. We assessed diagnostic usefulness for detecting CI (defined according to the National Institute on Aging-Alzheimer's Association criteria for mild cognitive impairment and dementia) according to the area under the receiver operating characteristic curve (AUC). Sensitivity, specificity, and positive and negative likelihood ratios were calculated for each cut-off point. Results: The study included 581 individuals (315 with CI); 55.1% were women and 27.7% had not completed primary studies. The Mini-Cog showed greater diagnostic usefulness than the CDT (AUC ± sensitivity: 0.88 ± 0.01 vs 0.84 ± 0.01; P < .01). Both instruments were less useful for screening in individuals with a low education level (0.74 ± 0.05 vs 0.75 ± 0.05, respectively). A cut-off point of 2/3 in the Mini-Cog achieved a sensitivity of 0.90 (95% CI, 0.87-0.93) and a specificity of 0.71 (95% CI, 0.65-0.76); a cut-off point of 5/6 in the CDT achieved a sensitivity of 0.77 (95% CI, 0.72-0.81) and a specificity of 0.80 (95% CI, 0.75-0.85). Conclusion: In our neurology clinic, the Mini-Cog showed acceptable diagnostic usefulness for detecting CI, greater than that of the CDT; neither test is an appropriate instrument for individuals with a low level of education. (AU)

Valores normativos del Fototest en pacientes neurológicos sin deterioro cognitivo / Normative data for the Fototest from neurological patients with no cognitive impairment

Objetivos: Proporcionar valores normativos del Fototest relativos a pacientes neurológicos sin deterioro cognitivo, que incluyan datos desagregados para cada uno de los dominios que conforman este instrumento (denominación, recuerdo libre, recuerdo total y fluidez de nombres). Material y métodos: Estudio transversal en pacientes neurológicos sin deterioro cognitivo a los que se aplicó el Fototest, registrándose las puntuaciones desagregadas y total. Estudio descriptivo de los resultados totales y desagregados del Fototest estratificados por sexo, edad (< 65/> 65 años) y estudios (< primaria/primaria/> primaria). Resultados: Muestra de 1.055 sujetos con predominio de mujeres (57,1%), mayores de 65 años (60,6%) y con bajo nivel educativo (36,8% sin estudios primarios). La puntuación total del Fototest (34,6 ± 5,3; 28; 27 [media ± DE; P10; P5]), así como las desagregadas para denominación (5,9 ± 0,3; 6; 5), recuerdo libre (8,5 ± 2,2; 6; 4), recuerdo total (10,0 ± 1,5; 8; 7) y fluidez de nombres (18,7 ± 4,9; 13; 12), están influidas por el sexo, la edad y el nivel educativo. Para la puntuación total, los resultados del estudio multivariante son: sexo (mujer) 1,5 ± 0,3 (ß ± EE), edad (> 65 años) −2,4 ± 0,3, estudios < primaria −1,6 ± 0,4 y estudios > primaria 3,3 ± 0,4 (primaria = referencia estudios). Conclusión: Se proporcionan valores normativos (media ± DE, P10; P5) del Fototest para cada uno de los estratos definidos por las variables sexo, edad y estudios tanto para las puntuaciones totales como desagregadas del Fototest, así como una distribución percentual para cada uno de los valores posibles de estas puntuaciones. Estos valores normativos es de esperar que se traduzcan en una mayor eficiencia del Fototest en el ámbito clínico. (AU)

Objectives: To contribute normative data for the Fototest from neurological patients with no cognitive impairment, including disaggregated data on each domain of the test (naming, free recall, total recall, and naming fluency). Material and methods: We performed a cross-sectional study in which neurological patients with no cognitive impairment were tested with the Fototest; we recorded total and domain scores. We performed a descriptive study of the total and domain scores, with data disaggregated by sex, age (over/under 65 years), and level of education (primary education completed/not completed; further study completed). Results: We included a sample of 1,055 patients, who were mainly women (57.1%), aged over 65 (60.6%), and had a low level of education (38.6% had not completed primary education). Sex, age, and level of education influence total Fototest score (34.6 ± 5.3; P10: 28; P5: 27) and naming (5,9±0,3; 6; 5), free recall (8.5 ± 2.2; 6; 4), total recall (10.0 ± 1.5; 8; 7), and naming fluency scores (18.7 ± 4.9; 13; 12). For total score, the multivariate analysis revealed values of 1.5 ± 0.3 (ß ± SE) for sex (female), −2.4 ± 0.3 for age (> 65), and −1.6 ± 0.4 and 3.3 ± 0.4 for incomplete primary education and completed post-primary education, respectively (completed primary study was used as a reference). Conclusion: We provide normative data for total and domain Fototest results for each of the groups defined according to sex, age, and level of education. We also provide a percentile distribution of scores. We hope that these normative data will translate into increases in efficiency in Fototest administration in the clinical setting. (AU)

Assessment of the diagnostic accuracy and discriminative validity of the Clock Drawing and Mini-Cog tests in detecting cognitive impairment.

INTRODUCTION AND OBJECTIVES: The Mini-Cog is a very brief, widely used cognitive test that includes a memory task and a simplified assessment of the Clock Drawing Test (CDT). There is not a formal evaluation of the Mini-Cog test in Spanish. This study aims to analyse the diagnostic usefulness of the Mini-Cog and CDT for detecting cognitive impairment (CI). METHODS: We performed a cross-sectional study, systematically including all patients who consulted at our neurology clinic over a 6-month period. We assessed diagnostic usefulness for detecting CI (defined according to the National Institute on Aging-Alzheimer's Association criteria for mild cognitive impairment and dementia) according to the area under the receiver operating characteristic curve (AUC). Sensitivity, specificity, and positive and negative likelihood ratios were calculated for each cut-off point. RESULTS: The study included 581 individuals (315 with CI); 55.1% were women and 27.7% had not completed primary studies. The Mini-Cog showed greater diagnostic usefulness than the CDT (AUC ±â€¯sensitivity: 0.88 ±â€¯0.01 vs 0.84 ±â€¯0.01; P < .01). Both instruments were less useful for screening in individuals with a low education level (0.74 ±â€¯0.05 vs 0.75 ±â€¯0.05, respectively). A cut-off point of 2/3 in the Mini-Cog achieved a sensitivity of 0.90 (95% CI, 0.87-0.93) and a specificity of 0.71 (95% CI, 0.65-0.76); a cut-off point of 5/6 in the CDT achieved a sensitivity of 0.77 (95% CI, 0.72-0.81) and a specificity of 0.80 (95% CI, 0.75-0.85). CONCLUSION: In our neurology clinic, the Mini-Cog showed acceptable diagnostic usefulness for detecting CI, greater than that of the CDT; neither test is an appropriate instrument for individuals with a low level of education.

Profilaxis pre-exposición de la infección por el VIH y Atención Primaria (AP) / Pre-exposure prophylaxis for HIV infection and Primary Care (PA)

No disponible

Extended composite index of anthropometric failure in Argentinean preschool and school children.

OBJECTIVE: The Composite Index of Anthropometric Failure (CIAF) can only be applied to children under 5 years of age and does not contemplate obesity. The aim of this study was to propose an Extended CIAF (ECIAF) that combines the characterization of malnutrition due to undernutrition and excess weight, and apply it in six Argentine provinces. DESIGN: ECIAF excludes children not in anthropometric failure (group A) and was calculated from a percentage of children included in malnutrition categories B: wasting only; C: wasting and underweight; D: wasting, stunting and underweight; E: stunting and underweight; F: stunting only; Y: underweight only; G: only weight excess; and H: stunting and weight excess. SETTING: Cross-sectional study conducted in Buenos Aires, Catamarca, Chubut, Jujuy, Mendoza and Misiones (Argentina). PARTICIPANTS: 10 879 children of both sexes aged between 3 and 13·99. RESULTS: ECIAF in preschool children (3 to 4·99 years) was 15·1 %. The highest prevalence was registered in Mendoza (16·7 %) and the lowest in Misiones (12·0 %). In school children (5 to 13·99 years) ECIAF was 28·6 %. Mendoza also recorded the highest rate (30·7 %), while Catamarca and Chubut had the lowest values (27·0 %). In the whole sample, about 25 % of the malnutrition was caused by undernutrition and 75 % by excess weight. CONCLUSIONS: The ECIAF summarizes anthropometric failure by both deficiency and excess weight and it highlights that a quarter of the malnutrition in the Argentine population was caused by undernutrition, although there are differences between Provinces (P < 0·05). ECIAF estimates are higher than those of CIAF or under-nutrition.

Evaluation of the anorectal motor response after percutaneous stimulation of the posterior tibial nerve in patients with fecal incontinence.

BACKGROUND: The effect of posterior tibial nerve stimulation (PTNS) on the mechanisms of anal continence has not been fully demonstrated. The aim of this study was to assess the anal manometric response after percutaneous PTNS in patients with fecal incontinence (FI). METHODS: This was a prospective study in patients with FI undergoing 1 weekly session of percutaneous PTNS for 8 weeks. A clinical assessment (Wexner scale) and a complete study of up to 22 manometric parameters were carried out prior to treatment and 2-4 weeks after the end of treatment. RESULTS: A total of 32 patients were evaluated. After therapy, there was a decrease in the average Wexner score [12.6 (± 5.2) to 9.5 (± 5.2) (P < 0.005)] and an increase in the "anal canal length at rest" [4.55 (± 0.60) to 4.95 (± 0.21) P = 0.004], without observing variations in other manometric parameters. The decrease in the Wexner score was significantly correlated with an increase in the "pressure at 5 cm at rest" after therapy (r = 0.464 P = 0.030). CONCLUSIONS: In our study, PTNS was associated with a significant decrease in the Wexner score and with an increase in the functional length of the anal canal at rest. The improvement in the Wexner scale was correlated with an increase in pressure at rest in the theoretical area of the anorectal junction.

Diagnostic performance of brief cognitive tests in cognitive impairment screening. / Utilidad diagnóstica de test cognitivos breves en el cribado de deterioro cognitivo.

INTRODUCTION AND OBJECTIVES: This study aims to assess and compare the diagnostic performance of brief cognitive tests for cognitive impairment (CI) screening recommended by the Spanish guidelines for the integral care of people with Alzheimer's disease and other dementias. MATERIAL AND METHODS: We performed a phase iii study into the accuracy of diagnostic tests, including patients with suspected CI in a primary care setting. All patients completed the Mini-Mental State Examination (MMSE), the Mini Examen Cognoscitivo (MEC), the Short Portable Mental Status Questionnaire (SPMSQ), the Memory Impairment Screen (MIS), the Clock Drawing Test (CDT), the Eurotest, the Fototest, and the Memory Alteration Test (M@T). CI was diagnosed independently by researchers blinded to scores on these tests. Diagnostic performance was evaluated by calculating the area under the receiver operating characteristic curve (AUC). RESULTS: The study included 141 individuals (86 with CI). The Eurotest and M@T (AUC ± SE: 0.91 ± 0.02 and 0.90 ± 0.02, respectively) took longer to administer (mean [SD]: 7.1 [1.8] and 6.8 [2.2] min, respectively) and have significantly better diagnostic performance compared to the MMSE, MEC, SPMSQ, and CDT, but not compared to MIS or Fototest (both with an AUC of 0.87 ± 0.03), with the latter taking less than half as long to administer (2.8 [0.8] min). The M@T and MIS only evaluate memory, and the latter cannot be administered to illiterate people. CONCLUSION: The most advisable tests for CI screening in primary care are the Eurotest, M@T, and Fototest, with the latter being the most efficient as it takes half as long to administer.

Evaluación del movimiento diafragmático por ultrasonografía mediante la medición del índice de excursión en perros / Evaluation of diaphragmatic movement measuring the excursion index with ultrasonography in dogs / Avaliação do movimento diafragmático pela ultrassonografia através da mensuração do índice de excursão em cães

Resumen El ultrasonido es una técnica portátil y repetible, que permite evaluar de forma dinámica los movimientos del diafragma. Existen muchas causas que pueden generar disfunción diafragmática y parálisis diafragmática como anestésicos, injuria del nervio frénico, postoperatorio de cirugía cardíaca, torácica o abdominal, enfermedades neuromusculares, metabólicas e infecciosas y causas relacionadas al paciente crítico como sepsis y ventilación mecánica prolongada. Se tuvieron en cuenta cuarenta y ocho perros, entre internados y programados para cirugía electiva, sin signos clínicos cardiorrespiratorios a los cuales se les realizó ultrasonido Global FAST, se evaluó el movimiento del diafragma en modo M en tres posiciones y se registró la medida del índice de excursión diafragmática. Tres de los perros internados fueron excluidos, debido a hallazgos en el ultrasonido, los perros programados para cirugía electiva fueron sometidos al mismo protocolo preanestésico en los mismos tiempos. No se presentaron diferencias estadísticas entre las posiciones. Al comparar la medida del índice de excursión diafragmática entre los perros internados y anestesiados en la posición DLD (decúbito lateral derecho) y DD (decúbito dorsal), se observaron diferencias significativas (p<0,01). El ultrasonido en modo M es una buena herramienta para medir el índice de excursión diafragmática, proporciona información cuantitativa para la evaluación de la función dinámica diafragmática, la anestesia puede llegar a causar una disminucion significativa en el índice de excursión diafragmático, el cual puede permanecer oculto y generar complicaciones anestésicas.

Abstract The ultrasonographic examination is a portable, non-invasive, repeatable technique that can assess the dynamic movements of the diaphragm. There are several causes for diaphragmatic dysfunction or paralysis, including anesthetic drugs, phrenic nerve injury, postoperative cardiac, thoracic or abdominal surgery; neuromuscular, infectious or metabolic diseases, critical patient comorbidities such as sepsis or prolonged mechanical ventilation complications. The study included forty-eight dogs that where either hospitalized or admitted for elective surgery without cardiorespiratory disease signs. They were evaluated following Global FAST protocol. The diaphragmatic movement was evaluated in M mode and the excursion diaphragmatic index was measured in three different positions. Three dogs were excluded due to their ultrasonographic findings. The same anesthetic protocol was used for the dogs admitted for elective surgery. There was no statistical difference between the dogs evaluated in the three different positions. The excursion diaphragmatic index of the hospitalized dogs compared to anesthetized dogs in right lateral recumbency (RLR) and dorsal recumbency (DR) was significantly different (p <0,01). Mode M ultrasonographic examination is a useful tool to measure the excursion diaphragmatic index in dogs because it provides quantitative information for the evaluation of the dynamic function of the diaphragm. Anesthetic drugs can cause a significant reduction of the excursion diaphragmatic index which, if not evaluated and detected promptly, can cause complications anesthetic.

Resumo O ultra-som é uma técnica portátil e repetível, que permite avaliar de forma dinâmica os movimentos do diafragma. Muitas causas podem gerar disfunção do diafragma e paralisia diafragmática como anestésicos, lesão do nervo frénico, cirurgia cardíaca, torácica ou abdominal, doenças neuromusculares, e infecciosa e metabólica relacionados para paciente crítico como sepsia e faz com que a ventilação mecânica prolongada. Quarenta e oito cães foram tidos em conta, incluindo estágios e agendada para cirurgia electiva sem sinais clínicos cardio-respiratórias que foram submetidos a ultrasons RÁPIDO global, o movimento do diafragma no modo-M foi avaliada em três posições e medição do índice foi gravado de excursão diafragmática. Três dos cães de embarque foram excluídos porque os resultados de ultrasom, cães agendados para cirurgia eletiva foram submetidos ao mesmo protocolo pré-anestésica, ao mesmo tempo. Não houve diferenças estatísticas entre as posições para a medição. Ao comparar a medida do índice de excursão diafragmática entre os cães admitidos e anestesiados na posição DLD (decúbito lateral direito) e DD (decúbito dorsal), foram observadas diferenças significativas (p <0,01), sendo este valor menor em cães anestesiado. A ultrassonografia modo-M para medir o índice de excursão diafragmática é uma boa ferramenta, pois fornece informações quantitativas para a avaliação da função dinâmica diafragmática. A anestesia pode causar uma diminuição significativa no índice de excursão diafragmática, que pode permanecem escondidos e geram complicações anestésicas.

Assessment of the diagnostic accuracy and discriminative validity of the Clock Drawing and Mini-Cog tests in detecting cognitive impairment. / Evaluación de la utilidad diagnóstica y validez discriminativa del Test del Reloj y del Mini-Cog en la detección del deterioro cognitivo.

INTRODUCTION AND OBJECTIVES: The Mini-Cog is a very brief, widely used cognitive test that includes a memory task and a simplified assessment of the Clock Drawing Test (CDT). There is not a formal evaluation of the Mini-Cog test in Spanish. This study aims to analyse the diagnostic usefulness of the Mini-Cog and CDT for detecting cognitive impairment (CI). METHODS: We performed a cross-sectional study, systematically including all patients who consulted at our neurology clinic over a 6-month period. We assessed diagnostic usefulness for detecting CI (defined according to the National Institute on Aging-Alzheimer's Association criteria for mild cognitive impairment and dementia) according to the area under the receiver operating characteristic curve (AUC). Sensitivity, specificity, and positive and negative likelihood ratios were calculated for each cut-off point. RESULTS: The study included 581 individuals (315 with CI); 55.1% were women and 27.7% had not completed primary studies. The Mini-Cog showed greater diagnostic usefulness than the CDT (AUC±sensitivity: 0.88±0.01 vs 0.84±0.01; P<.01). Both instruments were less useful for screening in individuals with a low education level (0.74±0.05 vs 0.75±0.05, respectively). A cut-off point of 2/3 in the Mini-Cog achieved a sensitivity of 0.90 (95%CI, 0.87-0.93) and a specificity of 0.71 (95%CI, 0.65-0.76); a cut-off point of 5/6 in the CDT achieved a sensitivity of 0.77 (95%CI, 0.72-0.81) and a specificity of 0.80 (95%CI, 0.75-0.85). CONCLUSION: In our neurology clinic, the Mini-Cog showed acceptable diagnostic usefulness for detecting CI, greater than that of the CDT; neither test is an appropriate instrument for individuals with a low level of education.

Prognostic implications of markers of the metabolic phenotype in human cutaneous melanoma.

BACKGROUND: Reprogramming of energy metabolism to enhanced aerobic glycolysis has been defined as a hallmark of cancer. OBJECTIVES: To investigate the role of the mitochondrial proteins, ß-subunit of the H+ -ATP synthase (ß-F1-ATPase), and heat-shock protein 60 (HSP60), and the glycolytic markers, glyceraldehyde-3-phosphate dehydrogenase (GAPDH) and pyruvate kinase M2 (PKM2), as well as the bioenergetic cellular (BEC) index, in melanoma progression. MATERIALS AND METHODS: The expression of energy metabolism proteins was assessed on a set of different melanoma cells representing the natural biological history of the disease: primary cultures of melanocytes, radial (WM35) and vertical (WM278) growth phases, and poorly (C81-61-PA) and highly (C8161-HA) aggressive melanoma cells. Cohorts of 63 melanocytic naevi, 55 primary melanomas and 35 metastases were used; and 113 primary melanoma and 33 metastases were used for validation. RESULTS: The BEC index was significantly reduced in melanoma cells and correlated with their aggressive characteristics. Overexpression of HSP60, GAPDH and PKM2 was detected in melanoma human samples compared with naevi, showing a gradient of increased expression from radial growth phase to metastatic melanoma. The BEC index was also significantly reduced in melanoma samples and correlated with worse overall and disease-free survival; the multivariate Cox analysis showed that the BEC index (hazard ratio 0·64; 95% confidence interval 0·4-1·2) is an independent predictor for overall survival. CONCLUSIONS: A profound alteration in the mitochondrial and glycolytic proteins and in the BEC index occurs in the progression of melanoma, which correlates with worse outcome, supporting that the alteration of the metabolic phenotype is crucial in melanoma transformation.

Transplantation of Human Neural Progenitor Cells (NPC) into Putamina of Parkinsonian Patients: A Case Series Study, Safety and Efficacy Four Years after Surgery.

Individuals with Parkinson's disease (PD) suffer from motor and mental disturbances due to degeneration of dopaminergic and non-dopaminergic neuronal systems. Although they provide temporary symptom relief, current treatments fail to control motor and non-motor alterations or to arrest disease progression. Aiming to explore safety and possible motor and neuropsychological benefits of a novel strategy to improve the PD condition, a case series study was designed for brain grafting of human neural progenitor cells (NPCs) to a group of eight patients with moderate PD. A NPC line, expressing Oct-4 and Sox-2, was manufactured and characterized. Using stereotactic surgery, NPC suspensions were bilaterally injected into patients' dorsal putamina. Cyclosporine A was given for 10 days prior to surgery and continued for 1 month thereafter. Neurological, neuropsychological, and brain imaging evaluations were performed pre-operatively, 1, 2, and 4 years post-surgery. Seven of eight patients have completed 4-year follow-up. The procedure proved to be safe, with no immune responses against the transplant, and no adverse effects. One year after cell grafting, all but one of the seven patients completing the study showed various degrees of motor improvement, and five of them showed better response to medication. PET imaging showed a trend toward enhanced midbrain dopaminergic activity. By their 4-year evaluation, improvements somewhat decreased but remained better than at baseline. Neuropsychological changes were minor, if at all. The intervention appears to be safe. At 4 years post-transplantation we report that undifferentiated NPCs can be delivered safely by stereotaxis to both putamina of patients with PD without causing adverse effects. In 6/7 patients in OFF condition improvement in UPDRS III was observed. PET functional scans suggest enhanced putaminal dopaminergic neurotransmission that could correlate with improved motor function, and better response to L-DOPA. Patients' neuropsychological scores were unaffected by grafting. Trial Registration: Fetal derived stem cells for Parkinson's disease https://doi.org/10.1186/ISRCTN39104513Reg#ISRCTN39104513.