Fluoxetine increased adult neurogenesis is mediated by 5-HT3 receptor.

Adult neurogenesis is an aspect of structural plasticity that remains active during adulthood in some brain regions. One of them is the subgranular zone (SGZ) of the dentate gyrus of the hippocampus. Adult neurogenesis is reduced by different factors and in disorders of the CNS, including major depression. Antidepressant treatments, such as chronic fluoxetine administration, recover the normal level of adult neurogenesis. Fluoxetine treatment increases the free concentration of the neurotransmitter serotonin and this monoamine is implicated in the regulation of the neurogenic process; however, the target of the action of this neurotransmitter has not been fully elucidated. In this study, we have tried to determine the relevance of the serotonin receptor 3 (5-HT3) in the hippocampal neurogenesis of adult rats. We have used fluorescent immunohistochemistry to study the expression of the 5-HT3 receptor in different neurogenesis stages in the SGZ, identifying its expression in stem cells, amplifying neural progenitors and immature neurons. Moreover, we have studied the impact of a 5-HT3 antagonist (ondansetron) in the fluoxetine-induced adult neurogenesis. We observed that fluoxetine alone increases the number of both proliferating cells (ki67 positive) and immature neurons (DCX positive) in the SGZ. By contrast, co-treatment with ondansetron blocked the increase in proliferation and neurogenesis. This study demonstrates that the activation of 5-HT3 receptors is necessary for the increase of adult neurogenesis induced by fluoxetine.

Habitat alteration assessment for the management of environmental flows in regulated basins.

The management of environmental flows is of paramount importance in regulated water resources systems to preserve river ecosystems. This work proposes a methodology to assess habitat alteration in river basins altered by management activities. The methodology is based on the joint application of a basin management model (SIMGES, AQUATOOL) and a model to estimate habitat time series (CAUDECO). CAUDECO is based on the weighted useable areas of the species in their different vital stages that, in turn, depend on the flows in each river stretch and the biological periods of the species. The final output is an indicator of habitat alteration, which is defined ad hoc for this work to relate the habitat suitability under regulated and natural regimes. The methodology was applied to a case study in north-western Spain: the Órbigo River basin. The results in the current management scenario highlight that the ecological flows improve the habitat suitability of several species with respect to natural regime conditions. For instance, the mean values of the habitat time series in the Órbigo River for the brown trout and bermejuela under regulated conditions are 69.6% and 88%; whereas in natural regime they are equal to 55.1% and 72.9%, respectively. Based on these results, eight additional scenarios of ecological flows were tested and their effects on both habitat alteration and water demand reliability were quantified and discussed. It was found that increases in the ecological flows up to 30% do not affect the reliability of water demands and reduce habitat alteration (i.e., lead to values of the habitat alteration indicator closer to 1) for all species present in the river basin. These results highlight that the methodology and indicator of habitat alteration proposed in this paper are useful to support the management of regulated river basins, since they allow assessing the implications of ecological flows on both habitat suitability and reliability of water demands.

Finding the bubble: atypical and unusual extrapulmonary air in the chest.

OBJECTIVE: To describe the radiologic findings of extrapulmonary air in the chest and to review atypical and unusual causes of extrapulmonary air, emphasizing the importance of the diagnosis in managing these patients. CONCLUSION: In this article, we review a series of cases collected at our center that manifest with extrapulmonary air in the thorax, paying special attention to atypical and uncommon causes. We discuss the causes of extrapulmonary according to its location: mediastinum (spontaneous pneumomediastinum with pneumorrhachis, tracheal rupture, dehiscence of the bronchial anastomosis after lung transplantation, intramucosal esophageal dissection, Boerhaave syndrome, tracheoesophageal fistula in patients with esophageal tumors, bronchial perforation and esophagorespiratory fistula due to lymph-node rupture, and acute mediastinitis), pericardium (pneumopericardium in patients with lung tumors), cardiovascular (venous air embolism), pleura (bronchopleural fistulas, spontaneous pneumothorax in patients with malignant pleural mesotheliomas and primary lung tumors, and bilateral pneumothorax after unilateral lung biopsy), and thoracic wall (infections, transdiaphragmatic intercostal hernia, and subcutaneous emphysema after lung biopsy).

A multicentric study on stigma towards people with mental illness in health sciences students.

BACKGROUND: There is evidence of negative attitudes among health professionals towards people with mental illness but there is also a knowledge gap on what training must be given to these health professionals during their education. The purpose of this study is to compare the attitudes of students of health sciences: nursing, medical, occupational therapy, and psychology. METHODS: A comparative and cross-sectional study in which 927 final-year students from health sciences university programmes were evaluated using the Mental Illness: Clinicians' Attitudes (both MICA-2 and MICA-4) scale. The sample was taken in six universities from Chile and Spain. RESULTS: We found consistent results indicating that stigma varies across university programmes. Medical and nursing students showed more negative attitudes than psychology and occupational therapy students in several stigma-related themes: recovery, dangerousness, uncomfortability, disclosure, and discriminatory behaviour. CONCLUSIONS: Our study presents a relevant description of the attitudes of each university programme for education against stigma in the formative years. Results show that the biomedical understanding of mental disorders can have negative effects on attitudes, and that education based on the psychosocial model allows a more holistic view of the person over the diagnosis.

Differences in clinical manifestations and increased severity of systemic lupus erythematosus between two groups of Hispanics: European Caucasians versus Latin American mestizos (data from the RELESSER registry).

BACKGROUND: Systemic lupus erythematosus (SLE) is regarded as a prototype autoimmune disease because it can serve as a means for studying differences between ethnic minorities and sex. Traditionally, all Hispanics have been bracketed within the same ethnic group, but there are differences between Hispanics from Spain and those from Latin America, not to mention other Spanish-speaking populations. OBJECTIVES: This study aimed to determine the demographic and clinical characteristics, severity, activity, damage, mortality and co-morbidity of SLE in Hispanics belonging to the two ethnic groups resident in Spain, and to identify any differences. METHODS: This was an observational, multi-centre, retrospective study. The demographic and clinical variables of patients with SLE from 45 rheumatology units were collected. The study was conducted in accordance with Good Clinical Practice guidelines. Hispanic patients from the registry were divided into two groups: Spaniards or European Caucasians (EC) and Latin American mestizos (LAM). Comparative univariate and multivariate statistical analyses were carried out. RESULTS: A total of 3490 SLE patients were included, 90% of whom were female; 3305 (92%) EC and 185 (5%) LAM. LAM patients experienced their first lupus symptoms four years earlier than EC patients and were diagnosed and included in the registry younger, and their SLE was of a shorter duration. The time in months from the first SLE symptoms to diagnosis was longer in EC patients, as were the follow-up periods. LAM patients exhibited higher prevalence rates of myositis, haemolytic anaemia and nephritis, but there were no differences in histological type or serositis. Anti-Sm, anti-Ro and anti-RNP antibodies were more frequently found in LAM patients. LAM patients also had higher levels of disease activity, severity and hospital admissions. However, there were no differences in damage index, mortality or co-morbidity index. In the multivariate analysis, after adjusting for confounders, in several models the odds ratio (95% confidence interval) for a Katz severity index >3 in LAM patients was 1.45 (1.038-2.026; p = 0.02). This difference did not extend to activity levels (i.e. SLEDAI >3; 0.98 (0.30-1.66)). CONCLUSION: SLE in Hispanic EC patients showed clinical differences compared to Hispanic LAM patients. The latter more frequently suffered nephritis and higher severity indices. This study shows that where lupus is concerned, not all Hispanics are equal.

Relaciones anatómicas en el síndrome de compresión traqueal por la arteria innominada: estudio de casos y controles retrospectivo / Anatomical relations in innominate artery compression syndrome: retrospective case-control study

Objetivo. Analizar las distintas relaciones anatómicas entre el tronco braquiocefálico (TB), la tráquea, la columna vertebral y el esternón en pacientes diagnosticados de síndrome de compresión de la arteria innominada (SCAI) y compararlas con las de los pacientes controles. Material y métodos. Estudio retrospectivo de casos y controles de los pacientes diagnosticados de SCAI en nuestro centro, a los que se realizó una tomografía computarizada con contraste (TC) y/o resonancia magnética (RM). Se compararon con pacientes controles, elegidos entre enfermos sin malformación cardiaca ni masa torácica deformante, y a los que se les había realizado una TC vascular torácico por distintos problemas respiratorios no obstructivos. Por cada caso, se seleccionaron tres controles, agrupándolos por grupos de edades. Se estableció p<0,05 como valor de significancia estadística. Resultados. Se incluyeron 9 casos (7 niños y 2 niñas) y 27 controles (20 niños y 7 niñas). Se estudió en cortes transversales de la TC la posición horaria del nacimiento del TB respecto a la tráquea, resultando en los casos una posición mediana correspondiente a las 01:30 (00:30- 03:00) y en los controles a las 01:30 (00:30-02:30), sin hallarse diferencias significativas (p= 0,72). Se midió el ratio entre el diámetro anteroposterior/diámetro transverso de la tráquea, este fue de 0,44 (0,184-0,6) en los casos y 0,885 (0,64-1,16) en los controles (p=0,00001). El ratio de la distancia esternón-tráquea/esternón-columna fue 0,685 (0,6-0,76) en los casos y 0,67 (0,49-0,79) en los controles (p=0,75). El ángulo de la cifosis torácica fue 29º (9-34) en los casos y 24º (4-33) en los controles (p=0,45). Conclusiones. No observamos la existencia de diferencias en el nacimiento del TB en pacientes con SCAI respecto a la población general. El TB nace en todos los niños en el lado izquierdo del cuerpo, poniendo en duda que el SCAI sea debido a un nacimiento más izquierdo del TB

Objective. To compare the anatomical relations between brachioce-phalic trunk (BT), trachea, spine and sternum in patients with Innominate Artery Compressing Syndrome (IACS) and control patients. Methods. Retrospective case-control study of patients diagnosed with IACS in our center, in whom vascular computerized tomography (CT) was performed. The CT were compared with those of control patients free of obstructive respiratory pathology, without congenital heart disease and free of deforming thoracic mass, in whom CT was performed due to other reason. Each case was paired with three controls per case, in similar age groups. The significance value was set as p<0,05.Results. Nine cases were included (7 boys and 2 girls) with their 27 respective controls (20 boys and 7 girls). The BT origin position with respect to the trachea, thought as a clock face, was 01:30 (00:30- 03:00) in cases and 01:30 (00:30-02:30) in controls. No differences were observed (p=0.72). The relation between anteroposterior/transversal tracheal diameters was 0.44 (0.184-0.6) in cases, 0.885 (0.64-1.16) in controls. The sternum-trachea/sternum-vertebra relation was 0.685 (0.6-0.76) in cases, 0.67 (0.49-0.79) in controls. No differences were observed (p=0.75). The angle of thoracic kyphosis was 29º (9º-34º) in cases, 24º (4º-33º) in controls. There were no statistically significant differences (p=0.45). Conclusions. We found no differences between the two groups in the BT origin in relation to the trachea. In all cases, the origin was on the left side of the body. Therefore, we question the premise that IACS is due to a more left origin of BT

[Anatomical relations in innominate artery compression syndrome: retrospective case-control study]. / Relaciones anatómicas en el síndrome de compresión traqueal por la arteria innominada: estudio de casos y controles retrospectivo.

OBJECTIVE: To compare the anatomical relations between brachiocephalic trunk (BT), trachea, spine and sternum in patients with Innominate Artery Compressing Syndrome (IACS) and control patients. METHODS: Retrospective case-control study of patients diagnosed with IACS in our center, in whom vascular computerized tomography (CT) was performed. The CT were compared with those of control patients free of obstructive respiratory pathology, without congenital heart disease and free of deforming thoracic mass, in whom CT was performed due to other reason. Each case was paired with three controls per case, in similar age groups. The significance value was set as p<0,05. RESULTS: Nine cases were included (7 boys and 2 girls) with their 27 respective controls (20 boys and 7 girls). The BT origin position with respect to the trachea, thought as a clock face, was 01:30 (00:30- 03:00) in cases and 01:30 (00:30-02:30) in controls. No differences were observed (p=0.72). The relation between anteroposterior/transversal tracheal diameters was 0.44 (0.184-0.6) in cases, 0.885 (0.64-1.16) in controls. The sternum-trachea/sternum-vertebra relation was 0.685 (0.6-0.76) in cases, 0.67 (0.49-0.79) in controls. No differences were observed (p=0.75). The angle of thoracic kyphosis was 29º (9º-34º) in cases, 24º (4º-33º) in controls. There were no statistically significant differences (p=0.45). CONCLUSIONS: We found no differences between the two groups in the BT origin in relation to the trachea. In all cases, the origin was on the left side of the body. Therefore, we question the premise that IACS is due to a more left origin of BT.

OBJETIVO: Analizar las distintas relaciones anatómicas entre el tronco braquiocefálico (TB), la tráquea, la columna vertebral y el esternón en pacientes diagnosticados de síndrome de compresión de la arteria innominada (SCAI) y compararlas con las de los pacientes controles. METODOS: Estudio retrospectivo de casos y controles de los pacientes diagnosticados de SCAI en nuestro centro, a los que se realizó una tomografía computarizada con contraste (TC) y/o resonancia magnética (RM). Se compararon con pacientes controles, elegidos entre enfermos sin malformación cardiaca ni masa torácica deformante, y a los que se les había realizado una TC vascular torácico por distintos problemas respiratorios no obstructivos. Por cada caso, se seleccionaron tres controles, agrupándolos por grupos de edades. Se estableció pp<0,05 como valor de significancia estadística. RESULTADOS: Se incluyeron 9 casos (7 niños y 2 niñas) y 27 controles (20 niños y 7 niñas). Se estudió en cortes transversales de la TC la posición horaria del nacimiento del TB respecto a la tráquea, resultando en los casos una posición mediana correspondiente a las 01:30 (00:30- 03:00) y en los controles a las 01:30 (00:30-02:30), sin hallarse diferencias significativas (p= 0,72). Se midió el ratio entre el diámetro anteroposterior/diámetro transverso de la tráquea, este fue de 0,44 (0,184-0,6) en los casos y 0,885 (0,64-1,16) en los controles (p=0,00001). El ratio de la distancia esternón-tráquea/esternón-columna fue 0,685 (0,6-0,76) en los casos y 0,67 (0,49-0,79) en los controles (p=0,75). El ángulo de la cifosis torácica fue 29º (9-34) en los casos y 24º (4-33) en los controles (p=0,45). CONCLUSIONES: No observamos la existencia de diferencias en el nacimiento del TB en pacientes con SCAI respecto a la población general. El TB nace en todos los niños en el lado izquierdo del cuerpo, poniendo en duda que el SCAI sea debido a un nacimiento más izquierdo del TB.

Relationship between damage and mortality in juvenile-onset systemic lupus erythematosus: Cluster analyses in a large cohort from the Spanish Society of Rheumatology Lupus Registry (RELESSER).

OBJECTIVES: To identify patterns (clusters) of damage manifestation within a large cohort of juvenile SLE (jSLE) patients and evaluate their possible association with mortality. METHODS: This is a multicentre, descriptive, cross-sectional study of a cohort of 345 jSLE patients from the Spanish Society of Rheumatology Lupus Registry. Organ damage was ascertained using the Systemic Lupus International Collaborating Clinics Damage Index. Using cluster analysis, groups of patients with similar patterns of damage manifestation were identified and compared. RESULTS: Mean age (years) ±â€¯S.D. at diagnosis was 14.2 ±â€¯2.89; 88.7% were female and 93.4% were Caucasian. Mean SLICC/ACR DI ±â€¯S.D. was 1.27 ±â€¯1.63. A total of 12 (3.5%) patients died. Three damage clusters were identified: Cluster 1 (72.7% of patients) presented a lower number of individuals with damage (22.3% vs. 100% in Clusters 2 and 3, P < 0.001); Cluster 2 (14.5% of patients) was characterized by renal damage in 60% of patients, significantly more than Clusters 1 and 3 (P < 0.001), in addition to increased more ocular, cardiovascular and gonadal damage; Cluster 3 (12.7%) was the only group with musculoskeletal damage (100%), significantly higher than in Clusters 1 and 2 (P < 0.001). The overall mortality rate in Cluster 2 was 2.2 times higher than that in Cluster 3 and 5 times higher than that in Cluster 1 (P < 0.017 for both comparisons). CONCLUSIONS: In a large cohort of jSLE patients, renal and musculoskeletal damage manifestations were the two dominant forms of damage by which patients were sorted into clinically meaningful clusters. We found two clusters of jSLE with important clinical damage that were associated with higher rates of mortality, especially for the cluster of patients with predominant renal damage. Physicians should be particularly vigilant to the early prevention of damage in this subset of jSLE patients with kidney involvement.

Differences associated with age at onset in early systemic sclerosis patients: a report from the EULAR Scleroderma Trials and Research Group (EUSTAR) database.

OBJECTIVE: The aim of this study was to analyse differences in clinical presentation in patients with early (< 3 years' duration) systemic sclerosis (SSc), comparing three age groups according to disease subsets. METHOD: Cross-sectional analysis of the prospective EULAR Scleroderma Trials and Research database (EUSTAR) was performed. Patients fulfilling preliminary American College of Rheumatology 1980 classification criteria for SSc, with < 3 years from the first non-Raynaud's SSc symptom at first entry, were selected. Patients with < 3 years from the first SSc symptom, including Raynaud's phenomenon, were also analysed. SSc-related variables, including antibodies, SSc subsets, and organ involvement, were examined. Age was categorized into ≤ 30, 31-59, and ≥ 60 years. We performed descriptive and bivariate analyses. RESULTS: The study included 1027 patients: 90% Caucasian, 80% women, and 40% with diffuse disease. In early stages of SSc, younger patients had significantly more anti-Scl-70 antibodies and diffuse disease. With increasing age, we observed more elevation of estimated pulmonary systolic pressure on echocardiography (5%, 13%, and 30%, respectively, in the three age groups), cardiac conduction blocks (6%, 6%, and 15%), and left ventricular diastolic dysfunction (4%, 12%, and 27%). The results were similar for 650 patients with < 3 years from first SSc symptom, including Raynaud's. CONCLUSION: In early stages of SSc, older patients showed data indicating more severe disease with greater cardiac involvement. The diffuse subset was more frequent in the younger subgroup. The identification of such differences may help in selecting appropriate management for individual patients in clinical practice.

Incidence and risk factors for post-traumatic stress disorder in a population affected by a severe flood.

OBJECTIVES: We aimed to study the risk of developing post-traumatic stress disorder (PTSD) symptoms in people who resided in an affected area by an extremely severe flood, and sociodemographic risk factors associated with this condition. STUDY DESIGN: A geographic information system (GIS) was used to distribute the rainfall data. A case-control study was developed to study the relationship between PTSD and sociodemographic risk factors. METHODS: To delineate the areas affected by the flood and the intensity of this rainfall in comparison with historical hydrological data, we employed geographical information systems (GIS). Then, we recruited a representative sample of the affected population and another population sample that lived at the time of this disaster in adjacent geographical areas that were not affected. Both groups were randomly selected in primary care practices, from December 1st 2012 to January 31st 2013. All participants, 70 from the affected areas and 91 from the non-affected, filled a sociodemographic questionnaire and the trauma questionnaire (TQ) to identify and rate PTSD symptoms. RESULTS: Our GIS analysis confirmed that the amount of precipitation in 2012 in the areas affected by the flood was exceptionally high compared with historical average rainfall data (461l per square metre vs 265). Individuals who resided in the affected areas at the time of the flood were at much higher risk of developing PTSD symptoms (OR: 8.18; 95% CI: 3.99-17.59) than those living in adjacent, non-affected localities. Among the sociodemographic variables included in this study, only material and financial losses were strongly associated with the onset of PTSD (P < 0.001). Physical risk during this life-threatening catastrophe also indicated a positive correlation with later development of PTSD symptoms; however, it did not reach statistical significance (P = 0.06). CONCLUSIONS: Populations affected by severe floods may suffer an increase of PTSD symptoms in the following months. This finding, along with the importance of material losses as a predictor for such disorder, may help develop effective plans to minimize the negative impact of these natural disasters on public health.

Experiencia deportiva, ansiedad y motivación en corredores populares / Experiência desportiva, ansiedade e motivação em corredores populares / Sport experience, anxiety and motivation in popular runners

El propósito del presente estudio es conocer la relación entre el estado psicológico de los corredores populares y su experiencia deportiva. Se consiguió una muestra de 473 corredores populares (374 hombres y 99 mujeres) participantes en distintas carreras populares, los hombres tenían una media de edad de 30,28 años y las mujeres de 31,70. El estudio se basa en una metodología cuantitativa, siendo su diseño descriptivo, observacional y correlacional (Tomas y Nelson, 2007). Para la evaluación de las variables personales y sociodemográficas se elaboró un cuestionario de autoinforme ad hoc; para evaluar la ansiedad previa a la competición, se utilizó el CSAI-2R de Andrade, Lois y Arce (2007); y para evaluar las motivaciones para correr se utilizó un cuestionario elaborado por Barrios y Cardozo (2002). Respecto a los resultados se destaca que los corredores con una experiencia deportiva de menos de 1 año y que entrenan durante 1-2 días/semana poseen mayor ansiedad cognitiva y menor ansiedad somática que los que llevan corriendo más años y entrenando más días; y aquellos corredores que corren más de 50 km/semana poseen mayor interés y mayor atracción por la competición que aquellos que corren menos kilómetros (AU)

The purpose of this study is to meet the relationship between psychological status of amateur runners and sporting experience. A sample of 473 amateur runners (374 men and 99 women) participating in various races, men had a mean age of 30.28 years and women an average age of 31.70. The study is based on a quantitative methodology, and its design is descriptive and correlational (Tomas & Nelson, 2007). For the evaluation of the personal variables and socio-demographic was prepared ad hoc self-report questionnaire; and to evaluate anxiety prior to the competition was used to the CSAI-2R by Andrade, Lois & Arce (2007); and to assess the motivations for running a questionnaire prepared by Barrios and Cardozo (2002) was used. The results indicate that runners with a sports experience less than 1 year and who train for 1-2 days/week have higher cognitive anxiety and lower somatic anxiety than those with running longer and more training days; and runners who run more than 50 km/week have greater interest and greater attraction for the competition than those who are less kilometers (AU)

O objetivo deste estudo foi determinar a relação entre o estado psicológico de corredores amadores e experiência desportiva. Uma amostra de 473 corredores amadores (374 homens e 99 mulheres) que participam em várias corridas divertidas, os homens tinham uma média de idade de 30,28 anos e as mulheres 31,70 foi alcançada. O estudo é baseado em uma metodologia quantitativa, e seu projeto descritivo e correlacional (Tomas & Nelson, 2007). Para a avaliação do questionário pessoais e sociodemográficos foi desenvolvido auto ad hoc; para avaliar a ansiedade antes da competição, o CSAI-2R Andrade, Lois e Arce (2007) foi utilizado; e avaliar as motivações para a execução de um questionário elaborado pela Barrios e Cardozo (2002) foi utilizado. Em relação aos resultados surgiram os corredores com uma experiência de desportos menos de 1 ano, e que treinam por 1-2 dias / semana tem ansiedade cognitiva superior e ansiedade somática menores do que aqueles com o funcionamento de mais dias de treinamento mais longo e mais; e os corredores que correm mais do que 50 km / semana têm maior interesse e maior atração para a concorrência do que aqueles que são menos quilómetros (AU)

The cost of sustaining a patient-centered medical home: experience from 2 states.

PURPOSE: As medical practices transform to patient-centered medical homes (PCMHs), it is important to identify the ongoing costs of maintaining these "advanced primary care" functions. A key required input is personnel effort. This study's objective was to assess direct personnel costs to practices associated with the staffing necessary to deliver PCMH functions as outlined in the National Committee for Quality Assurance Standards. METHODS: We developed a PCMH cost dimensions tool to assess costs associated with activities uniquely required to maintain PCMH functions. We interviewed practice managers, nurse supervisors, and medical directors in 20 varied primary care practices in 2 states, guided by the tool. Outcome measures included categories of staff used to perform various PCMH functions, time and personnel costs, and whether practices were delivering PCMH functions. RESULTS: Costs per full-time equivalent primary care clinician associated with PCMH functions varied across practices with an average of $7,691 per month in Utah practices and $9,658 in Colorado practices. PCMH incremental costs per encounter were $32.71 in Utah and $36.68 in Colorado. The average estimated cost per member per month for an assumed panel of 2,000 patients was $3.85 in Utah and $4.83 in Colorado. CONCLUSIONS: Identifying costs of maintaining PCMH functions will contribute to effective payment reform and to sustainability of transformation. Maintenance and ongoing support of PCMH functions require additional time and new skills, which may be provided by existing staff, additional staff, or both. Adequate compensation for ongoing and substantial incremental costs is critical for practices to sustain PCMH functions.

Validation and cross-cultural adaptation of the 'Fibromyalgia Participation Questionnaire' to the Spanish population: study protocol.

There are few high-quality instruments to evaluate the participation and social functioning of fibromyalgia patients. The Fibromyalgia Participation Questionnaire (FPQ) is a questionnaire that evaluates these aspects with high reliability and validity in its German original version. The aim of this work was to describe the translation and cross-cultural adaptation process of the FPQ into Spanish and its validation to ensure the equivalence against the original version. The questionnaire will be translated according to the FACIT methodology, and it will be tested in the Clinical Management Unit of North Almeria Health Area. This methodology includes several stages: double forward translation, reconciled version, back-translation, review of the previous versions and development of the prefinal version for the pretest. Once the pretest ends, the final version of the questionnaire will be developed, which will be subjected to a validation process to study its psychometric properties. Reliability will be studied by internal consistency and test-retest reliability through Cronbach's alpha and Pearson's correlation coefficient, respectively. External and construct validity will be analysed using correlation coefficients, content validity with an empirical analysis, and a differential item functioning analysis will be employed to measure discriminative validity. The presence of ceiling and floor effects will be calculated too. The validation of the FPQ into different languages will allow better evaluation and treatment based on the observed limitations fibromyalgia patients suffer from, as well as bringing the possibility to compare between other countries and generalize its use in the scientific community.

Unusual forms of subacute invasive pulmonary aspergillosis in patients with solid tumors.

OBJECTIVES: Aspergillus spp. can cause acute invasive disease in severely immunocompromised patients. Nonetheless, there are few reports of solid tumors complicated with subacute invasive pulmonary aspergillosis (subacute IPA). METHODS: Retrospective observational cohort study, performed in patients with primary lung cancer or secondary lung metastasis complicated with subacute IPA in three referral hospitals. RESULTS: From 2008 to 2011, 14 episodes of subacute IPA were diagnosed, including 11 (78.6%) probable and 3 proven (21.4%). Nine patients (64.3%) had primary lung cancer. Thirteen patients (92.9%) had more than one local or systemic predisposing factor for subacute IPA. No patient had previous fungal colonization. Aspergillus spp. was isolated in 6 specimens of bronchoalveolar lavage, 6 sputum, 2 biopsies, and 1 percutaneous lung puncture. At the time Aspergillus spp. was isolated, the most common radiologic findings on chest computed tomography (CT) were cavitary masses, and development or expansion of cavitation in existing masses or nodules (10/14, 71.4%). On CT follow-up, most patients (8/12, 66.7%) had new cavity formation or expansion of one or more existing cavities. All patients were treated with azoles and two underwent surgery. Ten (71.4%) patients died after Aspergillus spp. was detected (median time 73 days, IQR 33-243): 2 (20%) deaths were subacute IPA-attributable and 6 (60%) were related. CONCLUSIONS: Primary lung cancer and secondary lung metastasis seem to be triggering factors for Aspergillus spp. implantation, and predispose to subacute IPA. Once localized in the damaged lung, the mold can grow and cause or expand cavities. In lung cancer patients, Aspergillus spp. detection is associated with a very poor prognosis.

Manifestaciones neurológicas de los mixomas cardiacos. Experiencia en un centro de referencia / Neurological manifestations of cardiac myxoma: Experience in a referral hospital

Introducción: El mixoma cardiaco es una causa poco frecuente pero importante de infarto cerebral en pacientes jóvenes. Existen pocas series de pacientes que analicen la frecuencia de las manifestaciones neurológicas en pacientes con mixoma y su presentación clínica. Objetivo: Conocer las complicaciones neurológicas del mixoma cardiaco en nuestro hospital durante los últimos 28 años. Pacientes y métodos: Revisión retrospectiva de las manifestaciones neurológicas de 36 pacientes operados de mixoma cardiaco con confirmación patológica en nuestro centro desde diciembre de 1983 hasta marzo del 2012. Resultados: Ocho de los 36 pacientes con mixomas cardiacos (22%) intervenidos en nuestro centro presentaron clínica neurológica. El 50% eran mujeres y la edad media ± desviación estándar de 52,4 ± 11,6 años. El síntoma neurológico más frecuente fue la hemiparesia de aparición brusca (63%). El ictus isquémico establecido fue la manifestación clínica más frecuente (75%), seguido del accidente isquémico transitorio. El territorio más afectado fue el de la arteria cerebral media. En todos los casos se alcanzó el diagnóstico del tumor mediante ecocardiografía. El tamaño medio del mixoma fue de 4,12 cm. La mayoría (63%) presentaba una superficie polipoide. Todos los tumores fueron resecados quirúrgicamente con éxito. No hubo muertes hospitalarias. Conclusiones: Los mixomas cardíacos comienzan frecuentemente con manifestaciones neurológicas, en particular como eventos isquémicos (AIT o ictus establecidos) en pacientes jóvenes y sin factores de riesgo cardiovascular. El territorio anterior, en especial la arteria cerebral media, suele estar más frecuentemente afectado. La ecocardiografía puede facilitar el diagnóstico y permitir un tratamiento precoz de la lesión (AU)

Introduction: Cardiac myxoma is an important but uncommon cause of stroke in younger patients. Few published case series analyse the frequency and clinical presentation of neurological complications in patients with myxoma. Objective: To list all neurological complications from cardiac myxoma recorded in our hospital in the past 28 years. Patients and methods: We retrospectively reviewed the neurological manifestations of cardiac myxoma in patients treated in our hospital between December 1983 and March 2012. Results: Of the 36 patients with cardiac myxoma, 8 (22%) presented neurological manifestations. Half were women and mean age of patients was 52.4 ± 11.6 years. Sudden-onset hemiparesis was the most frequent neurological symptom (63%). Established ischaemic stroke was the most common clinical manifestation (75%), followed by transient ischemic attack. The most commonly affected territory corresponded to the middle cerebral artery. Myxoma was diagnosed by echocardiography in all cases. Mean myxoma size was 4.1 cm and most of the tumours (63%) had a polypoid surface. All tumours were successfully removed by surgery. There were no in-hospital deaths. Conclusions: Cardiac myxomas frequently present with neurological symptoms, especially ischaemic events (established stroke or transient ischaemic attack), in younger patients with no cardiovascular risk factors. The anterior circulation is more frequently affected, especially the middle cerebral artery. Echocardiography can facilitate prompt diagnosis and early treatment of the lesion (AU)

Infección diseminada por micobacterias no tuberculosas en paciente con síndrome hiper-IgE / Disseminated non-tuberculous mycobacterial infection in a patient with hyper-IgE syndrome

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Neurological manifestations of cardiac myxoma: experience in a referral hospital.

INTRODUCTION: Cardiac myxoma is an important but uncommon cause of stroke in younger patients. Few published case series analyse the frequency and clinical presentation of neurological complications in patients with myxoma. OBJECTIVE: To list all neurological complications from cardiac myxoma recorded in our hospital in the past 28 years. PATIENTS AND METHODS: We retrospectively reviewed the neurological manifestations of cardiac myxoma in patients treated in our hospital between December 1983 and March 2012. RESULTS: Of the 36 patients with cardiac myxoma, 8 (22%) presented neurological manifestations. Half were women and mean age of patients was 52.4 ± 11.6 years. Sudden-onset hemiparesis was the most frequent neurological symptom (63%). Established ischaemic stroke was the most common clinical manifestation (75%), followed by transient ischemic attack. The most commonly affected territory corresponded to the middle cerebral artery. Myxoma was diagnosed by echocardiography in all cases. Mean myxoma size was 4.1cm and most of the tumours (63%) had a polypoid surface. All tumours were successfully removed by surgery. There were no in-hospital deaths. CONCLUSIONS: Cardiac myxomas frequently present with neurological symptoms, especially ischaemic events (established stroke or transient ischaemic attack), in younger patients with no cardiovascular risk factors. The anterior circulation is more frequently affected, especially the middle cerebral artery. Echocardiography can facilitate prompt diagnosis and early treatment of the lesion.

Incommensurate sinusoidal oxygen modulations in layered manganites La(1-x)Sr(1+x)MnO4 (x≥0.5).

We have studied the incommensurate-ordered phase in overdoped La0.4Sr1.6MnO4 by resonant x-ray diffraction at the Mn K edge. Weak resonant superlattice (h±0.2 h±0.2 0) and (h±0.4 h±0.4 0) reflections of the tetragonal structure were found below ~240 K. The energy, azimuth angle, and polarization dependencies of the resonant scattering have revealed sinusoidal modulations of the oxygen motions that are transverse and longitudinal to the tetragonal [110] direction. This result discards (Mn(3+),Mn(4+))-like stripe-type order but point to a charge-density-modulation picture.