Variaciones de las células de cuadrícula y de posicionamiento de la corteza entorrinal y del giro dentado de 6 humanos de 56 a 87 años / Variations of the grid and place cells in the entorhinal cortex and dentate gyrus of 6 individuals aged 56 to 87 years

Introducción: La relación entre la corteza entorrinal y el hipocampo ha sido estudiada por diferentes autores, que han destacado la importancia de las células de cuadrícula, las células de posicionamiento y la conexión trisináptica en los procesos que regulan: la persistencia de la memoria espacial, explícita y reciente, y su posible afección con el envejecimiento. Objetivo: Observar si existen diferencias en el tamaño y número de células de cuadrícula contenidas en la lámina iii de la corteza entorrinal y en la capa granular del giro dentado del hipocampo de pacientes mayores. Métodos: Realizamos estudios posmortem del cerebro de 6 sujetos de edades comprendidas entre los 56 y 87 años. Los cortes de cerebros que contenían el giro dentado del hipocampo y la corteza entorrinal adyacente se tiñeron con el método de Klüver-Barrera, después se midió, mediante el programa Image J, el área neuronal individual, el área neuronal total, así como el número de neuronas, contenidas en cuadrículas rectangulares a nivel de la lámina iii de la corteza entorrinal y la lámina ii del giro dentado y se llevó a cabo un análisis estadístico. Resultados: Se ha observado una reducción de la población celular de la capa piramidal externa de la corteza entorrinal, así como de las neuronas de la capa granular del giro dentado relacionada con el envejecimiento. Conclusión: Nuestros resultados indican que el envejecimiento produce una disminución en el tamaño y la densidad neuronal en las células de cuadrícula de la corteza entorrinal y de posicionamiento del giro dentado.(AU)

Introduction: The relationship between the entorhinal cortex and the hippocampus has been studied by different authors, who have highlighted the importance of grid cells, place cells, and the trisynaptic circuit in the processes that they regulate: the persistence of spatial, explicit, and recent memory and their possible impairment with ageing. Objective: We aimed to determine whether older age causes changes in the size and number of grid cells contained in layer III of the entorhinal cortex and in the granular layer of the dentate gyrus of the hippocampus. Methods: We conducted post-mortem studies of the brains of 6 individuals aged 56-87 years. The brain sections containing the dentate gyrus and the adjacent entorhinal cortex were stained according to the Klüver-Barrera method, then the Image J software was used to measure the individual neuronal area, the total neuronal area, and the number of neurons contained in rectangular areas in layer III of the entorhinal cortex and layer II of the dentate gyrus. Statistical analysis was subsequently performed. Results: We observed an age-related reduction in the cell population of the external pyramidal layer of the entorhinal cortex, and in the number of neurons in the granular layer of the dentate gyrus. Conclusion: Our results indicate that ageing causes a decrease in the size and density of grid cells of the entorhinal cortex and place cells of the dentate gyrus.(AU)

Evaluación de la intervención de fisioterapia en los pacientes con sarcopenia y fractura de cadera: una revisión sistemática / Evaluation of physiotherapy intervention in patients with sarcopenia and hip fracture: A systematic review

Introducción La sarcopenia en los pacientes con fractura de cadera es cada vez más habitual en la población envejecida, aumentando el riesgo de hospitalización, dependencia y mortalidad. Objetivos Valorar el tratamiento de fisioterapia más efectivo en los pacientes con sarcopenia y fractura de cadera a través de la revisión de evidencia sistemática. Métodos Se realizó una búsqueda entre febrero y mayo de 2022 en 8 bases de datos electrónicas (Pubmed, Scopus, PEDro, Web of Science, Cochrane, Google Scholar y Springer Link), con el fin de extraer ensayos clínicos publicados en los últimos 12 años en español e inglés. Resultados Se seleccionaron 3 ensayos clínicos que cumplían los criterios de inclusión. En todos ellos las intervenciones de fisioterapia incluían ejercicio aeróbico, de fuerza, de alta intensidad, de movilizaciones y combinados. La calidad metodológica se evaluó con la escala PEDro (puntuación media entre 6 y 10). Uno de los estudios no encuentra diferencias entre el tratamiento estándar y el grupo que recibe además entrenamiento progresivo de fuerza muscular. Otro constata una mejora a corto plazo en el grupo que recibe además del tratamiento convencional entrenamiento en cinta rodante con soporte del peso corporal durante el ejercicio con seguimiento a los 3 y 6 meses. El estudio que suplementa con aminoácidos esenciales es el único que constata una mejoría en los pacientes con sarcopenia. Conclusión Los pacientes con sarcopenia y fractura de cadera, pueden tener una mejor evolución si combinan ejercicios de fisioterapia con un protocolo nutricional. Son necesarias más investigaciones metodológicamente rigurosas sobre este tema para poder ampliar la evidencia. (AU)

Introduction Sarcopenia in patients with hip fracture is increasingly common in the elderly population, increasing the risk of hospitalization, dependency, and mortality. Objectives To assess the most effective physiotherapy treatment in patients with sarcopenia and hip fracture through systematic evidence review. Methods Electronic databases were searched from February to May 2022 using Pubmed, Scopus, PEDro, Web of Science, Cochrane, Google Scholar, and Springer Link in order to extract randomized clinical trials published in full text both English and Spanish for the last 12 years. Results Three clinical trials that met the inclusion criteria were selected. In all of them, the physiotherapy interventions included aerobic, strength, high intensity, mobilization, and combined exercises. Methodological quality was assessed using the PEDro scale (average score between 6 and 10). One of the studies found no differences between the standard treatment and the group that also received progressive muscle strength training. Another found a short-term improvement in the group that received, in addition to conventional treatment, treadmill training with body weight support during exercise with follow-up that was not maintained at three and six months. The study that supplements with essential amino acids is the only one that confirms an improvement in patients with sarcopenia. Conclusion Patients with sarcopenia and hip fracture may have a better evolution if they combine physiotherapy exercises with a nutritional protocol. More methodologically rigorous research on this topic is needed to expand the evidence. (AU)

Evaluación de la intervención de fisioterapia en los pacientes con sarcopenia y fractura de cadera: una revisión sistemática / Evaluation of physiotherapy intervention in patients with sarcopenia and hip fracture: A systematic review

Introducción La sarcopenia en los pacientes con fractura de cadera es cada vez más habitual en la población envejecida, aumentando el riesgo de hospitalización, dependencia y mortalidad. Objetivos Valorar el tratamiento de fisioterapia más efectivo en los pacientes con sarcopenia y fractura de cadera a través de la revisión de evidencia sistemática. Métodos Se realizó una búsqueda entre febrero y mayo de 2022 en 8 bases de datos electrónicas (Pubmed, Scopus, PEDro, Web of Science, Cochrane, Google Scholar y Springer Link), con el fin de extraer ensayos clínicos publicados en los últimos 12 años en español e inglés. Resultados Se seleccionaron 3 ensayos clínicos que cumplían los criterios de inclusión. En todos ellos las intervenciones de fisioterapia incluían ejercicio aeróbico, de fuerza, de alta intensidad, de movilizaciones y combinados. La calidad metodológica se evaluó con la escala PEDro (puntuación media entre 6 y 10). Uno de los estudios no encuentra diferencias entre el tratamiento estándar y el grupo que recibe además entrenamiento progresivo de fuerza muscular. Otro constata una mejora a corto plazo en el grupo que recibe además del tratamiento convencional entrenamiento en cinta rodante con soporte del peso corporal durante el ejercicio con seguimiento a los 3 y 6 meses. El estudio que suplementa con aminoácidos esenciales es el único que constata una mejoría en los pacientes con sarcopenia. Conclusión Los pacientes con sarcopenia y fractura de cadera, pueden tener una mejor evolución si combinan ejercicios de fisioterapia con un protocolo nutricional. Son necesarias más investigaciones metodológicamente rigurosas sobre este tema para poder ampliar la evidencia. (AU)

Introduction Sarcopenia in patients with hip fracture is increasingly common in the elderly population, increasing the risk of hospitalization, dependency, and mortality. Objectives To assess the most effective physiotherapy treatment in patients with sarcopenia and hip fracture through systematic evidence review. Methods Electronic databases were searched from February to May 2022 using Pubmed, Scopus, PEDro, Web of Science, Cochrane, Google Scholar, and Springer Link in order to extract randomized clinical trials published in full text both English and Spanish for the last 12 years. Results Three clinical trials that met the inclusion criteria were selected. In all of them, the physiotherapy interventions included aerobic, strength, high intensity, mobilization, and combined exercises. Methodological quality was assessed using the PEDro scale (average score between 6 and 10). One of the studies found no differences between the standard treatment and the group that also received progressive muscle strength training. Another found a short-term improvement in the group that received, in addition to conventional treatment, treadmill training with body weight support during exercise with follow-up that was not maintained at three and six months. The study that supplements with essential amino acids is the only one that confirms an improvement in patients with sarcopenia. Conclusion Patients with sarcopenia and hip fracture may have a better evolution if they combine physiotherapy exercises with a nutritional protocol. More methodologically rigorous research on this topic is needed to expand the evidence. (AU)

Variations of the grid and place cells in the entorhinal cortex and dentate gyrus of 6 individuals aged 56 to 87 years.

INTRODUCTION: The relationship between the entorhinal cortex (EC) and the hippocampus has been studied by different authors, who have highlighted the importance of grid cells, place cells, and the trisynaptic circuit in the processes that they regulate: the persistence of spatial, explicit, and recent memory and their possible impairment with ageing. OBJECTIVE: We aimed to determine whether older age causes changes in the size and number of grid cells contained in layer III of the EC and in the granular layer of the dentate gyrus (DG) of the hippocampus. METHODS: We conducted post-mortem studies of the brains of 6 individuals aged 56-87 years. The brain sections containing the DG and the adjacent EC were stained according to the Klüver-Barrera method, then the ImageJ software was used to measure the individual neuronal area, the total neuronal area, and the number of neurons contained in rectangular areas in layer III of the EC and layer II of the DG. Statistical analysis was subsequently performed. RESULTS: We observed an age-related reduction in the cell population of the external pyramidal layer of the EC, and in the number of neurons in the granular layer of the DG. CONCLUSION: Our results indicate that ageing causes a decrease in the size and density of grid cells of the EC and place cells of the DG.

Influence of Seminal Metals on Assisted Reproduction Outcome.

Increased levels of metal ions in human seminal fluid have a significant correlation with male fertility. Few publications explain the effect of metals in semen and their influence on assisted reproductive treatments. Semen parameters and the levels of twenty-two metals were measured in the seminal fluid of 102 men attended in a Reproductive Unit. Metals were determined by optical emission spectrophotometry. A statistical relationship was found between spermiogram and iron, which was lower than expected in pathological spermiograms (p = 0.032); zinc (p = 0.066), calcium (p = 0.047), and magnesium (p = 0.048) mean levels were higher in normozoospermics. More days of sexual abstinence correlates with higher seminal zinc (p = 0.001) and magnesium levels (p = 0.002). Lower vanadium values were found to be associated with higher fertilization rates (p = 0.039). Higher values of lead (p = 0.052) and vanadium (p = 0.032) were obtained in patients who did not reach 100% embryo cleavage rate. Aluminium (p = 0.042) and sodium (p = 0.002) were found in lower amounts associated with better blastocyst rates. The implantation rate shows an inverse association with women's age and iron and calcium content, compared to magnesium and sodium which presented a significant direct association with this percentage. A significant direct relationship was found between the positive evolution of pregnancy and the values of zinc (p = 0.004), calcium (p = 0.013), potassium (p = 0.002), and magnesium (p = 0.009). The study confirms that zinc, iron, calcium, sodium, aluminium, magnesium, vanadium, and lead have positive-negative effects on reproduction and support the analysis of metals in semen as a new line of study on male fertility with implications for reproductive outcomes.

Telefarmacia como estrategia de dispensación coordinada entre Farmacia Hospitalaria y Atención Primaria / Telepharmacy as a strategy for co-ordinated dispensing between Hospital Pharmacy and Primary Care

A partir de la publicación de la Orden Ministerial SND/293/2020,del 25 de marzo, tras la declaración de la emergencia sanitariapor SARS-CoV-2 en España, se diseñaron una serie de medidasque garantizaran la restricción de movilidad de la población sinperjuicio del acceso a los medicamentos hospitalarios. Así, a raízde dicha publicación, en el Servicio de Farmacia Hospitalaria delHospital SAS La Línea se desarrolló un programa de Telefarmaciacon puntos de dispensación en los centros de Atención Primariaadscritos y una consulta telefónica de Atención Farmacéutica.Se realizaron un total de 1.007 dispensaciones en 301 pacientesdurante el periodo de estudio comprendido entre el 1 de julio al15 de noviembre de 2020. Así, al finalizar dicho periodo, 235fueron los pacientes que permanecieron incluidos en el programa de Telefarmacia con una edad media de 64 años y un54,5% (128) mujeres. A estos pacientes, se les enviaron por correo postal una encuesta de satisfacción que podrían devolvervoluntaria y anónimamente al Servicio de Farmacia. Se recibieronun total de 62 encuestas, mostrándose los pacientes satisfechosen un 96,77% (60) con el servicio de entrega, 90,32% (56) conel trato recibido, 87,10% (54) con la puntualidad y 98,39% (61)con las condiciones de conservación en el Centro de Salud.El alto grado de satisfacción de los pacientes encuestadosrefleja que el nuevo programa de Telefarmacia podrían responder a las necesidades individuales de los pacientes,siendo para ello fundamental la coordinación de todos losprofesionales implicados, así como la corresponsabilidad delos pacientes en el control de sus tratamientos.Con los resultados obtenidos en el presente estudio, parece justificado mantener en el futuro los centros de atención primariacomo punto de dispensación junto con un mayor desarrollo dela consulta no presencial de Atención Farmacéutica. (AU)

As of the publication of Ministerial OrderSND/293/2020, of March 25, after thedeclaration of the health emergency dueto SARS-CoV-2 in Spain, a series of measures were designed to guarantee therestriction of population mobility withoutprejudice to access to hospital medications. Thus, as a result of said publication,a telepharmacy program was developedat the clinical pharmacy service of theHospital SAS La Línea with dispensingpoints in the attached Primary Care centers and a Pharmaceutical Care Telephone Consultation.A total of 1,007 dispensations weremade in 301 patients during the studyperiod from July 1 to November 15,2020. Thus, at the end of that period,235 were the patients who remainedincluded in the Telepharmacy programwith a mean age 64 years and 54.5%(128) women. A satisfaction survey wassent to these patients by post, whichthey could return voluntarily and anonymously to the pharmacy service. A totalof 62 surveys were received, showing96.77% (60) satisfied patients with thedelivery service, 90.32% (56) with theattention received, 87.10% (54) withthe punctuality and 98.39% (61) withthe conditions of conservation in thehealth center.The high degree of satisfaction of thesurveyed patients reflects that the newTelepharmacy program could respondto the individual needs of the patients,being essential for this the coordinationof all the professionals involved, as wellas the co-responsibility of the patientsin the control of their treatments.With the results obtained in the present study, it seems justified in the future to maintain primary care centersas a dispensing point together with afurther development of the non-faceto-face consultation of PharmaceuticalCare. (AU)

Variations of the grid and place cells in the entorhinal cortex and dentate gyrus of 6 individuals aged 56 to 87 years. / Variaciones de las células de cuadrícula y de posicionamiento de la corteza entorrinal y del giro dentado de 6 humanos de 56 a 87 años.

INTRODUCTION: The relationship between the entorhinal cortex and the hippocampus has been studied by different authors, who have highlighted the importance of grid cells, place cells, and the trisynaptic circuit in the processes that they regulate: the persistence of spatial, explicit, and recent memory and their possible impairment with ageing. OBJECTIVE: We aimed to determine whether older age causes changes in the size and number of grid cells contained in layer III of the entorhinal cortex and in the granular layer of the dentate gyrus of the hippocampus. METHODS: We conducted post-mortem studies of the brains of 6 individuals aged 56-87 years. The brain sections containing the dentate gyrus and the adjacent entorhinal cortex were stained according to the Klüver-Barrera method, then the Image J software was used to measure the individual neuronal area, the total neuronal area, and the number of neurons contained in rectangular areas in layer III of the entorhinal cortex and layer II of the dentate gyrus. Statistical analysis was subsequently performed. RESULTS: We observed an age-related reduction in the cell population of the external pyramidal layer of the entorhinal cortex, and in the number of neurons in the granular layer of the dentate gyrus. CONCLUSION: Our results indicate that ageing causes a decrease in the size and density of grid cells of the entorhinal cortex and place cells of the dentate gyrus.

Crestal module design optimization of dental implants: finite element analysis and in vivo studies.

The aim of this study was to evaluate the biomechanical behavior of Bone Level dental implants with four different neck designs in contact with cortical bone. Numerical simulations were performed using a Finite Element Method (FEM) based-model. In order to verify the FEM model, the in silico results were compared with the results obtained from histological analysis performed in an in vivo study with New Zealand rabbits. FEM was performed using a computerized 3D model of Bone Level dental implants inserted in the lower jaw bone with an applied axial load of 100 N. The analysis was performed using four different implant neck designs: even surfaced, screwed, three-ring design and four-ring design. Interface are of bone growth was evaluated by analyzing the Bone-Implant-Contact (BIC) parameter obtained from in vivo histological process and analyzed by Scanning Electron Microscopy (SEM). Bone Level implants were inserted in the rabbit tibia, placing two implants per tibia. The BIC was evaluated after three and six weeks of implantation. FEM studies showed that the three-ring design presented lower values of stress distribution compared to the other studied designs. The lower levels of mechanical stress were then correlated with the in vivo studies, showing that the three-ring design presented the highest BIC value after 3 and 6 weeks of implantation. In silico and in vivo results both concluded that the implants with three-ring neck design presented the best biomechanical and histological behavior in terms of new bone formation, enhanced mechanical stability and optimum osseointegration.

Assessment of the Versius surgical robotic system for dual-field synchronous transanal total mesorectal excision (taTME) in a preclinical model: will tomorrow's surgical robots promise newfound options?

BACKGROUND: The aim of this study was to evaluate the feasibility of the Versius surgical robotic system for transanal total mesorectal excision (taTME) in a preclinical setting. METHODS: Dry laboratory and cadaveric sessions were first conducted for three experienced colorectal surgeons in order to gain familiarity with the modular surgical system and the robotic workstation. After introduction, the system was configured to allow for synchronous, totally robotic taTME in a cadaver. RESULTS: Using the modular robotic system, one surgeon performed the abdominal portion of the operation, including colonic mobilization and vascular pedicle ligation while simultaneously a second surgeon performed the transanal portion of the operation to the point of rendezvous at the peritoneal reflection, where the operation was completed cooperatively. The operation was successfully completed in 195 min demonstrating preclinical feasibility of this unique approach with an emerging robotic system. CONCLUSIONS: This is the first preclinical assessment of the Versius surgical robotic system for taTME. The ability to work simultaneously carries the theoretical advantage of reducing surgical time and thereby reducing overall operative costs. It may also allow surgeons to maintain focus on critical parts of the operation by halving the fatigue associated with long, complex cases such as taTME.

Robotic-assisted stereotactic real-time navigation: initial clinical experience and feasibility for rectal cancer surgery.

BACKGROUND: Real-time stereotactic navigation for transanal total mesorectal excision has been demonstrated to be feasible in small pilot series using laparoscopic techniques. The possibility of real-time stereotactic navigation coupled with robotics has not been previously explored in a clinical setting. METHODS: After pre-clinical assessment, and configuration of a robotic-assisted navigational system, two patients with locally advanced rectal cancer were selected for enrollment into a pilot study designed to assess the feasibility of navigation coupled with the robotic da Vinci Xi platform via TilePro interface. In one case, fluorescence-guided surgery was also used as an adjunct for structure localization, with local administration of indocyanine green into the ureters and at the tumor site. RESULTS: Each operation was successfully completed with a robotic-assisted approach; image-guided navigation provided computed accuracy of ± 4.5 to 4.6 mm. The principle limitation encountered was navigation signal dropout due to temporary loss of direct line-of-sight with the navigational system's infrared camera. Subjectively, the aid of navigation assisted the operating surgeon in identifying critical anatomical planes. The combination of fluorescence with image-guided surgery further augmented the surgeon's perception of the operative field. CONCLUSIONS: The combination of stereotactic navigation and robotic surgery is feasible, although some limitations and technical challenges were observed. For complex surgery, the addition of navigation to robotics can improve surgical precision. This will likely represent the next step in the evolution of robotics and in the development of digital surgery.

Outcomes of a 1-year randomized controlled trial to evaluate a behavioral 'stepped-down' weight loss intervention for adolescent patients with obesity.

BACKGROUND: Stepped-care approaches to weight loss have shown some success among adults. A 'stepped-down' version of the stepped-care approach to adolescent weight loss has never been evaluated. OBJECTIVES: We conducted a one-year randomized controlled trial to compare a stepped-down weight loss intervention versus enhanced usual care (EUC). METHODS: Study participants were obese adolescents age 11-13 (N = 106, 51% girls, and 82% Hispanic) recruited from primary care clinics in San Diego, California. The stepped-down intervention was delivered through clinician and health educator counseling (in-person and by phone) and mailed content. The intervention consisted of four-month 'steps' beginning with the most intensive contact followed by reduced contact if treatment goals were met. The EUC group received an initial physician visit, one session with a health counselor, and monthly mailed materials. Body mass index (BMI kg/m(2) ) was measured at baseline, 4, 8, and 12 months. Mixed-model regression analyses were stratified by sex. RESULTS: Results indicated a clinically significant treatment effect for boys on BMI (p < 0.001) but not girls. No between group differences were found for adiposity and biometric outcomes. Only 13% of intervention participants succeeded in stepping down from step 1 to step 2 or step 3. CONCLUSIONS: A stepped-down approach to weight loss showed some evidence of efficacy for weight loss in boys but not girls. The findings suggest the program as designed was not intensive enough to result in weight loss in this population segment.

Long-term decline of the Amazon carbon sink.

Atmospheric carbon dioxide records indicate that the land surface has acted as a strong global carbon sink over recent decades, with a substantial fraction of this sink probably located in the tropics, particularly in the Amazon. Nevertheless, it is unclear how the terrestrial carbon sink will evolve as climate and atmospheric composition continue to change. Here we analyse the historical evolution of the biomass dynamics of the Amazon rainforest over three decades using a distributed network of 321 plots. While this analysis confirms that Amazon forests have acted as a long-term net biomass sink, we find a long-term decreasing trend of carbon accumulation. Rates of net increase in above-ground biomass declined by one-third during the past decade compared to the 1990s. This is a consequence of growth rate increases levelling off recently, while biomass mortality persistently increased throughout, leading to a shortening of carbon residence times. Potential drivers for the mortality increase include greater climate variability, and feedbacks of faster growth on mortality, resulting in shortened tree longevity. The observed decline of the Amazon sink diverges markedly from the recent increase in terrestrial carbon uptake at the global scale, and is contrary to expectations based on models.

Robotic transanal surgery for local excision of rectal neoplasia, transanal total mesorectal excision, and repair of complex fistulae: clinical experience with the first 18 cases at a single institution.

BACKGROUND: Robotic transanal surgery represents a natural evolution of transanal minimally invasive surgery. This new approach to rectal surgery provides the ability to perform local excision of rectal neoplasia with precision. Robotic transanal surgery can also be used to perform more advanced procedures including repair of complex fistulae and transanal total mesorectal excision. METHODS: Data from patients who underwent transanal robotic surgery over a 33-month period were retrospectively reviewed. Patients underwent three types of procedures using this approach: (a) local excision of rectal neoplasia, (b) transanal total mesorectal excision, and (c) closure of complex fistulae, such as rectourethral fistulae. RESULTS: Eighteen patients underwent robotic transanal surgery during the 33-month study period. Of these, nine patients underwent local excision of rectal neoplasia; four patients underwent transanal total mesorectal excision; four patients underwent repair of rectourethral fistulae; and one patient underwent repair of an anastomotic fistula. Of the patients undergoing robotic transanal surgery for local excision, 6/9 were resections of benign neoplasia, while 3/9 were resections for invasive adenocarcinoma. There was no fragmentation (0/9) noted on any of the locally excised specimens, while one patient (1/9) had a positive lateral margin. During the mean follow-up of 11.4 months, no recurrence was detected. Four patients underwent robotic-assisted transanal total mesorectal excision for curative intent resection of rectal cancer confined to the distal rectum. Mesorectal quality was graded as complete or near complete, and an R0 resection was performed in all four cases. Other transanal robotic procedures performed were the repair of rectourethral fistulae (n = 3) and anastomotic fistula (n = 1). This approach was met with limited success, and only half of the rectourethral fistulae were closed. CONCLUSIONS: Robotic transanal surgery for local excision, transanal total mesorectal excision, and repair of fistulae is feasible, although these new approaches represent a work-in-progress. Improvement in platform design will likely facilitate the ability to perform more complex procedures. Further research with robotic transanal approaches is necessary to determine whether or not this approach can provide patients with significant benefit.

Trastornos neurológicos en cirugía cardíaca: diagnóstico de tumoraciones cerebrales durante el postoperatorio / Neurological disorders after cardiac surgery: Diagnosis of cerebral tumors in the postoperative period

Las alteraciones neurológicas en el postoperatorio de cirugía cardíaca son frecuentes y habitualmente consecuencia de una suma compleja de factores preoperatorios e intraoperatorios. Presentamos 2 casos de tumoraciones cerebrales diagnosticadas en el periodo postoperatorio inmediato tras presentar alteraciones neurológicas, y en las que las exploraciones complementarias proporcionaron información clínicamente útil (AU)

The incidence of neurologic disorders in the postoperative period of cardiac surgery is high and usually due to a combination of pre- and intraoperative factors. We present 2 patients with brain tumors diagnosed in the immediate postoperative period after sudden onset of neurologic dysfunction. Image studies yielded clinically useful information in these 2 cases (AU)

Relationships between depression, gender, and unhealthy weight loss practices among overweight or obese college students.

INTRODUCTION: Unhealthy weight loss practices are common among female college students. It is unknown if these practices are also most common among women in the subset of overweight or obese college students or if these practices are related to depression. We examined the relationship between gender, depression, and unhealthy weight loss practices among overweight or obese college students. METHODS: Students (body mass index between 25.0 and 34.9 kg/m(2)) from three Southern California universities (M(age) = 22 years, SD = 4; 70% women) were recruited from May 2011 to May 2012 for participation in a weight loss clinical trial (N = 404). Logistic regressions were performed with baseline data to assess the cross-sectional relationship between self-reported unhealthy weight loss practices and gender and depression as measured by the Center for Epidemiologic Studies Depression short form. RESULTS: Twenty-nine percent of participants reported engaging in at least one unhealthy weight loss behavior (e.g., fasting, purging) over the last 30 days, with no differences by gender. Self-report of at least one unhealthy weight loss behavior was associated with report of symptoms of depression (e(B) = 1.14 [confidence interval, CI: 1.08-1.20]), adjusting for potential confounders. Interactions between gender and depression were not significant (e(B) = 1.04 [CI: 0.93-1.16]). CONCLUSION: Among an overweight or obese sample of college students, unhealthy weight loss practices were equally common in both genders, and students with depressive symptomatology were at greatest risk. Obesity interventions targeting overweight or obese college students should educate both men and women about the dangers of unhealthy weight loss practices. In addition, screening for depression can help identify students who would benefit from additional supportive and coping strategies and resources.

Construcción de un modelo de cálculo y registro del percentil de peso neonatal / Construction of model for calculating and recording neonatal weight percentiles

OBJETIVOS: Elaborar unas curvas de peso neonatal con una metodología que permita el acceso al cálculo automático del percentil, el registro y almacenamiento secuencial de los resultados y compararlas con otros modelos creados para niños españoles. MATERIAL Y MÉTODOS: Se realizó un análisis de regresión múltiple considerando como variable dependiente el peso del recién nacido (RN) y la edad gestacional (EG) y el sexo como independientes, para construir un modelo de cálculo del peso óptimo y de los correspondientes percentiles. Se comparan los resultados al clasificar a los RN como grandes o pequeños para la EG con el modelo propuesto y con el de Carrascosa, con el de Figueras y con los de Ramos. RESULTADOS: Modelo de cálculo del peso óptimo: 3.311,062 + 68,074 *sexo + 143,267 *EG40 -13,481 * EG402 - 0,797 *EG403 + sexo* (5,528 *EG40 - 0,674 *EG402 - 0,064 *EG403). Los percentiles de peso se obtuvieron de los datos estandarizados usando el coeficiente de variación del peso óptimo. El grado de concordancia entre el modelo construido y el de Carrascosa, el de Ramos dado en percentiles empíricos y el de Ramos en percentiles suavizados resultó «casi perfecto», κ = 0,866, κ = 0,872 y κ = 0,876 (p < 0,001), respectivamente; y con el de Figueras «considerable», κ = 0,720 (p < 0,001). CONCLUSIONES: El modelo construido es comparable con los utilizados para niños españoles y ofrece como ventajas: La posibilidad de cálculo automático, actualizado y sin ajustes, del percentil de peso. Disponibilidad de forma abierta. Y la posibilidad de registrar y exportar los resultados a cualquier base de datos, puntualmente, o para el seguimiento longitudinal del crecimiento fetal

OBJECTIVES: To construct a model for calculating optimal foetal and neonatal weight curves with a method that allows automatic calculation of the percentile and sequential recording of results. MATERIAL AND METHODS: A model was constructed for calculating optimal weight and the corresponding percentiles for gestational age and sex from a sample of 23,578 newborns, after excluding cases with diseases. Birth weight was modelled using stepwise multiple regression analysis. Newborns were classified as small or large for gestational age (SGA or LGA) using the proposed model. The resulting classification was compared with those derived from other models designed for Spanish children. RESULTS: Optimal weight model: 3,311.062 + 68.074 *sex + 143.267 *GE40 -13.481 *GE402 - 0.797*GE403 + sex* (5.528 *GE40 - 0.674 *GE402 - 0.064 *GE403). (GE, gestational age). Weight percentiles were obtained from standardized data using the coefficient of variation of the optimal weight. The degree of agreement between our model classification and those of the Carrascosa model and Ramos model, with empirical and smooth percentiles, was «almost perfect» κ = 0.866, κ = 0.872, and κ = 0.876 (P<0.001), respectively), and between our model and that proposed by Figueras it was «substantial» κ = 0.720, (P<0.001). CONCLUSIONS: The new model is comparable to those used for Spanish children and allows accurate, updated automatic percentile calculation for gestational age and sex. The results can be digitally stored to track longitudinal foetal growth. Free access to the model is offered, together with the possibility of automatic calculation of foetal and neonatal weight percentiles

Effect of pregestational diabetes mellitus on first trimester placental characteristics: three-dimensional placental volume and power Doppler indices.

OBJECTIVE: To investigate whether pregestational diabetes mellitus (DM) induces changes in vascular placental development detectable at first trimester. METHODS: This was a prospective case-control study in 69 women with pregestational DM and 94 controls undergoing first-trimester combined screening for aneuploidies. Maternal characteristics, fetal nuchal translucency thickness, maternal serum pregnancy-associated plasma protein A (PAPP-A) and free ß human chorionic gonadotrophin (ß-hCG) were evaluated. Three-dimensional ultrasound was used to measure placental volume and three dimensional power Doppler (3D-PD) placental vascular indices including: vascularization index (VI), flow index (FI) and vascularization flow index (VFI). Pregnancy-associated hypertensive complications (PAHC) and perinatal outcomes were analyzed. The total group of diabetic women and the group of diabetic women without PAHC were compared separately with the control group. RESULTS: 3D-PD placental vascular indexes were significantly lower in women with DM than in controls (VI p = 0.007, FI p = 0.003 and VFI p = 0.04). These differences remained on excluding cases with PAHC in the DM group. No differences were found in placental volumes between the DM group and controls. Serum PAPP-A levels were also lower in diabetic women (p < 0.02) and negatively correlated with the degree of maternal metabolic control at first trimester. CONCLUSIONS: Pregestational DM induces demonstrable alterations in first trimester placental development, with significantly reduced placental vascularization indices and PAPP-A values. This effect is independent of the later development of PAHC.

[Neurological disorders after cardiac surgery: Diagnosis of cerebral tumors in the postoperative period]. / Trastornos neurológicos en cirugía cardíaca: diagnóstico de tumoraciones cerebrales durante el postoperatorio.

The incidence of neurologic disorders in the postoperative period of cardiac surgery is high and usually due to a combination of pre- and intraoperative factors. We present 2 patients with brain tumors diagnosed in the immediate postoperative period after sudden onset of neurologic dysfunction. Image studies yielded clinically useful information in these 2 cases.

[Construction of model for calculating and recording neonatal weight percentiles]. / Construcción de un modelo de cálculo y registro del percentil de peso neonatal.

OBJECTIVES: To construct a model for calculating optimal foetal and neonatal weight curves with a method that allows automatic calculation of the percentile and sequential recording of results. MATERIAL AND METHODS: A model was constructed for calculating optimal weight and the corresponding percentiles for gestational age and sex from a sample of 23,578 newborns, after excluding cases with diseases. Birth weight was modelled using stepwise multiple regression analysis. Newborns were classified as small or large for gestational age (SGA or LGA) using the proposed model. The resulting classification was compared with those derived from other models designed for Spanish children. RESULTS: Optimal weight model: 3,311.062+68.074 *sex+143.267 *GE40 -13.481 *GE40(2) - 0.797 *GE40(3)+sex* (5.528 *GE40 - 0.674 *GE40(2) - 0.064 *GE40(3)). (GE, gestational age). Weight percentiles were obtained from standardized data using the coefficient of variation of the optimal weight. The degree of agreement between our model classification and those of the Carrascosa model and Ramos model, with empirical and smooth percentiles, was "almost perfect" (κ=0.866, κ=0.872, and κ=0.876 (P<.001), respectively), and between our model and that proposed by Figueras it was "substantial" (κ=0.720, P<.001). CONCLUSIONS: The new model is comparable to those used for Spanish children and allows accurate, updated automatic percentile calculation for gestational age and sex. The results can be digitally stored to track longitudinal foetal growth. Free access to the model is offered, together with the possibility of automatic calculation of foetal and neonatal weight percentiles.