Clinical Outcomes of a Monofocal, Optimized, Aspheric, Hydrophobic Acrylic Intraocular Lens Implant.

Purpose: To evaluate the refractive and visual outcomes of eyes implanted with monofocal, optimized, aspheric, hydrophobic acrylic intraocular lenses (IOL) following cataract surgery. Methods: The study assessed 55 eyes implanted with CT LUCIA® 621P IOLs (Carl Zeiss Meditec AG, Jena, Germany) at 3-months postsurgery. The main outcome measures were refractive error, monocular corrected distance visual acuity (CDVA), monocular uncorrected distance visual acuity (UDVA), photopic and mesopic contrast sensitivity, and wavefront aberrations. Patients were asked to complete the Catquest-9SF questionnaire. Results: At 3 months, the cumulative Snellen visual acuity was 20/20 in 94.55% of eyes and 20/25 or better in 100%. The difference between the UDVA and CDVA was either the same (70.91%) or better (29.09%) in all eyes. The mean Snellen decimal UDVA and DCVA were 1.07 ± 0.15 and 1.13 ± 0.11, respectively. The safety and efficacy indexes were 1.48 and 1.40, respectively. 47.27% of eyes showed a spherical equivalent ±0.13 D, with 92.73% of the eyes were within ±0.50 D and all eyes were within ±1.00 D. The mean spherical equivalent was -0.03 ± 0.30 D and the mean refractive cylinder -0.36 ± 0.34 D. The log photopic and mesopic contrast sensitivity functions were good and similar for all spatial frequencies. All patients reported being either fairly satisfied (score 3) or very satisfied (score 4) with their vision (mean = 3.64 ± 0.49). No intra- and postoperative complications were reported during the 3 months of follow-up. Conclusion: The current study demonstrates that excellent visual and refractive outcomes, as well as patient satisfaction, can be achieved after cataract surgery with optimized, aspheric CT LUCIA 621P monofocal IOLs.

Efficacy, safety and cost-effectiveness of methotrexate, adalimumab or their combination in non-infectious non-anterior uveitis: a protocol for a multicentre, randomised, parallel three arms, active-controlled, phase III open label with blinded outcome assessment study.

INTRODUCTION: Non-infectious uveitis include a heterogeneous group of sight-threatening and incapacitating conditions. Their correct management sometimes requires the use of immunosuppressive drugs (ISDs), prescribed in monotherapy or in combination. Several observational studies showed that the use of ISDs in combination could be more effective than and as safe as their use in monotherapy. However, a direct comparison between these two treatment strategies has not been carried out yet. METHODS AND ANALYSIS: The Combination THerapy with mEthotrexate and adalImumAb for uveitis (CoTHEIA) study is a phase III, multicentre, prospective, randomised, single-blinded with masked outcome assessment, parallel three arms with 1:1:1 allocation, active-controlled, superiority study design, comparing the efficacy, safety and cost-effectiveness of methotrexate, adalimumab or their combination in non-infectious non-anterior uveitis. We aim to recruit 192 subjects. The duration of the treatment and follow-up will last up to 52 weeks, plus 70 days follow-up with no treatment. The complete and maintained resolution of the ocular inflammation will be assessed by masked evaluators (primary outcome). In addition to other secondary measurements of efficacy (quality of life, visual acuity and costs) and safety, we will identify subjects' subgroups with different treatment responses by developing prediction models based on machine learning techniques using genetic and proteomic biomarkers. ETHICS AND DISSEMINATION: The protocol, annexes and informed consent forms were approved by the Reference Clinical Research Ethic Committee at the Hospital Clínico San Carlos (Madrid, Spain) and the Spanish Agency for Medicines and Health Products. We will elaborate a dissemination plan including production of materials adapted to several formats to communicate the clinical trial progress and findings to a broad group of stakeholders. The promoter will be the only access to the participant-level data, although it can be shared within the legal situation. TRIAL REGISTRATION NUMBER: 2020-000130-18; NCT04798755.

Design and Application of Automated Algorithms for Diagnosis and Treatment Optimization in Neurodegenerative Diseases.

Neurodegenerative diseases represent a growing healthcare problem, mainly related to an aging population worldwide and thus their increasing prevalence. In particular, Alzheimer's disease (AD) and Parkinson's disease (PD) are leading neurodegenerative diseases. To aid their diagnosis and optimize treatment, we have developed a classification algorithm for AD to manipulate magnetic resonance images (MRI) stored in a large database of patients, containing 1,200 images. The algorithm can predict whether a patient is healthy, has mild cognitive impairment, or already has AD. We then applied this classification algorithm to therapeutic outcomes in PD after treatment with deep brain stimulation (DBS), to assess which stereotactic variables were the most important to consider when performing surgery in this indication. Here, we describe the stereotactic system used for DBS procedures, and compare different planning methods with the gold standard normally used (i.e., neurophysiological coordinates recorded intraoperatively). We used information collected from database of 72 DBS electrodes implanted in PD patients, and assessed the potentially most beneficial ranges of deviation within planning and neurophysiological coordinates from the operating room, to provide neurosurgeons with additional landmarks that may help to optimize outcomes: we observed that x coordinate deviation within CT scan and gold standard intra-operative neurophysiological coordinates is a robust matric to pre-assess positive therapy outcomes- "good therapy" prediction if deviation is higher than 2.5 mm. When being less than 2.5 mm, adding directly calculated variables deviation (on Y and Z axis) would lead to specific assessment of "very good therapy".

Extracorporeal membrane oxygenation in Jehovah's Witness patients: Case report, literature review, and summary of recommendations.

Extracorporeal Membrane Oxygenation (ECMO) is commonly associated with a high blood transfusion requirement. Jehovah's Witness patients present a particular challenge. The impossibility of transfusing blood cells and starting anticoagulation treatment are common contraindications for this supportive measure. Here we report the case of a Jehovah's Witness patient with refractory hypoxemia due to influenza A H1N1 pneumonia who required venovenous ECMO for 11 days. We describe the use of a bloodless approach to reduce the waste of blood, avoiding anticoagulation, and improving red blood cell production. We then summarize the current literature on the use of ECMO in Jehovah's Witness patients and, finally, we propose some recommendations for their management.

Functionality of beta-adrenergic receptors in patients with cirrhosis treated chronically with non-selective beta-blockers.

BACKGROUND: In patients with cirrhosis, beta-adrenoceptors expressed on peripheral blood mononuclear cells have a reduced response to catecholamine stimulation. This study aimed to determine if chronic treatment with beta-blockers influences these changes. METHODS: Blood samples were collected from patients with cirrhosis treated in outpatient clinics. Differences in cyclic AMP production before and after stimulation of mononuclear cells with epinephrine and/or N-Formylmethionine-leucyl-phenylalanine (fMLP) was used as a marker of beta-adrenoceptors activity in patients treated (N = 19) versus not treated (N = 55) with beta-blockers. In addition, we studied the gene expression of different types of adrenoceptors and possible associations with the activity of beta-adrenoceptors, the serum concentrations of catecholamines and cytokines, and the presence of bacterial antigens such as DNA or gram-negative bacterial endotoxin in patients' blood. RESULTS: The increase in intracellular cAMP concentrations after stimulation of adrenergic receptors with epinephrine was significantly higher in samples from patients treated with beta-blockers. Older patients showed lower responses to epinephrine stimulus, while the response increased linearly with the duration of the beta-blocker treatment. mRNA expression levels of adrenoceptors ß1, ß2, ß3 and α1-A, B and D showed no significant differences according to treatment with beta-blockers. Neither serum cytokines nor catecholamines levels were significantly associated with the intracellular production of cAMP after adrenergic stimulation. CONCLUSION: Chronic treatment with beta-blockers in patients with cirrhosis enables beta-adrenoceptors to respond to catecholamine stimulation irrespective of the degree of systemic adrenergic or immune activations of the patient at the time of sampling.

Association between periodontitis and anti-citrullinated protein antibodies in rheumatoid arthritis patients: a cross-sectional study.

AIM: The aim of this study was to evaluate the association between periodontal parameters related with the periodontal disease severity and the presence and levels of anti-citrullinated protein antibodies (ACPAs) in rheumatoid arthritis (RA) patients. MATERIALS AND METHODS: This cross-sectional study included 164 RA patients. Socio-demographics and RA disease characteristics, including ELISA-detected ACPA (anti-CCP-2), were recorded. Exposure was assessed by periodontal parameters: plaque index (PI), bleeding on probing (BoP), probing pocket depth, and clinical attachment levels (CAL). Presence and levels of ACPAs (outcome) and exposure variables were compared by both parametric and non-parametric tests and associations were evaluated by adjusted odds ratio (OR). RESULTS: A significant association was observed between the presence of anti-CCP antibodies and severity of periodontal outcomes such as the mean CAL (OR 1.483, p = 0.036), mean PI (OR 1.029, p = 0.012), and the number of pockets ≥ 5 mm (OR 1.021, p = 0.08). High anti-CCP antibodies levels were associated with mean CAL, mean PI, and number of pockets ≥ 5 mm with an OR of 1.593 (p = 0.043), 1.060 (p <  0.001), and 1.031 (p = 0.031), respectively. Furthermore, a significant increase of 4.45 U/mL in anti-CCP antibodies levels (p = 0.002) in RA patients was found for each pocket ≥ 5 mm after adjusting for age, gender, smoking, time of disease evolution, and RA activity. CONCLUSIONS: In RA patients, the severity of periodontal conditions such as mean CAL, mean PI, and the number of pockets ≥ 5 mm were linearly associated with both the presence and levels of anti-CCP antibodies.

Las esferas ocultas del síndrome de ovario poliquístico / The hidden faces of Polycystic Ovary Syndrome

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Association between severity of periodontitis and clinical activity in rheumatoid arthritis patients: a case-control study.

BACKGROUND: A high prevalence of periodontitis has been reported in rheumatoid arthritis (RA) patients, although the strength of this association, its temporal link and the possible relationship between the severity of periodontitis and RA disease activity remain unclear. The objective of this work was to investigate whether periodontitis is associated with RA and whether periodontitis severity is linked to RA disease activity. METHODS: This case-control study included 187 patients diagnosed with RA and 157 control patients without inflammatory joint disease. RA disease activity and severity were evaluated by the Disease Activity Score 28, the Simplified Disease Activity Index, the Clinical Disease Activity Index, rheumatoid factor, anti-citrullinated protein antibody titers, the erythrocyte sedimentation rate, C-reactive protein, presence of extra-articular manifestations and type of RA therapy. Exposure severity was assessed by the following periodontal parameters: plaque index, bleeding on probing, probing pocket depth and clinical attachment levels. Sociodemographic variables and comorbidities were evaluated as confounding variables. Outcome and exposure variables were compared by both parametric and nonparametric tests, and possible associations were assessed through regression analysis with a calculation for the adjusted odds ratio (OR). RESULTS: A significant association was demonstrated between periodontitis and RA with an adjusted OR of 20.57 (95% CI 6.02-70.27, p < 0.001). Compared with controls, all parameters related to periodontal status (plaque index, bleeding on probing, probing pocket depth and clinical attachment levels) were significantly worse in RA patients (p < 0.001). Periodontitis severity was significantly associated with RA disease activity (p < 0.001), showing in an ordinal logistic regression model an association between periodontal severity and disease activity with an adjusted OR of 2.66 (95% CI 1.24-5.74, p = 0.012). CONCLUSION: A significant association was demonstrated between periodontitis and RA, independent of other confounders. This association was more evident in patients with pronounced periodontal disease and higher RA disease activity.

Long-Term Results of Deep Brain Stimulation of the Mamillotegmental Fasciculus in Chronic Cluster Headache.

BACKGROUND: Deep brain stimulation (DBS) and the proper target for chronic cluster headache (CCH) are still subjects of controversy. OBJECTIVES: We present our long-term results of analysis of the target and its structural connectivity. METHODS: Fifteen patients with drug-resistant CCH underwent DBS in coordinates 4 mm lateral to the III ventricular wall and 2 mm behind and 5 mm below the intercommissural point. The clinical parameters recorded were the number of weekly attacks, pain intensity, and duration of the headache. Structural connectivity was studied using 3-T MR diffusion tensor imaging (DTI). RESULTS: All of our patients improved from a mean of 39 attacks/week to 2; pain intensity decreased from 9 to 3 out of 10, and the mean cephalalgia duration decreased from 53 to 8 min. The mean stereotactic coordinates of the effective contact location were 6.1 mm lateral to the midcommissural point and 1.2 mm behind and 4.0 mm below the intercommissural point. DTI analysis showed that this target was connected to tracts and nuclei of the posterior mesencephalic tegmentum, specifically the dorsal longitudinal and mamillotegmental fasciculi. CONCLUSIONS: Our data showed DBS to be a safe and useful procedure for the treatment of drug-resistant CCH; the rate of improvement was higher than those found in other series. Although these are promising results, larger series targeting those fasciculi with a longer follow-up are needed.

Meaning in Life and Psychological Weil-Being in Spanish Emerging Adults / Sentido de vida e bem-estar psicológico em adultos emergentes espanhóis / Sentido de vida y bienestar psicológico en adultos emergentes españoles

Abstract Experiencing meaning in life (MiL) and psychological well-being (PWB) is an important developmental task in emerging adulthood, perhaps more than in any other period in life due to its transitional character and to the nature of its features, in Western societies. This study analyzes the relationship between MiL and PWB, as well as the differences in PWB according to the level of MiL (lack of meaning, indefinite meaning, and presence of meaning), in a sample of 333 Spanish emerging adults (224 women, 109 men), age ranged from 17 to 26 years, M = 21.06, SD = 2.23. Both Spanish versions of the Purpose-In-Life Test and the Ryff's Scales of Psychological Well-Being were used. The Spearman's coefficient of correlation showed a positive, significant relationship between MiL and PWB (global and dimensions). The Kruskal-Wallis test showed significant differences in PWB between lack of meaning, indefinite meaning, and presence of meaning groups, except in Autonomy, in which only the difference between the presence of meaning group and the indefinite meaning group was significant. MiL is associated to the cognitive, emotional, and motivational aspects that directly point to PWB: positive self-worth and self-acceptance, perception and experience of freedom, responsibility and self-determination, positive view of both life as a whole and future, purpose and commitment of significant existential goals, self-trascendence and opening up to the others, integrative but not resigned coping of the adversity, life satisfaction, and self-realization.

Resumo Sentir que a vida tem sentido e experimentar bem-estar psicológico são uma importante tarefa evolutiva na idade adulta emergente, talvez mais que em qualquer outra etapa evolutiva, devido a seu caráter transicional e a suas características nas sociedades ocidentais. Neste estudo, analisam-se as relações entre sentido de vida e bem-estar psicológico, bem como as diferenças em bem-estar psicológico em função do nível de sentido de vida (vazio existencial, indefinição de sentido e experiência de sentido) numa amostra de 333 adultos emergentes espanhóis (224 mulheres e 109 homens) com idade entre 17 e 26 anos (M=21.06, DT=2.23). Como instrumentos, foram utilizadas versões espanholas do teste Purpose-In-Life e das Escalas de Bem-estar Psicológico de Ryff. Como resultado, o coeficiente de correlação de Spearman mostrou uma relação positiva e significativa entre sentido de vida e bem-estar psicológico (global e dimensões), enquanto o teste de Kruskal-Wallis mostrou diferenças significativas em bem-estar psicológico entre os grupos de vazio existencial, indefinição de sentido e experiência de sentido, exceto na dimensão de Autonomia, na qual somente foi significativa a diferença entre experiência de sentido e indefinição de sentido. O sentido de vida se relacionou com os aspectos cognitivos, emocionais e motivacionais que apontam diretamente ao bem-estar subjetivo, isto é: autovalorização positiva e autoaceitação, percepção e experiência de liberdade, responsabilidade e autodeterminação, visão positiva da vida como um todo e do futuro, propósito e compromisso com metas existenciais importantes, autotranscedência e abertura aos demais, enfrentamento integrador, mas não resignado, da adversidade, satisfação vital e autorrealização.

Resumen Sentir que la vida tiene sentido y experimentar bienestar psicológico son una importante tarea evolutiva en la adultez emergente, quizá más que en cualquier otra etapa evolutiva, debido a su carácter transicional y a sus características en las sociedades occidentales. En este estudio se analizan las relaciones entre sentido de la vida y bienestar psicológico, así como las diferencias en bienestar psicológico en función del nivel de sentido de vida (vacío existencial, indefinición de sentido y experiencia de sentido) en una muestra de 333 adultos emergentes españoles (224 mujeres y 109 hombres) con edades entre 17 y 26 años, M = 21.06, DT = 2.23. Como instrumentos, se utilizaron versiones españolas del test Purpose-In-Life y de las Escalas de Bienestar Psicológico de Ryff. Como resultado, el coeficiente de correlación de Spearman mostró una relación positiva y significativa entre sentido de vida y bienestar psicológico (global y dimensiones), mientras que el test de Kruskal-Wallis mostró diferencias significativas en bienestar psicológico entre los grupos de vacío existencial, indefinición de sentido y experiencia de sentido, excepto en la dimensión de Autonomía, en la cual solo fue significativa la diferencia entre experiencia de sentido e indefinición de sentido. El sentido de vida se relacionó con los aspectos cognitivos, emocionales y motivacionales que apuntan directamente al bienestar subjetivo, es decir: autovaloración positiva y autoaceptación, percepción y experiencia de libertad, responsabilidad y autodeterminación, visión positiva de la vida como un todo y del futuro, propósito y compromiso con metas existenciales importantes, autotrascendencia y apertura a los demás, afrontamiento integrativo pero no resignado de la adversidad, y satisfacción vital y autorrealización.

Undifferentiated connective tissue disease: predictors of evolution into definite disease.

OBJECTIVES: The natural evolution of undifferentiated connective tissue diseases (UCTD) has not yet been established. The aim of our study was to analyse the clinical outcomes of a cohort of UCTD patients followed in a routine outpatient setting and to establish which clinical, serological or capillaroscopy features are associated with an increased risk of evolution to definite connective tissue disease (CTD). METHODS: Data for this study were collected by a retrospective review of 758 patients referred to our hospital, between 1999 and 2008, with suspected CTD. After selection criteria, 98 patients were considered eligible and their records, laboratory findings and nailfold-capillaroscopy pattern (NCP) were analysed until clinical outcome. Three groups of patient outcomes were established: remission, UCTD, and definite CTD. Logistic regression analysis was performed to study the association of baseline clinical features, including NCP progression during monitoring, with clinical outcomes. RESULTS: After a mean follow-up of 11±3 years, 62% of the patients continued to suffer from UCTD, 24% regressed to a remission state and 14% developed definite CTD. Cytopenias (p=0.030), positivity for antibody specificities (ENA) (p=0.008), anti-Ro (p=0.036) and antiphospholipid antibodies (p=0.032), and the presence of an altered NCP (p=0.026) at baseline proved different between groups and were more frequently encountered in the group that evolved to definite CTD when compared with the others two groups. Specifically, cytopenias (odds ratio -OR- 4.20 [1.30-13.56] p=0.016), the presence of an antinuclear antibody (ANA) titre ≥1/640 (OR 7.00 [1.99-24.66], p=0.002) and anti-centromere positivity (OR 3.77 [1.03-13.79], p=0.045) at baseline and NCP progression (OR 6.63 [1.70-25.87], p=0.007) were associated with the future presence of definite CTD. CONCLUSIONS: Most patients with UCTD remain in an undifferentiated state after routine outpatient clinic follow-up. High ANA titres or the presence of cytopenias at baseline, as well as progression of NCP during follow-up, are the leading factors associated with evolution to definite CTD.

Isolated Ro52 Antibodies as Immunological Marker of a Mild Phenotype of Undifferentiated Connective Tissue Diseases.

The term undifferentiated connective tissue disease (UCTD) is used to describe undiagnosed patients that do not fulfill classification criteria for definite connective tissue disease (Systemic Lupus, Systemic Sclerosis, Sjögren Syndrome, and Dermatomyositis/Polymyositis). It is important to find serological markers as predictors of the evolution or severity of these diseases. The objective of this retrospective study was to investigate if there was a milder subgroup of UCTD with a special clinical profile consisting only in the presence of anti-Ro52 autoantibodies. Immunological and clinical records of 62 patients attending the hospital during 30 months were studied. Results showed a target population formed by mostly women, aged between 40 and 80 years at the moment of the study, with a registered age of onset between 40 and 60 years. Speckled pattern was the most frequent pattern found by indirect immunofluorescence. Given the obtained results and keeping in mind possible limitations because of sample size, isolated positive anti-Ro52 autoantibodies seem to lead to a benign effect in terms of evolution of the disease. As a future objective, the follow-up of these patients should be necessary to investigate new clinical symptoms, serological markers, or development of a definite connective tissue disease over time.

Comorbidities in Patients With Primary Sjögren's Syndrome and Systemic Lupus Erythematosus: A Comparative Registries-Based Study.

OBJECTIVE: To compare the prevalence of the main comorbidities in 2 large cohorts of patients with primary Sjögren's syndrome (SS) and systemic lupus erythematosus (SLE), with a focus on cardiovascular (CV) diseases. METHODS: This was a cross-sectional multicenter study where the prevalence of more relevant comorbidities in 2 cohorts was compared. Patients under followup from SJOGRENSER (Spanish Rheumatology Society Registry of Primary SS) and RELESSER (Spanish Rheumatology Society Registry of SLE), and who fulfilled the 2002 American-European Consensus Group and 1997 American College of Rheumatology classification criteria, respectively, were included. A binomial logistic regression analysis was carried out to explore potential differences, making general adjustments for age, sex, and disease duration and specific adjustments for each variable, including CV risk factors and treatments, when appropriate. RESULTS: A total of 437 primary SS patients (95% female) and 2,926 SLE patients (89% female) were included. The mean age was 58.6 years (interquartile range [IQR] 50.0-69.9 years) for primary SS patients and 45.1 years (IQR 36.4-56.3 years) for SLE patients (P < 0.001), and disease duration was 10.4 years (IQR 6.0-16.7 years) and 13.0 years (IQR 7.45-19.76 years), respectively (P < 0.001). Smoking, dyslipidemia, and arterial hypertension were associated less frequently with primary SS (odds ratio [OR] 0.36 [95% confidence interval (95% CI) 0.28-0.48], 0.74 [95% CI 0.58-0.94], and 0.50 [95% CI 0.38-0.66], respectively) as were life-threatening CV events (i.e., stroke or myocardial infarction; OR 0.57 [95% CI 0.35-0.92]). Conversely, lymphoma was associated more frequently with primary SS (OR 4.41 [95% CI 1.35-14.43]). The prevalence of severe infection was lower in primary SS than in SLE (10.1% versus 16.9%; OR 0.54 [95% CI 0.39-0.76]; P < 0.001). CONCLUSION: Primary SS patients have a consistently less serious CV comorbidity burden and a lower prevalence of severe infection than those with SLE. In contrast, their risk of lymphoma is greater.

Multiple-source current steering in subthalamic nucleus deep brain stimulation for Parkinson's disease (the VANTAGE study): a non-randomised, prospective, multicentre, open-label study.

BACKGROUND: High-frequency deep brain stimulation (DBS) with a single electrical source is effective for motor symptom relief in patients with Parkinson's disease. We postulated that a multiple-source, constant-current device that permits well defined distribution of current would lead to motor improvement in patients with Parkinson's disease. METHODS: We did a prospective, multicentre, non-randomised, open-label intervention study of an implantable DBS device (the VANTAGE study) at six specialist DBS centres at universities in six European countries. Patients were judged eligible if they were aged 21-75 years, had been diagnosed with bilateral idiopathic Parkinson's disease with motor symptoms for more than 5 years, had a Hoehn and Yahr score of 2 or greater, and had a Unified Parkinson's disease rating scale part III (UPDRS III) score in the medication-off state of more than 30, which improved by 33% or more after a levodopa challenge. Participants underwent bilateral implantation in the subthalamic nucleus of a multiple-source, constant-current, eight-contact, rechargeable DBS system, and were assessed 12, 26, and 52 weeks after implantation. The primary endpoint was the mean change in UPDRS III scores (assessed by site investigators who were aware of the treatment assignment) from baseline (medication-off state) to 26 weeks after first lead implantation (stimulation-on, medication-off state). This study is registered with ClinicalTrials.gov, number NCT01221948. FINDINGS: Of 53 patients enrolled in the study, 40 received a bilateral implant in the subthalamic nucleus and their data contributed to the primary endpoint analysis. Improvement was noted in the UPDRS III motor score 6 months after first lead implantation (mean 13·5 [SD 6·8], 95% CI 11·3-15·7) compared with baseline (37·4 [8·9], 34·5-40·2), with a mean difference of 23·8 (SD 10·6; 95% CI 20·3-27·3; p<0·0001). One patient died of pneumonia 24 weeks after implantation, which was judged to be unrelated to the procedure. 125 adverse events were reported, the most frequent of which were dystonia, speech disorder, and apathy. 18 serious adverse events were recorded, three of which were attributed to the device or procedure (one case each of infection, migration, and respiratory depression). All serious adverse events resolved without residual effects and stimulation remained on during the study. INTERPRETATION: The multiple-source, constant-current, eight-contact DBS system suppressed motor symptoms effectively in patients with Parkinson's disease, with an acceptable safety profile. Future trials are needed to investigate systematically the potential benefits of this system on postoperative outcome and its side-effects. FUNDING: Boston Scientific.

Lesiones cutáneas nodulares en paciente con artritis reumatoide en tratamiento con anti-factor de necrosis tumoral / Nodular skin lesions in a patient with rheumatoid arthritis under therapy with anti-tumor necrosis factor

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Predictive role of meaning in life on psychological well-being and gender-specific differences / Rol predictivo del sentido de la vida sobre el bienestar psicológico y diferencias de género / Papel preditivo do sentido da vida sobre o bem-estar psicológico e diferenças de gênero

This study examines the predictive role of meaning in life and gender-specific differences on psychological well-being of 226 Spanish undergraduates (87 men, 38.5%; 139 women, 61.5%) ranging in age from 17 to 25 years, M = 21.08, SD = 2.18. Measures included both the Spanish adaptations of the Crumbaugh and Maholic's Purpose-In -Life Test and the Ryff's Scales of Psychological Well-Being. The hypothesis stated that meaning in life would predict psychological well-being and that women would reach a higher score in several dimensions of psychological well-being. Statistical analysis included simple linear regressions, and a t-test. Results showed that: (1) meaning in life was a significant predictor variable of psychological well-being, especially of global psychological well-being, self-acceptance, purpose in life, and environmental mastery; and (2) women reached a higher score, statistically significant, in global psychological well-being, environmental mastery, personal growth and purpose in life. Findings were discussed in the light of previous researches.

Se examinaron el papel predictivo del Sentido de la Vida y las diferencias en función del género en el Bienestar Psicológico en un grupo de 226 estudiantes universitarios españoles (87 hombres, 38.5%; 139 mujeres, 61.5%), con edades entre los 17 y los 25 años, M = 21.08, DT = 2.18. Se usaron adaptaciones españolas del Purpose-In-Life Test de Crumbaugh y Maholic y de las Escalas de Bienestar Psicológico de Ryff. Las hipótesis a contrastar fueron que de manera significativa el Sentido de la Vida predeciría el Bienestar Psicológico y que las mujeres alcanzarían puntuaciones más altas en algunas dimensiones del mismo. Los análisis estadísticos incluyeron regresiones lineales simples y la prueba t para muestras independientes. Los resultados mostraron que: (1) El Sentido de la Vida predijo significativamente el Bienestar Psicológico, especialmente el Bienestar Psicológico global, la Autoaceptación, el Propósito en la Vida y el Dominio del Entorno, y (2) las mujeres alcanzaron puntuaciones significativamente superiores en Bienestar Psicológico global, Dominio del Entorno, Crecimiento Personal y Propósito en la Vida. Estos resultados fueron discutidos a la luz de la investigación precedente.

Examinou-se o papel preditivo do Sentido da Vida e as diferenças em função do gênero no Bem-estar Psicológico em um grupo de 226 estudantes universitários espanhóis (87 homens, 38.5%; 139 mulheres, 61.5%), com idade entre 17 e 25 anos, M = 21.08, DT = 2.18. Foram usadas adaptações espanholas do Purpose-In-Life Test de Crumbaugh e Maholic e das Escalas de Bem-estar Psicológico de Ryff. As hipóteses a contrastar foram que de maneira significativa o Sentido da Vida prediria o Bem-estar Psicológico e que as mulheres alcançariam pontuações mais altas em algumas dimensões do mesmo. As análises estatísticas incluíram lineais simples e o teste t para mostras independentes. Os resultados mostraram que: (1) O Sentido da Vida predisse significativamente o Bem-estar Psicológico, especialmente o Bem-estar Psicológico global, a Autoaceitação, o Propósito na Vida e o Domínio do Entorno, e (2) as mulheres alcançaram pontuações significativamente superiores em Bem-estar Psicológico global, Domínio do Entorno, Crescimento Pessoal e Propósito na Vida. Estes resultados foram discutidos à luz da pesquisa precedente.

Orientación religiosa y sentido de la vida / Religious Orientation and Meaning in Life

Se analizan las relaciones entre la orientación religiosa y el Sentido de la Vida en una muestra de 180 universitarios españoles (rango de edad 1855, Μ = 22.91, DE = 6.71), medidos a través de versiones españolas de la Religious Orientation Scale y del Purpose-in-Life Test, respectivamente. De ser cierta la concepción de Batson y Ventis de que la orientación de Búsqueda es madura y flexible, mientras que la Intrínseca es dogmática y acrítica, debería ser aquella la que se relacionara de manera más positiva con el Sentido de la Vida. Contrariamente a esto, los resultados confirman lo obtenido en investigaciones anteriores, siendo la orientación Intrínseca la que explica el mayor porcentaje de la varianza de Sentido de la Vida. Esto cuestiona el planteamiento de Batson y Ventis, y plantea la posibilidad de que las convicciones religiosas intrínsecas sean una fuente de sentido.

This paper analyzes the relationship between religious orientation and Meaning in Life, in a sample of 180 Spanish undergraduates (age range 18-55, Μ = 22.91, SD = 6.71), measured by means of both Spanish versions of the Religious Orientation Scale and the Purpose-In-Life Test, respectively. The starting point is the Batson and Ventis' conception that the Quest orientation is mature and flexible, but the Intrinsic orientation is dogmatic and uncritical. If it is so, the Quest orientation should be related more positively to meaning in life. Our results indicate that the Intrinsic orientation, but not Quest, explains a higher percentage of the variance of the Meaning in Life, confirming the results obtained in previous research. Batson and Ventis' approach is questioned, and it raises the possibility that intrinsic religious convictions are a source of meaning.

Análisis factorial confirmatorio de los principales modelos propuestos para el Purpose-In-Life Test en una muestra de universitarios españoles / Confirmatory factor analysis of the main models proposed for the Purpose-In-Life Test in a sample of Spanish undergraduates / Análise fatorial confirmatório dos principais modelos propostos para o Purpose-In-Life Test em uma mostra de universitários espanhóis

En los últimos años varios trabajos han analizado la estructura factorial del Purpose-In-Life Test, instrumento que mide el logro de sentido de la vida desde los planteamientos de la logoterapia, con resultados muy heterogéneos. El objetivo del presente trabajo consistió en poner a prueba distintos modelos propuestos en la literatura anterior, con una muestra de 766 alumnos de dos universidades de la Comunidad Valenciana (España), de los que 220 son hombres y 546 son mujeres, con edades comprendidas entre los 18 y los 36 años (M = 21.96; DT = 3.56). Se realizaron análisis factoriales confirmatorios de dichos modelos y se compararon los valores de ajuste y las estructuras factoriales obtenidas, encontrando apoyo empírico para tres modelos bifactoriales.

In recent years several papers have examined the structure of the Purpose-In-Life Test, which measures the achievement of meaning in life from the approach of logotherapy, having found heterogeneous results. The aim of this study was to test different models proposed in previous literature with a sample of 766 Spanish undergraduates (220 males, 546 females) from two universities of the Valencia Community (Spain), aged between 18 and 36 (M = 21.96; SD = 3.56). Confirmatory factor analysis of these models was conducted. The adjustment values and the factorial structures obtained were compared, finding empirical support for three bi-factorial models.

Nos últimos anos vários trabalhos analisaram a estrutura fatorial do Purpose-In-Life Test, instrumento que mede o sucesso do sentido da vida desde as propostas da logoterapia, havendo sido obtidos resultados muito heterogêneos. O objetivo do presente trabalho consistiu em testar diferentes modelos propostos na literatura anterior, com uma mostra de 766 alunos de duas universidades da Comunidade Valenciana (Espanha), dos quais 220 são homens e 546 são mulheres, com idades compreendidas entre 18 e 36 anos (M = 21.96; DT = 3.56). Realizaram-se análises fatoriais confirmatórias desses modelos e foram comparados os valores de ajuste e as estruturas fatoriais obtidas, encontrando apoio empírico para três modelos bifatoriais.

Diferencias asociadas al sexo en las puntuaciones total y factoriales del Purpose-In-Life Test en universitarios españoles / Sex differences on Purpose-In-Life Test total and factorial scores among spanish undergraduates

Se analizan las diferencias en las puntuaciones total y factoriales de la versión española del Purpose-In-Life Test [PIL] (Crumbaugh & Maholic, 1969; Noblejas de la Flor, 1994) asociadas al sexo, en un grupo de 309 estudiantes universitarios (207 mujeres y 102 hombres) de edades comprendidas entre 18 y 45 años. El PIL evalúa logro de sentido de la vida vs. vacío existencial. Las mujeres obtienen puntuaciones medias superiores a los hombres, tanto en la puntuación total del PIL como en sus diferentes factores. El análisis estadístico muestra que el sexo da lugar a diferencias estadísticamente significativas en la puntuación total y en los factores Percepción de sentido y Metas y tareas del PIL.

The aim of this paper is to analyze the differences on Purpose-In-Life Test [PIL] (Crumbaugh & Maholic, 1969) total and factorial scores associated to sex, among 309 spanish undergratudates (207 women, 102 men), range 18 to 45 years. PIL Spanish version is used (Noblejas de la Flor, 1994). PIL evalues life meaning achievement vs. existential vacuum. Women achieve higher means on PIL total and factorial scores, and estatistical analysis show that sex is significantly associated to total PIL score and on Purpose perception and Goals and tasks factors scores.