Association between myasthenia gravis and Alzheimer's disease. / Miastenia gravis y enfermedad de Alzheimer: una asociación a estudio.

INTRODUCTION: Myasthenia gravis (MG) and Alzheimer's disease (AD) are two of the most important diseases where the dysregulation of acetylcholine activity plays a crucial role. In the first, this dysregulation happens at the level of the neu-romuscular junction and in the second, in the central nervous system (CNS). AIM: To analyze the possible relationship between these two pathologies, analyzing the prevalence and the odds ratio of AD within patients previously diagnosed with MG. We will compare these data with respect to the prevalence of AD in the general population. PATIENTS AND METHODS: We examined the data obtained by the electronic medical records of patients in the health care system of Castilla La Mancha using the Natural Language Process provided by a clinical platform of artificial intelligence known as the Savana Manager?. RESULTS: We identified 970,503 patients over the age of 60 years, of which 1,028 were diagnosed with MG. The proportion of the patients diagnosed with AD within this group (4.28%) was greater than the rest of the population (2.82%) (p = 0,0047) with an odds ratio of 1.54 (confidence interval at 95% 1.13-2.08; p = 0.0051) without finding significant differences in the bivariate analysis for the rest of the most important actual known risk factors for AD. CONCLUSION: Our results suggest that there might be an increase in the prevalence of AD in patients previously diagnosed with MG.

TITLE: Miastenia gravis y enfermedad de Alzheimer: una asociación a estudio.Introducción. La miastenia gravis (MG) y la enfermedad de Alzheimer (EA) son dos de las enfermedades neurológicas en cuya fisiopatología interviene la acetilcolina en distintos niveles. En la primera, la alteración de este neurotransmisor se produce en la unión neuromuscular, y en la segunda, en el sistema nervioso central. Objetivo. Analizar la posible relación entre dichas patologías estudiando la prevalencia y la odds ratio de la EA dentro de los pacientes diagnosticados de MG con respecto a la prevalencia de EA en la población general. Pacientes y métodos. Se han examinado datos de las historias clínicas electrónicas del sistema de salud de Castilla-La Mancha utilizando el procesamiento de lenguaje natural a través de la plataforma clínica de inteligencia artificial Savana Manager?. Resultados. Se ha identificado a 970.503 pacientes mayores de 60 años, de los que 1.028 tenían diagnóstico de MG. La proporción de pacientes con diagnóstico de EA dentro de este grupo (4,28%) es mayor que en el resto de la población (2,82%; p = 0,0047), con una odds ratio de 1,54 (intervalo de confianza al 95%: 1,13-2,08; p = 0,0051), sin que se encuentren diferencias significativas en el análisis bivariante del resto de los factores de riesgo para EA más importantes conocidos hasta ahora. Conclusiones. Nuestros resultados sugieren que podría existir un aumento de la prevalencia de EA en pacientes con MG.

Ageing kinetics of fern chlorophyllous spores during dry storage is determined by its antioxidant potential and likely induced by photosynthetic machinery.

Ageing in dry chlorophyllous propagules is leaded by photooxidation through the photosynthetic machinery, but why species differ in longevity and the ageing mechanisms of when light and oxygen are absent are unknown. We hypothesize that the cellular antioxidant capacity is key for the inter- and intra-specific differences in the ageing process. We have tested this hypothesis in chlorophyllous spores of two ferns. They were subjected to four different storage regimes resulting from light/dark and normoxia/hypoxia combinations. Lipophilic and hydrophilic antioxidants, reactive oxygen species (ROS), and photosynthetic pigments were analysed in parallel to germination and the recovery of Fv/Fm over a storage period of up to 22-months. We show that light and oxygen accelerate the ageing process, but their mechanisms (ROS, increase, antioxidant capacity decrease, loss of efficiency of the photosystem II, pigment degradation) appear the same under all conditions tested. The end of the asymptomatic phase of longevity, when a sudden drop of germination occurs, seems to be determined by a threshold in the depletion of antioxidants. Our results support the hypothesis that ageing kinetics in dry plant propagules is determined by the antioxidant system, but also suggests an active role of the photosynthetic machinery during ageing, even in darkness and hypoxia.

Linear Interval Approximation of Sensor Characteristics with Inflection Points.

The popularity of smart sensors and the Internet of Things (IoT) is growing in various fields and applications. Both collect and transfer data to networks. However, due to limited resources, deploying IoT in real-world applications can be challenging. Most of the algorithmic solutions proposed so far to address these challenges were based on linear interval approximations and were developed for resource-constrained microcontroller architectures, i.e., they need buffering of the sensor data and either have a runtime dependency on the segment length or require the sensor inverse response to be analytically known in advance. Our present work proposed a new algorithm for the piecewise-linear approximation of differentiable sensor characteristics with varying algebraic curvature, maintaining the low fixed computational complexity as well as reduced memory requirements, as demonstrated in a test concerning the linearization of the inverse sensor characteristic of type K thermocouple. As before, our error-minimization approach solved the two problems of finding the inverse sensor characteristic and its linearization simultaneously while minimizing the number of points needed to support the characteristic.

[Potential teratogenicity of modafinil - Conflicting evidence, need for research]. / Tératogénicité potentielle du modafinil ­ des données contradictoires, un besoin de recherche.

Central disorders of hypersomnolence include narcolepsy type 1, narcolepsy type 2, idiopathic hypersomnia and hypersomnia associated with medical or mental disorders. Treatment is both non-pharmacological and pharmacological, including wake enhancing drugs and stimulants. One of the first-line treatment (modafinil, MODIODAL®) was the subject of a health authority alert in 2019 concerning a risk of major congenital malformations when taken during organogenesis. Since this date, three epidemiological studies have presented contradictory results. Given their methodological weaknesses, it is not possible at this stage to confirm or deny such a risk for the embryo and its nature if there is one. In clinical practice, because of these uncertainties, it is preferable if possible to suspend the treatment of a pregnant woman during the first 10 weeks from last menstrual period (organogenesis). There is an unmet clinical need for research to clarify the potential teratogenic impact of modafinil.

Analysis of Polarization Images in the Microphysical Blood Parameters Research for the Hematocrit Diagnostics.

The development of non-invasive optoelectronic technologies for human blood monitoring is one of the important research areas for medicine. A critical analysis of optoelectronic methods of blood research and the micromechanical systems based on them is carried out in this article. A design realization of a polarizing portable system for non-invasive monitoring of hematocrit as one of the basic homeostatic constants of the human body containing information about the microphysical parameters of blood cells has been substantiated. A physical model of polarized radiation conversion in a video information system of laser sensing of a biological research object has been formed. Visual and quantitative differences in the spatial distribution of polarization parameters of the scattered radiation for the states of the body with different hematocrit levels have been revealed. A scheme of a multichannel imaging portable system, based on a smartphone using miniature optical and microelectronic components of information conversion for non-invasive monitoring of microphysical blood parameters, has been created. The system implements the principle of polarimetric blood photometry and a multiparametric analysis of the polarization properties of the laser radiation scattered by blood. The developed portable optoelectronic system, based on a smartphone, can be used for rapid blood diagnostics in disaster medicine and the presence of clinical contraindications to the formation of invasive tests. The proposed polarization-based approach is a promising automated alternative to traditional devices and systems for the research of microphysical blood parameters.

Aumento de la confianza en la interpretación del PET con 18F-Florbetaben: “machine learning” basado en la aproximación cuantitativa / Increasing the confidence of 18F-florbetaben PET interpretations: Machine learning quantitative approximation

Objetivo: Determinar el valor a-adido de los parámetros semicuantitativos en el análisis visual y estudiar los patrones del depósito cerebral de 18F-Florbetaben. Material y métodos: Análisis retrospectivo de pacientes con deterioro cognitivo leve o demencia de origen incierto procedentes de un estudio multicentrico. Los PET con 18F-Florbetaben fueron interpretados de forma visual por dos observadores independientes, analizando las regiones “diana” con la finalidad de calcular el acuerdo interobservador. Se realizó análisis semicuantitativo de todas las regiones corticales con respecto a tres regiones de referencia para obtener índices de captación (SUVRs). Se analizó la capacidad de los SUVRs para predecir el resultado de la interpretación visual, la posibilidad de depósito preferencial del radiotrazador en algunas regiones “diana” así como las diferencias interhemisféricas. Resultados: Se evaluaron 135 pacientes. En la valoración visual, 72 estudios se clasificaron como positivos. El acuerdo interobservador fue excelente. Todos los SUVRs fueron significativamente superiores en pacientes con PET positivos con respecto a los negativos. Las regiones corticales correspondientes al área prefrontal y al cingulado posterior mostraron la mejor correlación con la evaluación visual, seguidas por la valoración integrada cortical. Usando análisis de ROC, los SUVRs obtenidos en las mismas regiones “diana” mostraron la mejor capacidad diagnóstica. Conclusiones: La información obtenida de las regiones “diana” parece ser de ayuda en la clasificación visual, basado en un depósito preferencial de amiloide, lo que permitiría el “machine learning”. El depósito de amiloide, aunque difuso en todas las regiones corticales, parece no ser uniforme ni simétrico (AU)

Aim: To assess the added value of semiquantitative parameters on the visual assessment and to study the patterns of 18F-Florbetaben brain deposition. Materials and methods: Retrospective analysis of multicenter study performed in patients with mild cognitive impairment or dementia of uncertain origin. 18F-Florbetaben PET scans were visually interpreted by two experienced observers, analyzing target regions in order to calculate the interobserver agreement. Semiquantification of all cortical regions with respect to three reference regions was performed to obtain standardized uptake value ratios (SUVRs). The ability of SUVRs to predict the visual evaluation, the possibility of preferential radiotracer deposition in some target regions and interhemisphere differenceswere analyzed. Results: 135 patients were evaluated. In the visual assessment, 72 were classified as positive. Interobserver agreement was excellent. All SUVRs were significantly higher in positive PET scans than in negative ones. Prefrontal area and posterior cingulate were the cortical regions with the best correlations with the visual evaluation, followed by the composite region. Using ROC analysis, the SUVRs obtained in same target locations showed the best diagnostic performance. Conclusions: The derived information from target regions seems to help the visual classification, based on a preferential amyloid deposit, allowing machine learning. The amyloid deposit, although diffuse in all cortical regions, seems not to be uniform and symmetric (AU)

Linear Interval Approximation for Smart Sensors and IoT Devices.

In this work, we introduce and use an innovative approach for adaptive piecewise linear interval approximation of sensor characteristics, which are differentiable functions. The aim is to obtain a discreet type of inverse sensor characteristic, with a predefined maximum approximation error, with minimization of the number of points defining the characteristic, which in turn is related to the possibilities for using microcontrollers with limited energy and memory resources. In this context, the results from the study indicate that to overcome the problems arising from the resource constraints of smart devices, appropriate "lightweight" algorithms are needed that allow efficient connectivity and intelligent management of the measurement processes. The method has two benefits: first, low-cost microcontrollers could be used for hardware implementation of the industrial sensor devices; second, the optimal subdivision of the measurement range reduces the space in the memory of the microcontroller necessary for storage of the parameters of the linearized characteristic. Although the discussed computational examples are aimed at building adaptive approximations for temperature sensors, the algorithm can easily be extended to many other sensor types and can improve the performance of resource-constrained devices. For prescribed maximum approximation error, the inverse sensor characteristic is found directly in the linearized form. Further advantages of the proposed approach are: (i) the maximum error under linearization of the inverse sensor characteristic at all intervals, except in the general case of the last one, is the same; (ii) the approach allows non-uniform distribution of maximum approximation error, i.e., different maximum approximation errors could be assigned to particular intervals; (iii) the approach allows the application to the general type of differentiable sensor characteristics with piecewise concave/convex properties.

Review of Microfluidic Methods for Cellular Lysis.

Cell lysis is a process in which the outer cell membrane is broken to release intracellular constituents in a way that important information about the DNA or RNA of an organism can be obtained. This article is a thorough review of reported methods for the achievement of effective cellular boundaries disintegration, together with their technological peculiarities and instrumental requirements. The different approaches are summarized in six categories: chemical, mechanical, electrical methods, thermal, laser, and other lysis methods. Based on the results derived from each of the investigated reports, we outline the advantages and disadvantages of those techniques. Although the choice of a suitable method is highly dependent on the particular requirements of the specific scientific problem, we conclude with a concise table where the benefits of every approach are compared, based on criteria such as cost, efficiency, and difficulty.

[Vegetarian Diets in Paediatrics. Nutrition Branch Recommendations]. / Dietas vegetarianas en Pediatría: Recomendaciones de la Rama de Nutrición.

In recent decades, the vegetarian dietary option has been increasing in the general population, in cluding the pediatric age group. This has led to numerous questions regarding the benefits and risks that may arise from its implementation. Food restriction implies the potential deficiency of several nutrients, establishing some of them as critical for this period of development and rapid growth, so the safety of vegetarian diets has not been fully established worldwide. The main critical nutrients are iron, zinc, calcium, vitamin B12, and omega-3 fatty acids. The groups most at risk of nutritional deficiencies are infants, adolescents, more restrictive vegetarian options, and those who do not have adequate professional nutritional counseling. Therefore, vegetarian diets should be strictly supervi sed. Scientific societies such as the American, Canadian, Italian, and British nutrition societies recog nize vegetarian diets as healthy in the pediatric age as long as they are supervised by qualified health professionals. However, there are others that do not support it as the French one, while the Spanish one supports it with restrictions in the infant period. The objective of this publication is to describe potential nutritional deficiencies and to provide recommendations to follow a balanced and safe ve getarian diet in the pediatric population according to the available information, paying attention to the limitations that we may have in the implementation of this diet in our population, especially in critical stages such as infants and adolescents.

Incidence of motor neuron disease/amyotrophic lateral sclerosis in South Africa: a 4-year prospective study.

BACKGROUND AND PURPOSE: Little is known about the epidemiological features of amyotrophic lateral sclerosis (ALS) in sub-Saharan Africa, and data from the region are limited to clinical series or case reports. The aim of the study was to investigate the incidence rate and presentation of ALS in an ethnically diverse region of South Africa. METHODS: We performed a 4-year prospective incidence study in the Western Cape Province of South Africa between 1 July 2014 and 30 June 2018, and used a two-source capture-recapture method for case ascertainment. Age- and sex-adjusted incidence rates (ASAIRs) were calculated using the 2010 US population as the reference. RESULTS: A total of 203 incident cases were identified over the study period, resulting in a crude incidence rate (IR) of 1.09 [95% confidence interval (CI) 0.94-1.24] per 100 000 person-years in the at-risk population (aged >15 years). Capture-recapture analysis resulted in an estimated IR of 1.11 (95% CI 1.01-1.22) per 100 000 person-years. The ASAIR was 1.67 (95% CI 1.09-2.26) overall; 1.99 (95% CI 1.60-2.39) for men and 1.37 (95% CI 1.06-1.68) for women. When analysed separately, there was a substantial difference in ASAIRs between the different population groups, with the highest in the European ancestry group (2.62; 95% CI 2.49-2.75), the lowest in the African ancestry group (0.56, 95% CI 0.0-1.23), and an ASAIR in between these two in the mixed ancestry group (1.09, 95% CI 0.80-1.37). CONCLUSION: The overall incidence of ALS in the Western Cape Province of South Africa appears to be lower than in North African and Western countries, but higher than in Asian countries. As suggested by previous epidemiological studies, ALS may be less frequent in people of African ancestry.

Aplicación de realidad virtual (Nesplora Aquarium) en la valoración cognitiva y control de incapacidad temporal por contingencia común en pacientes con trastorno psiquiátrico menor / Application of virtual reality (Nesplora Aquarium) in the cognitive evaluation and control of temporary disability by common contingency in patients with minor psychiatric disorder

INTRODUCCIÓN: Los Trastornos Psiquiátricos Menores originan incapacidades temporales de larga duración. Un porcentaje elevado refieren quejas subjetivas de déficits cognitivos difícilmente valorables. OBJETIVOS: Demostrar que pacientes con quejas subjetivas de déficits cognitivos muestran procesos de incapacidad temporal más largos. Demostrar que dichas quejas no siempre se corresponden con déficits reales utilizando pruebas específicas de Realidad Virtual (Nesplora Aquarium), lo que permitiría acortar la duración de la incapacidad en buenas condiciones para el trabajador. Material y MÉTODOS: SUJETOS: 100 pacientes valorados en psiquiatría- MAZ por Trastorno Psiquiátrico Menor. MÉTODO: Entrevista Psiquiátrica Estructurada y prueba de Realidad Virtual. RESULTADOS: 1) 62% de pacientes con quejas subjetivas cognitivas no confirmadas con Realidad Virtual. 2) Duración significativamente superior del proceso en resultados bajos de Nesplora. 3) Reducción duración del proceso altamente significativas tras Nesplora. CONCLUSIONES: Confirmamos la importancia de utilizar pruebas de realidad rirtual en valoración de funciones cognitivas de pacientes con Trastorno Psiquiátrico Menor

INTRODUCTION: Minor Psychiatric Disorders cause temporary, long-term disabilities. A high percentage of them refer to subjective complaints of cognitive deficits that are difficult to evaluate. OBJECTIVES: To demonstrate that patients with subjective complaints of cognitive deficits show longer processes of temporary disability. To demonstrate that such complaints do not always correspond to real deficits, using specific Virtual Reality tests (Nesplora Aquarium), allowing to shorten the duration in good conditions for the worker. MATERIALS AND METHODS: SUBJECTS: 100 patients assessed in psychiatry- MAZ for Minor Psychiatric Disorder. METHOD: Structured Psychiatric Interview + Virtual Reality test RESULTS: 1) 62% of patients with unconfirmed subjective cognitive complaints with Virtual Reality. 2) Significantly longer duration of the process in low Nesplora results. 3) Highly significant reduction in process duration after Nesplora. CONCLUSIONS: We confirm the importance of using Virtual Reality tests in assessing cognitive functions of patients with Minor Psychiatric Disorder

Hemorragia subaracnoidea de la convexidad cerebral causada por telangiectasia hereditaria hemorrágica / Convexity subarachnoid haemorrhage secondary to hereditary haemorrhagic telangiectasia

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Protocol for a randomized controlled trial to assess two procedures of vaginal native tissue repair for pelvic organ prolapse at the time of the questioning on vaginal prosthesis: the TAPP trial.

BACKGROUND: Native tissue cystocele repair has been the cornerstone of prolapse surgery, especially since the learned societies warned clinicians and patients about serious mesh-related complications. Surgical techniques mainly consist in anterior colporraphy and vaginal patch plastron. However, success rates of native tissue cystocele repair are heterogeneous, depending on the design of studies and definition of outcomes. To date, high-quality data comparing vaginal native tissue procedures are still lacking. METHODS: Herein we aimed to describe the design of the first randomized controlled trial (TAPP) comparing anterior colporraphy (plication of the muscularis and adventitial layers of the vaginal wall) and vaginal patch plastron (bladder support anchored on the tendinous arch of the pelvic fascia by lateral sutures) techniques. Our aim is to assess the effectiveness of vaginal native tissue repair at 1 year for cystocele with a combined definition of success-anatomic and functional. The primary endpoint will be the success rate 1 year after surgery with a composite of objective and subjective measures (Aa and Ba points < 0 from POP-Q (Pelvic Organ Prolapse Quantification System) and a negative answer to question 3 of Pelvic Floor Distress Inventory and no need for additional treatment). DISCUSSION: A prospective study has found a success rate at 35% for anterior colporraphy based on a combined definition, both anatomic and functional, as recently recommended. However, the definition of anatomic was strict (POP-Q< 2), while it seems that the best definition of anatomic success is "no prolapse among the hymen", that is to say Aa and Ba points from the POP-Q classification < 0. We hypothesize that vaginal patch plastron will have a better anatomic and functional success comparatively to anterior colporraphy because native tissue is added, as it corrects both median and lateral cystoceles thanks to bilateral paravaginal suspension. TRIAL REGISTRATION: CHU LIMOGES is the sponsor of this research (n°87RI18_0013). This research is supported by the French Department of Health (PHRC 2018-A03476-49) and will be conducted with the support of DGOS (PHRC interregional - GIRCI SOHO). The study protocol was approved by the Human Subjects Protection Review Board (Comité de Protection des Personnes) on May 16, 2019. The trial is registered in the ClinicalTrials.gov registry ( NCT03875989 ).

Eye lens radiation exposure in paediatric interventional treatment of retinoblastoma.

Retinoblastoma represents 3% of cancers in children under fifteen years of age. The standard paediatric treatment for saving the affected eye is supraselective intra-arterial chemotherapy performed in interventional rooms. In order to address the radiation toxicity due to the angiography, the aim of this study was to determine the typical dose value corresponding to the procedure, estimate the paediatric patients' eye lens dose and study the relationship between dose indicators and dose to the lens. An automatic dose management software was installed in two interventional rooms to obtain the distribution of the dose indicators kerma-area product and reference-point air kerma, getting a typical value 16 Gy·cm2 and 130 mGy, respectively (n = 35). The eye lens dose estimates were obtained with photoluminescent dosimeters placed on the patient's eyelids. In the left eye, the entrance surface air kerma was 44.23 ± 2.66 mGy, and 12.72 ± 0.89 mGy in the right eye (n = 10). There was a positive correlation between dose to the lens per procedure and dose indicators, with R2 > 0.65 for both eyes. Based on this information, the threshold for the onset of radiation-induce cataracts (500 mGy) will be exceeded if the treatment is performed for more than 8 sessions.