Prevalence and prognostic meaning of interstitial lung abnormalities in remote CT scans of patients with interstitial lung disease treated with antifibrotic therapy.

OBJECTIVES: To describe the prevalence and characteristics of interstitial lung abnormalities (ILA) in CT scans performed prior to the initiation of antifibrotics in a series of patients with interstitial lung disease (ILD), and to identify characteristics apparent on early CT scans that could help to predict outcomes. METHODS: We conducted a retrospective observational study. The original cohort consisted of 101 patients diagnosed with ILD and treated with antifibrotics in a tertiary hospital. Patients were included if they had a thoracic CT scan performed at least one year before initiation of therapy. They were classified radiologically in three groups: without ILA, with radiological ILA and extensive abnormalities. ILA were classified as subpleural fibrotic, subpleural non-fibrotic and non-subpleural. The initial scan and the latest CT scan performed before treatment were read for assessing progression. The relationship between CT findings of fibrosis and the radiological progression rate and mortality were analyzed. RESULTS: We included 50 patients. Only 1 (2%) had a normal CT scan, 25 (50%) had extensive alterations and 24 (48%) had radiological criteria for ILA, a median of 98.2 months before initiation of antifibrotics, of them 18 (75%) had a subpleural fibrotic pattern. Significant bronchiectasis and obvious honeycombing in the lower zones were associated with shorter survival (p = 0.04). Obvious honeycombing in the lower zones was also significantly (p < 0.05) associated with a faster progression rate. CONCLUSIONS: Fibrotic ILAs are frequent in remote scans of patients with clinically relevant ILD, long before they require antifibrotics. Findings of traction bronchiectasis and honeycombing in the earliest scans, even in asymptomatic patients, are related to mortality and progression later on.

Measuring impulsivity in Parkinson's disease: a correlational and structural neuroimaging study using different tests.

BACKGROUND AND PURPOSE: Impulsivity is an aspect of personality and a major component of multiple neuropsychiatric conditions. In Parkinson's disease, it has been associated with the expression of impulse control disorders, a highly prevalent non-motor complication. Even though multiple tests of impulsivity have been used in this context, the impact of test choice has not been addressed. The aim was to evaluate whether different impulsivity measures in Parkinson's disease share substantial inter-scale and anatomical correlations or rather mirror different underlying phenomena. METHODS: In a consecutive sample of 89 Parkinson's disease patients without impulse control disorders, four common tests were evaluated assessing different aspects of impulsivity: impulsiveness trait, decisions under implicit risk with and without losses, and delay discounting. Correlations among test scores were analysed and each score was used as a regressor in a set of grey matter volume (GMV) voxel-based morphometry analyses to explore their brain structural correlates. RESULTS: No significant correlations were found between the different impulsivity tests. Furthermore, their structural brain correlates were divergent. Impulsiveness trait appeared to be associated with lower GMV in dorsal-lateral prefrontal cortices, implicit risk (with losses) with higher GMV in the left nucleus accumbens and lower left insular GMV, implicit risk (without losses) with higher GMV in the left lingual gyrus and lower GMV in the gyri recti and delay discounting with higher GMV in the left nucleus accumbens. CONCLUSIONS: In Parkinson's disease, different impulsivity measures reflect very dissimilar behavioural and brain structural correlates. Our results suggest that parkinsonian impulsivity is not a unitary phenomenon but rather a heterogeneous entity.

Widespread Increased Diffusivity Reveals Early Cortical Degeneration in Huntington Disease.

BACKGROUND AND PURPOSE: Huntington disease is a devastating genetic neurodegenerative disorder for which no effective treatment is yet available. Although progressive striatal atrophy is its pathologic hallmark, concomitant cortical deterioration is assumed to occur, but it is poorly characterized. Our objective was to study the loss of cortical integrity and its association with clinical indicators throughout the course of the disease. MATERIALS AND METHODS: Using a cohort of 39 patients with Huntington disease and 25 controls with available MR imaging (T1WI and DTI), we compared cortical atrophy and intracortical diffusivity across disease stages. Intracortical diffusivity is a DTI-derived metric that has recently been suggested to detect incipient neuronal death because water can diffuse more freely in cortical regions with reduced neural density. RESULTS: We observed progressive thinning and increasing diffusivity within the cerebral cortex of patients with Huntington disease (P < .05, corrected for multiple comparisons). Most important, in the absence of pronounced atrophy, widespread increased diffusivity was already present in individuals with premanifest Huntington disease, correlating, in turn, with clinical and disease-specific progression markers. CONCLUSIONS: Intracortical diffusivity may be more sensitive than cortical thinning for tracking early neurodegeneration in Huntington disease. Moreover, our findings provide further evidence of an early cortical compromise in Huntington disease, which contributes to our understanding of its clinical phenotype and could have important therapeutic implications.

Valor de la 18F-FDG PET/TC en el diagnóstico de corea-acantocitosis / Value of 18F-FDG PET/CT in the diagnosis of chorea-acanthocytosis

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Neurocardiovascular pathology in pre-manifest and early-stage Huntington's disease.

BACKGROUND AND PURPOSE: Cardiovascular events are a major cause of early death in the Huntington's disease (HD) population. Dysautonomia as well as deterioration of circadian rhythms can be detected early in the disease progression and can have profound effects on cardiac health. The aim of the present study was to determine if patients with HD and pre-manifest mutation carriers present a higher risk of cardiovascular disease than non-mutation-carrying controls. METHODS: This was a prospective, cross-sectional, multicentre study of 38 HD mutation carriers (23 pre-manifest and 15 early-stage patients) compared with 38 age- and gender-matched healthy controls. Clinical and epidemiological variables, including the main haematological vascular risk factors, were recorded. Ambulatory blood-pressure monitoring and carotid intima-media thickness (CIMT) measurement were performed to assess autonomic function and as target-organ damage markers. RESULTS: Most (63.2%) patients with HD (86.7% and 47.8%, respectively, of the early-stage and pre-manifest patients) were non-dippers compared with 23.7% of controls (P = 0.001). CIMT values were in the 75th percentile in 46.7% and 43.5%, respectively, of the early-stage and pre-manifest patients, whereas none of the controls presented pathological values (P = 0.001 and P = 0.006, respectively). Nocturnal non-dipping was significantly associated with CIMT values in patients (P = 0.002) but not in controls. CONCLUSIONS: These results suggest that higher cardiovascular risks and target-organ damage are present even in pre-manifest patients. Although larger studies are needed to confirm these findings, clinicians should consider these results in the cardiovascular management of patients with HD.

Validación de la versión española del test Addenbrooke's Cognitive Examination III para el diagnóstico de demencia / Validation of the Spanish version of Addenbrooke's Cognitive Examination III for diagnosing dementia

Introducción: El Addenbrooke's Cognitive Examination (ACE) es un test de cribado para el diagnóstico de demencia. Recientemente, se ha desarrollado la tercera versión del test (ACE-III). El objetivo del estudio fue la traducción y adaptación del ACE-III al español y su validación. Material y métodos: El ACE-III fue traducido y adaptado al español. Se administró a un grupo de sujetos cognitivamente sanos y a pacientes con demencia leve de diferentes tipos en 2 centros españoles. Resultados: La consistencia interna del test (alfa de Cronbach = 0,927), la fiabilidad interevaluador (coeficiente de correlación intraclase = 0,976) y la fiabilidad test-retest (kappa = 0,995) fueron elevadas. Edad (r = –0,512) y escolaridad (r = 0,659) se correlacionaron significativamente con la puntuación total del test. La capacidad diagnóstica del ACE-III fue superior al Mini-Mental State Examination, especialmente en el grupo con mayor escolaridad. Se obtuvieron datos normativos por edad, y puntos de corte para la detección de demencia. Conclusiones: La versión española del test ACE-III es un instrumento válido para el diagnóstico de demencia, con una alta capacidad discriminatoria especialmente en pacientes con un mayor nivel educativo

Introduction: Addenbrooke's Cognitive Examination is a screening test used to diagnose dementia. The third edition of this test (ACE-III) was recently developed. The aim of this study was to translate and validate the ACE-III in Spanish. Methods: The ACE-III was translated and adapted to Spanish. It was then administered to a group of healthy subjects as well as a group of patients with different types of mild dementia treated in 2 hospitals in Spain. Results: Internal reliability (Cronbach's alpha = 0.927), inter-rater reliability (intraclass correlation coefficient = 0.976) and test-retest reliability (kappa 0.995) were excellent. Age (r = -0.512) and education (r = 0.659) showed a significant correlation with total test scores. The diagnostic accuracy of ACE-III was higher than that of the Mini-Mental State Examination, particularly for the group with the highest educational level. Researchers obtained normative data and cut-off points for the diagnosis of dementia. Conclusions: The Spanish version of the ACE-III is a reliable and valid test for diagnosing dementia. Its diagnostic accuracy is high, especially in patients with a higher level of education

Sap fluxes from different parts of the rootzone modulate xylem ABA concentration during partial rootzone drying and re-wetting.

Previous studies with partial rootzone drying (PRD) irrigation demonstrated that alternating the wet and dry parts of the rootzone (PRD-Alternated) increased leaf xylem ABA concentration ([X-ABA]leaf) compared with maintaining the same wet and dry parts of the rootzone (PRD-Fixed). To determine the relative contributions of different parts of the rootzone to this ABA signal, [X-ABA]leaf of potted, split-root tomato (Solanum lycopersicum) plants was modelled by quantifying the proportional water uptake from different soil compartments, and [X-ABA]leaf responses to the entire pot soil-water content (θpot). Continuously measuring soil-moisture depletion by, or sap fluxes from, different parts of the root system revealed that water uptake rapidly declined (within hours) after withholding water from part of the rootzone, but was rapidly restored (within minutes) upon re-watering. Two hours after re-watering part of the rootzone, [X-ABA]leaf was equally well predicted according to θpot alone and by accounting for the proportional water uptake from different parts of the rootzone. Six hours after re-watering part of the rootzone, water uptake by roots in drying soil was minimal and, instead, occurred mainly from the newly irrigated part of the rootzone, thus [X-ABA]leaf was best predicted by accounting for the proportional water uptake from different parts of the rootzone. Contrary to previous results, alternating the wet and dry parts of the rootzone did not enhance [X-ABA]leaf compared with PRD-Fixed irrigation. Further work is required to establish whether altered root-to-shoot ABA signalling contributes to the improved yields of crops grown with alternate, rather than fixed, PRD.

Validation of the Spanish version of Addenbrooke's Cognitive Examination III for diagnosing dementia.

INTRODUCTION: Addenbrooke's Cognitive Examination is a screening test used to diagnose dementia. The third edition of this test (ACE-III) was recently developed. The aim of this study was to translate and validate the ACE-III in Spanish. METHODS: The ACE-III was translated and adapted to Spanish. It was then administered to a group of healthy subjects as well as a group of patients with different types of mild dementia treated in 2 hospitals in Spain. RESULTS: Internal reliability (Cronbach's alpha = 0.927), inter-rater reliability (intraclass correlation coefficient = 0.976) and test-retest reliability (kappa 0.995) were excellent. Age (r = -0.512) and education (r = 0.659) showed a significant correlation with total test scores. The diagnostic accuracy of ACE-III was higher than that of the Mini-Mental State Examination, particularly for the group with the highest educational level. Researchers obtained normative data and cut-off points for the diagnosis of dementia. CONCLUSIONS: The Spanish version of the ACE-III is a reliable and valid test for diagnosing dementia. Its diagnostic accuracy is high, especially in patients with a higher level of education.

Discordant retinoblastoma in monozygotic twins due to deletion of 13q14.

PURPOSE: To report discordant retinoblastoma in monozygotic twins, confirmed by GeneScan. METHODS: One twin presented unilateral retinoblastoma that was treated with enucleation; the other twin had no retinoblastoma. To confirm monozygosity, DNA from leukocytes was analyzed through GeneScan with highly polymorphic markers; to exclude 13q14 deletion, FISH analysis was performed in leukocytes and oral cells of both twins and their parents and in retinal tissue of the affected twin with the cDNA LSI RB1 probe. RESULTS: GeneScan analysis confirmed monozygosity. 13q14 deletion was observed in homozygous state in retinal tissue and in heterozygous state in oral cells and leukocytes of the affected twin. The nonaffected twin and parents showed no deletion of 13q14. CONCLUSIONS: These data show unexpected differences in monozygotic twins that could be explained by postzygotic events in embryonic development.

Plasma progranulin levels in cortical dementia phenotypes with asymmetric perisylvian atrophy.

BACKGROUND AND PURPOSE: Decreased plasma progranulin levels are a very specific marker for the diagnosis of frontotemporal lobar degeneration (FTLD) caused by mutations in the progranulin gene (GRN). A frequent neuroimaging pattern in this type of dementia is asymmetric cortical atrophy. The aim of this study was to screen for GRN-linked FTLD in cases with different cortical dementia phenotypes and asymmetric perisylvian atrophy. METHODS: Progranulin plasma levels were analyzed in a variety of FTLD phenotypes (n = 71), dementia of the Alzheimer type (DAT) (n = 22) and probable Lewy body dementia (n = 8), both latter groups presented with asymmetric perisylvian atrophy. A group of elderly controls (n = 29) and DAT cases with symmetric atrophy (n = 33) were also analyzed. The GRN gene was sequenced in cases with lower plasma levels. RESULTS: Four cases with clinical FTLD phenotypes and plasma levels below 70 ng/ml were found to carry different GRN mutations: M1?, C139R, a point mutation in the splice donor site of intron 3 (A89VfsX41), and a deletion in exon 9 (A303AfsX57), this latter one being a new mutation. Thirteen cases with levels between 72 and 85 ng/ml did not show pathogenic changes in the GRN gene. None of the cases with asymmetric atrophy and clinical phenotypes other than FTLD had GRN mutations. CONCLUSIONS: Asymmetric perisylvian atrophy is not likely to predict progranulin-linked FTLD unless it is associated with a consistent FTLD clinical phenotype.

Leaf water relations and net gas exchange responses of salinized Carrizo citrange seedlings during drought stress and recovery.

BACKGROUND AND AIMS: Since salinity and drought stress can occur together, an assessment was made of their interacting effects on leaf water relations, osmotic adjustment and net gas exchange in seedlings of the relatively chloride-sensitive Carrizo citrange, Citrus sinensis x Poncirus trifoliata. METHODS: Plants were fertilized with nutrient solution with or without additional 100 mm NaCl (salt and no-salt treatments). After 7 d, half of the plants were drought stressed by withholding irrigation water for 10 d. Thus, there were four treatments: salinized and non-salinized plants under drought-stress or well-watered conditions. After the drought period, plants from all stressed treatments were re-watered with nutrient solution without salt for 8 d to study recovery. Leaf water relations, gas exchange parameters, chlorophyll fluorescence, proline, quaternary ammonium compounds and leaf and root concentrations of Cl(-) and Na(+) were measured. KEY RESULTS: Salinity increased leaf Cl(-) and Na(+) concentrations and decreased osmotic potential (Psi(pi)) such that leaf relative water content (RWC) was maintained during drought stress. However, in non-salinized drought-stressed plants, osmotic adjustment did not occur and RWC decreased. The salinity-induced osmotic adjustment was not related to any accumulation of proline, quaternary ammonium compounds or soluble sugars. Net CO(2) assimilation rate (A(CO2)) was reduced in leaves from all stressed treatments but the mechanisms were different. In non-salinized drought-stressed plants, lower A(CO2) was related to low RWC, whereas in salinized plants decreased A(CO2) was related to high levels of leaf Cl(-) and Na(+). A(CO2) recovered after irrigation in all the treatments except in previously salinized drought-stressed leaves which had lower RWC and less chlorophyll but maintained high levels of Cl(-), Na(+) and quaternary ammonium compounds after recovery. High leaf levels of Cl(-) and Na(+) after recovery apparently came from the roots. CONCLUSIONS: Plants preconditioned by salinity stress maintained a better leaf water status during drought stress due to osmotic adjustment and the accumulation of Cl(-) and Na(+). However, high levels of salt ions impeded recovery of leaf water status and photosynthesis after re-irrigation with non-saline water.

Deficit irrigation and rootstock: their effects on water relations, vegetative development, yield, fruit quality and mineral nutrition of Clemenules mandarin.

Differences between rootstocks, 'Cleopatra' mandarin and 'Carrizo' citrange, in soil-plant water relations and the influence of these factors on vigor, crop yield, fruit quality and mineral nutrition were evaluated in field-grown Clemenules mandarin trees irrigated at 100% of potential seasonal evaporation (ET(c)) (control treatment), or irrigated at 100% ET(c), except during Phases I and III of fruit growth and post-harvest when no irrigation was applied (deficit irrigation (DI) treatment), for 3 years. Differences between rootstocks in plant-soil water relations were the primary cause of differences among trees in vegetative development and fruit yield. After 3 years of DI treatment, trees on 'Cleopatra' showed more efficient soil water extraction than trees on 'Carrizo', and maintained a higher plant water status, a higher gas exchange rate during periods of water stress and achieved faster recovery in gas exchange following irrigation after water stress. The DI treatment reduced vegetative development more in trees on 'Carrizo' than in trees on 'Cleopatra'. Cumulative fruit yield decreased more in DI trees on 'Carrizo' (40%) than on 'Cleopatra' (27%). The yield component most affected by DI in 'Cleopatra' was the number of fruit, whereas in 'Carrizo' it depended on the severity of water stress reached in each phase (severe water stress in Phase I affected mainly the number of fruit, whereas it affected fruit size the most in Phase III). In the third year of DI treatment, water-use efficiency decreased sharply in trees on 'Carrizo' (70%) compared to trees on 'Cleopatra' (30%). Thus, trees on 'Cleopatra' were able to tolerate moderate water stress, whereas trees on 'Carrizo' were more sensitive to changes in soil water content.

Cólico nefrítico rebelde a tratamiento médico / Renal colic refractory to medical therapy

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[The knowledge, clinical control and attitudes of Primary Care physicians when dealing with epileptic patients. Preliminary findings]. / Conocimientos, control clínico y actitudes de los médicos de Atención Primaria frente a los pacientes epilépticos. Resultados previos.

INTRODUCTION: Epilepsy is a common disease with important social and economic repercussions. Patients with epilepsy have traditionally been discriminated by both the general population and physicians. A physician's lack of knowledge about epilepsy could be the cause of an incorrect clinical control (CC). AIMS: The purpose of this study is to examine the origins of the knowledge, the CC and the attitudes of physicians in Tenerife with respect to the treatment of patients with epilepsy. MATERIALS AND METHODS: In January 2003, all Primary Care physicians in Tenerife were given a questionnaire that asked them about their knowledge, CC and attitudes when dealing with cases of epilepsy. Of the 260 surveys initially sent out, 182 were returned. RESULTS: The questionnaire was answered by 70% of doctors, of which 34 were paediatricians and 148 were general practitioners, with no differences between sexes. Most physicians acquire their knowledge, observe and treat their first seizure in the Faculty and during their period of hospital residency. 44% of them are barely or not at all satisfied with their knowledge on the subject. The most highly valued therapists are neurologists and neuropaediatricians. The goal that is sought is to eliminate the impact of the disease on the patient's quality of life. They rarely establish or modify antiepileptic treatment and state that they have doubts about neuropsychological disorders and integrating patients with epilepsy in the workplace. CONCLUSIONS: The physicians in Tenerife define themselves as professionals with scant knowledge about epilepsy and feel they are poorly qualified to treat patients with the disease, who are usually referred to specialists in Neurology.

Conocimientos, control clínico y actitudes de los médicos de Atención Primaria frente a los pacientes epilépticos. Resultados previos / The knowledge, clinical control and attitudes of primary care physicians when dealing with epileptic patients. Preliminary findings

Introducción. La epilepsia es una enfermedad frecuente con gran impacto social y económico. Tradicionalmente, os epilépticos han sido discriminados por la población y por los médicos. La falta de conocimientos sobre la epilepsia por parte de los médicos podría ser causa de un control clínico (CC) incorrecto. Objetivo. Acercarse al origen de los conocimientos, al CC y a las actitudes de los médicos de Tenerife frente a los epilépticos. Materiales y métodos. Se entregó una encuesta que incluía cuestiones sobre conocimientos, CC y actitudes de los médicos frente a la epilepsia, a todos los médicos de Atención Primaria de Tenerife en enero de 2003. De 260 encuestas inicialmente repartidas, se recogieron 183. Resultados. Respondió un 70% de los médicos, 34 pediatras y 148 médicos generales y de familia, sin diferencias por sexos. La mayoría de los médicos adquieren sus conocimientos, observan y tratan una crisis por primera vez en la Facultad y durante la residencia hospitalaria. Un 44% está poco o nada satisfecho de sus conocimientos. Los terapeutas más valorados son el neurólogo y el neuropediatra. El objetivo deseado es la ausencia de impacto de la enfermedad sobre la calidad de vida del paciente. Raramente inician o modifican tratamientos antiepilépticos, y manifiestan dudas sobre la afectación neuropsicológica y la integración del epiléptico en el trabajo. Conclusiones. Los médicos de Tenerife se definen como profesionales con escasos conocimientos en epilepsia y poco capacitados para tratar a los pacientes

Introduction. Epilepsy is a common disease with mportant social and economic repercussions. Patients with epilepsy have traditionally been discriminated by both the general population and physicians. A physician’s lack of knowledge about epilepsy could be the cause of an incorrect clinical control (CC). Aims. The purpose of this study is to examine the origins of the knowledge, the CC and the attitudes of physicians in Tenerife with respect to the treatment of patients with epilepsy. Materials and methods. In January 2003, all Primary Care physicians in Tenerife were given a questionnaire that asked them about their knowledge, CC and attitudes when dealing with cases of epilepsy. Of the 260 surveys initially sent out, 182 were returned. Results. The questionnaire was answered by 70% of doctors, of which 34 were paediatricians and 148 were general practitioners, with no differences between sexes. Most physicians acquire their knowledge, observe and treat their first seizure in the Faculty and during their period of hospital residency. 44% of them are barely or not at all satisfied with their knowledge on the subject. The most highly valued therapists are neurologists and neuropaediatricians. The goal that is sought is to eliminate the impact of the disease on the patient’s quality of life. They rarely establish or modify antiepileptic treatment and state that they have doubts about neuropsychological disorders and integrating patients with epilepsy in the workplace. Conclusions. The physicians in Tenerife define themselves as professionals with scant knowledge about epilepsy and feel they are poorly qualified to treat patients with the disease, who are usually referred to specialists in Neurology

Dolor abdominal e inestabilidad hemodinámica en paciente con pluripatología / Abdominal pain, hypovolemic shock and comorbidity

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[Evaluation of food intake in hemodialysis using a food consumption and appetite questionnaire]. / Valoración de la ingesta en hemodiálisis mediante un cuestionario de consumo alimentario y apetito.

Protein calorie malnutrition is a common complication in chronic hemodialysis patients (CHP). Although many factors could promote malnutrition, inadequate nutrient intake seems to be one of the most important. An Appetite and Diet Assessment Questionnaire (ADAQ) was developed, and we have performed a cross-sectional study in 44 CHP to investigate its capacity to predict an inadequate intake. Dietary evaluation was based on a diet diary-assisted recalls (DDAR). On the other hand, the validity of PCR and the differences in the DDAR and ADAQ between the days of dialysis and the days without dialysis were studied. The predictive value of inadequate intake of the ADAQ and the PCR were analysed with the ROC curve. The protein intake was 1.3 +/- 0.3 g/kg/day and the energy intake 29.2 +/- 0.6 kcal/kg/day. The average PCR was 1.14 +/- 0.3. The ROC curve to predict inadequate intake from the ADAQ shows an area under the curve of 0.84 for the protein intake and 0.73 for the energy intake. A cut-off ponit of 18 gives a sensitivity of 100% and a specificity of 44% for the detection of poor protein intake (< 1.2 g/kg/day) and of 74% and 56% for the detection of poor energy intake (< 30 kcal/kg/day). The ROC curve to predict inadequate protein intake from the PCR obtains an area under the curve of 0.81. The cut-off 1.06 gives the best sensitivity (100%) and specificity (64%) for the detection of insufficient protein intake. We did not find any significant difference in the DDAR or in the ADAQ between the days of dialysis and the days without dialysis. Despite the subjective interpretation, the relationship between ADAQ and protein-energy intakes analysed by DDAR was highly significant. The questionnaire is simple and can therefore be used as a screening rest to detect and correct alterations in the diet which could otherwise lead to malnutrition. The determination of PCR gives a good sensitivity and specificity for the detection of poor protein intake, although the results are modified in anabolic or catabolic states which can clinically go undetected. We do not register differences in diet between the days of dialysis and the days without dialysis.