Screening over Speech in Unselected Populations for Clinical Trials in AD (PROSPECT-AD): Study Design and Protocol.

BACKGROUND: Speech impairments are an early feature of Alzheimer's disease (AD) and consequently, analysing speech performance is a promising new digital biomarker for AD screening. Future clinical AD trials on disease modifying drugs will require a shift to very early identification of individuals at risk of dementia. Hence, digital markers of language and speech may offer a method for screening of at-risk populations that are at the earliest stages of AD, eventually in combination with advanced machine learning. To this end, we developed a screening battery consisting of speech-based neurocognitive tests. The automated test performs a remote primary screening using a simple telephone. OBJECTIVES: PROSPECT-AD aims to validate speech biomarkers for identification of individuals with early signs of AD and monitor their longitudinal course through access to well-phenotyped cohorts. DESIGN: PROSPECT-AD leverages ongoing cohorts such as EPAD (UK), DESCRIBE and DELCODE (Germany), and BioFINDER Primary Care (Sweden) and Beta-AARC (Spain) by adding a collection of speech data over the telephone to existing longitudinal follow-ups. Participants at risk of dementia are recruited from existing parent cohorts across Europe to form an AD 'probability-spectrum', i.e., individuals with a low risk to high risk of developing AD dementia. The characterization of cognition, biomarker and risk factor (genetic and environmental) status of each research participants over time combined with audio recordings of speech samples will provide a well-phenotyped population for comparing novel speech markers with current gold standard biomarkers and cognitive scores. PARTICIPANTS: N= 1000 participants aged 50 or older will be included in total, with a clinical dementia rating scale (CDR) score of 0 or 0.5. The study protocol is planned to run according to sites between 12 and 18 months. MEASUREMENTS: The speech protocol includes the following neurocognitive tests which will be administered remotely: Word List [Memory Function], Verbal Fluency [Executive Functions] and spontaneous free speech [Psychological and/ or behavioral symptoms]. Speech features on the linguistic and paralinguistic level will be extracted from the recordings and compared to data from CSF and blood biomarkers, neuroimaging, neuropsychological evaluations, genetic profiles, and family history. Primary candidate marker from speech will be a combination of most significant features in comparison to biomarkers as reference measure. Machine learning and computational techniques will be employed to identify the most significant speech biomarkers that could represent an early indicator of AD pathology. Furthermore, based on the analysis of speech performances, models will be trained to predict cognitive decline and disease progression across the AD continuum. CONCLUSION: The outcome of PROSPECT-AD may support AD drug development research as well as primary or tertiary prevention of dementia by providing a validated tool using a remote approach for identifying individuals at risk of dementia and monitoring individuals over time, either in a screening context or in clinical trials.

The CORCOBIA study: Cut-off points of Alzheimer's disease CSF biomarkers in a clinical cohort.

INTRODUCTION: The analysis of the core biomarkers of Alzheimer's Disease (AD) in the cerebrospinal fluid (CSF) is recommended in the clinical units where it is available. Because of the absence of universal validated values, the determination of specific cut-off points for each center and its population is recommended. The main objective of the CORCOBIA study was to determine the cut-off points of core AD CSF biomarkers for several centers (Parc de Salut Mar, Barcelona and Hospital General de Granollers), which work with the same reference laboratory (Laboratori de Referència de Catalunya). METHODS: Prospective study including cognitively unimpaired individuals (CU, n = 42), subjects with amnestic mild cognitive impairment (aMCI, n = 35) and patients with dementia due to Alzheimer's Disease (AD, n = 48), in whom clinical and neuropsychological assessment, neuroimaging, APOE genotyping and lumbar puncture to analyse amyloid beta peptides (Aß42, Aß40), total tau (tTau) and phosphorylated Tau (pTau181) using the Lumipulse G600II (Fujirebio) was performed. The values of sensitivity (SE), specificity (SP), predictive values and area under the curve (AUC) were calculated, determining the cut-off point according to the Youden index by comparing the CU and AD groups. RESULTS: The resulting cut-offs and their AUC were the following: Aß42 750 pg/mL (AUC 0.809); Aß42/Aß40 0.062 (AUC 0.78); pTau181 69.85 pg/mL (AUC 0.81); tTau 522.0 pg/mL (AUC 0.79); Aß42/tTau 1.76 (AUC 0.86); Aß42/pTau181 10.25 (AUC 0.86). CONCLUSIONS: The determination of cut-off points of core AD CSF biomarkers for the participating centers allows a better diagnostic accuracy. The ratio CSF Aß42/pTau181 shows the highest AUC and better balance between sensitivity and specificity.

Comparative Analysis of Different Definitions of Amyloid-ß Positivity to Detect Early Downstream Pathophysiological Alterations in Preclinical Alzheimer.

Amyloid-ß (Aß) positivity is defined using different biomarkers and different criteria. Criteria used in symptomatic patients may conceal meaningful early Aß pathology in preclinical Alzheimer. Therefore, the description of sensitive cutoffs to study the pathophysiological changes in early stages of the Alzheimer's continuum is critical. Here, we compare different Aß classification approaches and we show their performance in detecting pathophysiological changes downstream Aß pathology. We studied 368 cognitively unimpaired individuals of the ALFA+ study, many of whom in the preclinical stage of the Alzheimer's continuum. Participants underwent Aß PET and CSF biomarkers assessment. We classified participants as Aß -positive using five approaches: (1) CSF Aß42 < 1098 pg/ml; (2) CSF Aß42/40 < 0.071; (3) Aß PET Centiloid > 12; (4) Aß PET Centiloid > 30 or (5) Aß PET Positive visual read. We assessed the correlations between Aß biomarkers and compared the prevalence of Aß positivity. We determined which approach significantly detected associations between Aß pathology and tau/neurodegeneration CSF biomarkers. We found that CSF-based approaches result in a higher Aß-positive prevalence than PET-based ones. There was a higher number of discordant participants classified as CSF Aß-positive but PET Aß-negative than CSF Aß-negative but PET Aß-positive. The CSF Aß 42/40 approach allowed optimal detection of significant associations with CSF p-tau and t-tau in the Aß-positive group. Altogether, we highlight the need for sensitive Aß -classifications to study the preclinical Alzheimer's continuum. Approaches that define Aß positivity based on optimal discrimination of symptomatic Alzheimer's disease patients may be suboptimal for the detection of early pathophysiological alterations in preclinical Alzheimer.

Color Regression and Maintenance Effect of Intracoronal Whitening on the Quality of Life: RCT-A One-year Follow-up Study.

OBJECTIVE:: This randomized clinical study evaluated two parameters: 1) the clinical color rebound of whitening patients' tooth discoloration using the walking bleaching technique and 2) the impact on psychological and aesthetic self-perception at the one-year follow-up of patients who underwent bleaching of nonvital teeth. METHODS AND MATERIALS:: Fifty study participants with nonvital tooth discoloration were recruited. Teeth were assigned randomly into one of two groups: 1) 35% hydrogen peroxide (n=25) and 2) 37% carbamide peroxide (n=25). Intracoronal bleaching was carried out over the course of four sessions using the walking bleach technique. Tooth color was evaluated after each session in order to measure the total color variation (ΔE). The guide was arranged from highest (B1) to lowest values (C4) for evaluating color, and color changes using Vita Classical Shade (ΔSGUs) units were calculated. Subjective and objective assessments were compared with the counterpart of the tooth. Aesthetic perception and psychosocial factors were evaluated before and after treatment by the Oral Health Impact Profile (OHIP) and Psychological Impact of Dental Impact Questionnaire (PIDAQ) surveys. RESULTS:: Color changes (ΔE) were 15.48 ± 5.17 and 14.02 ± 4.85 for carbamide and hydrogen peroxide groups, respectively. There were no significant differences ( p>0.05) between these two groups at the one-year follow-up. There was a decrease in the PIDAQ scores after treatment compared to baseline values ( p<0.05). The majority of OHIP values regressed to baseline values. CONCLUSION:: The technique of walking bleaching was highly effective and showed minimal color rebound in nonvital teeth and had a positive effect on patients' psychological impact at the one-year follow-up.

Extended gamma-ray sources around pulsars constrain the origin of the positron flux at Earth.

The unexpectedly high flux of cosmic-ray positrons detected at Earth may originate from nearby astrophysical sources, dark matter, or unknown processes of cosmic-ray secondary production. We report the detection, using the High-Altitude Water Cherenkov Observatory (HAWC), of extended tera-electron volt gamma-ray emission coincident with the locations of two nearby middle-aged pulsars (Geminga and PSR B0656+14). The HAWC observations demonstrate that these pulsars are indeed local sources of accelerated leptons, but the measured tera-electron volt emission profile constrains the diffusion of particles away from these sources to be much slower than previously assumed. We demonstrate that the leptons emitted by these objects are therefore unlikely to be the origin of the excess positrons, which may have a more exotic origin.

Rivaroxaban para el tratamiento de la trombocitopenia inducida por heparina: caso clínico / Treatment of heparin-induced thrombocytopenia with rivaroxaban: case report

Heparin-induced thrombocytopenia (HIT) is immune-mediated. It occurs more frequently with unfractionated heparin (UFH) than with low molecular weight heparins (LMWH). It is associated with thromboembolic rather than hemorrhagic events, as opposed to thrombocytopenia of other etiologies. The key in therapy is the cessation of heparin and the start of another anticoagulant. We report a 58 years old female with HIT secondary to the use of Enoxaparin who was successfully managed with Rivaroxaban. Our goal is to report a novel therapy and provide the evidence that supports its use.

Impaired ovarian response to exogenous gonadotropins in female rat offspring born to mothers perinatally exposed to Bisphenol A.

The ovary is sensitive to disruption by the environmental estrogen Bisphenol A (BPA). Our aim was to investigate whether perinatal exposure to BPA (50µg/kgday), orally administered, affects ovarian response to exogenous gonadotrophins (PMSG or PMSG+hCG) in prepubertal female offspring. An altered response to gonadotrophins was observed in BPA-exposed rats. Increased proportion of antral follicles, altered levels of ovarian steroidogenic enzymes, gonadotropin receptors, AR and ERß were observed in PMSG group. Besides that, in response to PMSG+hCG, a persistent high Fshr mRNA expression and a decreased number of follicles with high expression of PR before ovulation were observed. After ovulation, there was an increase in antral atretic follicles, reduced Lhcgr mRNA expression and high serum levels of E2. Therefore, an early exposure to a low dose of BPA during perinatal period induces ovarian changes leading to an altered response to exogenous gonadotropin treatment later in life.

Cierre de bolsillo subpectoral para la reconstrucción mamaria: descripción de una nueva técnica quirúrgica mediante el uso de celulosa oxidada regenerada NU-KNIT® / Closure of the sub pectoral pocket for breast reconstruction: description of a new surgical technique using oxidized regenerated cellulose NU-KNIT TM

Introducción: El uso de expansor mamario, previo a la reconstrucción definitiva con prótesis, no está exento de complicaciones. Las mismas no solo tienen relación con la presencia de radioterapia perioperatoria, o factores propios de las pacientes, sino que también guardan relación con la cobertura muscular íntegra del expansor mamario. Material y métodos: Revisión retrospectiva de pacientes sometidas a reconstrucción mamaria diferida utilizando una modificación de la técnica del cierre de bolsillo submuscular con celulosa oxidada regenerada NU-KNIT® de expansor mamario. Entre el 1 de enero de 2014 y el 31 de diciembre de 2015 un solo cirujano plástico (J.V.) de la Unidad de Patología Mamaria de la Clínica Alemana de Santiago realizó reconstrucción con dicha técnica en 31 pacientes. Se describe la modificación de la técnica, así como los datos demográficos, histológicos y complicaciones de la fase de expansión de las mismas. Resultados: Se realizaron 40 reconstrucciones mamarias en 31 pacientes. Se presentaron 11 seromas (27,5% del total de los expansores), 2 sufrimientos de colgajo cutáneo con dehiscencia de la herida (5% de los expansores) y una infección de la herida operatoria (2,5% de los expansores). Dos pacientes requirieron aseo quirúrgico por dehiscencia e infección. Una paciente requirió explantación del expansor (2,5% del total de los expansores). Discusión: La modificación de la técnica quirúrgica representa una alternativa segura y reproducible para lograr un cierre total del bolsillo muscular y con ello la cobertura completa del expansor, evitando así algunas de las complicaciones descritas secundarias a una cobertura insuficiente del mismo.

Introduction: The use of breast expander, prior to the final prosthetic reconstruction, is not exempt from complications. They not only relate to the presence of peri-operative radiation therapy, or patient-related issues; but also related to the muscle integrate coverage of the breast expander. Material and methods: Retrospective review of patients undergoing deferred breast reconstruction using a modification of the technique of sub muscular pocket closing with oxidized regenerated cellulose NU-KNIT TM for the breast expander. Between January 1, 2014 and December 31, 2015 one plastic surgeon (J.V.), from the Breast Pathology Unit at Clínica Alemana de Santiago, performed reconstruction surgeries with this technique in 31 patients. In the present article, the technique modification, demographic data, histological data and the complications which arose during the expansion phase of the same, will be described. Results: 40 breast reconstructions were performed in 31 patients. 11 seromas (27.5% of total expanders), 2 sufferings of skin flap wound dehiscence (5% expanders) and 1 wound infection (2.5% of expanders) were presented. Two patients required surgical debridement due to surgical dehiscence and infection. One patient required explantation of the expander (2.5% of total expanders). Discussion: The modification of the surgical technique represents a safe and reproducible alternative to achieve a complete closure of the muscular pocket and thus a complete coverage of the expander, consequently; avoiding some of the secondary complications drawn from an insufficient coverage of the expander.

Influence of central hemodynamics on VV ECMO oxygen delivery in neonatal animal model.

BACKGROUND: Recirculation of oxygenated blood in venovenous extracorporeal membrane oxygenation (VV ECMO) can decrease the oxygen delivery provided by the ECMO support. This study investigated the influence of central hemodynamics and catheter position on the amount of recirculation and oxygen delivery during VV ECMO. METHODS: Recirculation was measured in seven newborn lambs (mean weight 4.7 kg) during VV ECMO using the ELSA Monitor (Transonic Systems, Inc., Ithaca, NY) and using the central venous line (CVL) method. The ECMO pump was set at the prescribed flow of 110-120 mL/kg/min for a targeted oxygen delivery rate of 6cc/kg/min without recirculation. Hemodynamic status before and during ECMO was also measured by the COstatus Monitor (Transonic Systems, Inc.,Ithaca, NY). RESULTS: Lambs with a higher cardiac index (>160 ml/min/kg), had a tendency to have higher percent oxygen delivery (65-94%, at prescribed flow) while lambs with lower cardiac index (<150 ml/min/kg), tended to have lower percent oxygen delivery (39-62%, at prescribed flow). ELSA recirculation measurements had a squared correlation coefficient R2 = 0.8 with the CVL method. CONCLUSIONS: The ELSA monitor provides an easy to use, non-invasive method to measure recirculation in VV ECMO. The data suggests that cardiac function may play an important prognostic role in achieving effective VV ECMO support.

Seroprevalence and risk factors for Neospora caninum in small dairy farms in central Chile / Seroprevalencia y factores de riesgo de Neospora caninum en pequeñas granjas lecheras de la zona central de Chile

ABSTRACT Objective. To provide information about seroprevalence and risk factors of Neospora caninum infection in bovines of central Chile. Material and Methods. The study population are small dairy farms that are part of a Government Technical Support Service (SAT) in the O´Higgins region in central Chile. Sera samples were collected from milking cows and analyzed by a commercial ELISA kit. Additionally, a questionnaire was applied to farmers to identify risk factors through logistic regression. Results. The farm level prevalence was found to be 67%, and within farms seroprevalence 55%. Abortion history (p= 0.037, OR=5.09), dogs feed source (p= 0.0429, OR=6), cattle drinking water source (p=0.034, OR=4.5) and abortions management (p=0.017, OR=7.43) were found as significant risk factors for infection. Conclusion. There is a high N. caninum seroprevalence in small SAT´s dairy farms in O´Higgins region. These results highlight the need of improving N. caninum surveillance, and the development of preventive measures to avoid losses related with this disease.

RESUMEN Objetivos. Proveer información sobre la seroprevalencia y factores de riesgo asociados a la infección por Neospora caninum en bovinos en Chile central. Materiales y métodos. La población estudiada corresponde a pequeñas lecherías que son parte de un programa gubernamental de Asistencia Técnica (SAT), en la región de O´Higgins en Chile central. Muestras de suero fueron recolectadas desde vacas en lactancia y analizadas mediante un kit comercial ELISA. Además, se aplicó un cuestionario a los dueños de los animales para la identificación de factores de riesgo a través de regresión logística. Resultados. Se identificó una prevalencia a nivel de granja del 67%, mientras que dentro de las granjas positivas, esta fue en promedio de 55%. El historial de abortos (p= 0.037, OR=5.09), la fuente de alimentación de perros (p= 0.0429, OR=6), la fuente de agua de bebida de las vacas (p=0.034, OR=4.5) y el manejo de los abortos (p=0.017, OR=7.43) fueron identificados como factores de riesgo para la infección. Conclusiones. Se observa una alta seroprevalencia de N. caninum en pequeños productores lecheros pertenecientes al SAT en Chile central. Los resultados presentados resaltan la necesidad de mejorar las acciones de vigilancia de esta enfermedad y el desarrollo de medidas preventivas para evitar las pérdidas asociadas a esta enfermedad.

Síndrome de Goodpasture atípico como reto diagnóstico / Atypical Goodpasture syndrome as diagnostic challenge

Resumen La enfermedad de Goodpasture es una entidad clínica con una base fisiopatológica inmunológica como punto de partida, en la que la unión al dominio terminal NC1 afecta principalmente en la zona glomerular y pulmonar, con lo que su diagnóstico está orientado hacia estas insuficiencias orgánicas; su incidencia varía de 0.5 a 1 casos por millón de habitantes, por lo que se considera una enfermedad poco frecuente y de mortalidad elevada debido a las complicaciones derivadas del mecanismo inmunológico. La manifestación pulmonar de manera aislada representa un porcentaje aún menor; la hemoptisis es, incluso en 66% de los casos, la forma más frecuente de expresión clínica. El pronóstico de estos pacientes se asocia con la forma de manifestación de la enfermedad y la calidad en la atención recibida. El diagnóstico definitivo se realiza mediante toma de biopsia; sin embargo, la existencia de anticuerpos anti-MBG (antimembrana basal glomerular) mediante la prueba ELISA puede manejarse en el diagnóstico con buena sensibilidad.

Abstract Goodpasture's disease is a clinical entity with an immunological pathophysiological basis, where the union to terminal NC1 domain mainly affects glomerular and lungs; thus, its diagnosis is oriented to such organ failure; its incidence varies from 0.5 to 1 cases per million population, for this reason it is considered a rare disease with high mortality due to complications from immune mechanism. Isolated lung presentation accounts for an even fewer percentage; in two thirds of cases hemoptysis is the most common clinical expression of the disease. Prognosis of these patients is associated to the presentation of the disease and the quality of care provided during the same. The definitive diagnosis is made by biopsy; however, the presence of antiGBM antibodies (glomerular basement membrane) by ELISA can be handled in the diagnosis with good sensitivity.

[Treatment of heparin-induced thrombocytopenia with rivaroxaban. Case report]. / Rivaroxaban para el tratamiento de la trombocitopenia inducida por heparina. Caso clínico.

Heparin-induced thrombocytopenia (HIT) is immune-mediated. It occurs more frequently with unfractionated heparin (UFH) than with low molecular weight heparins (LMWH). It is associated with thromboembolic rather than hemorrhagic events, as opposed to thrombocytopenia of other etiologies. The key in therapy is the cessation of heparin and the start of another anticoagulant. We report a 58 years old female with HIT secondary to the use of Enoxaparin who was successfully managed with Rivaroxaban. Our goal is to report a novel therapy and provide the evidence that supports its use.

Does an internal focus really affect running performance? An experimental approach to the effect of attentional focus / ¿Afecta la focalización interna realmente en el rendimiento de carrera? Aproximación experimental hacia el efecto de la focalización atencional / Isso afeta o foco interno realmente no desempenho de corrida? A abordagem experimental para o efeito de foco de atenção

Up to now, the effects of attentional focus on performance in long distance running have showed controversial results, especially derived from methodological issues. It has been considered that an internal attentional focus on breathing increase the runner’s oxygen consumption, decreasing running economy. Nevertheless, none of these conclusion have controlled in real time if participants maintained the instructed attentional focus. We hypothesized that the controlled use of and internal vs. external attentional focus will not have an effect on running economy (oxygen consumption at a set speed) at a moderate intensity. A total of 30 (eight females) long distance runners, aged range from 18 to 50 years (M = 32,87, SD = 8,15) volunteered for the study. The experimental protocol consisted on three sessions (scheduled in three different days): (1) maximal incremental treadmill test, (2) internal attentional focus, and (3) external attentional focus. During sessions 2 and 3, participants performed a 55 min treadmill run at moderate intensity (70% VO2 max. Though a mobile application and a wireless controller it was possible to control for the first time if participants effectively maintained the requested attentional focus during the sessions. Results showed that there was not effect of attentional focus (internal vs. external) on running economy. We conclude that when the workload is controlled at a moderate intensity, runners are free to choose were to focus their attention without affecting their running economy (AU)

Hasta ahora, los estudios sobre los efectos del foco atencional sobre el rendimiento en carreras de fondo han mostrado resultados controvertidos, especialmente derivados de las metodológicas de estudio. Se ha sugerido que un foco atencional interno, centrado en la respiración, aumenta el consumo de oxígeno del corredor, disminuyendo así la economía de carrera. Sin embargo, en los estudios realizados hasta la fecha no se ha controlado en tiempo real a nivel experimental el uso de un foco atencional concreto. Nuestra hipótesis establece que el uso controlado de un foco atencional interno o externo no tiene un efecto sobre la economía de carrera (consumo de oxígeno a una velocidad establecida) si se corre a una intensidad moderada. Un total de 30 corredores de larga distancia (ocho mujeres), con edades de 18 a 50 años (M = 32,87, DT = 8,15) participaron como voluntarios. El protocolo experimental consistió un diseño intrasujeto realizado en tres sesiones: (1) prueba de esfuerzo para detectar el umbral aeróbico, (2) uso de un foco atencional interno, y (3) uso de un foco atencional externo. Durante las sesiones 2 y 3, los participantes realizaron 55 min carrera a intensidad moderada. Mediante el uso de una aplicación móvil y un mando inalámbrico patentados fue posible controlar, a nivel experimental, si los participantes mantenían eficazmente el foco atencional solicitado durante las sesiones. Los resultados muestran que no hubo efecto del uso del foco atencional interno o externo en la economía de carrera. Se concluye que, a una intensidad moderada, los corredores son libres de elegir se estrategia atencional sin que se afecte su rendimiento (AU)

Até agora, os efeitos de foco de atenção sobre o desempenho na corrida de longa distância têm mostrado resultados controversos, especialmente derivados de questões metodológicas. Considerou-se que um foco de atenção interna na respiração aumentar o consumo de oxigênio do corredor, diminuindo economia de corrida. No entanto, nenhum destes conclusão têm controlado em tempo real, se os participantes mantiveram o foco de atenção as instruções. Nossa hipótese é que o uso controlado do e interna vs. foco atencional externo não vai ter um efeito sobre a economia de corrida (consumo de oxigênio a uma velocidade set) em uma intensidade moderada. Um total de 30 (oito mulheres) corredores de longa distância, faixa de idade entre 18 a 50 anos (M = 32,87; DP = 8,15) se voluntariou para o estudo. O protocolo experimental consistiu em três sessões: (1) teste máximo incremental em esteira, (2) foco de atenção interna, e (3) foco atencional externo. Durante as sessões de 2 e 3, os participantes realizaram uma corrida (55 min) em intensidade moderada. Os resultados mostraram que não houve efeito do foco atencional (interno vs. externo) sobre a economia de corrida. Conclui-se que, quando a carga de trabalho é controlado em uma intensidade moderada, os corredores são livres para escolher se a centrar a sua atenção, sem afetar a economia de corrida (AU)

Frailty Is Associated with Disability and Recent Hospitalization in Community-Dwelling Elderly: The Coyoacan Cohort.

BACKGROUND: The phenotype of frailty proposed by Fried et al has shown to predict several adverse health-related outcomes in elderly populations worldwide; however, the description of such associations in Latin America is still scarce. OBJECTIVE: To describe the association between frailty and recent hospitalization, disability for basic (ADL) and instrumental activities of daily living (IADL). DESIGN, SETTING AND PARTICIPANTS: Cross-sectional study of 1,124 community-dwelling adults aged 70 and older participating in the Coyoacán cohort. MEASUREMENTS: Frailty was defined by the presence of at least three of the following criteria: weight loss, exhaustion, low physical activity, slowness, and weakness. Multiple regression analyses were used to test the association between frailty and the outcomes of interest, adjusting for potential confounders. RESULTS: Mean age was 78.2 (SD ±6.1) years. Prevalence of frailty was 14.1%. Adjusted multivariate models showed that frail status was associated with ADL disability (OR 3.06, 95%CI 1.52-6.17), IADL disability (OR 17.02, 95%CI 6.16-47.01), and recent hospitalization (OR 3.21, 95%CI 1.31-7.8). CONCLUSION: Among Mexican community-dwelling elderly, frailty is associated with ADL and IADL disability as well as with recent hospitalizations. Moreover, frailty's prevalence in this population appears to be greater compared to what has been reported elsewhere. Social and cultural traits should be further studied as correlates of frailty in diverse populations.

Molecular Crossroads of Frailty and HIV.

An epidemiological transition is occurring regarding Human Immunodeficiency Virus (HIV) infection. This phenomenon, explained by several mechanisms (e.g.: physiologic changes, pharmacologic advances, sexual behaviors), is demonstrated by a significant increase in the number of patients aged 50 years and older diagnosed with this infection. The immunological changes observed in HIV-infected patients may prompt the appearance of an accelerated aging process as well as that of comorbidities and other pathological entities commonly diagnosed in older adults. Frailty is a biologic syndrome characterized by a multi-systemic decrease of the individual's physiologic and homeostatic reserves, leading to diminished resistance against stressors and increased vulnerability. The purpose of this review is to describe the common molecular changes seen in both frailty and HIV-1 infection, offering an in-depth analysis of their pathophysiology and specifying common processes where their pathways meet.

Prominent psychiatric symptoms in patients with Parkinson's disease and concomitant argyrophilic grain disease.

In Parkinson's disease (PD), cognitive decline and psychiatric symptoms may occur and very often co-exist, eventually leading to PD-dementia. We report three patients with PD who presented striking psychiatric manifestations along with mild cognitive decline not progressing to dementia across the course of disease and in which postmortem neuropathological study revealed, besides alpha-synuclein inmunoreactive Lewy-body pathology, concomitant four-repeat tau positive argyrophilic grain pathology. We consider that argyrophilic grains might have modulated the clinical presentation of PD in these patients, being the main substrate of their prominent psychiatric symptoms in the absence of definite dementia.

Cardiovascular disease among Black Americans: comparisons between the U.S. Virgin Islands and the 50 U.S. states.

OBJECTIVES: Consistent findings show that black Americans have high rates of cardiovascular disease (CVD) and related behavioral risk factors. Despite this body of work, studies on black Americans are generally limited to the 50 U.S. states. We examined variation in CVD and related risk factors among black Americans by comparing those residing within the U.S. Virgin Islands (USVI) with those residing in the 50 U.S. states and Washington, D.C. (US 50/DC) and residing in different regions of the US 50/DC (Northeast, Midwest, South, and West). METHODS: Using data from the 2007 and 2009 Behavioral Risk Factor Surveillance System, we compared CVD and CVD risk factor prevalence in non-Hispanic black people (≥20 years of age) in the USVI and US 50/DC, examining the relative contributions of health behaviors, health insurance, and socioeconomic status (SES). RESULTS: Accounting for age, sex, education, health insurance, and health behaviors, US 50/DC black Americans were significantly more likely than USVI black people to report ever having a stroke and coronary heart disease, and to be hypertensive, diabetic, or obese. While there was heterogeneity by region, similar patterns emerged when comparing the USVI with different regions of the US 50/DC. CONCLUSION: USVI black people have lower CVD and risk factor prevalence than US 50/DC black people. These lower rates are not explained by differences in health behaviors or SES. Understanding health in this population may provide important information on the etiology of racial/ethnic variation in health in the U.S. and elsewhere, and highlight relevant public health policies to reduce racial/ethnic group disparities.

Evaluation of the new generation dual-lumen catheter for neonatal ECMO.

OBJECTIVES: The purpose of this study was to compare the newly designed dual-lumen venovenous catheter (VR13, OriGen Biomedical, Austin, TX) with the current dual-lumen catheter (VV12, OriGen Biomedical). METHODS: Five newborn lambs, 1 to 5 days old and weighing 4.2 ± 0.5 kg, were cannulated with the VV13 OriGen catheter and placed on extracorporeal membrane oxygenation (ECMO). ECMO flows were increased from 200 to 600 ml/min, with measurements taken after the changes. The experiment was then repeated using the VV12 catheter. RESULTS: Recirculation values were equal for both catheters. The pressure drop at the reinfusion port was equal for both catheters at 200 ml/min, increasing to 275 mmHg at 500 ml/min for the VR13 vs. 240 mmHg for the VV12 catheter. CONCLUSION: These findings indicate that the VR13 catheter resulted in levels of recirculation equal to the VV12. Based on resistance measurements, we do not recommend the use of this new catheter beyond 400 ml/min until minor design changes are made.

[Internal and external fixation for open tibial fracture. Case presentation]. / Fijación interna y externa en fractura expuesta de tibia. Presentación de un caso.

INTRODUCTION: Accidents currently rank first among causes of complex lower limb injuries. The most common open long bone fractures are tibial fractures. Estimates indicate that there are 492,000 new fractures every year, with a prevalence of 100,000 cases that do not heal. CLINICAL CASE: Young, female patient who underwent emergency surgery for a Gustilo III A open comminuted fracture of the left proximal tibia. Surgical toilette was performed several times until the soft tissues improved. Then internal fixation of large fragments was performed with a cortical screw and Professor Rodrigo Alvarez Cambras' external fixator was used to heal the fracture. The combined approach consisting of internal and external fixation is discussed within the setting of these difficult fractures.