Identificación del síndrome de piernas inquietas en estudios polisomnográficos y su asociación con otras variables / Identification of restless legs syndrome in polysomnography studies and its association with other variables

Introducción: El síndrome de piernas inquietas (SPI) es un trastorno del movimiento caracterizado por un impulso incontrolable de mover las piernas en respuesta a una sensación desagradable. La coexistencia de SPI junto con otros trastornos del sueño y del estado de ánimo puede modificar el enfoque terapéutico. El objetivo de este trabajo fue determinar la prevalencia de SPI en adultos estudiados con polisomnografía y evaluar su asociación con otros trastornos del sueño y del estado de ánimo. Pacientes y métodos: Estudio descriptivo transversal. Se incluyó a adultos estudiados con polisomnografía entre 2015 y 2021. Se recopiló información sobre sus antecedentes, datos polisomnográficos y trastornos del ánimo y del sueño mediante un cuestionario escrito autoadministrado que forma parte de la evaluación de todos los pacientes referidos a esta unidad de sueño. Se compararon estas variables en relación con la presencia de SPI. Resultados: Se incluyó a 406 pacientes. La prevalencia de SPI fue del 36,7% (n = 149). La presencia de fatiga (45,3%), insomnio moderado a grave (38,9%) y depresión (45,6%) fue mayor en sujetos con SPI. No se encontraron diferencias en relación con somnolencia diurna y síntomas de ansiedad. Los movimientos periódicos de las piernas no se asociaron con SPI (p = 0,26) y su prevalencia fue baja. Conclusión: La prevalencia de SPI en sujetos estudiados con polisomnografía fue elevada y se asoció a fatiga clínicamente significativa, insomnio y depresión. Estos síntomas deberían identificarse para establecer una estrategia terapéutica adecuada. La prevalencia de movimientos periódicos de las piernas fue baja y no se vinculó con SPI, hallazgo que contrasta con lo publicado previamente. Se requieren estudios adicionales para esclarecer la causa de esta asociación.(AU)

Introduction: Restless legs syndrome (RLS) is a movement disorder characterized by an uncontrollable urge to move the legs in response to an unpleasant sensation. The coexistence of RLS and other sleep and mood disorders may require adjustment in the therapeutic strategy. The objective of this study was to determine the prevalence of RLS in adults studied with polysomnography and to evaluate its association with other sleep and mood disorders. Patients and methods: Descriptive cross-sectional study. We included adults studied with polysomnography between 2015 and 2021. We collected information on their medical history, polysomnographic data and mood and sleep disorders using a self-administered written questionnaire which is part of the routine evaluation of all patients referred to this sleep unit. These variables were compared between patients with and without RLS. Results: We included 406 patients. The prevalence of RLS was 36.7% (n = 149). The presence of fatigue (45.3%), moderate to severe insomnia (38.9%) and depression (45.6%) was higher in subjects with RLS. We did not find differences regarding daytime sleepiness and anxiety symptoms. Periodic Limb Movements (PLM) was not associated with RLS (p = 0.26) and its prevalence was low. Conclusion: The prevalence of RLS in subjects studied with Polysomnography is high and it was associated with clinically significant fatigue, insomnia and depression. These symptoms should be identified in order to establish an adequate therapeutic strategy. The prevalence of periodic limb movements was low and was not linked with RLS. These findings contrast with previous publications. Therefore, it requires additional studies to clarify the cause of this variation.(AU)

[Identification of restless legs syndrome in polysomnography studies and its association with other variables]. / Identificación del síndrome de piernas inquietas en estudios polisomnográficos y su asociación con otras variables.

INTRODUCTION: Restless legs syndrome (RLS) is a movement disorder characterized by an uncontrollable urge to move the legs in response to an unpleasant sensation. The coexistence of RLS and other sleep and mood disorders may require adjustment in the therapeutic strategy. The objective of this study was to determine the prevalence of RLS in adults studied with polysomnography and to evaluate its association with other sleep and mood disorders. PATIENTS AND METHODS: Descriptive cross-sectional study. We included adults studied with polysomnography between 2015 and 2021. We collected information on their medical history, polysomnographic data and mood and sleep disorders using a self-administered written questionnaire which is part of the routine evaluation of all patients referred to this sleep unit. These variables were compared between patients with and without RLS. RESULTS: We included 406 patients. The prevalence of RLS was 36.7% (n = 149). The presence of fatigue (45.3%), moderate to severe insomnia (38.9%) and depression (45.6%) was higher in subjects with RLS. We did not find differences regarding daytime sleepiness and anxiety symptoms. Periodic Limb Movements (PLM) was not associated with RLS (p = 0.26) and its prevalence was low. CONCLUSION: The prevalence of RLS in subjects studied with Polysomnography is high and it was associated with clinically significant fatigue, insomnia and depression. These symptoms should be identified in order to establish an adequate therapeutic strategy. The prevalence of periodic limb movements was low and was not linked with RLS. These findings contrast with previous publications. Therefore, it requires additional studies to clarify the cause of this variation.

TITLE: Identificación del síndrome de piernas inquietas en estudios polisomnográficos y su asociación con otras variables.Introducción. El síndrome de piernas inquietas (SPI) es un trastorno del movimiento caracterizado por un impulso incontrolable de mover las piernas en respuesta a una sensación desagradable. La coexistencia de SPI junto con otros trastornos del sueño y del estado de ánimo puede modificar el enfoque terapéutico. El objetivo de este trabajo fue determinar la prevalencia de SPI en adultos estudiados con polisomnografía y evaluar su asociación con otros trastornos del sueño y del estado de ánimo. Pacientes y métodos. Estudio descriptivo transversal. Se incluyó a adultos estudiados con polisomnografía entre 2015 y 2021. Se recopiló información sobre sus antecedentes, datos polisomnográficos y trastornos del ánimo y del sueño mediante un cuestionario escrito autoadministrado que forma parte de la evaluación de todos los pacientes referidos a esta unidad de sueño. Se compararon estas variables en relación con la presencia de SPI. Resultados. Se incluyó a 406 pacientes. La prevalencia de SPI fue del 36,7% (n = 149). La presencia de fatiga (45,3%), insomnio moderado a grave (38,9%) y depresión (45,6%) fue mayor en sujetos con SPI. No se encontraron diferencias en relación con somnolencia diurna y síntomas de ansiedad. Los movimientos periódicos de las piernas no se asociaron con SPI (p = 0,26) y su prevalencia fue baja. Conclusión. La prevalencia de SPI en sujetos estudiados con polisomnografía fue elevada y se asoció a fatiga clínicamente significativa, insomnio y depresión. Estos síntomas deberían identificarse para establecer una estrategia terapéutica adecuada. La prevalencia de movimientos periódicos de las piernas fue baja y no se vinculó con SPI, hallazgo que contrasta con lo publicado previamente. Se requieren estudios adicionales para esclarecer la causa de esta asociación.

Age-related dermal collagen changes during development, maturation and ageing - a morphometric and comparative study.

The tissue organisation of dermal collagen is gaining importance as a contributing factor both in development and ageing, as well as in skin maturation processes. In this work we aim to study different representative parameters of this structural organisation in 45 human skin samples of assorted ages, by means of image analysis. The variation of these parameters on the basis of age was assessed using several regression models (linear, quadratic and cubic). The area occupied by collagen was significantly reduced as a function of age in the papillary dermis (R(2) = 0.437, P < 0.0001), as well as the thickness of the collagen bundles (R(2) = 0.461, P < 0.0001), following statistical models of cubic and quadratic regression, respectively. The width of the papillary dermis increased in a significant manner over a linear regression model (R(2) = 0.26, P < 0.0001). In the reticular dermis, the cubic regression indicated a significant decline (R(2) = 0.392, P = 0.002) of the area filled with collagen according to the age. Both collagen thickness and bundle orientation parameters fit a quadratic regression over the age in a significant way (R(2) = 0.433 and R(2) = 0.334, respectively, both P < 0.0001). The width of the reticular dermis followed also a significant quadratic distribution according to age (R(2) = 0.193, P = 0.011). These parameters could partially explain the lifelong functional changes taking place in the skin and propose a baseline providing a useful entry point for future investigation.

Design of the reflective optics for Tore Supra ECEI system.

A 2D electron cyclotron emission (ECE) imaging system for Tore Supra is under design for studying the MHD physics of the magnetically confined plasma such as sawteeth, tearing modes, and turbulent fluctuations. Complex beam path due to the tight access in Tore Supra led to the design of reflective optics made of 6 or more large cylindrical∕flat mirrors. The total path length of the ECE beam is about 11 m, including almost 4 m inside the vacuum vessel. The imaging property of the optics has been estimated using the Gaussian beam simulation and ray transfer analysis. The possible setups for the optical alignment of the diagnostic and the operation scenarios with single- or dual-array measurement system are discussed.

Effects of adjunctive reboxetine in patients with duloxetine-resistant depression: a 12-week prospective study.

The efficacy of the combination therapy with two antidepressants from different pharmacological families in patients with treatment-resistant depression has been reported in multiple studies. In this prospective 12-weeks open-label study, we assessed the effectiveness of the addition of reboxetine to 79 depressive outpatients diagnosed with major depressive disorder (MDD) according to the DSM-IV criteria who had previously not responded, or had done so only in a partial way, over 8 weeks of conventional treatment, in monotherapy, with duloxetine. Efficacy was assessed using the 21-item Hamilton Depression Rating Scale (HDRS) and the Clinical Global Impression-Improvement (CGI-I). Safety was evaluated by recording spontaneously reported adverse events. Data were analysed on an intent-to-treat basis, using the last-observation-carried-forward method. Mean HDRS reduction was 65.5% (P < 0.0001). The percentages of responders (>or=50% reduction in HDRS) and patients considered benefiting from complete remission (HDRS

Redistribution of suprathermal electrons due to fishbone frequency jumps.

MHD instabilities driven by fast electrons identified as fishbonelike modes have been detected on Tore Supra during lower hybrid current drive discharges. Direct experimental evidence is reported of a novel feature: the regular redistribution of suprathermal electrons toward external tokamak regions which are correlated to periodic mode frequency jumps. Sharp drops of the electron temperature time trace are factually linked to the cyclical deterioration of the fast electron confinement.

Demonstration of effective control of fast-ion-stabilized sawteeth by electron-cyclotron current drive.

In a tokamak plasma, sawtooth oscillations in the central temperature, caused by a magnetohydrodynamic instability, can be partially stabilized by fast ions. The resulting less frequent sawtooth crashes can trigger unwanted magnetohydrodynamic activity. This Letter reports on experiments showing that modest electron-cyclotron current drive power, with the deposition positioned by feedback control of the injection angle, can reliably shorten the sawtooth period in the presence of ions with energies >or=0.5 MeV. Certain surprising elements of the results are evaluated qualitatively in terms of existing theory.

Metástasis intestinal de sarcoma radioinducido de mama / No disponible

Objetivo: Se presenta un caso raro de metástasis de intestinodelgado de angiosarcoma mamario secundario a radioterapia,único descrito en la literatura hasta la fecha.Caso clínico: Mujer de 75 años intervenida de carcinomaductal infiltrante de mama izquierda mediante cirugía conservadoray tratamiento posterior con radioterapia, quimioterapiay hormonoterapia. A los 7 años desarrolla angiosarcoma en lacicatriz quirúrgica y a los 11 años del diagnóstico inicial presentacuadro de dolor abdominal que precisa cirugía extirpándoselesión abdominal compatible con metástasis intestinal desarcoma radioinducido de mama.Conclusión: En la actualidad se han extendido las técnicasde cirugía conservadora para el cáncer de mama, que precisande radioterapia como complemento al tratamiento locorregional.La posibilidad de lesiones sarcomatosas inducidas por radioterapiaobliga al diagnóstico temprano por biopsia excisionalde cualquier nódulo o lesión cutánea sospechosos en lamama conservada o en cicatrices de mastectomía. Tienen tendenciaa la recidiva local tardía y a desarrollar metástasis a distanciaprincipalmente en pulmón, hueso o hígado, sin habersedescrito metástasis de localización intestinal hasta la fecha, aexcepción del caso que describimos(AU)

Objective: We report a rare case of metastatic breast angiosarcomaof the small intestine secondary to radiation therapy,the only one described in the literature to date.Case report: 75 years-old woman diagnosed of infiltratingductal carcinoma of left breast was treated with conservativesurgery and subsequent radiotherapy, chemotherapy and hormone-therapy. At 7 years she developed angiosarcoma in thesurgical scar and 11 years after the initial diagnosis she presentedabdominal pain requiring surgery excising an abdominaltumor that was an intestinal metastasis of radio-inducedbreast sarcoma.Conclusion: At present, techniques of conservative surgeryhave been extended for breast cancer and they must be completedwith radiation treatment as a complement to the localsurgery. The possibility of sarcomatous lesions induced by radiationtherapy requires early diagnosis with biopsy of any suspiciousskin lesion or lump in the breast or in conservative surgeryscars. They frequently tend to develop local recurrenceand late distant metastases mainly located in lung, bone or liver.To date, intestinal metastases have not been described,except the case we report(AU)

Sci-Fri AM: YIS-10: Development of a flat panel detector with avalanche gain for low-dose x-ray imaging.

Digital flat panel detectors are increasingly being used in radiography and fluoroscopy. The imaging performance of current systems, however, is compromised by electronic noise at the low X-ray exposures employed in fluoroscopy and low-dose radiography. In other words, current flat panel detectors are not quantum noise limited at these low radiation exposures. There is thus a need to develop an imaging detector with the high sensitivity of an X-ray image intensifier and the inherent advantages of a solid-state flat panel detector. Towards this end, we have developed and characterized a novel solid-state device capable of providing very high avalanche gains and an excellent temporal response. The device which is based on the amorphous photoconductor a-Se, is scalable (i.e. can be manufactured in large areas), can overcome electronic noise even at the lowest X-ray exposures used in diagnostic imaging (0.1 µR/frame at the detector) and has a very low level of dark current. Here, we investigate the gain and temporal characteristics of this device and discuss its applicability for low exposure X-ray imaging as well as the effects of avalanche gain on the detective quantum efficiency. Coupled to a high-resolution structured CsI X-ray scintillator and a thin film transistor array, this device should provide a true solid-state alternative to the X-ray image intensifier, which is both robust and cost-effective. This should open the door to dose-efficient flat panel imagers for radiography and fluoroscopy as well as a number of other demanding medical imaging applications.

Giant oscillations of electron temperature during steady-state operation on Tore Supra.

During fully noninductively driven discharges in the Tore Supra tokamak, large spontaneous oscillations of the core electron temperature (DeltaTe/Te>50%) have been observed for the first time. They occurred during the standard O regime, which is itself characterized by periodic oscillations of much smaller amplitude. The "giant" oscillations appear to involve distinct mechanisms with respect to the O regime and provide a spectacular example of the complex nonlinear interactions between energy confinement, noninductive current sources, and MHD that may occur in a tokamak plasma during steady-state operation.

Parametric dependence of turbulent particle transport in tore supra plasmas.

Steady state full noninductive current tore supra plasmas offer a unique opportunity to study the local parametric dependence of particle pinch velocity, in order to discriminate among different theories. Magnetic field shear is found to generate an inward pinch which is dominant in the gradient region (normalized radius 0.3

Cadmium uptake in rat hepatocytes in relation to speciation and to complexation with metallothionein and albumin.

Cadmium (Cd) uptake has been studied in primary cultures of rat hepatocytes focusing on the impact of inorganic and organic speciation. Uptake time-course studies over a 60-min exposure to 0.3 microM (109)Cd revealed a zero-time uptake and a slower process of accumulation which proceeds within minutes. (109)Cd uptake showed saturation kinetics (K(m) = 3.5 +/- 0.8 microM), and was highly sensitive to inhibition by Zn and Hg. There was no evidence for sensitivity to the external pH nor for any preferential transport of the free cation Cd(2+) over CdCl(n) (2-n) chloro-complexes. According to the assumption that only inorganic metal species are available, metal uptake decreased upon albumin (BSA) addition to the exposure media. In contrast, higher levels of (109)Cd accumulation were obtained under optimal conditions for Cd complexation by MT. Comparison among uptake data obtained under inorganic and organic conditions revealed that Cd-MT would be taken up 0.4 times as rapidly as Cd(inorg). We conclude that uptake of Cd in rat hepatocytes involves specific transport mechanism(s) subjected to Zn or Hg interactions. Uptake of inorganic Cd is not proportional to the levels of free Cd(2+) and does not involve the divalent cation transporter DCT1 nor the co-transporter Fe(2+)-H(+) NRAMP2. We found Cd-MT but not Cd-BSA to be available for the liver cells, and have estimated a binding affinity four orders of magnitude higher for Cd complexation with MT compared to BSA; MT may have a significant role in Cd delivery to the liver.

Synergy of electron-cyclotron and lower-hybrid current drive in steady-state plasmas.

Improvement (up to a factor of approximately 4) of the electron-cyclotron (EC) current drive efficiency in plasmas sustained by lower-hybrid (LH) current drive has been demonstrated in stationary conditions on the Tore Supra tokamak. This was made possible by feedback controlled discharges at zero loop voltage, constant plasma current, and constant density. This effect, predicted by kinetic theory, results from a favorable interplay of the velocity space diffusions induced by the two waves: the EC wave pulling low-energy electrons out of the Maxwellian bulk, and the LH wave driving them to high parallel velocities.

New tokamak plasma regime with stationary temperature oscillations.

During noninductively driven discharges in the Tore Supra tokamak, steady sinusoidal oscillations of the central electron temperature, lasting as long as 2 min, have been observed for the first time. Having no helical structure, they cannot be ascribed to any known MHD instability. The most plausible explanation of this new phenomenon is that the plasma current density and the electron temperature evolve as a nonlinearly coupled predator-prey system. This interpretation is supported by the numerical solution of coupled resistive current diffusion and heat transport equations.

Alcoholism in 274 patients with panic disorder in Spain, one of the main producers of wine worldwide.

BACKGROUND: Though panic disorder (PD) and alcoholism have been found in epidemiologic studies to often co-occur, the influence of cultural factors on the order of onset of the disorders has not been frequently addressed. METHODS: A sample of 274 patients with PD was assessed and compared according to the presence of alcohol use disorder (AUD) (alcohol abuse or dependence), employing several clinical scales. RESULTS: A total of 26 subjects were diagnosed from AUD. In 73.1% of patients, onset of alcohol use was previous to PD onset. PD subjects with AUD were found to have an earlier age at PD onset. They were more likely to be males, to have a family history of alcoholism, to abuse other drugs and to experience a more severe PD (more attacks in the last month, higher scores in anticipatory anxiety). CONCLUSIONS: Patients with PD and alcoholism may represent a distinct clinical subgroup. Our finding of an uncommon order of onset for both disorders may reflect cultural influences. CLINICAL IMPLICATIONS: (i)The study of panic disorder patients with comorbid alcoholism may help to better characterize this subgroup of patients. (ii) Patterns of alcohol use and the order of onset of both disorders may be influenced by cultural factors, with important practical implications. (iii) Patients with panic disorder and alcoholism may represent a distinct clinical subgroup, with an earlier age at panic disorder onset and greater clinical severity of anxiety. LIMITATIONS: (i) Our results refer to a clinical sample, which may not be representative of the general population. (ii) Alcoholic patients with a history of other drug abuse or dependence were not excluded. (iii) Owing to the small sample size, patients with alcohol dependence and with alcohol abuse were not separated.

MAPKs entry into the nucleus at specific interchromatin domains in plant differentiation and proliferation processes.

Mitogen-activated protein kinases (MAPKs) are involved in the signaling of extracellular stimuli in eukaryotes, including plants. Different MAPKs have recently been shown to be expressed during plant cell proliferation and developmental processes such as pollen development and embryogenesis, but the structural subdomain where these MAPKs are targeted in the nucleus has not yet been characterized. We have determined the changes in the expression and subcellular localization of ERK homologues, proteins belonging to the MAPK family, and MAPK-active forms in two plant developmental processes which involved differentiation (pollen maturation) and proliferation (the initials of pollen embryogenesis). Immunofluorescence and immunogold labeling in the species studied showed that the progression of differentiation and proliferation was accompanied by an increase in the expression of ERKs and MAPK activation together with a translocation to the nucleus. Combining ultrastructural cytochemistry and immunogold for RNA and phosphorylated proteins we have identified the nuclear sites housing these MAPKs in areas of the interchromatin region enriched in RNA and phosphoproteins that include clusters of interchromatin granules. This could suggest a role of these MAPKs in the early events of activation of the transcription and processing machinery, via phosphorylation, which subsequently would be recruited to the transcription sites. The association of the nuclear localization of MAPKs with the progression through the cell cycle and the commitment toward differentiation in the two plant developmental processes can be correlated.

Phyllodes tumor of the breast with actin inclusions in stromal cells: diagnosis by fine-needle aspiration cytology.

The occurrence of hyaline inclusions in stromal cells in fibroepithelial tumors of the breast is very uncommon. These inclusions, characteristic of infantile digital fibromatosis, are comprised of actin filaments. This report illustrates a case of a benign phyllodes tumor of the breast with inclusion bodies, identified by fine-needle aspiration. Histologically, many of the stromal cells contained round intracytoplasmic inclusions, with positivity for smooth muscle actin.