A systematic review and meta-analysis of delayed coronary artery access for coronary angiography with or without percutaneous coronary intervention (PCI) in patients who underwent transcatheter aortic valve replacement (TAVR).

Coronary artery disease (CAD) and severe aortic valve stenosis frequently coexist. Given the progressive nature of CAD, silent or non-significant CAD may become symptomatic or functionally relevant years after TAVR. However, there is a paucity of data documenting the feasibility of either coronary angiography and/or PCI after TAVR. We systematically searched Medline, Pubmed, Embase, Cochrane database, Google Scholar, Science Direct, Web of Science, and conference abstracts from conception to March 2020 using OvidSP in TAVR patients undergoing coronary angiography with or without PCI at least 6 months after TAVR. Patients and procedural characteristics were summarized. The primary outcome of interest was successful coronary angiography for either the left main coronary artery (LMCA) or right coronary artery (RCA) with or without PCI. Pooled estimates were calculated using a random-effects meta-analysis. The study protocol was registered in PROSPERO. Eleven reports for a total of 696 coronary angiograms and 287 PCI were included in the analysis. Patients were slightly predominantly male, older and had a mean left ventricular ejection fraction of more than 50% with an intermediate STS. The summary estimate rates of successful LMCA and RCA angiography with a Medtronic self-expandable valve (SEV) were 84% (95% CI 73-90%, I2 = 79, p = 0.015) and 69% (95% CI 37-89%, I2 = 86, p = 0.23), respectively, while with the Edwards Lifesciences balloon expandable valve (BEV), the summary estimate rates for successful LMCA and RCA angiography were 94% (95% CI 72-99%, I2 = 66, p = 0.003) and 95% (95% CI 48-99%, I2 = 83, p = 0.05), respectively. The summary estimate rate of successful PCI post TAVR with either a Medtronic SEV or Edwards Lifesciences BEV was 93% (95% CI 86-96%, I2 = 33, p = 0.0001). The overall achievement of a successful coronary angiography with or without PCI in post-TAVR patients is high, with a lower success rate for RCA angiography in patients with the Medtronic SEV Mortality and bleeding did not differ in our analysis.

Efficacy and Safety of Endovascular Treatment in Acute Tandem Carotid Occlusions: Analysis of a Single-Center Cohort.

INTRODUCTION: Acute ischemic strokes with tandem occlusions, which represent 10-20% of all ischemic strokes, have a particularly poor prognosis. Since emergent treatment of tandem lesions has not been specifically addressed in randomized trials, there is an absence of standardized management. OBJECTIVE: We sought to assess the efficacy and safety of acute endovascular treatment in stroke due to tandem occlusions in our center and compare the results with previous reports. METHODS: From a prospective registry we analyzed data of 99 consecutive patients (males: 77.7%, mean age ± SD: 67.5 ± 9.5 years) with stroke due to tandem occlusions who underwent treatment with emergent carotid stenting and intracranial mechanical thrombectomy. Successful recanalization was defined as a TICI score of 2b-3 and a good functional outcome was defined as a modified Rankin scale score ≤2 at 90 days. Symptomatic intracranial hemorrhage (sICH) was considered when associated with worsening on the National Institutes of Health Stroke Scale (≥4 points). RESULTS: A successful recanalization rate was achieved in 87.8 and 48.5% of the patients had a good functional outcome. sICH and mortality rates were 12.1 and 20.2%, respectively, and 21.2% of the patients received combined treatment with intravenous thrombolysis, which did not affect neither the prognosis nor the recanalization or sICH rates. The time from symptom onset to recanalization and the degree of recanalization were the main factors associated with prognosis and the occurrence of sICH. CONCLUSIONS: Our results suggest that endovascular treatment with emergent carotid stenting and intracranial thrombectomy in patients with acute stroke due to tandem occlusions is an effective and safe procedure.

Left Atrial High-grade Sarcoma With Focal Osteosarcomatous Differentiation.

Approximately 75% of cardiac tumors are benign, and 25% are malignant cardiac tumors. Of these, sarcomas are extremely rare and have been described in isolated case reports. Due to its rarity, there is no published guideline for the management of this pathological entity. We present a case of an 85-year-old female who presented to our hospital with a chief complaint of shortness of breath and pinpointed left-sided chest pain. Computed tomography of the chest showed a filling defect in the left atrium concerning a mass versus thrombus. A transesophageal echocardiogram showed a 4 cm multi-lobular echogenic mass with calcifications in the left atrium likely arising from the pulmonary vein suspicious for malignancy. Cardiovascular surgery department scheduled the patient for surgical debulking/removal via a minimally invasive approach. The specimen was reported to be multi-lobular and was resected in several fragments of tan, fleshy, and somewhat gelatinous appearing tissue in aggregate. Histopathology showed spindle cell malignant neoplasm with small foci of bone and cartilaginous formation, suggestive of osteosarcoma. Expert consultation at John Hopkins reported this to be a high-grade sarcoma with focal osteosarcomatous differentiation. Cardiac synovial sarcomas are less than 0.1% of all primary cardiac tumors reported in the literature. Cardiac synovial sarcomas are not extensively described in literature due to their low incidence and prevalence. Thus, it is important to report cases and follow outcomes. This case reports an extremely rare diagnosis that has been reported in less than seven case reports.

Initial experience and one-year follow-up with Neuroform Atlas Stent System for the treatment of brain aneurysms.

INTRODUCTION: The Neuroform Atlas Stent System is a recently introduced modification of the original Neuroform Stent System consisting of a hybrid design with open and closed cells. Initial experience, technical considerations and treatment outcomes including 1-year follow-up using the Atlas stent in combination with coil embolization are reported. MATERIAL AND METHODS: Thirty patients with 30 unruptured aneurysms were treated with stent reconstruction. Immediate, 4-month and 12-month post-treatment angiography and clinical assessment were performed. DISCUSSION: In 29 cases, the stents were delivered and positioned without difficulty in deployment. Technical complications occurred in one patient related to advancement of the stent during delivery. One procedure-related clinical complication occurred with no permanent neurological deficit. On immediate post-treatment angiography, 29 of 30 aneurysms showed Raymond Class I or Class II occlusion. At 1-year follow-up, all 30 patients were clinically stable and 18 of 30 aneurysms showed Raymond Class I complete occlusion. Retreatment was performed in two patients with residual aneurysm. CONCLUSIONS: The Atlas stent is technically safe and simple to implant and has a low thrombogenic potential. We experienced fewer problems associated with deployment and implantation, thromboembolic complications and hemorrhagic events compared with other types of stents, including braided stents. However, because of its low thrombogenic potential, partially occluded aneurysms or those with aneurysm remnants do not progress to complete occlusion.

Análisis de los costes directos asociados a la trombectomía mecánica y a la fibrinólisis intravenosa en el Hospital Universitario Central de Asturias / Analysis of the direct costs associated with mechanical thrombectomy and intravenous fibrinolysis in the Hospital Universitario Central de Asturias

Introducción. La ampliación de las indicaciones de la trombectomía mecánica y su implementación en los hospitales españoles hacen necesario conocer los costes relacionados con este tratamiento para racionalizar los recursos económicos y permitir una adecuada distribución de éstos. Objetivos. Analizar los costes directos asociados a los pacientes con ictus isquémico agudo tratados con fibrinólisis intravenosa y con trombectomía mecánica, y valorar la efectividad y seguridad de ambos tratamientos durante los primeros 90 días de evolución en el Hospital Universitario Central de Asturias. Pacientes y métodos. Se realizó un análisis retrospectivo en el que se incluyó a 44 pacientes que recibieron fibrinólisis intravenosa y a 61 pacientes tratados con trombectomía mecánica, en los que se analizaron una serie de variables clínicas y económicas. Resultados. El coste total final medio por paciente fue de 16.059 euros en los tratados con trombectomía y de 8.169 euros en los que se administró fibrinólisis intravenosa. El porcentaje de pacientes con buen pronóstico funcional a los 90 días fue del 63,93% en los tratados de forma endovascular y del 56,82% en los que recibieron fibrinólisis intravenosa. Las tasas de mortalidad fueron del 18,03% y 11,36%, respectivamente. Conclusiones. El coste medio del tratamiento con trombectomía mecánica, así como el coste medio total por paciente durante la fase aguda de la enfermedad asociado a esta técnica, es mayor que en el caso de la fibrinólisis intravenosa. Tanto la fibrinólisis intravenosa como la trombectomía mecánica se configuran en nuestro medio como tratamientos efectivos y seguros (AU)

Introduction. The increase in the indications for mechanical thrombectomy and its implementation in Spanish hospitals makes it necessary to determine the costs related to this treatment so as to be able to streamline economic resources and allow them to be distributed in an appropriate manner. Aims. To analyse the direct costs associated with patients with acute ischaemic stroke who are treated with intravenous fibrinolysis and with mechanical thrombectomy, and to assess the effectiveness and safety of both treatments during the first 90 days of progression in the Hospital Universitario Central de Asturias. Patients and methods. A retrospective analysis was performed that included 44 patients who received intravenous fibrinolysis and 61 patients treated with mechanical thrombectomy, in whom a series of clinical and economic variables were analysed. Results. The mean final total cost per patient was 16,059 euros in treatments with thrombectomy and 8,169 euros in those in which intravenous fibrinolysis was administered. The percentage of patients with a good functional prognosis at 90 days was 63.93% in those treated by endovascular means and 56.82% in those who received intravenous fibrinolysis. Mortality rates were 18.03 and 11.36%, respectively. Conclusions. The mean cost of treatment with mechanical thrombectomy, as well as the total mean cost per patient during the acute phase of the disease associated with this technique, is higher than in the case of intravenous fibrinolysis. In our setting, both intravenous fibrinolysis and mechanical thrombectomy are considered to be effective and safe (AU)

Endovascular reconstruction of internal carotid artery dissection in patients with acute ischemic stroke using the Wingspan stent.

OBJECTIVE: The purpose of this study is to demonstrate our experience in endovascular reconstruction of carotid dissections using the Wingspan Stent System™ (Boston Scientific, Natick, MA, USA), a device we use because of its high radial force and its navigation in extreme curves. METHODS: We treated 11 consecutive patients with acute ischemic stroke due to carotid dissection with the Wingspan stent, in the cervical carotid artery. RESULTS: Functional evaluation revealed that 10 of the 11 patients were independent at 3 months post surgery and that the 11 stents used were found to be patent at the 6-month follow-up digital subtraction angiography (DSA). CONCLUSIONS: The Wingspan stent is an alternative to classic carotid stents and flow diverters for the treatment of cervical internal carotid artery (ICA) dissection associated with ectasias or large loops. The device remains patent over the long term and it is not associated with arterial wall complications.

Descripción de una serie hospitalaria de pacientes con fístula espinal / Description of a series of hospital patients with a spinal fistula

Introducción. Aunque las fístulas espinales suponen el 70% de las malformaciones arteriovenosas espinales, son una entidad infradiagnosticada. El shunt arteriovenoso produce una congestión vascular que da lugar a una mielopatía progresiva, en ocasiones irreversible si no se trata de forma precoz. Objetivo. Describir las características clinicorradiológicas de una serie de pacientes con fístula espinal. Pacientes y métodos. Se realizó una búsqueda retrospectiva de pacientes con diagnóstico de fístula espinal ingresados en el área de neurociencias de un hospital de tercer nivel asistencial. Resultados. Se identificaron 19 pacientes (7 mujeres y 12 varones) con una edad media de 56 años. La fístula espinal fue de tipo I en un 79% de los pacientes y la localización dorsal fue la más frecuente. La mayoría de los casos presentó un curso progresivo (90%). Un 74% de los pacientes se diagnosticó mediante resonancia magnética. En cuatro casos fue necesaria la realización de una angiografía para llegar al diagnóstico, y en uno de ellos se precisó una biopsia intraoperatoria. Se realizaron tres punciones lumbares, en dos de las cuales se objetivó pleocitosis linfocitaria e hiperproteinorraquia. El retraso diagnóstico medio fue de nueve meses. Se trató a un 79% de los pacientes, y de ellos sólo mejoró el 10%. Conclusiones. Ante una clínica sugestiva de fístula espinal, debe realizarse una angiografía espinal diagnóstica aunque el paciente estudiado pueda presentar características licuorales atípicas y normalidad en la resonancia magnética medular (AU)

Introduction. Although spinal fistulas account for 70% of all spinal arteriovenous malformations, they are an underdiagnosed condition. The arteriovenous shunt produces vascular congestion that gives rise to a progressive myelopathy, sometimes irreversible if it is not treated in the early stages. Aim. To describe the clinicoradiological characteristics of a series of patients with spinal fistulas. Patients and methods. A retrospective search was conducted for patients diagnosed with a spinal fistula who were hospitalised in the neuroscience area of a tertiary care hospital. Results. A total of 19 patients (7 females and 12 males) were identified, with a mean age of 56 years. The spinal fistula was type I in 79% of patients, and a dorsal location was the most frequent. Most of the cases (90%) presented a progressive course. Magnetic resonance imaging was used in the diagnosis in 74% of the patients. In four cases angiography was required to reach a diagnosis, and in one of them it was necessary to perform an intraoperative biopsy. Three lumbar punctures were performed, two of which revealed lymphocytic pleocytosis and high protein levels in cerebrospinal fluid. The average diagnostic delay was nine months. Seventy-nine per cent of the patients were treated and only 10% of them improved. Conclusions. When faced with a clinical picture suggestive of a spinal fistula, a diagnostic spinal angiography must be carried out, although the patient under study may present atypical cerebrospinal fluid characteristics and normal results in magnetic resonance imaging of the spinal cord (AU)

Analysis of endovascular treatment of ruptured aneurysms of the middle cerebral artery compared to other anatomical locations.

OBJECTIVE: The objective of this article is to compare the results of endovascular treatment of ruptured middle cerebral artery (MCA) aneurysms with ruptured aneurysms of other anatomic locations. METHODS: Fifty consecutive ruptured aneurysms of the MCA and 209 aneurysms at other anatomical locations were selected retrospectively. We compared epidemiological, clinical and radiological variables, prognosis and complications. RESULTS: The MCA aneurysms had a greater size and a poor dome/neck ratio. There were no significant differences in endovascular technique complications, occlusion rate or rebleeding between the two groups (p > 0.1). There were no significant differences in the mortality and number of dependent patients after one month. CONCLUSION: The endovascular treatment of ruptured MCA aneurysms without hematoma is as safe and effective as other aneurysm localizations. Complication rates, occlusion rates and rebleeding of ruptured MCA aneurysms are comparable to other locations.

Qualitative Evaluation of the Implementation of an Integrated Care Delivery Model for Chronic Patients with Multi-Morbidity in the Basque Country.

INTRODUCTION: The objective of this study was to assess a model for improving healthcare integration for patients with multiple chronic diseases in an integrated healthcare organisation in the Basque Country and to propose areas for improvement. METHODS: We organised four nominal groups composed of representatives from different categories of clinicians involved in the development of an integrated healthcare organisation and in the integrated care of patients with multiple diseases, namely, internists, general practitioners, and primary care and hospital nurses. RESULTS: The aspect rated most positively was the concept itself of an integrated care model, which is able to improve communication between levels of care, increase the quality of the care provided and enhance patient safety. Additionally, it was agreed that the role of assigned clinicians is a key element. The problems identified mostly concern its implementation in daily practice. CONCLUSIONS: The results of this study made it possible to suggest at least 8 areas of improvement to be implemented. These are related to: nurses' roles; care and monitoring of stable patients; team work; communication with patients; coordination with social workers and between internists and family doctors; as well as the development of an office of medical services to lead the integration process.

Anatomical results, rebleeding and factors that affect the degree of occlusion in ruptured cerebral aneurysms after endovascular therapy.

OBJECT: To present a series of ruptured cerebral aneurysms in consecutive non-selected patients treated with endovascular therapy, analyzing the initial degree of occlusion, its anatomical evolution mid-term and the variables that could statistically affect them. METHODS: 251 aneurysms were first treated with coiling (embolization). 203 patients were followed up with conventional angiography for 6-8 months after the initial treatment and 182 were followed up with three-dimensional time of flight MR angiography at 18-24 months. Postoperative and mid-term anatomical results were evaluated anonymously and independently using the modified Montreal Scale. RESULTS: The initial rate of complete occlusion was 70.9%, with rates of neck remnants and aneurysm remants of 18.3% and 10.7%, respectively. The recurrence rate was 13% after 6 months and 2% between 6 months and 2 years. The rate of retreatment was 11%. Statistically, the variables that were found to be related to the initial degree of occlusion were the use of a remodeling balloon technique (p=0.012), the size of the aneurysm neck (p=0.044) and the size of the aneurysm (p=0.004). The recanalization rate at mid-term depended on the size of the aneurysm. Although aneurysms with partial occlusion initially tended to evolve to a worse degree of closure than those with complete occlusion initially, the relationship was not statistically significant (p=0.110). CONCLUSIONS: Embolized aneurysms can develop a worse degree of closure even when the initial occlusion is complete. The degree of occlusion depends directly on morphological factors and the use of balloon-assisted techniques. The recanalization rate at mid-term depends on the size of the aneurysm and probably on the density of the packing achieved with the initial treatment.

Wikipedia vs peer-reviewed medical literature for information about the 10 most costly medical conditions.

CONTEXT: Since its launch in 2001, Wikipedia has become the most popular general reference site on the Internet and a popular source of health care information. To evaluate the accuracy of this resource, the authors compared Wikipedia articles on the most costly medical conditions with standard, evidence-based, peer-reviewed sources. METHODS: The top 10 most costly conditions in terms of public and private expenditure in the United States were identified, and a Wikipedia article corresponding to each topic was chosen. In a blinded process, 2 randomly assigned investigators independently reviewed each article and identified all assertions (ie, implication or statement of fact) made in it. The reviewer then conducted a literature search to determine whether each assertion was supported by evidence. The assertions found by each reviewer were compared and analyzed to determine whether assertions made by Wikipedia for these conditions were supported by peer-reviewed sources. RESULTS: For commonly identified assertions, there was statistically significant discordance between 9 of the 10 selected Wikipedia articles (coronary artery disease, lung cancer, major depressive disorder, osteoarthritis, chronic obstructive pulmonary disease, hypertension, diabetes mellitus, back pain, and hyperlipidemia) and their corresponding peer-reviewed sources (P<.05) and for all assertions made by Wikipedia for these medical conditions (P<.05 for all 9). CONCLUSION: Most Wikipedia articles representing the 10 most costly medical conditions in the United States contain many errors when checked against standard peer-reviewed sources. Caution should be used when using Wikipedia to answer questions regarding patient care.

Aneurisma cerebral roto tipo «blíster» / Ruptured cerebral artery blister aneurysm

Se presenta el caso clínico de un paciente joven con una hemorragia subaracnoidea bien tolerada clínicamente secundaria a la rotura de un aneurisma carotídeo tipo «blíster». Teniendo en cuenta que estos aneurismas son poco frecuentes, tienen paredes muy frágiles y sin un cuello definido, su tratamiento es controvertido. Inicialmente se planteó el abordaje endovascular mediante la implantación de una endoprótesis semicubierta redireccionadora de flujo, pero la evolución morfológica del aneurisma a los 10 días condicionó un cambio en el plan terapéutico. Finalmente se implantó una endoprótesis convencional cubriendo el cuello y se introdujeron 2 microcoils en el punto de rotura, con buen resultado morfológico. El paciente evolucionó de manera satisfactoria. En el seguimiento después de uno y 6 meses se demostró la estabilidad del tratamiento. Se realiza una breve introducción a esta patología y una pequeña discusión sobre las distintas opciones terapéuticas (AU)

We report the case of a young patient with subarachnoid haemorrhage secondary to a ruptured blister-like aneurysm. Since this kind of aneurysms have fragile walls without a well-defined neck, their treatment is difficult. We initially planned the deployment of a flow-diverter stent, but an angiogram obtained after 10 days revealed a morphological change of the aneurysm. Therefore, we finally deployed a conventional stent and introduced 2 micro coils into the point of rupture, obtaining a good morphological result without rebleeding. Follow-up at 1 and 6 months did not observe regrowth of the aneurysm. We offer a brief introduction and discussion of this pathology and its treatment (AU)

[Ruptured cerebral artery blister aneurysm]. / Aneurisma cerebral roto tipo «blíster¼

We report the case of a young patient with subarachnoid haemorrhage secondary to a ruptured blister-like aneurysm. Since this kind of aneurysms have fragile walls without a well-defined neck, their treatment is difficult. We initially planned the deployment of a flow-diverter stent, but an angiogram obtained after 10 days revealed a morphological change of the aneurysm. Therefore, we finally deployed a conventional stent and introduced 2 micro coils into the point of rupture, obtaining a good morphological result without rebleeding. Follow-up at 1 and 6 months did not observe regrowth of the aneurysm. We offer a brief introduction and discussion of this pathology and its treatment.

Use of Cuban recombinant human erythropoietin in Parkinson's disease treatment.

INTRODUCTION: Recombinant human erythropoietin is used primarily to treat anemia. There is evidence of its neuroprotective capacity from preclinical studies in Parkinson's disease and other neurodegenerative diseases. Recombinant human erythropoietin produced in Cuba (ior-EPOCIM) is registered and approved for use in humans in Cuba and in a number of other countries. OBJECTIVE: Assess safety and possible neuroprotective effect of ior-EPOCIM in a group of Parkinson's disease patients. METHODS: A three-phase exploratory study (proof of concept) was conducted from August 2008 to April 2009: preliminary assessment, treatment (weeks 1-5), and post-treatment (weeks 6-35). Participants were 10 Parkinson's disease patients (8 men, 2 women) from the outpatient clinic at the International Neurological Restoration Center, all at least one year post onset, aged 47-65 years. The ior-EPOCIM was administered subcutaneously in a once-weekly dose (60 IU/kg body weight) for five weeks. Therapy with patients' antiparkinsonian drugs was maintained throughout the study, except during motor examination, conducted following a 12-hour withdrawal (OFF condition). Safety was evaluated primarily by recording adverse events (by intensity and causality) from start of treatment until the study's completion. Hematological parameters and blood pressure were also measured because of their direct relationship to the medication's action. To evaluate possible neuroprotective activity, variables were included related to patients' motor function and cognitive and affective status, measured using internationally recognized scales. All variables were evaluated before, during and after treatment. Data were processed using a fixed-effects linear model, with a repeated-measures design (significance level p ≤ 0.05). RESULTS: Three patients experienced mild adverse events (precordial discomfort and hypertension in one; leg fatigue in another; renal colic in a third), with a possible causal relationship in the first two that was neither life threatening nor required hospitalization. Hemoglobin was the only hematological parameter that showed a growing and significant increase (p < 0.001), but without reaching pathological levels. The other variables presented clinically positive and statistically significant changes compared to pretreatment assessment: motor function (p < 0.001), cognitive status (p < 0.001) and mood (p = 0.013). CONCLUSIONS At the dosage used, ior-EPOCIM was safe and well tolerated in these Parkinson's disease patients. Further studies are needed to corroborate these results and evaluate the medication's possible neuroprotective effect. KEYWORDS Parkinson disease, erythropoietin, recombinant proteins, neuroprotective agents, clinical trial, safety, ior-EPOCIM, Cuba.

[Endovascular treatment of carotid stenosis: an experience in the Hospital Universitario Central de Asturias]. / Tratamiento endovascular de la estenosis carotídea: experiencia en el Hospital Universitario Central de Asturias.

INTRODUCTION: Carotid stenosis accounts for about 25% of all ischaemic cerebrovascular events. Carotid angioplasty and stenting (CAS) is a minimally invasive procedure used as an alternative to carotid endarterectomy, especially in high surgical risk patients. AIM: To analyse the effectiveness and safety of the endovascular treatment of carotid stenosis in the Hospital Universitario Central de Asturias. PATIENTS AND METHODS: The study consisted in a retrospective analysis of the carotid stenoses treated by means of CAS between February 2005 and April 2010, and the following information was recorded: demographic data, clinical diagnosis, indication of treatment, time between the onset of symptoms and beginning of treatment, angiographic findings, complications and long-term follow-up (including the rate of restenosis). RESULTS: Altogether 121 patients were treated (77.8% males and 22.2% females), with a mean age of 70.8 ± 10.7 years. The main vascular risk factors were arterial hypertension (65.3%), smoking (61.2%) and dyslipidaemia (42.1%). In 86% of cases the stenoses were symptomatic and in the remaining 14% they were asymptomatic. In 60.3% of cases they were stenoses > 70%, in 30.6% they were preocclusive stenoses and in 9.1% they were recanalisations of unstable carotid occlusions. The mean treatment time was 17.0 ± 8.3 days after the ischaemic event. The residual stenosis was less than 30% in all cases. The morbidity and mortality rate at 30 days was 4.1% and the rate of restenosis throughout a mean follow-up of 31.2 ± 10.8 months was 2.4%. CONCLUSIONS: In our hospital CAS is considered an effective and safe technique, with a rate of complications that is within the parameters that justify its indication.

Cognitive changes after stem cell transplantation in a patient with subcortical stroke.

The authors report a case of a 55-year-old Caucasian woman who received autologous bone marrow stem cell transplantation 3 years after a subcortical stroke. She exhibited positive cognitive changes 6 months and 1 year after the surgery without rehabilitation. The blood flow changes, measured with SPECT, were statistical significant in prefrontal areas. During the presurgical neuropsychological assessment, the patient presented a critical speech reduction, reflected in impaired performance in verbal fluency, vocabulary and in each task which required overt verbal response. One year later, she showed improvement in mental flexibility, receptive language, phonological fluency, verbal memory and auditory verbal memory. Positive cognitive changes in verbal and executive functions seem to be contingent on increased blood flow in prefrontal areas. Posterior neuropsychological evaluation 3 and 5 years after transplantation did not show deterioration of the cognitive improvement.

Stratified active screening: where neurotechnology meets public health.

Nearly one quarter of the global burden of disease stems from neurological, psychiatric and neurodevelopmental disorders due to malformations or dysfunctions of the central nervous system.[1] Such neuropsychiatric conditions influence quality of life worldwide, causing one third of years lost due to disability (YDL).[2] Ranging from congenital conditions to dementias of the elderly, these disorders appear throughout the life cycle and also account for a substantial proportion of mortality. Recent advances in neuroimaging and neuroinformatics have opened the way for early identification of dysfunctional brain networks, providing essential information for the early detection, proper diagnosis, treatment selection, and follow-up of people with disabilities due to brain disorders.

La familia y su papel en los problemas de promoción y prevención de salud bucal / Family and its role in oral health promotion and prevention

La familia es la institución básica de la sociedad; constituye la unidad de reproducción y mantenimiento de la especie humana y en ese sentido, es el elemento que sintetiza la producción de la salud a escala microsocial. Cumple funciones importantes en el desarrollo biológico, psicológico y social del individuo y ha asegurado, junto con otros grupos sociales, la socialización y educación de este para su inserción en la vida social y la transmisión generacional de valores culturales. Podemos decir que la familia es en sí misma una tríada ecológica, aún hoy en parte desconocida, y por lo tanto, con problemas de manejo por parte del estomatólogo. Esto motivó a realizar una revisión bibliográfica con el objetivo de profundizar en la importancia de la familia en la promoción y prevención de salud general y bucal, así como actualizar estos conocimientos sobre esta situación en nuestro país, concluyendo con la necesidad de perfeccionar la actividad de la familia, formando en ella una determinada cultura de salud que abarque todos los aspectos de la vida, incluyendo la salud bucal, para mejorar los resultados en la prevención de enfermedades y promoción de salud(AU)

The family is the basic institution of the society, the reproductive unit that keeps the human species, and thus, it constitutes the element that centered health production at microsocial scale. The family has important functions in the biological, psychological and social development of the individual and has assured, together with other social groups, the socialization and education of the human being for its integration into the social life and the transfer of cultural values from one generation to the other. We may say that the family is an ecological triade, still partly unknown, difficult to be managed by the dentist. The above-mentioned prompted us to make a literature review on the importance of family in the promotion and prevention of general and oral health status and to update knowledge on our country´s situation. It was concluded that the role of the family should be improved in this regard by creating certain health culture that embraces all aspects of life including oral health, in order to better the results in the prevention of diseases and health promotion(AU)

La familia y su papel en los problemas de promoción y prevención de salud bucal / Family and its role in oral health promotion and prevention

La familia es la institución básica de la sociedad; constituye la unidad de reproducción y mantenimiento de la especie humana y en ese sentido, es el elemento que sintetiza la producción de la salud a escala microsocial. Cumple funciones importantes en el desarrollo biológico, psicológico y social del individuo y ha asegurado, junto con otros grupos sociales, la socialización y educación de este para su inserción en la vida social y la transmisión generacional de valores culturales. Podemos decir que la familia es en sí misma una tríada ecológica, aún hoy en parte desconocida, y por lo tanto, con problemas de manejo por parte del estomatólogo. Esto motivó a realizar una revisión bibliográfica con el objetivo de profundizar en la importancia de la familia en la promoción y prevención de salud general y bucal, así como actualizar estos conocimientos sobre esta situación en nuestro país, concluyendo con la necesidad de perfeccionar la actividad de la familia, formando en ella una determinada cultura de salud que abarque todos los aspectos de la vida, incluyendo la salud bucal, para mejorar los resultados en la prevención de enfermedades y promoción de salud(AU)

The family is the basic institution of the society, the reproductive unit that keeps the human species, and thus, it constitutes the element that centered health production at microsocial scale. The family has important functions in the biological, psychological and social development of the individual and has assured, together with other social groups, the socialization and education of the human being for its integration into the social life and the transfer of cultural values from one generation to the other. We may say that the family is an ecological triade, still partly unknown, difficult to be managed by the dentist. The above-mentioned prompted us to make a literature review on the importance of family in the promotion and prevention of general and oral health status and to update knowledge on our country´s situation. It was concluded that the role of the family should be improved in this regard by creating certain health culture that embraces all aspects of life including oral health, in order to better the results in the prevention of diseases and health promotion(AU)

A theoretical formulation of the electrophysiological inverse problem on the sphere.

The construction of three-dimensional images of the primary current density (PCD) produced by neuronal activity is a problem of great current interest in the neuroimaging community, though being initially formulated in the 1970s. There exist even now enthusiastic debates about the authenticity of most of the inverse solutions proposed in the literature, in which low resolution electrical tomography (LORETA) is a focus of attention. However, in our opinion, the capabilities and limitations of the electro and magneto encephalographic techniques to determine PCD configurations have not been extensively explored from a theoretical framework, even for simple volume conductor models of the head. In this paper, the electrophysiological inverse problem for the spherical head model is cast in terms of reproducing kernel Hilbert spaces (RKHS) formalism, which allows us to identify the null spaces of the implicated linear integral operators and also to define their representers. The PCD are described in terms of a continuous basis for the RKHS, which explicitly separates the harmonic and non-harmonic components. The RKHS concept permits us to bring LORETA into the scope of the general smoothing splines theory. A particular way of calculating the general smoothing splines is illustrated, avoiding a brute force discretization prematurely. The Bayes information criterion is used to handle dissimilarities in the signal/noise ratios and physical dimensions of the measurement modalities, which could affect the estimation of the amount of smoothness required for that class of inverse solution to be well specified. In order to validate the proposed method, we have estimated the 3D spherical smoothing splines from two data sets: electric potentials obtained from a skull phantom and magnetic fields recorded from subjects performing an experiment of human faces recognition.