Changes in brain activity associated with cognitive-behavioral exposure therapy for specific phobias: searching for underlying mechanisms. / Cambios en la actividad cerebral asociados a la terapia de exposición cognitivo-conductual para fobias específicas: búsqueda de los mecanismos subyacentes.

INTRODUCTION: The current evidence collected consistent results about morphological and functional brain changes produced by psychological treatment. Exposure cognitive-behavioral therapy (CBT) is currently the most effective psychological treatment for phobias. AIMS: To explore the brain activation and self-reported changes in patients with specific phobias to small animals who underwent a CBT exposure program and to prove if the CBT program made phobic patients process feared stimuli similarly to non-phobic persons. SUBJECTS AND METHODS: The sample consisted of 32 adults, of which 16 (5 males and 11 females; mean age: 38.08) had specific phobia to small animals and 16 (4 males and 12 females; mean age: 21.81) had no phobias. A univariate before-and-after treatment design were used. In addition, the scores of the non-phobic group in self-reports and brain activity were compared with the post-treatment scores of the phobic group. RESULTS: Data show significant changes in brain activity, and improvements in self-reported measures because of applying CBT to specific phobias. As a highlight, participants showed a greater activation in points of the precuneus after receiving CBT. Also, when compared with non-phobic participants, phobic patients still remain with both fear and defensive responses to phobic stimuli. CONCLUSIONS: The precuneus seems to be a regulator that reorganizes the processing of phobic stimuli. It can imply as CBT/ exposure also active acceptance, self-awareness, and self-efficacy mechanisms.

TITLE: Cambios en la actividad cerebral asociados a la terapia de exposición cognitivo-conductual para fobias específicas: búsqueda de los mecanismos subyacentes.Introducción. La evidencia disponible recoge resultados consistentes sobre cambios cerebrales morfológicos y funcionales producidos por el tratamiento psicológico. La terapia cognitivo-conductual (TCC) de exposición es actualmente el tratamiento psicológico más eficaz para las fobias. Objetivos. Explorar los cambios cerebrales y autoinformados en pacientes con fobias específicas a animales pequeños sometidos a un programa de TCC de exposición y comprobar si el programa consiguió que estos pacientes procesaran los estímulos temidos de manera similar a las personas no fóbicas. Sujetos y métodos. La muestra estuvo compuesta por 32 adultos, de los que 16 (5 hombres y 11 mujeres; edad media: 38,08 años) tenían un diagnóstico de fobia específica a animales pequeños y 16 (4 hombres y 12 mujeres; edad media: 21,81 años) no tenían dicho diagnóstico. Se utilizó un diseño univariado de tratamiento antes-después. Las puntuaciones del grupo sin fobia en autoinformes y activación cerebral se compararon con las puntuaciones del grupo con fobia posteriores al tratamiento. Resultados. Los datos muestran cambios significativos en la actividad cerebral y mejoras en las medidas autoinformadas debido a la aplicación de la TCC a la fobia específica. Tras recibir TCC, los participantes mostraron una mayor activación en puntos del precúneo. Además, comparado con los participantes sin fobia, los pacientes fóbicos mantenían las respuestas defensivas y de miedo ante los estímulos fóbicos. Conclusiones. El precúneo parece ser un regulador que reorganiza el procesamiento de los estímulos fóbicos. Puede implicar que la TCC de exposición, además, activa mecanismos de aceptación, autoconciencia y autoeficacia.

TRPM8, ASIC1, and ASIC3 localization and expression in the human oropharynx.

BACKGROUND: Oropharyngeal dysphagia (OD) is a prevalent disease with poor prognosis among older people and has no pharmacological treatment. Polymodal sensory receptors like the TRP or ASIC family receptors are potential targets to treat OD. TRPM8 agonists and acidic solutions can improve the swallow response in patients with OD, but little is known about the expression of TRPM8, ASIC1, and ASIC3 in the human oropharynx. The aim of this study was to assess the expression and localization of TRPM8, ASIC1, and ASIC3 in human samples of the oropharynx to lay the basis for new pharmacological treatments for OD. METHODS: Pathology-free samples from oropharyngeal regions innervated by cranial nerves V, IX, and X were obtained during major ENT surgery and processed to obtain mRNA (20 patients) or to be used in immunohistochemical assays (12 patients). TRPM8, ASIC1, and ASIC3 expression and localization were studied with RT-qPCR and fluorescent immunohistochemistry. KEY RESULTS: ASIC3 was expressed in the 3 regions studied with similar levels and was localized on sensory fibers innervating the mucosa below the basal lamina of all studied regions. TRPM8 was also co-localized on the sensory fibers innervating the mucosa below the basal lamina of all studied regions. In contrast, ASIC1 was only found in the nerves innervating the tongue muscular fibers. CONCLUSIONS & INFERENCES: TRPM8 and ASIC3 are found on submucosal sensory nerves in the human oropharynx. Our study lays the basis to use oropharyngeal TRPM8 and ASIC3 receptors as therapeutic targets to develop new active pharmacological treatments for OD patients.

A meta-analytic review of neuroimaging studies of specific phobia to small animals

Introduction: Neuroimaging techniques have been used to identify the neurological bases of phobias. Objective: This meta-review examines functional magnetic resonance imaging studies of individuals with specific animal phobia compared to healthy controls. Method: Searches on Medline, Psycinfo, Academic Search Complete, PubMed, PsycARTICLES, Redalyc, Scopus, and Cochrane databases were conducted. Twenty high quality studies were selected. The effect size estimation was calculated. Results: The random-effects model showed a high overall effect size for both limbic and frontal sites. Data analyses showed greater brain activity in the left amygdala and insular cortex in phobic individuals. We also observed an activation of the fusiform gyrus, the dorsolateral prefrontal cortex left, and the left cingulate cortex, although these areas were less frequently involved. Healthy controls showed high heterogeneity in the brain areas activated by phobic stimuli. Conclusions: These findings suggest the possible existence of a double processing pathway in phobic stimuli: a rapid processing pathway involving limbic areas and a slow pathway involving both limbic and frontal areas

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Study on some risk factors and effects of bovine ketosis on dairy cows from the Galicia region (Spain).

The study was designed to determine the relation between ß-hydroxybutyrate (BHB) concentrations in milk from dairy cows after calving and the length of the previous lactation, the dry period and the 305-day normalized production, and to assess the influence of BHB concentrations on culling and test-day milk productions and somatic cell counts (SCC) throughout the lactation that followed the BHB measurement. The data used in the study were obtained from 59 187 cows in the Galicia region (Spain). BHB determination was performed using Fourier-transformed infrared spectrometry from the milk samples collected from each cow on the first post-partum test day. For statistical analysis, the following methods were applied: (i) ordinal regression to assess the effect of the length of the previous lactation, the dry period and the 305-day normalized milk production on milk BHB, (ii) a Cox model to estimate the influence of the BHB concentration on risk of culling (overall and for a variety of reasons) and (iii) linear regression to assess the link between BHB and the milk yield and SCC obtained from each of the tests day performed throughout lactation. The probability of having higher BHB concentrations increased when the length of the previous lactation (p = 0.006), the dry period (p = 0.003) and the 305-day normalized milk yield (p = 0.005) increased. However, the slight increase observed (especially for the case of the dry period and the 305-day milk yield) would not justify that measures be implemented to reduce these traits. Higher concentrations of BHB led to an increased risk of culling due to 'death' (p ≤ 0.001) and 'urgent slaughter' (p ≤ 0.002) (both causes of involuntary culling). It also led to a reduction in milk production (p < 0.001) and an increase in SCC (p < 0.001) in the post-partum; from that moment onward (including peak lactation), there were no differences in those two parameters depending on the BHB levels.

Síndrome paraneoplásico ocular: retinopatía asociada al cáncer / Ocular paraneoplastic syndrome: cancer-associated retinopathy

Caso clínico: Se presenta un síndrome paraneoplásico ocular con una retinopatía asociada al cáncer (RAC) que producía déficit visual, disminución de calibre y envainamiento de las arteriolas retinianas. El ERG mostraba grandes alteraciones de las ondas a y b. El proceso tumoral no se descubrió hasta pasados 6 meses, en que apareció una neoplasia escamosa que invadía útero y vagina. Discusión: Los síndromes paraneoplásicos son manifestaciones secundarias a la producción de sustancias, por las células neoplásicas, que actúan a distancia del foco tumoral. El síndrome RAC es una reacción autoinmune cruzada de antígenos de origen tumoral con la recoverina de la retina. El oftalmólogo debe conocer la existencia de estas manifestaciones paraneoplásicas oculares porque pueden constituir el primer signo de un tumor maligno no diagnosticado (AU)

Case Report: We review a patient with ocular manifestations of a paraneoplastic syndrome. It was a cancer-associated retinopathy (CAR) in a woman with visual loss, and attenuated and sheathed retinal arterioles. The electroretinography (ERG) showed severe abnormalities of the a and b-waves. The tumour process was not discovered until 6 months later, when a squamous neoplasia that invaded the uterus and vagina was observed. Discussion: Paraneoplastic syndromes are a group of manifestations produced as a remote effect of cancer cells. CAR syndrome is caused by autoimmune reactions to retinal antigens induced by aberrant expression of recoverin in cancer tissues. Ophthalmologists must be aware of ocular paraneoplastic signs as they can be the first manifestations of a malignant tumour (AU)

[Ocular paraneoplastic syndrome: cancer-associated retinopathy]. / Síndrome paraneoplásico ocular: retinopatía asociada al cáncer.

CASE REPORT: We review a patient with ocular manifestations of a paraneoplastic syndrome. It was a cancer-associated retinopathy (CAR) in a woman with visual loss, and attenuated and sheathed retinal arterioles. The electroretinography (ERG) showed severe abnormalities of the a and b-waves. The tumour process was not discovered until 6 months later, when a squamous neoplasia that invaded the uterus and vagina was observed. DISCUSSION: Paraneoplastic syndromes are a group of manifestations produced as a remote effect of cancer cells. CAR syndrome is caused by autoimmune reactions to retinal antigens induced by aberrant expression of recoverin in cancer tissues. Ophthalmologists must be aware of ocular paraneoplastic signs as they can be the first manifestations of a malignant tumour.

AMPD1 genotypes and exercise capacity in McArdle patients.

The purpose of this study was to assess if there exists an association between C34T muscle adenosine monophosphate deaminase ( AMPD1) genotypes (i.e., normal homyzygotes [CC] vs. heterozygotes [ CT]) and directly measured indices of exercise capacity (peak oxygen uptake [VO(2peak)], ventilatory threshold [VT], gross mechanical efficiency [GE], etc.) in 44 Caucasian McArdle patients (23 males, 21 females). All patients performed a graded cycle ergometer test until exhaustion (for VO(2peak) and VT determination) and a 12-min constant-load test at the power output eliciting the VT (for GE determination). We found no significant difference in indices of exercise capacity between CC (n = 18) and CT genotypes (n = 5) in the group of male patients (p > 0.05). In contrast, the VO(2) at the VT was significantly lower (p < 0.05) in CT (n = 4; 7.9 +/- 0.4 ml/kg/min) than in CC female patients (n = 17; 11.0 +/- 0.9 ml/kg/min). In summary, heterozigosity for the C34T allele of the AMPD gene is associated with reduced submaximal aerobic capacity in female patients with McArdle disease and might partly account, in this gender, for the variability that exists in the phenotypic manifestation of the disease.

Benefits of intrahospital exercise training after pediatric bone marrow transplantation.

The purpose of this study was to determine if an eight-week intrahospital supervised, conditioning program improves functional capacity and quality of life (QOL) in children (4 boys, 4 girls) (mean [SD] age: 10.9 [2.8] years [range: 8-16]) who have undergone bone marrow transplantation (BMT) for leukemia treatment within the last 12 months. A group of 8 age and gender-matched healthy children served as controls. The experimental group performed 3 weekly sessions of resistance and aerobic training inside an intra-hospital gymnasium. A significant combined effect of group and time (p < 0.05) was observed for muscle functional capacity (Timed Up and Down Stairs [TUDS] test) and peak oxygen uptake (V.O(2peak)), i.e., with BMT children showing greater improvements than controls (V.O(2peak) at pre- and post-training of 25.9 (8.2) and 31.1 (7.6) mL/kg/min in diseased children). Muscle strength (6 RM test for bench and leg press and seated row) also improved after training (p < 0.05) in the BMT group. Concerning QOL, a significant combined effect of group and time (p < 0.05) was also observed for children's self-report of comfort and resilience and for parents' report of their children's satisfaction and achievement. In summary, children who have received BMT experience physical and overall health benefits after a relatively short-term (8 weeks) supervised exercise training program.

Functional capacity of children with leukemia.

The purpose of this study was to determine if the functional capacity and quality of life of children receiving treatment against acute lymphoblastic leukemia (ALL) is decreased compared to healthy age and gender-matched children. Functional capacity was assessed with a number of measurements as the peak oxygen uptake (VO2peak) and ventilatory threshold determined during a ramp treadmill test, functional mobility (Timed Up and Down Stairs test [TUDS]) and ankle dorsiflexion passive and active range of motion (passive and active DF-ROM, respectively). Quality of life (QOL) was determined with the Spanish version of the Child Report Form of the Child Health and Illness Profile-Child Edition (CHIP-CE/CRF). Fifteen children (9 boys, 6 girls; mean [SD] age: 6.8 +/- 3.1 years) receiving maintenance therapy against ALL were studied and fifteen, nonathletic healthy children (9 boys, 6 girls; 6.9 +/- 3.3 years) were selected as controls. The mean values of VO2peak and active DF-ROM were significantly (p < 0.05) lower in patients (25.3 +/- 6.5 ml . kg (-1) . min (-1) vs. 31.9 +/- 6.8 ml . kg (-1) . min (-1) in controls and 19.6 +/- 8.0 degrees vs. 24.1 +/- 5.0 degrees , respectively). Children's self report of satisfaction (with self and health) (p < 0.05), comfort (concerning emotional and physical symptoms and limitations) (p < 0.01) and resilience (positive activities that promote health) (p < 0.01) were significantly decreased in patients with ALL. In summary, children receiving treatment against ALL have overall lower functional capacity and QOL than healthy children. However, their physical condition and health status are sufficiently high to allow them to participate in physical activities and supervised exercise programs.

A reattributional training program as a therapeutic strategy for fear of flying.

In this study the results for the validation of a reattributional training program applied to the fear of flying are presented. The program is made up of 13 (+/- 1) sessions and consists of three phases: Information; reattributional training; and the elaboration and application of the treatment designed by the patient with the help of the therapist. The program was applied to 24 patients while 24 other patients made up the waiting control group. The therapeutic success was evaluated by means of self-report scales, and by recording psychophysiological variables in a situation in which subjects viewed a video tape of a flight. Significant differences were obtained from the ANOVAs between experimental and control groups in all of the self-reported variables (p < 0.001) and in some of the psychophysiological variables (p < 0.05). The results support the effectiveness of the program.

[A meta-analytical review of the response by sex to vaccination against hepatitis B in hospital personnel]. / Revisión metaanalítica de la respuesta por sexo a la vacunación contra la hepatitis B en personal hospitalario.

OBJECTIVE: To study the influence of gender on the immunogenic response to the hepatitis B vaccine in healthy persons. DESIGN: Meta-analysis. SETTING: Primary care: prevention. PARTICIPANTS: The results published between 1983 and 1991 by several authors dealing with staff in Spanish hospitals were reviewed. MAIN MEASUREMENTS AND RESULTS: It was observed that the frequency of women's antibody response differed significantly from that of men (chi-squared = 23.35; p < 0.001) with an odds ratio of 2 (95% confidence intervals: 1.64-2.46) and a risk difference of 7.69% (95% CI: 5.2-10.19%). CONCLUSIONS: The response rate to the hepatitis B vaccine is significantly higher among women than men. However, several factors (e.g. age and weight) may affect these findings. These have not been examined because they were not described in the findings of the preliminary studies.