Greater extracellular free-water in first-episode psychosis predicts better neurocognitive functioning.

Free Water Imaging is a novel diffusion magnetic resonance (MR) imaging method that is able to separate changes affecting the extracellular space from those that reflect changes in neuronal cells and processes. A previous Free Water Imaging study in schizophrenia identified significantly greater extracellular water volume in the early stages of the disorder; however, its clinical and functional sequelae have not yet been investigated. Here, we applied Free Water Imaging to a larger cohort of 63 first-episode patients with psychosis and 70 healthy matched controls to better understand the functional significance of greater extracellular water. We used diffusion MR imaging data and the Tract-Based Spatial Statistics analytic pipeline to first analyze fractional anisotropy (FA), the most commonly employed metric for assessing white matter. This comparison was then followed by Free Water Imaging analysis, where two parameters, the fractional volume of extracellular free-water (FW) and cellular tissue FA (FA-t), were estimated and compared across the entire white matter skeleton between groups, and correlated with cognitive measures at baseline and following 12 weeks of antipsychotic treatment. Our results indicated lower FA across the whole brain in patients compared with healthy controls that overlap with significant increases in FW, with only limited decreases in FA-t. In addition, higher FW correlated with better neurocognitive functioning following 12 weeks of antipsychotic treatment. We believe this is the first study to suggest that an extracellular water increase during the first-episode of psychosis, which may be indicative of an acute neuroinflammatory process, and/or cerebral edema may predict better functional outcome.

Hippocampal subregion volume changes associated with antipsychotic treatment in first-episode psychosis.

BACKGROUND: Hippocampal dysfunction is considered central to many neurobiological models of schizophrenia, yet there are few longitudinal in vivo neuroimaging studies that have investigated the relationship between antipsychotic treatment and morphologic changes within specific hippocampal subregions among patients with psychosis. METHOD: A total of 29 patients experiencing a first episode of psychosis with little or no prior antipsychotic exposure received structural neuroimaging examinations at illness onset and then following 12 weeks of treatment with either risperidone or aripiprazole in a double-blind randomized clinical trial. In addition, 29 healthy volunteers received structural neuroimaging examinations at baseline and 12-week time points. We manually delineated six hippocampal subregions [i.e. anterior cornu ammonis (CA) 1-3, posterior CA1-3, subiculum, dentate gyrus/CA4, entorhinal cortex, and fimbria] from 3T magnetic resonance images using an established method with high inter- and intra-rater reliability. RESULTS: Following antipsychotic treatment patients demonstrated significant reductions in dentate gyrus/CA4 volume and increases in subiculum volume. Healthy volunteers demonstrated non-significant volumetric changes in these subregions across the two time points. We observed a significant quadratic (i.e. inverted U) association between changes in dentate gyrus/CA4 volume and cumulative antipsychotic dosage between the scans. CONCLUSIONS: This study provides the first evidence to our knowledge regarding longitudinal in vivo volumetric changes within specific hippocampal subregions in patients with psychosis following antipsychotic treatment. The finding of a non-linear relationship between changes in dentate gyrus/CA4 subregion volume and antipsychotic exposure may provide new avenues into understanding dosing strategies for therapeutic interventions relevant to neurobiological models of hippocampal dysfunction in psychosis.

[Assessment method for mobile health applications in Spanish: The iSYScore index]. / Método de valoración de aplicaciones móviles de salud en español: el índice iSYScore.

The widespread of mobile smartphones among the population has resulted in a growing range of mobile applications in health using iOS and Android devices. The level of confidence that such applications deserve and the health information available online to the general population is a widely debated issue. The main objective of this work was to develop a tool -a scale-, for evaluating the reliability of health apps. The scale was developed using a systematic evidence-based approach, and with an expert consensus, built with a Delphi process. This was followed by a health app catalogue, which was used to test and validate our method that helps to recommend the best apps for non-medical experts across 3 different user interest axes: 1) popularity and interest; 2) trust and quality; and 3) usefulness.

Brain-controlled neuromuscular stimulation to drive neural plasticity and functional recovery.

There is mounting evidence that appropriately timed neuromuscular stimulation can induce neural plasticity and generate functional recovery from motor disorders. This review addresses the idea that coordinating stimulation with a patient's voluntary effort might further enhance neurorehabilitation. Studies in cell cultures and behaving animals have delineated the rules underlying neural plasticity when single neurons are used as triggers. However, the rules governing more complex stimuli and larger networks are less well understood. We argue that functional recovery might be optimized if stimulation were modulated by a brain machine interface, to match the details of the patient's voluntary intent. The potential of this novel approach highlights the need for a better understanding of the complex rules underlying this form of plasticity.

Design and validation of a neuroprosthesis for the treatment of upper limb tremor.

Pathological tremor is the most prevalent movement disorder. In spite of the existence of various treatments for it, tremor poses a functional problem to a large proportion of patients. This paper presents the design and implementation of a novel neuroprosthesis for tremor management. The paper starts by reviewing a series of design criteria that were established after analyzing users needs and the expected functionality of the system. Then, it summarizes the design of the neuroprosthesis, which was built to meet the criteria defined previously. Experimental results with a representative group of 12 patients show that the neuroprosthesis provided significant (p < 0.001) and systematic tremor attenuation (in average 52.33 ± 25.48 %), and encourage its functional evaluation as a potential new treatment for tremor in a large cohort of patients.

Non-invasive characterization of motor unit behaviour in pathological tremor.

This paper presents the fully automatic identification of motor unit spike trains from high-density surface electromyograms (EMG) in pathological tremor. First, a mathematical derivation is provided to theoretically prove the possibility of decomposing noise-free high-density surface EMG signals into motor unit spike trains with high correlation, which are typical of tremor contractions. Further, the proposed decomposition method is tested on simulated signals with different levels of noise and on experimental signals from 14 tremor-affected patients. In the case of simulated tremor with central frequency ranging from 5 Hz to 11 Hz and signal-to-noise ratio of 20 dB, the method identified ∼8 motor units per contraction with sensitivity in spike timing identification ≥ 95% and false alarm and miss rates ≤ 5%. In experimental signals, the number of identified motor units varied substantially (range 0-21) across patients and contraction types, as expected. The behaviour of the identified motor units was consistent with previous data obtained by intramuscular EMG decomposition. These results demonstrate for the first time the possibility of a fully non-invasive investigation of motor unit behaviour in tremor-affected patients. The method provides a new means for physiological investigations of pathological tremor.

A modelling study on transmission of the central oscillator in tremor by a motor neuron pool.

In spite of decades of intense research, pathological tremors still constitute unknown disorders. This study addresses, based on a multi-scale model, the behavior of an entire pool of motor neurons in tremor, under the hypothesis that tremor is an oscillation of central origin commonly projected to all motor neurons that innervate a muscle. Our results show that under such conditions both paired discharges and enhanced motor neuron synchronization, two of the characteristic landmarks of tremor, emerge. Moreover, coherence and correlation analyses suggest that the central tremor oscillator is transmitted linearly by the motor neuron pool given that a small set (7 or 8) of motor neurons are sampled.

Noninvasive analysis of motor unit behavior in pathological tremor.

A robust surface EMG decomposition tool, referred to as tremor-optimized Convolution Kernel Compensation (CKC) technique, is described. This technique modifies and extends the previously published CKC method in order to circumvent the typical assumption on regularity and asynchrony of motor unit firings in normal condition and adapt to the discharge patterns in pathological tremor. The results on synthetic and experimental surface EMG signals demonstrate high performance of decomposition. In the case of simulated surface EMG with 20 dB SNR, excitation level of 20% maximum voluntary contraction (MVC) and simulated tremor frequency of 8 Hz, the newly proposed method identified 8 ± 2 motor units with sensitivity of motor unit discharge identification ≥ 95 % and false alarm and miss rates ≤ 5%. The performance worsened with increasing noise power, with 5 ± 2 motor units identified at 10 dB SNR and 3 ± 1 at 0 dB SNR. In 24 recordings of high-density surface EMG signals from four tremor-affected patients, the modified CKC technique identified 134 motor units (6 ± 4 motor units per contraction).

Multimodal BCI-mediated FES suppression of pathological tremor.

Tremor constitutes the most common movement disorder; in fact 14.5% of population between 50 to 89 years old suffers from it. Moreover, 65% of patients with upper limb tremor report disability when performing their activities of daily living (ADL). Unfortunately, 25% of patients do not respond to drugs or neurosurgery. In this regard, TREMOR project proposes functional compensation of upper limb tremors with a soft wearable robot that applies biomechanical loads through functional electrical stimulation (FES) of muscles. This wearable robot is driven by a Brain Neural Computer Interface (BNCI). This paper presents a multimodal BCI to assess generation, transmission and execution of both volitional and tremorous movements based on electroencephalography (EEG), electromyography (EMG) and inertial sensors (IMUs). These signals are combined to obtain: 1) the intention to perform a voluntary movement from cortical activity (EEG), 2) tremor onset, and an estimation of tremor frequency from muscle activation (EMG), and 3) instantaneous tremor amplitude and frequency from kinematic measurements (IMUs). Integration of this information will provide control signals to drive the FES-based wearable robot.

Goodpasture's syndrome in a patient using cocaine--a case report and review of the literature.

Glomerulonephritis is a very rare form of cocaine-induced renal pathology. We report a 26-year-old woman having inhaled cocaine, who presented with antiglomerular basement membrane glomerulonephritis and pulmonary hemorrhage. She was treated with immunosuppressive therapy and plasmapheresis. Maintenance hemodialysis was required on discharge. We stress the importance of early detection and treatment of this renal association for the potential fatal consequences implicated.

Evaluación fermentativa del ensilado del subproducto de alcachofa (Cynara scolymus L. ) en tres niveles de un microsilo / Fermentative evaluation of the artichoke (Cynara scolymus L. ) by-product ensilage on three levels of microsilo

Se ha estudiado la evolución de indicadores fermentativos durante 50 días de ensilaje en el subproductoagroindustrial de alcachofa (Cynara scolymus, L). Las muestras se analizaron a intervalos regulares de tiempo(1, 2, 3, 4, 8, 12, 24 y 50 días), en tres fracciones del microsilo (inferior, medio y superior). El pH se estabilizóen los primeros 12 días de fermentación. El contenido de ácido láctico y acético fue diferente entre los días defermentación (p<0,001), pero las diferencias entre fracciones no fue significativa. El contenido de hidratos de carbono solubles fue diferente solo entre los diferentes días de ensilaje (p<0,001). Los resultados demuestran que no existen cambios estadísticamente signifi cativos entre las fracciones evaluadas demostrando un buen nivel fermentativo del ensilaje. Se puede concluir que el subproducto crudo de alcachofa es un material muy idóneo para ser conservado mediante ensilaje

The fermentative indicators evolution has been studied during 50 days of silage in the agro-industrial artichokeby-product (Cynara scolymus, L). The samples were analyzed at different sampling days (1, 2, 3, 4, 8,12, 24 and 50), in three fractions of the microsilo (botton, medium and top). The pH stabilized in the first 12 days. The lactic and acetic acids content was different between the sampling days (p<0.001), but the differences between fractions were not significatives. Water soluble carbohydrates content was different between the different ensiling days (p<0.001). No changes on pH have found and lactic or acetic acids and water solublecarbohydrates between the fractions evaluated. We can conclude that crude artichoke by-product will be suitableto be conserved by ensilage

[Chronic idiopathic lithoptysis]. / Litoptisis crónica idiopática.

Broncholiths, which usually arise from calcified peribronchial lymph nodes, can be found by radiography or bronchoscopy. We describe the case of a 19-year-old man who had experienced lithoptysis of bronchial hydroxyapatite calculi for over 6 months and who reported having sandy expectoration since childhood. Exhaustive clinical, radiographic, and endoscopic diagnostic studies detected no calcified lesions in the thorax that could explain the origin of the broncholiths. Therefore, we propose that broncholiths may form by mechanisms similar to those involved in calculi formation in other locations.

Litoptisis crónica idiopática / Chronic idiopathic lithoptysis

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Mass transfer enhancement in supercritical fluids extraction by means of power ultrasound.

The use of high-intensity ultrasound represents an efficient manner of producing small scale agitation, enhancing mass transfer on supercritical fluids (SF) extraction processes. In this way, a supercritical CO(2) extraction of oil from particulate almonds using power ultrasound was studied. To examine the effect of the acoustic waves all experiments were performed with and without ultrasound. A power ultrasonic transducer for a working frequency of about 20 kHz was constructed and installed inside a high-pressure 5 l SF extractor. The experimental tests were carried out with CO(2) at 280 bar and 55 degrees C. Grounded almonds with an oil content of about 55%, in an amount of 1500 g were deposited inside the SF reactor where the solvent was introduced at a flow rate of 20 kg/h. The results show that the kinetics and the extraction yield of the oil were enhanced by 30% and 20% respectively, when a power of about 50 W was applied to the transducer. The average time of each extraction process was of about 8 h and 30 min. In addition, the transducer was also used as a sensitive probe capable to detect the phase behavior of supercritical fluids when it was driven with low power signals.

Neuropatía yatrogénica del XI par craneal o nervio accesorio / Iatrogenic neuropathy of the XI cranial nerve or accesory nerve

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