Valores de normalidad de sensibilidad retiniana y fijación foveal mediante microperimetría fotópica y escotópica en población sana / Fotopic and scotopic retinal sensitivity and foveal fixation normal values using microperimetry in healthy population

Objetivo Analizar los valores de sensibilidad retiniana y fijación foveal, en población sana, en condiciones fotópicas y escotópicas usando el microperímetro MP3-S (Nidek, Gamagori, Japón). Métodos Estudio observacional, transversal, unicéntrico. Se realizó una microperimetría (MP) fotópica y escotópica con una rejilla de estímulos personalizada de 13 puntos centrada en fóvea de 4,5×4,5mm en voluntarios sanos, sin enfermedad ocular. Se utilizó el ICC para evaluar la fiabilidad de la MP fotópica y escotópica. Resultados Se evaluaron 102 ojos de 54 voluntarios sanos (edad media: 49,8±15 años). La sensibilidad retiniana media (SRM) en la prueba fotópica y escotópica fue de 28,87±3,3 y 15,72±1,9dB, respectivamente. No se hallaron diferencias al comparar la SRM por grupo de sexos. Sin embargo, al analizar la SRM por grupos de edad se encontraron diferencias estadísticamente significativas en ambas modalidades de la prueba, siendo mayor la SRM en el grupo de sujetos menores de 35 años, con 30,3±1,7dB en la fotópica y 16,3±1,3dB en la escotópica, y menor en el grupo de mayores de 65 años, con 26,7±2,2dB en la fotópica y 13,8±1,8dB en la escotópica, con p=0,0001. En el análisis de fiabilidad, el coeficiente alfa de Cronbach reveló una excelente fiabilidad de la MP fotópica (0,958) y una buena fiabilidad de la MP escotópica (0,841). Conclusión La MP es un test con buena fiabilidad tanto en condiciones fotópicas como escotópicas. La SRM en condiciones fotópicas y escotópicas no difiere según el sexo, pero sí disminuye con la edad. Existe una correlación positiva entre la SRM fotópica y la escotópica (AU)

Purpose To determine normal values of fotopic and scotopic retinal sensitivity and foveal fixation obtained by microperimetry, using MP3-S microperimeter (Nidek, Gamagori, Japan), in a healthy population. Methods Observational, cros-sectional, single centre study. Fotopic and scotopic microperimetry (MP) was performed using with a customized 13-point fovea-centered pattern in healthy volunteers without ocular pathology. A intraclass correlation coefficient was performed to evaluate fotopic and scotopic MP reliability. Results We analyzed 102 eyes of 54 healthy volunteers (mean age 49.8±15 years old). The fotopic and scotopic mean retinal sensitivity (MRS) was 28.87±3.3dB and 15.72±1.9dB (95% CI 15.35-16.09), respectively, showing a significant statistical difference (P<.05). No differences were found when comparing MRS by gender group. However, when analyzing the MRS by age groups, statistically significant differences were found in both modalities of the test, MRS being higher in the group of subjects under 35 years of age, with 30.3±1.7dB in the photopic and 16.3±1.3dB in the scotopic, and lower in the group of older than 65 years, with 26.7±2.2dB in the photopic and 13.8±1.8dB in the scotopic, with P=.0001. The reliability analysis of both tests revealed an excellent reliability of the fotopic MP with a Cronbach alpha of 0.958 and a good reliability of 0.841 in scotopic MP. Conclusion MP is a test with good reliability both under photopic and scotopic conditons. MRS and fixation stability under photopic and scotopic conditions do not differ according to sex, but it does decrease with age. There is a positive correlation between photopic and scotopic MRS (AU)

Pacientes con afectación ganglionar inicial por cáncer de mama que han recibido quimioterapia neoadyuvante: técnica combinada ganglio centinela-cirugía radioguiada del ganglio patológico / Patients with initial nodal involvement due to breast cancer who have received neoadjuvant chemotherapy: Combined sentinel node-radioguided surgery of the pathological node

Objetivo Estudiar la viabilidad y utilidad de la técnica combinada biopsia selectiva de ganglio centinela (BSGC)-biopsia radioguiada del ganglio patológico en pacientes con cáncer de mama y afectación axilar sometidas a quimioterapia neoadyuvante (QTNA). aterial y métodos Estudio prospectivo en el que se incluyeron 30 pacientes con cáncer de mama y estadificación axilar cN1, con indicación de QTNA. El ganglio biopsiado se marcó (GBM) mediante un clip, antes del tratamiento QTNA. Tras completar este se valoró la respuesta axilar con ecografía. En caso de buena respuesta ecográfica se procedió a realizar BSGC (99mTc-nanocoloides) y disección axilar dirigida mediante biopsia radioguiada del GBM (99mTc-macroagregados albúmina). Se procedía a realizar una linfadenectomía axilar si el ganglio centinela (GC) y/o el GBM contenían células tumorales. Se evaluaron las tasas de localización-exéresis del GC y del GBM. También se evaluaron la tasa de falsos negativos y el valor predictivo positivo de la BSGC sola. Resultados Se extirpó el GC en todas las pacientes, mientras que el GBM se extirpó exitosamente en 27 (90%). El GC coincidió con el GBM en 15 pacientes (50%). En 12 pacientes el GC fue negativo pero el GBM fue positivo para metástasis, lo que comportó una tasa de falsos negativos del 44,4% y un valor predictivo positivo del 37% para la BSGC sola. Tanto el GC como el GBM resultaron negativos en 5 pacientes (18,5%), lo que permitió evitar realizarles la linfadenectomía axilar. Conclusiones La técnica combinada descrita BSGC-biopsia radioguiada del ganglio patológico es un procedimiento útil y accesible para la reestadificación precisa de la axila tras QTNA, evitando la alta tasa de falsos negativos de la BSGC sola en este grupo de pacientes y evitando un número mayor de linfadenectomías axilares (AU)

Objective To study the feasibility and usefulness of the combined technique selective sentinel lymph node biopsy (SLNB)-radioguided biopsy of the pathological lymph node in patients with breast cancer and axillary involvement undergoing neoadjuvant chemotherapy (NAC). Material and methods Prospective diagnostic study of 30 patients with breast cancer and cN1 axillary staging with NACT indication. Before NACT, the biopsied node was marked with a clip (MBN). After NACT an ultrasound was performed and in case of good response a SLNB (99mTc-nanocolloids) plus targeted axillary dissection MBN pathologic node radioguided biopsy (99mTc-albumin macroaggregates) was performed. Axillary lymph node dissection was performed if SLNB and/or MBN were positive for tumor cells. The localization-removal rate of the sentinel lymph node (SLN) and MBN were evaluated. False-negative rate and positive predictive value of SLNB alone were also evaluated. Results Thirty patients were included in the study. SLN could be detected in all patients while MBN was successfully removed in 27 (90%). The SLN coincided with MBN in 15 patients (50%). In 12 patients SLNB was negative while MBN positive, leading to a FNR of 44,4% for SLNB alone. We found a positive predictive value of 37% for the SLNB. In 5 patients (18,5%) both SLNB and MBN were negative, avoiding axillary lymph node dissection. Conclusions SLNB-MBN radioguided biopsy combined technique is a useful and accessible procedure for accurate axillary restaging after NACT, avoiding the high rate of false-negative rate of SLNB alone in this group of patients and avoiding a great number of axillary lymph node dissection (AU)

Fotopic and scotopic retinal sensitivity and foveal fixation normal values using microperimetry in healthy population.

PURPOSE: To determine normal values of fotopic and scotopic retinal sensitivity and foveal fixation obtained by microperimetry, using MP3-S microperimeter (Nidek, Gamagori, Japan), in a healthy population. METHODS: Observational, crossectional, single centre study. Fotopic and scotopic microperimetry was performed using with a customized 13-point fovea-centered pattern in healthy volunteers without ocular pathology. A intraclass correlation coefficient (ICC) was performed to evaluate fotopic and scotopic microperimetry reliability. RESULTS: We analyzed 102 eyes of 54 patients with a mean age of 49.8 +/- 15 years old. The fotopic and scotopic mean retinal sensitivity (MRS) was 28.55±3.3dB (95% CI=[27.87-29.23]) and 15.72±1.9dB (95% CI=[15.35-16.09]) respectively, showing a significant statistical difference (p<0.05). No differences were found when comparing SRM by gender group. However, when analyzing the SRM by age groups, statistically significant differences were found in both modalities of the test; SRM being higher in the group of subjects under 35 years of age with 30.3±1.7dB in the photopic and 16.3±1.3dB in the scotopic; and lower in the group of older than 65 years with 26.7±2.2dB in the photopic and 13.8±1.8dB in the scotopic with p=0.0001. The reliability analysis of both tests, revealed an excellent reliability of the fotopic microperimetry with a Crombach alpha of 0.958 and a good reliability of 0.841 in scotopic microperimetry. CONCLUSIONS: Microperimetry is a test with good reliability both under photopic and scotopic conditions. SRM and fixation stability under photopic and scotopic conditions do not differ according to sex, but it does decrease with age. There is a positive correlation between photopic and scotopic SRM.

Early-life stress elicits peripheral and brain immune activation differently in wild type and 5xFAD mice in a sex-specific manner.

BACKGROUND: The risk of developing Alzheimer's disease (AD) is modulated by genetic and environmental factors. Early-life stress (ELS) exposure during critical periods of brain development can impact later brain function and health, including increasing the risk of developing AD. Microglial dysfunction and neuroinflammation have been implicated as playing a role in AD pathology and may be modulated by ELS. To complicate matters further, sex-specific effects have been noted in response to ELS and in the incidence and progression of AD. METHODS: Here, we subjected male and female mice with either a wild type or 5xFAD familial AD-model background to maternal separation (MS) from postnatal day 2 to 14 to induce ELS. RESULTS: We detected hippocampal neuroinflammatory alterations already at postnatal day 15. By 4 months of age, MS mice presented increased immobility time in the forced swim test and a lower discrimination index in the novel object recognition memory test compared to controls. We found altered Bdnf and Arc expression in the hippocampus and increased microglial activation in the prefrontal cortex due to MS in a sex-dependent manner. In 5xFAD mice specifically, MS exacerbated amyloid-beta deposition, particularly in females. In the periphery, the immune cell population was altered by MS exposure. CONCLUSION: Overall, our results demonstrate that MS has both short- and long-term effects on brain regions related to memory and on the inflammatory system, both in the brain and periphery. These ELS-related effects that are detectable even in adulthood may exacerbate pathology and increase the risk of developing AD via sex-specific mechanisms.

Continuous thoracic paravertebral analgesia after minimally invasive atrial septal defect closure surgery in pediatric population: Effectiveness and safety analysis.

INTRODUCTION: Lateral thoracotomy is replacing traditional median sternotomy for atrial septal defect (ASD) closure in children in order to improve cosmetic outcomes. Continuous paravertebral block has been described as an effective and safe analgesic technique in children. The aim of this study is to assess pain management by continuous perfusion of local anesthetic through a thoracic paravertebral catheter (PVC) in a pediatric population after thoracotomy closure of ASD, and its effectiveness in a fast-track program. METHODS: Descriptive cross-sectional study. Analgesic effectiveness, perioperative and safety-related data were analyzed in 21 patients who underwent thoracotomy closure of ASD with PVC. In the postoperative period, patients received continuous perfusion of bupivacaine 0.125% and fentanyl (1 mcg.ml-1) at 0.2 ml.kg-1.h-1 through the PVC. RESULTS: The median of mean pain scale score for each patient was 1.5. All patients were extubated in the operating theatre. No patient with PVC required opioid rescue. The median length of stay in the Pediatric Intensive Care Unit was 48 hours. There were 3 adverse events related to PVC: 1 due to malposition and 2 due to accidental removal. No other complications or cases of local anesthetic toxicity were recorded. CONCLUSIONS: PVC provides effective, safe, opioid-saving analgesia in the postoperative period of ASD closure by thoracotomy in the context of a fast-track protocol.

Patients with initial nodal involvement due to breast cancer who have received neoadjuvant chemotherapy: Combined sentinel node-radioguided surgery of the pathological node.

OBJECTIVE: To study the feasibility and usefulness of ultrasound-guided pre-chemotherapy marking of pathologic lymph node followed by sentinel lymph node biopsy (SLNB)-pathologic node radioguided biopsy (ROLL) combined technique, in axillary involvement breast cancer patients undergoing neoadjuvant chemotherapy (NACT). MATERIAL AND METHODS: Prospective diagnostic study of 30 patients with breast cancer and cN1 axillary staging with NACT indication. Before NACT, the biopsied node was marked with a clip (MBN). After NACT an ultrasound was performed and in case of good response a SLNB (99mTc-nanocolloids) plus targeted axillary dissection MBN ROLL biopsy (99mTc-albumin macroaggregates) was performed. Axillary lymph node dissection (ALND) was performed if SLNB and/or MBN were positive for tumor cells. The localization-removal rate of the sentinel lymph node (SLN) and MBN were evaluated. False-negative rate (FNR) and positive predictive value (PPV) of SLNB alone were also evaluated. RESULTS: Thirty patients were included in the study. SLN could be detected in all patients while MBN was successfully removed in 27 (90%). The SLN coincided with MBN in 15 patients (50%). In 12 patients SLNB was negative while MBN positive, leading to a FNR of 44.4% for SLNB alone. We found a PPV of 37% for the SLNB. In 5 patients (18.5%) both SLNB and MBN were negative, avoiding ALND. CONCLUSIONS: SLNB-MBN radioguided biopsy ROLL combined technique is a useful and accessible procedure for accurate axillary restaging after NACT, avoiding the high rate of FNR of SLNB alone in this group of patients and avoiding a great number of ALND.

Analgesia paravertebral torácica continua tras cirugía mínimamente invasiva de cierre de comunicación interauricular en población pediátrica: análisis de eficacia y seguridad / Continuous thoracic paravertebral analgesia after minimally invasive atrial septal defect closure surgery in pediatric population: Effectiveness and safety analysis

Introducción: La toracotomía lateral está sustituyendo la esternotomía media clásica para el cierre de la comunicación interauricular (CIA) en niños con objetivo de obtener un menor impacto estético. El bloqueo paravertebral continuo se ha descrito como una técnica analgésica efectiva y segura en niños. El objetivo del estudio es valorar el control analgésico tras el cierre de CIA por toracotomía, mediante la administración de anestésico local en perfusión continua a través de un catéter paravertebral torácico (CPV) en población pediátrica, y su efectividad en un programa fast-track. Métodos: Estudio transversal descriptivo. Se analizaron datos de efectividad analgésica, datos perioperatorios y relacionados con la seguridad en 21 pacientes intervenidos de cierre de CIA mediante toracotomía con CPV. En el periodo postoperatorio se empleó una perfusión continua a través del CPV de bupivacaína al 0,125% y fentanilo (1μg.ml-1) a 0,2ml.kg-1.h-1. Resultados: La mediana de las puntuaciones medias en las escalas de dolor de cada paciente fue 1,5. Todos los pacientes se extubaron en quirófano. Ningún paciente con CPV requirió rescate con opioides. La mediana de tiempo de estancia en la unidad de cuidados intensivos pediátricos fue de 48h. Se objetivaron 3 eventos adversos relacionados con el CPV: uno debido a mala posición y 2 por salida accidental. No se registraron otras complicaciones ni casos de toxicidad por anestésicos locales. Conclusiones: El CPV proporciona una analgesia efectiva y segura en el postoperatorio de cierre de CIA mediante toracotomía en el contexto de un protocolo fast-track disminuyendo el consumo postoperatorio de opioides.(AU)

Introduction: Lateral thoracotomy is replacing traditional median sternotomy for atrial septal defect (ASD) closure in children in order to improve cosmetic outcomes. Continuous paravertebral block has been described as an effective and safe analgesic technique in children. The aim of this study is to assess pain management by continuous perfusion of local anesthetic through a thoracic paravertebral catheter (PVC) in a pediatric population after thoracotomy closure of ASD, and its effectiveness in a fast-track program. Methods: Descriptive cross-sectional study. Analgesic effectiveness, perioperative and safety-related data were analyzed in 21 patients who underwent thoracotomy closure of ASD with PVC. In the postoperative period, patients received continuous perfusion of bupivacaine 0.125% and fentanyl (1 μg.ml-1) at 0.2ml.kg-1.h-1 through the PVC. Results: The median of mean pain scale score for each patient was 1.5. All patients were extubated in the operating theatre. No patient with PVC required opioid rescue. The median length of stay in the Pediatric Intensive Care Unit was 48hours. There were 3 adverse events related to PVC: 1 due to malposition and 2 due to accidental removal. No other complications or cases of local anesthetic toxicity were recorded. Conclusions: PVC provides effective, safe, opioid-saving analgesia in the postoperative period of ASD closure by thoracotomy in the context of a fast-track protocol.(AU)

Planificación y manejo anestésico para cesárea en gestante con neumonía por SARS-CoV-2 / Anesthetic planning and management for a caesarian section in a pregnant woman affected by SARS-COV-2 pneumonía

Las mujeres embarazadas experimentan cambios fisiológicos e inmunológicos que les hacen más susceptibles a infecciones víricas o bacterianas, por lo que se les ha considerado grupo vulnerable frente al SARS-CoV-2. Así mismo, pueden desarrollar una forma grave de la enfermedad que requiera finalizar la gestación para mejorar la situación respiratoria o para salvaguardar el bienestar fetal que puede verse afectado por el estado crítico de la madre. En este contexto, cualquier intervención demanda una minuciosa planificación por parte del equipo quirúrgico en general y del anestesiólogo en particular tanto para asegurar el bienestar maternofetal como para evitar posibles contagios del personal sanitario. Describimos el caso de una gestante de 37semanas ingresada en la Unidad de Reanimación con soporte ventilatorio mediante alto flujo por insuficiencia respiratoria severa debida a COVID-19 que precisa ser sometida a cesárea urgente.(AU)

Pregnant women experience physiological and immunological changes which make them more prone to all kind of viral and bacterial infections, this is because they have been considered as vulnerable group if infected by SARS-CoV-2. They could even deploy a severe form of this disease which may require to end pregnancy to improve oxygenation and to safeguard foetal wellbeing the in case the mother situation gets worse. In this scenario, any intervention would require a detailed planning by the whole surgical team, and, specifically, by the anaesthesiologists, in order to guarantee both mother and child wellbeing and to prevent from infections all the healthcare team. We describe the case of 37week pregnant woman, admitted in our Critical Care Unit with respiratory high flows device support, due to severe respiratory failure due to COVID-19 which needed an urgent caesarean section.(AU)

Anesthetic planning and management for a caesarian section in a pregnant woman affected by SARS-COV-2 pneumonía. / Planificación y manejo anestésico para cesárea en gestante con neumonía por SARS-CoV-2.

Pregnant women experience physiological and immunological changes which make them more prone to all kind of viral and bacterial infections, this is because they have been considered as vulnerable group if infected by SARS-CoV-2. They could even deploy a severe form of this disease which may require to end pregnancy to improve oxygenation and to safeguard foetal wellbeing the in case the mother situation gets worse. In this scenario, any intervention would require a detailed planning by the whole surgical team, and, specifically, by the anaesthesiologists, in order to guarantee both mother and child wellbeing and to prevent from infections all the healthcare team. We describe the case of 37week pregnant woman, admitted in our Critical Care Unit with respiratory high flows device support, due to severe respiratory failure due to COVID-19 which needed an urgent caesarean section.

Planificación y manejo anestésico para cesárea en gestante con neumonía por SARS-CoV-2 / Anesthetic planning and management for a caesarian section in a pregnant woman affected by SARS-COV-2 pneumonía

Las mujeres embarazadas experimentan cambios fisiológicos e inmunológicos que les hacen más susceptibles a infecciones víricas o bacterianas, por lo que se les ha considerado grupo vulnerable frente al SARS-CoV-2. Así mismo, pueden desarrollar una forma grave de la enfermedad que requiera finalizar la gestación para mejorar la situación respiratoria o para salvaguardar el bienestar fetal que puede verse afectado por el estado crítico de la madre. En este contexto, cualquier intervención demanda una minuciosa planificación por parte del equipo quirúrgico en general y del anestesiólogo en particular tanto para asegurar el bienestar maternofetal como para evitar posibles contagios del personal sanitario. Describimos el caso de una gestante de 37semanas ingresada en la Unidad de Reanimación con soporte ventilatorio mediante alto flujo por insuficiencia respiratoria severa debida a COVID-19 que precisa ser sometida a cesárea urgente

Pregnant women experience physiological and immunological changes which make them more prone to all kind of viral and bacterial infections, this is because they have been considered as vulnerable group if infected by SARS-CoV-2. They could even deploy a severe form of this disease which may require to end pregnancy to improve oxygenation and to safeguard foetal wellbeing the in case the mother situation gets worse. In this scenario, any intervention would require a detailed planning by the whole surgical team, and, specifically, by the anaesthesiologists, in order to guarantee both mother and child wellbeing and to prevent from infections all the healthcare team. We describe the case of 37week pregnant woman, admitted in our Critical Care Unit with respiratory high flows device support, due to severe respiratory failure due to COVID-19 which needed an urgent caesarean section

Pioderma gangrenoso simulando un carcinoma epidermoide / Pyoderma Gangrenosum Mimicking a Squamous Cell Carcinoma

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Intubación orotraqueal a través de mascarilla laríngea Ambu(R) Auragain(TM) en paciente pediátrico con lipomatosis infiltrante congénita / Endotracheal intubation through laryngeal Ambu(R) Auragain(TM) mask airway mask in paediatric patients affected by congenital infiltrating lipomatosis

Las malformaciones congénitas que afectan a la vía aérea pueden generar problemas para realizar una ventilación efectiva, intubación o incluso ambas, con el consiguiente aumento del riesgo de hipoxemia. Es esencial para el anestesiólogo pediátrico el conocimiento exacto de la anatomía de la vía aérea del paciente, así como una planificación preoperatoria cuidadosa. Cada vez son más los dispositivos diseñados para el control de la vía aérea en el paciente pediátrico. Este caso clínico describe el uso de la mascarilla laríngea de tercera generación (Ambu(R) Auragain(TM)) para la intubación orotraqueal de un paciente pediátrico con vía aérea difícil prevista secundaria a lipomatosis infiltrante congénita en la región facial

Congenital defects that affect paediatric airway could lead to several difficulties for effective ventilation, intubation, or even both, increasing the risk of hypoxaemia. It is essential for the paediatric anaesthesiologist to have accurate knowledge of the anatomy of patient́s airway, as well as judicious preoperative planning. Increasingly, more devices have been designed for the control of difficult airway in the paediatric patient. This case report describes the application of a third-generation laryngeal mask (- Ambu(R) Auragain (TM)) for endotracheal intubation of a child with anticipated difficult airway, secondary to congenital diffuse infiltrating facial lipomatosis

Endotracheal intubation through laryngeal Ambu® Auragain™ mask airway mask in paediatric patients affected by congenital infiltrating lipomatosis. / Intubación orotraqueal a través de mascarilla laríngea Ambu® Auragain™ en paciente pediátrico con lipomatosis infiltrante congénita.

Congenital defects that affect paediatric airway could lead to several difficulties for effective ventilation, intubation, or even both, increasing the risk of hypoxaemia. It is essential for the paediatric anaesthesiologist to have accurate knowledge of the anatomy of patient́s airway, as well as judicious preoperative planning. Increasingly, more devices have been designed for the control of difficult airway in the paediatric patient. This case report describes the application of a third-generation laryngeal mask (- Ambu® Auragain ™) for endotracheal intubation of a child with anticipated difficult airway, secondary to congenital diffuse infiltrating facial lipomatosis.

Resultados y evolución funcional de pacientes críticos con ictus isquémico sometidos a trombectomía mecánica / Results and functional outcomes of acute ischemic stroke patients who underwent mechanical thrombectomy admitted to intensive care unit

OBJETIVO: Estudiar los resultados y las complicaciones del tratamiento endovascular (TEV) en pacientes con ictus isquémico agudo ingresados en una unidad de cuidados intensivos (UCI). Analizar los factores que podrían influir en la mortalidad y en el grado de discapacidad al alta y un año después del ictus. DISEÑO: Estudio prospectivo observacional. Ámbito: UCI polivalente. Hospital de tercer nivel. PACIENTES: Sesenta pacientes adultos. Muestra consecutiva. INTERVENCIONES: Ninguna. Variables de interés: Datos epidemiológicos, tiempo desde la clínica inicial hasta el TEV, resultado angiográfico, tiempo de estancia en UCI, días de ventilación mecánica, complicaciones neurológicas, National Institutes of Health Stroke Scale (NIHSS) al ingreso y al alta de UCI, escala de Rankin modificada (mRS) al año de evolución. RESULTADOS: Edad media 68,90±8,84años. Mediana de tiempo hasta el TEV: 180min. Mediana NIHSS al ingreso: 17,5; al alta: 3. Flujo distal en el 90% de los casos. Mediana estancia en UCI: 3días. Ventilación mecánica: 81,7%. Independencia funcional (mRS≤2) 50% al año del ictus. Fallecimientos: 22 (36,6%); 8 (13,3%) en la UCI y el resto durante el primer año. CONCLUSIONES: Las variables asociadas a un peor estado funcional fueron la transformación hemorrágica sintomática, la ausencia de recanalización y las complicaciones durante el procedimiento. La transformación hemorrágica y la hidrocefalia se asociaron a mayor mortalidad. Se consiguió flujo distal en la mayoría de los casos, con una baja tasa de complicaciones. La mitad de los pacientes alcanza independencia funcional al año del ictus

PURPOSE: To study the results and complications of endovascular treatment (EVT) in acute ischemic stroke patients admitted to Intensive Care Unit (ICU). To analyse the possible factors related to mortality and level of disability at ICU discharge and one year after stroke. DESIGN: Observational prospective study. SETTING: Mixed ICU. Third level hospital. PATIENTS: Sixty adult patients. Consecutive sample. INTERVENTIONS: None. Variables of interest: Epidemiological data, time from symptom onset to EVT, angiographic result, length of stay, days on mechanical ventilation, neurological complications, National Institutes of Health Stroke Scale (NIHSS) at ICU admission and discharge, modified Rankin scale score (mRS) at one year. RESULTS: Mean age 68,90±8,84years. Median time from symptom onset to EVT: 180minutes. Median NIHSS at admission: 17,5; at discharge: 3. Distal flow was achieved in 90% of cases. Median ICU stay: 3 days. Mechanical ventilation: 81,7.%. Functional independence (mRS≤2) 50% at one year. Deaths: 22 (36,6%) of which 8 (13,3%) died during UCI stay and the rest during the first year. CONCLUSIONS: The factors relating to a worse functional outcome were symptomatic hemorrhage transformation, lack of recanalization and complications during EVT. The factors relating to mortality were symptomatic hemorrhage and hydrocephalus. Distal flow was achieve in most cases with a low complication rate. Half of the patients presented functional independence one year after the stroke

Results and functional outcomes of acute ischemic stroke patients who underwent mechanical thrombectomy admitted to intensive care unit. / Resultados y evolución funcional de pacientes críticos con ictus isquémico sometidos a trombectomía mecánica.

PURPOSE: To study the results and complications of endovascular treatment (EVT) in acute ischemic stroke patients admitted to Intensive Care Unit (ICU). To analyse the possible factors related to mortality and level of disability at ICU discharge and one year after stroke. DESIGN: Observational prospective study. SETTING: Mixed ICU. Third level hospital. PATIENTS: Sixty adult patients. Consecutive sample. INTERVENTIONS: None. VARIABLES OF INTEREST: Epidemiological data, time from symptom onset to EVT, angiographic result, length of stay, days on mechanical ventilation, neurological complications, National Institutes of Health Stroke Scale (NIHSS) at ICU admission and discharge, modified Rankin scale score (mRS) at one year. RESULTS: Mean age 68,90±8,84years. Median time from symptom onset to EVT: 180minutes. Median NIHSS at admission: 17,5; at discharge: 3. Distal flow was achieved in 90% of cases. Median ICU stay: 3 days. Mechanical ventilation: 81,7.%. Functional independence (mRS≤2) 50% at one year. Deaths: 22 (36,6%) of which 8 (13,3%) died during UCI stay and the rest during the first year. CONCLUSIONS: The factors relating to a worse functional outcome were symptomatic hemorrhage transformation, lack of recanalization and complications during EVT. The factors relating to mortality were symptomatic hemorrhage and hydrocephalus. Distal flow was achieve in most cases with a low complication rate. Half of the patients presented functional independence one year after the stroke.

Biomechanical Description of Phonation in Children Affected by Williams Syndrome.

The voice of persons with Williams syndrome (WS) is described as hoarse with a deep and unstable fundamental frequency (f0). These observations may be justified by the deficit of elastin due to a haplo-insufficiency in the ELN gene characteristic of the syndrome. In view of the possible relationship between elastin deficit and dysphonia, a study of the dynamic function of WS phonation was conducted by means of biomechanical analysis. In order to assess the presence of dysphonic symptoms and their degree of severity, the biomechanical description of WS phonation has been evaluated in terms of dynamic mass and viscoelasticity estimates. Glottal biomechanical features such as vocal fold dynamic mass, stiffness, unbalances, and laryngeal tremor of 12 children with WS aged 3 to 8 years (five girls and seven boys) have been estimated and compared with the normative phonation of 97 children with typical development (53 girls and 44 boys). The results show that WS children show differences in f0, vocal fold mass and stiffness, phonation stability, glottal contact defects, and laryngeal tremor. The conclusions may help to make a more complete view of the connection between WS and dysphonia based on objective assessments.