Terson's syndrome after endoscopic removal of a colloid cyst.

An extremely rare complication of endoscopic colloid cyst removal is presented. Terson's syndrome related to endoscopic resection of a colloid cyst has been reported only twice before in the literature and it could be explained by intracranial hypertension related to rinsing during the procedure. The case is described and the complications in the neuroendoscopic removal of colloid cyst are reviewed from the literature.

Meningiomas de ángulo pontocerebeloso: tratamiento con radiocirugía mediante LINAC / Cerebellopontine angle meningiomas: LINAC stereotactic radiosurgery treatment

Objetivos Evaluar el resultado del tratamiento con radiocirugía estereotáctica (RC) mediante acelerador lineal (LINAC) en meningiomas de ángulo pontocerebeloso (APC). Métodos Analizamos 80 pacientes diagnosticados de meningiomas de APC entre los años 2001-2014, tratados mediante RC. El 81,9% (n=68) fueron mujeres, con una media de edad de 59,1años (32-79). La RC se aplicó como tratamiento primario en el 83,7% (n=67), y en el 16,3% (n=13) como adyuvante a la cirugía. El tratamiento con RC se lleva a cabo en un acelerador lineal (Varian600, 6MeV) con micromultiláminas M3 (BrainLab) y marco estereotáxico. El volumen tumoral medio fue de 3,14cm3 (0,34-10,36cm3) y la dosis de cobertura media fue de 14Gy (12-16Gy). Se realiza un análisis descriptivo retrospectivo, un análisis de supervivencia método Kaplan-Meier y se contrasta la relación entre las variables del estudio mediante análisis univariados. Resultados Tras un periodo de seguimiento medio de 86,9meses (12-184), la tasa de control tumoral fue del 92,8% (n=77). Se comprobó una reducción global del volumen tumoral al final del estudio del 32,8%, con un volumen medio final de 2,11cm3 (0-10,35cm3). La tasa de supervivencia libre de progresión fue del 98% al año, del 95% a los 5años y del 83,3% a los 10 y 12años. El mayor volumen tumoral previo al tratamiento (p=0,047) se relacionó con la progresión. Se produjo la mejoría clínica en el 26,5% (n=21) de los casos y el deterioro en el 16,2% (n=13); el empeoramiento se relaciona con la dosis de radiación que recibe el troncoencéfalo (p=0,02). Respecto a las complicaciones, el 8,7% (n=7) sufrieron deterioro de la audición, el 5% (n=4) radionecrosis y el 3,7% (n=3) neuropatía del Vpar craneal. La dosis máxima alcanzada (p=0,037) y el tamaño tumoral inicial (p=0,033) se relacionan con la progresión de la hipoacusia, y el desarrollo de radionecrosis, con la dosis máxima alcanzada (p=0,037) (AU)

Objectives To evaluate the efficacy of treatment with linear accelerator-based stereotactic radiosurgery (LINAC) in cerebellopontine angle meningiomas. Methods We analyzed 80 patients diagnosed with cerebellopontine angle meningiomas between 2001 and 2014, treated with stereotactic radiosurgery (SRS), of whom 81.9% (n=68) were women, with an average age of 59.1years (32-79). SRS was applied as primary treatment in 83.7% (n=67) and in 16.3% (n=13) as an adjuvant treatment to surgery. SRS treatment was provided using LINAC (Varian600, 6MeV) with M3 micromultilamines (brainLab) and stereotactic frame. The average tumor volume was 3.12cm3 (0.34-10.36cm3) and the coverage dose was 14Gy (12-16Gy). We performed a retrospective descriptive analysis and survival analysis was performed with the Kaplan-Meier method and multivariate analysis to determine those factors predictive of tumor progression or clinical improvement. Results After an average follow-up period of 86.9months (12-184), the tumor control rate was 92.8% (n=77). At the end of the study, there was an overall reduction in tumor volume of 32.8%, with an average final volume of 2.11cm3 (0-10.35cm3). The progression-free survival rate at 5, 10 and 12years was 98%, 95% and 83.3% respectively. The higher tumor volume (P=.047) was associated with progression. There was clinical improvement in 26.5% (n=21) of cases and clinical worsening in 16.2% (n=13). Worsening is related to the radiation dose received by the brainstem (P=.02). Complications were 8.7% (7 cases) of hearing loss, 5% (4 cases) of brain radionecrosis, and 3.7% (3 cases) of cranial nerveV neuropathy. Hearing loss was related to initial tumor size (P=.033) and maximum dose (P=.037). The occurrence of radionecrosis with the maximum dose (P=.037). Conclusions Treatment of cerebellopontine angle meningiomas with single-dose SRS using LINAC is effective in the long term. Better tumor control rates were obtained in patients with small lesions (AU)

Long-term Experience of LINAC Single-Dose Radiosurgery for Skull Base Meningiomas: A Retrospective Single-Center Study of 241 Cases.

BACKGROUND AND OBJECTIVES: Stereotactic radiosurgery (SRS) is increasingly applied to treat meningiomas, attributable to their increased incidence in older individuals at greater surgical risk. To evaluate the effectiveness of treatment with linear accelerator (LINAC)-based stereotactic radiosurgery in skull base meningiomas as either primary treatment or postresection adjuvant therapy. METHODS: This study included 241 patients diagnosed with skull base meningiomas treated by single-dose SRS, with a median age of 59 years. SRS was primary treatment in 68.1% (n = 164) and adjuvant treatment in 31.9% (n = 77), using LINAC (Varian 600, 6 MeV). The median tumor volume was 3.2 cm 3 , and the median coverage dose was 14 Gy. Bivariate and multivariate analyses were performed to determine predictive factors for tumor progression, clinical deterioration, and complications. Kaplan-Meier analysis was used for survival analysis. RESULTS: After the median follow-up of 102 months, the tumor control rate was 91.2% (n = 220). Progression-free survival rates were 97.07%, 90.1%, and 85.7% at 5, 10, and 14 years, respectively. Clinical improvement was observed in 56 patients (23.2%). In multivariate analysis, previous surgery (hazard ratio 3.8 [95%CI 1.136-12.71], P = .030) and selectivity (hazard ratio .21 [95%CI 0.066-0.677], P = .009) were associated with tumor progression and increased maximum dose (odds ratio [OR] 4.19 [95% CI 1.287-13.653], P = .017) with clinical deterioration. The permanent adverse radiation effect rate was 6.2% (n = 15) and associated with maximum brainstem dose >12.5 Gy (OR 3.36 [95% CI .866-13.03], P = .08) and cerebellopontine angle localization (OR 3.93 [95% CI 1.29-11.98], P = .016). CONCLUSION: Treatment of skull base meningiomas with single-dose SRS using LINAC is effective over the long term. Superior tumor control is obtained in patients without previous surgery. Adverse effects are related to localization in the cerebellopontine angle, and maximum brainstem radiation dose was >12.5 Gy.

Symptomatic sacral Tarlov cyst: Case report and review of literature / Quiste de Tarlov sacro sintomatico: presentacion de un caso y revision de la literatura

Tarlov cysts are a common finding in MRI. Most of them are asymptomatic but in some cases can cause pain in urogenital region. Diagnosis and treatment are controversial and most of the symptomatic cases are not well diagnosed and treated because of unawareness of neurosurgeons about them. Treatment of symptomatic TC is effective and good results have been published with percutaneous and surgical techniques. A case of a young woman with a symptomatic sacral cyst treated surgically successfully is presented and literature about it is reviewed (AU)

Los quistes de Talov son un hallazgo frecuente en resonancia magnética. La mayoría de ellos son asintomáticos, pero en algunos casos pueden producir síntomas dolorosos urogenitales. El diagnóstico y el tratamiento de los quistes de Tarlov es controvertido y la mayoría de los casos sintomáticos no son diagnosticados adecuadamente debido a que el neurocirujano no es capaz de identificar el cuadro clínico. El tratamiento de los quistes de Tarlov sintomáticos es efectivo y se han publicado buenos resultados tanto con técnicas percutáneas como quirúrgicas. Se presenta el caso de una mujer joven con quiste de Tarlov sintomático intervenida quirúrgicamente con resolución de la clínica y se revisa la literatura publicada al respecto (AU)

Inflammatory Cytokines Associated with Multiple Sclerosis Directly Induce Alterations of Neuronal Cytoarchitecture in Human Neurons.

Multiple sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) coined by inflammation and neurodegeneration. The actual cause of the neurodegenerative component of the disease is however unclear. We investigated here the direct and differential effects of inflammatory mediators on human neurons. We used embryonic stem cell-derived (H9) human neuronal stem cells (hNSC) to generate neuronal cultures. Neurons were subsequently treated with tumour necrosis factor alpha (TNFα), interferon gamma (IFNγ), granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin 17A (IL-17A) and interleukin 10 (IL-10) separately or in combination. Immunofluorescence staining and quantitative polymerase chain reaction (qPCR) were used to assess cytokine receptor expression, cell integrity and transcriptomic changes upon treatment. H9-hNSC-derived neurons expressed cytokine receptors for IFNγ, TNFα, IL-10 and IL-17A. Neuronal exposure to these cytokines resulted in differential effects on neurite integrity parameters with a clear decrease for TNFα- and GM-CSF-treated neurons. The combinatorial treatment with IL-17A/IFNγ or IL-17A/TNFα induced a more pronounced effect on neurite integrity. Furthermore, combinatorial treatments with two cytokines induced several key signalling pathways, i.e. NFκB-, hedgehog and oxidative stress signalling, stronger than any of the cytokines alone. This work supports the idea of immune-neuronal crosstalk and the need to focus on the potential role of inflammatory cytokines on neuronal cytoarchitecture and function.

Symptomatic sacral Tarlov cyst: Case report and review of literature.

Tarlov cysts are a common finding in MRI. Most of them are asymptomatic but in some cases can cause pain in urogenital region. Diagnosis and treatment are controversial and most of the symptomatic cases are not well diagnosed and treated because of unawareness of neurosurgeons about them. Treatment of symptomatic TC is effective and good results have been published with percutaneous and surgical techniques. A case of a young woman with a symptomatic sacral cyst treated surgically successfully is presented and literature about it is reviewed.

Cerebellopontine angle meningiomas: LINAC stereotactic radiosurgery treatment.

OBJECTIVES: To evaluate the efficacy of treatment with linear accelerator-based stereotactic radiosurgery (LINAC) in cerebellopontine angle meningiomas. METHODS: We analyzed 80 patients diagnosed with cerebellopontine angle meningiomas between 2001 and 2014, treated with stereotactic radiosurgery (SRS), of whom 81.9% (n=68) were women, with an average age of 59.1 years (32-79). SRS was applied as primary treatment in 83.7% (n=67) and in 16.3% (n=13) as an adjuvant treatment to surgery. SRS treatment was provided using LINAC (Varian 600, 6MeV) with M3 micromultilamines (brainLab) and stereotactic frame. The average tumor volume was 3.12cm3 (0.34-10.36cm3) and the coverage dose was 14Gy (12-16Gy). We performed a retrospective descriptive analysis and survival analysis was performed with the Kaplan-Meier method and multivariate analysis to determine those factors predictive of tumor progression or clinical improvement. RESULTS: After an average follow-up period of 86.9 months (12-184), the tumor control rate was 92.8% (n=77). At the end of the study, there was an overall reduction in tumor volume of 32.8%, with an average final volume of 2.11cm3 (0-10.35cm3). The progression-free survival rate at 5, 10 and 12 years was 98%, 95% and 83.3% respectively. The higher tumor volume (p=0.047) was associated with progression. There was clinical improvement in 26.5% (n=21) of cases and clinical worsening in 16.2% (n=13). Worsening is related to the radiation dose received by the brainstem (p=0.02). Complications were 8.7% (7 cases) of hearing loss, 5% (4 cases) of brain radionecrosis, and 3.7% (3 cases) of cranial nerve V neuropathy. Hearing loss was related to initial tumor size (p=0.033) and maximum dose (p=0.037). The occurrence of radionecrosis with the maximum dose (p=0.037). CONCLUSIONS: Treatment of cerebellopontine angle meningiomas with single-dose SRS using LINAC is effective in the long term. Better tumor control rates were obtained in patients with small lesions.

Brain lymphoma development related to a long lasting epidermoid cyst.

INTRODUCTION: Epidermoid cysts (EC) are benign and slow growing lesions. A primary brain lymphoma development related to a EC is presented, second case described in literature. CASE PRESENTATION: A woman 40 years old, harbouring a EC for more than 20 years, develops a fast growing brain lesion next to the EC. Surgery was performed and diagnosis was primary diffuse B cells lymphoma. DISCUSSION: Malignant transformation of EC has been described, usually to squamous cells carcinoma, and much less frequently, to another tumours. Inflammatory mechanisms have been advocated to explain this evolution. Chronic inflammation and lymphoma genesis are related, and this could be the mechanism behind this rare evolution of an EC. CONCLUSIONS: Even being benign lesions, EC can develop malignant tumours due to the chronic inflammation secondary to them.

Response to neoadjuvant chemotherapy and survival of children and adolescents with high-grade osteosarcoma treated based on the EURAMOS-1 protocol.

BACKGROUND: High-grade osteosarcoma is the most common malignant bone tumor in children and adolescents. This study aimed to evaluate the histologic response to neoadjuvant chemotherapy and overall and event-free survival rates in patients < 21 years of age with a diagnosis of conventional osteosarcoma. METHODS: We conducted an analytical and observational study of a cohort of patients < 21 years old with a diagnosis of conventional osteosarcoma treated with the OS INC-2009 protocol (based on EURAMOS-1). Descriptive analysis was performed, and overall and event-free survival rates were calculated by the Kaplan-Meier method. RESULTS: Between April 2009 and October 2016, 84 patients with conventional osteosarcoma (mean age 13.5 ± 3.2 years) were admitted. Metastatic disease at diagnosis was observed in 36 patients (42.8%). Of the 41 patients who received neoadjuvant chemotherapy (50.6%), 15 (36.6%; confidence interval [95% CI]: 49.9-75.6) were classified as good responders and 26 (63%; 95% CI: 22.5-58.0) as poor responders. The 5-year overall and event-free survival rates in good responders were 88.8% (95% CI: 43.3-98.3) and 81.4% (95% CI: 43.5-95.0); in poor responders it was 66.5% (95% CI: 40.7-83.1) and 31.4% (95% CI: 13.8-50.7), respectively. CONCLUSIONS: Good responders' evaluation of histologic response to neoadjuvant chemotherapy showed improved overall and event-free survival rates. Specialized centers with multidisciplinary and comprehensive management are required to make the application of high-toxicity protocols feasible.

INTRODUCCIÓN: El osteosarcoma de alto grado es el tumor óseo maligno más común en niños y adolescentes. El objetivo de este trabajo fue evaluar la respuesta histológica a la quimioterapia neoadyuvante y la supervivencia global y libre de eventos en pacientes menores de 21 años con diagnóstico de osteosarcoma convencional. MÉTODOS: Se llevó a cabo un estudio observacional analítico de una cohorte de pacientes menores de 21 años con diagnóstico de osteosarcoma convencional tratados con el protocolo OS INC-2009 (basado en EURAMOS-1). Se realizó el análisis descriptivo y se calcularon la supervivencia global y la supervivencia libre de eventos por el método de Kaplan-Meier. RESULTADOS: Entre abril de 2009 y octubre de 2016 se analizaron 84 pacientes con osteosarcoma convencional, cuya edad promedio fue de 13.5 años (desviación estándar: ± 3.2). La enfermedad metastásica al diagnóstico se observó en 36 pacientes (42.8%). De los 41 (50.6%) pacientes que recibieron terapia neoadyuvante, 15 (36.6%; intervalo de confianza del 95% [IC95%]: 49.9-75.6) se clasificaron como buenos respondedores y 26 (63%; IC95%: 22.5-58.0) como malos respondedores. Las supervivencias global y libre de eventos a 5 años en los buenos respondedores fueron del 88.8% (IC95%: 43.3-98.3) y el 81.4% (IC95% 43.5-95.0), y en los malos respondedores fueron del 66.5% (IC95%: 40.7-83.1) y el 31.4% (IC95%: 13.8-50.7), respectivamente. CONCLUSIONES: La evaluación de la respuesta histológica a la quimioterapia neoadyuvante de los pacientes buenos respondedores muestra unas mejores supervivencias global y libre de eventos. Se requieren centros especializados con manejos multidisciplinarios e integrales para hacer factible la aplicación de protocolos con alta toxicidad.

Brain lymphoma development related to a long lasting epidermoid cyst. / Desarrollo de un linfoma cerebral con relación a un quiste epidermoide de larga evolución.

INTRODUCTION: Epidermoid cysts (EC) are benign and slow growing lesions. A primary brain lymphoma development related to a EC is presented, second case described in literature. CASE PRESENTATION: A woman 40 years old, harbouring a EC for more than 20 years, develops a fast growing brain lesion next to the EC. Surgery was performed and diagnosis was primary diffuse B cells lymphoma. DISCUSSION: Malignant transformation of EC has been described, usually to squamous cells carcinoma, and much less frequently, to another tumours. Inflammatory mechanisms have been advocated to explain this evolution. Chronic inflammation and lymphoma genesis are related, and this could be the mechanism behind this rare evolution of an EC. CONCLUSIONS: Even being benign lesions, EC can develop malignant tumours due to the chronic inflammation secondary to them.

Performance of Saliva Specimens for the Molecular Detection of SARS-CoV-2 in the Community Setting: Does Sample Collection Method Matter?

Data on the performance of saliva specimens for diagnosing coronavirus disease 2019 (COVID-19) in ambulatory patients are scarce and inconsistent. We assessed saliva-based specimens for detecting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcriptase PCR (RT-PCR) in the community setting and compared three different collection methods. This prospective study was conducted in three primary care centers. RT-PCR was performed on paired nasopharyngeal swabs (NPS) and saliva samples collected from outpatients with a broad clinical spectrum of illness. To assess differences in collection methods, saliva specimens were obtained in a different way in each of the participating centers: supervised collection (SVC), oropharyngeal washing (OPW), and self-collection (SC). Pairs of NPS and saliva samples from 577 patients (median age, 39 years; 44% men; 42% asymptomatic) were collected and tested, and 120 (20.8%) gave positive results. The overall agreement with NPS results and kappa coefficients (κ) for saliva samples obtained by SVC, OPW, and SC were 95% (κ = 0.85), 93.4% (κ = 0.76), and 93.3% (κ = 0.76), respectively. The sensitivities (95% confidence intervals [95% CI]) of the saliva specimens ranged from 86% (72.6% to 93.7%) for SVC to 66.7% (50.4% to 80%) for SC samples. Sensitivity was higher for samples with lower cycle threshold (CT ) values. The best RT-PCR performance was observed for SVC, with sensitivities (95% CI) of 100% (85.9% to 100%) in symptomatic individuals and 88.9% (50.7% to 99.4%) in asymptomatic individuals at CT values of ≤30. We conclude that saliva is an acceptable specimen for the detection of SARS-CoV-2 in the community setting. Specimens collected under supervision perform comparably to NPS and can effectively identify individuals at higher risk of transmission under real-life conditions.

Mejoría en la supervivencia de los niños con leucemia mieloide aguda en el Instituto Nacional de Cancerología de Colombia / Improvement in the survival of children with acute myeloid leukemia at the Colombian National Cancer Institute

Resumen Objetivo: Describir las características demográficas y clínicas de los pacientes con leucemia mieloide aguda (LMA) no promielocítica, y evaluar la mortalidad y la supervivencia de los niños tratados con protocolo LMA-INC 2004 (modificado de BFM 93) en la clínica de oncología pediátrica del Instituto Nacional de Cancerología, desde su instauración y por un periodo de 10 años y medio de seguimiento (mayo de 2004 a diciembre de 2014). Pacientes y método: Estudio observacional descriptivo retrospectivo de una cohorte con análisis de supervivencia de los pacientes menores de 18 años de edad con diagnóstico LMA tratados con quimioterapia intensiva sin mantenimiento ni trasplante. El análisis de supervivencia se realizó usando el método de Kaplan Meir. Resultados: Se analizaron 41 pacientes con diagnóstico de LMA excepto LMA M3, tratados con protocolo LMA-INC 2004. Se logró remisión completa en el 75,6% de los pacientes. La tasa de recaída fue de 27,4% anual y la tasa de muertes de 20,3% durante el periodo. La supervivencia general acumulada a dos años fue de 60% y a cinco años del 53,5%, con promedio de seguimiento de 4,3 años (3,2 - 5,2 años), y la supervivencia libre de recaída a cinco años fue del 42% con un tiempo promedio de seguimiento de 3,5 años (3,3 - 4,6 años). Conclusión: Los resultados muestran mejoría del 30% en la supervivencia de los pacientes con LMA como resultado de un tratamiento más intenso, que incluye la administración de altas dosis de citarabina y mitoxantrone en la consolidación y la intensificación, y que implica mejoría en los cuidados de soporte.

Abstract Objective: To describe the demographic and clinical characteristics of patients with acute myeloid leukemia; and to evaluate the mortality and survival of children treated with the LMA-INC 2004 protocol (modified from BFM 93) in a pediatric oncology clinic of the Colombian National Cancer Institute (Instituto Nacional de Cancerología de Colombia) between May 2004 and December 2014. Patients and methods: Retrospective descriptive observational study of a cohort with survival analysis of patients aged under 18 years, with a diagnosis of acute myeloid leukemia, who were treated with intensive chemotherapy without maintenance or transplantation. The survival analysis was performed using the Kaplan-Meier method. Results: We analyzed 41 patients diagnosed with myeloid leukemia, except acute myeloid leukemia type M3, who were, treated with the LMA-INC 2004 protocol. Complete remission was achieved in 75.6% of patients. The annual relapse rate was 27.4%; and the death rate 20.3%. Cumulative overall survival at 2 and 5 years was 60% and 53.5% respectively, with an average follow-up of 4.3 years (3.2 - 5.2 years); and the 5-year relapse-free survival was 42%, with an average follow-up time of 3.5 years (3.3 - 4.6 years). Conclusion: The results showed a 30% improvement in the survival of patients with acute myeloid leukemia, attributed to a more intense treatment that included the administration of high doses of cytarabine and mitoxantrone in consolidation and intensification; which implies improvement in supportive care.

Infección espinal por una cepa defectiva de Streptococcus intermedius diagnosticada mediante PCR multiplex / Spinal infection caused by a defective strain of Streptococcus intermedius diagnosed by multiplex-PCR

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Purkinje cell-specific Grip1/2 knockout mice show increased repetitive self-grooming and enhanced mGluR5 signaling in cerebellum.

Cerebellar Purkinje cell (PC) loss is a consistent pathological finding in autism. However, neural mechanisms of PC-dysfunction in autism remain poorly characterized. Glutamate receptor interacting proteins 1/2 (Grip1/2) regulate AMPA receptor (AMPAR) trafficking and synaptic strength. To evaluate role of PC-AMPAR signaling in autism, we produced PC-specific Grip1/2 knockout mice by crossing Grip2 conventional and Grip1 conditional KO with L7-Cre driver mice. PCs in the mutant mice showed normal morphology and number, and a lack of Grip1/2 expression. Rodent behavioral testing identified normal ambulation, anxiety, social interaction, and an increase in repetitive self-grooming. Electrophysiology studies revealed normal mEPSCs but an impaired mGluR-LTD at the Parallel Fiber-PC synapses. Immunoblots showed increased expression of mGluR5 and Arc, and enhanced phosphorylation of P38 and AKT in cerebellum of PC-specific Grip1/2 knockout mice. Results indicate that loss of Grip1/2 in PCs contributes to increased repetitive self-grooming, a core autism behavior in mice. Results support a role of AMPAR trafficking defects in PCs and disturbances of mGluR5 signaling in cerebellum in the pathogenesis of repetitive behaviors.

Performance of the cobas u 701 Analyzer in Urinary Tract Infection Screening.

BACKGROUND: Negative urine cultures to rule out urinary tract infections (UTI) generate a considerable laboratory workload; thus, a rapid screening test is desirable. We evaluated the performance of a new automated microscopy analyzer, cobas u 701 (Roche Diagnostics International, Rotkreuz, Switzerland) for the screening of UTI, and developed a rule-out strategy to reduce the number of samples requiring culture. We also assessed squamous epithelial cell (SEC) count as a predictor of culture contamination. METHODS: In total, 1,604 urine samples from outpatients were analyzed with cobas u 701 and culture. Bacterial (BAC) and white blood cell (WBC) counts were used for sample interpretation. To determine a useful cut-off point to predict negative cultures, we selected the highest sensitivity and specificity values obtained from ROC curves. Diagnostic accuracy by age and gender was evaluated. RESULTS: Urine culture showed growth of ≥104 colony forming units (CFU)/mL in 256 samples (16.0%). The highest sensitivity (91.8%) and specificity (68.4%) were obtained for cut-off points of 119 BAC/µL and 22 WBC/µL. The combination of BAC and WBC improved the performance of the rule-out strategy with a low rate of false-negative results (1.5%) and a high negative predictive value (NPV, 97.3%). Fifty-seven percent of the samples would not have required culture. SEC count was a poor predictor of culture contamination. CONCLUSIONS: cobas u 701 can substantially reduce the number of urine samples requiring culture, with a low false-negative rate and a high NPV.

MR Elastography-Based Assessment of Matrix Remodeling at Lesion Sites Associated With Clinical Severity in a Model of Multiple Sclerosis.

Magnetic resonance imaging (MRI) with gadolinium based contrast agents (GBCA) is routinely used in the clinic to visualize lesions in multiple sclerosis (MS). Although GBCA reveal endothelial permeability, they fail to expose other aspects of lesion formation such as the magnitude of inflammation or tissue changes occurring at sites of blood-brain barrier (BBB) disruption. Moreover, evidence pointing to potential side effects of GBCA has been increasing. Thus, there is an urgent need to develop GBCA-independent imaging tools to monitor pathology in MS. Using MR-elastography (MRE), we previously demonstrated in both MS and the animal model experimental autoimmune encephalomyelitis (EAE) that inflammation was associated with a reduction of brain stiffness. Now, using the relapsing-remitting EAE model, we show that the cerebellum-a region with predominant inflammation in this model-is especially prone to loss of stiffness. We also demonstrate that, contrary to GBCA-MRI, reduction of brain stiffness correlates with clinical disability and is associated with enhanced expression of the extracellular matrix protein fibronectin (FN). Further, we show that FN is largely expressed by activated astrocytes at acute lesions, and reflects the magnitude of tissue remodeling at sites of BBB breakdown. Therefore, MRE could emerge as a safe tool suitable to monitor disease activity in MS.

Periodontal disease in adults with diabetes, prevalence and risk factors. Results of an observational study.

AIM: We sought (a) to assess the association between periodontal disease and diabetes, controlling for socio-demographic characteristics, comorbidities, oral health status and lifestyle variables; (b) to identify which of these variables are independently associated with periodontal disease among diabetes sufferers. METHODS: We conducted a case-control study using data from the National/European Health Interview Surveys, conducted from 2003 to 2014 in Spain. We included 65 295 subjects ≥40 years. Diabetes status was self-reported. One non-diabetic control was matched by the year-of-survey, age and sex for each diabetic patient. The presence of periodontal disease was defined using the answer "my teeth bleed spontaneously or while brushing" or/and "my teeth move" to the following question: "Do you suffer of any of these dental and oral disorders or disease?". Independent variables included demographic, socio-economic and healthcare related variables, oral health status and comorbidities. RESULTS: The prevalence of periodontal disease was higher among those suffering from diabetes than their non-diabetes controls (23.8% vs 19.5%; P < 0.001). Adjusted OR of periodontal disease for subjects with diabetes was 1.22 (95% CI; 1.03-1.45). Among diabetes sufferers, missing teeth status (OR 2.08, 95% CI; 1.70-2.53), suffering osteoporosis (OR 1.41, 95% CI; 1.07-1.63) and suffering depression (OR 1.39, 95% CI; 1.12-1.71) were positively associated with higher risk of periodontal disease. Older ages, using private insurance and university education level were associated with lower rates of periodontitis. CONCLUSIONS: Diabetes subjects have an increased likelihood of periodontal disease. Dentists and physicians should increase their awareness with their diabetic patients, especially those with lower educational level, with missing teeth, osteoporosis and depression.

Hipertensión intracraneal idiopática y fístula espontánea de líquido cefalorraquídeo. Utilidad de la monitorización de la presión intracraneal / Idiopathic intracranial hypertension and spontaneous cerebrospinal fluid fistula. Usefulness of intracranial pressure monitoring

Las fístulas espontáneas de líquido cefalorraquídeo (LCR) constituyen una entidad clínica relativamente frecuente en la práctica neuroquirúrgica. El tratamiento quirúrgico va encaminado al cierre del defecto y el porcentaje de recurrencias no es bajo. La asociación de fístula espontánea de LCR e hipertensión intracraneal idiopática (HII) es frecuente y posiblemente sea la causa de esta baja tasa de éxito. La semiología clínica de la HII asociada a la fístula espontánea de LCR no es típica, lo que hace que su diagnóstico pase a menudo desapercibido. La monitorización continua de la presión intracraneal permite diagnosticar situaciones de hipertensión intracraneal crónica en estos pacientes, por lo que su utilización es de extraordinaria utilidad a la hora de plantear alternativas terapéuticas

Spontaneous cerebrospinal fluid (CSF) fistulas are rather common in daily practice. The aim of the surgical treatment is closure of the leak, but recurrences are quite frequent. The association between spontaneous CSF fistulas and idiopathic intracranial hypertension (IIH) is not uncommon, and this is probably the cause of the low rate of success of the surgical treatment. Symptoms of IIH associated with spontaneous CSF fistula are atypical, and diagnosis is often missed. Continuous intracranial pressure monitoring is very useful in the diagnosis of chronic IIH and in patients with spontaneous CSF fistula, as it helps in making decisions on the treatment of these patients

[Idiopathic intracranial hypertension and spontaneous cerebrospinal fluid fistula. Usefulness of intracranial pressure monitoring]. / Hipertensión intracraneal idiopática y fístula espontánea de líquido cefalorraquídeo. Utilidad de la monitorización de la presión intracraneal.

Spontaneous cerebrospinal fluid (CSF) fistulas are rather common in daily practice. The aim of the surgical treatment is closure of the leak, but recurrences are quite frequent. The association between spontaneous CSF fistulas and idiopathic intracranial hypertension (IIH) is not uncommon, and this is probably the cause of the low rate of success of the surgical treatment. Symptoms of IIH associated with spontaneous CSF fistula are atypical, and diagnosis is often missed. Continuous intracranial pressure monitoring is very useful in the diagnosis of chronic IIH and in patients with spontaneous CSF fistula, as it helps in making decisions on the treatment of these patients.