Do Higher Transcranial Direct Current Stimulation Doses Lead to Greater Gains in Upper Limb Motor Function in Post-Stroke Patients?

Objective: To investigate whether a higher number of transcranial direct current stimulation (tDCS) sessions results in a greater improvement in upper limb function in chronic post-stroke patients. Materials and methods: A randomized, sham-controlled, double-blind clinical trial was conducted in 57 chronic post-stroke patients (≥ 3 months after their injuries). The patients were allocated to receive sessions of tDCS combined with physiotherapy and divided into three groups (anodal, cathodal, and sham). The Fugl-Meyer Assessment of Upper Extremity (FMA-UE) was used to assess the sensorimotor impairment of the patients' upper limbs before (baseline) and after five and ten sessions. The percentage of patients who achieved a clinically significant improvement (> five points on the FMA-UE) was also analyzed. Results: The FMA-UE score increased after five and ten sessions in both the anodal and cathodal tDCS groups, respectively, compared to the baseline. However, in the sham group, the FMA-UE score increased only after ten sessions. When compared to the sham group, the mean difference from the baseline after five sessions was higher in the anodal tDCS group. The percentage of individuals who achieved greater clinical improvement was higher in the stimulation groups than in the sham group and after ten sessions when compared to five sessions. Conclusions: Our results suggest that five tDCS sessions are sufficient to augment the effect of standard physiotherapy on upper limb function recovery in chronic post-stroke patients, and ten sessions resulted in greater gains.

Long-Term Outcomes After Autologous Versus Allogeneic Stem Cell Transplantation in Molecularly-Stratified Patients With Intermediate Cytogenetic Risk Acute Myeloid Leukemia: A PETHEMA Study.

Acute myeloid leukemia (AML) with intermediate risk cytogenetics (IRcyto) comprises a variety of biological entities with distinct mutational landscapes that translate into differential risks of relapse and prognosis. Optimal postremission therapy choice in this heterogeneous patient population is currently unsettled. In the current study, we compared outcomes in IRcyto AML recipients of autologous (autoSCT) (n = 312) or allogeneic stem cell transplantation (alloSCT) (n = 279) in first complete remission (CR1). Molecular risk was defined based on CEBPA, NPM1, and FLT3-ITD mutational status, per European LeukemiaNet 2017 criteria. Five-year overall survival (OS) in patients with favorable molecular risk (FRmol) was 62% (95% confidence interval [CI], 50-72) after autoSCT and 66% (95% CI, 41-83) after matched sibling donor (MSD) alloSCT (P = .68). For patients of intermediate molecular risk (IRmol), MSD alloSCT was associated with lower cumulative incidence of relapse (P < .001), as well as with increased nonrelapse mortality (P = .01), as compared to autoSCT. The 5-year OS was 47% (95% CI, 34-58) after autoSCT and 70% (95% CI, 59-79) after MSD alloSCT (P = .02) in this patient subgroup. In a propensity-score matched IRmol subcohort (n = 106), MSD alloSCT was associated with superior leukemia-free survival (hazard ratio [HR] 0.33, P = .004) and increased OS in patients alive 1 year after transplantation (HR 0.20, P = .004). These results indicate that, within IRcyto AML in CR1, autoSCT may be a valid option for FRmol patients, whereas MSD alloSCT should be the preferred postremission strategy in IRmol patients.

Estudio prospectivo de cinco años de los niveles de homocisteinemia y riesgo cardiovascular en pacientes de una unidad de hemodiálisis / A prospective study of five years about homocysteinemia levels and cardiovascular risk in patients in a hemodialysis unit

La enfermedad cardiovascular es compleja y multifactorial. Uno de los marcadores conocido como factor de riesgo vascular independiente es la homocisteína; el aumento en 5 µmol/l por encima del rango normal equivale, en riesgo vascular, a un aumento de 20 mg/ dl por encima del colesterol normal. En la población general niveles ligeramente elevados de homocisteína (>15µmol/l), se asocian al incremento de la mortalidad y de los eventos cardiovasculares. Este factor también está presente en pacientes renales, siendo sus niveles 3-4 veces superiores a la población en general. Los mecanismos por los que la homocisteína está elevada en la insuficiencia renal no están claros, ya que su excreción renal sólo representa el 1% de su eliminación; si embargo, si está comprobado que la utilización de membranas de diálisis de alto flujo, diálisis lenta nocturna, o hemodiafiltración on-line diarias reducen significativamente los niveles de este aminoácido. Tal vez estos tratamientos, al conseguir una mayor reducción de los niveles de homocisteína, puedan reducir la morbimortalidad cardiovascular renal y, por ello, es aconsejable medir los niveles de homocisteína anualmente en los pacientes renales. Nos planteamos conocer el riesgo vascular de nuestros pacientes renales a lo largo de cinco años, según valores de homocisteína y determinar su relación con modalidad y tiempo en tratamiento, edad, sexo y grupo étnico. Realizamos un estudio observacional prospectivo en pacientes de una unidad renal durante cinco años. Recogimos datos sobre: edad, sexo, grupo étnico, modalidad de tratamiento (hemodiafiltración versus hemodiálisis), tiempo en tratamiento y valores de homocisteína. Estudiamos 115 pacientes, de edad media 59 años, 68 hombres y 47 mujeres; 107 pacientes caucásicos mediterráneo, 4 caucásicos norteafricano y 4 negroide. El 54,8% llevaba menos de 4 años en tratamiento renal. Un 63% estaba en hemodiálisis, 27% en hemodiafiltración alterna y 10% en diaria. El valor medio de homocisteína en varones fue de 23.47 µmol/l y en mujeres 24.29 µmol/l. Los valores de homocisteína en el tercer y cuarto año de estudio según el grupo cultural fueron en pacientes negroides 51,50 y 69,35 µmol/l respectivamente, con significación estadística. En la población general el riesgo cardiovascular se asocia a la edad y el sexo sin embargo, los niveles de homocisteína versus estas variables en nuestra población renal a estudio no se ven modificados. Otras diferencias vienen marcadas por el grupo étnico: menores en raza negra y asiáticos que en personas de raza blanca, mientras que los latinoamericanos tenían concentraciones intermedias. Estas afirmaciones no coinciden con los resultados de nuestro estudio, ya que el grupo caucásico mediterráneo (la mayoría de nuestros pacientes) que presenta valores intermedios con riesgo moderado y el grupo de etnia negroide valores más elevados incluso de riesgo elevado. Concluimos que nuestros pacientes presentaban un nivel moderado de riesgo vascular. Al enfrentar homocisteína con sexo, edad, modalidad y tiempo de tratamiento sustitutivo no encontramos relación estadística significativa. Sin embargo, el grupo étnico si presentaba variaciones significativas siendo el grupo negroide el de mayor riesgo vascular con niveles más elevados en los tres últimos años del estudio (AU)

Cardiovascular disease is complex and multifactorial. One of the markers known as independent vascular risk factor is homocysteine. In relation to vascular risk, the increase of 5 mmol/l above the normal range, corresponds to an increase of 20 mg/dl above normal cholesterol. In the general population, slightly elevated homocysteine levels (> 15µmol/l), are associated with increased mortality and cardiovascular events. Also, this factor is present in renal patients, at 3-times higher levels than the general population. Mechanisms by which homocysteine is elevated in renal failure are unclear, since renal excretion represents only 1% of its elimination. However, it has been shown that the use daily of membranes of high flux dialysis, slow nocturnal home dialysis, or on-line hemodiafiltration, significantly reduce these amino acid levels. These treatments could achieve a greater reduction in homocysteine levels and reduce the cardiovascular renal morbid-mortality, therefore, it is advisable to measure homocysteine levels in renal patients annually. The aim was to study the vascular risk in our renal patients in a study of five years, according to the homocysteine levels and determine their relationship with modality and time of treatment, age, sex and ethnicity. A prospective observational study of five year was carried out in our dialysis unit. Data about age, sex, ethnicity, type of treatment (hemodiafiltration versus hemodialysis), duration of treatment and homocysteine levels were collected. 115 patients (68 men and 47 women) with a mean age of 59 years were studied. 107 patients were Mediterranean Caucasians, 4 North African Caucasian and 4 African blacks. 54.8% had less than four years in renal treatment. 63% were on hemodialysis, 27% patients were in alternating hemodiafiltration, and 10% in daily hemodialysis. The mean level of homocysteine in males was 23.47 mmol/l, and in women of 24.29 mmol/l. According to the cultural group, homocysteine levels in the third and fourth year of study, were significant in African black patients, with levels of 51.50 and 69.35 mol/l respectively. In the general population, cardiovascular risk is associated with age and sex. However, homocysteine levels versus these variables in our renal study population are not modified. Other differences are marked by ethnic group: lower in blacks and Asians than in Caucasians, while Latin American had intermediate concentrations. This information do not coincide with our findings, because the Caucasian Mediterranean group (most of our patients) had intermediate values at moderate risk and the African black group had higher values, even of the high risk. We conclude that our patients had a moderate level of vascular risk. When relating homocysteine with sex, age, mode and time of replacement therapy no statistical significant relationship was found. However, ethnicity if present significant variations being the African black the group with higher vascular risk with higher levels in the last three years of the study (AU)

Type of sexual contact and precoital sexual experience in Spanish adolescents / Tipo de contacto sexual y experiencia sexual precoital en adolescentes españoles

El objetivo de este estudio era evaluar algunas características de las conductas sexuales precoitales y el tipo de contacto sexual en adolescentes españoles. Participó una muestra representativa de 4.456 estudiantes españoles de enseñanza secundaria obligatoria. Se administró un cuestionario sobre conducta sexual. Se trata de un estudio transversal descriptivo de poblaciones mediante encuestas con muestras probabilísticas. Los adolescentes fueron seleccionados mediante un muestreo aleatorio estratificado en función del tipo de centro educativo y de la comunidad autónoma. En comparación con las mujeres, los varones comenzaron las experiencias sexuales sin penetración a una edad más temprana, tenían un mayor número de parejas y un mayor porcentaje de varones manifestó tener parejas ocasionales. Este estudio no solo contribuye al conocimiento sobre la conducta sexual de los adolescentes antes del inicio de las relaciones sexuales con penetración sino que en él se destaca la importancia de desarrollar estrategias de prevención sexual en los adolescentes.

The aim of this study was to examine characterisctics of precoital sexual behaviors and types of sexual contact in adolescent. A representative sample of 4,456 Spanish high school students participated. These participants were selected by means of a stratified random sampling procedure. They completed a questionnaire about their sexual behaviour. It is a cross-sectional survey study. Differences according to age and gender in characteristics of sexual behaviour before the onset of sexual intercourse were found. Compared to females, males started non penetrative sexual experiences earlier, had a higher number of sexual partners and a higher percentage of males reported having had casual sexual partner. This study not only adds to knowledge about sexual behaviour before the initiation of sexual intercourse among adolescents, it also highlights the importance of developing sexual prevention strategies for young adolescents.