Study Protocol for a Randomized Controlled Trial Assessing the Effectiveness of Personalized Computerized Cognitive Training for Individuals With Insomnia.

Insomnia is a frequent and heightened pathology in the general population of developed countries, and its condition generally leads to health discomfort and performance drop in daily and work-related tasks. As current pharmacological treatments for insomnia do not always seem sufficient to mitigate impairment, contemporary cognitive approaches might shed light on developing complementary therapies for this population. We propose a cognitive stimulation intervention program based on the importance of cognitive abilities as precipitating and maintenance variables of sleep disturbances. A full phase I-II-III clinical trial is proposed in which the first two studies will serve to assess the safety of the intervention and to identify the maximum tolerated time of the computerized cognitive training (phase I) and the minimum effective number of training sessions (phase II) in the absence of adverse events or side effects. Next, a phase-III double-blind randomized controlled trial design will be set. Sixty individuals with insomnia aged 25 to 55 years will enroll in a home-based personalized computerized cognitive stimulation program for a total time of 8 weeks, training 5 days per week. Sixty insomnia patients matched in a variety of factors will constitute the active control group, where the orthogonal activities will not be cognitively demanding. Sleep, cognitive, emotional, and quality of life variables will be measured before and immediately after training. A linear mixed model and hierarchical regression analysis will be used to investigate intervention effects. The results derived from this study will be precious for future research and treatment in cognitive performance and clinical pathologies. Clinical Trial Registration: [https://clinicaltrials.gov/], identifier [NCT05050292].

Does narrator variability facilitate incidental word learning in the classroom?

Recent studies have revealed that presenting novel words across various contexts (i.e., contextual diversity) helps to consolidate the meaning of these words both in adults and children. This effect has been typically explained in terms of semantic distinctiveness (e.g., Semantic Distinctiveness Model, Jones et al., Canadian Journal of Experimental Psychology, 66(2), 115, 2012). However, the relative influence of other, non-semantic, elements of the context is still unclear. In this study, we examined whether incidental learning of new words in children was facilitated when the words were uttered by several individuals rather than when they were uttered by the same individual. In the learning phase, the to-be-learned words were presented through audible fables recorded either by the same voice (low diversity) or by different voices (high diversity). Subsequently, word learning was assessed through two orthographic and semantic integration tasks. Results showed that words uttered by different voices were learned better than those uttered by the same voice. Thus, the benefits of contextual diversity in word learning extend beyond semantic differences among contexts; they also benefit from perceptual differences among contexts.

Enfermedad de Creutzfeldt-Jakob: experiencia de 5 años en un hospital terciario de Chile / Creutzfeldt-Jakob disease, experience in 17 patients

Background: Creutzfeldt-Jakob disease (CJD) is a prion affection that typically produces a rapidly progressive dementia with different neurologic and extra-neurologic manifestations. Aim: To characterize clinical, imaging and electroencephalography findings in patients with a probable CJD. Patients and Methods: A case series study of patients admitted in the Neurology department at a public hospital, between 2014 and 2019. Demographic, clinical, imaging, and electroencephalographic data of patients with probable CJD were analyzed. Results: Seventeen patients aged 63 ± 11 years (53% women) with a probable CJD were gathered. The incidence was 4.7 cases/year per million inhabitants. Twenty four percent of patients had a family history of CJD. The median time between the onset of symptoms and the hospital admission was three months with a survival of four months. The most common clinical manifestations were an amnesic syndrome in 88%, myoclonus in 76%, frontal syndrome and ataxia in 71%. Brain MRI was abnormal in all patients. The preponderant finding was the involvement of the caudate nucleus in 82% of cases. In the EEG, 94% of patients had abnormalities. All had a theta-delta slowing as a base rhythm. The pseudo-periodic pattern was observed in the 29% and status epilepticus in 18%. Conclusions: In this group of patients we observed the heterogeneity of the clinical manifestations of the disease, the frequent imaging and electroencephalographic alterations and the short evolution time leading to death.

Microsecretory Adenocarcinoma of Salivary Glands: An Expanded Series of 24 Cases.

Microsecretory adenocarcinoma (MSA) is a recently described salivary gland tumor with a characteristic histologic and immunophenotypic profile and recurrent MEF2C-SS18 fusions. Because only six cases of MSA have been published, its complete clinicopathologic spectrum is unclear, and its biologic behavior has not been documented. Here, we present an updated and expanded experience of 24 MSA cases. All cases of MSA were obtained from the authors' files. Immunohistochemistry for S100, SOX10, p63, p40, SMA, calponin, and mammaglobin was performed. Molecular analysis was performed by targeted RNA sequencing, SS18 break apart fluorescence in situ hybridization, and/or reverse transcriptase polymerase chain reaction for MEF2C-SS18 fusion. Clinical follow-up was obtained from medical records. A total of 24 MSA cases were collected, from 13 women and 11 men, ranging from 17 to 83 years (mean 49.5 years). The vast majority (23 of 24) arose in the oral cavity, with the palate (n = 14) and buccal mucosa (n = 6) as the most frequent subsites. Tumors showed consistent histologic features including: (1) microcystic tubules, (2) flattened intercalated duct-like cells, (3) monotonous oval hyperchromatic nuclei, (4) abundant basophilic luminal secretions, (5) fibromyxoid stroma, and (6) circumscribed borders with subtle infiltration. The tumors were very consistently positive for S100 (24 of 24), p63 (24 of 24), and SOX10 (14 of 14) and negative for p40 (0 of 21), calponin (0 of 12) and mammaglobin (0 of 16), while SMA (4 of 20) was variable. MEF2C-SS18 fusion was demonstrated in 21 of 24 cases; in the remaining 3 cases with insufficient RNA, SS18 break apart FISH was positive. Treatment information was available in 17 cases, all of which were managed with surgery only. In 14 cases with follow-up (1-216 months, mean 30), no cases recurred or metastasized. MSA is a distinct salivary gland neoplasm with remarkably consistent clinical, histologic, immunophenotypic, and genetic features that generally behaves in an indolent manner following surgery alone. These observations solidify MSA as a unique, low-grade salivary gland carcinoma that warrants inclusion in the next version of the WHO classification of head and neck tumors.

[Creutzfeldt-Jakob disease, experience in 17 patients]. / Enfermedad de Creutzfeldt-Jakob: experiencia de 5 años en un hospital terciario de Chile.

BACKGROUND: Creutzfeldt-Jakob disease (CJD) is a prion affection that typically produces a rapidly progressive dementia with different neurologic and extra-neurologic manifestations. AIM: To characterize clinical, imaging and electroencephalography findings in patients with a probable CJD. PATIENTS AND METHODS: A case series study of patients admitted in the Neurology department at a public hospital, between 2014 and 2019. Demographic, clinical, imaging, and electroencephalographic data of patients with probable CJD were analyzed. RESULTS: Seventeen patients aged 63 ± 11 years (53% women) with a probable CJD were gathered. The incidence was 4.7 cases/year per million inhabitants. Twenty four percent of patients had a family history of CJD. The median time between the onset of symptoms and the hospital admission was three months with a survival of four months. The most common clinical manifestations were an amnesic syndrome in 88%, myoclonus in 76%, frontal syndrome and ataxia in 71%. Brain MRI was abnormal in all patients. The preponderant finding was the involvement of the caudate nucleus in 82% of cases. In the EEG, 94% of patients had abnormalities. All had a theta-delta slowing as a base rhythm. The pseudo-periodic pattern was observed in the 29% and status epilepticus in 18%. CONCLUSIONS: In this group of patients we observed the heterogeneity of the clinical manifestations of the disease, the frequent imaging and electroencephalographic alterations and the short evolution time leading to death.

Contextual diversity facilitates learning new words in the classroom.

In the field of word recognition and reading, it is commonly assumed that frequently repeated words create more accessible memory traces than infrequently repeated words, thus capturing the word-frequency effect. Nevertheless, recent research has shown that a seemingly related factor, contextual diversity (defined as the number of different contexts [e.g., films] in which a word appears), is a better predictor than word-frequency in word recognition and sentence reading experiments. Recent research has shown that contextual diversity plays an important role when learning new words in a laboratory setting with adult readers. In the current experiment, we directly manipulated contextual diversity in a very ecological scenario: at school, when Grade 3 children were learning words in the classroom. The new words appeared in different contexts/topics (high-contextual diversity) or only in one of them (low-contextual diversity). Results showed that words encountered in different contexts were learned and remembered more effectively than those presented in redundant contexts. We discuss the practical (educational [e.g., curriculum design]) and theoretical (models of word recognition) implications of these findings.

Sialolipoma of minor salivary glands: presentation of five cases and review of the literature with an epidemiological analyze.

UNLABELLED: Sialolipoma is rare benign neoplasm arise from salivary glands (majors and minors) characterized by neoplastic adipose tissue with scattered non-neoplastic salivary gland acinus. To date 60 cases (including 5 cases reported in the present paper) have been reported in scientific literature. This article presents 5 new cases of sialolipoma affecting minor salivary glands (MiSG) and additionally reviews and analyzes the previously published cases to assess possible demographical differences between sialolipoma from minor and from major salivary glands. CASE REPORTS: 5 cases (3 females; 2 males; age means 63.8 years), of sialolipoma from MiSG, are reported. 2 of them were located in buccal mucosa, 1 in upper lip mucosa, 1 in floor of the mouth and 1 in retromolar area. All tumors were composed by neoplastic adipocytes cells interlaced with normal salivary gland acinus cover it by a fibrous tissue capsule. Analyzes of literature showed that MiSG sialolipoma is most frequent in females over 60 years old, therefore and in conclusion this article assess different demographical profile of sialolipoma in respect to their topography.

Indications and procedures for direct immunofluorescence biopsies of the oral mucosa.

A definitive diagnosis is crucial for management of any oral mucosal disease. Direct immunofluorescence (DIF) is a valuable diagnostic aid for immune-mediated blistering diseases and systemic connective tissue diseases of the skin and the mucosa. This paper gives an overview of the DIF biopsy technique for oral lesions and provides a background for the clinician to optimize the utilization of DIF biopsy. The key characteristic diagnostic findings of DIF of specific mucosal diseases are also discussed.

The challenges of defining oral cancer: analysis of an ontological approach.

An important inconsistency currently exists in the literature on oral cancer. Reviewing this literature, one finds that the term oral cancer is defined and described with great variation. In a search in PubMed, at least 17 different terms were found for titles of papers reporting data on oral cancer. The variability of the terms used for designating anatomic regions and type of malignant neoplasms for reporting oral cancer has hampered the ability of researchers to effectively retrieve information concerning oral cancer. Therefore, it is sometimes extremely difficult to provide meaningful comparisons among various studies of oral cancer. Recently, a new ontological strategy that is rooted in consensus-based controlled vocabularies has been proposed to improve the consistency of data in dental research (Smith et al. in J Am Dent Assoc 141:1173-1175, 2010). In this paper, we analyzed the terminology dilemma on oral cancer and explained the current situation. We proposed a possible solution to the dilemma using an ontology-based approach. The advantages for applying this strategy are also discussed.

En búsqueda del Phymatotrichopsis Omnívora, en pobladores de la Colonia Tovar, Venezuela, octubre 2007 / Phymatotrichopsis Omnivore, study search at Aragua Colonia Tovar residents, Venezuela, October 2007

Se realizó un estudio descriptivo, y de corte transversal, con el propósito de investigar la presencia del hongo Phymatotrichopsis omnívora como agente etiológico , del alerta epidemiológica denunciada en un medio de comunicación regional, la cual le atribuyo a este hongo el deterioro de la cosecha del durazno, conocida por los pobladores como secason y algunas lesiones de piel en pacientes adultos y pediátricos de los caseríos, Gabante, área urbana y el Cedral, del Municipio Tovar, Estado Aragua; Venezuela. Se examinaron 144 pacientes con lesiones de piel sospechosos de micosis superficial que acudieron a la consulta de los centros de salud de la zona. Se realizó examen de piel y faneras, examen directo; cultivos para hongos y biopsia de piel los cuales fueron procesados en el laboratorio del Hospital Central de Maracay y en el Servicio de Anatomía Patológica del Instituto Autónomo de Biomedicina, Caracas. Los datos básicos se registraron en ficha epidemiológica; se procedió al análisis estadístico; encontrándose entre las 10 primeras patologías dermatológicas: Pitiriasis alba (18,75%), Queratosis Folicular (11,1%), Quiste Millium (10,4%), Acné (6,25%),Prurigo Infantil (6,25%), Picaduras de Insectos (5,5%),Dermatitis Seborreica (4,9%), Micosis Superficial (4,16%), Urticaria (4,16%), Melasma (3.47%), otras (2.7%). De origen micótico encontramos, dos con Pitiriasis Versicolor cuyo agente etiológico fue Malassezia furfur; dos Onicomicosis, uno Tiña Corporal y uno con Tiña Inguinal; aislándose en los cultivos Trichophytum rubrum. En conclusión: de 144 personas examinadas ninguna presentó lesiones atribuidas al hongo Phymatotrichopsis omnívora.

It was made a cross-sectional descriptive, with the purpose of investigating the presence of the mushroom Phymatotrichopsis omnivore as an etiological agent, of an epidemic alert reported on a regional communications medium; which attributed to this fungus deterioration peach crop, known to residents as 'secasón' and some skin lesions in adult and paediatrics patients in the hamlets, Gabante, urban and Cedral, Tovar Municipality, Aragua; Venezuela. We examined 144 patients with skin lesions suspected of superficial fungal infections and they were seen at the health centers in the area. Examination was made of skin and appendages, direct examination, fungal cultures and skin biopsies which were processed in the laboratory of the Central Hospital of Maracay and the Pathology Department of the Autonomous Institute of Biomedicine, Caracas. Baseline data were recorded in epidemiological record, we proceeded to statistical analysis to be among the top 10 dermatological diseases: Pityriasis Alba (18.75%), follicular keratosis (11.1%), cyst Millium (10.4%) Acne (6.25%), Child Prurigo (6.25%), insect bites (5.5%), seborrheic dermatitis (4.9%) Superficial Mycoses (4.16%), urticaria (4.16 %), melasma (3.47%), other (2.7%). Of fungal origin found, two with Pityriasis Versicolor whose etiologic agent was Malassezia furfur; two onychomycosis, one Corporal and one Tinea jock itch, isolated from cultures Trichophytum rubrum. In conclusion: of 144 people tested had no injuries attributed to the fungus Phymatotrichopsis omnivorous.

Gingival melanoacanthoma: case report and discussion of its clinical relevance.

Oral melanoacanthoma is an uncommon reactive condition that appears as a solitary pigmented lesion and is most often found on the buccal mucosa. For it to appear in the gingiva is extremely rare--only 11 cases are reported in the literature. This article presents a case of gingival melanoacanthoma and reviews the previously published cases. Because gingival melanoacanthoma shares clinical features with other pigmented lesions with diverse genesis, the differential diagnosis of a solitary pigmented lesion on the gingiva is also discussed.

Solitary fibrous tumor with entrapment of minor salivary gland tissue: an unusual presentation that requires exclusion of pleomorphic adenoma.

We report two unusual cases of solitary fibrous tumor (SFT) of minor salivary glands that microscopically mimicked pleomorphic adenoma. One of these lesions presented in the retromolar region and the other in the buccal mucosa. The microscopic features of these two tumors and their intimate relationship with regional mucous minor salivary glands posed a diagnostic challenge. Awareness of the morphological diversity of SFT coupled to a judicious use of appropriate immunohistochemical probes should prove valuable to accurately segregate SFT from pleomorphic adenoma.

Inflammatory response to dental polishing and prophylaxis materials in rats.

OBJECTIVE: To describe the tissue response to implanted polishing and prophylaxis materials using a rat model system. MATERIAL AND METHODS: Two polishing pastes (diamond polishing paste and aluminum polishing paste), two prophylaxis materials (prophylaxis paste with fluoride and air polishing prophylaxis powder) and negative and positive controls were subcutaneously implanted in rats. Tissue specimens obtained after 2 days, 1, 4, 6 and 8 weeks after implantation were processed for routine hematoxylin and eosin staining and polarized light evaluation. RESULTS: Air polishing prophylaxis powder produced a mild inflammatory response. A more intense inflammation was elicited by diamond polishing paste, and the prophylaxis paste with fluoride elicited an even greater response. The aluminum polishing paste produced the most severe and persistent tissue response, which was of the granulomatous type. CONCLUSIONS: This finding suggests that foreign body reaction should be considered in a gingivitis that does not respond to plaque control or does not represent a mucocutaneous lesion.

Estimation of individual neonatal survival using birthweight and gestational age: a way to improve neonatal care.

The study was conducted to determine the combined effect of birthweight and gestational age at birth on neonatal mortality using individually-identified livebirths. Logistic regression was used for studying the interactive effect of birthweight and gestational age on the individual probability of neonatal death. All livebirths from Chile in 2000 were included in a linked file. Odds ratio models for birthweight and gestational age were developed for each sex. The probability of neonatal death by sex was presented using contour plots. The models were statistically significant, and odds ratios were different and non-linear for the effects of birthweight and gestational age. Contour plots of constant neonatal mortality according to birthweight and gestational age were presented; they were similar for each sex. A single graph for both sexes that estimates the survival potential of infants born too early or too small would improve neonatal care in developing countries.

Effects of a dairy product fortified with multiple micronutrients and omega-3 fatty acids on birth weight and gestation duration in pregnant Chilean women.

OBJECTIVE: To test the hypothesis that maternal food fortification with omega-3 fatty acids and multiple micronutrients increases birth weight and gestation duration, as primary outcomes. DESIGN: Non-blinded, randomised controlled study. SETTING: Pregnant women received powdered milk during their health check-ups at 19 antenatal clinics and delivered at two maternity hospitals in Santiago, Chile. SUBJECT: Pregnant women were assigned to receive regular powdered milk (n = 477) or a milk product fortified with multiple micronutrients and omega-3 fatty acids (n = 495). RESULTS: Intention-to-treat analysis showed that mean birth weight was higher in the intervention group than in controls (65.4 g difference, 95% confidence interval (CI) 5-126 g; P = 0.03) and the incidence of very preterm birth (0.80 just for mean birth weight and birth length in the on-treatment analysis; birth length in that analysis had a difference of 0.57 cm (95% CI 0.19-0.96 cm; P = 0.003). CONCLUSIONS: The new intervention resulted in increased mean birth weight. Associations with gestation duration and most secondary outcomes need a larger sample size for confirmation.

La expresión de Yin-Yang-1 (YY-1) y Fas en las biopsias de niños con nefritis lúpica tipo IV se correlaciona con la condición clínica / Ying-Yang (YY-1) expression and Fas in biopsies of children with type IV lupus nephritis correlates with the clinical condition

Antecedentes: La apoptosis mediada por Fas participa en la fisiopatología de la nefritis lúpica. Debido a que YY-1 regula negativamente el Fas en líneas celulares de cáncer, es razonable considerar que este factor de transcripción pueda controlar la expresión de Fas en la nefritis lúpica. El objetivo es determinar la correlación de la expresión de YY-1 y Fas en biopsias de niños con nefritis lúpica de tipo IV y su asociación con la condición clínica de los pacientes. Material y métodos: Se estudiaron 18 biopsias de niños con nefritis lúpica de tipo IV y 5 controles. La expresión de Fas y YY-1 se determinó mediante inmunohistoquímica y se cuantificó mediante análisis densitométrico. Se obtuvo información sobre el estado clínico de los pacientes en el momento de la biopsia a partir de los expedientes, y los resultados se analizaron mediante ANOVA de una vía. Se consideró significativo un valor p < 0,005. Resultados: Los resultados del análisis densitométrico muestran una relación inversa entre la expresión de YY- 1 y Fas. Se agrupó YY-1, de acuerdo con la intensidad de su expresión, en baja, moderada y alta para poder compararla con la expresión de Fas. Las biopsias de nefritis lúpica que mostraron alta expresión de YY-1 correspondieron a pacientes con menor número de complicaciones clínicas, mejor desenlace y menor número de alteraciones en la función renal. En contraste, la expresión de YY-1 baja se correlacionó con alta expresión de Fas y peores condiciones clínicas. Conclusiones: En conclusión, el presente estudio indica que YY-1 regula la expresión de Fas en la nefritis lúpica y que se encuentra asociada con el desenlace clínico de los pacientes, si bien son necesarios más estudios para determinar si puede servir como marcador pronóstico. Hasta donde sabemos, ésta es la primera evidencia de que YY-1 participa en la fisiopatología de la nefritis lúpica (AU)

Background: It has been demonstrated that Fasmediated apoptosis participates in the physiopathology of lupus nephritis, although it is not clear whether it contributes to the development of the tissue damage. Since YY-1 down regulates Fas in cancer cell lines, it is reasonable to consider that this transcription factor may control Fas expression in lupus nephritis. The objective was to determine the correlation between YY-1 and Fas expression in renal biopsies from children with type IV lupus nephritis, and their association with the clinical condition of the patients. Material and methods: Eighteen biopsies from children with type IV lupus nephritis and 5 controls were studied. Fas and YY-1 expression were determined by immunochemistry and quantified by densytometric analysis. The clinical conditions at the moment the biopsy were obtained from the clinical records and the results were analyzed through a one-way ANOVA with p < 0.005. Results: The results of the densytometric analysis showed an inverse relationship between YY-1 and Fas expression. YY-1 was grouped according to the intensity of expression in low, moderate and high and compared with the expression of Fas. The lupus nephritis biopsies, which revealed high expression of YY-1, corresponded to patients with less number of clinical complications, better outcome and fewer alterations on renal function. In contrast, low expression of YY-1 correlated with high Fas expression and worst clinical conditions. Conclusions: The present study suggests that YY-1 regulates Fas expression in lupus nephritis and that it is associated with the clinical outcome of the patients, although further studies are necessary to determine weather it factor may serve as a prognosis factor. This is the first evidence of YY-1 participation in the physiopathology of lupus nephritis (AU)