Gastric neuroendocrine tumor presenting with carcinoid syndrome.

Carcinoid tumors are rare neoplasms, most frequently found in the gastrointestinal tract, responsible for the production of neuroendocrine mediators. Carcinoid syndrome is even rarer and consists of a set of symptoms characteristic of the release of these mediators into the systemic circulation. We present an interesting case of a patient with carcinoid syndrome as a late manifestation of a gastric neuroendocrine tumor with, highlighting the importance of knowing how to identify the carcinoid syndrome.

Capsule endoscopy: beyond the small bowel.

Capsule endoscopy (CE) is considered the first-line for the investigation of OGIB after conventional non-diagnostic endoscopic examinations. A detection rate of lesions outside the small bowel segment has been reported to range from 3.5% to >30%. Our primary objective was to analyze the role of CE in identifying lesions outside the small bowel segment that were not identified on conventional endoscopy in patients suspected of OGIB. In our study, CE appears to be effective and safe in diagnosing OGIB, also proving to be a tool in identifying lesions outside the small intestine segment.

Anorectal melanoma: a rare entity.

Anorectal melanoma is a rare malignant tumor with the potential of simulating a benign anorectal disease, making its diagnosis difficult. We describe a case of anorectal melanoma, in which the interpretation of symptoms as hemorrhoidal disease delayed diagnosis and appropriate intervention.

Corrigendum: Deep brain stimulation neuromodulation for the treatment of mood disorders: obsessive compulsive disorder and treatment resistant depression.

[This corrects the article DOI: 10.3389/fpsyt.2021.764776.].

Magmatic immiscibility and the origin of magnetite-(apatite) iron deposits.

The origin of magnetite-(apatite) iron deposits (MtAp) is one of the most contentious issues in ore geology with competing models that range from hydrothermal to magmatic processes. Here we report melt inclusions trapped in plagioclase phenocrysts in andesite hosting the MtAp mineralization at El Laco, Chile. The results of our study reveal that individual melt inclusions preserve evidence of complex processes involved in melt immiscibility, including separation of Si- and Fe-rich melts, the latter hosting Cu sulfide-rich, phosphate-rich, and residual C-O-HFSE-rich melts, with their melting temperature at 1145 °C. This association is consistent with the assemblages observed in the ore, and provides a link between silicate and Fe-P-rich melts that subsequently produced the magnetite-rich magmas that extruded on the flanks of the volcano. These results strongly suggest that the El Laco mineralization was derived from crystallization of Fe-P-rich melts, thus providing insight into the formation of similar deposits elsewhere.

Esophagitis dissecans superficialis: a rare endoscopic finding.

Esophagitis dissecans superficialis is an extremely rare benign illness. Although an association with medications, skin conditions, heavy smoking, and physical trauma has been reported, most cases remain unexplained. We present a previously healthy 42-year-old woman found to have EDS secondary to trauma. The patient started on PPI therapy with rapid and complete resolution of the endoscopic abnormality. This case shows the importance of identification of EDS, a rare and often underdiagnosed entity.

Prefrontal γ-Aminobutyric Acid Levels in Never-Medicated Individuals With Chronic Schizophrenia.

This cross-sectional study analyzes spectroscopy data for long-term, never-medicated patients with schizophrenia to examine their levels of γ-aminobutyric acid (GABA) compared with those of healthy controls.

Relationship between the novel and traditional anthropometric indices and subclinical atherosclerosis evaluated by carotid intima-media thickness (c-IMT).

Introduction: Over the last few years, novel anthropometric indices have been developed as an alternative to body mass index (BMI) and other traditional anthropometric measurements to enhance the estimate of fat proportion and its relationship to a future cardiovascular event. The purpose of this study was to investigate the association of carotid intima-media thickness (c-IMT) estimated by Doppler ultrasound with current anthropometric indices (traditional and novel). Methods: A cross-sectional study was conducted on a total of 789 Spanish patients. Traditional (BMI, WHR, and WHtR) and new (WWI, AVI, ABSI, BRI, BAI, CUN-BAE, and CI) anthropometric indices were determined, and carotid Doppler ultrasound was performed to evaluate c-IMT (≥0.90 mm). Results: Most of the anthropometric indices analyzed were significantly higher among patients with pathological c-IMT, except for BMI, BAI, and CUN-BAE. In multiple linear regression analysis, c-IMT was positively related to ABSI, AVI, BRI, CI, and WWI but not to CUN-BAE, BAI, or traditional anthropometric indices. Similarly, in univariate analysis, all indices were associated with a c-IMT of ≥0.90 mm (p < 0.05), except BMI, BAI, and CUN-BAE; however, only ABSI (adjusted OR: 1.61; 95% CI: 1.08-2.40; p = 0.017), CI (adjusted OR: 1.73; 95% CI: 1.15-2.60; p = 0.008), and WWI (adjusted OR: 1.74; 95% CI: 1.14-2.64; p = 0.009) were significantly associated in multivariate analysis. Finally, CI, ABSI, and WWI provided the largest AUC, and BMI and CUN-BAE showed the lowest AUC. Conclusion: ABSI, CI, and WWI were positively associated with pathological c-IMT (≥0.90 mm), independent of other confounders.

Innovative perspectives in limbic surgery using deep brain stimulation.

Limbic surgery is one of the most attractive and retaken fields of functional neurosurgery in the last two decades. Psychiatric surgery emerged from the incipient work of Moniz and Lima lesioning the prefrontal cortex in agitated patients. Since the onset of stereotactic and functional neurosurgery with Spiegel and Wycis, the treatment of mental diseases gave attention to refractory illnesses mainly with the use of thalamotomies. Neurosis and some psychotic symptoms were treated by them. Several indications when lesioning the brain were included: obsessive-compulsive disorder, depression, and aggressiveness among others with a diversity of targets. The indiscriminately use of anatomical sites without enough scientific evidence, and uncertainly defined criteria for selecting patients merged with a deficiency in ethical aspects, brought a lack of procedures for a long time: only select clinics allowed this surgery around the world from 1950 to the 1990s. In 1999, Nuttin et al. began a new chapter in limbic surgery with the use of Deep Brain Stimulation, based on the experience of pain, Parkinson's disease, and epilepsy. The efforts were focused on different targets to treat depression and obsessive-compulsive disorders. Nevertheless, other diseases were added to use neuromodulation. The goal of this article is to show the new opportunities to treat neuropsychiatric diseases.

The thrombus proteome in stroke reveals a key role of the innate immune system and new insights associated with its etiology, severity, and prognosis.

BACKGROUND: Nowadays little is known about the molecular profile of the occluding thrombus of patients with ischemic stroke. OBJECTIVES: To analyze the proteomic profile of thrombi in patients who experienced an ischemic stroke in order to gain insights into disease pathogenesis. METHODS: Thrombi from an exploratory cohort of patients who experienced a stroke were obtained by thrombectomy and analyzed by sequential window acquisition of all theoretical spectra-mass spectrometry. Unsupervised k-means clustering analysis was performed to stratify patients who experienced a stroke. The proteomic profile was associated with both the neurological function (National Institute of Health Stroke Scale [NIHSS]) and the cerebral involvement (Alberta Stroke Program Early CT Score [ASPECTS]) prior to thrombectomy and the clinical status of patients at 3 months using the modified Rankin Scale. In an independent cohort of 210 patients who experienced a stroke, the potential role of neutrophils in stroke severity was interrogated. RESULTS: Proteomic analysis identified 580 proteins in thrombi, which were stratified into 4 groups: hemostasis, proteasome and neurological diseases, structural proteins, and innate immune system and neutrophils. The thrombus proteome identified 3 clusters of patients with distinctive severity, prognosis, and etiology of the stroke. A protein signature clearly distinguished atherothrombotic and cardioembolic strokes. Several proteins were significantly correlated with the severity of the stroke (NIHSS and ASPECTS). Functional proteomic analysis highlighted the prominent role of neutrophils in stroke severity. This was in line with the association of neutrophil activation markers and count with NIHSS, ASPECTS, and the modified Rankin Scale score 90 days after the event. CONCLUSION: The use of sequential window acquisition of all theoretical spectra-mass spectrometry in thrombi from patients who experienced an ischemic stroke has provided new insights into pathways and players involved in its etiology, severity, and prognosis. The prominent role of the innate immune system identified might pave the way for the development of new biomarkers and therapeutic approaches in this disease.

Amygdala and hippocampus dialogue with neocortex during human sleep and wakefulness.

ABSTRACT: Previous studies have described synchronic electroencephalographic (EEG) patterns of the background activity that is characteristic of several vigilance states. STUDY OBJECTIVES: To explore whether the background synchronous activity of the amygdala-hippocampal-neocortical circuit is modified during sleep in the delta, theta, alpha, sigma, beta, and gamma bands characteristic of each sleep state. METHODS: By simultaneously recording intracranial and noninvasive scalp EEG (10-20 system) in epileptic patients who were candidates for neurosurgery, we explored synchronous activity among the amygdala, hippocampus, and neocortex during wakefulness (W), Non-Rapid Eye Movement (NREM), and Rapid-Eye Movement (REM) sleep. RESULTS: Our findings reveal that hippocampal-cortical synchrony in the sleep spindle frequencies was spread across the cortex and was higher during NREM versus W and REM, whereas the amygdala showed punctual higher synchronization with the temporal lobe. Contrary to expectations, delta synchrony between the amygdala and frontal lobe and between the hippocampus and temporal lobe was higher during REM than NREM. Gamma and alpha showed higher synchrony between limbic structures and the neocortex during wakefulness versus sleep, while synchrony among deep structures showed a mixed pattern. On the one hand, amygdala-hippocampal synchrony resembled cortical activity (i.e. higher gamma and alpha synchrony in W); on the other, it showed its own pattern in slow frequency oscillations. CONCLUSIONS: This is the first study to depict diverse patterns of synchronic interaction among the frequency bands during distinct vigilance states in a broad human brain circuit with direct anatomical and functional connections that play a crucial role in emotional processes and memory.

Association of Subclinical Carotid Atherosclerosis Assessed by High-Resolution Ultrasound With Traditional and Novel Anthropometric Indices.

Novel anthropometric indices have been proposed as an alternative to body mass index (BMI) and waist circumference (WC) to determine visceral adipose tissue and body mass. Little is known about the relationship of these new anthropometric indices to subclinical carotid atherosclerosis. The objective of this study was to assess the association of anthropometric indices, both new and traditional, with the presence of subclinical carotid artery arteriosclerosis (SCAA) estimated by Doppler ultrasound. This cross-sectional study analyzed 788 Spanish patients who consecutively attended a vascular risk consultation between June 2021 and September 2022. Traditional anthropometric indices (BMI, WHR and WHtR) and novel indices (ABSI, AVI, BAI, BRI, CI, CUNBAE and WWI) were calculated, and Doppler ultrasound in the carotid artery (cIMT and atherosclerosis plaque) was performed to detect SCAA. All analyzed anthropometric indices, except BMI, BAI and CUNBAE, were significantly higher in patients with SCAA. ABSI, BRI, CI, WHR, WHtR and WWI and were associated with SCAA in the univariate analysis (p<0.05); however, only ABSI (adjusted OR: 1.15; 95% CI: 1.10-2.38; p= 0.042) was significantly associated with SCAA in the multivariate analysis. In conclusion, only ABSI was significantly positively associated with SCAA, independent of other confounders.

The elimination of trachoma as a public health problem in Mexico: From national health priority to national success story.

INTRODUCTION: Mexico was the first country in the Americas and the third in the world to eliminate trachoma as a public health problem, as validated by the WHO in 2017. OBJECTIVE: To describe the critical elements that favored the elimination of trachoma as a public health problem in Mexico and the public health impact of this success. METHODOLOGY: A revision and compilation of data and information contained in the dossier presented by the country to PAHO/WHO to obtain the validation of trachoma elimination as a public health problem was conducted by a group of delegates from the national and local trachoma prevention and control program. Data from the national and local surveillance systems and reports of actions conducted after achieving the elimination goal were also included. Critical elements that favored the achievement of the elimination goal from 1896 to 2019 were extracted. RESULTS: Mexico reached the elimination of trachoma in 2016 obtaining the validation in 2017. 264 communities were no longer endemic and 151,744 people were no longer at risk of visual impairment or possible blindness due to trachoma. The key to the success of this elimination process was primarily the local leadership of health authorities with sustained funding for brigades, increased access to potable water and sanitation, and key alliances with indigenous authorities, health authorities, and government institutions that contributed to the achievement of the goal. The SAFE strategy started implementation in Mexico in 2004 as a comprehensive package of interventions. SAFE stands for surgery, antibiotics, facial cleanliness, and improvement of the environmental conditions. These actions impacted drastically on the number of new cases trachmatous trichiasis (TT) and trachomatous inflammation-follicular (TF), which decreased from 1,794 in 2004 to zero in 2016. CONCLUSIONS: The elimination of trachoma as a public health problem in Mexico is a true success story that may serve as a model example for the elimination of other neglected infectious diseases in the Americas.

Deep Brain Stimulation for Refractory Temporal Lobe Epilepsy. Current Status and Future Trends.

A comparative analysis of the targets for deep brain stimulation (DBS) to treat refractory temporal lobe epilepsy and the rationale for its use is presented, with an emphasis on the latency to obtain the significant antiepileptic effect and the long-term seizure control. The analysis includes consideration of surgical techniques currently used to optimize antiseizure effects and decrease surgical risks. Seizure control is similar for programed DBS and DBS responsive to abnormal cortical or subcortical electroencephalogram (EEG) activity. There is no difference in the long-term seizure control between programmed and responsive and intermittent or continuous DBS. However, intermittent programed DBS may have a significant antiseizure effect starting in the first month when applied to a non-sclerotic tissue such as the parahippocampal cortex. DBS induces no neuropsychological deterioration.

Psychological impact on care professionals due to the SARS-Cov-2 virus in Spain.

OBJECTIVE: To analyze the psychological impact of the SARS-Cov-2 pandemic on nurses in Spain in three different dimensions: exposure to stressors, perceived emotions, and stress coping. BACKGROUND: On March 11, 2019, the World Health Organization recognized a global pandemic caused by a SARS-Cov-2 virus, COVID-19, which rapidly spread across the planet, involving a community health emergency of international scope. INTRODUCTION: The pandemic situation in health centers has led to significant changes in the work environment, compromising care professionals' physical and psychological health and resulting in strong physical and mental exhaustion. METHODS: An observational, descriptive, cross-sectional study was carried out, between February and April 2021, in a large sample of 1360 participants. The researchers conducted the dissemination of a validated questionnaire to working nurses in Spain. RESULTS: The sex variable in relation to the study dimensions (stressors, perceived emotions, and coping strategies) showed a mean for stressors of 62.2 ± 10.5 in women and 59.8 ± 12.5 in men (p = 0.010), showing statistically significant differences. Age was a protective factor for all dimensions (p < 0.001). Time of experience showed statistically significant differences for stressors and coping strategies in professionals with more than 15 years of experience. DISCUSSION: Female nurses who are younger, have less work experience, have not built a family of their own, and live in smaller or indoor flats may be more vulnerable to the effects of the COVID-19 pandemic on their mental health. Other national and international studies, in this line, have shown an important psychological impact on these professionals. CONCLUSION: It is necessary to design and adopt effective strategies and measures for the protection of nurses' mental health, as well as for the prevention and early diagnosis of possible mental health problems.

Influence of Gamification and Cooperative Work in Peer, Mixed and Interdisciplinary Teams on Emotional Intelligence, Learning Strategies and Life Goals That Motivate University Students to Study.

It is necessary to motivate university students to reduce the dropout rate in Spain, and to look for strategies that help university students acquire professional competencies; this is where gamification can be useful. The purpose of the study was to evaluate the influence of a learning methodology based on gamification and cooperative work in peers, and in mixed and interdisciplinary teams on the emotional intelligence, learning strategies, and life goals that motivate university students to learn. The sample consisted of 102 students who took a subject with a gamification-based methodology, through the Mechanics-Dynamics-Aesthetics model, in a cooperative way. The Self-Perception Scale of Personal Academic Motivation and the Trait Meta Mood Scale 24 were used. The results of the study showed an increase in learning strategies and life goals that motivated university students to study, as well as increases in emotional clarity and significantly in emotional repair. It was concluded that gamification is a positive tool for its ability to increase emotional intelligence, life goals, and learning strategies in university students' motivation to learn.

Historical Review and Cost-Effectiveness Assessment of the Programs to Eliminate Onchocerciasis and Trachoma in Mexico.

We present a historical review of two neglected tropical diseases (NTD), namely, onchocerciasis and trachoma, both which were successfully eliminated in Mexico. In addition, we present a cost-effectiveness assessment (CEA) demonstrating that these were worthwhile health interventions. Historically, an estimate of $310.68 and $38.92 per person were spent during the period of time the onchocerciasis and trachoma elimination programs operated, respectively.

Variability in Oral Iron Prescription and the Effect on Spanish Mothers' Health: A Prospective Longitudinal Study.

BACKGROUND: No consensus exists regarding the hemoglobin (Hb) values that define postpartum anemia. Knowledge is currently lacking regarding prescription and consumption practices, which prevents evaluating the rational use of iron supplementation postpartum. AIM: In this study, our objective was to describe this practice and analyze its association with maternal health outcomes. METHODS: A prospective observational study was conducted with 1010 women aged between 18 and 50. The hemoglobin value on the first postpartum day; the prescription schedule at hospital discharge; iron consumption; and data on hemoglobin, serum ferritin, maternal fatigue, type of breastfeeding, and perceived health six weeks after delivery were collected. FINDINGS: Oral iron was prescribed to 98.1% of mothers with anemia and 75.8% without anemia. At the same Hb value, the maximum amount of total iron prescribed was between 8 and 10 times greater than the minimum amount. Iron intake was significantly lower than prescribed (p < 0.01). At six weeks, anemic mothers who took iron presented a 3.6-, 3-, and 2.4-times lower probability of iron deficiency, anemia, and abandoning breastfeeding, respectively. DISCUSSION: Postpartum iron intake shows a protective effect on iron deficiency and anemia at six weeks, but not on fatigue or self-perceived health level. CONCLUSION: We conclude that there is wide variability in the prescription regimen. Oral iron supplementation can benefit mothers with anemia and harm those without. Subsequent studies should further explore the Hb figure that better discriminates the need for postpartum iron.

Vitamin D serum levels and non-melanoma skin cancer risk.

BACKGROUND: Skin cancer is one of the common malignancies. There is sufficient evidence that sunlight (ultraviolet radiation) contributes to the development of skin cancer, but there is also evidence that relates adequate serum levels of vitamin D produced on the skin by the action of ultraviolet radiation with the decreased risk of various types of cancers, including skin cancer. The aim of this study was to investigate the association of vitamin D serum levels among patients with non-melanoma skin cancers (basal cell carcinoma and squamous cell carcinoma) and controls. METHODS: A prospective observational case-control study was conducted in a sample of 84 subjects in Extremadura (Spain). Forty-one patients with histologically diagnosed basal cell carcinomas and squamous cell carcinomas and 43 healthy controls were randomly chosen to assess whether vitamin D (25(OH)D3) serum level, age and sex were related to non-melanoma skin cancer and to determine the possible risk of this type of skin cancer for these variables. RESULTS: When analysing serum vitamin D levels, we ensured that all our subjects, both cases and controls, had normal or low serum vitamin D levels, even though the samples were taken during months with the highest solar irradiance in our region. It is striking in our results that there was a higher percentage of subjects with deficits of vitamin D who did not have skin cancer (66%) than patients with deficits with these types of skin cancers (34%). When adjusting the model for age and sex, vitamin D values above 18 ng/ml increased the risk of suffering from non-melanoma skin cancer by nearly 7-fold (aOR: 6.94, 95% CI [1.55-31.11], p = 0.01). CONCLUSIONS: Despite the controversial data obtained in the literature, our results suggest that lower levels of vitamin D may be related to a reduced incidence of non-melanoma skin cancer.

LQG Control for Dynamic Positioning of Floating Caissons Based on the Kalman Filter.

This paper presents the application of an linear quadratic gaussian (LQG) control strategy for concrete caisson deployment for marine structures. Currently these maneuvers are carried out manually with the risk that this entails. Control systems for these operations with classical regulators have begun to be implemented. They try to reduce risks, but they still need to be optimized due to the complexity of the dynamics involved during the sinking process and the contact with the sea bed. A linear approximation of the dynamic model of the caisson is obtained and an LQG control strategy is implemented based on the Kalman filter (KF). The results of the proposed LQG control strategy are compared to the ones given by a classic controller. It is noted that the proposed system is positioned with greater precision and accuracy, as shown in the different simulations and in the Monte Carlo study. Furthermore, the control efforts are less than with classical regulators. For all the reasons cited above, it is concluded that there is a clear improvement in performance with the control system proposed.