Occipital cortex activation by long-term repetitive tactile stimulation is necessary for object recognition in blinds: a case report.

Tactile vision has been approached from a variety of angles using different techniques. So far, a certain kind of object (and text) recognition has been shown, though seeing as such has not been achieved yet, and it remains unclear. Trough repetitive passive tactile stimulation perceptual processing is transferred from temporo-parietal to occipital areas, which affects object recognition. We report the results of passive tactile stimulation, as well as rTMS, applied to a 50 year old left handed blind male with over 97% loss of vision, who suffers from Peter's anomaly and microphthalmia. After 15 weeks of passive tactile stimulation, the subject showed increased activity in occipital areas associated with the development of visual-like perception which remained unchanged after three months without passive tactile stimulation. Inhibitory rTMS over the visual cortex led to noticeable reduction of spatial recognition performance and visual sensations in this subject. Stable changes in occipital cortical activity can be associated with subjective sensations of seeing. Once occipital activation has been achieved, it is necessary for spatial object recognition. Both facts highlight the implication of occipital areas in tactile vision and the cortical plasticity of passive tactile long-term stimulation in people with blindness.

Examining the influence of self-care practices on brain activity in healthy older adults.

Introduction: Studies on the aging brain often occur in active settings, but comparatively few investigate brain activity in resting states. However, exploring brain activity in a resting state offers valuable insights into spontaneous neural processes unaffected by task-specific influences. Objective: To investigate the relationship between self-care practices, cognitive function, and patterns of brain activity in healthy older adults, taking into account predictions from aging brain models. Methodology: 77 older adults aged 61 to 87 completing a self-care practices questionnaire, neuropsychological tests, and resting-state electroencephalogram (EEG) recordings. Participants were classified into two groups according to their self-care practices: traditional self-care (T-SC) and developmental self-care (D-SC). Results: Although neuropsychological tests did not yield significant differences between the D-SC and T-SC groups, patterns of brain activity revealed distinct behaviors. The T-SC group demonstrated patterns more consistent with established aging brain models, contrasting with the D-SC group, which exhibited brain activity akin to that observed in younger adults. Specifically, the T-SC group displayed hyperactivation related to memory and executive function performance, alongside heightened alpha power in posterior regions. Furthermore, bilateral frontal activation in the beta band was evident. Conclusions: The findings suggest a nuanced relationship between self-care practices and brain activity in older adults. While the T-SC group demonstrated brain activity patterns consistent with conservative aging, indicating the preservation of typical aging characteristics, the D-SC group displayed activity suggestive of a potential protective effect. This effect may be linked to self-care strategies that foster development and resilience in cognitive aging.

Practices of Self-Care in Healthy Old Age: A Field Study.

Two competing psychological approaches for how to care for oneself to stay healthy in old age have coexisted and dominated the scientific literature. OBJECTIVE: Identify the self-care practices of healthy older adults and establish the relationship between these practices and the cognitive processes involved. METHOD: 105 healthy older people (83.91% women) recorded their self-care practices using the Care Time Test and underwent a cognitive evaluation. RESULTS: The frequency and variety of different activities that participants spent performing on a day of the week where they had the fewest obligations are as follows: nearly 7 h on seven survival activities, 4 h and 30 min on three maintenance of functional independence activities and 1 h on one activity that promoted personal development. Older people who carry out activities in a developmental approach showed better everyday memory (8.63 points) and attention levels (7.00 points) than older people who carry out activities using a conservative approach (memory: 7.43; attention level: 6.40). CONCLUSION: The results evidenced that the frequency and variety of activities that promote personal development are associated with better attention and memory performance.

Self-care interventions of community-dwelling older adults: a systematic review and meta-analysis.

Introduction: The current notion of "care in old age" should be reconceptualized in the ageing societies of the 21st century. Currently, "being old" means that one is actively involved in their care and has the desire to retain control and independence. Objective: Understand and analyze the efficacy of interventions in the physical and psychological self-care practices of healthy community-dwelling older people. Methodology: Systematic review and meta-analysis. The guidelines of the PRISMA guide were followed. The methodological quality of the studies was checked using Cochrane Effective Practice and Organisation of Care criteria, and the search was performed between 2016 and 2021. Results: Of the 1,866 evaluated, 8 studies met the criteria. The systematic review reveals that self-care interventions focus on physical health-related variables but not on psychological variables. The meta-analysis shows that interventions significantly improve physical health-related variables (care visits, hospital admission, medication, and gait speed). Conclusion: Self-care training programs should include psychological variables to increase health and well-being in healthy older people.

Electrophysiological connectivity of logical deduction: Early cortical MEG study.

Complex human reasoning involves minimal abilities to extract conclusions implied in the available information. These abilities are considered "deductive" because they exemplify certain abstract relations among propositions or probabilities called deductive arguments. However, the electrophysiological dynamics which supports such complex cognitive processes has not been addressed yet. In this work we consider typically deductive logico-probabilistically valid inferences and aim to verify or refute their electrophysiological functional connectivity differences from invalid inferences with the same content (same relational variables, same stimuli, same relevant and salient features). We recorded the brain electrophysiological activity of 20 participants (age = 20.35 ± 3.23) by means of an MEG system during two consecutive reasoning tasks: a search task (invalid condition) without any specific deductive rules to follow, and a logically valid deductive task (valid condition) with explicit deductive rules as instructions. We calculated the functional connectivity (FC) for each condition and conducted a seed-based analysis in a set of cortical regions of interest. Finally, we used a cluster-based permutation test to compare the differences between logically valid and invalid conditions in terms of FC. As a first novel result we found higher FC for valid condition in beta band between regions of interest and left prefrontal, temporal, parietal, and cingulate structures. FC analysis allows a second novel result which is the definition of a propositional network with operculo-cingular, parietal and medial nodes, specifically including disputed medial deductive "core" areas. The experiment discloses measurable cortical processes which do not depend on content but on truth-functional propositional operators. These experimental novelties may contribute to understand the cortical bases of deductive processes.

Electrical analysis of logical complexity: an exploratory eeg study of logically valid/invalid deducive inference.

INTRODUCTION: Logically valid deductive arguments are clear examples of abstract recursive computational procedures on propositions or on probabilities. However, it is not known if the cortical time-consuming inferential processes in which logical arguments are eventually realized in the brain are in fact physically different from other kinds of inferential processes. METHODS: In order to determine whether an electrical EEG discernible pattern of logical deduction exists or not, a new experimental paradigm is proposed contrasting logically valid and invalid inferences with exactly the same content (same premises and same relational variables) and distinct logical complexity (propositional truth-functional operators). Electroencephalographic signals from 19 subjects (24.2 ± 3.3 years) were acquired in a two-condition paradigm (100 trials for each condition). After the initial general analysis, a trial-by-trial approach in beta-2 band allowed to uncover not only evoked but also phase asynchronous activity between trials. RESULTS: showed that (i) deductive inferences with the same content evoked the same response pattern in logically valid and invalid conditions, (ii) mean response time in logically valid inferences is 61.54% higher, (iii) logically valid inferences are subjected to an early (400 ms) and a late reprocessing (600 ms) verified by two distinct beta-2 activations (p-value < 0,01, Wilcoxon signed rank test). CONCLUSION: We found evidence of a subtle but measurable electrical trait of logical validity. Results put forward the hypothesis that some logically valid deductions are recursive or computational cortical events.

Brain electrical traits of logical validity.

Neuroscience has studied deductive reasoning over the last 20 years under the assumption that deductive inferences are not only de jure but also de facto distinct from other forms of inference. The objective of this research is to verify if logically valid deductions leave any cerebral electrical trait that is distinct from the trait left by non-valid deductions. 23 subjects with an average age of 20.35 years were registered with MEG and placed into a two conditions paradigm (100 trials for each condition) which each presented the exact same relational complexity (same variables and content) but had distinct logical complexity. Both conditions show the same electromagnetic components (P3, N4) in the early temporal window (250-525 ms) and P6 in the late temporal window (500-775 ms). The significant activity in both valid and invalid conditions is found in sensors from medial prefrontal regions, probably corresponding to the ACC or to the medial prefrontal cortex. The amplitude and intensity of valid deductions is significantly lower in both temporal windows (p = 0.0003). The reaction time was 54.37% slower in the valid condition. Validity leaves a minimal but measurable hypoactive electrical trait in brain processing. The minor electrical demand is attributable to the recursive and automatable character of valid deductions, suggesting a physical indicator of computational deductive properties. It is hypothesized that all valid deductions are recursive and hypoactive.

Vital satisfaction as a health indicator in elderly women.

The long life expentancy of the elderly motivates interest in their quality of life. Our study analyzes vital satisfaction as a global indicator of the three dimensions (physical, mental, and social) of the quality of life in relation to health. The subjects were 310 women, with an average age of 71.22 years old (SD 6.72), with minimum education, and active aging. The reliability was examined with the COOP-WONCA Charts and the Nottingham Health Profile. The results show that vital satisfaction significantly correlates with the three dimensions of health, in particular with the mental domain.

Single Time-Point Study of the Home Environment and Functionality of Older Adults in Spain.

Background: The literature favors discussion on socio-spatial conditions at the macro- (city) and micro- (housing) level that promote healthy aging in place. Objectives: (a) Identify the association between physical and social characteristics of the family home and the functional level and quality of life of older people and (b) provide normative data on adequate/inadequate households based on the Home Observation for Measurement of the Environment (HOME) inventory and the Spanish Informant Questionnaire on Cognitive Decline in the Elderly (S-IQCODE) test. Methods: In total, 79 healthy older adults completed the HOME inventory and the Montreal Cognitive Assessment (MoCA), S-IQCODE, Kessler Psychological Distress Scale (K-10) and ICEpop CAPability measure for Older people (ICECAP-O) tests. A regression model, the effect size and the means of the scores of HOME (adequate/inadequate) test and the cognitive level (optimal/normal) were calculated. Results: The regression model discloses that adequate home scores are associated with cognitive level (odds ratio (OR): 0.955, confidence interval (CI)95%: 0.918-0.955); quality of life (OR: 6.542, CI95%: 1.750-24.457), living with other people (OR: 5.753, CI95%: 1.456-22.733) and level of education (OR: 0.252, CI95%: 0.064-0.991). The normative data between HOME and S-IQCODE scores showed a good adjustment (d = 0.70). Conclusion: There is a significant relationship between the physical environment of the home and personal variables (sociodemographic information, quality of life and cognitive functionality). In addition, from this last variable, the normative data of an adequate/inadequate household for an older person have been established.

Evaluating Successful Aging in Older People Who Participated in Computerized or Paper-and-Pencil Memory Training: The Memoria Mejor Program.

Background. The evaluation of successful aging includes objective criteria to measure cognitive function and psychological well-being and levels of functional capacity needed to perform daily activities related to the preservation of autonomy. In addition, the emergence of computerized cognitive training programs has allowed us to use a new class of tools to verify the theoretical postulates of neural plasticity in aging. Objective. The present study investigates subjective and objective criteria of successful aging in healthy older adults participating in a memory training program offered as two versions: computer and paper-and-pencil. Method. Fifty-four healthy older adult participants recruited for the study were organized into two training groups. Group 1 (G1) used the computer program and Group 2 (G2) used the paper-and-pencil program. Results. The analysis revealed no significant differences in psychological well-being between the two training groups. However, the groups did differ significantly in objective evaluations of successful aging, as measured by attention and everyday memory, and brain activity as measured by sLORETA, with G1 outperforming G2 on both measures. Conclusion. Computerized memory training programs show promise for restoring cognitive and cerebral functioning in older adults, and consequently, may be better suited to achieving the objective criteria of successful aging than paper-and-pencil memory training programs. However, this conclusion should be taken with caution since differences in age and educational level may have influenced the results.

Six-Year Training Improves Everyday Memory in Healthy Older People. Randomized Controlled Trial.

PURPOSE OF THE STUDY: Everyday memory of older persons does not improve with intensive memory training programs. This study proposes a change in these programs based on a time-extended and massive intervention format. DESIGN AND METHODS: The sample of 1007 healthy older persons (mean age 71.85; SD = 5.12) was randomized into 2 groups. The experimental group followed an extended 6 years of training (192 sessions over 192 weeks) whereas the control group received an intensive training (3 sessions per week for a total of 32 sessions in 11 weeks). The program included cognitive and emotional content whose effects were assessed with the Rivermead Behavioral Memory Test (RBMT) and with the Mini-Mental State Examination (MMSE). Both groups were evaluated initially, after 32 sessions, and again after 6 years. RESULTS: The relative improvements measured with Blom's derivative showed that everyday memory and mental status of the experimental group were significantly better both in the short (Δ% 8.31 in RBMT and Δ% 1.51 in MMSE) and in the long term (Δ% 12.54 in RBMT and Δ% 2.56 in MMSE). For everyday memory and mental level, the overall gain estimate representing the mean difference in pre-post change between time-extended and intensive groups was 0.27 (95% CI: 0.13-0.40) and 0.54 (95% CI: 0.40-0.67), respectively. Time-extended programs have significantly improved everyday memory in contrast with the usual intensive programs whose effects decay with time. There are also significant increases in mental level scores while daily life functionality is preserved in all subjects who completed the training. IMPLICATIONS: These results suggest that it is possible to preserve everyday memory in the long term with continuous training and practice. Massive and time-extended formats may contribute in the future to a paradigm shift in memory programs for healthy older people.

Proyecto de investigación: elaboración de una medida de la reserva cognitiva basada en la ocupación / Research project: development of an occupation-based cognitive reserve measure

OBJETIVOS: desarrollar una medida de la reserva cognitiva a partir de las variables formativas ocupacionales en personas mayores. MÉTODOS: la investigación se compone de tres fases: 1) definición teórica de las variables formativas ocupacionales; 2) desarrollo de una medida de reserva cognitiva compuesta por variables formativas ocupacionales; 3) estudio piloto para la validación de la medida desarrollada en población mayor. DISCUSIÓN: el desarrollo de una medida de este tipo, además de novedoso, contribuye a precisar este constructo y podría aportar información útil para el desarrollo de programas de intervención

OBJECTIVE: To develop a cognitive reserve measure from occupational formative variables in older people. METHODS: The research is composed of three phases: 1) theoretical definition of occupational formative variables; 2) development of a cognitive reserve measure made up of occupational formative variables; 3) pilot study to validate the measure developed in elderly population. DISCUSSION: The development of a measure of this type, in addition to novel, contributes to specify this construct and it could provide useful information for development intervention programs

Measurable benefits on brain activity from the practice of educational leisure.

UNLABELLED: Even if behavioral studies relate leisure practices to the preservation of memory in old persons, there is unsubstantial evidence of the import of leisure on brain activity. AIM: This study was to compare the brain activity of elderly retired people who engage in different types of leisure activities. METHODS: Quasi-experimental study over a sample of 60 elderly, retired subjects distributed into three groups according to the leisure activities they practised: educational leisure (G1), memory games (G2), and card games (G3). Applied measures include the conceptual distinction between free time and leisure, the test of the organization of free time measuring 24 clock divisions, and EEG register during 12 word list memorizing. RESULTS: The results show that the type of leisure activity is associated with significant quantitative differences regarding the use of free time. G1 devotes more time to leisure activities than G2 (p = 0.007) and G3 (p = 0.034). G1 rests more actively than the other two groups (p = 0.001). The electrical localization of brain activity indicated a reverse tendency of activation according to the bands and groups. DISCUSSION: Engaging in educational leisure activities is a useful practice to protect healthy brain compensation strategies. Future longitudinal research may verify the causal relation between practicing educational leisure activities and functional brain aging.

Localización cerebral del procesamiento semántico / Brain localization of semantic processing

Introducción. El procesamiento del contenido semántico se asocia al potencial N400, y el P600 se vincula con el procesamiento de reglas sintácticas y gramaticales. Objetivo. Verificar si el procesamiento semántico de estímulos visuales complejos, como la repetición, la identidad, el orden y la doble incongruencia, es recursivo o computable. Sujetos y métodos. Veintisiete universitarios respondieron a un paradigma adaptado N400 con cinco condiciones, cada una con 80 tareas, mientras se registraba su actividad cerebral con un gorro de 64 electrodos. Resultados. Dos ventanas temporales de 400 a 550 ms y de 550 a 800 ms se analizaron mediante un contraste ANOVA del factor condición por regiones de interés. Además, se calculó la solución inversa de las ventanas mediante tomografía electromagnética de baja resolución para identificar las fuentes corticales subyacentes a los potenciales eléctricos. Se corroboran diferencias significativas (p < 0,05) en los potenciales N400 y P600 en áreas frontales y centroparietales asociadas a los operadores lógicos estudiados. Conclusión. Se confirma que el procesamiento cerebral de imágenes complejas (congruentes/incongruentes) es modulado por la repetición, la identidad y el orden, pero no por la negación. Por consiguiente, se puede decir que el procesamiento semántico de imágenes complejas es semicomputable

Introduction. Semantic content processing is associated with the potential N400, and the P600 is linked with the processing of syntactic and grammatical rules. Aim. To verify whether the semantic processing of complex visual stimuli such as repetition, identity, order and double incongruence is recursive or computable. Subjects and methods. 27 university students responded to an adapted N400 paradigm with five conditions, each with 80 tasks, while recording their brain activity with a 64-channel cap. Results. Two temporal windows of 400 to 550 ms and 550 to 800 ms were analyzed using an ANOVA contrast of the condition factor by regions of interest. In addition, the inverse solution of the windows was calculated by low resolution electromagnetic tomography (LORETA) to identify the main sources related to the electrical power. The significant differences (p <0.05) in the results for the N400 and P600 in frontal and centroparietal areas in the logical operators studied are corroborated. Conclusion. It is confirmed that the brain processing of complex images is modulated by repetition, identity and order, but not by negation. Therefore, it can be said that the semantic processing of complex images is semi-computable

[Is the early brain organisation of spatial information conveyed by tactile stimuli performed in different ways in congenital and acquired blind children? A pilot study]. / Es distinta la organizacion cerebral temprana de la informacion espacial transmitida a traves de estimulos tactiles en ninos invidentes congenitos y adquiridos?: un estudio piloto.

Cortical reorganization after congenital blindness is not sufficiently known yet it does offer an optimum window of opportunity to study the effects of absolute sensorial deprivation. Cross-modality in people with blindness has been documented, but it may differ in congenital blindness and in early blindness. Vibrotactile passive stimulation of lines and letters generates different electroencephalographic patterns with different source localizations in two children with blindness, aged 9 and 10, respectively with congenital blindness and early blindness with some remnants of vision. Most of the brain electrical activity is centered in auditive areas in P50 and P100 in the case of the child with congenital blindness, while the other shows activity in multiple areas. Reaction times to letters are shorter than to lines of different orientation in both children.

[Psychopathy in children and teenagers: models, theories and the latest research]. / Psicopatia en ninos y adolescentes: modelos, teorias y ultimas investigaciones.

Most research about psychopathy have been conducted on adults. It is important to focus on the study of psychopathy in children to better understand the evolution of this disorder. This article focuses on a brief review of the contributions from psychology, where trait callous unemotional is closely related to the presence of antisocial behavior and conduct disorders, therefore, is an important factor in development of psychopathy. Also, we reviewed from the perspective of neuroscience where we found a reduced response of the amygdala in young people with presence of characteristic high scores on callous unemotional and psychopathy. We have also found an abnormal response in the ventromedial prefrontal cortex. It is important to note these results because children with these characteristics are very difficult to socialize.

Recruitment of occipital cortex during sensory substitution training linked to subjective experience of seeing in people with blindness.

Over three months of intensive training with a tactile stimulation device, 18 blind and 10 blindfolded seeing subjects improved in their ability to identify geometric figures by touch. Seven blind subjects spontaneously reported 'visual qualia', the subjective sensation of seeing flashes of light congruent with tactile stimuli. In the latter subjects tactile stimulation evoked activation of occipital cortex on electroencephalography (EEG). None of the blind subjects who failed to experience visual qualia, despite identical tactile stimulation training, showed EEG recruitment of occipital cortex. None of the blindfolded seeing humans reported visual-like sensations during tactile stimulation. These findings support the notion that the conscious experience of seeing is linked to the activation of occipital brain regions in people with blindness. Moreover, the findings indicate that provision of visual information can be achieved through non-visual sensory modalities which may help to minimize the disability of blind individuals, affording them some degree of object recognition and navigation aid.

Parálisis vocal, logopedia y análisis acústico. Estudio de resultados de 43 pacientes / Vocal paralysis, speech therapy and acoustic analysis. 43-patient-results study

Introducción y objetivos: Consideramos que existe patología vocal cuando apreciamos anomalías en el tono, volumen y/o calidad de emisión que en conjunto afectan a la comunicación oral. La literatura actual en torno al trastorno vocal subraya la importancia de una voz cuidada y de calidad para cumplir requisitos sociales y ocupacionales. Además, la voz es una herramienta profesional esencial para un tercio de la población adulta laboralmente activa. Nuestro objetivo es conocer la evolución de pacientes diagnosticados de parálisis vocal con apreciaciones subjetivas y el estudio de las variaciones sucedidas en el análisis acústico antes y tras el periodo de rehabilitación logopédica. Métodos: Se ha realizado un estudio descriptivo, longitudinal, prospectivo, observacional y unicéntrico de 43 pacientes por medio de entrevista, exploración ORL completa, estudio de voz instrumental y puntuaciones subjetivas profesionales y del paciente, mediante encuestas de satisfacción y valoración del daño. Tras ello, se realizó un análisis multidimensional de los resultados con el programa SPSS. Resultados: Una vez analizados los datos, hallamos que la parálisis de cuerda vocal se manifestó más frecuentemente en el sexo femenino, en edades alrededor de los 50 años, tras cirugía tiroidea, y especialmente en la cuerda vocal izquierda. Por medio de la terapia se obtuvieron mejorías significativas y medibles en los parámetros jitter, shimmer, GRABS, tiempos máximos fonatorios (TMF) e índice de incapacidad vocal (VHI). De las variables estudiadas, las que mejor correlacionan entre sí son jitter, shimmer, y TMF /e/ y /s/. Destaca la alta correlación positiva de los VHI entre sí; y en cuanto a correlaciones negativas, destaca la existente entre shimmer y la razón armónicos-ruido (HNR). Conclusiones: A la vista de los resultados, consideramos eficaz iniciar terapia logopédica precoz y valorar la evolución antes de plantear opciones quirúrgicas. Además, sin duda, sería preciso reducir las demoras tanto en el diagnóstico como en los tratamientos en la atención especializada. Creemos necesario mejorar la comunicación entre especialistas ORL y logopedas para aumentar el éxito de la rehabilitación, obteniendo mayores cuotas de información desde ambos profesionales

Introduction and objectives: A voice disorder exists when there is a change in pitch, volume and/or emission quality that, together, affects oral communication. Currently, literature related to vocal impairment highlights the importance of a healthy voice to achieve social and occupational requirements. Besides, voice is a basic professional tool for a third of active working population. It was our intention to study the evolution of patients diagnosed of vocal paralysis with subjective measurements and also acoustic analysis variations before and after speech therapy. Methods: In this study, 43 patients were included and underwent an instrumental examination and interview, with complete endoscopic otolaryngologic examination, as also subjective punctuations and damage and satisfaction standard scores filling out. Further statistic study shows results and conclusions are inferred. Results: Vocal cord palsy has been brought about more frequently in the left side, in women, at an age around 50, and after thyroid surgery. Significant improvement in measurements were observed in jitter, shimmer, GRABS, Maximum Phonation Time (MPT) and Voice Handicap Index (VHI). Best correlating parameters are jitter, shimmer and MPT /e/ and /s/. It stands out a high positive correlation between VHI, and as for negative, the one between shimmer and Harmonics-Noise-Ratio (HNR) is flashy. Conclusions: We find speech therapy very effective in early rehabilitation, before surgery is considered. It would be desirable to shorten delays in specialized medical care diagnosis and therapy onset. It is our believe that a better and wider communication between ENT specialists and speech and language specialists would improve results and prognosis

Darbepoetin alpha for the treatment of anemia in patients with myelodysplastic syndromes.

BACKGROUND: Anemia occurs as a comorbidity in from 80% to 85% of patients with myelodysplastic syndromes (MDS): It causes fatigue, increases transfusion needs, and reduces quality of life. Darbepoetin alpha (DA) is an erythropoiesis-stimulating protein (ESP) that is more highly glycosylated and has a longer half-life relative to recombinant human erythropoietin (rHuEPO), thus, allowing less frequent administration, increased convenience, and better compliance. METHODS: This retrospective analysis included 81 patients with MDS who were enrolled at 9 Spanish centers and who received once-weekly, subcutaneous DA (75-300 microg) for 16 weeks. RESULTS: Fifty-five percent of all patients (38 of 69 evaluable patients) achieved responses; 30.4% of were major responses, and 24.6% were minor responses; 64.7% of rHuEPO-naive patients and 45.7% rHuEPO-treated patients responded; and 43.2% had received previous rHuEPO. Most responses (65.8%) occurred at or before Week 8. The median age at diagnosis was 70 years (range, 38-87 years), the median age at the initiation of DA treatment was 75 years (range, 39-91 years), and 56.8% of patients were women. The median time from last ESP dose to DA initiation was 16.8 weeks (range, 0.0-159.0 weeks; <1 week in 53.1% of patients). According to the French-American-British classification system (n = 81 patients), 39.5% had refractory anemia (RA), 46.9% had RA with ringed sideroblasts, 9.9% had RA with excess blasts (RAEB), 1.2% had RAEB in transformation, and 2.5% had chronic myelomonocytic leukemia. According to the International Prognostic Scoring System (n = 47 patients), 55.3% of patients were in the low-risk group, and 36.2% of patients were in the intermediate-1-risk group. The median baseline hemoglobin level was 8.9 g/dL (range, 8.4-9.1 g/dL). The Starting DA dose was 75 microg per week in 3.7% of patients, 150 microg per week in 65.4% of patients, and 300 microg per week in 29.6% of patients (the dose was increased in 18.5% of patients and reduced in 9.9% of patients; median time to dose adjustment, 8 weeks). Five patients received granulocyte colony-stimulating factors. No DA-related adverse reactions occurred. CONCLUSIONS: In the current study, 55% of evaluable patients with MDS safely achieved an erythroid response.

Un estridor para no temer / A not-to-fear stridor

Presentamos una rara patología laríngea conocida, entre otros nombres, como «movimiento vocal paradójico» (MVP), de causa no filiada formalmente pero susceptible de tener un importante componente psicógeno, aparte de algunos otros estímulos físicos, y que se traduce en una alteración funcional mediante inversión del ciclo inspiratorio glótico, con firme aducción inspiratoria y abducción espiratoria. Nuestro caso describe una paciente de 15 años que acudió al Servicio de Urgencias Hospitalario con disnea laríngea de 48 h de evolución, sin compromiso respiratorio vital ni claros antecedentes infeccioso-inflamatorios, pero sí de tipo psicológico. El MVP es una discinesia laríngea que se manifiesta con un estridor inspiratorio laríngeo con grado de obstrucción variable, y en el que la abducción glótica inspiratoria es reemplazada por aducción. En estos pacientes no suelen encontrarse lesiones laríngeas ni neurológicas. No existe una causa establecida, y se manejan teorías sobre todo psicopatológicas que incluyen trastornos conversivos, ansiedad, etc., aparte de algunos estímulos físicos. Durante la fase de diagnóstico y estudio de la paciente, toma de decisiones y puesta en práctica del tratamiento, nos damos cuenta de lo desconocido de la patología en nuestra actividad diaria, de las dudas suscitadas frente a su manejo y de la necesidad de actualizarnos y difundir esta entidad entre los profesionales que desarrollan su actividad en primera línea frente a esta patología, tanto el médico especialista en ORL como el logopeda (AU)

This article presents a rare laryngeal disorder known as paradoxical vocal cord movement (PVCM), among other names. This disorder has no established etiology, but may have a substantial psychogenic component, apart from some physical stimuli, and consists of a functional disorder due to an inverted respiratory cycle, with strong inspiratory glottic closure and a full expiratory opening phase. We describe the case of a 15-year-old woman who attended the hospital emergency service with 48-hour history of laryngeal dyspnea. She had no life-threatening or infectious-inflammatory symptoms, but did have some psychopathological antecedents. PVCM is a rare laryngeal dyskinesia that manifests as inspiratory laryngeal stridor with a variable degree of obstruction. In this disorder, glottic inspiratory abduction is replaced by adduction. In these patients, it is not usual to find laryngeal morphologic or neurological lesions. There is no clear established etiology. Several psychopathological theories have been proposed, including conversion reactions, anxiety, etc., in addition to certain physical stimuli. During the diagnostic phase, decision-making and treatment initiation, we became aware of the lack of knowledge of this disorder in daily practice, doubts about its management, and the need to update our knowledge and increase awareness of this entity among professionals in first-line contact with PVCM, primarily otorhinolaryngologists and speech therapists (AU)