Efficacy of prompted voiding for reversing urinary incontinence in older adults hospitalized in a functional recovery unit: Study protocol.

AIMS: To assess the efficacy of a prompted voiding programme for restoring urinary continence at discharge in hospitalized older adults who presented with reversible urinary incontinence (UI) on admission to a functional recovery unit (FRU). To assess the maintenance of the outcomes achieved after hospitalization. To identify modifiable and unmodifiable factors associated with the success of the prompted voiding programme. DESIGN: Quasi-experimental, pre-/post-intervention study without a control group. METHODS: Participants were aged 65 and over with a history of reversible UI in the previous year who had been admitted to a FRU and were on a prompted voiding programme throughout their hospitalization period. The sample consisted of 221 participants. A non-probabilistic sampling method, in order of recruitment after signing the informed consent form, was used. The primary outcomes were UI assessed at discharge and 1 month, 3 months and 6 months after discharge. Funding was granted in July 2019 by the Spain Health Research Fund (PI19/00168, Ministry of Health). The proposal was approved by the Spanish Research Ethics Committee. DISCUSSION: The prompted voiding programme described can reverse UI or decrease the frequency and amount of urine loss in hospitalized older adults. IMPACT: Urinary incontinence is highly prevalent in hospitalized older adults. There is a need for care aimed at prevention, recovery and symptom control. Prompted voiding is a therapy provided by the nursing team during hospitalization and can also be provided by family caregivers at home after receiving proper training by the nursing team. Prompted voiding will enhance the health, functional ability and quality of life of older adults with UI, resulting in the reduction of associated healthcare costs and the risk of developing complications.

Towards a Combined Use of Geophysics and Remote Sensing Techniques for the Characterization of a Singular Building: "El Torreón" (the Tower) at Ulaca Oppidum (Solosancho, Ávila, Spain).

This research focuses on the study of the ruins of a large building known as "El Torreón" (the Tower), belonging to the Ulaca oppidum (Solosancho, Province of Ávila, Spain). Different remote sensing and geophysical approaches have been used to fulfil this objective, providing a better understanding of the building's functionality in this town, which belongs to the Late Iron Age (ca. 300-50 BCE). In this sense, the outer limits of the ruins have been identified using photogrammetry and convergent drone flights. An additional drone flight was conducted in the surrounding area to find additional data that could be used for more global interpretations. Magnetometry was used to analyze the underground bedrock structure and ground penetrating radar (GPR) was employed to evaluate the internal layout of the ruins. The combination of these digital methodologies (surface and underground) has provided a new perspective for the improved interpretation of "El Torreón" and its characteristics. Research of this type presents additional guidelines for better understanding of the role of this structure with regards to other buildings in the Ulaca oppidum. The results of these studies will additionally allow archaeologists to better plan future interventions while presenting new data that can be used for the interpretation of this archaeological complex on a larger scale.

Sustained Gq-Protein Signaling Disrupts Striatal Circuits via JNK.

The dorsal striatum is a major input structure of the basal ganglia and plays a key role in the control of vital processes such as motor behavior, cognition, and motivation. The functionality of striatal neurons is tightly controlled by various metabotropic receptors. Whereas the Gs/Gi-protein-dependent tuning of striatal neurons is fairly well known, the precise impact and underlying mechanism of Gq-protein-dependent signals remain poorly understood. Here, using different experimental approaches, especially designer receptor exclusively activated by designer drug (DREADD) chemogenetic technology, we found that sustained activation of Gq-protein signaling impairs the functionality of striatal neurons and we unveil the precise molecular mechanism underlying this process: a phospholipase C/Ca2+/proline-rich tyrosine kinase 2/cJun N-terminal kinase pathway. Moreover, engagement of this intracellular signaling route was functionally active in the mouse dorsal striatum in vivo, as proven by the disruption of neuronal integrity and behavioral tasks. To analyze this effect anatomically, we manipulated Gq-protein-dependent signaling selectively in neurons belonging to the direct or indirect striatal pathway. Acute Gq-protein activation in direct-pathway or indirect-pathway neurons produced an enhancement or a decrease, respectively, of activity-dependent parameters. In contrast, sustained Gq-protein activation impaired the functionality of direct-pathway and indirect-pathway neurons and disrupted the behavioral performance and electroencephalography-related activity tasks controlled by either anatomical framework. Collectively, these findings define the molecular mechanism and functional relevance of Gq-protein-driven signals in striatal circuits under normal and overactivated states. SIGNIFICANCE STATEMENT: The dorsal striatum is a major input structure of the basal ganglia and plays a key role in the control of vital processes such as motor behavior, cognition, and motivation. Whereas the Gs/Gi-protein-dependent tuning of striatal neurons is fairly well known, the precise impact and underlying mechanism of Gq-protein-dependent signals remain unclear. Here, we show that striatal circuits can be "turned on" by acute Gq-protein signaling or "turned off" by sustained Gq-protein signaling. Specifically, sustained Gq-protein signaling inactivates striatal neurons by an intracellular pathway that relies on cJun N-terminal kinase. Overall, this study sheds new light onto the molecular mechanism and functional relevance of Gq-protein-driven signals in striatal circuits under normal and overactivated states.

Coeliac disease and gastrointestinal symptom screening in adult first-degree relatives.

BACKGROUND AND AIM: The first-degree relatives (FDRs) of patients with coeliac disease are the main risk group for disease development. The study aims to evaluate the screening strategy in FDRs with negative coeliac serology based on human leukocyte antigen (HLA) genotyping, followed by duodenal biopsy, and to analyze the prevalence of gastrointestinal symptoms and the influence of gluten intake. METHODS: Adult FDRs with negative coeliac serology were invited to participate (n = 205), and a total of 139 completed the study protocol. HLA genotyping, transglutaminase antibody assessment, and duodenal biopsy were performed. Symptomatology was assessed using questionnaires during the various phases of dietary modification (baseline diet, gluten-free diet, and gluten overload). RESULTS: The study included 139 participants (mean age, 42 years; 53.2% women). HLA-DQ2/8 was positive in 78.4% of the participants (homozygous, 15.1%; heterozygous, 63.3%). Histopathological alterations were noted in 37.1% of participants who underwent duodenal biopsy (Marsh I, 32.7%; Marsh IIIa, 4.4%). At baseline, symptoms were observed in 45.7% of the participants, and the proportion decreased to 24.5% after the gluten-free diet (P < 0.001). Symptoms were not associated with the presence of histological alterations or genetic risk. However, younger age (odds ratio [OR] = 0.91), female sex (OR = 2.9), and the presence of autoimmune disorders (OR = 2.8) were independently associated with a significant symptom response to the gluten-free diet. CONCLUSIONS: Duodenal lymphocytosis and atrophy are frequently noted in FDRs, despite negative serological markers. In addition, gastrointestinal symptoms are commonly present and associated with gluten intake regardless of the histological pathology.

A restricted population of CB1 cannabinoid receptors with neuroprotective activity.

The CB1 cannabinoid receptor, the main molecular target of endocannabinoids and cannabis active components, is the most abundant G protein-coupled receptor in the mammalian brain. Of note, CB1 receptors are expressed at the synapses of two opposing (i.e., GABAergic/inhibitory and glutamatergic/excitatory) neuronal populations, so the activation of one and/or another receptor population may conceivably evoke different effects. Despite the widely reported neuroprotective activity of the CB1 receptor in animal models, the precise pathophysiological relevance of those two CB1 receptor pools in neurodegenerative processes is unknown. Here, we first induced excitotoxic damage in the mouse brain by (i) administering quinolinic acid to conditional mutant animals lacking CB1 receptors selectively in GABAergic or glutamatergic neurons, and (ii) manipulating corticostriatal glutamatergic projections remotely with a designer receptor exclusively activated by designer drug pharmacogenetic approach. We next examined the alterations that occur in the R6/2 mouse, a well-established model of Huntington disease, upon (i) fully knocking out CB1 receptors, and (ii) deleting CB1 receptors selectively in corticostriatal glutamatergic or striatal GABAergic neurons. The data unequivocally identify the restricted population of CB1 receptors located on glutamatergic terminals as an indispensable player in the neuroprotective activity of (endo)cannabinoids, therefore suggesting that this precise receptor pool constitutes a promising target for neuroprotective therapeutic strategies.

The stress-regulated protein p8 mediates cannabinoid-induced apoptosis of tumor cells.

One of the most exciting areas of current research in the cannabinoid field is the study of the potential application of these compounds as antitumoral drugs. Here, we describe the signaling pathway that mediates cannabinoid-induced apoptosis of tumor cells. By using a wide array of experimental approaches, we identify the stress-regulated protein p8 (also designated as candidate of metastasis 1) as an essential mediator of cannabinoid antitumoral action and show that p8 upregulation is dependent on de novo-synthesized ceramide. We also observe that p8 mediates its apoptotic effect via upregulation of the endoplasmic reticulum stress-related genes ATF-4, CHOP, and TRB3. Activation of this pathway may constitute a potential therapeutic strategy for inhibiting tumor growth.

Enhancing Thermal Efficiency in Water Storage Tanks Using Pigmented Recycled Concrete.

The present work investigated the manufacture of elements such as water tanks from recycled concrete for applications where industries require water heating. This proposal leverages precast rejects for recycled concrete and incorporates colouring pigments. It is expected to contribute to the circularity of construction materials (due to the total replacement of natural aggregates by recycled aggregates) as well as to energy and emissions savings, which are attributed to improved thermal performance driven by the thermal behaviour that the coloration pigment gives to the manufactured concrete elements. To assess the efficacy of the proposed solution, on the one hand, mechanical tests were carried out in tensile, compression and modulus of elasticity, which showed a suitable concrete dosage for HA-30 structural concrete. Simultaneously, in search for a material that would increase the internal temperature of the tanks, thermal tests were carried out in a controlled laboratory environment on samples with different percentages of pigment, and an optimum concentration of 1% was obtained. It was also found that the thermal conductivity remained almost unaffected. Finally, two water tank prototypes were manufactured and tested under real environmental conditions: one with the optimised pigment concentration solution and other (the reference tank) without pigment. The results revealed that the colourised tank with the optimal concentration resulted in an average water temperature increase of 2 °C with respect to the reference tank. Finally, the economic and environmental benefits of this temperature increase were studied for industrial processes requiring water heating with a potential saving of 8625 kWh per month.

Deformity correction from the convexity of the curve in neuromuscular scoliosis.

Background: "Convex Pedicle Screw Technique" reduces the theoretical risk of neurovascular injury. Our aim is to evaluate the efficacy of this technique in patients with neuromuscular scoliosis (NMS). Methods: Retrospective study of 12 patients who underwent a Convex Pedicle Screw Technique and were diagnosed with NMS. Patients who had undergone previous spinal surgery were excluded. The minimum follow-up required was 24 months. Demographic data, intraoperative data, neurovascular complications and neurophysiological events requiring implant repositioning, as well as pre- and postoperative radiological variables were collected. Results: Twelve patients diagnosed with NMS underwent surgery. The median operative time was 217 minutes. Mean blood loss was 3.8±1.1 g/dL hemoglobin (Hb). The median postoperative stay was 8.8±4 days. A reduction of the Cobb angle in primary curve of 49.1% (from 52.8°±18° to 26.5°±12.6°; P<0.001) and in secondary curve of 25.2% (from 27.8°±18.9° to 18.3°±13.3°; P=0.10) was achieved. Coronal balance improved by 69.4% (7.5±46.2 vs. 2.3±20.9 mm; P=0.72) and sagittal balance by 75% (from -14.1±71.8 vs. -3.5±48.6 mm; P=0.50). There were no neurovascular complications. There were no intraoperative neurophysiological events requiring implant repositioning, nor during reduction maneuvers. No infections were reported. Conclusions: The correction of the deformity from convexity in NMS achieves similar results to other techniques, and a very low complication rate.

Bipolar hybrid posterior instrumentation tecnique for the correction of Scheuermann's kyphosis.

Scheuermann´s kyphosis (SK) is the most common cause of painful and progressive structural hyperkyphosis in adolescents. Surgical treatment should be considered in cases of refractory pain or progressive deformities. We present the clinical and radiological results obtained using a bipolar, hybrid posterior instrumentation tecnique. We analysed 12 males and 6 females, with mean age of 15.8 years. Minimum follow-up was 2 years. We used transverse process hooks at the cranial level and polyaxial screws for the remaining levels. We did not instrument the periapical segment. We used the sagittal stable vertebra (SSV) as the lower instrumented vertebra (LIV) in most cases, the "barely touched SSV" if the above disc space is lordotic. The mean preoperative kyphosis was 73.6º, mean postoperative kyphosis 44.7º, and mean correction of 28.9º (p = 0.0002). The mean reduction in lumbar lordosis (LL) was 8.9º (p = 0.0018). There were no significant differences in the spinopelvic parameters or sagittal balance. The mean number of instrumented levels was 8.9. Type II osteotomies were necessary in only three patients. Three patients had a cranial sagittal angle greater than 10°, all of them asymptomatic. Postoperatively, all patients had VAS scores less than 2 and SRS-22 scores greater than 4. Hybrid bipolar posterior instrumentation offers adequate curve correction, less operative time, implant density, bleeding, material protrusion and risk of spinal cord injury, leaving a large periapical bed for graft supply. We propose to measure the flexibility of the curve in MRI. In flexible curves (those that correct at least 20% in the supine decubitus position), wide facetectomies offer adequate correction of the deformity.

The CB1 receptor interacts with cereblon and drives cereblon deficiency-associated memory shortfalls.

Cereblon/CRBN is a substrate-recognition component of the Cullin4A-DDB1-Roc1 E3 ubiquitin ligase complex. Destabilizing mutations in the human CRBN gene cause a form of autosomal recessive non-syndromic intellectual disability (ARNSID) that is modelled by knocking-out the mouse Crbn gene. A reduction in excitatory neurotransmission has been proposed as an underlying mechanism of the disease. However, the precise factors eliciting this impairment remain mostly unknown. Here we report that CRBN molecules selectively located on glutamatergic neurons are necessary for proper memory function. Combining various in vivo approaches, we show that the cannabinoid CB1 receptor (CB1R), a key suppressor of synaptic transmission, is overactivated in CRBN deficiency-linked ARNSID mouse models, and that the memory deficits observed in these animals can be rescued by acute CB1R-selective pharmacological antagonism. Molecular studies demonstrated that CRBN interacts physically with CB1R and impairs the CB1R-Gi/o-cAMP-PKA pathway in a ubiquitin ligase-independent manner. Taken together, these findings unveil that CB1R overactivation is a driving mechanism of CRBN deficiency-linked ARNSID and anticipate that the antagonism of CB1R could constitute a new therapy for this orphan disease.

Weight of the resected specimen after transurethral resection as a new predictive variable for recurrence of non-muscle-invasive bladder tumour.

OBJECTIVE: To evaluate the role of the weight of the resected specimen after transurethral resection as a predictive factor for recurrence and progression of non-muscle-invasive bladder tumour (NMIBT). PATIENTS AND METHODS: The weight of the resected tumour was measured consecutively in 144 subjects who underwent transurethral resection of bladder tumours at our institution. The median (interquartile range [IQR]) follow-up was 58 (61.3) months. The probability of recurrence and progression at 1 and 5 years were calculated using the currently accepted variables. Thresholds for the specimen weight were determined according to percentiles and receiver-operating characteristic curves. RESULTS: The median (IQR) weight of the specimen was 6 (16) g. Multivariate analysis showed that the weight of the resected specimen was an independent predictive risk factor for recurrence at a threshold value of 6 g with a hazard ratio of 1.7 (95% confidence interval: 1.048-2.761) P = 0.03. Progression was not associated with the weight of the resected specimen. CONCLUSIONS: The weight of the resected specimen is a new variable for predicting the risk of recurrence of NMIBT. Tumours weighing >6 g, according to the present data, have a 1.7-fold higher likelihood of recurrence than those tumours that weigh less.

Feasibility and safety of hospital discharge 24 hours after laparoscopic radical prostatectomy.

OBJECTIVES: Minimally invasive techniques for the surgical treatment of prostate cancer have aimed to achieve the same functional and oncological outcomes of open surgery with a significant decrease in postoperative morbidity and a subsequent decreasing hospital stay. These improvements are important in the current economic context. Our aim was to evaluate the feasibility and safety of hospital discharge 24 h after laparoscopic radical prostatectomy (LRP). METHODS: A total of 266 consecutive patients with clinical diagnosis of localized prostate cancer consecutively treated with extraperitoneal LRP between May 2007 and December 2010 were analyzed. There were no exclusion criteria for the surgical procedure. Patients were discharged in less than 24 h only in the case of absence of medical complications, with drainage of less than 50 mL allowing its removal before discharge, normal oral feeding tolerance, no significant hematuria by bladder catheter and good functional recovery of the patient. All surgery-related complications that occurred within 90 days after surgery were recorded and were classified according to the modified Clavien scale. RESULTS: A total of 266 patients who underwent LRP were studied with a median follow-up of 34 months. 80 (30.1%) patients were discharged from the hospital in less than 24h. 89 (33.4%) patients were discharged within 48 h and 97 (36.5%) after 48 h.The mean hospital stay of the entire case series was 2.9 days (SD 3.08). The mean hospital stay of patients who were discharged after 48 h was 5,5 days (SD 3.94) Thirty-one patients (10.7%). experienced post-surgical complications. 25 (9.31%). of them were classified as Clavien I or II, and 6 (2.2%). Clavien III or IV. A total of 9 (3.3%) patients were readmitted. Of the group of patients who were discharged within 24h only one was readmitted due to hematuria. CONCLUSIONS: Extraperitoneal LRP is the standard treatment for localized prostate cancer in our institution. This treatment reliably and safely allows a hospital stay shorter than 24 h in a significant percentage of our patients.

Comorbidity and nutritional status in adult with advanced chronic kidney disease influence the decision-making choice of renal replacement therapy modality: A retrospective 5-year study.

Background: Nutritional and inflammation status are significant predictors of morbidity and mortality risk in advanced chronic kidney disease (ACKD). To date, there are a limited number of clinical studies on the influence of nutritional status in ACKD stages 4-5 on the choice of renal replacement therapy (RRT) modality. Aim: This study aimed to examine relationships between comorbidity and nutritional and inflammatory status and the decision-making on the choice of RRT modalities in adults with ACKD. Methods: A retrospective cross-sectional study was conducted on 211 patients with ACKD with stages 4-5 from 2016 to 2021. Comorbidity was assessed using the Charlson comorbidity index (CCI) according to severity (CCI: ≤ 3 and >3 points). Clinical and nutritional assessment was carried out by prognosis nutritional index (PNI), laboratory parameters [serum s-albumin, s-prealbumin, and C-reactive protein (s-CRP)], and anthropometric measurements. The initial decision-making of the different RRT modalities [(in-center, home-based hemodialysis (HD), and peritoneal dialysis (PD)] as well as the informed therapeutic options (conservative treatment of CKD or pre-dialysis living donor transplantation) were recorded. The sample was classified according to gender, time on follow-up in the ACKD unit (≤ 6 and >6 months), and the initial decision-making of RRT (in-center and home-RRT). Univariate and multivariate regression analyses were carried out for evaluating the independent predictors of home-based RRT. Results: Of the 211 patients with ACKD, 47.4% (n = 100) were in stage 5 CKD, mainly elderly men (65.4%). DM was the main etiology of CKD (22.7%) together with hypertension (96.6%) as a CV risk factor. Higher CCI scores were significantly found in men, and severe comorbidity with a CCI score > 3 points was 99.1%. The mean time of follow-up time in the ACKD unit was 9.6 ± 12.8 months. A significantly higher CCI was found in those patients with a follow-up time > 6 months, as well as higher mean values of eGFR, s-albumin, s-prealbumin, s-transferrin, and hemoglobin, and lower s-CRP than those with a follow-up <6 months (all, at least p < 0.05). The mean PNI score was 38.9 ± 5.5 points, and a PNI score ≤ 39 points was found in 36.5%. S-albumin level > 3.8 g/dl was found in 71.1% (n = 150), and values of s-CRP ≤ 1 mg/dl were 82.9% (n = 175). PEW prevalence was 15.2%. The initial choice of RRT modality was higher in in-center HD (n = 119 patients; 56.4%) than in home-based RRT (n = 81; 40.5%). Patients who chose home-based RRT had significantly lower CCI scores and higher mean values of s-albumin, s-prealbumin, s-transferrin, hemoglobin, and eGFR and lower s-CRP than those who chose in-center RRT (p < 0.001). Logistic regression demonstrated that s-albumin (OR: 0.147) and a follow-up time in the ACKD unit >6 months (OR: 0.440) were significantly associated with the likelihood of decision-making to choose a home-based RRT modality (all, at least p < 0.05). Conclusion: Regular monitoring and follow-up of sociodemographic factors, comorbidity, and nutritional and inflammatory status in a multidisciplinary ACKD unit significantly influenced decision-making on the choice of RRT modality and outcome in patients with non-dialysis ACKD.

Neuronal Cannabinoid CB1 Receptors Suppress the Growth of Melanoma Brain Metastases by Inhibiting Glutamatergic Signalling.

Melanoma is one of the deadliest forms of cancer. Most melanoma deaths are caused by distant metastases in several organs, especially the brain, the so-called melanoma brain metastases (MBMs). However, the precise mechanisms that sustain the growth of MBMs remain elusive. Recently, the excitatory neurotransmitter glutamate has been proposed as a brain-specific, pro-tumorigenic signal for various types of cancers, but how neuronal glutamate shuttling onto metastases is regulated remains unknown. Here, we show that the cannabinoid CB1 receptor (CB1R), a master regulator of glutamate output from nerve terminals, controls MBM proliferation. First, in silico transcriptomic analysis of cancer-genome atlases indicated an aberrant expression of glutamate receptors in human metastatic melanoma samples. Second, in vitro experiments conducted on three different melanoma cell lines showed that the selective blockade of glutamatergic NMDA receptors, but not AMPA or metabotropic receptors, reduces cell proliferation. Third, in vivo grafting of melanoma cells in the brain of mice selectively devoid of CB1Rs in glutamatergic neurons increased tumour cell proliferation in concert with NMDA receptor activation, whereas melanoma cell growth in other tissue locations was not affected. Taken together, our findings demonstrate an unprecedented regulatory role of neuronal CB1Rs in the MBM tumour microenvironment.

Ruminococcus gnavus, an unusual cause of surgical site infection following vertebral posterior instrumentation: a case report.

Background: Ruminococcus gnavus (R. Gnavus) is an anaerobic Gram-positive coccus, common commensal of the gastrointestinal tract of animals and humans. Anaerobic organisms as etiologic agents of bone and joint infections (BJI) are uncommon and frequently underestimated. New technologies, such as mass spectrometry techniques and molecular techniques like 16S rRNA, allow for more efficient diagnosis of these anaerobic bacteria. We present the first case report of deep surgical site infection (SSI) due to R. Gnavus, following spinal surgery. Case Description: We report the case of a deep SSI caused by R. Gnavus following posterior spinal instrumentation in an 81-year-old woman. The patient underwent extension of her previous fusion L2-L5, due to adjacent segment disease (ASD). We performed a T10 to S2-alar-iliac instrumentation. During the postoperative period, the patient presented with a paralytic ileus that required the placement of a nasogastric tube followed by gastrointestinal bleeding and two gastroscopies. Subsequently the patient showed signs of deep SSI. We performed surgical irrigation and debridement. All six cultures in anaerobic media showed short Gram-positive diplococci, using matrix-assisted laser desorption/ionization time of flight mass spectrometry (Maldi-TOF MS) all six strains were identified as R. Gnavus. The patient was treated with amoxicilin 1 g/8 h and ciprofloxacin 750 mg/12 h for 4 weeks. Six months postoperative, she was asymptomatic. Conclusions: As is the case with our patient, all previously described cases of R. Gnavus infection had a history of intestinal disease or immunosupression. We believe the isolation of R. Gnavus should raise the possibility of intestinal injury. Immunosuppression is also an important risk factor for the development of R. Gnavus infection.

Abducens nerve palsy associated with pseudomeningocele after cervical spine surgery: a case report.

Background: Cerebrospinal fluid leakage can cause abducens nerve palsy (ANP) secondary to downward brain traction, caused by intracranial hypotension. We present the first case after cervical fixation and fusion with spinal cord decompression. Case Description: We present a 65-year-old male, who undergone C5-C6 decompression by laminectomy and C3-T2 fixation and fusion, without intraoperative complications. Two months later, the patient referred a 2-week history of diplopia, with no other accompanying symptom. Clinical examination revealed a lack of lateral gaze of the left eye. Cervical MRI disclosed findings compatible with pseudomeningocele. Given the time of evolution, the subacute clinical findings and the absence of image or clinical data of infection or intracranial hypotension, we decided to perform conservative treatment. We submitted the patient to periodic clinical examinations and we confirmed progressive clinical improvement of diplopia, in association with neurologic and ophthalmologic specialists. At this time, six months after surgery, the patient is asymptomatic. The swelling has significantly decreased in size. Control MRI revealed no growth of the pseudomeningocele. Conclusions: ANP secondary to intracranial hypotension after cervical spine surgery requires immediate imaging tests and clinical evaluation from neurology and ophthalmology specialists. Management can be conservative, as long as diplopia is the only clinical and radiological finding and wound does not show signs of infection.

PLAR: a combined percutaneous and arthroscopic treatment for iliotibial band syndrome description of surgical technique and short-term results: description of surgical technique and short-term results.

INTRODUCTION: Description of a new surgical procedure (percutaneous lengthening and arthroscopic release, PLAR) that combines all the possible interventions on the iliotibial band (ITB), and evaluates its outcomes in a group of distance runners diagnosed with ITBS. METHODS: A prospective observational study was made of distance runners diagnosed with ITBS and operated upon using the PLAR technique between 1 and 2018 and 31 June 2020. The surgical technique is described in detail, and the demographic data and functional outcomes measured by the sports performance scales Activity Rating Scale (ARS) and International Knee Documentation Committee (IKDC) are presented. RESULTS: A total of 14 patients were included, with a mean follow-up of 16 months (range 12-42 months). All the patients resumed their previous sporting activity after an average of 4 (range 2.5-6) months, and no complications were recorded. In all cases, statistically significant improvement was evidenced by the ARS and IKDC scales following PLAR (p < 0.001), with excellent outcomes in 71% of the cases according to the ARS scale and in 86% according to the IKDC scale (mean difference between preoperative and final follow-up scores of 12.1/16 and 34.2/100 points, respectively). CONCLUSION: The PLAR technique is effective in allowing a return to previous sports performance levels in a short period of time among patients with ITBS refractory to conservative management, with a high satisfaction rate and the absence of complications.

Loss of striatal type 1 cannabinoid receptors is a key pathogenic factor in Huntington's disease.

Endocannabinoids act as neuromodulatory and neuroprotective cues by engaging type 1 cannabinoid receptors. These receptors are highly abundant in the basal ganglia and play a pivotal role in the control of motor behaviour. An early downregulation of type 1 cannabinoid receptors has been documented in the basal ganglia of patients with Huntington's disease and animal models. However, the pathophysiological impact of this loss of receptors in Huntington's disease is as yet unknown. Here, we generated a double-mutant mouse model that expresses human mutant huntingtin exon 1 in a type 1 cannabinoid receptor-null background, and found that receptor deletion aggravates the symptoms, neuropathology and molecular pathology of the disease. Moreover, pharmacological administration of the cannabinoid Δ(9)-tetrahydrocannabinol to mice expressing human mutant huntingtin exon 1 exerted a therapeutic effect and ameliorated those parameters. Experiments conducted in striatal cells show that the mutant huntingtin-dependent downregulation of the receptors involves the control of the type 1 cannabinoid receptor gene promoter by repressor element 1 silencing transcription factor and sensitizes cells to excitotoxic damage. We also provide in vitro and in vivo evidence that supports type 1 cannabinoid receptor control of striatal brain-derived neurotrophic factor expression and the decrease in brain-derived neurotrophic factor levels concomitant with type 1 cannabinoid receptor loss, which may contribute significantly to striatal damage in Huntington's disease. Altogether, these results support the notion that downregulation of type 1 cannabinoid receptors is a key pathogenic event in Huntington's disease, and suggest that activation of these receptors in patients with Huntington's disease may attenuate disease progression.

A comparison between midwifery and obstetric care at birth in Spain: Across-sectional study of perinatal outcomes.

BACKGROUND: The organizational structure of maternity services determines the choice of which professionals provide care during pregnancy, birth, and the postnatal period, and it influences the kind of care they deliver and the level of continuity of care offered. There is considerable evidence that demonstrates a relationship between how care is provided and the maternal and neonatal health outcomes. Registered midwives and obstetricians provide maternity care across Spain. To date, no studies have assessed whether maternity outcomes differ between these two groups. OBJECTIVE: The aim of this study was to examine the association between the care received (midwifery care versus obstetric care) and the maternal and neonatal outcomes in women with normal, low- and medium-risk pregnancies in Spain from 2016 to 2019. DESIGN: A prospective, multicentre, cross-sectional study was carried out as part of COST Action IS1405 at 44 public hospitals in Spain in the years 2016-2019. The protocol can be accessed through the registry ISRCTN14062994. The sample size of this study was 11,537 women. The primary outcome was mode of birth. The secondary outcomes included augmentation with oxytocin, use of epidural analgesia, women's position at birth, perineal integrity, third stage of labour management, maternal and neonatal admission to intensive care, Apgar score, neonatal resuscitation, and early initiation of breastfeeding. Chi-square tests for categorical variables and independent sample t-test for continuous variables to assess differences between the midwifery and obstetric groups were calculated. Odds ratio with intervals of confidence at 95% were calculated for obstetric interventions and perinatal outcomes. A multivariate logistic regression model was applied in order to examine the effect of type of healthcare provider on perinatal outcomes. These models were adjusted for care provider, type of onset of labour, use of anaesthesia, pregnancy risk, maternal age, parity, and gestational age at birth. RESULTS: Midwifery care was associated with lower rates of operative births and severe perineal damage and had no higher adverse outcomes. No statistically significant differences were observed in the use of other obstetric interventions between the two groups. CONCLUSIONS: The findings of this study should encourage a shift in the current maternity care system towards a greater integration of midwifery-led services in order to achieve optimal birth outcomes for women and newborns. REGISTRY NUMBER: ISRCTN14062994.