Effects of acute and long-term mindfulness on neural activity and the conflict resolution component of attention.

Mindfulness practices have been linked to enhanced attention and conflict resolution abilities. While much research has focused on the long-term effects of mindfulness, the immediate impact of a single session has been less studied. This study recruited 20 experienced meditators and 20 novices and assigned them to a mindfulness or a control condition. They completed a Stroop Task to measure cognitive conflict resolution before and after the intervention, with brain activity monitored via functional near-infrared spectroscopy (fNIRS). Novices showed an age-related decline in conflict resolution ability, while experienced meditators didn't. Initially, both groups showed similar Stroop performance, but experienced meditators had greater brain activation in the left dorsolateral prefrontal cortex (DLPFC). Post-intervention, novices in the breath count task became more similar to experienced meditators in their neural activity during conflict resolution. Our findings indicate that long-term mindfulness experience may protect against age-related decline in cognitive conflict resolution speed, and may alter neural processing of cognitive conflict resolution.

Music training is related to late ERP modulation and enhanced performance during Simon task but not Stroop task.

Increasing evidence suggests that music training correlates with better performance in tasks measuring executive function components including inhibitory control, working memory and selective attention. The Stroop and Simon tasks measure responses to congruent and incongruent information reflecting cognitive conflict resolution. However, there are more reports of a music-training advantage in the Simon than the Stroop task. Reports indicate that these tasks may differ in the timing of conflict resolution: the Stroop task might involve early sensory stage conflict resolution, while the Simon task may do so at a later motor output planning stage. We hypothesize that musical experience relates to conflict resolution at the late motor output stage rather than the early sensory stage. Behavioral responses, and event-related potentials (ERP) were measured in participants with varying musical experience during these tasks. It was hypothesized that musical experience correlates with better performance in the Simon but not the Stroop task, reflected in ERP components in the later stage of motor output processing in the Simon task. Participants were classified into high- and low-music training groups based on the Goldsmith Musical Sophistication Index. Electrical brain activity was recorded while they completed visual Stroop and Simon tasks. The high-music training group outperformed the low-music training group on the Simon, but not the Stroop task. Mean amplitude difference (incongruent-congruent trials) was greater for the high-music training group at N100 for midline central (Cz) and posterior (Pz) sites in the Simon task and midline central (Cz) and frontal (Fz) sites in the Stroop task, and at N450 at Cz and Pz in the Simon task. N450 difference peaks occurred earlier in the high-music training group at Pz. Differences between the groups at N100 indicate that music training may be related to better sensory discrimination. These differences were not related to better behavioral performance. Differences in N450 responses between the groups, particularly in regions encompassing the motor and parietal cortices, suggest a role of music training in action selection during response conflict situations. Overall, this supports the hypothesis that music training selectively enhances cognitive conflict resolution during late motor output planning stages.

Music Training, Working Memory, and Neural Oscillations: A Review.

This review focuses on reports that link music training to working memory and neural oscillations. Music training is increasingly associated with improvement in working memory, which is strongly related to both localized and distributed patterns of neural oscillations. Importantly, there is a small but growing number of reports of relationships between music training, working memory, and neural oscillations in adults. Taken together, these studies make important contributions to our understanding of the neural mechanisms that support effects of music training on behavioral measures of executive functions. In addition, they reveal gaps in our knowledge that hold promise for further investigation. The current review is divided into the main sections that follow: (1) discussion of behavioral measures of working memory, and effects of music training on working memory in adults; (2) relationships between music training and neural oscillations during temporal stages of working memory; (3) relationships between music training and working memory in children; (4) relationships between music training and working memory in older adults; and (5) effects of entrainment of neural oscillations on cognitive processing. We conclude that the study of neural oscillations is proving useful in elucidating the neural mechanisms of relationships between music training and the temporal stages of working memory. Moreover, a lifespan approach to these studies will likely reveal strategies to improve and maintain executive function during development and aging.

Clinical value of event-free survival in acute myeloid leukemia.

The value of event-free survival (EFS) as an end point in acute myeloid leukemia (AML) trials has been questioned. We hypothesized that rather than a surrogate for overall survival (OS), improvement in EFS may decrease the use of health care. In this retrospective study, we identified 400 patients with AML who were treated on first-line therapy trials and had OS between 2 and 36 months. We captured health care use from diagnosis until death or until the patient was censored at stem cell transplantation (SCT). We used correlation and regression analysis to determine the relation between health care use and EFS. Among patients with newly diagnosed AML, 35% had adverse-risk AML, 48% received intensive chemotherapy, and 28% received hypomethylating agents. The median EFS censored at SCT was 9.7 months. Longer EFS led to a significant decline in health care use regardless of OS. This held true for all observations, including overall health care use (r = -0.45), sum of clinic visits, emergency room visits, hospitalizations, consultations (r = -0.44), sum of invasive procedures, laboratory and imaging studies (r = -0.51), and blood product transfusions (r = -0.19). These correlations were stronger for patients who achieved a complete remission and held true across age, treatment, and disease risk subgroups. In patients with newly diagnosed AML, improvement in EFS correlates with a decrease in all health care use irrespective of OS duration.

Paget's disease of the breast without associated ductal carcinoma: case report and review of the literature / Enfermedad de Paget de la mama sin carcinoma ductal asociado: reporte de caso y revisión de la literatura

Objective: To present one case of Paget's disease (PD) of the breast without associated ductal carcinoma, and to conduct a review of the literature on its diagnosis and treatment. Materials and methods: 59-year-old woman with a two-year history of a chronic erythematous, ulcerated, itchy lesion in the left nipple, initially treated dermatologically with topical steroids with no improvement, finally visits a primary healthcare institution in the city of Tunja, Colombia for diagnosis. A biopsy and histochemical testing were performed to make the diagnosis and the lesion was then treated with central quadrantectomy. The post-operative pathology testing was negative for malignancy, without recurrence at one-year follow-up. A search was conducted in the PubMed, SciELO, ProQuest, ScienceDirect and Google Scholar databases using the terms "Paget´s Disease," "Breast Neoplasms," "Mammography," "Ultrasonography," Mammary," "Biopsy," and "Mastectomy," tracking bibliographic review articles, editorials, reports and clinical case series in English and Spanish, without time limitation. Results: Overall, 11 publications were included consisting of 5 case reports, 3 case series, 1 review of the literature based on a clinical case, and 2 letters to the editor describing cases related to Paget's disease of the nipple with no associated carcinoma. The diagnosis was based on the clinical suspicion of the disease and a biopsy of the lesion. Histochemistry was useful for the differential diagnosis: treatment options ranged from mastectomy to nipple-areolar complex resection. Radiotherapy has also been used. Conclusions: The diagnosis of Paget's disease with no associated ductal carcinoma is based on early clinical suspicion and histopathology of the nipple- areolar complex. There is no consensus regarding surgical management of this lesion. Follow-up studies of this subgroup of patients treated with radiotherapy or conservative surgery are required.

TITULO: ENFERMEDAD DE PAGET DE LA MAMA, SIN CARCINOMA DUCTAL ASOCIADO: REPORTE DE CASO Y REVISIÓN DE LA LITERATURA. Objetivo: Presentar un caso de enfermedad de Paget (EP) de la mama, sin carcinoma ductal asociado, y realizar una revisión de literatura respecto a su diagnóstico y tratamiento. Materiales y métodos: Mujer de 59 años, con lesión pruriginosa, eritematosa y ulcerada crónica, en pezón izquierdo, de 2 años de evolución, quien recibió inicialmente manejo dermatológico con corticoides tópicos sin mejoría clínica, que acude finalmente a una institución de atención primaria en Tunja (Colombia) para su diagnóstico, el cual se realizó por biopsia mediante inmunohistoquímica y posterior manejo por cuadrantectomía central con patología posquirúrgica negativa para malignidad, sin recurrencia al año de seguimiento. Se realizó una búsqueda en las bases de datos Medline vía PubMed, SciELO, ProQuest, ScienceDirect y Google Académico con los términos "Paget´s Disease", "Breast Neoplasms", "Mammography" "Ultraso- nography Mammary", "Biopsy" y "Mastectomy", rastreando artículos de revisión bibliográfica, editoriales, reportes y series de casos clínicos en inglés y español, sin límite de tiempo. Resultados: Se incluyeron 11 publicaciones correspondientes a 5 reportes de caso, 3 series de casos, 1 revisión de la literatura a partir de un caso clínico, y 2 cartas al editor que describieron casos relacionados con enfermedad de Paget del pezón sin carcinoma asociado. El diagnóstico se funda- mentó en la sospecha clínica de la enfermedad con la posterior realización de biopsia de la lesión; la inmunohistoquímica fue útil en el diagnóstico diferencial. El tratamiento varió desde mastectomía hasta resección de complejo areola-pezón. La radioterapia también ha sido utilizada. Conclusiones: El diagnóstico de la enfermedad de Paget sin carcinoma ductal asociado se fundamenta en una sospecha clínica temprana y en el estudio histopatológico del complejo areola-pezón. No hay consenso sobre el manejo quirúrgico de esta lesión. Se requieren estudios de seguimiento de este subgrupo de pacientes tratado con radioterapia o cirugía conservadora.

Paget's disease of the breast without associated ductal carinoma: Case report and review of the literature / Enfermedad de paget de la mama, sin carcinoma ductal asociado: reporte de caso y revisión de la literatura

RESUMEN Objetivo: presentar un caso de enfermedad de Paget (EP) de la mama, sin carcinoma ductal asociado, y realizar una revisión de literatura respecto a su diagnóstico y tratamiento. Materiales y métodos: mujer de 59 años, con lesión pruriginosa, eritematosa y ulcerada crónica, en pezón izquierdo, de 2 años de evolución, quien recibió inicialmente manejo dermatológico con corticoides tópicos sin mejoría clínica, que acude finalmente a una institución de atención primaria en Tunja (Colombia) para su diagnóstico, el cual se realizó por biopsia mediante inmunohistoquímica y posterior manejo por cuadrantectomía central con patología posquirúrgica negativa para malignidad, sin recurrencia al año de seguimiento. Se realizó una búsqueda en las bases de datos Medline vía PubMed, SciELO, ProQuest, ScienceDirect y Google Académico con los términos "Paget´s Disease", "Breast Neoplasms", "Mammography" "Ultrasonography Mammary", "Biopsy" y "Mastectomy", rastreando artículos de revisión bibliográfica, editoriales, reportes y series de casos clínicos en inglés y español, sin límite de tiempo. Resultados: se incluyeron 11 publicaciones correspondientes a 5 reportes de caso, 3 series de casos, 1 revisión de la literatura a partir de un caso clínico, y 2 cartas al editor que describieron casos relacionados con enfermedad de Paget del pezón sin carcinoma asociado. El diagnóstico se fundamentó en la sospecha clínica de la enfermedad con la posterior realización de biopsia de la lesión; la inmunohistoquímica fue útil en el diagnóstico diferencial. El tratamiento varió desde mastectomía hasta resección de complejo areola-pezón. La radioterapia también ha sido utilizada. Conclusiones: el diagnóstico de la enfermedad de Paget sin carcinoma ductal asociado se fundamenta en una sospecha clínica temprana y en el estudio histopatológico del complejo areola-pezón. No hay consenso sobre el manejo quirúrgico de esta lesión. Se requieren estudios de seguimiento de este subgrupo de pacientes tratado con radioterapia o cirugía conservadora.

ABSTRACT Objective: To present one case of Paget's disease (PD) of the breast without associated ductal carcinoma, and to conduct a review of the literature on its diagnosis and treatment. Materials and methods: A 59-year-old woman with a two-year history of a chronic erythematous, ulcerated, itchy lesion in the left nipple, initially treated dermatologically with topical steroids with no improvement, finally visits a primary healthcare institution in the city of Tunja, Colombia for diagnosis. A biopsy and histochemical testing were performed to make the diagnosis and the lesion was then treated with central quadrantectomy. The post-operative pathology testing was negative for malignancy, without recurrence at one-year follow-up. A search was conducted in the PubMed, SciELO, ProQuest, ScienceDirect and Google Scholar databases using the terms "Paget´s Disease," "Breast Neoplasms," "Mammography," "Ultrasonography," Mammary," "Biopsy," and "Mastectomy," tracking bibliographic review articles, editorials, reports and clinical case series in English and Spanish, without time limitation. Results: Overall, 11 publications were included consisting of 5 case reports, 3 case series, 1 review of the literature based on a clinical case, and 2 letters to the editor describing cases related to Paget's disease of the nipple with no associated carcinoma. The diagnosis was based on the clinical suspicion of the disease and a biopsy of the lesion. Histochemistry was useful for the differential diagnosis: treatment options ranged from mastectomy to nipple-areolar complex resection. Radiotherapy has also been used. Conclusions: The diagnosis of Paget's disease with no associated ductal carcinoma is based on early clinical suspicion and histopathology of the nipple-areolar complex. There is no consensus regarding surgical management of this lesion. Follow-up studies of this subgroup of patients treated with radiotherapy or conservative surgery are required.

Conocimiento, abordaje y manejo de drogas emergentes en servicios de urgencias de Medellín, Colombia / Knowledge, approach and management of new drugs of abuse in the emergency departments in Medellin, Colombia

Objetivo: describir los conocimientos, abordaje y manejo de las drogas emergentes en el servicio de urgencias, de un grupo de próximos médicos generales y urgentólogos, que permitan su inclusión como área de interés en los planes de estudio de los futuros profesionales. Materiales y métodos: estudio observacional, con aplicación de encuestas a 89 internos y residentes de medicina de una universidad privada de la ciudad de Medellín en el año 2016, con el fin de indagar mecanismos de acción, síndromes clínicos, diagnóstico y tratamiento de las intoxicaciones por las drogas emergentes más frecuentes en los servicios de urgencias. Resultados: el conocimiento global sobre las nuevas drogas fue bajo, tanto en los internos como en los residentes de urgencias. En el abordaje se encontró un nivel medio en los residentes, mientras que en los internos los conocimientos correspondieron a un nivel bajo; los mismos resultados fueron encontrados con respecto al manejo que se le daría a estos pacientes. Conclusión: se evidencia la necesidad de capacitación teórica en el abordaje de pacientes bajo el efecto de drogas emergentes, pues, siendo Medellín una ciudad donde se reporta una mayor frecuencia de consumo de drogas ilícitas, es necesario que el personal que trabaja en servicios de urgencias tenga un sustento teórico adecuado para enfrentarse a esta problemática..(AU)

Objective: to describe previous knowledge, approach and management of intoxications by new drugs of abuse in emergency services in a subgroup of future general doctors and Emergency Medicine specialists in order to justify the inclusion of this subject in the different study programs of such future profesionals. Materials and methods: observational study in which a survey was answered by 89 last year medical students and emergency medicine residents of a private university in the city of Medellín in the year 2016. Questions about mechanisms of action, clinical syndromes, diagnosis and treatment of intoxications caused by the most frequent emerging drugs of abuse in the emergency department were made. Data was processed in a statistical package and analized with frequency measurements. Results: global knowledge about these new drugs was categorized as low, both in the last year medical students and emergency medicine residents groups. As for the approach questions, an intermediate level was found in the resident's group, whereas the last year medical student's group got a low level of knowledge. The same results were found in the management questions for each group. Conclussion: this study shows the need to include this subject as part of the educational programs of undergraduate studies and postgraduate studies in emergency medicine in the city.

Íleo biliar: reporte de un caso / Biliary ileus: a case report

El íleo biliar se define como una obstrucción intestinal mecánica secundaria a la impactación de un cálculo biliar en el tracto gastrointestinal. Es responsable, aproximadamente, del 1% al 4% de las obstrucciones intestinales de origen mecánico y se asocia con alta morbimortalidad (1). La tomografía computarizada es en la actualidad considerada como el patrón de oro para el diagnóstico de esta patología, la cual se manifiesta con neumobilia, neumocolecisto, visualización directa de la fístula bilio-entérica, niveles hidroaéreos, líquido libre en cavidad peritoneal y localización ectópica de un cálculo.

Metástasis de melanoma maligno a intestino delgado: reporte de un caso / Metastases of malignant melanoma to the small bowel: a case report

El melanoma maligno puede cursar con metástasis al tracto gastrointestinal. El artículo presenta el caso de un paciente con antecedente de melanoma maligno de pared torácica y masa abdominal correspondiente a metástasis a intestino delgado.

Estudio de un brote de intoxicación por alcohol metílico en Santa Fe de Bogotá, 1994 / Study of a outbreak of methyl alcohol poisoning in Santa Fe of Bogotá

El Laboratorio de Toxicologia del Instituto Nacional de Medicina Legal y Ciencias Forenses (INML y CF) observó un incremento de muestras positivas para metanol en sangre, entre las necropsias medicolegales practicadas en junio de 1994. Por lo anterior, se llevó a cabo un estudio epidemiológico con el fin de establecer el diagnóstico, identificar los factores de riesgo y controlar y prevenir la presencia de nuevos brotes. Se realizó un estudio descriptivo, se revisaron los protocolos de necropsia, los resultados de alcoholemia e historias clíncas de los casos y se aplicó un formulario de necropsia verbal. se definió como caso mortal de intoxicación metílica (ITM) aquella defunción ocurrida durante junio de 1994, cuya necropsia se realizó en el INML y CF, con concentraciones de metanol superiores a 30 mg/dL y cuyo informe establecía intoxicación por metanol como causa básica de la defunción. Se identificaron 14 personas fallecidas por ITM, siendo la totalidad de los casos indigentes. La función estadística scan (p=0,004) indicó que el exceso de defunciones de junio era estadísticamente significativo en relación con los meses previos. Doce de los casos recibieron atención médica y a cuatro se les diagnosticó ITM antes de su muerte. Todos los casos presentaron concentraciones de metanol en sangre entre 43 y 190,4 mg/dL. Este es el primer conglemerado de intoxicación por metanol en indigentes que se describen en el país y plantea la necesidad de establecer políticas de salud pública dirigidas a la protección de indigentes y prevención de intoxicación por metanol

Tecnica de Harrington en Luxofracturas Dorsolumbares / Harrington's Technique in Dorso-lumbar Unstable Fractures

En el Hospital Universitario del Valle en Cali, Colombia, se intervinieron de Febrero de 1977 a Agosto de 1981, 35 pacientes con fracturas inestables dorsolumbares, a quienes se practico fusion posterior con barras de Harrington. Casi todos los enfermos (86%) pertenecian al sexo masculino. Dos pacientes con deficit neurologico parcial empeoraron despues de la cirugia. El resto no se modifico o mejoro de su deficit. Los controles postoperatorios mostraron en las radiografias simples, una correccion notable de las deformidades pre-existentes. El numero de infecciones, inicialmente alto, disminuyo con la prontitud del tratamiento quirurgico en los ultimos casos