A small series of high-frequency wavelets overlapping the earliest part of the N20 wave (high-frequency oscillations, HFOs) can be observed in the somatosensory evoked potentials (SSEPs) of normal ...subjects after filtering then with a high-pass filter (>500 Hz). These HFOs have been related to interneuronal activity in the primary somatosensory cortex. In patients with cortical myoclonus there is a sensorimotor cortical hyperexcitability, expressed neurophysiologically as high-amplitude waves in the SSEPs (giant SSEPs). There have been contradicting reports in the literature on the changes in the HFOs in these patients. The authors studied HFOs in a group of 20 patients with cortical myoclonus of different origins and in a control group by means of time-frequency transforms, comparing the results obtained with the amplitude and latency of the classical SSEP waves. All controls had normal HFOs, with two components. Nine patients had no HFOs, nine patients had low-amplitude and/or delayed HFOs, and the remaining two patients, the only without ataxia, had high-amplitude HFOs with a long latency. These results suggest heterogeneity in the pathophysiology of cortical myoclonus, which might be related to the different systems affected.
Las infecciones del sistema nervioso central son enfermedades frecuentes en la atención urgente, pudiendo ser de origen bacteriano, parasitario o vírico. Los síntomas iniciales pueden ser ...inespecíficos, lo que puede dificultar y retrasar su diagnóstico, por lo que es de suma importancia toda la información que pueda obtenerse a través de la anamnesis y exploración física y con frecuencia exploraciones complementarias. En los últimos cien años, con la introducción de fármacos antibióticos ha disminuido de forma importante la mortalidad secundaria a meningoencefalitis, pero a pesar de ello siguen provocando alta morbi-mortalidad. Otros fenómenos, como las campañas de vacunación, movimientos migratorios, infección por el virus de la inmunodeficiencia humana y otros estados de inmunosupresión, han dado lugar a importantes cambios epidemiológicos como son la práctica desaparición de algunas infecciones o la aparición de otras previamente casi inexistentes. La lista de infecciones potenciales de sistema nervioso central es extensa por lo que en este artículo de revisión expondremos desde el punto de vista clínico, diagnóstico y terapéutico las más frecuentes en nuestro medio y algunas que, aunque poco frecuentes, pueden requerir atención urgente por su gravedad.
1 Department of Endocrinology, Clínica Universitaria
de Navarra, 2 Metabolic Research Laboratory, and
3 Department of Histology and Pathology, University of Navarra,
31008 Pamplona, Spain
The ...ability to ensure
continous availability of energy despite highly variable supplies in
the environment is a major determinant of the survival of all species.
In higher organisms, including mammals, the capacity to efficiently
store excess energy as triglycerides in adipocytes, from which stored
energy could be rapidly released for use at other sites, was developed.
To orchestrate the processes of energy storage and release, highly
integrated systems operating on several physiological levels have
evolved. The adipocyte is no longer considered a passive bystander,
because fat cells actively secrete many members of the cytokine family,
such as leptin, tumor necrosis factor- , and interleukin-6, among
other cytokine signals, which influence peripheral fuel storage,
mobilization, and combustion, as well as energy homeostasis. The
existence of a network of adipose tissue signaling pathways, arranged
in a hierarchical fashion, constitutes a metabolic repertoire that
enables the organism to adapt to a wide range of different metabolic
challenges, such as starvation, stress, infection, and short periods of
gross energy excess.
leptin; tumor necrosis factor- ; interleukins; obesity; insulin
resistance
Introduction: Epithelial ovarian cancer (EOC) is primarily confined to the peritoneal cavity. When primary complete surgery is not possible, neoadjuvant chemotherapy (NACT) is provided; however, the ...peritoneum-plasma barrier hinders the drug effect. The intraperitoneal administration of chemotherapy could eliminate residual microscopic peritoneal tumor cells and increase this effect by hyperthermia. Intraperitoneal hyperthermic chemotherapy (HIPEC) after interval cytoreductive surgery could improve outcomes in terms of disease-free survival (DFS) and overall survival (OS). Materials and Methods: A multicenter, retrospective observational study of advanced EOC patients who underwent interval cytoreductive surgery alone (CRSnoH) or interval cytoreductive surgery plus HIPEC (CRSH) was carried out in Spain between 07/2012 and 12/2021. A total of 515 patients were selected. Progression-free survival (PFS) and OS analyses were performed. The series of patients who underwent CRSH or CRSnoH was balanced regarding the risk factors using a statistical analysis technique called propensity score matching. Results: A total of 170 patients were included in each subgroup. The complete surgery rate was similar in both groups (79.4% vs. 84.7%). The median PFS times were 16 and 13 months in the CRSH and CRSnoH groups, respectively (Hazard ratio (HR) 0.74; 95% CI, 0.58–0.94; p = 0.031). The median OS times were 56 and 50 months in the CRSH and CRSnoH groups, respectively (HR, 0.88; 95% CI, 0.64–1.20; p = 0.44). There was no increase in complications in the CRSH group. Conclusion: The addition of HIPEC after interval cytoreductive surgery is safe and increases DFS in advanced EOC patients.
To evaluate the efficacy and safety of plasma rich in growth factors (PRGF) in photorefractive keratectomy (PRK) versus Mitomycin C (MMC).This is a comparative, longitudinal and retrospective ...case-control study (MMC vs PRGF), in patients with a spherical correction from -0.25 to -8.00 D and cylinder correction from -0.25 to -3.00. The uncorrected distance visual acuity (UDVA), refractive efficacy and safety indices, and changes in endothelial cell density were evaluated. The predictability was assessed with the postoperative manifest spherical equivalent.Forty-four patients (72 eyes) were treated with MMC and twenty-five patients (45 eyes) with PRGF. The final UDVA (LogMar) in MMC was 0.029 ± 0.065 and in PRGF it was 0.028 ± 0.048 (p = 0.383). The efficacy index for MMC was 0.98 ± 0.10 and 1.10 ± 0.46 for patients treated with PRGF (p = 0.062). The safety index for MMC was 1.03 ± 0.11 and 1.12 ± 0.46 (p = 0.158) for PRGF group. The change percentage of endothelial cell density was 0.9 ± 11.6 for MMC and 4.3 ± 13.1 for PRGF (p = 0.593). The predictability for MMC was 92.1% and for the PRGF was 91.9% (p = 0.976). Hyperemia, eye pain and superficial keratitis were observed in 11.1% of the MMC group; no adverse events were observed with the PRGF.The use of PRGF in PRK surgery is as effective as MMC. The PRGF shows a better safety profile than MMC for its intraoperative use in PRK.
Background
Diagnosis of non-facial melanomas on sun-damaged skin or extrafacial lentigo maligna is challenging.
Objectives
To identify the evolutionary dermoscopic signs, characteristic of this type ...of non-facial melanoma on sun-damaged skin.
Materials & Methods
This retrospective descriptive observational study included 90 dermoscopic follow-up images of 22 non-facial melanomas on sun-damaged skin from 17 high-risk melanoma patients, followed with digital dermoscopy and diagnosed between January 2016 and October 2020. We recorded dermoscopic changes by comparing each dermoscopic image with the previous one (mean dermoscopic follow-up of the excised lesions was 3.6 years). Confocal microscopy images were taken at diagnosis.
Results
In total, 51.5% (95% CI: 39–64) showed an appearance or increase in featureless areas with surrounding small round or triangular dark brown-blue structures, 23% (95% CI: 23-46) showed an increase in other geometric structures (angulated lines, zig-zag lines and polycyclic structures), 5.9% (95% CI: 2-14) showed an appearance or increase in bright white lines and atypical vascularization, 26.5% (95% CI: 17-39) showed an appearance or increase in follicular pigmentation structures or follicular radial lines, and 39.7% (95% CI: 28-52) showed focal islands of pigmentation in these areas. Of the changes, 54% occurred at the last and diagnostic visit. There was an increase in size in only 20.6% (95% CI: 12-32). Also, 81.8% showed pagetoid cells in the epidermis, 95.5% atypical cells at the dermoepidermal junction by reflectance confocal microscopy, and 95.5% showed non-edged or edged and non-edged papillae.
Conclusion
This study identifies the dermoscopic evolutionary changes associated with extrafacial lentigo maligna.
Hypertension is a prominent preventable cause of premature morbidity and mortality. People with hypertension and established cardiovascular disease are at particularly high risk, so reducing blood ...pressure below standard targets may be beneficial. This strategy could reduce cardiovascular mortality and morbidity but could also increase adverse events. The optimal blood pressure target in people with hypertension and established cardiovascular disease remains unknown.
To determine if 'lower' blood pressure targets (≤ 135/85 mmHg) are associated with reduction in mortality and morbidity as compared with 'standard' blood pressure targets (≤ 140 to 160/ 90 to 100 mmHg) in the treatment of people with hypertension and a history of cardiovascular disease (myocardial infarction, angina, stroke, peripheral vascular occlusive disease).
The Cochrane Hypertension Information Specialist searched the following databases for randomized controlled trials up to February 2017: the Cochrane Hypertension Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1946), Embase (from 1974), the World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov. We also searched the Latin American and Caribbean Health Science Literature Database (from 1982) and contacted authors of relevant papers regarding further published and unpublished work. There were no language restrictions.
We included randomized controlled trials (RCTs) with more than 50 participants per group and at least six months follow-up. Trial reports needed to present data for at least one primary outcome (total mortality, serious adverse events, total cardiovascular events, cardiovascular mortality). Eligible interventions were lower target for systolic/diastolic blood pressure (≤ 135/85 mmHg) compared with standard target for blood pressure (≤ 140 to 160/90 to 100 mmHg).Participants were adults with documented hypertension or who were receiving treatment for hypertension and cardiovascular history for myocardial infarction, stroke, chronic peripheral vascular occlusive disease or angina pectoris.
Two review authors independently assessed search results and extracted data using standard methodological procedures expected by The Cochrane Collaboration.
We included six RCTs that involved a total of 9795 participants. Mean follow-up was 3.7 years (range 1.0 to 4.7 years). Five RCTs provided individual patient data for 6775 participants.We found no change in total mortality (RR 1.05, 95% CI 0.90 to 1.22) or cardiovascular mortality (RR 0.96, 95% CI 0.77 to 1.21; moderate-quality evidence). Similarly, no differences were found in serious adverse events (RR 1.02, 95% CI 0.95 to 1.11; low-quality evidence). There was a reduction in fatal and non fatal cardiovascular events (including myocardial infarction, stroke, sudden death, hospitalization or death from congestive heart failure) with the lower target (RR 0.87, 95% CI 0.78 to 0.98; ARR 1.6% over 3.7 years; low-quality evidence). There were more participant withdrawals due to adverse effects in the lower target arm (RR 8.16, 95% CI 2.06 to 32.28; very low-quality evidence). Blood pressures were lower in the lower' target group by 9.5/4.9 mmHg. More drugs were needed in the lower target group but blood pressure targets were achieved more frequently in the standard target group.
No evidence of a difference in total mortality and serious adverse events was found between treating to a lower or to a standard blood pressure target in people with hypertension and cardiovascular disease. This suggests no net health benefit from a lower systolic blood pressure target despite the small absolute reduction in total cardiovascular serious adverse events. There was very limited evidence on adverse events, which lead to high uncertainty. At present there is insufficient evidence to justify lower blood pressure targets (≤ 135/85 mmHg) in people with hypertension and established cardiovascular disease. More trials are needed to answer this question.
Cantabria Cohort stems from a research and action initiative lead by researchers from Valdecilla Research Institute (IDIVAL), Marqués de Valdecilla University Hospital and University of Cantabria, ...supported by the regional Goverment. Its aim is to identify and follow up a cohort that would provide information to improve the understanding of the etiology and prognosis of different acute and chronic diseases. The Cantabria Cohort will recruit between 40,000-50,000 residents aged 40-69 years at baseline, representing 10-20% of the target population. Currently, more than 30,000 volunteers have been enrolled. All participants will be invited for a re-assessment every three years, while the overall duration is planned for twenty years. The repeated collection of biomaterials combined with broad information from participant questionnaires, medical examinations, actual health system records and other secondary public data sources is a major strength of its design, which will make it possible to address biological pathways of disease development, identify new factors involved in health and disease, design new strategies for disease prevention, and advance precision medicine. It is conceived to allow access to a large number of researchers worldwide to boost collaboration and medical research.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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