En muchas teorías traductológicas se ha evidenciado un paralelismo entre el estatus del texto traducido, considerado inferior a la obra original, y el de las mujeres, subestimadas tanto en la ...sociedad como en la literatura. Por lo tanto, en las últimas décadas, la perspectiva de género se ha ocupado de rescatar el trabajo de las traductoras y de de-construir una teoría que no había incorporado a las mujeres en el proceso de estudio del fenómeno y en la reflexión crítica. En concreto, en este artículo pretendemos dar una muestra de la innovación que las mujeres han aportado en este campo y de las estrategias que han llevado a cabo para subrayar su identidad en el texto. Debido a la centralidad del mundo anglonorteamericano en las especulaciones de género sobre traducción, nuestro recorrido se fundamenta sobre todo en el trabajo de las investigadoras y traductoras canadienses, para luego abrirse a un breve estado de la cuestión acerca de la recepción que su pensamiento ha tenido en el contexto español.
Background. Motor practice is an important component of neurorehabilitation. Imaging studies in healthy individuals show that dynamic brain activation changes with practice. Defining patterns of ...functional brain plasticity associated with motor practice following stroke could guide rehabilitation. Objective. The authors aimed to test whether practice-related changes in brain activity differ after stroke and to explore spatial relationships between activity changes and patterns of structural degeneration. Methods. They studied 10 patients at least 6 months after left-hemisphere subcortical strokes and 18 healthy controls. Diffusion-weighted magnetic resonance imaging (MRI) was acquired at baseline, and functional MRI (fMRI) was acquired during performance of a visuomotor tracking task before and after a 15-day period of practice of the same task. Results. Smaller short-term practice effects at baseline correlated with lower fractional anisotropy in the posterior limbs of the internal capsule (PLIC) bilaterally in patients (t > 3; cluster P < .05). After 15 days of motor practice a Group × Time interaction (z > 2.3; cluster P < .05) was found in the basal ganglia, thalamus, inferior frontal gyrus, superior temporal gyrus, and insula. In these regions, healthy controls showed decreases and patients showed increases in activity with practice. Some regions of interest had a loss of white matter connectivity at baseline. Conclusions. Performance gains with motor practice can be associated with increased activity in regions that have been either directly or indirectly impaired by loss of connectivity. These results suggest that neurorehabilitation interventions may be associated with compensatory adaptation of intact brain regions as well as enhanced activity in regions with impaired structural connectivity.
IMPORTANCE: Uncertainty remains about how aggressively to treat early multiple sclerosis. High-efficacy disease-modifying therapies (DMTs) are often reserved for individuals expressing poor ...prognostic features at baseline. OBJECTIVE: To analyze long-term outcomes in a population-based cohort according to initial treatment strategy. DESIGN, SETTING AND PARTICIPANTS: In this cohort study, data were derived from January 1998 to December 2016, and analysis was performed in January 2017. From a total of 720 patients prescribed a DMT, 592 (82%) were included in analysis. Reasons for exclusion were first treated elsewhere or privately (n = 39), clinical trial participant (n = 25), and insufficient clinical data (n = 45). EXPOSURES: Patients were classified according to first-line treatment strategy: high-efficacy (early intensive treatment EIT) or moderate-efficacy DMT (escalation ESC). MAIN OUTCOMES AND MEASURES: Primary outcome was 5-year change in Expanded Disability Status Scale score. Secondary outcome was time to sustained accumulation of disability (SAD). Models were adjusted for sex, age at treatment, year of starting DMT, and escalation to high-efficacy treatment in the ESC group. RESULTS: Mean (SD) age of 592 patients at symptom onset was 27.0 (9.4) years. Mean (SD) 5-year change in Expanded Disability Status Scale score was lower in the EIT group than the ESC group (0.3 1.5 vs 1.2 1.5); this remained significant after adjustment for relevant covariates (β = −0.85; 95% CI, −1.38 to −0.32; P = .002). Median (95% CI) time to SAD was 6.0 (3.17-9.16) years for EIT and 3.14 (2.77-4.00) years for ESC (P = .05). For those within the ESC group who escalated to high-efficacy DMT as second-line treatment, median (95% CI) time to SAD was 3.3 years (1.8-5.6; compared with EIT group log-rank test P = .08). After adjustment for relevant covariates, there was no difference in hazard of SAD between the groups. However, 60% of those who escalated to high-efficacy DMTs were observed to develop SAD while still receiving initial moderate-efficacy treatment before escalation. CONCLUSIONS AND RELEVANCE: In a real-life setting, long-term outcomes were more favorable following early intensive therapy vs first-line moderate-efficacy DMT. Contemporary surveillance strategies and escalation protocols may be insufficiently responsive. This finding is particularly relevant as patients in real-world practice are typically selected for an EIT approach to therapy on the basis of clinical and radiological features predictive of a poor outcome. These data support the need for a prospective randomized clinical trial.
Background
Case-reports/series and cohorts of Guillain–Barré syndrome (GBS) associated with COVID-19 vaccination have been reported.
Methods
A systematic review and meta-analysis of cohort studies of ...GBS after COVID-19 vaccination was carried out. Incidence and incidence rate ratio for a number of vaccine doses and risk of GBS, also considering the specific vaccine technology, were calculated in a random-effects model.
Results
Of 554 citations retrieved, 518 were discarded as irrelevant. We finally included 15 studies. The random effect model yielded, regardless of the vaccine technology, 1.25 (95%CI 0.21; 2.83) GBS cases per million of COVID-19 vaccine doses, 3.93 (2.54; 5.54) cases per million doses for adenovirus-vectored vaccines and 0.69 (0.38; 1.06) cases per million doses for mRNA vaccines. The GBS risk was 2.6 times increased with the first dose. Regardless of the vaccine technology, the GBS risk was not increased but disaggregating the data it was 2.37 (1.67; 3.36) times increased for adenovirus-vectored vaccines and 0.32 (0.23; 0.47) for mRNA vaccines. Mortality for GBS after vaccination was 0.10 per million doses and 4.6 per GBS cases.
Conclusions
Adenovirus-vectored vaccines showed a 2.4 times increased risk of GBS that was about seven times higher compared with mRNA-based vaccines. The decreased GBS risk associated with mRNA vaccines was possibly due to an elicited reduction of infections, including SARS-CoV-2, associated with GBS during the vaccination period. How adenovirus-vectored COVID-19 vaccines may trigger GBS is unclear and further studies should investigate the relationship between vaccine technologies and GBS risk.
Background and purpose
The association between Guillain−Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is debated. This study reappraises, after three pandemic ...years, the epidemiological data and the features of GBS in SARS‐CoV‐2 patients.
Methods
A systematic review and meta‐analysis of case reports/series and cohort studies published between 1 January 2020 and 19 April 2023 was performed.
Results
In all, 209 case reports/series (304 patients) and 26 cohort studies were included. The risk of GBS in northern Italy during the first pandemic wave was 2.85 times increased (95% confidence interval CI 1.54; 5.25) whereas in some countries the risk during the first pandemic year was 0.17 times reduced (risk ratio 0.83, 95% CI 0.75; 0.93). The incidence of GBS in SARS‐CoV‐2 Italian hospitalized cohorts was 8.55 per 1000 (95% CI 5.33; 12.49) with an estimated incidence of 0.13 GBS per 1000 in the SARS‐CoV‐2 infected population. In European cohorts the pooled rate of GBS with SARS‐CoV‐2 infection was 61.3% of the total. GBS patients with SARS‐CoV‐2 infection showed more frequently, but not differently from non‐infected patients, the classical clinical presentation and the demyelinating subtype. Cranial nerves were more frequently involved in SARS‐CoV‐2 infected patients.
Conclusions
An increased risk of GBS occurred in northern Italy during early COVID‐19 pandemic. The recognition of the ‘Italian factor’ reconciles contrasting results of the epidemiological studies. The slightly reduced GBS risk in other countries and the relatively high frequency of GBS associated with SARS‐CoV‐2 infection can be explained by the adopted health measures that decreased the circulation of other GBS infective antecedents.
Guillain‐Barré Syndrome during COVID‐19 pandemics: results from single cases and cohort studies.
Normal ageing is associated with gradual brain atrophy. Determining spatial and temporal patterns of change can help shed light on underlying mechanisms. Neuroimaging provides various measures of ...brain structure that can be used to assess such age-related change but studies to date have typically considered single imaging measures. Although there is consensus on the notion that brain structure deteriorates with age, evidence on the precise time course and spatial distribution of changes is mixed. We assessed grey matter (GM) and white matter (WM) structure in a group of 66 adults aged between 23 and 81. Multimodal imaging measures included voxel-based morphometry (VBM)-style analysis of GM and WM volume and diffusion tensor imaging (DTI) metrics of WM microstructure. We found widespread reductions in GM volume from middle age onwards but earlier reductions in GM were detected in frontal cortex. Widespread age-related deterioration in WM microstructure was detected from young adulthood onwards. WM decline was detected earlier and more sensitively using DTI-based measures of microstructure than using markers of WM volume derived from conventional T1-weighted imaging.
Multiple sclerosis (MS) and type 1 diabetes (T1D) are chronic conditions that result from dysfunction of the immune system. Their common root in autoimmunity stimulates interest in the exploration of ...similarities and differences between the two diseases. Genetic susceptibility is relevant, creating a substrate, on which environmental factors act as a trigger of an aberrant immune response. Despite being both T‐cell mediated disorders with a strong involvement of the humoral arm, immunomodulation is a mainstay of MS management, whereas hormone replacement therapy remains the principal approach for T1D. T1D is usually diagnosed in children and adolescents, while MS is typical of young adults. This difference has implications for disease progression and treatment. The SARS‐CoV‐2 pandemic and its effect on immunity may affect the prevalence of these conditions, as well as their clinical manifestation.
Free water fraction (FWF) represents the amount of water per unit volume of brain parenchyma, which is not bound to macromolecules. Its excess in multiple sclerosis (MS) is related to increased ...tissue loss. The use of mcDESPOT (multicomponent driven single pulse observation of T1 and T2), a 3D imaging method which exploits both the T1 and T2 contrasts, allows FWF to be derived in clinically feasible times. However, this method has not been used to quantify changes of FWF and their potential clinical impact in MS. The aim of this study is to investigate the changes in FWF in MS patients and their relationship with tissue damage and cognition, under the hypothesis that FWF is a proxy of clinically meaningful tissue loss. To this aim, we tested the relationship between FWF, MS lesion burden and information processing speed, evaluated via the Symbol Digit Modalities Test (SDMT). In addition to standard sequences, used for T1‐ and T2‐weighted lesion delineation, the mcDESPOT sequence with 1.7 mm isotropic resolution and a diffusion weighted imaging protocol (b = 0, 1200 s/mm2, 40 diffusion directions) were employed at 3 T. The fractional anisotropy map derived from diffusion data was used to define a subject‐specific white matter (WM) atlas. Brain parenchyma segmentation returned masks of gray matter (GM) and WM, and normal‐appearing WM (NAWM), in addition to the T1 and T2 lesion masks (T1L and T2L, respectively). Ninety‐nine relapsing–remitting MS patients (age = 43.3 ± 9.9 years, disease duration 12.3 ± 7.7 years) were studied, together with twenty‐five healthy controls (HC, age = 38.8 ± 11.0 years). FWF was higher in GM and NAWM of MS patients, compared to GM and WM of HC (both p < .001). In MS patients, FWF was the highest in the T1L and GM, followed by T2L and NAWM, respectively. FWF increased significantly with T1L and T2L volume (ρ ranging from 0.40 to 0.58, p < .001). FWF in T2L was strongly related to both T1L volume and the volume ratio T1L/T2L (ρ = 0.73, p < .001). MS patients performed worse than HC in the processing speed test (mean ± SD: 54.1 ± 10.3 for MS, 63.8 ± 10.8 for HC). FWF in GM, T2L, perilesional tissue and NAWM increased with SDMT score reduction (ρ = −0.30, −0.29, −0.33 respectively and r = −.30 for T2L, all with p < .005). A regional analysis, conducted to determine which NAWM regions were of particular importance to explain the relationship between FWF and cognitive impairment, revealed that FWF spatial variance was negatively related to SDMT score in the corpus callosum and the superior longitudinal fasciculus, WM structures known to be associated with cognitive impairment, in addition to the left corticospinal tract, the sagittal stratum, the right anterior limb of internal capsule. In conclusion, we found excess free water in brain parenchyma of MS patients, an alteration that involved not only MS lesions, but also the GM and NAWM, impinging on brain function and negatively associated with cognitive processing speed. We suggest that the FWF metric, derived from noninvasive, rapid MRI acquisitions and bearing good biological interpretability, may prove valuable as an MRI biomarker of tissue damage and associated cognitive impairment in MS.
The fraction of unbound water (free water fraction) in the brains of relapsing–remitting multiple sclerosis (MS) patients exceeds that of healthy controls, reflects T1‐hypointense and T2‐hyperintense lesion volume and correlates with information processing speed (Symbol Digit Modalities Test score) in MS patients' normal‐appearing white matter.
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