Practical application of brief cognitive tests Olazarán, J.; Hoyos-Alonso, M.C.; del Ser, T. ...
Neurología (Barcelona, English ed. ),
April 2016, 2016-04-00, 2016-04-01, Volume:
31, Issue:
3
Journal Article
Peer reviewed
Open access
Brief cognitive tests (BCT) may help detect cognitive impairment (CI) in the clinical setting. Several BCT have been developed and/or validated in our country, but we lack specific recommendations ...for use.
Review of studies on the diagnostic accuracy of BCT for CI, using studies conducted in Spain with BCT which take less than 20minutes. We provide recommendations of use based on expert consensus and established on the basis of BCT characteristics and study results.
The Fototest, the Memory Impairment Screen (MIS) and the Mini-Mental State Examination (MMSE) are the preferred options in primary care; other BCT (Clock Drawing Test CDT, test of verbal fluency TVF) may also be administered in cases of negative results with persistent suspected CI or concern (stepwise approach). In the specialised care setting, a systematic assessment of the different cognitive domains should be conducted using the Montreal Cognitive Assessment, the MMSE, the Rowland Universal Dementia Assessment, the Addenbrooke's Cognitive Examination, or by means of a stepwise or combined approach involving more simple tests (CDT, TVF, Fototest, MIS, Memory Alteration Test, Eurotest). Associating an informant questionnaire (IQ) with the BCT is superior to the BCT alone for the detection of CI.
The choice of instruments will depend on the patient's characteristics, the clinician's experience, and available time. The BCT and IQ must reinforce—but never substitute—clinical judgement, patient–doctor communication, and inter-professional dialogue.
Los test cognitivos breves (TCB) pueden ayudar a detectar el deterioro cognitivo (DC) en el ámbito asistencial. Se han desarrollado y/o validado varios TCB en nuestro país, pero no existen recomendaciones específicas para su uso.
Revisión de estudios sobre el rendimiento diagnóstico en la detección del DC llevados a cabo en España con TCB que requieran menos de 20min y recomendaciones de uso consensuadas por expertos, sobre la base de las características de los TCB y de los estudios disponibles.
El Fototest, el Memory Impairment Screen (MIS) y el Mini-Mental State Examination (MMSE) son las opciones más recomendables para el primer nivel asistencial, pudiendo añadirse otros test (Test del Reloj TR y test de fluidez verbal TFV) en caso de resultado negativo y queja o sospecha persistente (aproximación escalonada). En el segundo nivel asistencial es conveniente una evaluación sistemática de las distintas áreas cognitivas, que puede llevarse a cabo con instrumentos como el Montreal Cognitive Assessment, el MMSE, el Rowland Universal Dementia Assessment o el Addenbrooke's Cognitive Examination, o bien mediante el uso escalonado o combinado de herramientas más simples (TR, TFV, Fototest, MIS, Test de Alteración de la Memoria y Eurotest). El uso asociado de cuestionarios cumplimentados por un informador (CCI) aporta valor añadido a los TCB en la detección del DC.
La elección de los instrumentos vendrá condicionada por las características del paciente, la experiencia del clínico y el tiempo disponible. Los TCB y los CCI deben reforzar —pero nunca suplantar— el juicio clínico, la comunicación con el paciente y el diálogo interprofesional.
Combinations of nontrivial band topology and long-range magnetic order hold promise for realizations of novel spintronic phenomena, such as the quantum anomalous Hall effect and the topological ...magnetoelectric effect. Following theoretical advances, material candidates are emerging. Yet, so far a compound that combines a band-inverted electronic structure with an intrinsic net magnetization remains unrealized. MnBi_{2}Te_{4} has been established as the first antiferromagnetic topological insulator and constitutes the progenitor of a modular (Bi_{2}Te_{3})_{n}(MnBi_{2}Te_{4}) series. Here, for n=1, we confirm a nonstoichiometric composition proximate to MnBi_{4}Te_{7}. We establish an antiferromagnetic state below 13 K followed by a state with a net magnetization and ferromagnetic-like hysteresis below 5 K. Angle-resolved photoemission experiments and density-functional calculations reveal a topologically nontrivial surface state on the MnBi_{4}Te_{7}(0001) surface, analogous to the nonmagnetic parent compound Bi_{2}Te_{3}. Our results establish MnBi_{4}Te_{7} as the first band-inverted compound with intrinsic net magnetization providing a versatile platform for the realization of magnetic topological states of matter.
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For advanced CMOS nodes, high performance is reached with the down scaling of both critical gate length and dielectrics stack. The aggressive reduction of dielectric thickness leads to a reduction of ...reliability margin due to breakdown. However, the first breakdown (BD) event does not always cause a functional failure in digital circuits. Lifetime extension based on device level parameters drift is difficult to handle, an accurate BD model is thus mandatory for predictive simulations at circuit level. Two dedicated test structures have been designed to track BD events impact on logic gates. Different AC-DC conditions are examined to be closer to operating conditions of digital circuits. Then a compact model for BD in logic gates is proposed: according to device level measurements, different severities of the BD event impact can be selected. Next Monte Carlo simulations are performed and enable to discuss the real impact of BD on logic gates in comparison with the measurements. In this way the measurements at device and circuit levels can be linked and the most likely post-BD device characteristics are highlighted. Therefore, the real impact of hard BD can be mitigated.
Bifunctional DNA intercalating agents have long attracted considerable attention as anticancer agents. One of the lead compounds in this category is the dimeric antitumor drug elinafide, composed of ...two tricyclic naphthalimide chromophores separated by an aminoalkyl linker chain optimally designed to permit bisintercalation of the drug into DNA. In an effort to optimize the DNA recognition capacity, different series of elinafide analogues have been prepared by extending the surface of the planar drug chromophore which is important for DNA sequence recognition. We report here a detailed investigation of the DNA sequence preference of three tetracyclic monomeric or dimeric pyrazinonaphthalimide derivatives. Melting temperature measurements and surface plasmon resonance (SPR) studies indicate that the dimerization of the tetracyclic planar chromophore considerably augments the affinity of the drug for DNA, polynucleotides, or hairpin oligonucleotides and promotes selective interaction with G·C sites. The (CH2)2NH(CH2)3NH(CH2)2 connector stabilizes the drug−DNA complexes. The methylation of the two nitrogen atoms of this linker chain reduces the binding affinity and increases the dissociation rates of the drug−DNA complexes by a factor of 10. DNase I footprinting experiments were used to investigate the sequence selectivity of the drugs, demonstrating highly preferential binding to G·C-rich sequences. It also served to select a high-affinity site encompassing the sequence 5‘-GACGGCCAG which was then introduced into a biotin-labeled hairpin oligonucleotide to accurately measure the binding parameters by SPR. The affinity constant of the unmethylated dimer for this sequence is 500 times higher than that of the monomer compound and ∼10 times higher than that of the methylated dimer. The DNA groove accessibility was also probed with three related oligonucleotides carrying G → c7G, G → I, and C → M substitutions. The level of drug binding to the two hairpin oligonucleotides containing 7-deazaguanine (c7G) or 5-methylcytosine (M) residues is unchanged or only slightly reduced compared to that of the unmodified target. In contrast, incorporation of inosine (I) residues considerably decreases the extent of drug binding or even abolishes the interaction as is the case with the monomer. The pyrazinonaphthalimide derivatives are thus much more sensitive to the deletion of the exocyclic guanine 2-amino group exposed in the minor groove of the duplex than to the modification of the major groove elements. The complementary SPR footprinting methodology combining site selection and quantitative DNA affinity analysis constitutes a reliable method for dissecting the DNA sequence selectivity profile of reversible DNA binding small molecules.
Immunosuppression, although crucial for short-term management, has been described in renal transplantation to be a major hurdle for long-term graft survival. Efforts have been directed at achieving a ...true state of allotolerance, thereby reducing the load of immunosuppression. Recently, increased frequencies of CD4
+CD25
high regulatory T cells (Tregs) have been described as an additional mechanism to induce alloimmune tolerance.
We assessed 64 renal transplant recipients with stable renal function for at least 1 year, divided into two groups: one composed of patients receiving rapamycin but not calcineurin inhibitors (CNIs), and another, of those receiving CNIs but not rapamycin.
We demonstrated that T cells with a regulatory phenotype were decreased in peripheral blood of renal transplant recipients under CNI therapy compared to those who were CNI-free. The Tregs in our patients showed a modest association with renal function as measured by the delta serum creatinine, which was not significant.
CNIs, but not rapamycin, reduce the frequencies of circulating Tregs in renal transplant recipients. The use of rapamycin might be further exploited in strategies reducing immunosuppression in renal transplantation. Furthermore, quantification of blood Tregs may be a suitable tool to identify those recipients who are candidates for reducing immunosuppression.
In this paper we report the determination of the ETU processes of lead fluoroborate glasses produced at Faculty of technology of São Paulo, doped with concentrations of Nd2O3 ranging from 0.04wt% up ...to 3.49wt%. The samples have a high refractive index of 2.2 and density of about 6.9g/cm3. Concentration quenching was observed at 3.49wt% doping. The spectroscopic results suggest that these materials can be considered as candidates for laser applications when compared to other known glasses used as laser media. The best spectroscopic performance was obtained for a sample doped with 1.75wt% of Nd2O3 : emission cross-section of 3.6×10−20cm2 at 1060nm, fluorescence lifetime of 0.06ms and effective fluorescence bandwidth of 30.43nm. No visible emission from the 4F3/2 level is observed when pumping with a diode laser at 797nm. From analysis of the temporal evolution of the infrared emission from the 4F3/2 state pumped at two excitation powers, we estimated the macroscopic energy transfer up-conversion (ETU) parameter for the studied samples. The results show ETU probability has a quadratic dependence on neodymium concentration.
Rare vertebral metastasis in a case of Hereditary Paraganglioma da Silva, Manuel Eduardo Ribeiro; Carvalho, Manuel João Queiroz de Fariados Santos; Rodrigues, António Pedro Cacho ...
Hereditary cancer in clinical practice,
09/2012, Volume:
10, Issue:
1
Journal Article
Peer reviewed
Open access
Paragangliomas are rare tumours with a prevalence of 1/10000 to 1/30000. Tumors arising from the paraganglia are characteristically of low malignant potential. Vertebral metastases are exceedingly ...rare, and only isolated case reports have described them. The authors present the clinical course of a 47 years-old female patient with a familial paraganglioma PGL with vertebral metastastization, who underwent an intralesional tumor excision and corpectomy. Genetic screening demonstrated a new germinal frameshift mutation of the SDHB exon 6 c.587-591DelC. After surgery there was normalization of the analytical parameters and imagiologic screening. One year later she presented a new image in the the pedicle of T11 on the contralateral side of the surgical incision. She performed 2 treatments with MIBG and 1 cicle of radiotherapy that made the new lesion regress. Currently the patient does not present any clinical or analytical evidence of new metastasis.This case outlines the clinical course of a patient with a PGL syndrome for whom a rare vertebral metastasis was diagnosed. It highlights the importance of identifying patients with germline SDHB mutations, as these patients are at a high risk of developing malignant disease.
Results will be presented from recent experimental studies of intense femtosecond (fs) laser pulse interactions with small organic molecules. By electrostatically trapping the ionisation products to ...obtain high resolution mass spectra, we have characterised how fragment spectra change for a range of laser pulse parameters.
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