The clinical characteristics of patients with relapsing anti-NMDA receptor (NMDAR) encephalitis are not well-defined. In this study, we report the clinical profile and outcome of relapses in a series ...of anti-NMDAR encephalitis.
We did a retrospective review of relapses that occurred in 25 patients with anti-NMDAR encephalitis. Relapses were defined as any new psychiatric or neurologic syndrome, not explained by other causes, which improved after immunotherapy or, less frequently, spontaneously.
A total of 13 relapses were identified in 6 patients. Four of them had several, 2 to 4, relapses. There was a median delay of 2 years (range 0.5 to 13 years) for the first relapse. Median relapse rate was 0.52 relapses/patient-year. Relapse risk was higher in patients who did not receive immunotherapy in the first episode (p = 0.009). Most cases (53%) presented partial syndromes of the typical anti-NMDAR encephalitis. Main symptoms of relapses were speech dysfunction (61%), psychiatric (54%), consciousness-attention disturbance (38%), and seizures (31%). Three relapses (23%) presented with isolated atypical symptoms suggestive of brainstem-cerebellar involvement. An ovarian teratoma was detected at relapse in only 1 patient (17%). Relapses did not add residual deficit to that caused by the first episode.
Relapses in anti-NMDAR encephalitis are common (24%). They may occur many years after the initial episode. Relapses may present with partial aspects or with isolated symptoms of the full-blown syndrome. Immunotherapy at first episode reduces the risk of relapses.
The position of a firm in inter-organizational networks that occur in geographic clusters can affect innovation. This study analyzes a wide range of ties and how they impact on the transmission of ...tacit and explicit knowledge. Thus, a firm's position influences its innovative performance in different ways, according to the type of network—tacit or explicit—and the type of innovation—process or product—under analysis. Few empirical studies have analyzed the relation between social networks and innovation in mature geographic clusters; an appropriate context bearing in mind the contingent nature of the relations under study. The results support the idea that a central position in both tacit and explicit knowledge networks is especially significant in the case of product innovation, but that the influence of structural holes is weaker. These findings contribute to the literature on clusters and social networks by explaining how strategic management of positions in knowledge networks can improve the innovative performance of a firm.
Background and Aims
We aimed to assess the associations of exposure to air pollutants and standard and advanced lipoprotein measures, in a nationwide sample representative of the adult population of ...Spain.
Methods
We included 4647 adults (>18 years), participants in the national, cross‐sectional, population‐based di@bet.es study, conducted in 2008–2010. Standard lipid measurements were analysed on an Architect C8000 Analyzer (Abbott Laboratories SA). Lipoprotein analysis was made by an advanced 1H‐NMR lipoprotein test (Liposcale®). Participants were assigned air pollution concentrations for particulate matter <10 μm (PM10), <2.5 μm (PM2.5) and nitrogen dioxide (NO2), corresponding to the health examination year, obtained by modelling combined with measurements taken at air quality stations (CHIMERE chemistry‐transport model).
Results
In multivariate linear regression models, each IQR increase in PM10, PM2.5 and NO2 was associated with 3.3%, 3.3% and 3% lower levels of HDL‐c and 1.3%, 1.4% and 1.1% lower HDL particle (HDL‐p) concentrations (p < .001 for all associations). In multivariate logistic regression, there was a significant association between PM10, PM2.5 and NO2 concentrations and the odds of presenting low HDL‐c (<40 mg/dL), low HDL‐p (<p25) and higher LDL particle (LDL‐p) concentrations (≥p75). In subgroup analyses there were stronger associations between PM10 and NO2 and low HDL‐p in men (p for interaction .008 and .034), and between NO2 and low HDL‐p in individuals with obesity (p for interaction .015).
Conclusions
Our study shows an association between the exposure to air pollutants and blood lipids in the general population of Spain, suggesting a link to atherosclerosis.
In this national, cross‐sectional, population‐based study, carried out in the Spanish population, each IQR increase in PM10, PM2.5 and NO2 was associated with 3.3%, 3.3% and 3% lower levels of HDL‐c and 1.3%, 1.4% and 1.1% lower HDL particle (HDL‐p) concentrations (p < .001 for all associations). There was a significant association between PM10, PM2.5 and NO2 concentrations and the odds of presenting low HDL‐c (<40 mg/dL), low HDL‐p (<p25) and higher LDL particle (LDL‐p) concentrations (≥p75).
The kinetics of the reaction of CO2 with a primary amine functionalized ionic liquid (NH2-RTIL) at 303K and 333K are studied in this work. The absorption of CO2 was carried out by the decreasing ...pressure method in a gas–liquid stirred cell reactor. The volumetric mass transfer coefficient of the liquid phase was determined from the experiments using bmimBF4 as liquid phase and the kinetics of the reaction was studied based on the experiments carried out with a liquid phase containing bmimBF4 and 1-(3-aminopropyl)-3-methylimidazolium tetrafluoroborate (APmimBF4) at concentrations between 45 and 253molm−3. The enhancement factor due to the chemical reaction was calculated from the fluxes of CO2 absorbed. The kinetic results were analyzed using the general solution given by Van Krevelen and Hoftijzer based on the film model and the approximate solution of DeCoursey based on the Danckwerts surface renewal model. The results indicate that the reaction takes place in an intermediate regime limited by diffusion of the amine functionalized ionic liquid. The reaction was assumed first order in both CO2 and APmimBF4 and the calculated kinetic constants (k1,1) are of the same order of magnitude as the ones available for primary amines and CO2 in viscous media.
There is evidence that demonstrates the benefits of practicing physical activity/exercise for the mother after childbirth. However, this postpartum period (PP) is often a missed opportunity in a ...lifetime for women to start or resume physical exercise and get the great benefits that it can bring them. The objective of this article was to analyze the benefits of physical exercise during PP; the prescription of physical exercise; recommendations on when to resume your practice; barriers and facilitators; physical exercise during breastfeeding; as well as its role in the most frequent illnesses and discomforts in this period, always keeping in mind that the work of the primary care doctor is essential to motivate and encourage women to perform physical exercise in the PP.
Summary
For many years, tonsillectomy has been used routinely in children to treat chronic or recurrent acute tonsillitis. Palatine tonsils are secondary lymphoid organs and the major barrier ...protecting the digestive and respiratory tracts from potential invasive microorganisms. They have been used as sources of lymphoid tissue; however, despite the hundreds of papers published on tonsillectomy, no studies addressing the functionality of the CD4+ and CD8+ T cells from chronically infected tonsils have yet been published. The aim of this study was to analyse the functionality of the CD4+ and CD8+ T cells with respect to tonsillar tissue. We used an affordable approach to measure the frequency of antigen‐specific CD4+ T cells, the direct ex‐vivo cytotoxicity of CD8+ T cells, memory T cell phenotype, cytokine profile and DC phenotype. Our results demonstrate that CD4+ and CD8+ T cells from tonsillar tissue are totally functional, as shown by their ability to produce cytokines, to degranulate and to differentiate into effector‐memory T cells.
Objective The activity of brown adipose tissue is sensitive to changes in ambient temperature. A lower exposure to cold could result in an increased risk of developing diabetes at population level, ...although this factor has not yet been sufficiently studied. Design We studied 5072 subjects, participants in a national, cross-sectional population-based study representative of the Spanish adult population (Di@bet.es study). All subjects underwent a clinical, demographic and lifestyle survey, a physical examination and blood sampling (75 g oral glucose tolerance test). Insulin resistance was estimated with the homeostasis model assessment (HOMA-IR). The mean annual temperature (°C) in each individual municipality was collected from the Spanish National Meteorology Agency. Results Linear regression analysis showed a significant positive association between mean annual temperature and fasting plasma glucose (β: 0.087, P < 0.001), 2 h plasma glucose (β: 0.049, P = 0.008) and HOMA-IR (β: 0.046, P = 0.008) in multivariate adjusted models. Logistic regression analyses controlled by multiple socio-demographic variables, lifestyle, adiposity (BMI) and geographical elevation showed increasing odds ratios for prediabetes (WHO 1999), ORs 1, 1.26 (0.95–1.66), 1.08 (0.81–1.44) and 1.37 (1.01–1.85) P for trend = 0.086, diabetes (WHO 1999) ORs 1, 1.05 (0.79–1.39), 1.20 (0.91–1.59) and 1.39 (1.02–1.90) P = 0.037, and insulin resistance (HOMA-IR ≥75th percentile of the non-diabetic population): ORs 1, 1.03 (0.82–1.30), 1.22 (0.96–1.55), 1.26 (0.98–1.63) (P for trend = 0.046) as the mean annual temperature (into quartiles) rose. Conclusions Our study reports an association between ambient temperature and the prevalence of dysglycemia and insulin resistance in Spanish adults, consistent with the hypothesis that a lower exposure to cold could be associated with a higher risk of metabolic derangements.
The existing literature on slack resources points to a relationship with organizational performance, though little attention have been given to their dynamic deployment. Arising from the idea that ...companies present different levels of slack resources, this paper analyzes the slack‐performance relationship using a dynamic performance and configurational approach. We investigate the existence of coherent configurations of slack resources and analyze the generation and use of slack resources in a period of crisis and economic recovery. Seemingly unrelated regressions were used on 419 Spanish manufacturing companies to assess the effect of slack configuration on performance from a cross‐sectional and longitudinal perspective. The results show clear configurations and a continuous slack–performance relationship, so available and potential slack positively affect performance, whereas recoverable slack negatively affects performance, although these relationships are contingent on the economic situation. Therefore, firms increase their available and potential slack when faced with an environmental jolt, whereas this increase varies depending on the configuration or availability of slack resources. Configurational equifinality in the slack–performance relationship is also confirmed, with the effect being contingent on time.
Utilizing the theory of planned behaviour (TPB), this article proposes and tests relationships among the nature of export stimuli, the personal characteristics of decision makers and the decisions ...they make with regard to internationalization. The conceptual model for the study includes psychological variables that might condition owner-managers’ decision-making responses to such export stimuli. Using structural equation modelling, the study analyses data obtained by a survey questionnaire from 110 Spanish small- and medium-sized enterprises. The analysis reveals the importance of two particular variables, the perception of risks and opportunities in exports and the decision maker’s proactiveness, in determining the export stimuli and how these in turn affect the international behaviour of firms.
Research to date has shown that a company can accumulate slack resources for a variety of reasons. But how do managers use this excess of resources in a general economic crisis? This study aims to ...ascertain how companies apply these resources when faced with a financial crisis and economic meltdown, in order to provide answers to the underexplored questions regarding the ways in which firms consume their slack resources. Through the analysis of a sample of 449 Spanish industrial companies during the 2006-2017 period, and the application of Latent Growth Modelling, the evolution of the different slack and performance indicators is observed for the identification of disparate behaviour between companies with high and low initial endowments of slack resources. The results also show that each type of slack serves a different purpose and, therefore, their consumption or use shows clear divergences.
Las investigaciones realizadas hasta la fecha han demostrado que una empresa puede acumular un exceso de recursos por diversas razones. Pero, ¿cómo utilizan los directivos este exceso de recursos en una crisis económica generalizada? Este estudio pretende averiguar cómo aplican las empresas estos recursos cuando se enfrentan a una crisis financiera y a un colapso económico, con el fin de dar respuesta a las cuestiones poco exploradas sobre las formas en que las empresas consumen sus recursos holgados. Mediante el análisis de una muestra de 449 empresas industriales españolas durante el periodo 2006-2017, y la aplicación de la Modelización Latente del Crecimiento, se observa la evolución de los distintos indicadores de holgura y rendimiento para la identificación de comportamientos dispares entre empresas con altas y bajas dotaciones iniciales de recursos de holgura. Los resultados también muestran que cada tipo de holgura sirve a un propósito diferente y, por tanto, su consumo o utilización muestra claras divergencias.
PDF
