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Particulate and gaseous microemboli (GME) are side effects of cardiac surgery that interfere with postoperative recovery by causing endothelial dysfunction and vascular blockages. GME sources during surgery are multiple, and cardiopulmonary bypass (CPB) is contributory to this embolic load. Hematic antegrade repriming (HAR) is a novel procedure that combines the benefits of repriming techniques with additional measures, by following a standardized procedure to provide a reproducible hemodilution of 300 ml. To clarify the safety of HAR in terms of embolic load delivery, a prospective and controlled study was conducted, by applying Doppler probes to the extracorporeal circuit, to determine the number and volume of GME released during CPB. A sample of 115 patients (n = 115) was considered for assessment. Both groups were managed under strict normothermia, and similar clinical conditions and protocols, receiving the same open and minimized circuit. Significant differences in GME volume delivery (control group [CG] = 0.28 ml vs. HAR = 0.08 ml; p = 0.004) and high embolic volume exposure (>1 ml) were found between the groups (CG = 30.36% vs. HAR = 4.26%; p = 0.001). The application of HAR did not represent an additional embolic risk and provided a four-fold reduction in the embolic volume delivered to the patient (coefficient, 0.24; 95% CI, 0.08-0.72; p = 0.01), which appears to enhance GME clearance of the oxygenator before CPB initiation., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the ASAIO.)

Introduction: Amyotrophic lateral sclerosis (ALS) is an insidious, clinically heterogeneous neurodegenerative disease associated with a diagnostic delay of approximately 12 months. No study conducted to date has analysed the diagnostic pathway in Spain., Methods: We gathered data on variables related to the diagnostic pathway and delay for patients diagnosed with ALS between October 2013 and July 2017., Results: The study included 143 patients with ALS (57% men; 68% spinal onset). Patients were diagnosed in public centres in 86% of cases and in private centres in 14%. The mean diagnostic delay was 13.1 months (median 11.7). Patients were examined by neurologists a mean time of 7.9 months after symptom onset, with diagnosis being made 5.2 months later. Half of all patients underwent unnecessary diagnostic tests and multiple electrophysiological studies before diagnosis was established. Diagnostic delay was longer in cases of spinal onset (P=.008) due to onset of the disease in the lower limbs. No differences were found between the public and private healthcare systems (P=.897)., Conclusions: The diagnostic delay in ALS in Spain is similar to that of neighbouring countries and seems to depend on disease-related factors, not on the healthcare system. Patients with lower-limb onset ALS constitute the greatest diagnostic challenge. Misdiagnosis is frequent, and partly attributable to an incorrect approach or erroneous interpretation of electrophysiological studies. Specific training programmes for neurologists and general neurophysiologists and early referral to reference centres may help to reduce diagnostic delay., (Copyright © 2018 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.)

Background and Purpose: Primary lateral sclerosis (PLS) is a progressive upper motor neuron (UMN) disorder. It is debated whether PLS is part of the amyotrophic lateral sclerosis (ALS) spectrum, or a syndrome encompassing different neurodegenerative diseases. Recently, new diagnostic criteria for PLS have been proposed. We describe four patients of two pedigrees, meeting definite PLS criteria and harboring two different mutations in presenilin 1 ( PSEN1 )., Methods: Patients underwent neurological and neuropsychological examination, MRI, 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), amyloid-related biomarkers, and next-generation sequencing (NGS) testing., Results: Four patients, aged 25-45 years old, presented with a progressive UMN syndrome meeting clinical criteria of definite PLS. Cognitive symptoms and signs were mild or absent during the first year of the disease but appeared or progressed later in the disease course. Brain MRI showed microbleeds in two siblings, but iron-related hypointensities in the motor cortex were absent. Brain FDG-PET showed variable areas of hypometabolism, including the motor cortex and frontotemporal lobes. Amyloid deposition was confirmed with either cerebrospinal fluid (CSF) or imaging biomarkers. Two heterozygous likely pathogenic mutations in PSEN1 (p.Pro88Leu and p.Leu166Pro) were found in the NGS testing., Conclusion: Clinically defined PLS is a syndrome encompassing different neurodegenerative diseases. The NGS testing should be part of the diagnostic workup in patients with PLS, at least in those with red flags, such as early-onset, cognitive impairment, and/or family history of neurodegenerative diseases., Competing Interests: JV-C received personal fees from Roche. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Vázquez-Costa, Payá-Montes, Martínez-Molina, Jaijo, Szymanski, Mazón, Sopena-Novales, ENoD Consortium, Pérez-Tur and Sevilla.)

Objective: To analyze those factors contributing to the diagnostic delay in ALS. Methods: Consecutive ALS patients were categorized as those studied in departmental hospitals and those studied in a referral ALS center. Demographic and clinical variables, together with data of the diagnostic pathway were collected. Multivariable models were used to assess their effect in the time between symptoms onset and the first neurologist visit (time symptoms-neurologist), in the time between the first neurologist visit and the diagnosis (time neurologist-diagnosis) and in the diagnostic delay. Results: 166 ALS patients with a median diagnostic delay of 11.53 months (IQR: 6.68, 15.23) were included. The median diagnostic delay was 8.57 months (5.16, 11.61) in the referral center vs. 12.08 months (6.87, 16.8) in departmental centers. Bulbar onset, fast progression rate, upper motor neuron predominant phenotype and an early referral to the neurologist were associated with a shorter time between symptoms-neurologist. Being studied in a referral center was associated with a shorter time between neurologist-diagnosis. Comorbidities, familial ALS, bulbar onset, early referral to the neurologist and being studied in a referral center were associated with a shorter diagnostic delay. For patients studied in departmental hospitals, fast progression rate was also strongly associated with a shorter time between neurologist-diagnosis and diagnostic delay. Conclusion: Unmodifiable factors (comorbidities, familial ALS, bulbar onset, and progression rate) as well as modifiable factors (early referral to the neurologist and the evaluation in an ALS referral center) have an independent effect in the diagnostic delay. The universalization of ALS Units is probably the most efficient measure to reduce the diagnostic delay., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2020 Martínez-Molina, Argente-Escrig, Polo, Hervás, Frasquet, Cortés, Sevilla and Vázquez-Costa.)

Effective classroom management is a critical teaching skill and a key concern for educators. Disruptive behaviors disturb effective classroom management and can influence school satisfaction if the teacher does not have the competencies to control them. Two objectives were set in this work: to understand the differences that exist in school satisfaction, disruptive behaviors, and teaching competencies according to the gender of the students; and to analyze school satisfaction and disruptive student behaviors based on perceived teaching competence. A non-probabilistic and convenience sample selection process was employed, based on the subjects that we were able to access. 758 students participated (male = 45.8%) from seven public secondary schools in the Murcia Region (Spain). The age range was between 13 and 18 years ( M = 15.22; DT = 1.27). A questionnaire composed of the following scales was used: Competencies Evaluation Scale for Teachers in Physical Education, School Satisfaction and Disruptive Behaviors in Physical Education. Mixed Linear Models performed with the SPSS v.23 was used for statistical analyses. The results revealed statistically significant differences based on gender and physical education teaching competencies. In conclusion, the study highlights that physical education teacher skills influence disruptive behaviors in the classroom, and that this is also related to school satisfaction. Furthermore, it highlights that boys showed higher levels of negative behaviors than girls., (Copyright © 2020 Granero-Gallegos, Baños, Baena-Extremera and Martínez-Molina.)

The objectives of this work were two-fold: Firstly, to identify the profiles of disruptive behaviours and motivation in secondary school physical education students using cluster analysis; and secondly, to analyse the interaction of the profiles with school satisfaction and perceived teaching competence. A group of 758 secondary school students (54.2% female) between the ages of 13 and 18 ( M = 15.22, DT = 1.27) participated in the study by responding to the following scales: The Disruptive Behaviours in Physical Education Questionnaire, The School Satisfaction Scale, The Sport Motivation Scale adapted to Physical Education, and the Evaluation of Teaching Competencies Scale in Physical Education. The cluster analysis established two distinct profiles: High levels of disruptive behaviours and low levels of disruptive behaviours. The results showed that the students with the high disruptive behaviours profile were mostly boys, having low levels of intrinsic motivation and high levels of amotivation and misbehaviour in the classroom. In contrast, those students with the low disruptive behaviours profile were mostly girls, having the highest levels of intrinsic motivation and the lowest levels in all the disruptive behaviours. It was shown that students exhibiting the worse classroom behaviours were more bored in school, while those students with better behaviour perceived greater teaching competence.

Currently, disruptive and aggressive behaviours of a physical and verbal nature are a reality among adolescent students and a concern in the educational context. Therefore, the main objective of this research was to analyse the effects of perceived teaching competence, motivation and basic psychological needs on disruptive behaviours in secondary school PE students. The sample was composed of 758 adolescent students from seven public secondary schools. The following instruments adapted to physical education were used: The Disruptive Behaviours Questionnaire, The Evaluation of Teaching Competencies Scale, The Sport Motivation Scale, and The Basic Psychological Needs Scale. Multilevel regression models with the MIXED procedure were performed for data analysis. The results show that misbehaviour is more likely among male students and that disruptive behaviours decrease when a teacher is perceived as competent. Students with greater self-determined motivation are more likely to exhibit fewer behaviours related to low engagement and irresponsibility while amotivation increases the different disruptive behaviours in the classroom. In conclusion, it is proposed that educators work in line with the students' needs by responding to their interests and that this will increase self-determined motivation.

In view of the rise in sedentary lifestyle amongst young people, knowledge regarding their intention to partake in physical activity can be decisive when it comes to instilling physical activity habits to improve the current and future health of school students. Therefore, the object of this study was to find a predictive model of the intention to partake in leisure- time physical activity based on motivation, satisfaction and competence. The sample consisted of 347 Spanish, male, high school students and 411 female students aged between 13 and 18 years old. We used a questionnaire made up of the Sport Motivation Scale, Sport Satisfaction Instrument, and the competence factor in the Basic Psychological Needs in Exercise Scale and Intention to Partake in Leisure-Time Physical Activity, all of them adapted to school Physical Education. We carried out confirmatory factor analyses and structural equation models. The intention to partake in leisure-time physical activity was predicted by competence and the latter by satisfaction/fun. Intrinsic motivation was revealed to be the best predictor of satisfaction/fun. Intrinsic motivation should be enhanced in order to predict an intention to partake in physical activity in Physical Education students.