Search

Insulin-like growth factor 1 (IGF-1) seems to be involved in the neural circuits associated with social cognition and brain structure., Study funded by Gerencia Regional de Salud de Castilla y Leon (Sacyl GRS 1768/A/18).

BACKGROUND Huntington's disease (HD) is an inherited neurodegenerative disorder, autosomal dominant caused by an expanded triplet (CAG) repeat in HTT gene on chromosome 4p, with a prevalence of 14/100,000 people. Major clinical features are involuntary movements, psychiatric symptoms, and cognitive dysfunction [1, 2]. There is no curative treatment for HD, with only symptomatic pharmacological treatments available. Due to the progressive course of neurodegeneration, HD patients progressively lose their functional capacity with increased dependence and risk for cardiovascular events, sepsis, and death.[3] Among the different clinical manifestations, weight loss and energy deficit (ED) have been described in HD, even in the early stages of the disease, contributing to the progression. The underlying mechanisms contributing to weight loss and the energy requirement in different stages of HD remain unknown.[4, 5] Surprisingly, HD patients often report an increased appetite with higher energy intake,[4, 6] and higher weight is associated with a slower rate of disease progression. [7] In this regard, the alterations in the brain and muscle metabolism and weight loss underscore that ED is likely an early phenomenon in the cascade of events leading to HD pathogenesis.[7] Biochemical studies support that mitochondrial dysfunction is a relevant factor in the alteration of ED in HD, and the hypothalamic dysfunction would contribute to weight loss.[5] Calories are units that measure the energy in food and the energy produced, stored, and utilized by living organisms. One calorie is defined as the amount of heat energy required to raise 1 g of water by 1°C [8]. TEE is the amount of energy an individual uses to maintain essential body functions (respiration, circulation, digestion) as a result of physical activity (PA).[9] TEE is then the sum of several components: resting energy expenditure (REE; 60–80%), PA (20–40%), and diet-induced thermogenesis (7–10%).[10] Adequate EB is achieved when TEE equals energy intake, defined as the energy consumed via food and beverage [8]. Previous literature in HD suggests that EB is not adequate, either due to reduced food intake (HD patients frequently suffer from dysphagia), abnormal REE secondary to structural damage (hypothalamic, mitochondrial disturbances produced by the neurodegeneration process per se), or abnormal PA due to chorea, or decreased mobility.[5, 11] Few studies on EB in neurodegenerative diseases, including HD, have comprehensively addressed and analyzed its contributing components.[12] Because most of these EB studies have been performed in controlled-laboratory research, there is a lack of knowledge about EB estimates in free-living environments. Valid measurement of PA in free-living environments is needed to describe and quantify PA and to assess the effectiveness of interventions and health promotion techniques.[13] Since their introduction as an objective measure of free-living PA in the early 1980s,[14] accelerometers have become a staple of the PA assessment repertoire. They have been used extensively in validating self-reported PA surveys, as outcome measures in intervention studies, and in research designed to identify the psychosocial and environmental correlates of PA behaviors. Accelerometry has the potential to provide information about the intensity, duration, and frequency of PA. A challenge in accelerometry-based approaches is that the raw outputs (typically called counts) must be converted into meaningful and interpretable units.[13] In most calibration accelerometer studies, counts are converted to oxygen consumption, metabolic equivalents (METs), or caloric expenditure as meaningful and interpretable measurements of PA intensity. [15] However, to predict energy expenditure related to PA, we should differentiate community-based samples vs. disease-based samples and calibrate these accelerometers with accurate cut points to distinguish levels of PA (mild, moderate, or vigorous). Sarcopenia defined as decreased muscle mass, is another important aspect of weight loss in HD and leads to higher dependency rates.[16] Overall, muscle mass can be quantified at different levels of body composition. Some methods, such as dual-energy X-ray absorptiometry (DXA), or Magnetic Resonance Imaging, have high validity but are complex and expensive.[17] In this regard, BIA is inexpensive and easy to perform in most settings, being the preferred method for clinical practice.[17] However, as in any other measurement, the accuracy of BIA in HD has not been established. Considering the lack of knowledge about EB in HD and its impact on body composition, it is important to conduct a study to validate different tools to calculate the EB and body composition in HD, and to provide preliminary data on EB in HD, which is the main objective. The present publication presents the protocol for this study. OBJECTIVE SPECIFIC GOALS The main aim of this study is to calculate the EB in patients with HD. Specific objectives of this study are 1) to validate the use of accelerometers to quantify energy expenditure related to PA under controlled conditions for HD patients using Indirect Calorimetry (IC) as the gold standard; 2) to study the EB (i.e., EE and energy caloric intake) in HD patients and to compare it with healthy controls; 3) to validate the use of BIA for HD to study body composition using DXA as the gold standard; 4) to study the impact of EB on functional capacity, sarcopenia status, the severity of motor and non-motor symptoms, psychiatric, and cognitive manifestations, QoL, and caregiver burden in HD patients. METHODS MATERIALS AND METHODS DESIGN This study is a protocol of a cross-sectional observational, multicentre study of a cohort of patients with HD patients compared to age, gender matched-control subject. The protocol of this study followed the STROBE statement reporting criteria for protocol case-control reports (figure 1). This study is registered on clinicalTrials.gov Identifier, with the registration number NCT05250323. We will conduct this study at the Universidad Isabel I, in collaboration with the Hospital Universitario de Burgos (HUBU). STUDY POPULATION A convenience sample of symptomatic, ambulatory, manifest, and premanifest patients with a confirmed genetic mutation for HD with >36 CAG repeats in the HTT gene, able to walk with minimal support, males and non-pregnant females > 18 years old, will participate in this project. To minimize the effects of environmental conditions, age and gender matched non-HD controls, will be recruited from family members and/or acquaintances or people in the private environment of cases, with similar lifestyles. All participants must sign the informed consent. Patients and controls who had hospital admissions for 3 or more days in the last four weeks, with diabetes mellitus on pharmacological treatment, thyroid, other neurodegenerative, heart, pulmonary or skeletomuscular diseases, pregnancy or breastfeeding, active cancer, and medication known to affect metabolism/endocrine function will be excluded. TEE assessments in all participants will be obtained by fasting for at least 5 hours. All participants will be instructed to avoid vigorous exercise on the day before testing. ETHICAL CONSIDERATIONS This study will be conducted according to the standards for Good Clinical Practice, the fundamental ethical principles established in the Declaration of Helsinki and the Oviedo Convention, and the requirements established in Spanish legislation in the research field. This project has been approved by the Comité Ético Complejo Universitario Burgos y Soria (Certificate number: CEIM-2429, January 26th, 2021). In order to participate in the study, all participants must read the informed consent, be able to ask questions and sign the document. Two copies will be signed, both signed by participants, researchers, and guardians or legal representatives (if any). The data's confidentiality and anonymity will be guaranteed throughout the study, available only to the researchers. The research documents will not be identified by the participant's name but will be assigned a code. The researchers will protect the participants' records, and the information on the codes, names, and addresses of the participants will remain confidential and available only to the researchers. The researchers will store all files in a secure location in a single folder dedicated to this study. The results of this research may be presented at meetings or publications; however, the participants' identities will not be revealed in these presentations. The risks during the research are minimal or nonexistent, but the assessment procedures may cause discomfort due to the presence of involuntary movements. If discomfort is experienced, the data acquisition may be paused until medical interventions are performed, if necessary. However, if discomfort persists, the participant will be removed from the research, the data collected will be excluded from analysis, and the patient will not be reallocated to another group Quality assurance: Investigator team The investigator team will be composed of one movement disorders UHDRS certified, two occupational therapists, two PhD Scientists in Nutrition and Dietetics, one biostatistician (Hospital Universitario of Burgos, Spain), and three PhD Sport Scientists. STUDY TIMETABLE Overall, the study timetable includes several breaks due to Covid-19 pandemic issues. 1. Pre-start procedures: June-July 2021. 2. Evaluation: July 2021-July 2022. 3. Data analysis: August 2022-September 2022. 4. Report and publications: year 2023. PROCEDURE After signing the informed consent form, investigators will invite HD patients and controls to participate. There will be no personal expenses for the participant during the study. All the evaluations will be performed on the same day at Hospital Universitario Burgos, and at the Sports Science Laboratory, University Isabel I, Spain. Demographics such as gender, age, education background, HD duration, and pharmacological and non-pharmacological treatment data will be collected from the medical chart. A flow diagram will be included, providing information for participation during the study. 1.Study assessments and Outcomes Disease severity: We will collect Sociodemographic information (gender, age, education background), and disease severity using standardized HD assessment tools: Unified Huntington's Disease Scale (UHDRS) and total functional capacity (TFC).[17] The UHDRS includes motor, behavioral, and cognitive evaluation, where low motor and behavioral scores and high cognitive scores denote better performance. TFC is derived from participant's and companion reports and quantifies a patient's ability to perform basic and instrumental activities (occupation, finances, housework, activities of daily living, and care level) ranging from 0 to 13, with higher scores indicating more intact functioning.[18] The severity of psychiatric symptoms will be assessed using the PBAs, with higher scores indicating greater severity.[19] Caregiver burden will be assessed using the Caregiver Burden Inventory,[20] with higher scores indicating higher caregiver burden and quality of life using the SF-12 Health Survey, with higher scores indicating higher quality of life.[21] A 3-day dietary record will assess dietary intake and adherence to the traditional MeDi by a trained nutritionist at baseline.[22] In all cases, oral nutritional supplements or vitamin and mineral supplements will be considered. Food groups, macro-and micronutrients, current caffeine, and alcohol consumption (caffeinated coffee, caffeinated tea, and other caffeinated beverages), and calorie intake information will be analyzed using the software Alimentación y Salud, version 2.0. We computed the MeDi adherence according to previous publications.[23] Briefly, sex-specific medians of food group intake will be calculated. For beneficial components, such as cereals, vegetables, fruits, fish, legumes, and the ratio of MUFA/SFA, 1 point will be attributed if consumption was at or above the sex-specific median value. For components presumed to be detrimental, such as meats and dairy products, 1 point will be given if consumption is below the sex-specific median value. The MeDi adherence will be generated for each participant by adding the scores in the food categories (ranging 0-9); values 0-3 will be considered low adherence, and values 4-9 will be considered moderate/high adherence. Energy Balance: To estimate EB, we will analyze EI and TEE. EI, macro, and micronutrients will be measured by using the Spanish validated questionary food consumption "Seguimiento Universidad de Navarra",[24] and a 3-day dietary record,[22] of 3 non-consecutive days. TEE will be calculated as the sum of REE, PA, and an estimated 10% diet-induced thermogenesis (Figure 2). REE will be measured by IC, using a gas analyzer (Medisoft Ergocard, Medisoft Group, Sorinnes, Belgium), and heart rate (Polar Electro V800, Kempele, Finland). The IC will be carried out in the morning after an overnight fast and not smoking, and REE will be obtained twice for 30 min after resting in bed in a quiet room and stabilizing respiratory quotient values for at least 5 min. Energy expenditure related to PA will be evaluated by IC, and two accelerometers simultaneously: Fitbit Charge 4® in the dominant hand and an ActiGraph wGT3X-BT® on the right hip. IC and both accelerometers will indirectly estimate energy expenditure using METs (Figure 3). Test protocol: All participants will receive a familiarization session on the treadmill before the test. During this session, participants will be accustomed to walking at different speeds on the treadmill without using the handrails while breathing through the mouthpiece. They will be advised to stop at any time by giving an agreed signal or pressing the stop button. Energy expenditure related to PA will be evaluated using different activities: 1) daily living simulation activities such as combing and eating, and dressing (putting on and taking off a jacket), with a duration of 3 minutes each; and 2) treadmill walk (Cosmos Pulsar 4.0®, Cosmos Sports & Medical, Nussdorf-Traunstein, Germany) with different intensities (3.2-5.3 km/h) and constant slope (1%). The participant will be able to use the sidebars to hold on and facilitate adaptation to walking on the mat, with a previous familiarization of 2 minutes and using a harness throughout the test (risk protection). Walking at a constant intensity of 3.2 km/h with a constant gradient of 1%, will serve as a measure of the activity of daily living–walking, and at a constant intensity of 5.2 km/h with a constant gradient of 1% as a measure of moderate activity. We will allow a recovery of 3 minutes between each finished test. After 10 minutes of recovery, participants will perform a walking test for 6 minutes in a corridor to calculate the maximal length (meters) each person can achieve in 6 minutes. Outdoor activity: participants with HD will be instructed to wear the Fitbit Charge 4® in the dominant hand and an ActiGraph wGT3X-BT® in the right hip for one week to quantify the total PA energy expenditure. Sarcopenia, frailty and nutrition status: Anthropometry: Body mass index (BMI) will be calculated by the following formula: weight (kg)/height2 (m2). We will classify the BMI according to the International WHO standards with BMI≥18.5102 cm for men and > 88 cm for women, and waist-to-height ratio associated with risk of abdominal obesity and chronic diseases as >0.5 cm.[26] The calf circumference for each leg will be used as a surrogate marker of muscle mass for diagnosing sarcopenia.[26] The presence of sarcopenia will be evaluated following the sarcopenia European consensus (Figure 4),[28] based on 1) Muscle quantity: total body Skeletal Muscle Mass, as Appendicular Skeletal Muscle assessed by DXA (Prodigy. General Electric Healthcare, United States) as our gold standard. In addition, we will use a multiple frequency BIA (Body Composition Analyzer Seca mBCA 525 (Hamburg, Germany), which uses eight electrodes. Impedance will be measured with a current of 100 μA at frequencies of 1, 2, 5, 10, 20, 50, 100, 200, and 500 kHz and an impedance measuring range of 10 Ω to 1000 Ω 29. We will validate BIA estimates against DXA to estimate body composition. For muscle quantity, we will obtain the fat mass, fat-free mass defined as the lean mass plus the bone mineral content 30; fat mass index defined as fat-free mass/height2 (kg/m2). [30] The following cutoff measurements will be used for men: 0.90. 32. We performed Bland-Altman plots for bias assessment with fat mass, fat-free mass. Fourth Goal "Estimates of the impact of EB on HD severity, health-related quality of life (QoL), and caregiver burden": We will perform correlation analyses of 1) EB with functional capacity, sarcopenia status, UHDRS motor and cognitive scores, psychiatric and cognitive manifestations, SF-12, and caregiver burden in HD patients; and 2) TEE and RE with TFC, UHDRS motor and cognitive scores, PBA, SF-12, and caregiver burden scores. Finally, we will conduct a multivariate linear regression analysis, including EB as the dependent variable and demographics, UHDRS cognitive and motor subdomain, PBA scores, SF-12, and caregiver burden as the independent variables. The analyses will not attempt to estimate missing data. RESULTS We will report the results with tables and graphs. We will report the validation of accelerometers against IC, BIA estimates versus DXA, EB estimates and comparison between HD and controls, and estimates of the impact of EB on HD severity, health-related quality of life (QoL), and caregiver burden. CONCLUSIONS Besides the common existence of neuronal loss, neurodegenerative diseases are also associated with metabolic changes such as weight changes, fat mass loss, and altered feeding behavior. Importantly, preclinical research and clinical studies have demonstrated that altered energy homeostasis influences disease progression in HD, suggesting that identifying the pathways leading to perturbed EB might provide valuable therapeutic targets.[37] This study will analyze the benefits of measuring EB for patients with HD and understand the effects of EB on HD severity, QoL, and caregiver burden. In order to analyze EB adequately, especially energy expenditure related to PA, it is recommended to conduct these studies in a free-living setting to replicate the regular patient motor behavior. Therefore, we will conduct this study at different stages: The first stage will determine the accuracy of accelerometers for estimating energy expenditure related to PA, and BIA for estimating body composition in HD. The second stage will determine and compare EB in HD patients vs. controls. The third stage will analyze the impact of EB on motor, and cognition severity caregiver burden, patient's quality of life, and frailty in terms of body composition and sarcopenia estimates in HD. To date, very few studies have studied EB in HD.[12, 38, 39] In a previous study conducted by our group, patients with HD appeared to have lower TEE mainly due to decreased PA but were still able to maintain their weight with an adequate food intake.[12] Decreased PA has also been seen in other neurodegenerative diseases, such as Parkinson's disease, suggesting that mobility problems or impaired cognition could also be a determinant factor for decreased energy expenditure related to PA.[12] Maintaining a neutral EB prevents malnutrition and its complications and might improve physical functioning, quality of life, and survival. [40] EB is a complex, multifactorial, poorly understood clinical problem requiring integrated multidisciplinary research and approach development. For this reason, one of the most important public health challenges would be to identify cost-effective interventions to prevent EB deficit, improve health status, and prevent disability in patients with neurodegenerative diseases. The main limitation of this laboratory-based study will be the small sample size of HD patients and controls given a limited budget and, consequently, lack of statistical power, selection bias, and lack of extrapolation to the general HD community. However, the results of this study will provide the scientific rationality to understand this complex problem and facilitate the integration of pharmacological and non-pharmacological strategies to prevent EB deficit. The results of this study should be confirmed in a real-life environment. Likewise, the results of this study could be used to calculate sample sizes in further studies. In terms of clinical utility, these results could be used to develop non-pharmacological strategies, providing adequate nutrition counseling to counteract a deficit in EB and prevent weight loss.[41, 43] Likewise, adequate PA counseling could improve functional health and EB, reducing sarcopenia and frailty in HD. [43] It should be noted that it would be interesting to carry out this study with a larger sample of both patients and controls. This would facilitate obtaining greater statistical power. In conclusion, this study is a challenging and original initiative designed to provide scientific background to provide therapeutic strategies to prevent EB deficit in HD. We hope this project will provide important information about EB estimates, the accuracy of wearable devices to quantify EE related to PA in a free-living setting, BIA to estimate body composition, and increase the knowledge about the clinical impact of EB on HD. All results from the study will be communicated by publication without any restriction. ACKNOWLEDGMENTS CLINICALTRIAL

Producción Científica, Accelerometers can estimate the intensity, frequency, and duration of physical activity in healthy adults. Although thresholds to distinguish varying levels of activity intensity using the Actigraph wGT3X-B have been established for the general population, their accuracy for Huntington’s disease (HD) is unknown. We aimed to define and cross-validate accelerometer cut-points for different walking speeds in adults with mild to moderate HD. A cross-sectional, multicentre, case-control, observational study was conducted with a convenience sample of 13 symptomatic ambulatory HD participants. The accelerometer was placed around the right hip, and a heart monitor was fitted around the chest to monitor heart rate variability. Participants walked on a treadmill at three speeds with light, moderate and vigorous intensities. Correlation and receiver operation curve analyses were performed between the accelerometer magnitude vector with relative oxygen and heart rate. Optimal cut-points for walking speeds of 3.2 km/h were ≤2852; 5.2 km/h: >2852 to ≤4117, and in increments until their maximum velocity: >4117. Our results support the application of the disease-specific cut-points for quantifying physical activity in patients with mild to moderate HD and promoting healthy lifestyle interventions., Fundación “la Caixa" - (grant ID100010434) under agreement FUI1-PI008

Background and Objetives: Currently, total knee arthroplasty is one of the most common surgeries, increasing with the increase in life expectancy. Whether or not to replace the patella has been a subject of debate over the years, remaining in controversy and without reaching a consensus. Over the years, different meta-analyses have been carried out in order to provide evidence on the subject, although, in recent times, there have not been many new studies in this regard. Therefore, it is considered necessary that the latest works form part of a new meta-analysis. Materials and Method: We searched the literature using PUBMED, SCOPUS, the Cochrane database and VHL from 2010 to 2020. The search terms used were “patellar” AND “resurfacing” OR “Replacement” and “no resurfacing” OR “no replacement”. A meta-analysis was performed with Stata software (Stata version 15.1). Forest plots were generated to illustrate the overall effect of knee arthroplasty interventions. Results: As a result, it was obtained that there is a significantly higher risk of suffering AKP in the non-resurfacing group, in addition to a significant increase in the risk of undergoing a reoperation in the non-resurfacing group. On the other hand, significant differences were obtained in favor of the resurfacing group in both the clinical and Feller KSS, with functional KSS being inconclusive. After analyzing different variables throughout the literature, it does seem clear that the non-resurfacing group may present a higher risk of reoperation than the resurfacing group. Conclusions: For all these reasons, we think that, although it does seem that not replacing the patella can precipitate a reoperation, it is not clear whether this reoperation is a direct consequence of not having replaced the patella. Therefore, in our opinion, the treatment must be individualized for each patient.

Background Body composition is a strong indicator of nutritional and health status. Dual energy X-ray absorptiometry (DXA), multifrecuency bioelectrical impedance analysis (BIA), anthropometry and, skinfolds are non invasive methods to assess body composition with different levels of reliability. The validity of anthropometric and skinfolds to estimate body composition in HD is still controversial. Aims To determine and compare body composition according to DXA, BIA, anthropometry and, skinfolds estimates in HD. Methods Cross-sectional, multicenter and, national study. 20 genetically confirmed HD patients and, 10 gender gender-aged paired controls. Body composition was assessed under standardized conditions using the DXA (Prodigy of General Electric Healthcare), and BIA (Body Composition Analyzer Seca mBCA 525). Skinfold thicknesses were measured by Holtain skinfold caliper. Circumferences at waist, hip, calf, arm, wrist were measured using soft non stretchable tape Seca and, weight and heigth by Seca brand electronic scale with height rod. To analize the accuracy of BIA, anthropometrics, and skin folds against DXA, correlations and receiver operating curve analysis will be performed. Results Whereas DXA is a method where is necessary to have technical staff and qualified in the handling of X-rays equipment, rarely used in routine clinical practice. BIA has limitations due to the chemical composition of fat free mass because of considerable inter- and intraindividual variability. The accuracy of BIA measurements is high when specific predictive equations and standardized measurement protocols are utilized. Anthropometry and skinfolds are very-low cost, accesible to health personnel in routine clinical practice, with good sensitivity and specificity in the adult, healthy population. The results of this study will be presented. Conclusions The results will help to estimate body composition with low-cost methods easy to use to prevent malnutrition and sarcopenia in HD.

Background There is a need for accurate quantitative measures of speech in Huntington’s disease that can be used for home and in-clinic assessment. Mobile devices provide an easy-to-use, low-cost alternative to laboratory standard microphone-amplifier equipment but require validation prior to clinical use Aims To establish if mobile devices are suitable for monitoring speech in HD, and to examine how acoustic features from speech vary between HD and control participants. Acoustic features from speech tasks recorded using mobile devices from a HD and control group were then compared. Methods Voice was recorded using a mobile device in a control group (Xiaomi Mi 8 or Samsung Tab S6 Lite, N=11, 8 females, Ireland), and a HD group (Wales: Samsung Tab A, N=8, 2 females; Spain: Huawei Mate 10 Lite, N=19, 12 females). In the control group, voice was recorded simultaneously with a gold standard microphone-amplifier and mobile devices. Acoustic data were recorded during sustained vowel phonation (/a:/) and syllable repetition (/pa/). Features estimated are detailed in the supplementary material. Statistical analysis was performed using linear mixed models. Results In the control group, Bland-Altman analysis revealed good agreement between devices for all features. Linear mixed models showed no significant difference between devices during both tasks (p>0.05). When control and HD data were compared, no significant difference was observed in signal quality. Preliminary data suggests, similar to previous studies, an effect of gender1 and differences in acoustic features between HD and control groups.2 Conclusion Preliminary findings indicate the potential clinical use of mobile devices for objectively measuring speech in HD. Data collection is ongoing to allow comparison across clinical sites, with age and gender matched control participants. Supplementary Material: Features estimated were: signal-to-noise ratio (SNR), mean, standard deviation and perturbation of fundamental frequency (f0, stdf0), PPQ5, harmonics-to-noise ratio (HNR), jitter (j%), and shimmer (s%). Figure 1 presents mean and standard deviation for participants groups, data collection sites and Bland-Altman plots for fundamental frequency and jitter features across recording devices. Bland-Altman plots revealed low bias estimated from different devices. Analysis of preliminary data suggests a tendency of decreased f0 and HNR, and increased j%, s%, stdf0 in HD group, consistent with what has been reported previously in a French cohort of 24 controls and 61 HD participants.2 References Fitch James L, Anthony Holbrook. Modal vocal fundamental frequency of young adults. Archives of Otolaryngology 1970;92.4:379–382. Riad Rachid, et al. Vocal markers from sustained phonation in huntington’s disease. arXiv preprint arXiv:2006.05365 2020.

Background: A growing body of evidence relates restless legs syndrome (RLS) to an increased risk of mortality attributable to both cerebrovascular and cardiovascular events. The aim was to investigate survival in patients with RLS. Methods: This was an observational, retrospective longitudinal study of a cohort of patients followed up for 11 years. RLS was diagnosed by a physician using the International RLS Study Group criteria. Mortality was analyzed using age-standardized mortality ratios (SMR: observed/expected deaths) and Cox regression analysis. Results: Vital status was studied in a cohort of 232 patients: 181 women (78%), 96 with RLS (41.4%) with a mean age at baseline of 49.8 ± 15.0 years and a mean RLS duration of 14.1 ± 1.9 years, and 136 non-RLS (58.6%) with a mean age of 51.3 ± 14.9 years. This RLS cohort was followed up for a period of 10.4 ± 2.0 years. As of September 2019, 17 (7.3%) patients died (6 with RLS, 6.3%), and the most frequent cause was oncological (66.7%). A total of 944 person-years of observations were available for survival analysis. RLS was not associated with increased mortality in adjusted Cox regression analysis (HR = 1.12, 95% CI: 0.40–3.15), and survival was similar to that expected for the general population (SMR = 0.61, 95% CI: 0.27–1.36). Conclusions: RLS seems not to be associated with increased mortality compared to the general population. Still, studies with prospective data collection with large samples are needed to study the long-term mortality risk factors in RLS cohorts.

Objetivo: Analizar la influencia que los distintos factores de riesgo ejercen sobre la edad a la que se produce un ictus. Método: Estudio observacional transversal en el que se incluyeron a todos los pacientes con ictus ingresados de forma consecutiva en el Hospital Universitario de Burgos (España). Se recogieron parámetros sociodemográficos y clínicos, estudiándose su posible relación con la edad mediante análisis univariante y multivariante. Resultados: Se incluyeron 436 pacientes, siendo la edad media de 75,39 años (DE ±12,674). Los factores de riesgo más frecuentes fueron la hipertensión arterial y la enfermedad cardiovascular. Se observó que el tener antecedentes personales de hipertensión arterial (OR 2,49; IC95% 1,49-4,16) ó el no tener un estilo de vida sedentario (OR 3,24; 1,97-5,31) se relacionó con una mayor probabilidad de que el paciente tuviera una edad igual o superior a 75 años. Sin embargo, el tener sobrepeso/obesidad (OR 0,51; IC95% 0,30-0,88), el ser fumador activo (OR 0,47; 0,02-0,11) ó el consumir alcohol (OR 0,42; 0,26-0,69) aumentó la probabilidad de que el ictus ocurriera antes de 75 años. Conclusión: La edad de aparición de un ictus se relaciona con la ocurrencia de determinados factores de riesgo, los cuales deberían ser considerados en la planificación de futuras campañas educacionales.

There are many studies whose results reveal possible risk factors for developing an infection after a total knee arthroplasty (TKA). The objective of this study is to analyse the risk factors that depend on the hospital and, especially, if the patellar replacement influences the appearance of periprosthetic infection. A retrospective study was performed, where data from the electronic registry of patients of people over 18 and who had undergone TKA, between the years 2015 and 2018, were reviewed. Dependent variables on the patients and the health care system were collected. The possible associations between the factors and the appearance of infection after TKA were studied using univariate and multivariate regression analyses. A total of 907 primary knee arthroplasties were included in the study. Those patients who had their patella replaced had a significantly higher risk of developing an infection (OR 2.07, 95% confidence interval 1.01–6.31). Likewise, patients who underwent surgery by surgeons with more than 10 years of experience were more than twice as likely to become infected than those operated on by younger surgeons (OR 2.64, 95%CI 1.01–6.97). Male patients were also found to be three times more likely to be infected than women (OR 2.99, 95%CI 1.32–5.74). Those interventions that were longer had a higher risk of infection. The same happened with patients who stayed in the hospital for a longer period of time. The rest of the variables did not show statistically significant results. In this study, it was found that the replacement of the patella may be a factor of infection, but it should be corroborated with randomized clinical trials. Furthermore, patients who underwent longer surgeries or those with prolonged hospital stays should be closely monitored to detect infection as soon as possible and establish the most appropriate treatment.

Background Skeletal muscle loss has been associated with declining physical performance and a negative prognostic effect on falls, disability, and mortality risk in Parkinson's disease. Objectives We aimed to analyze the clinical correlates associated with skeletal muscle wasting in Parkinson's disease. Methods This was a cross-sectional, case-control, observational study. We collected information on dietary intake with a 24-hour recall questionnaire, body composition with bioelectrical impedance, motor severity with the Unified Parkinson's disease Rating Scale, and physical activity with the Global Physical Activity Questionnaire. We used multivariate linear regression analysis to analyze the sociodemographic and clinical correlates associated with skeletal muscle loss after adjusting for confounding variables. Results Forty-three patients with Parkinson's disease and 21 matched family members were included. Patients and family members had similar body composition, anthropometrics, and nutritional parameters. Advanced patients had similar nutrient intakes compared to patients with mild-to-moderate Parkinson's disease. In the multivariate linear regression analysis, female patients with low physical activity and low energy intake were more likely to have skeletal muscle loss. Conclusions Skeletal muscle wasting is a complex multifactorial problem. Dietary strategies and physical exercise should be recommended, especially to females with Parkinson's disease, to prevent significant skeletal muscle wasting.

IntroductionNeuroplasticity is defined as the capacity of the brain to reorganise new neuronal pathways. Mirror therapy (MT) and cognitive therapeutic exercise (CTE) are two neurorehabilitation techniques based on neuroplasticity and designed to improve the motor functions of the affected upper extremity in patients with severe hemiparesis after a stroke. Home-based interventions are an appropriate alternative to promote independence and autonomy. The objective of this study is to evaluate which of these techniques, MT and CTE, combined with task-oriented training, is more effective in functional recovery and movement patterns of the upper extremities in patients with severe hemiparesis after a stroke.Methods and analysisThis is a home-based, single-blind, controlled, randomised clinical trial with three parallel arms, including 154 patients who had a stroke aged above 18 years. The primary outcome will be the functionality of the affected upper extremity measured using the Fugl-Meyer Assessment. Secondary variables will include cognitive performance, emotional state, quality of life and activities of daily living. During 6 weeks, one of the intervention groups will receive a treatment based on MT and the other one on CTE, both combined with task-oriented training. No additional interventions will be provided to the control group. To assess the progress of patients who had a stroke in the subacute phase, all variables will be evaluated at different visits: initial (just before starting treatment and 4 weeks post-stroke), post-intervention (6 weeks after initial) and follow-up (6 months).Ethics and disseminationThis protocol has been approved by the Institutional Review Board (CEIm-2.134/2.019) and registered at ClinicalTrials.gov (NCT04163666). The results will be disseminated through open-access peer-reviewed journals, conference presentation, broadcast media and a presentation to stakeholders. These study results will provide relevant and novel information on effective neurorehabilitation strategies and improve the quality of intervention programmes aimed at patients after a stroke.Trial registration numberClinicalTrials.gov (NCT04163666).

El escenario económico mundial actual demanda que las empresas que se dedican a la actividad de comercio exterior realicen, de manera cada vez más eficiente, una correcta gestión de precios. Por tal motivo, el presente artículo trata sobre la importancia de realizar una correcta formación de precios en las empresas que comercializan commodities para, así, lograr menores pérdidas y mayores ganancias ante la volatilidad existente de los mismos. Además, se realiza un análisis de la situación actual de cuatro empresas vinculadas al comercio exterior en Cuba, con la finalidad de proponer un plan de acción que propicie mejores resultados para dichas empresas. The current world economic scene demands on those companies that dedicate to the foreign trade activity, to carry out in a more efficient way, a correct management of the stock market products’ prices. For this reason, the present study is about the importance of doing an accurate pricing, to achieve fewer losses and higher profits, given the existent volatilityof the prices. Moreover, a diagnosis is done to four Cubans companies in order to identify the principal problems and, finally proposing a measure plan with the main goal to improve the company’s results.

Esta investigación descriptiva transversal estudia la relación entre el número de caídas durante el último mes y el riesgo de caídas de una parte; y la situación de fragilidad en adultos mayores de otra parte; en una muestra de 194 personas mayores institucionalizadas.La fragilidad se mide con la herramienta Short Physical Performance Battery, las caídas previas durante el último mes se recogen de manera numérica y el riesgo de caídas se mide mediante la escala Downton. Los resultados no muestran diferencias significativas entre los grupos de fragilidad en relación al número de caídas previas durante el último mes. Sin embargo, sí que existen diferencias significativas entre los grupos de fragilidad que establece el SPPB y el riesgo de caídas; así, ya desde los resultados descriptivos se observa como las medias obtenidas en riesgo de caídas aumentan según el continumm robusto-prefrágil-frágil-dependiente avanza hacia la dependencia. En relación a las diferencias entre grupos, se encuentra que el grupo dependiente tiene diferencias significativas con todos los demás (p=,001); además, existen diferencias significativas entre frágil y robusto (p=,003).Por el contrario en las relaciones frágil-prefrágil y prefrágil-robusto las diferencias no son significativas. Los resultados obtenidos permiten la detección de la población con mayor riesgo de caídas, lo que posibilitaría implementar intervenciones precoces encaminadas a la prevención de caídas en base a las diferencias encontradas entre los grupos.

Esta investigación descriptiva transversal estudia la relación de la situación de fragilidad en adultos mayores y la existencia o no de dependencia para las actividades de la vida diaria divididas en básicas e instrumentales con una muestra de 194 personas mayores institucionalizadas. La fragilidad se mide con la herramienta Short Physical Performance Battery, las actividades básicas de la vida diaria mediante el Índice de Barthel y las actividades instrumentales de la vida diaria con la escala de Lawton y Brody.Los resultados descriptivos muestran como las medias obtenidas en ambas actividades de la vida diaria disminuyen según el continumm robusto-prefrágil-frágil-dependiente avanza hacia la dependencia. Las diferencias en todas las subescalas de la Short Phisical Performance Battery son significativas, al igual que en Barthel y Lawton y Brody (pp>,001) excepto en la relación robusto-frágil, en el que las diferencias no son significativas. En cuanto Lawton y Brody las diferencias son significativas (,041>p>,001); exceptuando el caso de los grupos frágil y prefrágil.Las diferencias encontradas entre los grupos permiten un diagnóstico precoz e intervencionesencaminadas a la prevenir o revertir el avance hacia una situación de dependencia.

Resumen: Introducción: La discapacidad intelectual presenta una serie de manifestaciones clínicas que repercuten a nivel psicológico, emocional, social y funcional. El Mindfulness pretende cambiar la relación que las personas mantienen con las actividades diarias, procurando dirigirlas al momento presente. De esta forma conocerán mejor sus respuestas en el medio, y se favorecerá una regulación emocional y conductual. Objetivo: Evidenciar el efecto que la aplicación de la técnica Mindfulness tiene como medio para mejorar las destrezas de comunicación y sociales en personas con discapacidad intelectual, desde terapia ocupacional. Metodología: Estudio de tipo longitudinal, cuasi-experimental. Se recogen datos sobre las habilidades sociales de los usuarios y las facetas del Mindfulness, mediante las escalas EHS y FFMQ respectivamente. La intervención se realizó con la técnica Mindfulness en 8 sesiones de 45 minutos. Y una muestra de 12 usuarios, con una edad promedio de 40 años (DT = ± 8,21307). Resultados: Se obtuvieron mejoras estadísticamente significativas en la autoexpresión en situaciones sociales y en el inicio de interacciones positivas con el sexo opuesto. Conclusiones: Las puntuaciones han mejorado en todas las variables en el post-test, aunque no todas de forma significativa. Probablemente aumentar el número de sesiones incrementaría la probabilidad de encontrar resultados más significativos. Abstract: Introduction: Intellectual disability presents a series of clinical manifestations that affect psychological, emotional, social, and functional level. The Mindfulness aims to change the relationship that people have with daily activities, trying to point them at the present moment. In this way you will know better answers in the Middle, and you will favour emotional regulation, and behavioral. Objective: Demonstrate the effect of applying the Mindfulness technique as a means to improve communication skills and social in people with intellectual disabilities from occupational therapy. Methodology: Type longitudinal, quasi-experimental study. Collected data about the social skills of the users and the facets of the Mindfulness, using the EHS and FFMQ scales respectively. The intervention was carried out with the Mindfulness technique in 8 sessions of 45 minutes. And a sample of 12 users, with an average age of 40 years (DT = ± 8,21307). Results: Were statistically significant improvement in self-expression in social situations and in the beginning of positive interactions with the opposite sex. Conclusions: Scores have improved in all the variables in the post-test, but not all in a meaningful way. Likely to increase the number of sessions would increase the probability of finding more significant results.