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Background Air pollutants increase the risk of myocardial infarction. Air pollution-induced atherosclerotic plaque destabilization may be related to inflammation, but the specific inflammatory alterations remain unclear. Purpose The aim of this prospective study was to assess the inflammatory changes in circulating immune cells and microRNAs in patients with acute coronary syndrome related to short-term exposure to PM2.5. Methods We prospectively included all consecutive patients admitted between March 2017 and July 2018 with the diagnosis of acute coronary syndrome (STEMI, NSTEMI, unstable angina) and coronary angiography in the acute phase of the disease. We also included a control group of patients with stable angina. For each patient we collected air concentrations of PM2.5 from the closest meteorological station to the patient residence obtaining the previous 24-hour average before hospital admission. All patients underwent systematic circulating inflammatory cell analysis. A selection of patients underwent miRNAs analysis. Results A total of 261 patients were included. According to PM2.5 exposure, 31 patients were selected for miRNA analyses. STEMI patients exposed to PM2.5 showed a reduction of CD4+ regulatory T (Treg) cells (Figure 1A). In the microRNA assessment, PM2.5 exposure was associated with higher circulating levels of let-7f-5p, miR-223-3p, miR-423-3p, miR-197-3p, miR-335–5, miR-376c-3p and miR-501-3p. Regarding clinical presentation, PM2.5 exposure in STEMI and NSTEMI patients was associated with an increase of miR-let-7f-5p, whereas miR-423-3p and miR-146a-5p were increased only in STEMI patients (Figure 1B). Conclusions STEMI related to PM2.5 short-term exposure is associated to specific changes involving CD4+CD25+Foxp3+ Treg cells and miR-146a-5p. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Ministerio de Ciencia e Innovaciόn; Fundaciόn BBVA Equipos de Investigaciόn Científica 2018 and from Caixa Banking Foundation; Sociedad Espanola de Cardiologia; Ministerio de Ciencia, Innovaciόn y Universidades, Carlos III Institute of Health-Fondo de Investigaciόn Sanitaria; Comunidad de Madrid; Fondo Europeo de Desarrollo Regional

Este estudo avaliou a influência do acesso endodôntico convencional e minimamente invasivo na mecânica de fratura de três materiais com diferentes módulos de elasticidade (E), usados para confecção de coroas monolíticas em CAD/CAM: Empress CAD (E = 62 GPa), Suprinity (E = 70 GPa) e Enamic (E = 30 GPa). Foram usinadas 45 coroas de 1 mm de espessura, cimentadas sobre um troquel em resina composta (E = 18 GPa). Os espécimes foram subdivididos em três grupos de acordo com o acesso endodôntico: Controle (sem acesso), Acesso Convencional (formato triangular de 3 x 3 x 3 mm) e Acesso Minimamente Invasivo (formato circular de 1,4 mm de diâmetro). Todos os acessos foram reparados com resina composta e as coroas então submetidas ao teste de carregamento até a fratura. Observou-se que Enamic suportou mais carga que os demais (p < 0,002), já Empress e Suprinity foram semelhantes (p > 0,121). A presença do acesso determinou redução na carga de fratura nos grupos Empress e Enamic (p < 0,002). Não foram observadas diferenças estatisticamente significantes entre os tipos de abertura (p > 0,216), independente do material. No momento da abertura endodôntica, três coroas de Empress e uma de Suprinity fraturaram no grupo abertura Convencional e nenhuma no grupo abertura Minimamente Invasiva. Na situação clínica de necessidade de acesso endodôntico em dente com coroa monolítica, o material que oferece maior previsibilidade é o Enamic e o tipo de abertura endodôntica é a Minimamente Invasiva por minimizar o risco de fratura na abertura. This study evaluated the influence of the conventional and minimally invasive endodontic access approach on the fracture mechanics of three materials, with different elastic modulus (E), used to mill CAD/CAM monolithic crowns: Empress CAD (E = 62 GPa), Suprinity (E = 70 GPa) and Enamic (E = 30 GPa). Forty-five crowns with 1 mm thickness were machined and cemented on composite resin dies (E = 18 GPa). The specimens were then subdivided into three groups according to endodontic access: Control (no access), Conventional Access (3 x 3 x 3 mm triangular shape) and Minimally Invasive Access (1.4 mm circular shape). All accesses were repaired with composite resin and the crowns the subjected to load-bearing test. Enamic was able to bear more load than the other materials (p 0.121). The presence of the access reduced the load-bearing for Empress and Enamic (p 0.216), regardless of the material. At the time of endodontic access, three Empress and one Suprinity crowns fractured in the Conventional access group and none in the Minimally Invasive access group. In the clinical situation of need for endodontic access to a tooth with a monolithic crown, the material that offers greater predictability is Enamic and the type of endodontic access is the Minimally Invasive, as it reduces the risk of fracture at the opening.

Summary Purpose Deep brain stimulation (DBS) of the thalamus is an emerging surgical option for people with medically refractory epilepsy that is not suitable for resective surgery, or in whom surgery has failed. Our main aim was to evaluate the efficacy of bilateral centromedian thalamic nucleus (CMN) DBS for seizure control in generalized epilepsy and frontal lobe epilepsy with a two-center, single-blind, controlled trial. Methods Participants were adults with refractory generalized or frontal lobe epilepsy. Seizure diaries were kept by patients/carers prospectively from enrollment. The baseline preimplantation period was followed by a control period consisting of a blind stimulation-OFF phase of at least 3 months, a 3-month blind stimulation-ON phase, and a 6-month unblinded stimulation-ON phase. The control period was followed by an unblinded long-term extension phase with stimulation-ON in those patients in whom stimulation was thought to be effective. Key Findings Eleven patients were recruited at King's College Hospital (London, United Kingdom United Kingdom) and at University Hospital La Princesa (Madrid, Spain). Among the five patients with frontal lobe epilepsy, only one patient had >50% improvement in seizure frequency during the blind period. In the long-term extension phase, two patients with frontal lobe epilepsy had >50% improvement in seizure frequency. All six patients with generalized epilepsy had >50% improvement in seizure frequency during the blind period. In the long-term extension phase, five of the six patients showed >50% improvement in the frequency of major seizures (one became seizure free, one had >99% improvement, and three had 60–95% reduction in seizure frequency). Among patients with generalized epilepsy, the DBS implantation itself appears to be effective, as two patients remained seizure free during 12 and 50 months with DBS OFF, and the remaining four had 50–91% improvement in the initial 3 months with DBS OFF. Significance DBS implantation and stimulation of the CMN appears to be a safe and efficacious treatment, particularly in patients with refractory generalized epilepsy. CMN stimulation was not as effective in frontal lobe epilepsy, which requires further studies. DBS of the CMN should be considered as a treatment option, particularly in patients with refractory generalized epilepsy syndromes.

Summary Familial hypertrophic cardiomyopathy (HCM) is a prevalent hereditary cardiac disorder linked to arrhythmia and sudden cardiac death. While the causes of HCM have been identified as genetic mutations in the cardiac sarcomere, the pathways by which sarcomeric mutations engender myocyte hypertrophy and electrophysiological abnormalities are not understood. To elucidate the mechanisms underlying HCM development, we generated patient-specific induced pluripotent stem cell cardiomyocytes (iPSC-CMs) from a ten-member family cohort carrying a hereditary HCM missense mutation (Arg663His) in the MYH7 gene. Diseased iPSC-CMs recapitulated numerous aspects of the HCM phenotype including cellular enlargement and contractile arrhythmia at the single-cell level. Calcium (Ca 2+ ) imaging indicated dysregulation of Ca 2+ cycling and elevation in intracellular Ca 2+ ([Ca 2+ ] i ) are central mechanisms for disease pathogenesis. Pharmacological restoration of Ca 2+ homeostasis prevented development of hypertrophy and electrophysiological irregularities. We anticipate that these findings will help elucidate the mechanisms underlying HCM development and identify novel therapies for the disease.

Outer hair cells provide amplification within the mammalian cochlea to enhance audition. The mechanism is believed to reside within the lateral membrane of the cell that houses an expansive array of molecular motors, identified as prestin, which drives somatic electromotility. By measuring nonlinear capacitance, the electrical signature of electromotility, at kilohertz rates we have uncovered new details of the early molecular events that arise from voltage perturbations of prestin. We show that dynamic changes in motor state probability occur within the kilohertz range, and signify an amplificatory event. Additionally, we show a lack of effect of Cl driving force, an absence of cell length effect (indicating that the kinetics does not vary across auditory frequency), and the first demonstration of the time dependence of tension induced amplificatory shifts. The process we have identified, where the stimulus-response function shifts in time along the stimulus axis in a multi-exponential manner, bears similarities to those components of adaptation found in the OHC stereociliar transducer identified recently. As with the forward transducer, the speed of the reverse transducer amplificatory event consequently impacts on high frequency peripheral auditory processing.

Summary Purpose: The identification of the epileptic zone in patients with mesial temporal lobe epilepsy sometimes requires intracranial recordings, for example, with foramen ovale electrodes (FOE). This paper reviews and analyzes the resulting complications in a series of patients studied with bilateral FOE for presurgical evaluation. Methods: The clinical records of 331 consecutive FOE implantations in 329 patients were reviewed. Complications related to FOE were divided into two groups: those that were non–life-threatening or not directly attributable to FOE, or life-threatening complications and those clearly related to FOE. Results: The mean length of hospital stay in the v-EEG unit with FOE was 5.8 ± 0.2 days (range 1–19) following a bimodal distribution (peaks at 4 and 8 days). Complications were observed in 6.64% of patients, but in 4.83% of cases, complications were non–life-threatening (moderate disaesthesia, cheek bleeding, FOE expulsion). Complications were only severe in 1.81% of patients (clotting or intracranial hemorrhage). One patient died more than 20 days after FOE removal and after several episodes of status epilepticus. Patients suffering from life-threatening complications were more likely to be female (83.3%) than patients experiencing no complications or non–life-threatening complications. Patients with life-threatening complications had a more prolonged stay in the v-EEG unit during monitoring with FOE (8.2 ± 0.7; n = 6) than the group without complications (5.7 ± 0.2; n = 309; p < 0.01; Kruskal–Wallis test). Discussion: FOE is a reasonably safe intracranial technique for v-EEG monitoring with low rates of potentially severe complications, but its indication should be carefully evaluated, especially if monitoring for more than 8 days is expected.

Patients with systemic lupus erythematosus (SLE) often show cognitive impairment on traditional neuropsychological tests; however, many of these tests are unsuitable for use with mixed ethnic populations. Computer-administered cognitive tests are promising, but have not been validated against traditional tests or with predominantly Hispanic samples. We gave 67 lupus patients a computer-administered test battery (Automated Neuropsychological Assessment Metrics--ANAM) and a battery of traditional neuropsychological tests. The two batteries were compared using correlation and multiple regression analyses. All patients were fluent in English, 54% were Hispanic and 13% were bilingual. Non-Hispanic patients were predominantly European American (37%). About 80% of patients were rated as impaired on traditional tests. Hispanics were younger, had less education and more current SLE disease activity than non-Hispanics; but did not differ in lifetime SLE-related organ damage or current steroid use. Hispanics and younger patients were more impaired on many of the traditional tests, while ANAM was not affected by Hispanic ethnicity or education. ANAM tests were moderately correlated with analogous traditional tests. Age and selected ANAM scores accounted for about 60% of the variance in the traditional battery. These results replicate the high prevalence of cognitive deficits in SLE found by others and suggest that computer-administered tests like ANAM may be useful for assessment of cognitive impairment in mixed-ethnic samples. Confounding variables such as age, education, English language fluency and prior experience with tests were identified and need to be controlled statistically or with comparison groups in future studies.

Objective: The San Antonio Lupus Study of Neuropsychiatric Disease is a longitudinal study designed to characterize the spectrum of and important risk factors for specific neuropsychiatric systemic lupus erythematosus (NPSLE) syndromes.Methods: Subjects must meet criteria for SLE and must be at least 18 years of age. A standardized medical history, neurologic, rheumatologic, and psychiatric examinations, computerized neuropsychological evaluation, and serologic testing are performed.Results: This report is based on the first 128 subjects (120 women and 8 men) who completed the initial study visit. Data from this initial study visit were evaluated for the prevalence of NPSLE using the American College of Rheumatology case definitions for 19 NPSLE syndromes. One or more NPSLE syndromes were present in 80% of subjects: cerebrovascular disease (2, 2%; ischemic stroke); headaches (73, 57%); mononeuropathy (9, 8%; median 8, ulnar 1); movement disorder (1, 1%; chorea); neuropathy, cranial (2, 2%; trigeminal); polyneuropathy (29, 22%; sensorimotor); seizures (21, 16%; partial); anxiety disorder (27, 24%); major depressive-like episode (37, 28%); mood disorder with depressive features (21, 19%); mood disorder with manic features (3, 3%); mood disorder with mixed features (1, 1%); psychosis (6, 5%). In a subset of 67 patients who received standardized neuropsychological testing, 21% had normal results. In the remainder, the following levels of impairment were seen: 43% mild, 30% moderate, and 6% severe.Conclusions: The prevalence of NPSLE was high in this cohort of unselected patients with SLE. Headaches, cognitive dysfunction, and psychiatric disorders were the most common NPSLE syndromes seen. These results will be easily comparable to other studies also using standardized diagnostic criteria. However, the lack of ethnicity and language-matched normative neuropsychological data may make comparisons of cognitive dysfunction in SLE populations difficult.

Objective: To evaluate different CO2 laser procedures on children with various types of laryngomalacia and determine the role of associated anomalies on the outcome. Design: Retrospective chart review. Setting: Academic tertiary referral center. Patients: Twenty-three children who underwent laser supraglottoplasty for laryngomalacia between 1991 and 1998 at the UC Davis Medical Center. Interventions: CO2 laser vaporization of redundant supraglottic mucosa of the aryepiglottic fold, arytenoid, and the epiglottis, or modification of the latter, either individually or in combination, based on the obstructing anatomy. Outcome measures: Immediate, short term, intermediate and long term relief of respiratory symptoms, feeding difficulties, effect of associated anomalies on outcome, effect of specific anatomic obstructing site and surgical procedure performed on outcome, and the incidence of complications inherent to the procedure. Results: Children without associated anomalies invariably did very well, with 78% immediately resolving their respiratory symptoms and 100% within a week. Twelve of the 14 patients with unfavorable immediate results (P

Background— Drug-induced arrhythmia is one of the most common causes of drug development failure and withdrawal from market. This study tested whether human induced pluripotent stem cell–derived cardiomyocytes (hiPSC-CMs) combined with a low-impedance microelectrode array (MEA) system could improve on industry-standard preclinical cardiotoxicity screening methods, identify the effects of well-characterized drugs, and elucidate underlying risk factors for drug-induced arrhythmia. hiPSC-CMs may be advantageous over immortalized cell lines because they possess similar functional characteristics as primary human cardiomyocytes and can be generated in unlimited quantities. Methods and Results— Pharmacological responses of beating embryoid bodies exposed to a comprehensive panel of drugs at 65 to 95 days postinduction were determined. Responses of hiPSC-CMs to drugs were qualitatively and quantitatively consistent with the reported drug effects in literature. Torsadogenic hERG blockers, such as sotalol and quinidine, produced statistically and physiologically significant effects, consistent with patch-clamp studies, on human embryonic stem cell–derived cardiomyocytes hESC-CMs. False-negative and false-positive hERG blockers were identified accurately. Consistent with published studies using animal models, early afterdepolarizations and ectopic beats were observed in 33% and 40% of embryoid bodies treated with sotalol and quinidine, respectively, compared with negligible early afterdepolarizations and ectopic beats in untreated controls. Conclusions— We found that drug-induced arrhythmias can be recapitulated in hiPSC-CMs and documented with low impedance MEA. Our data indicate that the MEA/hiPSC-CM assay is a sensitive, robust, and efficient platform for testing drug effectiveness and for arrhythmia screening. This system may hold great potential for reducing drug development costs and may provide significant advantages over current industry standard assays that use immortalized cell lines or animal models.

Samples of bivalves mussels Tagelus dombeii and Semelle solida (Navajuelas and Almejas Chilenas respectively) were collected at Corral Bay-Chile. Simultaneously, samples of water and sediments from the same site were collected. Seven sampling were carried out between July 1990 and July 1993. The total metals concentration in whole tissue of molluscs, sediment and the dissolved metals in water were determined. For Tagelus dombeii, the Cd concentrations ranged between 2.9 to 6.4 µg g−1 and for Cu between 2.2 to 3.6 µg g−1. For Almejas Cd concentrations ranged between 0.6 – 1.2 µg g−1 d.w. while Cu levels ranged from 4.8 to 11 µg g−1. The Cd/Cu ratio Tagelus dombeii was around 5, while for Semelle solida it was always lower than 1. The results show that Tagelus dombeii is a more effective bioaccumulator of Cd than Semelle solida. A comparison between the metal levels in sediment and water samples taken in Pacific coastal areas, from four rivers surrounding the Corral Bay sampling site shows that the partitio...

Characterized by ventricular dilatation, systolic dysfunction, and progressive heart failure, dilated cardiomyopathy (DCM) is the most common form of cardiomyopathy in patients. DCM is the most common diagnosis leading to heart transplantation and places a significant burden on healthcare worldwide. The advent of induced pluripotent stem cells (iPSCs) offers an exceptional opportunity for creating disease-specific cellular models, investigating underlying mechanisms, and optimizing therapy. Here, we generated cardiomyocytes from iPSCs derived from patients in a DCM family carrying a point mutation (R173W) in the gene encoding sarcomeric protein cardiac troponin T. Compared to control healthy individuals in the same family cohort, cardiomyocytes derived from iPSCs from DCM patients exhibited altered regulation of calcium ion (Ca(2+)), decreased contractility, and abnormal distribution of sarcomeric α-actinin. When stimulated with a β-adrenergic agonist, DCM iPSC-derived cardiomyocytes showed characteristics of cellular stress such as reduced beating rates, compromised contraction, and a greater number of cells with abnormal sarcomeric α-actinin distribution. Treatment with β-adrenergic blockers or overexpression of sarcoplasmic reticulum Ca(2+) adenosine triphosphatase (Serca2a) improved the function of iPSC-derived cardiomyocytes from DCM patients. Thus, iPSC-derived cardiomyocytes from DCM patients recapitulate to some extent the morphological and functional phenotypes of DCM and may serve as a useful platform for exploring disease mechanisms and for drug screening.

Although temporal lobe epilepsy (TLE) is traditionally associated with both hypersynchronous activity in the form of interictal epileptic discharges and hippocampal sclerosis, recent findings suggest that desynchronization also plays a central role in the dynamics of this pathology. The objective of this work is to show the imbalance existing between mesial activities in patients suffering from mesial TLE, with normal mesial structures. Foramen ovale recordings from six patients with mesial TLE and one with lateral TLE were analyzed through a cluster analysis and synchronization matrices. None of the patients present findings in the MRI presurgical evaluation. Numerical analysis was carried out in three different situations: awake and sleep interictal and also during the preictal stage. High levels of desynchronization ipsilateral to the epileptic side were present in mesial TLE patients. Low levels of desynchronization were present in the lateral TLE patient during the interictal stage and almost zero in the preictal stage. Implications of these findings in relation with seizure spreading are discussed.

Samples of bivalve mussels Tagelus dombeii and Semelle sólida (Navajuelas and Almejas chilenas, respectively) caught at different sites along the coast of Chile were analysed for Cu, Cd, Hg and Pb content. The analyses were performed on samples of fresh and canned products, classified according to their length. Each Navajuela sample was divided into two subsamples. One was dissected and the visceral tissue, branchial tissue and gonads were removed, while the other sample consisted of the whole tissues. The heavy metal concentration of fresh mussel samples was compared with the same samples as canned products. The data show that for both species there are no significant differences in the metal concentration with the mollusc size in fresh samples and canned products. It has been shown that there is no contribution to the trace metal content (Cd, Pb and Hg) in canned Navajuelas and Almejas mussels as a consequence of the industrial process. A clear and significant reduction in the Cd and Cu content was observed in Navajuelas without visceral tissue and Almejas without mantle tissue for both the fresh and canned products. This is consistent and is corroborated with the high metal concentrations found in the visceral and mantle tissue.

Epilepsy is a neurological disorder that affects 1-2% of the population. The majority of epileptic patients achieve a good seizure control with the current available treatments. However, there is a subgroup of patients that remain severely disable despite the variety of anti-epileptic drugs, the possibility of surgery for resection of the epileptogenic foci in selected patients, and vagal nerve stimulation; various lines of research are being carried out to look for new treatment alternatives. Deep brain stimulation (DBS) of the thalamus has emerged as a therapeutic alternative for patients who remain in-capacitated; the efficacy of this new therapy is subject of several studies, and its effectiveness and safety has not been established yet. There are other targets for deep brain stimulation that may be useful for drug-resistant epilepsy. Experiments with animal models and preliminary human studies have shown encouraging results with DBS on cerebellum, subthalamic nucleus, substantia nigra, hippocampus and cerebral cortex, among others. The purpose of this review is to revisit the studies that have been carried out on these brain nuclei, as targets for DBS for drug-resistant epilepsy. Studies have shown varying degrees of effectiveness, and there is a need for controlled trials to draw any definite conclusions.

Epilepsy is a neurological disorder that affects 1-2% of the population. Despite the available treatments (drug therapy, resective surgery, vagus nerve stimulation), there is a significant subgroup of patients that continues to have disabling seizures. The indications of deep brain stimulation are exponentially growing, and there is a wide experience with deep brain stimulation (DBS) for the treatment of abnormal movements. DBS for epilepsy may be a new therapy for the subgroup of patients that remain disabled despite other treatments. Experiments with animal models, and the new advances in our knowledge about the neurophysiological processes that govern the genesis of epilepsy, have led to the selection of various brain targets for stimulation. The thalamus is a fundamental relay centre in the corticothalamic and corticostriatal thalamocortical circuits, and it has been studied with this purpose. Studies on epileptic patients have shown various degrees of effectiveness; however, controlled studies do not permit definitive conclusions about the role of DBS in the treatment of epilepsy. Probably a better patient selection would lead to more decisive conclusions. Further randomised studies are needed to draw reliable conclusions and scientific evidence on the effectiveness of DBS for refractory epilepsy.

La epilepsia es un trastorno neurológico que afecta a alrededor de un 1-2% de la población. Se han desarrollado diversas estrategias terapéuticas, útiles para el control de las crisis en la mayoría de los casos. A pesar del gran desarrollo de fármacos antiepilépticos, de la posibilidad de resección de los focos epileptógenos en pacientes seleccionados y de la estimulación vagal, existe un subgrupo de pacientes con mal control de sus crisis, para los que se están llevando a cabo diversas líneas de investigación en busca de nuevas alternativas de tratamiento. La estimulación cerebral profunda del tálamo ha surgido como otra posibilidad terapéutica para pacientes que permanecen incapacitados; su utilidad es objeto de varios estudios, y aún no se ha establecido su eficacia y seguridad con suficiente evidencia científica. Existen otras dianas susceptibles de estimulación cerebral profunda como tratamiento para la epilepsia resistente. Los experimentos con modelos animales y estudios preliminares en humanos han mostrado resultados esperanzadores con estimulación cerebral profunda en el cerebelo, núcleo subtalámico, sustancia negra, hipocampo y corteza cerebral, entre otros. A continuación se muestran los estudios realizados en núcleos cerebrales extratalámicos que mostraron eficacia en la epilepsia farmacorresistente. Los estudios han mostrado distintos grados de efectividad, y es preciso realizar ensayos controlados para establecer conclusiones definitivas sobre su eficacia, Epilepsy is a neurological disorder that affects 1-2% of the population. The majority of epileptic patients achieve a good seizure control with the current available treatments. However, there is a subgroup of patients that remain severely disable despite the variety of anti-epileptic drugs, the possibility of surgery for resection of the epileptogenic foci in selected patients, and vagal nerve stimulation; various lines of research are being carried out to look for new treatment alternatives. Deep brain stimulation (DBS) of the thalamus has emerged as a therapeutic alternative for patients who remain incapacitated; the efficacy of this new therapy is subject of several studies, and its effectiveness and safety has not been established yet. There are other targets for deep brain stimulation that may be useful for drug-resistant epilepsy. Experiments with animal models and preliminary human studies have shown encouraging results with DBS on cerebellum, subthalamic nucleus, substantia nigra, hippocampus and cerebral cortex, among others. The purpose of this review is to revisit the studies that have been carried out on these brain nuclei, as targets for DBS for drug-resistant epilepsy. Studies have shown varying degrees of effectiveness, and there is a need for controlled trials to draw any definite conclusions

It is necessary to know the degree of concordance of preoperative studies in temporal lobe epilepsy (TLE). AIM. To analyze the relative importance of different preoperative tests (vEEG, EEG, SPECT and MRI), the degree of agreement between them, and to develop a Bayesian probability model for diagnosis.We analyzed 73 patients operated by TLE, with a minimum postoperative follow-up of two years. To analyze the localization capability of different test, we used only patients with an Engel's grade I outcome during all the follow-up time (n = 60).Engel's grades percentages at 2 years were 87.7/8.2/3.0/0.0 (I/II/III/IV, respectively). The preoperative correlation was50% for three tests and 33% for the four. MRI studies were found normal in 33.3% of cases. According to the localization index, the arrange was vEEGRMSPECTEEG. The conditional probability of correct localization for a test was vEEG (0.950)EEG (0.719)SPECT (0.717)RM (0.683). Concordance for more than two tests, was = 0.587 (vEEG + MRI). The probability of obtaining a priori correct localization was vEEG (0.983)RM (0.414)EEG (0.285)SPECT (0.209). The Bayesian model is highly reliable.Probably it is not always possible to obtain a high degree of agreement among preoperative test, despite this, it is possible to obtain a good functional result. The most effective test is the vEEG.

Protein-energy malnutrition and hypervolemia are major causes of morbidity and mortality in patients on chronic hemodialysis (CHD). The methods used to evaluate nutritional status and volume status remain controversial. Vector bioelectric impedance analysis (vector- BIA) has recently been developed to assess both nutritional status and tissue hydration. The purpose of the study was to assess the nutritional status and volume status of patients on CHD with conventional nutritional assessment methods and with vector-BIA and then to compare the resulting findings.76 Mexican patients on CHD were studied. Nutritional status and body composition were assessed with anthropometry, biochemical variables, and the modified Bilbrey nutritional index (mBNI), the results were compared with both conventional BIA and vector-BIA.The BNI was used to determine the number of patients with normal nutritional status (n = 27, 35.5%), and mild (n = 31, 40.8%), moderate (n = 10, 13.2%) and severe malnutrition (n = 8, 10.5%). Patients displayed shorter vectors with smaller phase angles or with an overhydration vectorial pattern before the initiation of their hemodialysis session. There was general improvement to normal hydration status post-dialysis (p0.05); however, 28% remained overhydrated as assessed by vector-BIA. The vector-BIA results showed that worse malnutrition status was associated with greater volume overload (p0.05). Diabetes mellitus (DM) was associated with shorter vectors with smaller phase angles (a vectorial pattern of overhydration and cachexia) (p0.05). Patients with lower serum creatinine presented with shorter vectors and smaller phase angles (vectorial patterns of malnutrition and/or overhydration) (p0.05). In women, lower serum albumin (3.4 g/dl) correlated with greater overhydration and malnutrition (p0.05).In this population, the vector-BIA showed that 28% of the population remained overhydrated after their hemodialysis session. Diabetics and those with moderate or severe malnutrition were more overhydrated, which is a condition that may be associated with increased cardiovascular morbidity. Because nutritional and volume status are important factors associated with morbidity and mortality in CHD patients, we focused on optimizing the use of existing methods. Our studies suggest that vector-BIA offers a comprehensive and reliable reproducible means of assessing both volume and masses at the bedside and can complement the traditional methods.

Vagus nerve stimulation (VNS) was introduced as a novel method for the treatment of patients with medically and/or surgically refractory epilepsy. VNS typically involves placement of the electrode on the left vagus nerve. However, there are some patients who cannot be implanted on this side because of complications related to the surgical procedure or side effects or infections forcing the left side VNS (L-VNS) explant. Because right side VNS (R-VNS) implants have shown similar effectiveness compared to L-VNS in reducing the frequency of seizures in animal models, treatment with R-VNS should be considered in patients who may not tolerate L-VNS. We present two adult patients who underwent R-VNS. One of the patients improved dramatically after L-VNS, but the device had to be removed because of mechanical malfunction. This patient was thought to be at high risk for nerve injury if L-VNS reimplantation was done, thus R-VNS was chosen. In the other patient, L-VNS was first attempted, but the operation had to be stopped due to significant bleeding caused by the accidental tearing of an ectopic vein. Both patients had a marked reduction in their seizure activity and none of them had cardiac side effects from therapeutic R-VNS. We conclude that R-VNS therapy is an alternative, promising therapy for reducing seizure activity in those patients who cannot undergo L-VNS implantation. Close follow-up and frequent ECG monitoring is required to detect the presence of cardiac side effects.

Chile is a well known producer and exporter of shell fish. These seafoods, like other specimens of marine origin, are susceptible to environmental and other contamination by trace elements, including toxicants. Therefore, adequate analytical quality assurance is mandatory before accepting analytical results. In this context, the use of at least two independent methods of determination and validation with certified reference materials (CRM) provides acceptable criteria for judging the reliability of the data. This paper describes sample treatments and analytical procedures for Cd, Cu and Hg determinations in mollusc samples. Three independent analytical techniques, namely differential pulse anodic stripping voltammetry, neutron activation analysis and atomic absorption spectrometry, were used. CRM standards of the IAEA, NIST and BCR were analyzed to evaluate quality assurance. Following the quality control phase, the concentrations of cadmium, copper and mercury in fresh and canned mollusc samples Tagelus dombeei and Semella solida (Navajuelas and Almejas chilenas respectively) from different locations were determined.

A large amount of current schizophrenia research has been centered on the understanding of its etiological mechanisms and the detection of vulnerability markers in people at risk. This vulnerability called schizotypy can be identified in people not affected by the illness at the clinical level.To check if the schizotypic personality disorder as a vulnerability marker of the disorders in the schizophrenic spectrum predicts the presence of psychopathologic symptoms and alcohol and drugs intake.From a population of 442 university students tested with the Schizotypy Personality Questionnaire (SPQ), it was selected a sample including people scoring on the 20% superior and inferior for the characteristic factors of schizophrenia corresponding to positive symptoms (cognitive-perceptual), negative symptoms (interpersonal) and thought disorder (disorganized). Furthermore, it was evaluated the presence of psychopathological problems and symptoms. Also, the participants gave information about alcohol and drugs intake as a passive coping strategy with stress.Compared with the low scored, subjects with high scores in the schizotypic personality disorder showed a significant increase in the presence of psychopathological problems and symptoms and a higher alcohol and drugs intake. That occurs mainly when those scores are found in symptoms associated to thought disorder and negative symptoms as lack of interest in social activities and emotional flattening.The schizotypic personality disorder, in accordance with its role as vulnerability factor, seems to co-occur with a higher volume of somatic and psychopathologic symptoms, and alcohol and drugs intake.

We present experimental results on the light transmission and intermode power exchange in multimode fibers with rough surfaces. The experiments were performed with chemically etched $200\text{\ensuremath{-}}\ensuremath{\mu}\mathrm{m}\text{\ensuremath{-}}\text{diameter}$ cores of fused silica fibers that can support up to $700\ifmmode\times\else\texttimes\fi{}700$ guided modes at the wavelength employed, $\ensuremath{\lambda}\ensuremath{\approx}0.6\phantom{\rule{0.3em}{0ex}}\ensuremath{\mu}\mathrm{m}$. After propagation through some rough fiber section the mode power profile acquires a Gaussian shape that propagates along the mean axis of the corrugated fiber, with a slowly reducing radius $(\ensuremath{\propto}1∕\sqrt{z})$, and practically without attenuation of the central intensity. These features, and other observed characteristics, are reproduced with a theory that assumes a ballistic regime of light propagation through a one-dimensional slab waveguide, relating the characteristic propagation lengths to parameters of the fiber surface roughness.

Electrocorticography (ECoG) monitoring in temporal lobe epilepsy (TLE) has been employed since the 40 s as a means to delineate surgical removal especially in lesional epilepsy, to reduce resection size and decrease cognitive sequelae (memory, naming). However in recent years, ECoG has been claimed to lack indications and prognostic value in cases of non lesional TLE. On the grounds of the pathophysiological relationship between mesial structures and neocortex (through propagation pathways) we have suggested a classification of ECoG activity patterns regarding the activities simultaneously recorded in mesial and neocortical grids.Two experienced neurophysiologists (over 200 ECoG performed) have independently reviewed the recordings (including video EEG monitoring with foramen ovale electrodes) of 33 consecutive (28 non-lesional) TLE patients with the major criterion of a leading activity in mesial or neocortical areas, and related the results to the clinical course.As a result we identified five patterns: I. Pure mesial; II. Mesial with neocortial-related activity; III. Non-related mesial and neocortical activities; IV. Neocortical preponderance (although some mesial unrelated discharges may be seen), and V. Neocortical origin. In all 33, a tailored, ECpG-guided two-steps resection was performed. Surgical success significantly (c2 test) associated with patterns I, II and IV. Pattern V precluded a good outcome.ECoG reflects the state of pathological involvement of neocortex and mesial structures. An expertise approach, although brief in time (20-30 min), may either lead to preservation of relevant tissue (patterns I, II) and to establish a prognosis on the grounds of the initial epileptogenic activity.

In the outer hair cell (OHC), membrane capacitance principally derives from two components - that associated with lateral membrane sensor/motor charge movement, and that proportional to the membrane surface area (C(sa)). We used measures of membrane capacitance to test a model hypothesis that OHC lateral membrane molecular motors, recently identified as the protein prestin, fluctuate between two area states. By measuring membrane capacitance in native OHCs or prestin-transfected HEK cells at extreme voltages (+/-200 mV) where motor-derived charge movement is small or absent, we observed that C(sa) depends on the state of the motors, or correspondingly on membrane voltage. Deiters cells or control HEK cells, which lack motors, do not show this dependence. We modeled the voltage-dependent change in C(sa) as a Boltzmann process with the same parameters that describe the charge movement of the motors' voltage sensors. C(sa) is 3.28+/-0.75 pF (mean +/-SD; n=23) larger during extreme hyperpolarization, and the number of motors in OHCs and prestin-transfected HEK cells correlates with the magnitude of Delta C(sa)( r=0.78). Although these data are consistent with the area motor model, the corresponding area change, assuming 0.5 microF/cm(2) under constant membrane thickness, is unphysiologically large, and indicates that the capacitance change must result from changes not only in lateral membrane area but also specific capacitance. Thus, we conclude that a conformational change in the lateral membrane motor, prestin, additionally alters the dielectric constant and/or thickness of the lateral plasma membrane.

Antiphospholipid antibody syndrome (APS) has been associated with central nervous system (CNS) involvement in a large number of patients. However, not all studies have found a significant correlation between antiocardiolipin (aCL) levels and neurological/neuropsychiatric manifestations of APS [1]. Clinical manifestations of APS associated with the CNS include arterial thrombotic events, psychiatric manifestations and a variety of other non-thrombotic neurological syndromes [2] (see Table 5.1). In fact, some of the most debilitating clinical aspects of APS are the neurological and neuropsychiatric manifestations. Nevertheless, the specific role of antiphospholipid antibodies (aPL) in the CNS remains one of the least understood aspects of this syndrome, which is partly due to the heterogeneity of its symptomatology. Patients may present with diffuse or global dysfunction, including coma, grand mal seizures, and cognitive dysfunction, psychosis, affective disorders, as well as focal symptoms attributable to lesions to a specific area of the brain. A majority of cognitive disorders associated with aPL area are probably the result of thrombotic events; however, there may be other aPL-mediated mechanisms, as well [3].

La epilepsia es un trastorno neurologico que afecta al 1-2% de la poblacion. A pesar de los tratamientos disponibles (farmacoterapia, cirugia resectiva, estimulacion del nervio vago...), hay un subgrupo importante de pacientes que continua teniendo crisis incapacitantes. La estimulacion cerebral profunda esta experimentando un incremento exponencial de sus indicaciones y se dispone de experiencia amplia en el campo de los movimientos anormales. El tratamiento de la epilepsia mediante estimulacion cerebral profunda podria ser una nueva terapia aplicable al subgrupo de pacientes resistentes a otros tratamientos. Los experimentos con modelos animales, y el avance en los conocimientos neurofisiologicos de los procesos que gobiernan la genesis de la epilepsia, han dado pie a la seleccion de diversas dianas cerebrales para la estimulacion. El talamo, por ser un centro fundamental de relevo en los circuitos corticotalamicos y corticoestriado-talamocorticales, ha sido objeto de estudio con esta finalidad. Los estudios realizados en pacientes epilepticos han tenido distintos grados de efectividad, si bien los estudios controlados no permiten conclusiones definitivas sobre cual es su papel en el tratamiento de la epilepsia. Probablemente la seleccion de pacientes mas adecuada favorezca la realizacion de estudios con conclusiones mas determinantes. Es preciso realizar mas estudios aleatorizados controlados para extraer conclusiones fidedignas y evidencia cientifica sobre su eficacia.