Functional Evaluation of the Visual Pathway in Patients with Multiple Sclerosis Using a Multifunction Stimulator Monitor

Objectives. To assess the capability of the vision monitor unit Monpack One of detecting visual function alterations in patients with multiple sclerosis (MS) and to evaluate the correlation between structural retinal parameters and functional measurements obtained with this device. Methods. Forty-eight patients with MS and 46 healthy controls were included in a cross-sectional study. All participants underwent a complete functional evaluation of the visual pathway, which included low-contrast visual acuity (LCVA), contrast sensitivity vision (CSV), automated perimetry, multifocal visual evoked potentials (mfVEPs), and pattern electroretinogram (ERG). All tests were performed using the vision monitor unit Monpack One (Metrovision, France), a multifunction stimulator device. Retinal structural measurements were obtained in all subjects using Triton swept source optical coherence tomography (Topcon, Japan). Results. Patients with MS presented reduced low-contrast VA (p<0.001) and reduced CSV at medium (p=0.001, p=0.013) and low (p=0.001, p=0.002) spatial frequencies. All visual field parameters were found to be altered in MS patients compared with controls (<= 0.001). Patients with MS presented lower amplitude of the P100 waveform of the mfVEP in areas corresponding to central (p<0.001), inferonasal (p=0.001), and inferotemporal (p=0.003) retina. The pattern ERG did not show significant differences. Significant correlations were observed between structural retinal measurements and functional parameters, especially between the inner macular areas and measurements corresponding to contrast sensitivity and perimetry indexes. Conclusions. Patients with MS present visual dysfunction detectable with the vision monitor unit Monpack One. This device may be a fast and useful tool to provide a full evaluation of axonal damage in patients with multiple sclerosis

Impacto en los tiempos puerta-aguja de un conjunto de medidas para optimizar la atención hospitalaria del código ictus

Introducción: El tiempo sigue siendo una variable determinante para los tratamientos de reper-fusión del ictus isquémico agudo. A pesar de las recomendaciones de las guías clínicas, soloalrededor de la tercera parte de los pacientes con ictus isquémico agudo son fibrinolizadosen = 60 min. El objetivo de este trabajo es describir nuestra experiencia implementando unprotocolo específico de atención del ictus isquémico agudo y evaluar su impacto en nuestrostiempos puerta-aguja. Métodos: A finales del 2015, se implantaron gradualmente unas medidas dise ~nadas para acortarlos tiempos de actuación y optimizar la atención del ictus isquémico agudo incluyendo unaguardia específica de Neurovascular. Se compararon los tiempos de actuación antes (2013-2015)y después (2017-2019) de la introducción de este protocolo. Resultados: Se incluyó a 182 pacientes antes y 249 después de la intervención. Cuando todas lasmedidas fueron introducidas, la mediana global de tiempo puerta-aguja fue de 45 min (previa74 min, 39% menos, p < 0, 001) con un 73, 5% de pacientes tratados en = 60 min (47% más quepreintervención, p < 0, 001). El tiempo global al tratamiento (inicio síntoma-aguja) se redujo en20 min de mediana (p < 0, 001). Conclusiones: Las medidas asociadas en nuestro protocolo han conseguido una disminución deltiempo puerta-aguja de forma significativa y sostenida, aunque todavía nos queda margen demejora, la dinámica establecida de control de resultados y mejora continua hará posible seguiravanzando en este sentido. Introduction: Time continues to be a fundamental variable in reperfusion treatments for acute ischaemic stroke. Despite the recommendations made in clinical guidelines, only around one-third of these patients receive fibrinolysis within 60 minutes. In this study, we describe our experience with the implementation of a specific protocol for patients with acute ischaemic stroke and evaluate its impact on door-to-needle times in our hospital. Methods: Measures were gradually implemented in late 2015 to shorten stroke management times and optimise the care provided to patients with acute ischaemic stroke; these measures included the creation of a specific on-call neurovascular care team. We compare stroke management times before (2013-2015) and after (2017-2019) the introduction of the protocol. Results: The study includes 182 patients attended before implementation of the protocol and 249 attended after. Once all measures were in effect, the overall median door-to-needle time was 45 minutes (vs 74 minutes before, a 39% reduction; P<.001), with 73.5% of patients treated within 60 minutes (a 47% increase; P<.001). Median overall time to treatment (onset-to-needle time) was reduced by 20 minutes (P<.001). Conclusions: The measures included in our protocol achieved a significant, sustained reduction in door-to-needle times, although there remains room for improvement. The mechanisms established for monitoring outcomes and for continuous improvement will enable further advances in this regard

Retinal and Optic Nerve Degeneration in Patients with Multiple Sclerosis Followed up for 5 Years

Purpose: To quantify retinal nerve fiber layer (RNFL) changes in patients with multiple sclerosis (MS) and healthy controls with a 5-year follow-up and to analyze correlations between disability progression and RNFL degeneration. Design: Observational and longitudinal study. Participants: One hundred patients with relapsing-remitting MS and 50 healthy controls. Methods: All participants underwent a complete ophthalmic and electrophysiologic exploration and were re-evaluated annually for 5 years. Main Outcome Measures: Visual acuity (Snellen chart), color vision (Ishihara pseudoisochromatic plates), visual field examination, optical coherence tomography (OCT), scanning laser polarimetry (SLP), and visual evoked potentials. Expanded Disability Status Scale (EDSS) scores, disease duration, treatments, prior optic neuritis episodes, and quality of life (QOL; based on the 54-item Multiple Sclerosis Quality of Life Scale score). Results: Optical coherence tomography (OCT) revealed changes in all RNFL thicknesses in both groups. In the MS group, changes were detected in average thickness and in the mean deviation using the GDx-VCC nerve fiber analyzer (Laser Diagnostic Technologies, San Diego, CA) and in the P100 latency of visual evoked potentials; no changes were detected in visual acuity, color vision, or visual fields. Optical coherence tomography showed greater differences in the inferior and temporal RNFL thicknesses in both groups. In MS patients only, OCT revealed a moderate correlation between the increase in EDSS and temporal and superior RNFL thinning. Temporal RNFL thinning based on OCT results was correlated moderately with decreased QOL. Conclusions: Multiple sclerosis patients exhibit a progressive axonal loss in the optic nerve fiber layer. Retinal nerve fiber layer thinning based on OCT results is a useful marker for assessing MS progression and correlates with increased disability and reduced QOL

Optical Coherence Tomography as a Biomarker for Diagnosis, Progression, and Prognosis of Neurodegenerative Diseases

Neurodegenerative diseases present a current challenge for accurate diagnosis and for providing precise prognostic information. Developing imaging biomarkers for multiple sclerosis (MS), Parkinson disease (PD), and Alzheimer''s disease (AD) will improve the clinical management of these patients and may be useful for monitoring treatment effectiveness. Recent research using optical coherence tomography (OCT) has demonstrated that parameters provided by this technology may be used as potential biomarkers for MS, PD, and AD. Retinal thinning has been observed in these patients and new segmentation software for the analysis of the different retinal layers may provide accurate information on disease progression and prognosis. In this review we analyze the application of retinal evaluation using OCT technology to provide better understanding of the possible role of the retinal layers thickness as biomarker for the detection of these neurodegenerative pathologies. Current OCT analysis of the retinal nerve fiber layer and, specially, the ganglion cell layer thickness may be considered as a good biomarker for disease diagnosis, severity, and progression

Changes in health behaviors, mental and physical health among older adults under severe lockdown restrictions during the covid-19 pandemic in spain

We used data from 3041 participants in four cohorts of community-dwelling individuals aged =65 years in Spain collected through a pre-pandemic face-to-face interview and a telephone interview conducted between weeks 7 to 15 after the beginning of the COVID-19 lockdown. On average, the confinement was not associated with a deterioration in lifestyle risk factors (smoking, alcohol intake, diet, or weight), except for a decreased physical activity and increased sedentary time, which reversed with the end of confinement. However, chronic pain worsened, and moderate declines in mental health, that did not seem to reverse after restrictions were lifted, were observed. Males, older adults with greater social isolation or greater feelings of loneliness, those with poorer housing conditions, as well as those with a higher prevalence of chronic morbidities were at increased risk of developing unhealthier lifestyles or mental health declines with confinement. On the other hand, previously having a greater adherence to the Mediterranean diet and doing more physical activity protected older adults from developing unhealthier lifestyles with confinement. If an-other lockdown were imposed during this or future pandemics, public health programs should spe-cially address the needs of older individuals with male sex, greater social isolation, sub-optimal housing conditions, and chronic morbidities because of their greater vulnerability to the enacted movement restrictions. © 2021 by the authors. Licensee MDPI, Basel, Switzerland

Long-term adherence to IFN beta-1a treatment when using rebismart1device in patients with relapsing-remitting multiple sclerosis

The effectiveness of disease-modifying drugs in the treatment of multiple sclerosis is associated with adherence. RebiSmart® electronic device provides useful information about adherence to the treatment with subcutaneous (sc) interferon (IFN) ß-1a (Rebif®). The aim of the study was to determine long-term adherence to this treatment in patients with relapsing- remitting multiple sclerosis (RRMS). This retrospective multicentre observational study analysed 258 patients with RRMS who were receiving sc IFN ß-1a (Rebif®) treatment by using RebiSmart® until replacement (36 months maximum lifetime) or treatment discontinuation. Adherence was calculated with data (injection dosage, time, and date) automatically recorded by RebiSmart®. Patients in the study had a mean age of 41 years with a female proportion of 68%. Mean EDSS score at start of treatment was 1.8 (95% CI, 1.6-1.9). Overall adherence was 92.6%(95% CI, 90.6-94.5%). A total of 30.2% of patients achieved an adherence rate of 100%, 80.6% at least 90%, and only 13.2% of patients showed a suboptimal adherence (<80%). A total of 59.9% of subjects were relapse-free after treatment initiation. Among 106 subjects (41.1%) who experienced, on average, 1.4 relapses, the majority were mild (40.6%) or moderate (47.2%). Having experienced relapses from the beginning of the treatment was the only variable significantly related to achieving an adherence of at least 80% (OR = 3.06, 1.28-7.31). Results of this study indicate that sc IFN ß-1a administration facilitated by RebiSmart® could lead to high rates of adherence to a prescribed dose regimen over 36 months

Ideal cardiovascular health and inflammation in European adolescents: The HELENA study

Background and aims Inflammation plays a key role in atherosclerosis and this process seems to appear in childhood. The ideal cardiovascular health index (ICHI) has been inversely related to atherosclerotic plaque in adults. However, evidence regarding inflammation and ICHI in adolescents is scarce. The aim is to assess the association between ICHI and inflammation in European adolescents. Methods and results As many as 543 adolescents (251 boys and 292 girls) from the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) study, a cross-sectional multi-center study including 9 European countries, were measured. C-reactive protein (CRP), complement factors C3 and C4, leptin and white blood cell counts were used to compute an inflammatory score. Multilevel linear models and multilevel logistic regression were used to assess the association between ICHI and inflammation controlling by covariates. Higher ICHI was associated with a lower inflammatory score, as well as with several individual components, both in boys and girls (p < 0.01). In addition, adolescents with at least 4 ideal components of the ICHI had significantly lower inflammatory score and lower levels of the study biomarkers, except CRP. Finally, the multilevel logistic regression showed that for every unit increase in the ICHI, the probability of having an inflammatory profile decreased by 28.1% in girls. Conclusion Results from this study suggest that a better ICHI is associated with a lower inflammatory profile already in adolescence. Improving these health behaviors, and health factors included in the ICHI, could play an important role in CVD prevention

Synthesis, characterisation and NMR study of paramagnetic heteropolinuclear anionic Pt-Co species. Crystal structures of [NBu4]2[{cis-Pt(C6F5)2(C=CSiMe3)2}CoCl2]·0.5(CH3)2CO and [NBu4]2[{Pt(CºCtBu)4}{CoCl2}2].1.5(CH3)2CO

The reactions of [NBu4]2[cis-Pt(C6F5) 2(CCR)2] (R=tBu or SiMe3) with CoCl2·6H2O in a 1:1 molar ratio yielded the paramagnetic binuclear species [NBu4]2[{cis-Pt(C6F5) 2(-CCR)2}CoCl2] (R=tBu (1a), SiMe, (1b)) in which thecobalt(II) chloride is coordinated 2-side on to both alkynyl ligands of the platinum fragment. Similar treatment of [NBu4]2[Pt(C=CR)4]·2H2O (R=tBu or SiMe3) with CoCl2·6H2O in a 1:2 molar ratio gave the corresponding trinuclear 1:2 adducts [NBu4]2[{Pt(-CCR)4}{CoCl 2}2] (2). The compounds were characterised by analytical and spectroscopic data and, in addition, the crystal structures of a representative complex of each category were determined: 1b·acetone and 2a·acetone. Surprisingly, whilst in the binuclear anion [{Pt(C6F5)2(CCSiMe3) 2}CoCl2]2- the cobalt atom is well embedded by the alkynyl fragments giving a precisely planar PtC4Co core and a very long PtCo separation (3.446(3) Å), in the trinuclear derivative [{Pt(CCtBu)4}{CoCl2}2] 2- the PtC4Co cores are hinged imposing significantly shorter PtCo distances (3.077(3) Å). © 1997 Elsevier Science S.A

Neutral PtRh2 and PtRh4 tetraalkynyl complexes. X-ray crystal structures of {Pt(C=CBut)4[Rh2(μ-X)(COD)2] 2} (X = Cl, OH)

The reaction of 2 equiv of [Rh(COD)(acetone)2]+ with the dianionic homoleptic species [Pt(CCR)4]2- (R = But (1a), SiMe3 (1b)) in acetone (molar ratio 2:1) gives the expected neutral trinuclear adducts {Pt(-C-CCR)4[Rh(COD)]2} (R = But (2a), SiMe3 (2b)) in moderately good yield. Further reaction of 2a with the binuclear [Rh(-X)(COD)]2 (X = Cl, OH) derivatives (molar ratio 1:1) produces the formation of unusual pentanuclear {Pt(-C=CBut)4-[Rh2(-X)(COD) 2]2} complexes (X = Cl (3a), OH (4a)), which are formed by a dianionic "Pt-(CCBut)4" fragment and two dinuclear cationic "Rh2(COD)2(-X)" units connected through bridging alkynyl ligands. The molecular structures of complexes 3a and 4a have been established by X-ray crystallography

Synthesis of bis(eta2-alkyne) Trinuclear Zwitterionic Platinum Hydride Complexes by Reaction of [trans-Pt(C6F5)2(C=CR)2]2- with the Solvento species [trans-PtH L2(acetone)]+

The alkynylation of trans-[Pt(C6F5)2(tht)2] (tht = tetrahydrothiophene) with LiCCR in diethyl ether (R = Ph, SiMe3) or THF (R = tBu) leads to novel dianionic species [trans-Pt-(C6F5)2(CCR)2] 2- (R = Ph (1), SiMe3 (2), tBu (3)) which have been isolated as tetrabutylammonium salts. Treatment of (NBu4)2[trans-Pt(C6F5) 2(CCR)2] (R = Ph, SiMe3, tBu) with 2 equiv of cationic hydride reagents of the type [trans-PtHL2(acetone)]+ (L = PPh3, PEt3) in acetone form, via a ligand replacement, simple bis(2-alkyne) trinuclear zwitterionic complexes trans,trans,trans-{[Pt(C6F5)2(- 1:2-CCR)2](PtHL2) 2} (R = Ph, L = PPh3 (4a), PEt3 (4b); R = SiMe3, L = PPh3 (5a), PEt3 (5b); R = tBu, L = PEt3 (6b)). The structure of complex 4b has been determined by X-ray diffraction methods