Stereo-Encephalographic Presurgical Evaluation of Temporal Lobe Epilepsy: An Evolving Science

Drug-resistant epilepsy is present in nearly 30% of patients. Resection of the epileptogenic zone has been found to be the most effective in achieving seizure freedom. The study of temporal lobe epilepsy for surgical treatment is extensive and complex. It involves a multidisciplinary team in decision-making with initial non-invasive studies (Phase I), providing 70% of the required information to elaborate a hypothesis and treatment plans. Select cases present more complexity involving bilateral clinical or electrographic manifestations, have contradicting information, or may involve deeper structures as a part of the epileptogenic zone. These cases are discussed by a multidisciplinary team of experts with a hypothesis for invasive methods of study. Subdural electrodes were once the mainstay of invasive presurgical evaluation and in later years most Comprehensive Epilepsy Centers have shifted to intracranial recordings. The intracranial recording follows original concepts since its development by Bancaud and Talairach, but great advances have been made in the field. Stereo-electroencephalography is a growing field of study, treatment, and establishment of seizure pattern complexities. In this comprehensive review, we explore the indications, usefulness, discoveries in interictal and ictal findings, pitfalls, and advances in the science of presurgical stereo-encephalography for temporal lobe epilepsy

Escala de Familismo: Análise Fatorial Confirmatória numa Amostra de Cuidadores de Idosos

El objetivo del presente estudio fue traducir y confirmar la estructura factorial de la Escala de Familismo a la versión del portugués brasileño. La muestra incluyó a 716 cuidadores brasileños que cuidaron de sus propios padres ancianos con enfermedad de Alzheimer. Las medidas incluyeron la Escala de Familismo, la Escala de Obligación Filial, la Escala de Satisfacción con la Vida y el Center for Epidemiologic Studies-Depression (CES-D). El cuestionario se rellenó en línea, de manera individual, utilizando la herramienta de software de encuestas en línea Qualtrics. El análisis factorial confirmatorio (AFC) se utilizó para examinar la estructura factorial. Un modelo modificado demostró un adecuado ajuste (RMSEA =.063, CFI =.912). Se sostuvieron las hipótesis que implican la convergencia y la divergencia de validez de las variables relevantes. Estos resultados respaldan el uso de la Escala de Familismo modificada de doce ítems y tres factores, que tiene propiedades psicométricas aceptables en una muestra de cuidadores brasileños de personas con enfermedad de Alzheimer.O objetivo deste estudo foi traduzir e confirmar a estrutura fatorial da Escala de Familismo na versão da língua portuguesa brasileira. A amostra incluiu 716 cuidadores brasileiros que cuidavam de seus próprios pais idosos com doença de Alzheimer. As medidas incluíram a Escala de Familismo, Escala de Obrigação Filial, Escala de Satisfação com a Vida e a Center for Epidemiologic StudiesDepression (CES-D). O questionário foi preenchido on-line e respondido individualmente usando a ferramenta de software de pesquisa da Qualtrics. A análise fatorial confirmatória (AFC) foi utilizada para examinar a estrutura fatorial. Um modelo modificado demonstrou um ajuste adequado (RMSEA = .063, CFI = .912). Hipóteses envolvendo convergência e divergência de validade de variáveis relevantes foram suportadas. Estes resultados apoiam o uso da Escala de Familismo modificada em doze itens e três fatores, que tem propriedades psicométricas aceitáveis em uma amostra de cuidadores brasileiros de pessoas com doença de Alzheimer.The objective of this study was to translate and confirm the factor structure of the Familism Scale in the Brazilian Portuguese version. The sample included 716 Brazilian caregivers providing care to their own aging parents with Alzheimer’s Disease. The measures included the Familism Scale, the Filial Obligation Scale, the Life Satisfaction scale and the Center for Epidemiological Studies-Depression scale (CES-D). The questionnaire was individually filled online with use of the survey software package Qualtrics. Confirmatory Factor Analysis was used to examine the factor structure. The modified model demonstrated adequate fit (RMSEA = .063, CFI = .912). The hypotheses concerning convergence and divergence of validity from relevant variables were corroborated. These results support the use of the modified Familism Scale including twelve items and two factors with acceptable psychometric properties in a sample of Brazilian caregivers with Alzheimer’s Disease

Variantes anatómicas del segmento anterior del polígono de Willis: relación con aneurismas cerebrales

The circle of Willis is a vascular network that supplies blood to the brain and surrounding structures. One of its main functions is to maintain the irrigation through the anastomoses when a certain condition compromises the flow of any of its branches. It is composed of the anterior cerebral, anterior communicating, internal carotid, posterior cerebral, and posterior communicating arteries. Its conformation varies in the population. More than 30-60% of people have a different composition than the usual, with hypoplasia of one or more vessels being the most common anatomical variant. This is defined as the existence of less than 1 mm of external caliber in the anterior communicating and posterior cerebral arteries and the arterial segments A1 of the anterior cerebral and P1 of the posterior cerebral arteries. The posterior cerebral artery is the most frequently hypoplastic, followed by the P1 segment of the posterior cerebral artery, the A1 segment of the anterior cerebral artery, and the anterior communicating artery. The formation of intracranial aneurysms is more common in the anterior communicating artery; and the unilateral predominance of the ACA trunk, aplasia/hypoplasia of the A2 segment, and hypoplasia of the A1 segment have been determined as risk factors for its appearance. This last variant constitutes the main risk factor for rupture of intracranial aneurysms of the anterior communicating artery, since it increases blood flow on the opposite side causing an increase in intramural pressure that favors the development of the aneurysm.El polígono de Willis es una red vascular que aporta sangre al cerebro y a las estructuras circundantes. Una de sus principales funciones es mantener la irrigación a través de las anastomosis, cuando se presenta alguna condición que compromete el flujo de alguna de sus ramas. Está compuesto por las arterias cerebral anterior, comunicante anterior, carótida interna, cerebral posterior y comunicante posterior. Su conformación varía en la población. Más del 30-60% de las personas presentan una composición distinta a la habitual, siendo la hipoplasia de uno o más vasos la variante anatómica más común. Esta se define como la existencia de menos de 1 mm de calibre externo en la comunicante anterior y cerebral posterior, y los segmentos arteriales A1 de la cerebral anterior y P1 de la cerebral posterior. La arteria cerebral posterior es la que se encuentra hipoplásica con mayor frecuencia, seguida del segmento P1 de la cerebral posterior, el segmento A1 de la cerebral anterior y la comunicante anterior. La formación de aneurismas intracraneales es más frecuente en la arteria comunicante anterior. Se han determinado como factores de riesgo para su aparición el predominio unilateral del tronco de la arteria cerebral anterior, la aplasia/hipoplasia del segmento A2, y la hipoplasia del segmento A1. Esta última variante constituye el principal factor riesgo para la ruptura de los aneurismas intracraneales de la arteria comunicante anterior, ya que aumenta el flujo sanguíneo en el lado opuesto y, con ello, provoca un incremento de la presión intramural que favorece el desarrollo del aneurisma

¿Beneficios económicos periódicos: Una alternativa para la vejez digna de los más vulnerables?

Mediante el Acto Legislativo 01 de 2005 y la Ley 1328 de 2009, se ideó la manera de conceder beneficios económicos periódicos inferiores al salario mínimo a personas de escasos recursos que no cumplan con las condiciones requeridas para tener derecho a una pensión y que hayan realizado aportes o ahorros periódicos o esporádicos a través del medio o mecanismo de ahorro determinados por el Gobierno Nacional. El mecanismo de Beneficios Económicos Periódicos (BEP a partir de ahora) se define así: es un Servicio Social Complementario que hace parte del Sistema de Protección a la Vejez y constituye una alternativa para la protección a largo plazo de las personas, uniendo el esfuerzo de ahorro que realicen por medio de este mecanismo, con el subsidio o incentivo entregado por parte del Estado, materializándose así los principios de participación y solidarida

Understanding the retreat of the Jurassic Cantabrian coast (N. Spain): comprehensive monitoring and 4D evolution model of the Tazones Lighthouse landslide

Forecasting coastal dynamics and sea cliff retreat under different sea level rise scenarios requires a good understanding of the conditioning factors and their relative contribution to cliff stability. The so-called Jurassic Cantabrian Coast extends along 76 km of the coastline of the Asturias region (N Spain) and is well-known worldwide due to its paleontological heritage, in particular the presence of dinosaur remains and footprints. The abundance of stratigraphic, paleontological and tectonic studies contrasts with the scarcity of studies focused on the stability of this rocky coastline where cliffs predominate, sometimes exceeding 120 m in height. In fact, evidence of current and recent instability processes can be observed along the entire coastline. In this regard, continuous monitoring is crucial to understand ongoing instabilities in rocky coastlines, as in these settings some instabilities might initiate as slow movements that induce subtle topographic changes whose detection from either satellite or aerial imagery is problematic due to the spatial and temporal resolutions.This research is part of 1) the “COSINES” Project [CGL2017-83909-R], Call 2017 for RETOS Projects funded by the Spanish Economy, Industry and Competitiveness Ministry-Ministerio de Economía, Industria y Competitividad (MINECO), the Spanish Research Agency-Agencia Estatal de Investigación (AEI) and the European Regional Development Found (FEDER) and 2) the GEOCANCOSTA research group, supported by the Asturian Regional Government (Spain) [grant number GRUPIN-IDI-2018-184]

Differences in ex-vivo Chemosensitivity to Anthracyclines in First Line Acute Myeloid Leukemia

Induction schedules in acute myeloid leukemia (AML) are based on combinations of cytarabine and anthracyclines. The choice of the anthracycline employed has been widely studied in multiple clinical trials showing similar complete remission rates. Using an ex vivo test we have analyzed if a subset of AML patients may respond differently to cytarabine combined with idarubicin, daunorubicin or mitoxantrone. Bone marrow (BM) samples of 198 AML patients were incubated for 48 hours in 96 well plates, each well containing different drugs or drug combinations at different concentrations. Ex vivo drug sensitivity analysis was made using the PharmaFlow platform maintaining the BM microenvironment. Drug response was evaluated as depletion of AML blast cells in each well after incubation. Annexin V-FITC was used to quantify the ability of the drugs to induce apoptosis, and pharmacological responses were calculated using pharmacokinetic population models. Similar dose-respond graphs were generated for the three anthracyclines, with a slight decrease in EC with idarubicin (p=1.462E-06), whereas the interpatient variability of either drug was large. To identify those cases of selective sensitivity to anthracyclines, potency was compared, in terms of area under the curve. Differences in anthracycline monotherapy potency greater than 30% from 3 pairwise comparisons were identified in 28.3% of samples. Furthermore, different sensitivity was detected in 8.2% of patients comparing combinations of cytarabine and anthracyclines. A third of the patients could benefit from the use of this test in the first line induction therapy selection, although it should be confirmed in a clinical trial specifically designed

Brain health in diverse settings : How age, demographics and cognition shape brain function

Peer reviewe

A precision medicine test predicts clinical response after idarubicin and cytarabine induction therapy in AML patients

Complete remission (CR) after induction therapy is the first treatment goal in acute myeloid leukemia (AML) patients and has prognostic impact. Our purpose is to determine the correlation between the observed CR/CRi rate after idarubicin (IDA) and cytarabine (CYT) 3 + 7 induction and the leukemic chemosensitivity measured by an ex vivo test of drug activity. Bone marrow samples from adult patients with newly diagnosed AML were included in this study. Whole bone marrow samples were incubated for 48 h in well plates containing IDA, CYT, or their combination. Pharmacological response parameters were estimated using population pharmacodynamic models. Patients attaining a CR/CRi with up to two induction cycles of 3 + 7 were classified as responders and the remaining as resistant. A total of 123 patients fulfilled the inclusion criteria and were evaluable for correlation analyses. The strongest clinical predictors were the area under the curve of the concentration response curves of CYT and IDA. The overall accuracy achieved using MaxSpSe criteria to define positivity was 81%, predicting better responder (93%) than non-responder patients (60%). The ex vivo test provides better yet similar information than cytogenetics, but can be provided before treatment representing a valuable in-time addition. After validation in an external cohort, this novel ex vivo test could be useful to select AML patients for 3 + 7 regimen vs. alternative schedules

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Canagliflozin and renal outcomes in type 2 diabetes and nephropathy

BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to &lt;90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], &gt;300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of &lt;15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P&lt;0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P&lt;0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years