Relationship between intraoperative regional cerebral oxygen saturation trends and cognitive decline after total knee replacement: a post-hoc analysis

Background Bilateral regional brain oxygen saturation (rSO2) trends, reflecting intraoperative brain oxygen imbalance, could warn of brain dysfunction. Various types of cognitive impairment, such as memory decline, alterations in executive function or subjective complaints, have been described three months after surgery. Our aim was to explore the potential utility of rSO2 values as a warning sign for the development of different types of decline in postoperative psychological function. Methods Observational post-hoc analysis of data for the patient sample (n = 125) of a previously conducted clinical trial in patients over the age of 65 years undergoing total knee replacement under spinal anesthesia. Demographic, hemodynamic and bilateral rSO2 intraoperative values were recorded. An absolute rSO2 value of 20% or >25% below baseline were chosen as relevant cutoffs. Composite function test scores were created from baseline to three months for each patient and adjusted for the mean (SD) score changes for a control group (n = 55). Tests were used to assess visual-motor coordination and executive function (VM-EF) (Wechsler Digit Symbol-Coding and Visual Reproduction, Trail Making Test) and memory (Auditory Verbal Learning, Wechsler Memory Scale); scales were used to assess psychological symptoms. Results We observed no differences in baseline rSO2 values; rSO2 decreased significantly in all patients during surgery (P < 0.0001). Seventy-five patients (60%) had no sign of cognitive decline or psychological symptoms. Twenty-one patients (16.8%) had memory decline, 3 (2.4%) had VM-EF decline, and 33 (26.4%) had psychological symptoms. Left and right rSO2 values were asymmetric in patients who had memory decline (mean [SD] left-right ratio of 95.03 [8.51] vs 101.29 [6.7] for patients with no changes, P = 0.0012). The mean right-left difference in rSO2 was also significant in these patients (-2.87% [4.73%], lower on the right, P = 0.0034). Conclusions Detection of a trend to asymmetry in rSO2 values can warn of possible postoperative onset of memory decline. Psychological symptoms and memory decline were common three months after knee replacement in our patients over the age of 65 years

Association between depressive and anxious symptoms with cognitive function and quality of life in drug-resistant epilepsy

Altres ajuts: acords transformatius de la UABDepressive/anxious disorders and cognitive impairment are frequent comorbidities in epilepsy and have a more deleterious effect in DRE.•Studies concerning the relationship between anxiety and depression and cognitive performance in DRE are scarce.•Higher scores in HADS are associated with lower QOLIE-31 scores and might be considered as predictors of QOL in DRE.•A relationship between anxious and depressive symptoms -measured with HADS and SCL-90R- and cognition might not exist.•There remains an unexplored study area regarding this relationship which requires more attention to improve the assessment of DRE

Epilepsy surgery in drug resistant temporal lobe epilepsy associated with neuronal antibodies

We assessed the outcome of patients with drug resistant epilepsy and neuronal antibodies who underwent epilepsy surgery. Retrospective study, information collected with a questionnaire sent to epilepsy surgery centers. Thirteen patients identified, with antibodies to GAD (8), Ma2 (2), Hu (1), LGI1 (1) or CASPR2 (1). Mean age at seizure onset: 23 years. Five patients had an encephalitic phase. Three had testicular tumors and five had autoimmune diseases. All had drug resistant temporal lobe epilepsy (median: 20 seizures/month). MRI showed unilateral temporal lobe abnormalities (mainly hippocampal sclerosis) in 9 patients, bilateral abnormalities in 3, and was normal in 1. Surgical procedures included anteromesial temporal lobectomy (10 patients), selective amygdalohippocampectomy (1), temporal pole resection (1) and radiofrequency ablation of mesial structures (1). Perivascular lymphocytic infiltrates were seen in 7/12 patients. One year outcome available in all patients, at 3 years in 9. At last visit 5/13 patients (38.5%) (with Ma2, Hu, LGI1, and 2 GAD antibodies) were in Engel's classes I or II. Epilepsy surgery may be an option for patients with drug resistant seizures associated with neuronal antibodies. Outcome seems to be worse than that expected in other etiologies, even in the presence of unilateral HS. Intracranial EEG may be required in some patients

Importancia de la variable "Investigador" en los resultados de las técnicas de control

This paper tries to contribute to a better knowledge of factors or mechanisms to which the �package� technique of Azrin and Nunn known as �habit reversal� -designed to modify onychophagy-, really owns its success. The article tries to give an empirical answer to the question of whether the interpersonal relation between the therapist and the client (accidental element of this technique), influences the results. In the experiment 36 women with at least a year of habit history were divided into three groups: a) Group 1, to which is administrated the habit reversal technique; b) Group 2, the same technique is applied but with some complementary interactions therapist/client; c) group 3, control group. The results corroborate the high efficiency of the technique founded by other authors and suggest also that even if a higher number of interactions between the therapist and the client seems not to have much short term influence, could be a main factor to consolidate the achieved results and to avoid future relapses.El presente trabajo desea contribuir en algun medida a un mejor conocimiento de los factores o mecanismos a los que verdaderamente debe su éxito la técnica �paquete� de Azrin y Nunn denominada �inversión del hábito�, diseñada para modificar la conducta de onicofagia. Trata de dar una respuesta empírica a la pregunta de hasta que punto la relación interpersonal que se establece entre el terapeuta y el cliente -elemento accidental en esta técnica- influye en los resultados. Han participado en la experiencia como sujetos 36 mujeres con un arraigo del hábito superior a un año, divididas en tres grupos: a) Grupo 1, al que se ha administrado la técnica de inversión del hábito; b) Grupo 2, al que se le ha aplicado la misma técnica pero con interacciones del terapeuta-cliente complementarias; y c) Grupo 3, de control. Los resultados comprobaron la elevada eficacia de la técnica encontrada por otros autores pero sugieren, además, que aunque un mayor número de interacciones entre el terapeuta y el cliente parece tener escasa influencia a corto plazo, puede ser un factor decisivo en la consolidación de los resultados obtenidos y para evitar recaídas en el futuro

Indefensión aprendida y dependencia de sustancias

Objetivo. Realizar una revisión sistemática de la teoría de la indefensión aprendida así como de la relación entre ésta y la dependencia de sustancias. Material y métodos. Se realizó una búsqueda sistemática de la bibliografía a través dle sistema MEDLINE y PSYCINFO sobre artículos relacionados con el tema. Resultados. La teoría de la indefensión aprendida puede aplicarse al ámbito de las adicciones como modelo explicativo de la incontrolabilidad, eje central de estos trastornos. Concretamente, la indefensión aprendida desempeñaría un papel relevante como variable predictora de consumo y como variable relacionada con la evolución de dicho consumo, asociándose a alteraciones emocionales y déficits neuropsicológicos. Conclusiones. La indefensión aprendida constituye un paradigma válido aplicable a los trastornos por dependencia de sustancias. Se requiere de más estudios para determinar sus implicaciones clínicas y terapéutucas en las adicciones

Relationship between intraoperative regional cerebral oxygen saturation trends and cognitive decline after total knee replacement: a post-hoc analysis

Background Bilateral regional brain oxygen saturation (rSO2) trends, reflecting intraoperative brain oxygen imbalance, could warn of brain dysfunction. Various types of cognitive impairment, such as memory decline, alterations in executive function or subjective complaints, have been described three months after surgery. Our aim was to explore the potential utility of rSO2 values as a warning sign for the development of different types of decline in postoperative psychological function. Methods Observational post-hoc analysis of data for the patient sample (n = 125) of a previously conducted clinical trial in patients over the age of 65 years undergoing total knee replacement under spinal anesthesia. Demographic, hemodynamic and bilateral rSO2 intraoperative values were recorded. An absolute rSO2 value of 20% or >25% below baseline were chosen as relevant cutoffs. Composite function test scores were created from baseline to three months for each patient and adjusted for the mean (SD) score changes for a control group (n = 55). Tests were used to assess visual-motor coordination and executive function (VM-EF) (Wechsler Digit Symbol-Coding and Visual Reproduction, Trail Making Test) and memory (Auditory Verbal Learning, Wechsler Memory Scale); scales were used to assess psychological symptoms. Results We observed no differences in baseline rSO2 values; rSO2 decreased significantly in all patients during surgery (P < 0.0001). Seventy-five patients (60%) had no sign of cognitive decline or psychological symptoms. Twenty-one patients (16.8%) had memory decline, 3 (2.4%) had VM-EF decline, and 33 (26.4%) had psychological symptoms. Left and right rSO2 values were asymmetric in patients who had memory decline (mean [SD] left-right ratio of 95.03 [8.51] vs 101.29 [6.7] for patients with no changes, P = 0.0012). The mean right-left difference in rSO2 was also significant in these patients (-2.87% [4.73%], lower on the right, P = 0.0034). Conclusions Detection of a trend to asymmetry in rSO2 values can warn of possible postoperative onset of memory decline. Psychological symptoms and memory decline were common three months after knee replacement in our patients over the age of 65 years

Validation of an automatic dose injection system for Ictal SPECT in epilepsy

The purpose of our study was to evaluate the performance and clinical usefulness of an automated injector system (AIS) that administers an automated injection for ictal SPECT after calculating the volume of tracer to be injected over time. Methods: To test the AIS, repeated injections were performed at different times after tracer preparation. The clinical study consisted of 56 patients with drug-resistant, complex partial seizures. Tracer for ictal SPECT was injected using automated injection in 27 patients and manual injection (MI) in the remaining 29. Injection time (TI) was measured in seconds from seizure onset to the end of volume injection. The SISCOM (Subtraction Ictal Spect Co-registered to MRI) procedure was used to locate the epileptogenic seizure focus with SPECT. The definition of seizure focus was made by consensus of the epilepsy unit using conventional diagnostic methods. Results: During the experimental phase, there were no system failures, and the error in injected doses when using automated injection was lower than with MI. During the clinical phase, TI using manual injection was 41 s with a range of 14-103 s, compared with an AIS average of 33 s with a range of 19-63 s (P , 0.05). Ictal SPECT and SISCOM successfully localized the seizure focus in 21 of the 27 patients (78%) by AIS and in 19 of the 29 patients (65%) by MI (P 5 0.14). Furthermore, nursing staff found the AIS method more convenient than the MI method. Conclusion: An AIS can improve the quality of work of the nursing staff in the neurology ward and allow a finer adjustment of the injection dose. Early results using an AIS would indicate a reduction in injection time and improved SPECT accuracy

Psicobiología de las conductas agresivas

En este artículo hacemos una revisión sobre qué es la agresión y la violencia, para desentrañar sus posibles causas psicobiológicas, ya que consideramos que el estudio de los mecanismos psicobiológicos de la agresión hará posible un mayor entendimiento de la evolución de este comportamiento hasta el ser humano, así como una mejor clasificación de las manifestaciones patológicas de las conductas violentas. Definimos la violencia como una agresión destructiva que implica imposición de daños físicos a personas o a objetos de su propiedad, en cuanto que tales objetos son medios de vida para las personas agredidas o símbolos de ellas. Presentamos los diversos modelos psicobiológicos: genéticos, endocrinológicos, etológicos y neurobiológicos; describiendo cómo ciertos tipos de conductas violentas impulsivas patológicas, pueden ser abordadas como un problema comportamental con cierto correlato biológico

Diferencias sexuales en el sistema nervioso humano: una revisión desde el punto de vista psiconeurobiológico

Resumo: Actualmente tem sido descrita a existência de diferenças sexuais na neuropsicologia da cognição. Neste estudo teórico abordamos o tema do papel que os factores biológicos desempenham nas ditas diferenças. Tem sido demonstrado que as mulheres têm vantagem sobre os homens nas capacidades verbais, na motricidade fina e na velocidade perceptiva, enquanto que os homens têm melhores capacidades para resolver provas espaciais. Estas diferenças relacionadas com a cognição podem ser explicadas com base em seis hipóteses: organização cerebral diferente, factores endócrinos, meio ambiente social, modelo genético, velocidade de maturação e hipótese antropológica. Após um estudo cuidadoso destas hipóteses podemos concluir que as diferenças sexuais na neuropsicologia da cognição são, em parte, a factores genéticos, e em parte, podem ser moduladas por factores socio-culturais. A variável sexual deve ser considerada como independente na avaliação de diferentes programas e ter em conta o dimorfismo sexual cerebral para explicar as diferenças na prevalência de distintas patologias neuropsiquiátricas. Palavras Chave: Assimetria funcional. Diferenças sexuais. Dismorfismo sexual cerebral. Estudo teórico.Resumen: Actualmente se ha descrito la existencia de diferencias sexuales en la neuropsicología de la cognición. En este estudio teórico abordamos el tema de si los factores biológicos desempeñan un papel importante en dichas diferencias. Ha sido demostrado que las mujeres aventajan a los hombres en habilidades verbales, en motricidad fina y en velocidad perceptiva, mientras que los hombres adultos tienen mayor habilidad para resolver pruebas espaciales, estas diferencias cognitivas se pueden explicar mediante seis hipótesis: organización cerebral diferente, factores endocrinos, medio ambiente social, modelo genético, velocidad de maduración e hipótesis antropológica. Tras el estudio detallado de estas hipótesis podemos llegar a la conclusión que las diferencias sexuales en la neuropsicología de la cognición son debidas, en parte, a factores genéticos y, en parte, pueden ser moduladas por los factores socio-culturales. Hay que considerar al sexo como una variable independiente en la evaluación de diferentes programas y tener en cuenta el dimorfismo sexual cerebral para explicar las diferencias en la prevalencia de distintas patologías neuropsiquiátricas. Palabras Clave: Asimetría funcional. Diferencias sexuales. Dimorfismo sexual cerebral. Estudio teórico