Psychology in Latin America: Legacies and Contributions. Part 3

The purpose of this series is to advance the dissemination of psychological knowledge generated in Latin America and the Caribbean in an effort to balance the predominant influence and presence of European psychology and, more recently, Asian psychology, in the U.S.A. This is the third and final part of a series discussing the Interamerican Society of Psychology (www.sipsych.org), known as SIP (for the acronym of its name in Spanish, Sociedad Interamericana de Psicología) and featuring the Spanish or Portuguese speaking psychologists distinguished with the Interamerican Psychology Award. Every two years, SIP’s board of directors, in consultation with nominations from SIP’s membership, grants an award to an English or French speaking psychologist and another to a Spanish or Portuguese speaking psychologist1 whose work has advanced psychology as a science and profession in the Americas.Fil: Consoli, Andres J.. University of California; Estados UnidosFil: Morgan Consoli, Melisa L.. University of California; Estados UnidosFil: Klappenbach, Hugo Alberto Arturo. Universidad Nacional de San Luis. Facultad de Psicología. Instituto de Ciencias Computacionales, Cognitivas, Psicológicas y Sociales; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - San Luis; ArgentinaFil: Scheltzer, Joshua. University of California; Estados UnidosFil: Romero Morales, Ana. University of California; Estados Unido

Brain-Computer Interfaces: Investigating the Transition from Visually Evoked to Purely Imagined Steady-State Potentials

Brain-Computer Interfaces (BCIs) based on Steady State Visually Evoked Potentials (SSVEPs) have proven effective and provide significant accuracy and information-transfer rates. This family of strategies, however, requires external devices that provide the frequency stimuli required by the technique. This limits the scenarios in which they can be applied, especially when compared to other BCI approaches. In this work, we have investigated the possibility of obtaining frequency responses in the EEG output based on the pure visual imagination of SSVEP-eliciting stimuli. Our results show that not only that EEG signals present frequency-specific peaks related to the frequency the user is focusing on, but also that promising classification accuracy can be achieved, paving the way for a robust and reliable visual imagery BCI modality. Clinical relevance-Brain computer interfaces play a fundamental role in enhancing the quality of life of patients with severe motor impairments. Strategies based on purely imagined stimuli, like the one presented here, are particularly impacting, especially in the most severe cases

Delayed Bilateral Symptomatic Vasospasm after Resection of a Skull Base Meningioma: Report on a New Case and Literature Review

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Congenital defects of pericardium: case reports and review of literature

Introduction: Pericardial defects are a rare condition, generally asymptomatic, due to failure in development of pericardial sac. They are difficult to detect, particularly the complete absence of the pericardium. At present magnetic resonance imaging (MRI) is considered the best performing exam and it could be the first choice in the diagnosis of agenesia of the pericardium. Materials and Methods: A comprehensive review of dedicated books and PubMed literature was performed and three clinical cases have been analyzed. Results: We report three cases , one with partial and two with total agenesia of the left pericardium, seen at our Institute and diagnosed at MRI as unexpected findings. Discussion: The diagnosis of a congenital defect of the pericardium is challenging, even for expert radiologists, because this kind of deformity does not provide specific clinical nor conventional radiology findings. Nowadays, the most effective instrument for a certain diagnosis is MRI, interlocked with electrocardiography

Semi-quantitative and qualitative evaluation of pial leptomeningeal collateral circulation in acute ischemic stroke of the anterior circulation: the Careggi Collateral Score

Introduction: The imaging of ischemic penumbra in acute stroke is a debated issue and establishing commonly accepted criteria is difficult. Computerized tomography-perfusion studies conducted in animals have showed that the modifications occurring in the brain parenchima are part of a dynamic and progressive process involving the microcirculation. The purpose of this paper is to propose a new angiographic classification of collateral circulation in patients with acute ischemic stroke, with a possible correlation with the clinical outcome. Materials and methods: The basal angiograms of 57 patients with acute ischemic stroke is the territory of anterior circulation secondary to a major occlusion, who underwent endovascular treatment, were retrospectively reviewed and collaterals were classified according to our novel Careggi Collateral Score in 6 grades (0-6). The clinical outcome after 3 months was evaluated with modified Rankin Scale. A ROC (receiver operating characteristic) curve analysis identified a cut-off value of 1. Results: Patients with favorable collateral circulation (grades 2-5) showed a significant correlation with good clinical outcome (modified Rankin Scale ≤2). Conclusions: The Careggi Collateral Score resulted a useful tool to evaluate the chance of obtaining a favorable result with endovascular treatment in patients with acute ischemic stroke in the anterior circulation secondary to the occlusion of a major artery

Effect of extracranial lesion severity on outcome of endovascular thrombectomy in patients with anterior circulation tandem occlusion: analysis of the TITAN registry

Introduction Endovascular treatment (EVT) for tandem occlusion (TO) of the anterior circulation is complex but effective. The effect of extracranial internal carotid artery (EICA) lesion severity on the outcomes of EVT is unknown. In this study we investigated the effect of EICA lesion severity on the outcomes of tandem occlusion EVT. Methods A multicenter retrospective TITAN (Thrombectomy In TANdem lesions) study that included 18 international endovascular capable centers was performed. Patients who received EVT for atherosclerotic TO with or without EICA lesion intervention were included. Patients were divided into two groups based on the EICA lesion severity (high-grade stenosis (>= 90% North American Symptomatic Carotid Endarterectomy Trial) vs complete occlusion). Outcome measures included the 90-day clinical outcome (modified Rankin Scale score (mRS)), angiographic reperfusion (modified Thrombolysis In Cerebral Ischemia (mTICI) at the end of the procedure), procedural complications, and intracranial hemorrhage at 24 hours follow-up. Results A total of 305 patients were included in the study, of whom 135 had complete EICA occlusion and 170 had severe EICA stenosis. The EICA occlusion group had shorter mean onset-to-groin time (259 +/- 120 min vs 305 +/- 202 min;p=0.037), more patients with diabetes, and fewer with hyperlipidemia. With respect to the outcome, mTICI 2b-3 reperfusion was lower in the EICA occlusion group (70% vs 81%;p=0.03). The favorable outcome (90-day mRS 0-2), intracerebral hemorrhage and procedural complications were similar in both groups. Conclusion Atherosclerotic occlusion of the EICA in acute tandem strokes was associated with a lower rate of mTICI 2b-3 reperfusion but similar functional and safety outcomes when compared with high-grade EICA stenosis

Time to treatment with bridging intravenous alteplase before endovascular treatment:subanalysis of the randomized controlled SWIFT-DIRECT trial.

BACKGROUND We hypothesized that treatment delays might be an effect modifier regarding risks and benefits of intravenous thrombolysis (IVT) before mechanical thrombectomy (MT). METHODS We used the dataset of the SWIFT-DIRECT trial, which randomized 408 patients to IVT+MT or MT alone. Potential interactions between assignment to IVT+MT and expected time from onset-to-needle (OTN) as well as expected time from door-to-needle (DTN) were included in regression models. The primary outcome was functional independence (modified Rankin Scale (mRS) 0-2) at 3 months. Secondary outcomes included mRS shift, mortality, recanalization rates, and (symptomatic) intracranial hemorrhage at 24 hours. RESULTS We included 408 patients (IVT+MT 207, MT 201, median age 72 years (IQR 64-81), 209 (51.2%) female). The expected median OTN and DTN were 142 min and 54 min in the IVT+MT group and 129 min and 51 min in the MT alone group. Overall, there was no significant interaction between OTN and bridging IVT assignment regarding either the functional (adjusted OR (aOR) 0.76, 95% CI 0.45 to 1.30) and safety outcomes or the recanalization rates. Analysis of in-hospital delays showed no significant interaction between DTN and bridging IVT assignment regarding the dichotomized functional outcome (aOR 0.48, 95% CI 0.14 to 1.62), but the shift and mortality analyses suggested a greater benefit of IVT when in-hospital delays were short. CONCLUSIONS We found no evidence that the effect of bridging IVT on functional independence is modified by overall or in-hospital treatment delays. Considering its low power, this subgroup analysis could have missed a clinically important effect, and exploratory analysis of secondary clinical outcomes indicated a potentially favorable effect of IVT with shorter in-hospital delays. Heterogeneity of the IVT effect size before MT should be further analyzed in individual patient meta-analysis of comparable trials. TRIAL REGISTRATION NUMBER URL: https://www. CLINICALTRIALS gov ; Unique identifier: NCT03192332

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

La collatéralité et les anastomoses leptoméningées dans les accidents vasculaires cérébraux

L’objet de cette thèse est centré sur l’évaluation de la circulation collatérale chez les patients présentant un accident vasculaire cérébral ischémique (AVCi). Le rôle de cette circulation collatérale a été investigué dans la littérature alors que les caractéristiques hémodynamiques restent encore peu connues. Depuis 2018 on a pu observer un intérêt croissant autour de la circulation collatérale et plusieurs équipes dans le monde ont concentré leurs efforts dans la compréhension de la physiopathologie des AVCi ainsi que dans des nouvelles méthodes d’imagerie pour décrire de manière plus détaillée le fonctionnement hémodynamique de la circulation collatérale.Les objectifs de la thèse ont été développés sur trois axes distincts : (i) l’analyse de l’impact clinique de la circulation collatérale dans les accidents vasculaires cérébraux ischémiques, (ii) l’analyse critique de l’évaluation de la circulation collatérale par artériographie cérébrale et le (iii) développement d’un algorithme de caractérisation de la circulation collatérale applicable en temps réel aux images artériographiques.L’impact clinique de la circulation collatérale représente une étape essentielle dans la compréhension physiopathologique. Plusieurs études ont mis en évidence des corrélations significatives entre une bonne circulation collatérale et les résultats cliniques favorables et les patients avec une bonne circulation collatérale sont considérés comme les meilleurs candidats pour les procédures de thrombectomie mécanique. Dans cette thèse je présente les résultats d’une étude rétrospective d’analyse clinique (étude UNCLOSE), ciblée sur ce sous-groupe spécifique de patients présentant un AVCi et une bonne circulation collatérale évaluée par artériographie cérébrale (échelle ASITN/SIR) et traités par thrombectomie mécanique. Les conclusions de cette étude ont mis en évidence un résultat clinique défavorable dans presque la moitié de ce sous-groupe (47%) malgré la présence d’une bonne circulation collatérale. Les facteurs qui peuvent expliquer ce type de résultats ne différent pas de ceux déjà décrit chez les patients avec une collatéralité insuffisante ou absente, avec l’exception de l’absence de significativité du First Pass Effect et un rôle protectif de la thrombolyse intraveineuse. En outre, ces résultats posent l’accent sur la modalité d’évaluation de la circulation collatérale par artériographie cérébrale et la nécessité de proposer d’autres paramètres d’évaluation.Un nouveau paramètre d’évaluation a été décrit tout en proposant une analyse critique de l’évaluation artériographique de la circulation collatérale : la phase veineuse artériographique de la collatéralité (CVP, collateral venous phase). Je présente les résultats d’une étude rétrospective d’évaluation artériographique de la présence d’une phase veineuse collatérale en rapport avec l’efficacité de la circulation collatérale (évaluation qualitative). Ce type de paramètre représente l’interprétation physiopathologique du rôle du système veineux et venulaire de la circulation collatérale dans le maintien de la perfusion cérébrale pendant l’occlusion artérielle et l’évolution de l’ischémie cérébrale. Le CVP a été comparé à l’évaluation faite par l’échelle ASITN/SIR et le CVP seul ainsi que l’évaluation composite de ces deux paramètres ont montré des meilleurs résultats en termes de corrélation avec les résultats cliniques.La dernière partie de la thèse est centrée sur le développement d’un algorithme de caractérisation de la circulation collatérale (algorithme ASCOT). L’algorithme permettra d’analyser en temps réel les images d’artériographie cérébrale en cours de traitement par thrombectomie mécanique et de fournir des données d’efficacité de la circulation collatérale qui pourront aider à élargir les connaissances physiopathologiques sur les AVCi, orienter les choix thérapeutiques intra-procédurales et de prise en charge post-procédurale.The focus of this thesis is on the evaluation of collateral circulation in patients with acute ischemic stroke (AIS). The role of this collateral circulation has been investigated in the literature while the hemodynamic characteristics are still little known. Since 2018 there has been a growing interest around collateral circulation and several teams around the world have focused their efforts on understanding the pathophysiology of AIS as well as on new imaging methods to further describe the hemodynamic functioning of the collateral circulation.The objectives of the thesis were developed on three distinct axes: (i) the analysis of the clinical impact of collateral circulation in ischemic stroke, (ii) the critical analysis of collateral circulation assessment by cerebral angiography and (iii) the development of a real-time collateral circulation characterization algorithm for angiographic images.The clinical impact of collateral circulation is an essential step in the pathophysiological understanding. Several studies have shown significant correlations between good collateral circulation and favorable clinical outcomes and patients with good collateral circulation are considered the best candidates for mechanical thrombectomy procedures. In this thesis I present the results of a retrospective clinical analysis study (UNCLOSE study), targeted on this specific subgroup of patients with AIS and good collateral circulation evaluated by cerebral arteriography (ASITN/SIR scale) and treated by mechanical thrombectomy. The findings of this study showed an adverse clinical outcome in almost half of this subgroup (47%) despite the presence of good collateral circulation. The factors that may explain this type of results are not different from those already described in patients with insufficient or absent collaterals, with the exception of the lack of significance of First Pass Effect and a protective role of intravenous thrombolysis. In addition, these results focus on the modality of evaluation of collateral circulation by cerebral arteriography and the need to propose other evaluation parameters.A new evaluation parameter was described while proposing a critical analysis of the angiographical evaluation of collateral circulation: the angiographical venous phase of collateral (CVP, collateral venous phase). I present the results of a retrospective study of angiographic evaluation of the presence of a collateral venous phase in relation to the collateral circulation efficiency (qualitative evaluation). This type of parameter represents the physiopathological interpretation of the role of the venous and venular system of collateral circulation in maintaining cerebral perfusion during arterial occlusion and progression of cerebral ischemia. The CVP was compared to the ASITN/SIR assessment and the CVP alone and the composite assessment of these two parameters showed better results in terms of correlation with clinical results.The last part of the thesis focuses on the development of a collateral circulation characterization algorithm (ASCOT). The algorithm will enable real-time analysis of brain angiography images acquired during mechanical thrombectomy procedures and provide data about collateral circulation effectiveness that could help expand pathophysiology knowledge on AIS, and drive intraprocedural and post-procedural treatment choices

La collatéralité et les anastomoses leptoméningées dans les accidents vasculaires cérébraux

The focus of this thesis is on the evaluation of collateral circulation in patients with acute ischemic stroke (AIS). The role of this collateral circulation has been investigated in the literature while the hemodynamic characteristics are still little known. Since 2018 there has been a growing interest around collateral circulation and several teams around the world have focused their efforts on understanding the pathophysiology of AIS as well as on new imaging methods to further describe the hemodynamic functioning of the collateral circulation.The objectives of the thesis were developed on three distinct axes: (i) the analysis of the clinical impact of collateral circulation in ischemic stroke, (ii) the critical analysis of collateral circulation assessment by cerebral angiography and (iii) the development of a real-time collateral circulation characterization algorithm for angiographic images.The clinical impact of collateral circulation is an essential step in the pathophysiological understanding. Several studies have shown significant correlations between good collateral circulation and favorable clinical outcomes and patients with good collateral circulation are considered the best candidates for mechanical thrombectomy procedures. In this thesis I present the results of a retrospective clinical analysis study (UNCLOSE study), targeted on this specific subgroup of patients with AIS and good collateral circulation evaluated by cerebral arteriography (ASITN/SIR scale) and treated by mechanical thrombectomy. The findings of this study showed an adverse clinical outcome in almost half of this subgroup (47%) despite the presence of good collateral circulation. The factors that may explain this type of results are not different from those already described in patients with insufficient or absent collaterals, with the exception of the lack of significance of First Pass Effect and a protective role of intravenous thrombolysis. In addition, these results focus on the modality of evaluation of collateral circulation by cerebral arteriography and the need to propose other evaluation parameters.A new evaluation parameter was described while proposing a critical analysis of the angiographical evaluation of collateral circulation: the angiographical venous phase of collateral (CVP, collateral venous phase). I present the results of a retrospective study of angiographic evaluation of the presence of a collateral venous phase in relation to the collateral circulation efficiency (qualitative evaluation). This type of parameter represents the physiopathological interpretation of the role of the venous and venular system of collateral circulation in maintaining cerebral perfusion during arterial occlusion and progression of cerebral ischemia. The CVP was compared to the ASITN/SIR assessment and the CVP alone and the composite assessment of these two parameters showed better results in terms of correlation with clinical results.The last part of the thesis focuses on the development of a collateral circulation characterization algorithm (ASCOT). The algorithm will enable real-time analysis of brain angiography images acquired during mechanical thrombectomy procedures and provide data about collateral circulation effectiveness that could help expand pathophysiology knowledge on AIS, and drive intraprocedural and post-procedural treatment choices.L’objet de cette thèse est centré sur l’évaluation de la circulation collatérale chez les patients présentant un accident vasculaire cérébral ischémique (AVCi). Le rôle de cette circulation collatérale a été investigué dans la littérature alors que les caractéristiques hémodynamiques restent encore peu connues. Depuis 2018 on a pu observer un intérêt croissant autour de la circulation collatérale et plusieurs équipes dans le monde ont concentré leurs efforts dans la compréhension de la physiopathologie des AVCi ainsi que dans des nouvelles méthodes d’imagerie pour décrire de manière plus détaillée le fonctionnement hémodynamique de la circulation collatérale.Les objectifs de la thèse ont été développés sur trois axes distincts : (i) l’analyse de l’impact clinique de la circulation collatérale dans les accidents vasculaires cérébraux ischémiques, (ii) l’analyse critique de l’évaluation de la circulation collatérale par artériographie cérébrale et le (iii) développement d’un algorithme de caractérisation de la circulation collatérale applicable en temps réel aux images artériographiques.L’impact clinique de la circulation collatérale représente une étape essentielle dans la compréhension physiopathologique. Plusieurs études ont mis en évidence des corrélations significatives entre une bonne circulation collatérale et les résultats cliniques favorables et les patients avec une bonne circulation collatérale sont considérés comme les meilleurs candidats pour les procédures de thrombectomie mécanique. Dans cette thèse je présente les résultats d’une étude rétrospective d’analyse clinique (étude UNCLOSE), ciblée sur ce sous-groupe spécifique de patients présentant un AVCi et une bonne circulation collatérale évaluée par artériographie cérébrale (échelle ASITN/SIR) et traités par thrombectomie mécanique. Les conclusions de cette étude ont mis en évidence un résultat clinique défavorable dans presque la moitié de ce sous-groupe (47%) malgré la présence d’une bonne circulation collatérale. Les facteurs qui peuvent expliquer ce type de résultats ne différent pas de ceux déjà décrit chez les patients avec une collatéralité insuffisante ou absente, avec l’exception de l’absence de significativité du First Pass Effect et un rôle protectif de la thrombolyse intraveineuse. En outre, ces résultats posent l’accent sur la modalité d’évaluation de la circulation collatérale par artériographie cérébrale et la nécessité de proposer d’autres paramètres d’évaluation.Un nouveau paramètre d’évaluation a été décrit tout en proposant une analyse critique de l’évaluation artériographique de la circulation collatérale : la phase veineuse artériographique de la collatéralité (CVP, collateral venous phase). Je présente les résultats d’une étude rétrospective d’évaluation artériographique de la présence d’une phase veineuse collatérale en rapport avec l’efficacité de la circulation collatérale (évaluation qualitative). Ce type de paramètre représente l’interprétation physiopathologique du rôle du système veineux et venulaire de la circulation collatérale dans le maintien de la perfusion cérébrale pendant l’occlusion artérielle et l’évolution de l’ischémie cérébrale. Le CVP a été comparé à l’évaluation faite par l’échelle ASITN/SIR et le CVP seul ainsi que l’évaluation composite de ces deux paramètres ont montré des meilleurs résultats en termes de corrélation avec les résultats cliniques.La dernière partie de la thèse est centrée sur le développement d’un algorithme de caractérisation de la circulation collatérale (algorithme ASCOT). L’algorithme permettra d’analyser en temps réel les images d’artériographie cérébrale en cours de traitement par thrombectomie mécanique et de fournir des données d’efficacité de la circulation collatérale qui pourront aider à élargir les connaissances physiopathologiques sur les AVCi, orienter les choix thérapeutiques intra-procédurales et de prise en charge post-procédurale