High prevalence of obstructive sleep apnea syndrome in Spain’s Stroke Belt

[Objective] Spain’s so-called Stroke Belt is an area with high prevalence of vascular disease. We aimed to determine the prevalence of undetected obstructive sleep apnea–hypopnea syndrome (OSAHS) among patients with acute ischemic stroke (AIS) in southern Spain.[Methods] We conducted a cross-sectional study at the Virgen Macarena University Hospital Stroke Unit during 2018 to 2019. We included patients <72 hours after AIS with a neuroimaging lesion and performed sleep tests.[Results] Seventy-two patients were included. The median participant age was 72 years. Mean body mass index was 27.07 kg/m2, and 40.28% were daily alcohol drinkers. Hypertension, atrial fibrillation, ischemic cardiomyopathy, and previous stroke were detected in 63.9%, 11.1%, 15.3%, and 17.6% of patients, respectively. Polygraphy was feasible in 91.38% of patients. The prevalence of OSAHS was 84.72% (apnea–hypopnea index ≥5). Patients with moderate and severe OSAHS were more likely to be obese and to have a larger neck circumference and facial palsy. The diagnostic criteria of central sleep apnea syndrome were met in only 1.38% of patients.[Conclusions] The high prevalence of OSAHS found in the Spanish Stroke Belt justifies further investigation and development of a screening program as a strategy to identify patients with undetected OSAHS.The authors disclosed receipt of the following financial support for the research, authorship and/or publication of this article: This work was supported by the Neurovascular Research Group, part of the Cooperative Cerebrovascular Disease Research Network (INVICTUS+) (RD16/0019/0015).Peer reviewe

Tissue engineered in-vitro vascular patch fabrication using hybrid 3D printing and electrospinning

Three-dimensional (3D) engineered cardiovascular tissues have shown great promise to replace damaged structures. Specifically, tissue engineering vascular grafts (TEVG) have the potential to replace biological and synthetic grafts. We aimed to design an in-vitro patient-specific patch based on a hybrid 3D print combined with vascular smooth muscle cells (VSMC) differentiation. Based on the medical images of a 2 months-old girl with aortic arch hypoplasia and using computational modelling, we evaluated the most hemodynamically efficient aortic patch surgical repair. Using the designed 3D patch geometry, the scaffold was printed using a hybrid fused deposition modelling (FDM) and electrospinning techniques. The scaffold was seeded with multipotent mesenchymal stem cells (MSC) for later maturation to derived VSMC (dVSMC). The graft showed adequate resistance to physiological aortic pressure (burst pressure 101 ​± ​15 ​mmHg) and a porosity gradient ranging from 80 to 10 ​μm allowing cells to infiltrate through the entire thickness of the patch. The bio-scaffolds showed good cell viability at days 4 and 12 and adequate functional vasoactive response to endothelin-1. In summary, we have shown that our method of generating patient-specific patch shows adequate hemodynamic profile, mechanical properties, dVSMC infiltration, viability and functionality. This innovative 3D biotechnology has the potential for broad application in regenerative medicine and potentially in heart disease prevention.This research was funded by ​Instituto de Salud Carlos III ​through the projects ​PI17/01409, PT20/00069 (Plataforma ISCIII de Biobancos y Biomodelos) and ​PI20/00467 ​(Co-funded by European Regional Development Fund/European Social Fund ​“A way to make Europe"/"Investing in your future”) ​and by the Foundation ​‘Menudos Corazones to help children with heart disease' and the Spanish Society of Paediatric Cardiology and Congenital Heart Disease (SECPCC), grant number ​‘Menudos Corazones 2020’. This work was also supported by the Spanish Ministry of Economy and Competitiveness (PID2019-104084GB-C22) and ANID – Millennium Science Initiative Program – ICN2021_004 and ANID – Millennium Science Initiative Program – NCN17_129, ANID FONDECYT de Iniciación en Investigación #11200481, ANID FONDECYT #1181057

Agrárpiaci Jelentések, Baromfi

Amerikai Egyesült Államok agrárminisztériumának (USDA) májusban megjelent jelentése szerint az USA csirkehústermelése 4,6 millió tonna körül alakult 2017 első negyedévében, ami 2 százalékkal haladta meg az előző év azonos időszakának kibocsátását. Az Európai Bizottság adatai alapján 2017 első 20 hetében 178 euró/100 kilogramm volt az egész csirke uniós átlagára, kismértékben csökkent az előző év hasonló időszakának átlagárához viszonyítva. Magyarországon a vágócsirke élősúlyos termelői ára (245,9 forint/kilogramm) 4,3 százalékkal volt alacsonyabb 2017 20. hetében az egy évvel korábbinál

Association of candidate genetic variants and circulating levels of ApoE/ApoJ with common neuroimaging features of cerebral amyloid angiopathy

IntroductionCerebral amyloid angiopathy (CAA) is characterized by the accumulation of amyloid-beta (A beta) in brain vessels and is a main cause of lobar intracerebral hemorrhage (ICH) in the elderly. CAA is associated with magnetic resonance imaging (MRI) markers of small vessel disease (SVD). Since A beta is also accumulated in Alzheimer's disease (AD) in the brain parenchyma, we aimed to study if several single nucleotide polymorphisms (SNPs) previously associated with AD were also associated with CAA pathology. Furthermore, we also studied the influence of APOE and CLU genetic variants in apolipoprotein E (ApoE) and clusterin/apolipoprotein J (ApoJ) circulating levels and their distribution among lipoproteins. MethodsThe study was carried out in a multicentric cohort of 126 patients with lobar ICH and clinical suspicion of CAA. ResultsWe observed several SNPs associated with CAA neuroimaging MRI markers [cortical superficial siderosis (cSS), enlarged perivascular spaces in the centrum semiovale (CSO-EPVS), lobar cerebral microbleeds (CMB), white matter hyperintensities (WMH), corticosubcortical atrophy and CAA-SVD burden score]. Concretely, ABCA7 (rs3764650), CLU (rs9331896 and rs933188), EPHA1 (rs11767557), and TREML2 (rs3747742) were significantly associated with a CAA-SVD burden score. Regarding circulating levels of apolipoproteins, protective AD SNPs of CLU [rs11136000 (T) and rs9331896 (C)] were significantly associated with higher HDL ApoJ content in the lobar ICH cohort. APOE epsilon 2 carriers presented higher plasma and LDL-associated ApoE levels whereas APOE epsilon 4 carriers presented lower plasma ApoE levels. Additionally, we observed that lower circulating ApoJ and ApoE levels were significantly associated with CAA-related MRI markers. More specifically, lower LDL-associated ApoJ and plasma and HDL-associated ApoE levels were significantly associated with CSO-EPVS, lower ApoJ content in HDL with brain atrophy and lower ApoE content in LDL with the extent of cSS. DiscussionThis study reinforces the relevance of lipid metabolism in CAA and cerebrovascular functionality. We propose that ApoJ and ApoE distribution among lipoproteins may be associated with pathological features related to CAA with higher ApoE and ApoJ levels in HDL possibly enhancing atheroprotective, antioxidative, and anti-inflammatory responses in cerebral beta-amyloidosis

Urocortin-2 Prevents Dysregulation of Ca2+ Homeostasis and Improves Early Cardiac Remodeling After Ischemia and Reperfusion

Aims: Urocortin-2 (Ucn-2) is a potent cardioprotector against Ischemia and Reperfusion (I/R) injuries. However, little is known about its role in the regulation of intracellular Ca2+ concentration ([Ca2+]i) under I/R. Here, we examined whether the addition of Ucn-2 in reperfusion promotes cardioprotection focusing on ([Ca2+]i handling.Methods and Results: Cardiac Wistar rat model of I/R was induced by transient ligation of the left coronary artery and experiments were conducted 1 week after surgery in tissue and adult cardiomyocytes isolated from risk and remote zones. We observed that I/R promoted significant alteration in cardiac contractility as well as an increase in hypertrophy and fibrosis in both zones. The study of confocal [Ca2+]i imaging in adult cardiomyocytes revealed that I/R decreased the amplitude of [Ca2+]i transient and cardiomyocytes contraction in risk and remote zones. Interestingly, intravenous infusion of Ucn-2 before heart’s reperfusion recovered significantly cardiac contractility and prevented fibrosis, but it didn’t affect cardiac hypertrophy. Moreover, Ucn-2 recovered the amplitude of [Ca2+]i transient and modulated the expression of several proteins related to [Ca2+]i homeostasis, such as TRPC5 and Orai1 channels. Using Neonatal Rat Ventricular Myocytes (NRVM) we demonstrated that Ucn-2 blunted I/R-induced Store Operated Ca2+ Entry (SOCE), decreased the expression of TRPC5 and Orai1 as well as their interaction in reperfusion.Conclusion: Our study provides the first evidences demonstrating that Ucn-2 addition at the onset of reperfusion attenuates I/R-induced adverse cardiac remodeling, involving the [Ca2+]i handling and inhibiting the expression and interaction between TRPC5 and Orai1

Neuropsychological tests in patients with vascular cognitive impairment due to cerebral small vessel disease

[ES] El deterioro cognitivo vascular es una de las causas principales de demencia y de discapacidad en el paciente adulto. La enfermedad de pequeño vaso cerebral (EPVC) representa la etiología más frecuente. El objetivo es cuáles pueden ser los mejores test neuropsicológicos para el diagnóstico y el seguimiento del deterioro cognitivo por EPVC en poblaciones que hablam francés o español (incluyendo pacientes iletrados). Se ha realizado una revisión sistemática según la metodología PRISMA. Se ha tomado como referencia los criterios diagnósticos de deterioro cognitivo del manual DSM-5 de 2013. Como test de cribado, la escala de Mattis (validada en castellano y francés) presenta buen rendimiento diagnóstico. En pacientes iletrados de habla castellana, la mejor escala de cribado validada es el Fototest. Para la evaluación de funciones ejecutivas y atención, se han demostrado sensibles las siguientes pruebas: Test del trazo A y B, Test de los 5 dígitos, Test de los símbolos y dígitos y el Test cubos de Corsi Wechsler no verbal. Nuestra batería aplicada por neuropsicólogos puede estandarizar el diagnóstico precoz y seguimiento adecuado de la EPVC en países en los que se habla francés o español.[EN] Vascular cognitive impairment is one of the leading causes of dementia and disability. Cerebral small vessel cerebral vascular disease (CSVD) represents the most frequent etiology. The aim of this study is to evaluate the best neuropsychological tests for the diagnosis and follow-up of cognitive impairment due to CSVD in French and Spanish populations (including illiterate patients). A systematic review was carried out according to PRISMA methodology. The diagnostic criteria for cognitive impairment of the 2013 DSM-5 manual were used. As a screening test, the MATTIS test has showed good diagnostic performance. In illiterate Spanish-speaking patients, the best validated screening tool is Fototest. The following tools have been shown to be sensitive to the evaluation of executive functions and attention: Trail Making Test A and B, the 5-Digit Test, the Symbols and Digits Test, and the non-verbal Wechsler Corsi Cube test. Our battery applied by neuropsychologists can standardize the early diagnosis and adequate follow-up of patients with CSVD in Europe.Peer reviewe

Uncovering the neurological effects of West Nile virus during a record-breaking southern Spain outbreak in 2020–2021

The 2020–21 West Nile Virus (WNV) outbreak in Andalusia, Spain, was the largest reported in the country, with eight cases of West Nile Neuroinvasive Disease (WNND) diagnosed in a tertiary hospital. Diagnosis of WNND is based on detecting WNV RNA, viral isolation, or demonstrating a specific immune response against the virus, with additional tests used to support the diagnosis. Treatment remains supportive, with variable outcomes. The potential efficacy of plasma exchange (PLEX) in select cases raises the possibility of an autoimmune component secondary to infectious pathology of the central nervous system. The influence of climate change on the expansion of WNV into new regions is a significant concern. It is crucial for physicians practicing in high-risk areas to be knowledgeable about the disease for early prevention and effective control measures.Peer reviewe

Efficacy of clozapine versus standard treatment in adult individuals with intellectual disability and treatment-resistant psychosis (CLOZAID): study protocol of a multicenter randomized clinical trial

BackgroundIntellectual disability (ID) affects approximately 1% of the worldwide population and individuals with ID have a higher comorbidity with mental illness, and specifically psychotic disorders. Unfortunately, among individuals with ID, limited research has been conducted since ID individuals are usually excluded from mental illness epidemiological studies and clinical trials. Here we perform a clinical trial to investigate the effectiveness of clozapine in the treatment of resistant psychosis in individuals with ID. The article highlights the complexity of diagnosing and treating psychopathological alterations associated with ID and advocates for more rigorous research in this field.MethodsA Phase IIB, open-label, randomized, multicenter clinical trial (NCT04529226) is currently ongoing to assess the efficacy of oral clozapine in individuals diagnosed with ID and suffering from treatment-resistant psychosis. We aim to recruit one-hundred and fourteen individuals (N=114) with ID and resistant psychosis, who will be randomized to TAU (treatment as usual) and treatment-with-clozapine conditions. As secondary outcomes, changes in other clinical scales (PANSS and SANS) and the improvement in functionality, assessed through changes in the Euro-QoL-5D-5L were assessed. The main outcome variables will be analyzed using generalized linear mixed models (GLMM), assessing the effects of status variable (TAU vs. Clozapine), time, and the interaction between them.DiscussionThe treatment of resistant psychosis among ID individuals must be directed by empirically supported research. CLOZAID clinical trial may provide relevant information about clinical guidelines to optimally treat adults with ID and treatment-resistant psychosis and the benefits and risks of an early use of clozapine in this underrepresented population in clinical trials.Trial registrationClinicaltrials.gov: NCT04529226. EudraCT: 2020-000091-37

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p &lt; 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Revisión sobre las mejoras en la comunicación de los pacientes afásicos gracias al uso de aplicaciones digitales

Background: Stroke is an abrupt interruption of brain circulation that constitutes a neurological emergency. Aphasia is a language disorder caused by stroke. It can affect patients’ reading, writing, comprehension and expression. The aim of the study is to find out if the use of the latest portable technologies such as tablets, computers and mobile phones can help to improve the rehabilitation of patients with aphasia. Methods: A literature review has been carried out on the main databases; Pubmed, Scopus and Cinahl, of articles in english and spanish published between june and december 2019 following the PRISMA methodology. Results: Sixty-two articles were included in which the use of technologies alongside traditional rehabilitation therapies showed that might improve the recovery of aphasic patients. Most studies have a sample size of less than fifty patients (21.7%), with only three publications having a sample size of more than 150 patients (1.86%). Conclusions: The review shows that the use of digital applications might improve aphasia rehabilitation in patients who have suffered a stroke, but more studies are needed due to the small sample size of those conducted so far and to explore whether that improvement hold up over time.Fundamentos: El ictus es una interrupción brusca de la circulación cerebral que constituye una urgencia neurológica. La afasia es un trastorno del lenguaje provocado por el ictus, el cual puede afectar a la lectura, la escritura, la comprensión y la expresión de los pacientes. El objetivo del estudio es saber si el uso de las aplicaciones digitales desarrolladas en las tecnologías más recientes como son tabletas, ordenadores y teléfonos móviles pueden ayudar a mejorar la rehabilitación de los pacientes con afasia. Métodos: Se realizó una revisión bibliográfica en las principales bases de datos (Pubmed, Scopus y Cinahl) de artículos en inglés y español publicados entre junio y diciembre de 2019 siguiendo la metodología PRISMA. Resultados: Se incluyeron 62 artículos, en los que se mostró que el uso de las aplicaciones digitales, junto a las terapias tradicionales de rehabilitación, podría mejorar la recuperación de los pacientes afásicos. La mayoría de los estudios tenían un tamaño muestral inferior a cincuenta pacientes, (21,7%) habiendo sólo tres publicaciones que tuvieran un tamaño muestral superior a 150 pacientes (1,86%). Conclusiones: La revisión muestra que el uso de aplicaciones digitales es una ayuda para la rehabilitación de la afasia en pacientes que han sufrido un ictus, pero son necesarios más estudios debido al bajo tamaño muestral de los que se han realizado, y para comprobar si esas mejorías se mantienen en el tiempo