Evolución de las publicaciones en neurología clínica en España, Francia, Italia y Alemania en el período 2000-2009

This study analyzes the productivity and visibility of Spanish publications in the area of clinical neurology in the period 2000-2009 and compared with those for Italy, France and Germany. MATERIALS AND METHODS: We used the database Web of Science. The analysis (annual and in five-year) was restricted to the citable documents (original articles, reviews and proceedings papers). Bibliometric indicators used were the number of publications, citations received by publications and Hirsch's h-index. We also assessed the slope of the annual growth rate (b), the number of publications by language and the international collaboration. RESULTS: In the period 2000-2009 there were 46,114 publications in neurology clinic of which 6,998 were Spanish publications (h = 75), 11,629 in Italy (h = 101), French 9,745 (h = 102) and 20,143 in Germany (h = 124). The rate of increase in the total number of publications in Spain (b = 15) was lower than that observed in Italy (b = 65), Germany (b = 61) or France (b = 34). In the case of publications in English, the growth rate was higher for Spain (b = 37) than for France (b = 36) but lower than for Germany (b = 54) and Italy (b = 65). CONCLUSIONS: Although the total number of publications and the observed increase are lower in Spain compared to Italy, France or Germany, the Spanish publications in Clinical Neurology shows good trend indicators with regard to publications in English and international collaboration. This improvement was associated with greater visibility as showed by the five-year analysis of citations received by Spanish publications

Improving elevation resolution in phased-array inspections for NDT

The Phased Array Ultrasonic Technique (PAUT) offers great advantages over the conventional ultrasound technique (UT), particularly because of beam focusing, beam steering and electronic scanning capabilities. However, the 2D images obtained have usually low resolution in the direction perpendicular to the array elements, which limits the inspection quality of large components by mechanical scanning. This paper describes a novel approach to improve image quality in these situations, by combining three ultrasonic techniques: Phased Array with dynamic depth focusing in reception, Synthetic Aperture Focusing Technique (SAFT) and Phase Coherence Imaging (PCI). To be applied with conventional NDT arrays (1D and non-focused in elevation) a special mask to produce a wide beam in the movement direction was designed and analysed by simulation and experimentally. Then, the imaging algorithm is presented and validated by the inspection of test samples. The obtained images quality is comparable to that obtained with an equivalent matrix array, but using conventional NDT arrays and equipments, and implemented in real time.Fil: Brizuela, Jose David. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Camacho, J.. Consejo Superior de Investigaciones Científicas; EspañaFil: Cosarinsky, Guillermo Gerardo. Comisión Nacional de Energía Atómica; ArgentinaFil: Iriarte, Juan Manuel. Comisión Nacional de Energía Atómica; ArgentinaFil: Cruza, Jorge F.. Consejo Superior de Investigaciones Científicas; Españ

Clasificación de los trastornos del sueño

Sleep disorders are frequent processes, both as a symptom associated with other diseases and as independent disorders. However, only in the last 4 decades has Sleep medicine gained its position among the medical specialties. In fact, it was only in these years that significant advances were obtained in the study of the etiology and treatment of these disorders. Similarly, the different classifications have been evolving over the years. First, they were based upon the clinical symptom; later on, more emphasis was given to the diseases. Finally, in 2005, the new classification was once again based on the symptoms. More than 90 disorders are listed in this latest classification, and an attempt is made to include the symptoms and the diseases of sleep, as well as those in which sleep disorders are fundamental. It is essential to have a clear idea of this complete classification of sleep disorders in order to deal with these patients appropriately

Estimulación vagal en el tratamiento de la epilepsia

The vagal nerve stimulation is a new technique for the treatment of drug resistant epilepsies. DEVELOPMENT: In 1997, it was approved in United States by the FDA to be used in adults with refractory focal epilepsies not candidates for epilepsy surgery. Its mechanism of action is unknown. The results in the controlled studies indicated a decrease of 30 50% in the seizure frequency in around 50% of the patients. Although more experience is needed to corroborate these results, it seems reasonable as a treatment for patients with difficult epilepsies, especially when the response to the antiepileptic drugs is poor or they are producing secondary effects, and the resection of the focus is not possible

Changes in the heart rate variability in patients with obstructive sleep apnea and its response to acute CPAP treatment

Obstructive Sleep Apnea (OSA) is a major risk factor for cardiovascular disease. The goal of this study was to demonstrate whether the use of CPAP produces significant changes in the heart rate or in the heart rate variability of patients with OSA in the first night of treatment and whether gender and obesity play a role in these differences. METHODS: Single-center transversal study including patients with severe OSA corrected with CPAP. Only patients with total correction after CPAP were included. Patients underwent two sleep studies on consecutive nights: the first night a basal study, and the second with CPAP. We also analyzed the heart rate changes and their relationship with CPAP treatment, sleep stages, sex and body mass index. Twenty-minute segments of the ECG were selected from the sleep periods of REM, no-REM and awake. Heart rate (HR) and heart rate variability (HRV) were studied by comparing the R-R interval in the different conditions. We also compared samples from the basal study and CPAP nights. RESULTS: 39 patients (15 females, 24 males) were studied. The mean age was 50.67 years old, the mean AHI was 48.54, and mean body mass index was 33.41 kg/m(2) (31.83 males, 35.95 females). Our results showed that HRV (SDNN) decreased after the use of CPAP during the first night of treatment, especially in non-REM sleep. Gender and obesity did not have any influence on our results. CONCLUSIONS: These findings support that cardiac variability improves as an acute effect, independently of gender or weight, in the first night of CPAP use in severe OSA patients, supporting the idea of continuous use and emphasizing that noncompliance of CPAP treatment should be avoided even if it is just once

Alpha and beta oscillatory activity during a sequence of two movements

OBJECTIVE: We studied movement-related electroencephalographic oscillatory changes in the alpha and beta range during a sequence of two movements in 7 healthy volunteers, in order to investigate the relationship between these changes and each component in the sequence. METHODS: The sequence consisted of a wrist active extension-passive flexion followed by a first and second finger pincer. A total of 10.5 s sweeps were recorded using the level of surface electromyographic (EMG) activity in wrist extensors as trigger, including a 7.5 s pre-stimulus. The sweeps were also realigned manually offline using as trigger the end of the first EMG burst, or the beginning of the second movement. An index of the changes in non-phase-locked energy in the 7-37 Hz range was obtained by averaging single-sweep time-frequency transforms. RESULTS: The duration of each of the movements in the sequence and the relationship between them were compatible with the use of two different motor programmes in the sequence. In the beta band, a decrease in energy (event-related desynchronisation, ERD) began 1.5 s before the onset of the first movement, and was sustained until the end of the second movement. No energy increases were observed until the end of the second movement. In the alpha band, the ERD began 0.5 seconds before the first movement and was sustained throughout the recording. CONCLUSION: These findings suggest that the beta-event-related synchronisation is related to the end of the whole motor process, and not to the end of each motor programme

Paresia poscrítica durante estudios de monitorización de vídeo-EEG

To know the frequency of Todd s paralysis during the video EEG monitoring studies, to investigate in its pathophysiology, and to confirm its value to localise the epileptic focus. PATIENTS AND METHODS: We reviewed 114 monitoring studies, in 102 patients. RESULTS: Sixty patients had epileptic seizures. An obvious paresis was noted in four seizures of two patients (3 and 1, respectively). Both patients had frontal epilepsy. During the paralysis, in the first patient the EEG showed ictal discharges on the contralateral centrotemporal area. In the second patient, the EEG demonstrated slow waves in the contralateral frontal region. The ictal onset was contralateral to the paresis in all cases. No patient with pseudoseizures had paralysis. CONCLUSIONS: Postconvulsive paralysis are not frequent in video EEG monitoring studies. However, if present it points out to a contralateral seizure onset. In our series it happened in patients with frontal seizures. The EEG may help to clarify if it correspond to a true postictal phenomenon or to a ictal paralysis

Hyperleptinaemia, respiratory drive and hypercapnic response in obese patients

Leptin is a powerful stimulant of ventilation in rodents. In humans, resistance to leptin has been consistently associated with obesity. Raised leptin levels have been reported in subjects with sleep apnoea or obesity-hypoventilation syndrome. The aim of the present study was to assess, by multivariate analysis, the possible association between respiratory centre impairment and levels of serum leptin. In total, 364 obese subjects (body mass index >or=30 kg.m(-2)) underwent the following tests: sleep studies, respiratory function tests, baseline and hypercapnic response (mouth occlusion pressure (P(0.1)), minute ventilation), fasting leptin levels, body composition and anthropometric measures. Subjects with airways obstruction on spirometry were excluded. Out of the 346 subjects undergoing testing, 245 were included in the current analysis. Lung volumes, age, log leptin levels, end-tidal carbon dioxide tension, percentage body fat and minimal nocturnal saturation were predictors for baseline P(0.1). The hypercapnic response test was performed by 186 subjects; log leptin levels were predictors for hypercapnic response in males, but not in females. Hyperleptinaemia is associated with a reduction in respiratory drive and hypercapnic response, irrespective of the amount of body fat. These data suggest the extension of leptin resistance to the respiratory centre

El síndrome de apneas obstructivas del sueño en la obesidad: un conspirador en la sombra

The obstructive sleep apnoea syndrome (OSAS) is caused by upper airway collapse during sleep. These episodes are associated with recurrent oxyhaemoglobin desaturations and arousals which lead to disruption of the sleep pattern and cognitive deterioration. Factors such as age, male sex, menopause, tobacco and alcohol consumption and anatomic abnormalities are demonstrated risk factors for OSAS development. Obesity, specially of abdominal type, is also a very strong predictor of OSAS, increasing the risk of apnoea by ten times. OSAS prevalence may reach 80% and 50% en males and females with morbid obesity respectively. OSAS induces sympathoexcitation, insulin resistance, renin-angiotensin system activation, oxidative stress, endothelial dysfunction, hypercoagulability and reduction of fibrinolysis leading to hypertension and increased cardiovascular risk. The best diagnostic procedure is polysomnography. Obesity treatment is followed by a dramatic improvement in OSAS. Weight loss of 10% results in reductions of apnoea index by 26%. Application of a positive pressure system is a very effective treatment for OSAS which reduces the apnoea index and improves cardiovascular risk and cognitive impairment

Demencia por sobrecrecimiento bacteriano en paciente portador de gastrectomía Billroth II

We report the case of a patient in the Psychiatric Department who complained of progressive impairment of cerebral functions consistent with dementia, diarrhea and fecal incontinence in the last few months. His medical history included a Billroth II gastrectomy for gastric ulcer. Biochemical tests detected cobalamine deficiency, without megaloblastic anemia, and an abnormal Shilling test that was not due to intrinsic factor deficiency. Once other causes of cobalamine deficiency were ruled out, we considered it as a deficiency disease due to blind loop syndrome. Treatment with parenteral vitamin B complex and long term oral antibiotic therapy allowed the complete and permanent resolution of neurologic and digestive symptoms. We consider this case to be interesting because it shows the existence of curable dementias and the usefulness of taking into account bacterial overgrowth, usually underestimated, as an entity that can produce a variety of disorder