Longitudinally extensive transverse myelitis with AQP4 antibodies revealing ovarian teratoma.

Paraneoplastic myelitis is a rare inflammatory disorder most frequently associated with solid tumors or lymphoproliferative disorders. Patients often harbor onconeuronal antibodies and their prognosis is usually poor. Here we report a 42-year old woman with longitudinally extensive transverse myelitis and aquaporin-4 (AQP4) antibodies that led to the diagnosis of ovarian teratoma. After tumor removal and immune therapy (including corticosteroids, plasma exchange, intravenous immunoglobulins and rituximab) the patient progressively improved achieving complete recovery. Histological study of the teratoma demonstrated neural tissue containing AQP4 expressing cells and intense inflammatory infiltrates, providing evidence for a possible paraneoplastic link between both disorders

Cooperar en la escuela : la responsabilidad de educar para la democracia

El presente libro contiene distintas aportaciones a la concepción de cooperación que puede darse en la escuela y en el aula. Se habla de cooperación y de aprendizaje como procesos de comunicación y participación a distintos niveles, en distintas situaciones y con distintos colectivos; entre los chicos, entre los educadores y las familias, entre distintas comunidades. El abanico de propuestas, unas más teóricas que otras, pueden promover ideas y actividades de cooperación innovadoras, así como la reflexión y la discusión necesaria entre los profesionales de la educación, para introducir el trabajo cooperativo en la escuela como un valor y un instrumento de formación intelectual y social de los alumnos. La organización de los contenidos se centra, en primer lugar, en el aula, justificando el trabajo cooperativo como instrumento mediador de aprendizaje y de nuevas estrategias de desarrollo cognoscitivo y ético. Seguidamente se trata de ampliar el contexto de colaboración, incluyendo a distintos grupos de edades, a la comunidad y a las familias. Se profundiza también en la colaboración entre los profesionales de la educación, presentando una experiencia de colaboración entre dos escuelas. Finalmente, se aborda el tema de las minorías extranjeras en la escuela y el de las nuevas tecnologías y la revolución metodológica que suponen para el profesorado.CataluñaBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín, 5; 28014 Madrid; Tel. +34917748000; [email protected]

Lipid-specific immunoglobulin M bands in cerebrospinal fluid are associated with a reduced risk of developing progressive multifocal leukoencephalopathy during treatment with natalizumab

[Objective]: Progressive multifocal leukoencephalopathy (PML) is a serious side effect associated with natalizumab treatment in multiple sclerosis (MS). PML risk increases in individuals seropositive for anti–John Cunningham virus (JC) antibodies, with prolonged duration of natalizumab treatment, and with prior exposure to immunosuppressants. We explored whether the presence of lipid‐specific immunoglobulin M oligoclonal bands in cerebrospinal fluid (CSF; IgM bands), a recognized marker of highly inflammatory MS, may identify individuals better able to counteract the potential immunosuppressive effect of natalizumab and hence be associated with a reduced risk of developing PML. [Methods]: We studied 24 MS patients who developed PML and another 343 who did not suffer this opportunistic infection during natalizumab treatment. Patients were recruited at 25 university hospitals. IgM bands were studied by isoelectric focusing and immunodetection. CSF lymphocyte counts were explored in 151 MS patients recruited at Ramon y Cajal Hospital in Madrid, Spain. [Results]: IgM bands were independently associated with decreased PML risk (odds ratio [OR] = 45.9, 95% confidence interval [CI] = 5.9–339.3, p < 0.0001) in patients treated with natalizumab. They were also associated with significantly higher CSF CD4, CD8, and B‐cell numbers. Patients positive for IgM bands and anti‐JC antibodies had similar levels of reduced PML risk to those who were anti‐JC negative (OR = 1.55, 95% CI = 0.09–25.2, p = 1.0). Higher risk was observed in patients positive for anti‐JC antibodies and negative for IgM bands (19% of the total cohort, OR = 59.71, 95% CI = 13.6–262.2). [Interpretation]: The presence of IgM bands reflects a process that may diminish the risk of PML by counteracting the excess of immunosuppression that may occur during natalizumab therapy. Ann Neurol 2015;77:447–457This work was supported by grants; PI12–00239 from FIS; Instituto de Salud Carlos III; SAF 2012‐34670, and RD12/0032/0005 from the Spanish Ministry of Economy and Competitiveness; and BMBF grant KKNMS (Competence Net Multiple Sclerosis; H.T.)