To Shunt or Not to Shunt Patients with Idiopathic Normal Pressure Hydrocephalus? A Reappraisal of an Old Question

The possibility that the cerebral ventricles can dilate without any increase in the pressure of the cerebrospinal fluid (CSF) was recognized in 1935 by Penfield who reported a patient in whom "…the cerebrospinal fluid spaces are closed and the ventricles progressively enlarge without the measured intraventricular pressure rising above 150 to 200 mm of water"

Prognostic Markers in Patients with Cirrhosis and Portal Hypertension Who Have Not Bled

Prognostic markers of compensated cirrhosis should mainly investigate factors involved with progression to decompensation because death in cirrhosis is related with decompensation. Portal hypertension plays a crucial role in the pathophysiology of most complications of cirrhosis. Accordingly, HVPGmonitoring has strong prognostic value. An HVPG ≥ 10 mmHg determines a significantly higher risk of developing decompensation. Esophageal varices also can develop when the HVPG is ≥ 10 mmHg, although an HVPG ≥ 12 mmHg is required for variceal bleeding to occur. Monitoring the changes induced by the treatment of portal hypertension on HVPG, provides strong prognostic information. In compensated cirrhosis hemodynamic response is appropriate when the HVPG decreased to 10% from baseline, because the incidence of complications such as bleeding or ascites significantly decrease when these targets are achieved. Whether serum markers, such as the FibroTest, they, may be valuable to predict decompensation should be established. Transient Elastography is a promising technique that has shown an excellent accuracy to detect severe portal hypertension. However, whether it can adequately determine clinically significant portal hypertension, and risk of developing varices and decompensation, should be established. Magnetic Resonance Elastography is also promising

Efectes del tractament de la hidrocefàlia crònica de l'adult

La hidrocefàlia crònica de l'adult (HCA) és una causa de demència potencialment reversible. Per això, és molt important diferenciar-la d'altres causes de demència, com l'Alzheimer o el Parkinson, que poden presentar símptomes semblants. Investigadors de l'Hospital Universitari Vall Hebron-UAB, han estudiat la cognició i comportament d'un grup de pacients per analitzar els canvis que es produeixen després del tractament i descriure les variables que infueixien en la millora dels pacients per així poder diferenciar els pacients que presenten aquest síndrome dels altres.La hidrocefalia crónica del adulto (HCA) es una causa de demencia potencialmente reversible. Por ello, es muy importante diferenciarla de otras causas de demencia, como el Alzheimer o el Parkinson, que pueden presentar síntomas similares. Investigadores del Hospital Universitario Vall Hebron-UAB, han estudiado la cognición y comportamiento de un grupo de pacientes para analizar los cambios que se producen después del tratamiento y describir las variables que influyen en la mejora de los pacientes para así poder diferenciar los pacientes que presentan este síndrome de los demás

Evaluación de la calidad de vida en los pacientes con una malformación de Chiari tipo I. Estudio piloto en una cohorte de 67 pacientes

Introducción: La malformación de Chiari tipo I (MC-I) es una entidad de baja prevalencia, cuya clínica es muy variada dependiendo del cortejo malformativo asociado, y en la que pueden existir síntomas ansiosodepresivos y una pérdida no definida de la calidad de vida de los pacientes. El objetivo principal de este estudio es determinar la repercusión de la MC-I en la calidad de vida, así como la presencia de ansiedad y depresión en estos pacientes. Pacientes y métodos: Estudio prospectivo de una cohorte de 67 pacientes afectos de MC-I en los que se valoraron la calidad de vida, la presencia de ansiedad y síntomas depresivos mediante las escalas Sickness Impact Profile, inventario de ansiedad estado-rasgo e inventario de depresión de Beck, respectivamente. En cada paciente se registró la presencia de siringomielia o hidrocefalia, así como el grado de ectopia de las amígdalas del cerebelo. Resultados: El impacto de la MC-I en la calidad de vida fue nulo en seis pacientes (9%), leve en 36 (53,7%), moderado en 17 (25,4%) y grave en ocho (11,9%). El área de actividad más afectada fue el trabajo. El 86,6% de los pacientes presentó un nivel de ansiedad moderado o elevado. En el 25,4% de los pacientes también se constataron síntomas depresivos moderados o graves. Conclusiones: La gran mayoría de los pacientes con una MC-I considera que su enfermedad implica una pérdida de calidad de vida que, en muchos casos, se asocia a una alta ansiedad y a síntomas depresivo

Chiari malformation type I: a case-control association study of 58 developmental genes

Chiari malformation type I (CMI) is a disorder characterized by hindbrain overcrowding into an underdeveloped posterior cranial fossa (PCF), often causing progressive neurological symptoms. The etiology of CMI remains unclear and is most likely multifactorial. A putative genetic contribution to CMI is suggested by familial aggregation and twin studies. Experimental models and human morphometric studies have suggested an underlying paraxial mesoderm insufficiency. We performed a case-control association study of 303 tag single nucleotide polymorphisms (SNP) across 58 candidate genes involved in early paraxial mesoderm development in a sample of 415 CMI patients and 524 sex-matched controls. A subgroup of patients diagnosed with classical, small-PCF CMI by means of MRI-based PCF morphometry (n = 186), underwent additional analysis. The genes selected are involved in signalling gradients occurring during segmental patterning of the occipital somites (FGF8, Wnt, and retinoic acid pathways and from bone morphogenetic proteins or BMP, Notch, Cdx and Hox pathways) or in placental angiogenesis, sclerotome development or CMI-associated syndromes. Single-marker analysis identified nominal associations with 18 SNPs in 14 genes (CDX1, FLT1, RARG, NKD2, MSGN1, RBPJ1, FGFR1, RDH10, NOG, RARA, LFNG, KDR, ALDH1A2, BMPR1A) considering the whole CMI sample. None of these overcame corrections for multiple comparisons, in contrast with four SNPs in CDX1, FLT1 and ALDH1A2 in the classical CMI group. Multiple marker analysis identified a risk haplotype for classical CMI in ALDH1A2 and CDX1. Furthermore, we analyzed the possible contributions of the most significantly associated SNPs to different PCF morphometric traits. These findings suggest that common variants in genes involved in somitogenesis and fetal vascular development may confer susceptibility to CMI

Mecanismes de recuperació de la comprensió del llenguatge després d'una lesió massiva de l'hemisferi dominant

Els pacients que sobreviuen a un infart hemisfèric maligne presenten greus seqüeles motores, a les quals cal afegir una afàsia global (impossibilitat d'emetre i comprendre llenguatge oral i escrit) si l'hemisferi afectat és el dominant. El tractament més eficaç per a aquests pacients és l'extracció temporal d'una part de la volta cranial per tal de permetre l'expansió del cervell inflamat. Tanmateix, aquest tractament és controvertit quan l'hemisferi infartat és el dominant, per les seqüeles esperables. L'estudi d'una pacient de 20 anys amb un infart massiu esquerre a la qual se li va aplicar aquest tractament mostra resultats inesperadament favorables.Los pacientes que sobreviven a un infarto hemisférico maligno presentan graves secuelas motoras, a las que hay que añadir una afasia global (imposibilidad de emitir y comprender lenguaje oral y escrito) si el hemisferio afectado es el dominante. El tratamiento más eficaz para estos pacientes es la extracción temporal de una parte de la bóveda craneal para permitir la expansión del cerebro inflamado. Sin embargo, este tratamiento es controvertido cuando el hemisferio infartado es el dominante por las secuelas esperables. El estudio de una paciente de 20 años con un infarto masivo izquierdo a la que se le aplicó este tratamiento muestra resultados inesperadamente favorables

Bacteriophages immunomodulate the response of monocytes

Bacteriophages are present in fluids from cirrhosis patients. However, their effect on the immune response is unknown. In this work, we explore the role of phages in the phenotype, function, and cytokine production of monocytes. We stimulated healthy monocytes with five different butanol-purified phage suspensions infective for Gram-negative and Gram-positive bacteria. We studied the expression of the monocyte markers involved in lipopolysaccharide recognition (LPS; CD14), antigen presentation (HLA-DR) and co-stimulation (CD86), and the concentration of induced cytokines (TNF-α, IFN-α, and IL-10) by phages. To confirm the direct role of phages without the interference of contaminating soluble LPS in phage suspensions, polymyxin B was added to the cell cultures. Phagocytosis experiments were assessed by flow cytometry using labeled phage suspensions. We observed that butanol-purified phages reduced the surface levels of CD14 and CD86 in monocytes and increased the secreted levels of TNF-α and IL-10 compared with the control sample containing only butanol buffer. All phage suspensions showed downregulation of HLA-DR expression but only Staphylococcus aureus phage contaminated with Escherichia coli reached statistical significance. The addition of polymyxin B did not restore the monocytic response induced by phages, suggesting that the effect was not caused by the presence of LPS. Monocytes were able to phagocyte phages in a dose- and time-dependent manner. To conclude, the phagocytosis of butanol-purified phages altered the phenotype and cytokine production of monocytes suggesting they become tolerogenic

Comparison of cerebral metabolic rate of oxygen, blood flow, and bispectral index under general anesthesia

Cerebral blood flow; Diffuse optics; Propofol-induced anesthesiaFlujo sanguíneo cerebral; Óptica difusa; Anestesia inducida por propofolFlux sanguini cerebral; Òptica difusa; Anestèsia induïda per propofolSignificance The optical measurement of cerebral oxygen metabolism was evaluated. Aim Compare optically derived cerebral signals to the electroencephalographic bispectral index (BIS) sensors to monitor propofol-induced anesthesia during surgery. Approach Relative cerebral metabolic rate of oxygen (rCMRO2) and blood flow (rCBF) were measured by time-resolved and diffuse correlation spectroscopies. Changes were tested against the relative BIS (rBIS) ones. The synchronism in the changes was also assessed by the R-Pearson correlation. Results In 23 measurements, optically derived signals showed significant changes in agreement with rBIS: during propofol induction, rBIS decreased by 67% [interquartile ranges (IQR) 62% to 71%], rCMRO2 by 33% (IQR 18% to 46%), and rCBF by 28% (IQR 10% to 37%). During recovery, a significant increase was observed for rBIS (48%, IQR 38% to 55%), rCMRO2 (29%, IQR 17% to 39%), and rCBF (30%, IQR 10% to 44%). The significance and direction of the changes subject-by-subject were tested: the coupling between the rBIS, rCMRO2, and rCBF was witnessed in the majority of the cases (14/18 and 12/18 for rCBF and 19/21 and 13/18 for rCMRO2 in the initial and final part, respectively). These changes were also correlated in time (R > 0.69 to R = 1, p-values < 0.05). Conclusions Optics can reliably monitor rCMRO2 in such conditions.This work received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 675332 (BitMap), No. 101016087 (VASCOVID) and No. 101017113 (TinyBRAINS), KidsBrainIT (ERA-NET NEURON), FEDER EC and LASERLAB-EUROPE V (EC H2020 no. 871124). It was also supported by Fundació CELLEX Barcelona, Fundació Mir-Puig the “Severo Ochoa” Programme for Centres of Excellence in R&D (SEV-2015-0522), the Obra social “la Caixa” Foundation (LlumMedBcn), Generalitat de Catalunya (CERCA, AGAUR-2017-SGR-1380, RIS3CAT-001-P-001682 CECH), la Fundació La Marató de TV3 (201724.31 and 201709.31), and by Agencia Estatal de Investigación (PHOTOMETABO, PID2019-106481RB-C31/10.13039/501100011033)

Phase angle by electrical bioimpedance is a predictive factor of hospitalisation, falls and mortality in patients with cirrhosis

The phase angle is a versatile measurement to assess body composition, frailty and prognosis in patients with chronic diseases. In cirrhosis, patients often present alterations in body composition that are related to adverse outcomes. The phase angle could be useful to evaluate prognosis in these patients, but data are scarce. The aim was to analyse the prognostic value of the phase angle to predict clinically relevant events such as hospitalisation, falls, and mortality in patients with cirrhosis. Outpatients with cirrhosis were consecutively included and the phase angle was determined by electrical bioimpedance. Patients were prospectively followed to determine the incidence of hospitalisations, falls, and mortality. One hundred patients were included. Patients with phase angle ≤ 4.6° (n = 31) showed a higher probability of hospitalisation (35% vs 11%, p = 0.003), falls (41% vs 11%, p = 0.001) and mortality (26% vs 3%, p = 0.001) at 2-year follow-up than patients with PA > 4.6° (n = 69). In the multivariable analysis, the phase angle and MELD-Na were independent predictive factors of hospitalisation and mortality. Phase angle was the only predictive factor for falls. In conclusion, the phase angle showed to be a predictive marker for hospitalisation, falls, and mortality in outpatients with cirrhosis

Prognostic Markers in Patients with Cirrhosis and Portal Hypertension Who Have Not Bled

Prognostic markers of compensated cirrhosis should mainly investigate factors involved with progression to decompensation because death in cirrhosis is related with decompensation. Portal hypertension plays a crucial role in the pathophysiology of most complications of cirrhosis. Accordingly, HVPGmonitoring has strong prognostic value. An HVPG ≥ 10 mmHg determines a significantly higher risk of developing decompensation. Esophageal varices also can develop when the HVPG is ≥ 10 mmHg, although an HVPG ≥ 12 mmHg is required for variceal bleeding to occur. Monitoring the changes induced by the treatment of portal hypertension on HVPG, provides strong prognostic information. In compensated cirrhosis hemodynamic response is appropriate when the HVPG decreased to 10% from baseline, because the incidence of complications such as bleeding or ascites significantly decrease when these targets are achieved. Whether serum markers, such as the FibroTest, they, may be valuable to predict decompensation should be established. Transient Elastography is a promising technique that has shown an excellent accuracy to detect severe portal hypertension. However, whether it can adequately determine clinically significant portal hypertension, and risk of developing varices and decompensation, should be established. Magnetic Resonance Elastography is also promising