The value of magnetic resonance imaging and computed tomography in the study of spinal disorders

Computed tomography (CT) and magnetic resonance imaging (MRI) have replaced conventional radiography in the study of many spinal conditions, it is essential to know when these techniques are indicated instead of or as complementary tests to radiography, which findings can be expected in different clinical settings, and their significance in the diagnosis of different spinal conditions. Proper use of CT and MRI in spinal disorders may facilitate diagnosis and management of spinal conditions. An adequate clinical approach, a good understanding of the pathological manifestations demonstrated by these imaging techniques and a comprehensive report based on a universally accepted nomenclature represent the indispensable tools to improve the diagnostic approach and the decision-making process in patients with spinal pain. Several guidelines are available to assist clinicians in ordering appropriate imaging techniques to achieve an accurate diagnosis and to ensure appropriate medical care that meets the efficacy and safety needs of patients. This article reviews the clinical indications of CT and MRI in different pathologic conditions affecting the spine, including congenital, traumatic, degenerative, inflammatory, infectious and tumor disorders, as well as their main imaging features. It is intended to be a pictorial guide to clinicians involved in the diagnosis and treatment of spinal disorders

Prevalence and Risk Factors Associated with Tumors and Other Structural Anomalies in Brain MRI Performed to Rule out Secondary Headache: A Multicenter Observational Study

This research was funded by MCIN/AEI/10.13039/501100011033, grant number PID2020118224RB-I00.Headache disorders (HDs) are among the most common conditions of the central nervous system, with an estimated prevalence of 50% in adult population. The aim of this work is to analyze the prevalence of structural anomalies that may explain HDs in MRI exams performed to rule out secondary headache in real-world practice, as well as risk factors associated with these lesions. We conducted a retrospective observational study based on a consecutive case series of all patients that underwent brain MRI due to headache from 1 January 2019 to 31 May 2019. We included patients from six MRI diagnostic centers accounting for four provinces of Andalusia (southern Spain). Bivariate and multivariate logistical regression models were performed to identify risk factors associated with the outcomes (1) presence of a structural finding potentially explaining headache, (2) presence of intracranial space-occupying lesions (SOLs), and (3) presence of intracranial tumors (ITs). Of the analyzed sample (1041 patients), a structural finding that could explain headache was found in 224 (21.5%) patients. SOLs were found in 50 (6.8%) patients and ITs in 12 (1.5%) patients. The main factors associated with structural abnormalities were female sex (OR, 1.35; 95% CI, 1.02–1.85), accompanying symptoms (OR, 1.34; 95% CI, 1.05–1.89), use of gadolinium-based contrast agents (OR, 1.89; 95% CI, 1.31–2.72) and previously known conditions potentially explaining headache (OR, 2.44; 95% CI, 1.55–3.84). Female sex (p = 0.048) and accompanying symptoms (p = 0.033) were also associated with ITs in bivariate analyses. Our results may be relevant for different medical specialists involved in the diagnosis, management and prevention of headache. Moreover, the risk factors identified in our study might help the development of public health strategies aimed at early diagnosis of brain tumors. Future studies are warranted to corroborate our findings.MCIN/AEI/10.13039/501100011033 PID2020118224RB-I0

The controversial relationship between neuroscience and moral responsibility in psychopaths

Abstract Background From fields such as neuroethics and legal medicine it is increasingly common to raise the issue on whether it is necessary to rethink questions such as moral and criminal responsibility in individuals fulfilling Hare’s criteria for psychopathy. The Hare’s Psychopathy Checklist Revised is currently the diagnostic gold standard for psychopathy and defines a type of personality characterized by interpersonal, affective, and behavioral symptoms. Moral and criminal responsibility in these individuals is now being reconsidered due to new data provided by neuroscience. However, the translation from these neuroscientific findings into terms of moral responsibility is neither direct nor evident. The aim of this review is to assemble the available neuroscientific evidence and to clarify the moral consequences of these findings. Main text A genetic base for psychopathy exists as well as brain functionality or even structural variations. However, these structural changes are not robust and consistent across the different studies. Moreover, this body of evidence uses different methodologies and, for this reason, it is hardly comparable. Findings from the field of neuropsychology such as the emotional alterations, empathy impairment or emotional theory of mind (ToM) deviance are equivocal, controversial, and a focus of debate. These can be well understood as correlates of the particular psychopaths’ moral functioning more than as a deterministic causality for their conduct. In addition, a biological and neuropsychological model of moral responsibility open to scientific analysis does not exist. Ultimately, moral responsibility has a biological and neuropsychological basis, but it cannot be fully explained by these constructs. Conclusion This review assesses new findings in the study of moral and criminal responsibility in psychopaths, and the different interpretations about them. It concludes that, in the absence of an experimental model of moral responsibility, current data, though controversial, are not definitive arguments that can reduce or to eliminate moral, and subsequently, criminal responsibility

[18F]Fluorocholine PET/CT false positive: foreign body reaction mimicking anaplastic glioma progression. A case report

Abstract Background Foreign body reaction in brain tissue is a very rare immune response that has not been well studied. Hemostatic material has been reported as a possible trigger of this response in other organs and could be detected by [18F]fluorodeoxyglucose positron emission tomography/computerized tomography ([18F]FDG PET/CT), but there is no reported experience about the role of [18F]fluorocholine in this finding. [18F]Fluorocholine has the potential to differentiate viable central nervous system tumors from other entities, so it is frequently used in the follow-up of neurosurgery patients. Case presentation A right frontoparietal neoplastic lesion was found in a young-aged patient with analgesic refractory headache. Surgical resection and postsurgical radiotherapy were performed, and the pathologist analysis turned out a cellular ependymoma with signs of anaplasia. In the follow-up, an magnetic resonance imaging (MRI) showed a suspicious lesion, so a [18F]fluorocholine PET/CT was performed. Increased uptake was described in the right parietal region on the margin of the residual cystic lesion. The patient got a complete resection which was confirmed later by MRI. In the pathology analysis, a focally congestive cerebral parenchyma with a central histiocytic reaction to a foreign body area was described. Conclusions Following the experience of the current case report, [18F]fluorocholine PET/CT could also show a false positive related to foreign body reaction. This entity should be considered to avoid unnecessary major surgery on our patients

El funcionamiento moral de los maestros en formación. FMMF

Innovación EducativaComo formadores de maestros, estamos convencidos de que la ética y la moral son aspectos fundamentales en el bagaje profesional de todo educador. Sin ellos se podrá enseñar, pero no educar. Hasta donde sabemos, instituciones como las facultades de educación no tienen posibilidad de utilizar mecanismos de selección que exploren la capacidad para hacer juicios o consideraciones morales en quienes inician sus estudios de maestro. Por tanto, parece coherente que estos centros dispongan de estrategias de intervención encaminadas a que, durante el proceso de formación, los estudiantes tengan la posibilidad/obligación de tomar conciencia de aspectos tan relevantes, cuya finalidad es conseguir profesionales moralmente íntegros y capacitados para educar en esa misma dirección. Es el sentido del que hemos querido dotar a las acciones consecutivas que conforman este proyecto de innovación centrado en la moralidad de los maestros en formación. Partimos de un estudio exploratorio sobre el nivel de funcionamiento moral de los estudiantes de Educación Primaria. Para ello diseñamos un instrumento para evaluarlo, basado en dilemas morales, que se ha aplicado entre el alumnado del grado en Educación Primaria. Posteriormente, se ha implementado un programa de intervención educativa centrado en hacer conscientes los juicios, intenciones y comportamientos morales de los participantes. De este modo, durante la intervención se han generado discusiones con el fin de promover la reconsideración de sus puntos de vista desde una de las materias de la mención de Educación Física del grado en Educación Primaria. Finalmente, hemos comprobado los efectos que este produce respecto a su nivel de funcionamiento moral inicial y en la comprensión de cómo esto repercute en el futuro desarrollo de su profesión como maestros.Didáctica de la Expresión Musical, Plástica y Corpora

Synaptonemal complex assembly and H3K4Me3 demethylation determine DIDO3 localization in meiosis

Synapsis of homologous chromosomes is a key meiotic event, mediated by a large proteinaceous structure termed the synaptonemal complex. Here we describe a role in meiosis for the murine Death inducer obliterator (Dido) gene. The Dido gene codes for three proteins that recognize trimethylated histone H3 lysine 4 through their aminoterminal PHD domain. DIDO3, the largest of the three isoforms, localizes to the central region of the synaptonemal complex in germ cells. DIDO3 follows the distribution of the central region protein SYCP1 in Sycp3-/- spermatocytes, which lack the axial elements of the synaptonemal complex. This indicates that synapsis is a requirement for DIDO3 incoporation. Interestingly, DIDO3 is missing from the synaptonemal complex in Atm mutant spermatocytes, which form synapses but show persistent trimethylation of histone H3 lysine 4. In order to further address a role of epigenetic modifications in DIDO3 localization, we made a mutant of the Dido gene that produces a truncated DIDO3 protein. This truncated protein, which lacks the histone-binding domain, is incorporated in the synaptonemal complex irrespective of histone trimethylation status. DIDO3 protein truncation in Dido mutant mice causes mild meiotic defects, visible as gaps in the synaptonemal complex, but allows for normal meiotic progression. Our results indicate that histone H3 lysine 4 demethylation modulates DIDO3 localization in meiosis, and suggest epigenetic regulation of the synaptonemal complex.Ministerio de Salud (FIS PI051965) Comunidad de Madrid (S-BIO-0189-2006, P-GEN-0166-2006) Ministerio de Ciencia (RyC004-1886)Peer reviewe

Clinical and microbiological characteristics of bacterial infections in patients with cirrhosis. A prospective cohort study from Argentina and Uruguay

Introduction and Objectives: there is insufficient data regarding bacterial infections in patients with cirrhosis to support recommendations for empiric antibiotic treatments, particularly in Latin America. This study aimed to evaluate bacterial infection's clinical impact and microbiological characteristics, intending to serve as a platform to revise current practices. Materials and Methods: multicenter prospective cohort study of patients with cirrhosis and bacterial infections from Argentina and Uruguay. Patient and infection-related information were collected, focusing on microbiology, antibiotic susceptibility patterns, and outcomes. Results: 472 patients were included. Spontaneous bacterial infections and urinary tract infections (UTIs) were registered in 187 (39.6%) and 116 (24.6%) patients, respectively, representing the most common infections. Of the 256 culture-positive infections, 103 (40.2%) were caused by multidrug-resistant organisms (reaching 50% for UTI), and 181 (70.7%) received adequate initial antibiotic treatment. The coverage of cefepime and ceftriaxone was over 70% for the empirical treatment of community-acquired spontaneous infections, but ceftazidime´s coverage was only 40%. For all UTI cases and for healthcare-associated or nosocomial spontaneous bacterial infections, the lower-spectrum antibiotics that covered at least 70% of the isolations were imipenem and meropenem. During hospitalization, a second bacterial infection was diagnosed in 9.8% of patients, 23.9% required at least one organ support, and 19.5% died. Conclusions: short-term mortality of bacterial infections in patients with cirrhosis is very high, and a high percentage were caused by multidrug-resistant organisms, particularly in UTIs. The information provided might serve to adapt recommendations, particularly related to empirical antibiotic treatment in Argentina and Uruguay. The study was registered in Clinical Trials (NCT03919032)