Observation of Collider Muon Neutrinos with the SND@LHC Experiment.

We report the direct observation of muon neutrino interactions with the SND@LHC detector at the Large Hadron Collider. A dataset of proton-proton collisions at sqrt[s]=13.6 TeV collected by SND@LHC in 2022 is used, corresponding to an integrated luminosity of 36.8 fb^{-1}. The search is based on information from the active electronic components of the SND@LHC detector, which covers the pseudorapidity region of 7.2<η<8.4, inaccessible to the other experiments at the collider. Muon neutrino candidates are identified through their charged-current interaction topology, with a track propagating through the entire length of the muon detector. After selection cuts, 8 ν_{µ} interaction candidate events remain with an estimated background of 0.086 events, yielding a significance of about 7 standard deviations for the observed ν_{µ} signal.

Can deep learning beat numerical weather prediction?

The recent hype about artificial intelligence has sparked renewed interest in applying the successful deep learning (DL) methods for image recognition, speech recognition, robotics, strategic games and other application areas to the field of meteorology. There is some evidence that better weather forecasts can be produced by introducing big data mining and neural networks into the weather prediction workflow. Here, we discuss the question of whether it is possible to completely replace the current numerical weather models and data assimilation systems with DL approaches. This discussion entails a review of state-of-the-art machine learning concepts and their applicability to weather data with its pertinent statistical properties. We think that it is not inconceivable that numerical weather models may one day become obsolete, but a number of fundamental breakthroughs are needed before this goal comes into reach. This article is part of the theme issue 'Machine learning for weather and climate modelling'.

[Membrane induction and transposition of non-vascularized ipsilateral fibula in posttraumatic bone neoformation. Case report]. / Inducción de membrana y trasposición de peroné ipsolateral no vascularizado en neoformación ósea postraumática. Reporte de caso.

OBJECTIVE: To demonstrate the outcome of tibial bone neo formation, using induced-membrane technique and non-vascularized ipsolateral fibular graft transposition. CASE REPORT: A 25 years old male with a 2 years ago firearm injury in left leg, presenting an initial diagnosis of open fracture Gustilo IIIB AO 42C3 IO4NV1MT2 with a 7cm tibial diaphyseal bone defect. During his hospital evolution multiple interventions were made including surgical debridement and skin grafts placement, with unfavorable results. Therefore, we decided to use the induced-membrane technique and non-vascularized ipsolateral fibular graft transposition, resulting in a cane dependent ambulation, in 4 months evolution after last intervention. CONCLUSION: Induced-membrane technique and non-vascularized ipsolateral fibular graft transposition could be a successful alternative for the management of patients with severe bone loss.

OBJETIVO: Demostrar los resultados en la neoformación ósea de tibia utilizando la técnica de inducción de membrana más la transposición de peroné ipsolateral no vascularizado. CASO CLÍNICO: Masculino de 25 años, antecedente de sufrir impacto por arma de fuego en pierna izquierda dos años antes, presentó un diagnóstico inicial de fractura expuesta Gustilo IIIB AO 42C3 IO4NV1MT2 con pérdida ósea de 7 cm de diáfisis tibial. Durante su evolución se realizaron múltiples aseos quirúrgicos y colocación de injertos cutáneos con resultados no favorables, por lo que se emplea la técnica de membrana inducida más colocación de peroné ipsolateral no vascularizado, teniendo una evolución a los cuatro meses posterior a su última intervención con deambulación dependiente de bastón. CONCLUSIÓN: La técnica de inducción de membrana con transposición de peroné ipsolateral no vascularizado podría ser una alternativa adecuada para el manejo de pérdidas óseas en los pacientes.

Tratamiento quirúrgico del síndrome de sobrecarga en valgo y extensión en atletas / Traitement chirurgical du syndrome de surcharge en valgus et en extension chez les athlètes / Surgical treatment of valgus extension overload syndrome in athletes

Introducción: la sobrecarga en valgo y extensión (choque posteromedial) es una lesión que se presenta con cierta frecuencia en atletas de lanzamiento, que en ocasiones puede requerir de cirugía para que el atleta pueda seguir compitiendo. Objetivos: realizar el diagnóstico y tratamiento del síndrome de sobrecarga en valgo y extensión en atletas, hacer diagnóstico precoz y el tratamiento adecuado. Métodos: se realizó un estudio longitudinal prospectivo de intervención que incluyó a deportistas de alto rendimiento operados por síndrome de sobrecarga en valgo y extensión. La muestra estuvo formada por 8 pacientes, todos masculinos, edad media 26 años (rango entre 22 y 29), deportes que practicaban: 6 béisbol (5 lanzadores y uno jardinero), un paciente de pesas y otro de jabalina. El tiempo de seguimiento mínimo fue de 6 meses y máximo de 4 años y una media de 2.3 años. Resultados: fueron operados ocho pacientes, de ellos cuatro presentaban neuropatía por compresión del nervio cubital a nivel del codo, a cuatro se les realizó además transferencia del nervio cubital, dos subcutáneo y en dos se le realizó una polea con fascia flexora pronadora. Las complicaciones que se presentaron fueron: recidiva del dolor por insuficiencia del ligamento colateral medial (1/8) pacientes. Los resultados funcionales según escala de Conway fueron excelentes (5/8), bueno (2/8) y pobre (1/8). Conclusiones: el estrés repetido, la insuficiencia de los flexores pronadores y del ligamento colateral medial son las causas desencadenantes del síndrome de sobrecarga en valgo y extensión. La cirugía favorece el retorno a la actividad deportiva en la mayoría de los atletas(AU)

Introduction: valgus extension overload (posteromedial shock) is a type of injure that is relatively frequent in throwing athletes and may require surgical procedures to be performed so that the athlete can keep on competing. Objective: To early diagnose and adequately treat the valgus extension overload syndrome in athletes. Methods: a prospective, longitudinal and intervention study was conducted in high performance athletes operated on for valgus extension overload syndrome. The sample was made up of 8 male athletes aged 26 years as average (range of 22 to 29 years), who practiced baseball (five pitchers and one outfielder), weightlifting (one) and javelin throw (one). The minimal follow-up was 6 months and the maximum was 4 years, for a mean of 2.3 years. Results: eight patients were operated on, four of them presented with neuropathy from compressed cubital nerve at the elbow; four underwent transfer of their cubital nerve, two subcutaneous and two with a pulley with flexor pronator fascia. The most observed complication was pain relapse due to medial collateral ligament insufficiency in one patient. The functional results according to Conway's scale were excellent in 5 patients, good in two and unsatisfactory in just one patient. Conclusions: repeated stress, insufficiency in flexor pronators and in the medial collateral ligament were the causes that unleash the valgus extension overload syndrome. The surgical procedure helps most of the athletes to come back to their normal sports activity(AU)

Introduction: la surcharge en valgus et en extension (choc postéro-médial) est une lésion assez fréquente chez les sportifs de lancers exigeant parfois un traitement chirurgical pour qu'ils puissent retourner aux compétitions. Objectifs: cette étude a été visée à déterminer un diagnostic précoce et un traitement approprié du syndrome de surcharge en valgus et en extension chez des athlètes. Méthodes: une étude longitudinale prospective interventionnelle comprenant des sportifs de haut niveau, traités chirurgicalement pour syndrome de surcharge en valgus et en extension, a été effectuée. L'échantillon est composé de 8 patients, tous du sexe masculin, âge moyen de 26 ans (22-29 ans), pratiquant baseball (5 lanceurs et 1 joueur de champ), haltérophilie (1), et lancer du javelot (1), avec un suivi de 6 mois au minimum et 4 ans au maximum, et une médiane de 2.3 ans. Résultats: sur 8 patients opérés, quatre étaient atteints d'une neuropathie par pincement du nerf cubital au niveau du coude, quatre ont subi une chirurgie de transfert du nerf cubital, 2 sous-cutanés, et 2 ont subi la reconstruction de poulie par plastie autologue de fascia des fléchisseurs-pronateurs. Dans un seul cas, une complication est survenue: douleur récidivante due à un trouble du ligament collatéral médial. Selon l'échelle de Conway, les résultats sont excellents (5 patients), bons (2 patients) et faibles (1 patient). Conclusions: on conclut que le stress persistant et les troubles des fléchisseurs pronateurs et du ligament collatéral médial entraînent un syndrome de surcharge en valgus et en extension, et c'est le traitement chirurgical qui permet le retour de la plupart des athlètes affectés à la pratique de leur sport respectif(AU)

Tratamiento quirúrgico del síndrome de sobrecarga en valgo y extensión en atletas / Surgical treatment of valgus extension overload syndrome in athletes

Introducción: la sobrecarga en valgo y extensión (choque posteromedial) es una lesión que se presenta con cierta frecuencia en atletas de lanzamiento, que en ocasiones puede requerir de cirugía para que el atleta pueda seguir compitiendo. Objetivos: realizar el diagnóstico y tratamiento del síndrome de sobrecarga en valgo y extensión en atletas, hacer diagnóstico precoz y el tratamiento adecuado. Métodos: se realizó un estudio longitudinal prospectivo de intervención que incluyó a deportistas de alto rendimiento operados por síndrome de sobrecarga en valgo y extensión. La muestra estuvo formada por 8 pacientes, todos masculinos, edad media 26 años (rango entre 22 y 29), deportes que practicaban: 6 béisbol (5 lanzadores y uno jardinero), un paciente de pesas y otro de jabalina. El tiempo de seguimiento mínimo fue de 6 meses y máximo de 4 años y una media de 2.3 años. Resultados: fueron operados ocho pacientes, de ellos cuatro presentaban neuropatía por compresión del nervio cubital a nivel del codo, a cuatro se les realizó además transferencia del nervio cubital, dos subcutáneo y en dos se le realizó una polea con fascia flexora pronadora. Las complicaciones que se presentaron fueron: recidiva del dolor por insuficiencia del ligamento colateral medial (1/8) pacientes. Los resultados funcionales según escala de Conway fueron excelentes (5/8), bueno (2/8) y pobre (1/8). Conclusiones: el estrés repetido, la insuficiencia de los flexores pronadores y del ligamento colateral medial son las causas desencadenantes del síndrome de sobrecarga en valgo y extensión. La cirugía favorece el retorno a la actividad deportiva en la mayoría de los atletas(AU)

Introduction: valgus extension overload (posteromedial shock) is a type of injure that is relatively frequent in throwing athletes and may require surgical procedures to be performed so that the athlete can keep on competing. Objective: To early diagnose and adequately treat the valgus extension overload syndrome in athletes. Methods: a prospective, longitudinal and intervention study was conducted in high performance athletes operated on for valgus extension overload syndrome. The sample was made up of 8 male athletes aged 26 years as average (range of 22 to 29 years), who practiced baseball (five pitchers and one outfielder), weightlifting (one) and javelin throw (one). The minimal follow-up was 6 months and the maximum was 4 years, for a mean of 2.3 years. Results: eight patients were operated on, four of them presented with neuropathy from compressed cubital nerve at the elbow; four underwent transfer of their cubital nerve, two subcutaneous and two with a pulley with flexor pronator fascia. The most observed complication was pain relapse due to medial collateral ligament insufficiency in one patient. The functional results according to Conway's scale were excellent in 5 patients, good in two and unsatisfactory in just one patient. Conclusions: repeated stress, insufficiency in flexor pronators and in the medial collateral ligament were the causes that unleash the valgus extension overload syndrome. The surgical procedure helps most of the athletes to come back to their normal sports activity(AU)

[Effects of two methods of heat therapy on the acute vascular response and hemodynamics in healthy subjects]. / Efectos de dos métodos de termoterapia sobre la respuesta vascular aguda y parámetros hemodinámicos en un grupo de sujetos sanos.

OBJECTIVE: Recently, non-pharmacological resources to relieve pain like hot packs and ultrasound (US) have become common in clinical practice. However, little experimental evidence is available about the possible mechanisms through which these methods bring about pain relief. We aimed to determine the effects of hot packs and US on the acute vascular response and on hemodynamic parameters in healthy subjects. MATERIALS AND METHODS: We conducted an experimental study in 20 healthy subjects (10 men and 10 women; mean age, 22.54±1.70 years). The two interventions were randomly applied: a) hot packs (n=10): 15min at 60°C and b) US (n=10): 15min at 1Mhz. Before and after each intervention, the following vascular parameters were measured in the brachial artery using Doppler ultrasonography with a 7MHz probe: arterial compliance, elastic modulus, beta stiffness index, systolic and diastolic arterial diameters, systolic flow velocity and diastolic flow velocity, systolic/diastolic ratio, resistance index, and pulsatility index. The following hemodynamic parameters were monitored: heart rate and blood pressure (systolic, diastolic, and mean). RESULTS: After the application of hot packs, we observed changes in diastolic flow velocity and in the pulsatility index (P<05). After the application of US, we observed changes in diastolic flow velocity, systolic/diastolic ratio, resistance index, and arterial compliance (P<05). No changes in hemodynamic parameters were observed after either intervention. CONCLUSIONS: Applying hot packs or US modifies the physiology of the vascular system but does not affect hemodynamic parameters in healthy subjects.

Expression, cellular distribution, and heterogeneity of growth hormone in the chicken cerebellum during development.

Although growth hormone (GH) is mainly synthesized and secreted by pituitary somatotrophs, it is now well established that the GH gene can be expressed in many extrapituitary tissues, including the central nervous system (CNS). Here we studied the expression of GH in the chicken cerebellum. Cerebellar GH expression was analyzed by in situ hybridization and cDNA sequencing, as well as by immunohistochemistry and confocal microscopy. GH heterogeneity was studied by Western blotting. We demonstrated that the GH gene was expressed in the chicken cerebellum and that its nucleotide sequence is closely homologous to pituitary GH cDNA. Within the cerebellum, GH mRNA is mainly expressed in Purkinje cells and in cells of the granular layer. GH-immunoreactivity (IR) is also widespread in the cerebellum and is similarly most abundant in the Purkinje and granular cells as identified by specific neuronal markers and histochemical techniques. The GH concentration in the cerebellum is age-related and higher in adult birds than in embryos and juveniles. Cerebellar GH-IR, as determined by Western blot under reducing conditions, is associated with several size variants (of 15, 23, 26, 29, 35, 45, 50, 55, 80 kDa), of which the 15 kDa isoform predominates (>30% among all developmental stages). GH receptor (GHR) mRNA and protein are also present in the cerebellum and are similarly mainly present in Purkinje and granular cells. Together, these data suggest that GH and GHR are locally expressed within the cerebellum and that this hormone may act as a local autocrine/paracrine factor during development of this neural tissue.

Primer consenso venezolanode enfermedad por reflujo gastroesofágico / Venezuelan consensus on gastroesophageal reflux diseases

El Consenso Venezolano de Enfermedad por Reflujo Gastroesófágico (ERGE) se realizó con el objeto de proveer guías para mejorar la identificación, el diagnóstico y el tratamiento de este trastorno en el país. Los coordinadores establecieron las líneas de consenso, basado en una revisión sistemática de la literatura médica de los últimos 15 años a partir de 1995. Participaron 55 miembros con el aval de sus respectivas cátedras y sociedades locales de gastroenterología. Éstos revisaron y presentaron los temas con sus niveles de evidencia y grados de recomendación para discutirlos y votarlos en una reunión plenaria. Tras un informe final de los miembros, los coordinadores prepararon las declaraciones finales. El consenso concluyó que la enfermedad por reflujo gastroesofágico tiene una prevalencia estimada del 11,54% en Venezuela, a predominio del sexo femenino (Grado B). El diagnóstico es fundamentalmente clínico, basado en la presencia de síntomas típicos y/o atípicos, e incluso síntomas de alarma que sugieren alguna complicación (Grado B). La endoscopia es importante en la investigación de la presencia de esofagitis de reflujo y laringitis de reflujo (Grado B). Las otras pruebas diagnósticas como lo son la pHmetría esofágica de 24 horas con o sin impedancia intraluminal multicanal son importantes en los pacientes que no tienen esofagitis, tienen síntomas atípicos o cuando hay falla en la respuesta al tratamiento médico (Grado B). La radiología, manometría esofágica y el ultrasonido endoscópico no están indicados en el diagnóstico de la ERGE (Grado B). El objetivo del tratamiento es reducir la exposición ácida en el esófago y con esto: aliviar los síntomas, cicatrizar las lesiones en la mucosa esofágica, prevenir la recurrencia y las complicaciones. Los inhibidores de bomba de protones deberían ser la primera opción en el tratamiento en el síndrome de ERGE y en la esofagitis por reflujo tanto en la fase aguda como durante el mantenimiento...

The Venezuelan Gastroesophageal Reflux Disease (GERD) Consensus was carried out in order to provide guidelines to improve the identification, diagnosis and treatment of this illness in Venezuela.  The coordinators established the consensuslines, based on a systematic revision of the medical literature of the last 15 years starting from 1995. 55 physicians participated with the support of their respective medical schools and local societies. They revised and presented the topics with their respective evidence levels and recommendation grades to discuss and vote them in a plenary meeting. After a final report of the members, the coordinators prepared the definitive declarations. The consensus concluded that GERD prevalence in Venezuela is 11,54%, higher in women than men (Grade B). The diagnosis is mainly clinical, based on the presence of typical and/or atypical symptoms and alarm symptoms that may suggest the presence of complications (Grade B). Endoscopy is important when reflux esophagitis and laryngitis are present (Grade B). Other diagnostic tests as ambulatory 24 hours pH monitoring with or without multichannel intraluminal impedance are important in patients without esophagitis, with atypical symptoms or when there is flaw in the answer to the medical treatment (Grade B). Radiology, esophageal manometry and endoscopic ultrasonography are not indicated in the diagnosis of GERD (Grade B). The objective of the treatment is to reduce the presence of acid in the esophagus and consequently: alleviate the symptoms and heal lesions in the esophagus mucosa to prevent recurrence and complications. Proton pump inhibitors should be the first option drug in the treatment of GERD syndrome andin esophagitis during the acute and the maintenance phase using standard or half dose (Grade A). So far, pokinetics are drugs with a limited use in GERD patients; they stimulate the esophagus/gastric motility...

[Paediatric pseudotumour cerebri]. / Pseudotumor cerebral pediátrico.

INTRODUCTION: Paediatric pseudotumour cerebri or idiopathic intracranial hypertension syndrome is rare in the paediatric age and presents with clinical features that differ from the clinical picture seen in adults. It is not a benign condition in children and, although sometimes used to identify this syndrome, the term 'benign intracranial hypertension' must therefore be avoided. It is characterised by an increase in the intracranial pressure with analytically normal cerebrospinal fluid and the absence of expansive injuries detected by means of neuroimaging. DEVELOPMENT: It is a complex syndrome that causes intense headaches in children with acute loss of vision and, on occasions, optic atrophy. Its treatment has to be tailored to each patient and the use of different pharmacological or neurosurgical treatments must be considered to avoid permanent visual damage. We reviewed the case mix at our Institute over the last 10 years (1995-2005) and found 23 children (between 3 and 15 years of age) who fulfilled Dandy criteria confirming a diagnosis as suffering from paediatric pseudotumour cerebri, with no predominance of sex or associated obesity. CONCLUSIONS: Its treatment must be established on an individualised basis, as well as ongoing and multidisciplinary; fenestration of the optic nerve sheath or the implantation of lumboperitoneal shunts correct refractory syndromes, which in our case accounted for 35% of the total number. The rest were treated with acetazolamide, diet and steroids.

Pseudotumor cerebral pediátrico / Paediatric pseudotumour cerebri

Introducción. El pseudotumor cerebral pediátrico o síndromede hipertensión endocraneal idiopático; es infrecuente en laedad pediátrica y se presenta con características clínicas diferentesal cuadro visto en adultos. No es una condición benigna enniños y por ello debe evitarse el término ‘hipertensión endocranealbenigna’, algunas veces usado para identificar este síndrome, quese caracteriza por un aumento de la presión intracraneal con líquidocefalorraquídeo analíticamente normal y sin lesiones expansivasdetectadas mediante neuroimágenes. Desarrollo. Es un síndromecomplejo, una causa de cefalea intensa en niños, con pérdidavisual aguda y, eventualmente, atrofia óptica; su tratamiento debeser individualizado y las opciones de tratamiento farmacológico oneuroquirúrgico deben contemplarse para evitar daño visual permanente.Revisamos la casuística de nuestro instituto en los últimos10 años (1995-2005), donde encontramos 23 niños (entre los 3y 15 años) que cumplían con los criterios de Dandy para su diagnósticocomo pseudotumor cerebral pediátrico, sin predominio desexo, ni obesidad asociada. Conclusiones. Su tratamiento debe serindividualizado, continuo y multidisciplinario; la fenestración dela vaina del nervio óptico o el implante de derivaciones lumboperitonealescorrigen el síndrome refractario, que en nuestro caso estuvoen el 35%. El porcentaje restante se trató con acetazolamida,dieta y esteroides

Introduction. Paediatric pseudotumour cerebri or idiopathic intracranial hypertension syndrome is rare in thepaediatric age and presents with clinical features that differ from the clinical picture seen in adults. It is not a benign conditionin children and, although sometimes used to identify this syndrome, the term ‘benign intracranial hypertension’ must thereforebe avoided. It is characterised by an increase in the intracranial pressure with analytically normal cerebrospinal fluid and theabsence of expansive injuries detected by means of neuroimaging. Development. It is a complex syndrome that causes intenseheadaches in children with acute loss of vision and, on occasions, optic atrophy. Its treatment has to be tailored to each patientand the use of different pharmacological or neurosurgical treatments must be considered to avoid permanent visual damage.We reviewed the case mix at our Institute over the last 10 years (1995-2005) and found 23 children (between 3 and 15 years ofage) who fulfilled Dandy criteria confirming a diagnosis as suffering from paediatric pseudotumour cerebri, with nopredominance of sex or associated obesity. Conclusions. Its treatment must be established on an individualised basis, as wellas ongoing and multidisciplinary; fenestration of the optic nerve sheath or the implantation of lumboperitoneal shunts correctrefractory syndromes, which in our case accounted for 35% of the total number. The rest were treated with acetazolamide, dietand steroids

[Attention deficit hyperactivity disorder and sleep disorders]. / Trastorno por déficit de atención ehiperactividad y trastornos del sueño.

INTRODUCTION: The purpose of the present review was to analyse the comorbidity that exists between attention deficit hyperactivity disorder (ADHD) and sleep disorders in children and adolescents, together with their clinical characteristics, diagnosis and treatment regimens. DEVELOPMENT: ADHD and sleep disorders are a frequent cause of visits in neuropaediatric departments. Around 25% of children with ADHD have some kind of sleep disorder but, unlike the case of adults, these often remain undetected. We nearly always choose to improve hyperactivity, attention deficit and impulsiveness symptomatically and forget to treat the associated sleep disorder. CONCLUSIONS: There is a clear correlation between ADHD and sleep disorders and they are very common in visits to the neuropaediatric department. Diagnosis of these patients is clinical. Neurophysiological evaluation, especially using polysomnography, provides objective confirmation of the symptoms. Novel treatments such as melatonin and other drugs are now available to improve the sleep pattern. By improving these children's sleep, the symptoms of ADHD are diminished and thus avoid the need to administer psychostimulants, which have undesirable side effects that produce a great deal of anxiety in the parents of these children.

Trastorno por déficit de atención e hiperactividad y trastornos del sueño / Attention deficit hyperactivity disorder and sleep disorders

Objetivo. Analizar la comorbilidad existente entre el trastornopor déficit de atención e hiperactividad (TDAH) y los trastornosdel sueño en niños y adolescentes; sus características clínicas,diagnóstico y pautas de tratamiento. Desarrollo. El TDAH ylos trastornos del sueño son una causa frecuente de consulta enneuropediatría. Aproximadamente el 25% de niños con TDAH presentanalgún trastorno del sueño, pero, a diferencia de los adultos,muchas veces pasan desapercibidos. Casi siempre optamos pormejorar sintomáticamente la hiperactividad, el déficit de atencióny la impulsividad, y nos olvidamos de tratar el trastorno del sueñoasociado. Conclusiones. El TDAH y los trastornos del sueño tienenuna alta correlación y son muy frecuentes en una consulta de neuropediatría.El diagnóstico de estos pacientes es clínico. La evaluaciónneurofisiológica, especialmente la polisomnografía, corroboraobjetivamente los síntomas. Existen tratamientos novedososcomo la melatonina y otros fármacos que mejoran el patrón hípnico.Al mejorar el sueño de estos niños disminuyen los síntomas delTDAH y se evita la administración de psicoestimulantes cuyos efectossecundarios indeseables generan gran ansiedad en los padresde estos niños

Introduction. The purpose of the present review was to analyse the comorbidity that exists between attention deficithyperactivity disorder (ADHD) and sleep disorders in children and adolescents, together with their clinical characteristics,diagnosis and treatment regimens. Development. ADHD and sleep disorders are a frequent cause of visits in neuropaediatricdepartments. Around 25% of children with ADHD have some kind of sleep disorder but, unlike the case of adults, these oftenremain undetected. We nearly always choose to improve hyperactivity, attention deficit and impulsiveness symptomaticallyand forget to treat the associated sleep disorder. Conclusions. There is a clear correlation between ADHD and sleep disorders andthey are very common in visits to the neuropaediatric department. Diagnosis of these patients is clinical. Neurophysiologicalevaluation, especially using polysomnography, provides objective confirmation of the symptoms. Novel treatments such asmelatonin and other drugs are now available to improve the sleep pattern. By improving these children’s sleep, the symptomsof ADHD are diminished and thus avoid the need to administer psychostimulants, which have undesirable side effects thatproduce a great deal of anxiety in the parents of these children

[Autoimmune neuropsychiatric disorders associated to infection by streptococcus in the paediatric age: PANDAS]. / Trastornos neuropsiquiátricos autoinmunes asociados a la infección estreptocócica en la edad pediátrica: PANDAS.

INTRODUCTION: The acronym PANDAS (Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus) describes the neuropsychiatric disorders resulting from an autoimmune response to an infection by streptococcus in children. AIMS: The aim of this study was to clinically analyse 38 patients under the age of 16 with tics, Tourette syndrome (TS) or obsessive compulsive disorder (OCD) and their possible association to an infection caused by group A beta-haemolytic streptococcus (GABHS). METHOD: We reviewed the medical records at the Instituto Neurológico in Valencia (Venezuela) over a 12 year period (1988-2000). All the patients met the inclusion criteria set out by the National Institute of Mental Health in Bethesda (1997) and the DSM-IV. RESULTS: Onset of the symptoms was higher in the group of schoolchildren (n=24), followed by the group of preschool children (n=8) and adolescents (n=6). Males were predominant (n=33) (86.8%). 17 patients presented chronic tics (44.7%), 13 had transitory tics (34.2%) and there were eight cases of TS (21.1%). The most frequently related comorbid disorders were: difficulties in learning (n=30) (78.9%), ADHD (n=27) (71.1%), OCD 14 (36.8%), sleep disorders (n=14) (36.8%), behavioural disorders (n=12) (31.6%), language disorders (n=11) (28.9%), psychomotor disorders (n=10) (26.3%) and nocturnal enuresis (n=7) (18.4%). Electroencephalogram patterns were abnormal in 72.4% (n=12), and the disorganised pattern was the most frequently observed (n=12) (41.4%), followed by a slow diffuse pattern (n= 7) (24.1%) and the left centro-parieto-temporal focal paroxysmal specific pattern (n=7) (24.1%). Less frequently we found unspecific generalised paroxysmal patterns, in four cases (13.8%), and asymmetrical patterns (n=1) (3.4%). The association with an infection by streptococcus was shown in two cases, which amounted to 5.2% of the sample. CONCLUSIONS: The obtained are similar to those reported in the literature. Only 5.2% of the cases were linked to a prior streptococcus infection.

[Indications for neuroendoscopy]. / Indicaciones de la neuroendoscopia.

INTRODUCTION: In order to reduce intracerebral trauma in the diagnosis and treatment of intracranial lesions in children, neuroendoscopy is an important tool in current neurosurgery. Using this minimally invasive technique intraventricular objectives may be approached with little damage caused to adjacent structures. OBJECTIVES: There are two aspects to current indications for neuroendoscopy. Firstly, diagnosis is achieved by taking intraventricular biopsies of cystic lesions and tumours and for anatominical vigilance in microsurgical operations. Secondly, there is the therapeutic aspect, especially in operations to restore the circulation of cerebrospinal fluid (CSF), correct complex hydrocephaly, insert or remove intraventricular shunts, aspiration of cysts or haematomas, fenestration of cysts, resection of tumours within or near the ventricles. DEVELOPMENT: At the present time in neurosurgical paediatric management, neuroendoscopy is a tool used daily in common lesions such as hydrocephaly and the identification of intraventricular lesions. It may be safely used as a primary method of approach to the lesions or as a complement to open or guided surgery to the patient s advantage. We therefore reviewed the literature in the light of our own experience in neuroendoscopy since 1996. CONCLUSIONS: The formal indications for neuroendoscopy are greater in paediatric neurosurgery. In fact, the management of the CSF circulation, and disorders associated with this, together with the identification of tumours using minimally invasive methods, make this technique directly useful for solving these problems. This is most obvious in lesions such as multiseptate complex hydrocephaly, and intraventricular tumours and cysts where it is the first surgical option. In the short term, thanks to improvements in neuro navigation and frameless stereotaxis, its use will be wider and more precise

Immunoglobulin heavy chain expression shapes the B cell receptor repertoire in human B cell development.

Developing B cells must pass a series of checkpoints that are regulated by membrane-bound Ig(mu) through the Igalpha-Igbeta signal transducers. To determine how Ig(mu) expression affects B cell development and Ab selection in humans we analyzed Ig gene rearrangements in pro-B cells from two patients who are unable to produce Ig(mu) proteins. We find that Ig(mu) expression does not affect V(H), D, or J(H) segment usage and is not required for human Igkappa and Iglambda recombination or expression. However, the heavy and light chains found in pro-B cells differed from those in peripheral B cells in that they showed unusually long CDR3s. In addition, the Igkappa repertoire in Ig(mu)-deficient pro-B cells was skewed to downstream Jkappas and upstream Vkappas, consistent with persistent secondary V(D)J rearrangements. Thus, Ig(mu) expression is not required for secondary V(D)J recombination in pro-B cells. However, B cell receptor expression shapes the Ab repertoire in humans and is essential for selection against Ab's with long CDR3s.

Biopsia estereotaxica en el Instituto Nacional de Cancerologia 1996-1999: Correlacion mamografica e histologica / Stereotaxic Biopsy in Instituto Nacional de Cancerologia 1996-1999: mamographic and histological correlation

La biopsia por estereotaxia del seno es un método económico, accesible y bien tolerado que se utiliza para el diagnostico histológico definitivo de diversas lesiones del seno. En el Instituto Nacional de Cancerología empezó a realizarse desde 1996,en este trabajo describimos su uso y evolución hasta marzo de 1999, con un total de 159 procedimientos realizados. La indicación más frecuente fueron las microcalcificaciones amorfas(38,4 por ciento ). La categoría 4 constituyó el 64,5 por ciento , de todas las biopsias. El porcentaje de malignidad fue 5,9 por ciento para la categoría tres , para la categoría cuatro 20,2 y 72,9 por ciento para la categoría cinco. El hallazgo mamográfico que más se correlacionó con malignidad fue las masas espiculadas con microcalcificaciones(100 por ciento ). Los resultados de este estudio nos permiten plantear el papel fundamental de la biopsia por estereotaxia al acortar el proceso diagnóstico y terapéutico de las diferentes lesiones mamarias detectadas

[Development of a canine model of chronic progressive right ventricular hypertension]. / Desarrollo de un modelo canino de hipertensión ventricular derecha crónica progresiva.

INTRODUCTION: Several animal models of right ventricle hypertension (RVH) have been produced through pulmonary artery banding with linen, tygon or teflon. Nevertheless few devices attempting a progressive, step by step graduated chronic development of RVH have been reported. The present study describes the results in our animal model of chronic RVH. MATERIAL AND METHODS: We designed a software programmed to obtain hemodynamic data and installed a small occlusive hydraulic device (OHD) at the pulmonary artery trunk producing a raise in the right ventricular systolic pressure (RVSP); this pressure can be modified externally through the OHD. We studied 12 healthy mongrel dogs (18 to 28 kg of weight) in the course of 6 months. Hemodynamic measurements were performed at different RVSP at two months intervals; (Baseline, 40 mmHg and 60 mmHg). RESULTS: The software was useful to analyze several hemodynamic variables at each RVSP. At 60 mmHg, the end diastolic pressure of the right ventricle (RVEDP) increased from 4.2 +/- 0.4 mmHg to 13.2 +/- 1.1 mmHg, p < 0.000, accompanied with a fall in cardiac output adjusted to the dogs weight from 0.16 +/- 0.03 L/min/kg to 0.09 +/- 0.01 L/min/kg, p > 0.000. Also an increase of the end diastolic pressure of the left ventricle (LVEDP) from 7.4 +/- 0.8 mmHg to 16.3 +/- 2.8 mmHg, p < 0.000, was observed. RVSP was maintained in chronic condition and the intraclass correlation coefficient was 0.83, P < 0.005. CONCLUSIONS: Right ventricular chronic hypertension is created. The device is useful and reliable to maintain chronic increments of RVSP. The software permits a versatile analysis.

Formación de recursos humanos en enfermería gerontogeriátrica / Training human resources in gerontogeriatric nursing

El objetivo general del trabajo fue proponer estrategias metodológicas para la formación de recursos humanos en enfermería gerontogeriátrica con la finalidad de brindar una atención más especializada al anciano en los tres niveles de atención en Cuba. Para ello se realizó primero un estudio del número de ancianos existentes en Cuba y de su proyección futura. Seguidamente se analizaron los planes de preparación y formación de enfermera(o)s, licenciada(o)s en enfermería y aquellos de la formación postgraduada existentes en Cuba. Se efectuó una encuesta sobre envejecimiento y geriatría al personal de enfermería dedicado a la atención especial de ancianos antes y después de finalizar el primer diplomado dedicado a este tema. Se concluye que: a) Los aspectos del adulto mayor aunque son tratados durante los estudios en algunas asignaturas de las carreras son escasos y no están agrupados de modo coherente que permitan preparar al enfermero o licenciado que se dedicará a la Gerontogeriatría para su labor integral; b) Los postgrados de enfermería gerontogeriátrica son escasos y de reciente creación; c) No obstante las actividades que se realizan para garantizar las condiciones de vida y la salud de los ancianos las tareas encaminadas para preparar el personal que atenderá a los adultos mayores desde el punto de vista de la enfermería gerontogeriátrica son aún escasas. Por ello resultará conveniente el establecimiento de cursos, diplomados, maestrías y doctorados dirigidos a ese fin en el campo de la enfermería (AU)