Validation of Neuromyotype: a smart keyboard for the evaluation of spinal muscular atrophy patients.

INTRODUCTION: Spinal muscular atrophy 5q (SMA) is a genetic neurodegenerative disease that affects alpha motor neurons producing progressive weakness. New outcome measures are currently required to accurately characterise the disease progression and the efficacy of new available treatments. The objective of this work is to preliminarily validate a new intelligent keyboard (Neuromyotype) measuring typing strength and speed in patients with SMA. MATERIAL AND METHODS: Twenty two SMA patients older than 15 years, and 26 healthy controls were included. Three measurements were obtained with the keyboard (maximum strength, execution time of a random typing task, execution time of a sequential typing task) together with the time to complete the Nine-Hole Peg Test (9HPT). Patients were also administered motor (Hammersmith Functional Motor Scale Expanded, HFMSE; Revised Upper Limb module, RULM), and functional scales (Egen Klassification, EK2; and the revised version of Amyotrophic Lateral Sclerosis Functional Rating Scale, ALSFRS-R). The viability and construct validity of the Neuromyotype were analysed, measuring the discriminative power between patients and controls (using ROC curves and the Bangdiwala's B statistic), between the different functional types of SMA (walker, sitter and non-sitter) and their correlation with the rest of motor scales. RESULTS: Neuromyotype measurements could be performed in all patients, unlike the rest of the scales. Its administration was quick and easy. The 3 variables on the keyboard discriminated very well between patients and controls, with strength (ROC = 0.963) being the one that best differentiates from the 3, equaling 9HPT (ROC = 0.966). They also showed a good ability to differentiate by functional type (especially non-sitters from sitters and walkers), with sequential time (B = 0.83) being the tool that best discriminates between the three groups above the rest of motor scales. All motor and functional scales showed strong or very strong correlations with each other (rs = 0.71-0.99), with strength correlating better with motor scales and timed variables with functional scales. CONCLUSION: This study shows the feasibility and validity of Neuromyotype for the evaluation of adolescent and adult patients with SMA. Data obtained with this tool could be of great clinical relevance, saving time and resources compared to the rest of the scales.

Delphi consensus on recommendations for the treatment of spinal muscular atrophy in Spain (RET-AME consensus).

INTRODUCTION: Spinal muscular atrophy (SMA) is a neurodegenerative disease caused by a biallelic mutation of the SMN1 gene, located on the long arm of chromosome 5, and predominantly affects the motor neurons of the anterior horn of the spinal cord, causing progressive muscle weakness and atrophy. The development of disease-modifying treatments is significantly changing the natural history of SMA, but uncertainty remains about which patients can benefit from these treatments and how that benefit should be measured. METHODOLOGY: A group of experts specialised in neurology, neuropediatrics, and rehabilitation and representatives of the Spanish association of patients with SMA followed the Delphi method to reach a consensus on 5 issues related to the use of these new treatments: general aspects, treatment objectives, outcome assessment tools, requirements of the treating centres, and regulation of their use. Consensus was considered to be achieved when a response received at least 80% of votes. RESULTS: Treatment protocols are useful for regulating the use of high-impact medications and should guide treatment, but should be updated regularly to take into account the most recent evidence available, and their implementation should be assessed on an individual basis. Age, baseline functional status, and, in the case of children, the type of SMA and the number of copies of SMN2 are characteristics that should be considered when establishing therapeutic objectives, assessment tools, and the use of such treatments. The cost-effectiveness of these treatments in paediatric patients is mainly influenced by early treatment onset; therefore, the implementation of neonatal screening is recommended. CONCLUSIONS: The RET-AME consensus recommendations provide a frame of reference for the appropriate use of disease-modifying treatments in patients with SMA.

[Cognitive reserve as a modulating factor in the impact of surgery on visual memory and naming in temporal lobe epilepsy patients]. / La reserva cognitiva como factor modulador del impacto de la cirugía sobre la memoria visual y la denominación en pacientes con epilepsia del lóbulo temporal.

INTRODUCTION: Temporal lobe epilepsy (TLE) surgery is an effective procedure that produces cognitive changes. Factors modulating such changes have been proposed, but the influence of cognitive reserve remains unclear. OBJECTIVE: To examine the effect of intellectual quotient (IQ) on postsurgical changes in verbal fluency, naming, and verbal and visual memory in a sample of patients with TLE. PATIENTS AND METHODS: 64 adult patients with drug-resistant TLE (mean age ± SD: 39.16 ± 11.67) underwent a neuropsychological evaluation before and one year after surgery. RESULTS: Patients with high IQ showed better immediate visual memory before surgery than those with medium IQ, as well as an absence of postsurgical changes. Patients with high manipulative IQ had better naming before surgery than those with medium manipulative IQ, as well as a significant postsurgical worsening. Both before and after surgery, patients with high IQ showed better phonemic and semantic verbal fluency and short- and long-term verbal memory than those with medium IQ. CONCLUSIONS: IQ is a relevant factor in the evolution of immediate visual memory and naming after surgery in patients with TLE. Surgery does not impact on the advantage of high IQ patients in verbal fluency and verbal memory, suggesting that cognitive reserve has a positive effect on cognitive function, even after TLE surgery.

TITLE: La reserva cognitiva como factor modulador del impacto de la cirugía sobre la memoria visual y la denominación en pacientes con epilepsia del lóbulo temporal.Introducción. La cirugía de la epilepsia del lóbulo temporal (ELT) es un procedimiento eficaz que produce cambios cognitivos. Se han propuesto factores moduladores de dichos cambios, pero permanece sin esclarecer la influencia de la reserva cognitiva. Objetivo. Examinar el efecto del cociente intelectual (CI) sobre los cambios posquirúrgicos en medidas de fluencia verbal, denominación y memoria verbal y visual en una muestra de pacientes con ELT. Pacientes y métodos. Sesenta y cuatro pacientes adultos con ELT farmacorresistente (edad media ± desviación típica: 39,16 ± 11,67) fueron sometidos a una evaluación neuropsicológica antes y un año después de la cirugía. Resultados. Los pacientes con un CI alto presentaron un mejor funcionamiento de la memoria visual inmediata antes de la cirugía que los que tenían un CI medio, así como ausencia de cambios posquirúrgicos. Los pacientes con un CI manipulativo alto presentaron mejor denominación antes de la cirugía que los que tenían un CI manipulativo medio, así como un empeoramiento posquirúrgico significativo. Tanto antes como después de la cirugía, los pacientes con un CI alto presentaron mejor fluencia verbal fonémica y semántica y memoria verbal a corto y largo plazo que los que tenían un CI medio. Conclusiones. El CI es un factor relevante en la evolución de la memoria visual inmediata y de la denominación tras la cirugía en pacientes con ELT. La cirugía no repercute en la ventaja que tienen los pacientes con un CI alto en fluencia verbal y memoria verbal, lo que sugiere que la reserva cognitiva tiene un efecto positivo sobre la función cognitiva, incluso tras la cirugía de la ELT.

La reserva cognitiva como factor modulador del impacto de la cirugía sobre la memoria visual y la denominación en pacientes con epilepsia del lóbulo temporal / Cognitive reserve as a modulating factor in the impact of surgery on visual memory and naming in temporal lobe epilepsy patients

Introducción:La cirugía de la epilepsia del lóbulo temporal (ELT) es un procedimiento eficaz que produce cambios cognitivos. Se han propuesto factores moduladores de dichos cambios, pero permanece sin esclarecer la influencia de la reserva cognitiva. Objetivo: Examinar el efecto del cociente intelectual (CI) sobre los cambios posquirúrgicos en medidas de fluencia verbal, denominación y memoria verbal y visual en una muestra de pacientes con ELT. Pacientes y métodos: Sesenta y cuatro pacientes adultos con ELT farmacorresistente (edad media ± desviación típica: 39,16 ± 11,67) fueron sometidos a una evaluación neuropsicológica antes y un año después de la cirugía. Resultados: Los pacientes con un CI alto presentaron un mejor funcionamiento de la memoria visual inmediata antes de la cirugía que los que tenían un CI medio, así como ausencia de cambios posquirúrgicos. Los pacientes con un CI manipulativo alto presentaron mejor denominación antes de la cirugía que los que tenían un CI manipulativo medio, así como un empeoramiento posquirúrgico significativo. Tanto antes como después de la cirugía, los pacientes con un CI alto presentaron mejor fluencia verbal fonémica y semántica y memoria verbal a corto y largo plazo que los que tenían un CI medio. Conclusiones: El CI es un factor relevante en la evolución de la memoria visual inmediata y de la denominación tras la cirugía en pacientes con ELT. La cirugía no repercute en la ventaja que tienen los pacientes con un CI alto en fluencia verbal y memoria verbal, lo que sugiere que la reserva cognitiva tiene un efecto positivo sobre la función cognitiva, incluso tras la cirugía de la ELT.(AU)

Introduction: Temporal lobe epilepsy (TLE) surgery is an effective procedure that produces cognitive changes. Factors modulating such changes have been proposed, but the influence of cognitive reserve remains unclear. Objective: To examine the effect of intellectual quotient (IQ) on postsurgical changes in verbal fluency, naming, and verbal and visual memory in a sample of patients with TLE. Patients and methods: 64 adult patients with drug-resistant TLE (mean age ± SD: 39.16 ± 11.67) underwent a neuropsychological evaluation before and one year after surgery. Results: Patients with high IQ showed better immediate visual memory before surgery than those with medium IQ, as well as an absence of postsurgical changes. Patients with high manipulative IQ had better naming before surgery than those with medium manipulative IQ, as well as a significant postsurgical worsening. Both before and after surgery, patients with high IQ showed better phonemic and semantic verbal fluency and short- and long-term verbal memory than those with medium IQ. Conclusions: IQ is a relevant factor in the evolution of immediate visual memory and naming after surgery in patients with TLE. Surgery does not impact on the advantage of high IQ patients in verbal fluency and verbal memory, suggesting that cognitive reserve has a positive effect on cognitive function, even after TLE surgery.(AU)

Analysis of the diagnostic pathway and delay in patients with amyotrophic lateral sclerosis in the Valencian Community.

INTRODUCTION: Amyotrophic lateral sclerosis (ALS) is an insidious, clinically heterogeneous neurodegenerative disease associated with a diagnostic delay of approximately 12 months. No study conducted to date has analysed the diagnostic pathway in Spain. METHODS: We gathered data on variables related to the diagnostic pathway and delay for patients diagnosed with ALS between October 2013 and July 2017. RESULTS: The study included 143 patients with ALS (57% men; 68% spinal onset). Patients were diagnosed in public centres in 86% of cases and in private centres in 14%. The mean diagnostic delay was 13.1 months (median 11.7). Patients were examined by neurologists a mean time of 7.9 months after symptom onset, with diagnosis being made 5.2 months later. Half of all patients underwent unnecessary diagnostic tests and multiple electrophysiological studies before diagnosis was established. Diagnostic delay was longer in cases of spinal onset (P=.008) due to onset of the disease in the lower limbs. No differences were found between the public and private healthcare systems (P=.897). CONCLUSIONS: The diagnostic delay in ALS in Spain is similar to that of neighbouring countries and seems to depend on disease-related factors, not on the healthcare system. Patients with lower-limb onset ALS constitute the greatest diagnostic challenge. Misdiagnosis is frequent, and partly attributable to an incorrect approach or erroneous interpretation of electrophysiological studies. Specific training programmes for neurologists and general neurophysiologists and early referral to reference centres may help to reduce diagnostic delay.

Análisis del trayecto y retraso diagnóstico de los pacientes con esclerosis lateral amiotrófica en la Comunidad Valenciana / Analysis of the diagnostic pathway and delay in patients with amyotrophic lateral sclerosis in the Valencian Community

Introducción: La esclerosis lateral amiotrófica (ELA) es una enfermedad insidiosa y clínicamente heterogénea, lo que resulta en un retraso diagnóstico de unos 12 meses. En España el trayecto diagnóstico no ha sido analizado.MétodosSe recogieron variables relativas al trayecto y retraso diagnóstico de pacientes diagnosticados de ELA entre octubre del 2013 y julio del 2017.ResultadosSe incluyó a 143 pacientes con ELA (57% varones, 68% de inicio espinal). El 86% de ellos fueron estudiados en centros públicos y un 14% en privados. El retraso diagnóstico medio fue de 13,1 meses (mediana 11.7). El paciente tardó de media 7,9 meses en llegar al neurólogo y este, 5,2 meses más en diagnosticarlo. En la mitad de los pacientes se realizaron pruebas innecesarias y más de un estudio electrofisiológico para llegar al diagnóstico. El retraso diagnóstico fue mayor en los casos espinales (p = 0,008), atribuible a los pacientes cuyos síntomas se iniciaron en miembros inferiores, pero sin diferencias entre el sistema público y privado (p = 0,897).ConclusionesEl retraso diagnóstico de la ELA en nuestro medio es similar al de países de nuestro entorno y parece determinado por factores propios de la enfermedad e independiente del sistema sanitario. Las formas de inicio en miembros inferiores constituyen el mayor reto. Los errores diagnósticos del neurólogo son frecuentes y en parte atribuibles a una mala orientación o interpretación del estudio electrofisiológico. La formación específica del neurólogo y neurofisiólogo general y la derivación precoz a centros de referencia podrían ayudar a reducir la demora. (AU)

Introduction: Amyotrophic lateral sclerosis (ALS) is an insidious, clinically heterogeneous neurodegenerative disease associated with a diagnostic delay of approximately 12 months. No study conducted to date has analysed the diagnostic pathway in Spain.MethodsWe gathered data on variables related to the diagnostic pathway and delay for patients diagnosed with ALS between October 2013 and July 2017.ResultsThe study included 143 patients with ALS (57% men; 68% spinal onset). Patients were diagnosed in public centres in 86% of cases and in private centres in 14%.The mean diagnostic delay was 13.1 months (median 11.7). Patients were examined by neurologists a mean time of 7.9 months after symptom onset, with diagnosis being made 5.2 months later. Half of all patients underwent unnecessary diagnostic tests and multiple electrophysiological studies before diagnosis was established. Diagnostic delay was longer in cases of spinal onset (P = .008) due to onset of the disease in the lower limbs. No differences were found between the public and private healthcare systems (P = .897).ConclusionsThe diagnostic delay in ALS in Spain is similar to that of neighboring countries and seems to depend on disease-related factors, not on the healthcare system. Patients with lower-limb onset ALS constitute the greatest diagnostic challenge. Misdiagnosis is frequent, and partly attributable to an incorrect approach or erroneous interpretation of electrophysiological studies. Specific training programmes for neurologists and general neurophysiologists and early referral to reference centers may help to reduce diagnostic delay. (AU)

Ultrasound-guided lumbar puncture for nusinersen administration in spinal muscular atrophy patients.

BACKGROUND AND PURPOSE: The purpose was to report the results of ultrasound-guided lumbar puncture for the administration of nusinersen in spinal muscular atrophy (SMA) patients with complex spines. METHODS: Eighteen SMA patients (five children, five adolescents and eight adults) with either severe scoliosis or spondylodesis were evaluated for ultrasound-guided lumbar puncture. Ultrasound was performed with a 3.5 MHz transducer to guide a 22 gauge × 15 mm needle, which was placed in the posterior lumbar space following a parasagittal interlaminar approach. RESULTS: Twelve patients had undergone spinal instrumentation (nine growing rods and three spinal fusion) whilst the other six showed severe scoliosis. Success was achieved in 91/94 attempts (96.8%), in 14/18 patients (77.8%), including 100% of children and adolescents and 50% of adult patients. In two of the unsuccessfully treated patients, computed tomography and fluoroscopy-guided transforaminal lumbar punctures were also tried without success. After a median follow-up of 14 months, only few adverse events, mostly mild, were observed. CONCLUSION: The ultrasound-guided lumbar puncture, following an interlaminar parasagittal approach, is a safe and effective approach for intrathecal treatment with nusinersen in children, adolescents and carefully selected adult SMA patients with complex spines and could be considered the first option in them.

Measuring Outcomes in Adults with Spinal Muscular Atrophy - Challenges and Future Directions - Meeting Report.

Spinal muscular atrophy (SMA) is a progressive autosomal recessive motor neuron disease which affects 1 in 6,000-10,000 live births, caused by loss of the survival motor neuron 1 gene (SMN1). A major focus of therapeutic developments has been on increasing the full-length SMN protein by increasing the inclusion of exon 7 in SMN2 transcripts, enhancing SMN2 gene expression, stabilizing the SMN protein or replacing the SMN1 gene.In June 2017, FDA and EMA have approved the antisense oligonucleotide Nusinersen as the first treatment for all SMA subtypes without age restriction. While prominent treatment effects have been observed in the earlier stages of the disease and in patients up to 15 years of age, there is only limited data from clinical trials in adult SMA patients. First real-world data from neuromuscular clinical centers suggest a therapeutic benefit of nusinersen with a favourable safety profile also in adult SMA patients: in several cases, relevant improvements of motor function is achieved, which might lead to enhanced autonomy in daily life activities and improved quality of life. Systematic follow-up of the motor status with validated instruments is crucial for an adequate monitoring of the therapeutic effects but most of the widely used scales and scores have been developed and evaluated for the pediatric population only. International neuromuscular experts have met in Frankfurt/Main, Germany in May 2019 to discuss relevant aspects of the diagnostic pathway and patient management in adult SMA. The recommendations and challenges in this patient population are discussed.

Clinical spectrum of BICD2 mutations.

BACKGROUND AND PURPOSE: Mutations in the BICD2 gene cause autosomal dominant lower extremity-predominant spinal muscular atrophy 2A (SMALED2A), a condition that is associated with a specific pattern of thigh and calf muscle involvement when studied by magnetic resonance imaging (MRI). Patients may present minor clinical sensory impairment, but objective sensory involvement has yet to be demonstrated. METHODS: We collected clinical data from 11 patients from five different families carrying mutations in BICD2. Genetic diagnosis was achieved using gene panel testing and skin biopsies were taken from two patients to study the epidermal nerve fiber density. RESULTS: In the studied patients, three new pathogenic mutations were detected as well as the already defined pathogenic p.Ser107Leu mutation. The most frequent clinical picture was characterized by lower-limb weakness in combination with foot deformities. One patient manifested clinical and electrophysiological sensory impairment, and the epidermal nerve fiber density study of another patient revealed the existence of a small-fiber neuropathy. Muscle MRI showed a common pattern of fat deposition including selective involvement of gluteus medius and minimus at the pelvic level, the anterior compartment of the thigh and the posterior compartment of the calf, with only mild or no involvement of the intrinsic foot muscles. CONCLUSIONS: We report three new pathogenic mutations in the BICD2 gene. Muscle MRI confirms the existence of a selective pattern of thigh and leg muscle involvement in SMALED2A, providing additional information regarding pelvic and foot muscles. Moreover, our results raise the possibility of sensory involvement in the disease.

Increased pulsatility index supports diagnosis of vascular parkinsonism versus idiopathic Parkinson's disease. / El índice de pulsatilidad intracraneal elevado apoya el diagnóstico de parkinsonismo vascular frente a enfermedad de Parkinson idiopática.

INTRODUCTION: The diagnosis of vascular parkinsonism (VP) is based on a series of clinical criteria and neuroimaging findings. An increase in transcranial Doppler ultrasonography pulsatility index (PI) has been described as a frequent finding in patients with VP. We aimed to confirm this association and to determine the PI value with the highest sensitivity and specificity for diagnosis of VP. METHOD: PI was determined in all patients admitted to Hospital Universitari i Politècnic La Fe due to parkinsonism between January 2012 and June 2016. We assessed the probability of having VP based on PI values in patients with a definite diagnosis of either VP or idiopathic Parkinson's disease (IPD). A ROC curve was created to determine the PI value with the highest sensitivity and specificity. RESULTS: We assessed a total of 146 patients with suspected parkinsonism; 54 (37%) were diagnosed with IPD and 15 (10%) with VP. Patients with VP were significantly older than those with IPD (mean age of 79 vs 68.5, P=.00144) and had a higher PI (median of 1.29 [IQR: 1.09-1.38] vs 0.96 [IQR: 0.89-1.16], P=.01328). In our sample, a PI of 1.09 conferred 84% sensitivity and 70% specificity. CONCLUSIONS: In our series, the PI was significantly higher in patients with VP than in those with IPD. We therefore support the use of transcranial Doppler ultrasonography for the initial assessment of elderly patients with akinetic-rigid syndrome.

New insights into the pathophysiology of fasciculations in amyotrophic lateral sclerosis: An ultrasound study.

OBJECTIVE: To describe the fasciculation pattern in ALS and to analyse its clinical and pathophysiological significance. METHODS: Ultrasound of 19 muscles was performed in 44 patients with a recent diagnosis (<90 days) of ALS. The number of fasciculations was recorded in each muscle and the muscle thickness and strength were additionally measured in limb muscles. A subgroup of patients were electromyographically assessed. RESULTS: US was performed in 835 muscles and EMG was available in 263 muscles. US detected fasciculations more frequently than EMG. Fasciculations were widespread, especially in upper limbs onset patients and in the cervical region. Fasciculations' number inversely associated with ALSFR-R and body mass index (BMI) and directly with BMI loss and upper motor neuron (UMN) impairment. Our statistical model suggest that fasciculations increase with the initial lower motor neuron (LMN) degeneration, reach their peak when the muscle became mildly to moderately weak, decreasing afterwards with increasing muscle weakness and atrophy. CONCLUSIONS: Our study suggests that both UMN and LMN degeneration trigger fasciculations causing BMI loss. The degree of LMN impairment could account for differences in fasciculations' rates within and between muscles. SIGNIFICANCE: In ALS, fasciculations could explain the link between hyperexcitability and BMI loss.

Hematological and immunological development from birth to six months of age in Holstein calves / Desenvolvimento hematológico e imunológico em bezerros Holandeses do nascimento aos seis meses de idade

The hematological and immunological development of calves from birth to 6 months of age was performed by hemogram and cellular phenotype. Ten male Holstein calves were assessed in 13 moments: before colostrum intake (D0), every 2 days until the 10th day of life (D2 to D10), at the 15th day after birth (D15), and then monthly up to 6 months (D180). Calves presented hemoconcentration on day (D) 0 and showed a gradual decrease in hematimetric rates until D180. The inversion of the neutrophilic for lymphocytic profile was observed on D4. The percentage of CD3+ cells on D10 was higher than D30 up to D180. The number of CD4+ and CD8+ cells did not change between time points. The number of CD21+ lymphocytes was significantly higher at early time points of D0 up to D15, compared on D30 until D150. In conclusion, the neonatal period was marked by stress leukogram in the first 4 days, and low number of B lymphocytes. These might be risk factors for bacterial infections responsible for navel inflammation and diarrhea. The increase in the number of B cells from 30 days of age demonstrated that the calves were functional and able to generate an immune response.(AU)

O desenvolvimento hematológico e o imunológico de bezerros do nascimento aos seis meses de idade foram avaliados por meio hemograma e imunofenotipagem dos linfócitos. Para tanto, 10 bezerros machos Holandeses foram avaliados em 13 momentos: antes da ingestão do colostro (D0), a cada dois dias até o 10º dia (D2 a D10), 15º dia (D15) e, em seguida, mensalmente até seis meses de idade (D180). Os bezerros apresentaram hemoconcentração em D0 e decréscimo gradual dos índices hematimétricos até D180. A inversão do perfil neutrofílico para linfocítico foi observada em D4. Os valores de CD3+ (%) em D10 foram maiores que aqueles observados em D30 até D180. CD4+ e CD8+ não apresentaram alterações entre os momentos. Os linfócitos B CD21+ aumentaram significativamente a partir dos primeiros momentos D0 até D15, em comparação com os momentos subsequentes D30 até D150. Em conclusão, o período neonatal foi caracterizado pelo leucograma de estresse nos primeiros quatro dias e o baixo número de linfócitos B. Esses fatos podem ser considerados como fatores de risco para infecções bacterianas responsáveis pelas inflamações umbilicais e pela diarreia. Por outro lado, o aumento de células B após os 30 dias de vida demonstrou que os bezerros foram capazes de gerar uma resposta imune.(AU)

Imunidade celular em vacas Holandesas soropositivas para o Vírus da Leucose Bovina (BLV) durante o período de transição / Cellular immunity in Holstein cows seropositive for Bovine Leukosis Virus (BLV) during the transition period

Esta pesquisa avaliou a dinâmica dos leucócitos e das subpopulações de linfócitos em vacas Holandesas soropositivas para o BLV no período de transição. Amostras de sangue (n=72) provenientes de 12 vacas foram coletadas entre as semanas -2 e +3 para a realização do leucograma, imunofenotipagem, dosagem de cortisol e haptoglobina (Hp). O perfil leucocitário foi caracterizado por leucocitose, neutrofilia, monocitose e eosinopenia próximo ao parto. Linfocitose e elevada proporção de linfócitos B CD21+ foram achados constantes entre as semanas -2 e +3; assim, as vacas foram testadas e confirmadas soropositivas para o BLV. Os valores das subpopulações de linfócitos T apresentaram-se baixos durante o período de transição, observando-se dois picos máximos que coincidiram com as elevações nas concentrações de cortisol no parto (2,11µg/dL) e semana +3 (1,97µg/dL). Hp apresentou aumento crescente de -2 (166µg/mL) a +3 (576µg/mL), provavelmente associada à elevada taxa de infecções uterinas observadas nas semanas +2 e +3. As vacas soropositivas para o BLV apresentaram leucograma de estresse próximo ao parto, exceto para linfócitos. A linfocitose e as elevadas proporções de células B CD21+, associadas com as baixas proporções de células T, podem ser indicativo de imunossupressão e predisposição aos processos inflamatórios no período pós-parto.(AU)

This research evaluated the dynamics of leukocytes and lymphocytes subsets in seropositive Holstein cows for BLV during the transition period. Blood samples (n=72) from 12 cows were harvested from week -2 up to week +3 to perform leukogram, immunophenotyping, cortisol and haptoglobin (Hp). Leukocytes pattern was characterized by leukocytosis, neutrophilia, monocytosis and eosinopenia around calving. Lymphocytosis and high proportions of B cells CD21+ were a constant finding between week -2 and +3, thus cows were tested and confirmed seropositive for BLV. The values of T lymphocytes subsets were low during the transition period, observing two peaks that coincided with high levels of cortisol at delivery (2.11µg/dL) and week +3 (1.97µg/dL). Hp had gradual increase from week -2 (166µg/mL) until week +3 (576g/mL) probably due to high rate of uterine infection detected between week +2 and +3. The seropositive cows for BLV presented stress leukogram around delivery, except for lymphocytes. Lymphocytosis and the high proportions of B cells, associated with the low proportions of T lymphocytes, can be indicative of immunosuppression and predisposition to the inflammatory process observed in the post-partum period.(AU)

Varicocele embolization with glue and coils: A single center experience.

PURPOSE: The purpose of this study was to compare metallic coils and glue (n-butyl-2 cyanoacrylate) for varicocele embolization, regarding immediate technical and clinical success, procedure time, complications and recurrence rates. MATERIALS AND METHODS: A retrospective analysis of a consecutive series of varicocele embolization procedures performed between July 2012 and July 2015 was undertaken. A total of 129 procedures were performed, 26 using glue (20.2%; 26 men with a mean age of 32.6 years) and 103 using coils (79.8%; 103 men with a mean age of 32.3 years). Demographic data, indications, technique, procedure time, complications and outcomes were compared. RESULTS: A total of 89 procedures (69%) were motivated by infertility (glue=20, coils=69) and 40 (31%) by testicular pain (glue=6, coils=34). The mean procedure time was 35.58±13.44 (SD) min for glue and 45.97±17.46 (SD) min for coils (P=0.0054). Immediate technical success rate was 100% using glue and 99% using coils (P=1.0000). A single minor complication was observed after coil embolization (0.97%). Both materials showed significant improvement of semen parameters, with similar clinical success rates. For patients referred for testicular pain, clinical success rate was 66.67% using glue and 88.24% using coils (P=0.2147). Recurrence rate was 11.54% with glue and 5.83% with coils (P=0.4000). Procedure time was significantly shorter with glue (P=0.0054). CONCLUSION: Glue and coils are both safe and effective for varicocele embolization. However, the use of glue yields shorter procedure time.