Increases in functional connectivity between the default mode network and sensorimotor network correlate with symptomatic improvement after transcranial direct current stimulation for obsessive-compulsive disorder.

BACKGROUND: Non-invasive neuromodulation is a promising intervention for obsessive-compulsive disorder (OCD), although its neurobiological mechanisms of action are still poorly understood. Recent evidence suggests that abnormalities in the connectivity of the default mode network (DMN) and the supplementary motor area (SMA) with other brain regions and networks are involved in OCD pathophysiology. We examined if transcranial direct current stimulation (tDCS) alters these connectivity patterns and if they correlate with symptom improvement in treatment-resistant OCD. METHODS: In 23 patients from a larger clinical trial (comparing active tDCS to sham) who underwent pre- and post-treatment MRI scans, we assessed resting-state functional MRI (rs-fMRI) data. The treatment involved 30-minute daily tDCS sessions for four weeks (weekdays only), with the cathode over the SMA and the anode over the left deltoid. We conducted whole-brain connectivity analysis comparing active tDCS-treated to sham-treated patients. RESULTS: We found that active tDCS, but not sham, led to connectivity increasing between the DMN and the bilateral pre/postcentral gyri (p = 0.004, FDR corrected) and temporal-auditory areas plus the SMA (p = 0.028, FDR corrected). Also, symptom improvement was directly associated with connectivity increasing between the left lateral sensorimotor network and the left precuneus (r = 0.589, p = 0.034). LIMITATIONS: Limited sample size (23 participants with resting-state neuroimaging), inability to analyze specific OCD symptom dimensions (e.g., harm, sexual/religious, symmetry/checking, cleaning/contamination). CONCLUSIONS: These data offer novel information concerning functional connectivity changes associated with non-invasive neuromodulation interventions in OCD and can guide new brain stimulation interventions in the framework of personalized interventions.

[Quality of life and coping: differences between patients receiving continuous ambulatory peritoneal dialysis and those under hospital hemodialysis]. / Calidad de vida y afrontamiento: diferencias entre los pacientes de diálisis peritoneal continua ambulatoria y hemodiálisis hospitalaria.

OBJECTIVE: To compare satisfaction with life and quality of life in patients receiving continuous ambulatory peritoneal dialysis (CAPD) and hospital hemodialysis (HHD) and to analyze their relationship with coping strategies. METHODS: We performed a cross-sectional study in 61 patients aged<70 years old under HHD and 32 patients receiving CAPD. We applied the Charlson Index, the State-Trait Anxiety Inventory (Stai-R), the Perceived Stress Scale (PSS), the MOS Social Support Survey, and the Short-Form 36 questionnaire for quality of life. Coping strategies, perceived control and satisfaction with life were also analyzed. Statistical analyses were adjusted by differences in age and sex. RESULTS: Women accounted for 35.5% of the patients. The mean age was 54 years. The CAPD group was younger and had a higher proportion of women. Charlson Comorbidity Index scores were similar in patients receiving HHD and in those receiving CAPD. The use of psychoactive drugs was higher in the CAPD group than in the HHD group (38% vs. 13%; p<0.01). The CAPD group scored significantly higher in strategies of seeking help, emotional regulation skills, problem resolving and distraction. No differences were found in social support between the two groups. No significant differences were found in the physical or mental components or in the seven dimensions of the SF-36. Satisfaction with life was higher in the CAPD group (7.12 versus 6.21; p=0.07). CONCLUSIONS: No differences in the perception of quality of life were found between patients receiving the two modalities. The CAPD group tended to show greater satisfaction with life and more adaptive coping strategies (emotional regulation and search for meaning), suggesting that these patients may have greater acceptance and control over the disease process.

[Retrospective analysis of 6 cases of elastofibroma dorsi]. / Elastofibroma dorsi: estudio retrospectivo de seis casos.

Elastofibroma dorsi is a benign lesion of fibroelastic tissue. It often presents bilaterally, is frequently localized to the subscapular region, and is more common in middle-aged and elderly women. The pathogenesis is still unclear but it has been suggested to involve reactive, degenerative, or neoplastic processes. We present a retrospective study of the findings from 6 patients with elastofibroma dorsi. Elastofibroma should be included in the differential diagnosis of subcutaneous scapular tumors, as it is a benign lesion that only requires surgery when associated with symptoms or the lesion is extensive. Noninvasive techniques such as ultrasonography, computed tomography, and, above all, magnetic resonance imaging, may be sufficient to guide diagnosis. The results of histology and imaging are closely correlated, so the need for unnecessary biopsy and surgery may be avoided.

Gingivostomatitis after eating fish parasitized by Anisakis simplex: a case report.

Anisakis simplex (AS) is a nematode that may be encountered as a parasite in various kinds of seafood. Human beings may accidentally acquire AS larvae by eating raw or undercooked seafood. In addition to human parasitization (anisakiasis), this nematode can induce allergic reactions. AS-related diseases are frequent, especially in those countries with a high level of fish consumption and with traditions of eating raw or undercooked seafood. To our knowledge, this is the first report of gingivostomatitis secondary to the ingestion of fish with AS parasites.

Functional outcome and subset identification in RA patients from meridional Europe: analysis of a Spanish cohort.

The aim of this study was to study the short-term functional and anatomical prognosis of rheumatoid arthritis (RA) in a series of Spanish patients and to identify different subsets of patients as well as possible baseline factors associated with specific outcomes. All patients seen in our division who met the ACR criteria for RA and with disease duration between 2 and 7 years were eligible for the study. Available patients were further evaluated at the clinic for disease activity using biological tests and joint indices as joint counts and Thompson's index, functional capacity using the ACR functional classification (ACR-FC) and the modified Health Assessment Questionnaire (M-HAQ) and radiologic damage by the Sharp's radiologic scoring method. Cluster analysis was used to identify different clinical subsets of patients. One hundred and sixty-three patients were eligible for the study, 13 could not be located or refused to participate and 12 had died. Mean (+/-SD) age at disease onset and mean disease duration were, respectively, 56(+/-14) years and (55+/-20) months. Median (interquartile range) of M-HAQ was 0.4 (0.1-1.1) and 41% of patients were in III or IV ACR-FC. The majority of patients (93%) showed radiologic lesions and 65% had erosions. Cluster analysis identified three subsets: cluster I (70% of patients) was characterised by a good prognosis, cluster II (13%) by a high level of disease activity, and cluster III (17%) by a greater anatomic damage and longer disease duration. No baseline predictive markers were found for these different outcomes. We concluded that RA portends an overall poor short-term prognosis in a relative large percentage of our patients with significant anatomic and functional sequelae. Aggressive management is specially indicated in this subgroup of patients, although definitive prognostic markers for its early identification are still lacking.

Soft tissue Burkitt's lymphoma: radiological findings.

An unusual case is reported of a soft tissue mass in the lower extremity, without bone involvement, in an 85-year-old woman; the histopathological diagnosis was Burkitt's lymphoma. Pertinent clinical history, histological examination, and imaging procedures allowed early diagnosis. To our knowledge, the radiological findings in Burkitt's lymphoma with this unusual clinical presentation have not been described previously.

Spindle cell hemangioendotheliomas associated with multiple skeletal enchondromas: a variant of Maffucci's syndrome.

An unusual case of Maffucci's syndrome confined to an extremity with an additional superficial lymphangioma in the same limb is described. The patient, a 47-year-old woman, presented with several painful subcutaneous spindle cell hemangioendotheliomas (SCHs) and multiple lytic bone lesions, some calcified, in the left leg. She has been followed for two years and continues to do well. The combination of SCHs and multiple enchondromas (ENCHs) should be searched in any patient who presents with SCHs or multiple ENCHs, because there is a significant risk of malignant transformation.

[Microangiopathic hemolytic anemia associated with breast cancer]. / Anemia hemolítica microangiopática asociada a cáncer de mama.

A case of microangiopathic hemolytic anemia associated to metastatic breast cancer, in remission with chemotherapy, is presented. We review the etiopathogenetic mechanism of its association and focus on the priority of neoplasia therapy when disseminated intravascular coagulation is not present.