Volume of hippocampal activation as a determining factor for the lateralisation of the epileptogenic zone in patients with drug-resistant mesial temporal lobe epilepsy.

INTRODUCTION: Approximately 30% of patients with mesial temporal lobe epilepsy (MTLE) will develop drug resistance, which requires early surgical treatment. The success of the surgical procedure largely depends on the correct lateralisation of the epileptogenic zone, which can only be determined in 70% of patients with such conventional diagnostic tools as video electroencephalography and volumetric structural magnetic resonance imaging. We evaluated the performance of a memory functional magnetic resonance imaging (fMRI) paradigm in lateralising the epileptogenic zone in patients with drug-resistant MTLE. METHODS: We included 18 patients with MTLE attended at the Instituto Neurológico Colombiano in Medellin (Colombia) between 2018 and 2019. The volume of functional activation in both temporal lobes was determined with a memory fMRI paradigm. A concordance analysis was performed to compare the performance of fMRI against that of conventional tests. RESULTS: In patients with left MTLE, lower total activation was found in the hemisphere ipsilateral to the epileptogenic zone as compared to the contralateral hemisphere (121.15 ± 16.48 voxels vs 170.23 ± 17.8 voxels [P < .001]), showing substantial concordance with conventional tests. Patients with right MTLE displayed lower hippocampal activation ipsilateral to the epileptogenic zone (18.5 ± 3.38 voxels vs 27.8 ± 3.77 voxels in the contralateral hippocampus [P = .048]), showing moderate concordance with conventional tests. CONCLUSIONS: These findings suggest that lower functional activation as determined by a memory fMRI paradigm has a high level of concordance with conventional tests for lateralising the epileptogenic zone in patients with drug-resistant MTLE.

Atrapamiento de un catéter epidural. Reconstrucción de imágenesde tomografía computarizada / Trapped epidural catheter: reconstruction of computed tomography images

El atrapamiento de un catéter epidural sin la formaciónde un nudo, es una complicación rara. Durante la colocaciónde un catéter epidural para el control del dolordurante el parto, se encontró una resistencia que impedíaajustar su posición dentro del espacio epidural. Un segundocatéter se colocó para realizar la analgesia durante elparto. Retirado el segundo catéter, se identificó en imágenesde tomografía computarizada que la punta del primercatéter se encontraba en una zona próxima a la articulacióninterapofisiaria derecha.En un nuevo intento no se logró su extracción. Ante esasituación, se introdujo una guía metálica por el lumen delcatéter, y con la paciente sentada en ligera flexión lateral dela columna, se traccionó suavemente del conjunto catéterguíalogrando su salida sin que su punta se fragmentara.La reconstrucción tridimensional de las imágenes nospermitió observar la punta del catéter y las característicasde las carillas articulares.Se discuten qué pautas seguir ante la dificultad de quitarun catéter epidural, qué pruebas de imagen son másadecuadas, y qué alternativas disponemos para lograr suextracción (AU)

A trapped epidural catheter without a knot is a rarecomplication. During placement of an epidural catheterfor analgesia during labor, resistance made it impossible toposition the catheter within the epidural space. A secondcatheter was inserted to provide the required analgesia.When the second catheter was removed, computedtomography (CT) revealed that the tip of the first catheterwas close to the the right facet joint space.A second attempt to extract the catheter failed. In lightof this situation, the patient was seated with the spineslightly bent to one side, a guidewire was inserted throughthe catheter lumen, and the catheter and guidewire weregently pulled; the catheter was extracted without causingthe tip to break up.Three-dimensional CT reconstruction allowed thecatheter tip and characteristics of the joint surfaces to beobserved.We discuss protcols and alternative strategies that canbe followed when an epidural catheter is difficult toremove, including the most appropriate images to use forguidance (AU)

[Trapped epidural catheter: reconstruction of computed tomography images]. / Atrapamiento de un catéter epidural. Reconstrucción de imágenes de tomografía computarizada.

A trapped epidural catheter without a knot is a rare complication. During placement of an epidural catheter for analgesia during labor, resistance made it impossible to position the catheter within the epidural space. A second catheter was inserted to provide the required analgesia. When the second catheter was removed, computed tomography (CT) revealed that the tip of the first catheter was close to the the right facet joint space. A second attempt to extract the catheter failed. In light of this situation, the patient was seated with the spine slightly bent to one side, a guidewire was inserted through the catheter lumen, and the catheter and guidewire were gently pulled; the catheter was extracted without causing the tip to break up. Three-dimensional CT reconstruction allowed the catheter tip and characteristics of the joint surfaces to be observed. We discuss protcols and alternative strategies that can be followed when an epidural catheter is difficult to remove, including the most appropriate images to use for guidance.

Ethanol production in a membrane bioreactor: pilot-scale trials in a corn wet mill.

Pilot plant trials were conducted in a corn wet mill with a 7000-L membrane recycle bioreactor (MRB) that integrated ceramic microfiltration membranes in a semi-closed loop configuration with a stirred-tank reactor. Residence times of 7.5-10 h with ethanol outputs of 10-11.5% (v/v) were obtained when the cell concentration was 60-100 g/L dry wt of yeast, equivalent to about 10(9)-10(10) cells/mL. The performance of the membrane was dependent on the startup mode and pressure management techniques. A steady flux of 70 L/(m2 x h) could be maintained for several days before cleaning was necessary. The benefits of the MRB include better productivity; a clear product stream containing no particulates or yeast cells, which should improve subsequent stripping and distillation operations; and substantially reduced stillage handling. The capital cost of the MRB is $21-$34/(m3 x yr) ($0.08-$0.13/[gal x yr]) of ethanol capacity. Operating cost, including depreciation, energy, membrane replacement, maintenance, labor, and cleaning, is $4.5-9/m3 ($0.017-$0.034/gal) of ethanol.

Molecular systematics of new world gopher, bull, and pinesnakes (Pituophis: Colubridae), a transcontinental species complex.

Pituophis melanoleucus (gopher, bull, and pinesnakes) is among the most widely distributed polytypic species complexes in North America, with most authors recognizing from a single transcontinental species (the melanoleucus complex, composed of 15 subspecies) to four (monotypic and polytypic) species. We used mitochondrial gene sequences from the two middle American species, P. deppei and P. lineaticollis, and from 13 subspecies from most of the range of the melanoleucus complex to test various phylogenetic hypotheses for Pituophis. Maximum parsimony and maximum likelihood methods identified the same major clades within Pituophis and indicated that two segments of the melanoleucus complex, the lodingi-melanoleucus-mugitus eastern pinesnake clade and the affinis-annectens-bimaris-catenifer-deserticola- sayi-ruthveni-vertebr alis clade from central and western United States and northern Mexico, represent divergent, allopatric lineages with no known intergradation zone. We recognize each of these two groupings as a different species. Our data also indicate that some ruthveni are more closely related to sayi than to other ruthveni. Nonetheless, ruthveni is an allopatric taxon diagnosable from its closest relatives by a combination of morphometric characters, and because it is likely that at least some of these traits are independent and genetically inherited, we interpret this as evidence that ruthveni has attained the status of independent evolutionary lineage, despite the fact that it retains strong genetic affinities with sayi. The endemic Baja Californian gopher snakes (bimaris and vertebralis) are considered by some taxonomists as a different species, P. vertebralis, but we discovered that these serpents belong to two different clades and hence we do not agree with the recognition of P. vertebralis as presently defined. In summary, we believe that three distinct species are included in the melanoleucus complex, Pituophis melanoleucus (sensu stricto), P. catenifer, and P. ruthveni, and that their recognition better represents the evolutionary diversity within this species complex.

Ectopic noggin blocks sensory and nonsensory organ morphogenesis in the chicken inner ear.

Bone morphogenetic protein 4 (Bmp4) is expressed during multiple stages of development of the chicken inner ear. At the otocyst stage, Bmp4 is expressed in each presumptive sensory organ, as well as in the mesenchymal cells surrounding the region of the otocyst that is destined to form the semicircular canals. After the formation of the gross anatomy of the inner ear, Bmp4 expression persists in some sensory organs and restricted domains of the semicircular canals. To address the role of this gene in inner ear development, we blocked BMP4 function(s) by delivering one of its antagonists, Noggin, to the developing inner ear in ovo. Exogenous Noggin was delivered to the developing otocyst by using a replication-competent avian retrovirus encoding the Noggin cDNA (RCAS-N) or implanting beads coated with Noggin protein. Noggin treatment resulted in a variety of phenotypes involving both sensory and nonsensory components of the inner ear. Among the nonsensory structures, the semicircular canals were the most sensitive and the endolymphatic duct and sac most resistant to exogenous Noggin. Noggin affected the proliferation of the primordial canal outpouch, as well as the continual outgrowth of the canal after its formation. In addition, Noggin affected the structural patterning of the cristae, possibly via a decrease of Msx1 and p75NGFR expression. These results suggest that BMP4 and possibly other BMPs are required for multiple phases of inner ear development.

[Outpatient rehabilitation in the Foral community of Navarra: 1972-1997]. / Rehabilitación extrahospitalaria en la Comunidad Foral de Navarra: 1972-1997.

Rehabilitation care for persons with disabilities who live in zones distant from the hospital of reference represents a challenge even for the Health Services of the most advanced countries. The requirements of the principles of "Health for All in the Year 2000" of the 1981 WHO Assembly, fully assumed by Foral Law 10/1990 (integral conception of health, efficiency, equity, decentralisation, quality and humanisation in the service) have stimulated the initiatives proceeding from the Rehabilitation Service of the "Virgen del Camino" Hospital orientated towards the pragmatic application of those principles to the reality our Community. The result has been the creation of an outpatient care network with units in both the Specialties Units and the Health Centres. As in other neighbouring Communities, we are witnessing a growing increase in the demand for rehabilitation treatment; to a great extent this is due to the increasing age of the population. This must be regulated in order to guarantee access to quality rehabilitation for every person who requires it. In order to achieve the complete fulfillment of the objectives of the WHO we propose the co-ordination between levels of attention (Primary care and Specialised care), consolidation of the figure of the rehabilitation doctor as a specialised individual providing support to Primary care in the whole community, and the realisation of certain protocols for rehabilitation referral agreed upon with the Primary care doctors

Development of galanin- and enkephalin-like immunoreactivities in the sympathoadrenal lineage of the avian embryo. In vivo and in vitro studies.

The neurochemical differentiation of the sympathoadrenal nervous system has been analyzed by focusing on the developmental expression of two neuropeptides, galanin and enkephalin. Both peptides are expressed early in the formation of the sympathetic ganglia and adrenal gland. Expression in the adrenal persists during embryogenesis to hatching while expression in the sympathetic is lost as sympathoblasts differentiate into neurons. Galanin expression and its modulation by nerve growth factor (NGF) and dexamethasone (Dex) was also studied in vitro. Differential effects of these factors were found on adrenal versus sympathetic cultures. However, the results coincided with proposed role of the factors in inducing either neuronal properties (NGF) or chromaffin characteristics (Dex).

The Spemann organizer signal noggin binds and inactivates bone morphogenetic protein 4.

Signals released by the Spemann organizer of the amphibian gastrula can directly induce neural tissue from ectoderm and can dorsalize ventral mesoderm to form muscle. The secreted polypeptide noggin mimics these activities and is expressed at the appropriate time and place to participate in the organizer signal. Neural induction and mesoderm dorsalization are antagonized by bone morphogenetic proteins (BMPs), which induce epidermis and ventral mesoderm instead. Here we report that noggin protein binds BMP4 with high affinity and can abolish BMP4 activity by blocking binding to cognate cell-surface receptors. These data suggest that noggin secreted by the organizer patterns the embryo by interrupting BMP signaling.