Trastornos del espectro autista: observaciones en el patrón evolutivo. Lo que los padres nos cuentan en la consulta / Autism spectrum disorders: observations in the evolutionary pattern. What parents tell us in the consultation

La necesidad de mejorar la detección temprana del trastorno del espectro autista (TEA) implica mejorar las herramientas en la primera línea de atención al niño. La dimensionalidad del TEA, recogida en las clasificaciones internaciones (APA y CIE), reconoce el carácter heterogéneo del trastorno y la afectación de múltiples áreas en diferentes niveles de gravedad. Con el fin de evitar la demora en el proceso de diagnóstico se propone que, en la entrevista general de anamnesis, el pediatra incluya la exploración de manifestaciones conductuales que suelen concurrir en el patrón evolutivo de estos niños para agilizar la evaluación por el especialista correspondiente, quien determinará finalmente el diagnóstico, si fuera el caso. Estas observaciones se encuentran diferenciadas en 11 áreas, recogiendo además cómo expresan estos problemas los padres en la consulta. Se espera que esta aportación sirva de orientación práctica para la detección precoz de los TEA entre los profesionales que atienden en primer lugar al niño (AU)

The need to improve early detection of Autism Spectrum Disorder (ASD) implies improving tools in the first line of care for the child. The dimensionality of ASD, according to the international classifications (APA and ICD), recognizes the heterogeneous nature of the disorder and the involvement of multiple areas at different levels of severity. In order to avoid delay in the diagnosis process, it is proposed that the paediatrician could include in the general anamnesis the exploration of behavioural manifestations that usually concur in the evolutionary pattern of these children to expedite the evaluation by the corresponding specialist who finally determines the diagnosis, if applicable. These observations are differentiated in 11 areas, also reflecting how parents express these problems in the consultation. This contribution is expected to serve as a practical guide for the early detection of ASD among the professionals who care for the child first. (AU)

Sexual experiences during the climacteric years: what do women think about it?

PURPOSE: To describe women's sexual experiences during the climacteric years. METHODS: The analysis was conducted using a theoretical-methodological perspective based on phenomenology. Data were obtained through a group interview method: the focus group. Participants were women attending a health education programme during the climacteric period. This programme was developed by the sexual and reproductive health services for the area of Barcelona (Spain). RESULTS: Reading and analysis of participants' discourse revealed four categories: the climacteric stage, a time for self-reassertion; the relative burden of biology; the journey through sexual life; and the importance of social/family factors as regards sexual experiences. CONCLUSIONS: In this study, social, family and structural factors had the greatest impact on sexual experience during this stage of life. The lack of independence with respect to parents, who have often moved into the family's residence, turns many of these women into informal carers. Tiredness, lack of intimacy and a reduced living space that is often shared with parents or grownup children are strong determinants as regards the free expression of sexuality.

Recruiting new neurons from the subventricular zone to the rat postnatal cortex: an organotypic slice culture model.

The neurogenic subventricular zone (SVZ) of the lateral ventricle is a potential source for neuronal replacement in the postnatal or adult neocortex after injury. Here we present a novel model system to directly explore the cellular mechanisms of this process. In order to visualize directed migration from the SVZ towards the cortex, we transplanted green fluorescent protein-labeled progenitor/stem cells into the SVZ of newborn rats. At 2 days after transplantation, we generated organotypic slice cultures and applied fluorescent time-lapse imaging to explore directly the migration and integration of donor cells into the host tissue for up to 2 weeks. Our studies revealed that subventricular grafts provide a significant number of immature neurons to neocortical regions. In the cortex, immature neurons first migrate radially towards the pial surface and then differentiate into GABAergic interneurons. We conclude that our model system presents a novel and effective experimental paradigm to evaluate the recruitment of SVZ-derived neurons into the postnatal cortex, a phenomenon that may represent a potential route for cortical repair.

Potentially toxic effects of anaesthetics on the developing central nervous system.

A growing body of experimental evidence suggests that anaesthetics, by influencing GABAergic and glutaminergic neural signalling, can have adverse effects on the developing central nervous system. The biological foundation for this is that gamma-aminobutyric acid and glutamate could act non-synaptically, in addition to their role in neurotransmission in the adult brain, in the regulation of neuronal development in the central nervous system. These neurotransmitters and their receptors are expressed from very early stages of central nervous system development and appear to influence neural progenitor proliferation, cell migration and neuronal differentiation. During the synaptogenetic period, pharmacological blockade of N-methyl-d-aspartate (NMDA)-type glutamate receptors as well as stimulation of GABAA receptors has been reported to be associated with increased apoptosis in the developing brain. Importantly, recent data suggest that even low, non-apoptogenic concentrations of anaesthetics can perturb neuronal dendritic development and thus could potentially lead to impairment of developing neuronal networks. The extrapolation of these experimental observations to clinical practice is of course very difficult and requires extreme caution as differences in drug concentrations and exposure times as well as interspecies variations are all important confounding variables. While clinicians should clearly not withhold anaesthesia based on current animal studies, these observations should urge more laboratory and clinical research to further elucidate this issue.

Sequential activation of p75 and TrkB is involved in dendritic development of subventricular zone-derived neuronal progenitors in vitro.

Dendritic arbor development of subventricular zone-derived interneurons is a critical step in their integration into functional circuits of the postnatal olfactory bulb. However, the mechanism and molecular control of this process remain unknown. In this study, we have developed a culture model where dendritic development of purified subventricular zone cells proceeds under serum-free conditions in the absence of added growth factors and non-neural cells. We demonstrate that the large majority of these cells in culture express GABA and elaborate dendritic arbors with spine-like protrusions but they do not possess axons. These neurons expressed receptors for neurotrophins including p75, TrkB and TrkC but not TrkA. Application of exogenous neurotrophins, including brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT3) and nerve growth factor (NGF), to cultures stimulated dendritic growth and led to more complex dendritic arbors during the initial 3 days in culture. Our results suggest that these effects are independent of Trk receptors and mediated by the p75/ceramide signaling pathway. We also show that brain-derived neurotrophic factor is the only neurotrophin that is able to influence late-phase dendritic development via TrkB receptor activation. These results suggest that dendritic arbor development of subventricular zone-derived cells may be regulated by neurotrophins through the activation of p75 and the TrkB receptor signaling pathways in a sequentially defined temporal pattern.

Removal of PSA from NCAM affects the survival of magnocellular vasopressin- and oxytocin-producing neurons in organotypic cultures of the paraventricular nucleus.

The expression of the polysialic acid neural cell adhesion molecule (PSA-NCAM) in the hypothalamo-neurohypophyseal system has been correlated with morphofunctional plasticity. In this study, we investigated the role of PSA-NCAM in the survival of oxytocin (OT)- and vasopressin (VP)-producing magnocellular cells of this system. We used a recently developed organotypic slice culture model of the rat hypothalamic paraventricular nucleus (PVN) in which ciliary neurotrophic factor (CNTF) and leukemia inhibitory factor (LIF) are potent survival factors for magnocellular neurons. We demonstrate by means of confocal microscopy that cultured magnocellular VP and OT neurons express strong immunoreactivity for PSA-NCAM. Removal of PSA from NCAM by the enzyme Endo N leads to a significant loss of both VP and OT neurons in the presence of low concentrations of CNTF. Endo N treatment did not change cell survival in the presence of LIF. These results suggest that, in addition to its role in neuro-glial plasticity, PSA-NCAM might also influence the trophic factor responsiveness of hypothalamic VP and OT neurosecretory cells.

[Unifocal Langerhans cell granulomatosis in a young woman]. / Granulomatosis de células de Langerhans unifocal en una mujer joven.

We report a 24-years-old woman who presented with thoracic pain after coughing. Physical exam revealed no abnormalities except pain after pressing under blade-bone area. A rib radiography and CT of the thorax showed a lonely osteolytic lesion inside eleventh left costal arch without affecting others tissues. There were no more osteolytic lesions at other levels and the histopathological study of a resection-biopsy of the lesion was diagnosed as Langerhans' cell granulomatosis. This is an uncommon disease which diagnosis can only be made through histopathological study of suspected lesions.

Granulomatosis de células de Langerhans unifocal en una mujer joven / Langerhans´ cell granulomatosis in young woman

Mujer de 24 años de edad sin antecedentes personales de interés, que consultó por un dolor en región subescapular tras un acceso de tos. En la exploración física no había hallazgos, excepto el dolor a la palpación en la región subescapular. La radiografía de la parrilla costal objetivó una lesión lítica en el undécimo arco costal izquierdo que se confirmó en una TAC de tórax, en la que no había afectación de partes blandas. En el estudio general no se objetivaron otras lesiones líticas a otros niveles ni causa de la lesión, por lo que se realizó una biopsia-excisión, cuyo estudio anatomopatológico fue de Granulomatosis de células de Langerhans unifocal. Es ésta una enfermedad infrecuente, en la que sólo tras el estudio anatomopatológico puede establecerse el diagnóstico (AU)

[Evolution of epidemiological methods in clinical research in Spain (1975-1994)]. / Evolución de los diseños epidemiológicos de la investigación clínica en España (1975-1994).

BACKGROUND: Previous studies have shown a sparing utilization of analytical and experimental designs in Spanish clinical research journals. The study aims are to compare among countries, the use of epidemiologic method in articles published in scientific journals, and to determine the extent to which this research has direct funding. METHODS: Cross-sectional study including all original papers published during 1994 in Medicina Clinica [(Med Clin (Barc)], Revista Clinica Española (Rev Clin Esp), The Lancet (Lancet) and New England Journal of Medicine (N Engl J Med). They were classified according to epidemiological design and we verified the financial support mention. RESULTS: 594 papers were included. Epidemiological studies without control group prevailed in Spanish journals. The most common designs were descriptive studies in Med Clin (Barc), with 45.5%, and clinical series in Rev Clin Esp, with 41.7%. The 33.6% of original papers published in Lancet and 28.4% of N England J Med were randomized trials. We found information about financial support in 73.7% of papers published in Lancet, in 77.4% of N Engl J Med, in 23.1% of Med Clin (Barc) papers and not one in the Rev Clin Esp studies. CONCLUSIONS: In Spanish clinical journals the use of epidemiological methods with control group is limited and direct financial support unusual. Wherefore these studies have a limited applicability.

There is no evidence that Kanizsa-type subjective contours can be detected in parallel.

Davis and Driver presented evidence suggesting that Kanizsa-type subjective contours could be detected in a visual search task in a time that is independent of the number of nonsubjective contour distractors. A linking connection was made between these psychophysical data and the physiological data of Peterhans and von der Heydt which showed that cells in primate area V2 respond to subjective contours in the same way that they respond to luminance-defined contours. Here in three experiments it is shown that there was sufficient information in the displays used by Davis and Driver to support parallel search independently of whether subjective contours were present or not. When confounding properties of the stimuli were eliminated search became slow whether or not subjective contours were present in the display. One of the slowest search conditions involved stimuli that were virtually identical to those used in the physiological studies of Peterhans and von der Heydt to which Davis and Driver wish to link their data. It is concluded that while subjective contours may be represented in the responses of very early visual mechanisms (eg in V2) access to these representations is impaired by high-contrast contours used to induce the subjective contours and nonsubjective figure distractors. This persistent control problem continues to confound attempts to show that Kanizsa-type subjective contours can be detected in parallel.

[Opinion on health priorities in the community of Valencia]. / Estudio de opinión sobre prioridades en Salud en la Comunidad Valenciana.

In this study we have used a qualitative approach partially based on the Delphi technique to establish the ten priorities for health in the Valencian Community for the next five years. Two rounds of mail surveys were made sending questionnaires to 1834 people including Health Councillors of the Town Halls, nurses and doctors of the three valencian provinces. The overall response rate was 28.3%. The priorities which were perceived as most important by the respondents were the development of primary care, improvements in the management of health services and the development of preventive medicine. The fourth and fifth places of the ranking were: improvements of emergency services and increasing the budget devoted to hospital care. The 6th priority was preventive measures in cardiovascular diseases, the 7th actions against drug abuse, the 8th special attention to childhood and ageing populations and the last two priorities were protection of the environment and infectious diseases prevention. We consider this approach as useful to obtain additional valuable information complementary to the information obtained from traditional statistics or health surveys specially in the areas of management, diseases prevention and actions towards special groups of population.

[Predictive value of obligatory reporting of sexually transmitted diseases]. / Valor predictivo de la declaración obligatoria en enfermedades de transmisión sexual.

Sexually transmitted diseases (STD) were recently included in the Spanish reporting system, or Compulsory Reporting of Diseases (EDO). In the present study, the validity of this system is evaluated with the estimation of the positive predictive values of the EDO. A preestablished questionnaire was administered by phone to the reporting physicians of the 478 cases of STD that had been reported to the EDO system from August 1987 to May 1988 in the Alicante and Valencia provinces. In this survey, in addition to data related to the reporting physician (specialty and place of work) and to the patient (sex, clinical symptoms and signs), information permitting to classify each diagnosis as certain, likely and unlikely was collected (incubation time, laboratory tests). Considered as a whole, the results suggested an acceptable accuracy (positive predictive value 79.09%, confidence limits 76.7%-81.5%) for both diseases. This permits to consider STD statistics as fairly accurate. Among the factors influencing the diagnostic precision are the disease itself, the patient's sex, the qualification of the reporting physician and his place of work. The predictive value of the cases reported from centers of diagnosis of STD was higher. We think that, although these results are acceptable for the epidemiological survey, the quality of care could be enhanced by a better organization of services and an improved undergraduate and postgraduate education.