Autoimmune inflammation triggers aberrant astrocytic calcium signaling to impair synaptic plasticity.

Cortical pathology involving inflammatory and neurodegenerative mechanisms is a hallmark of multiple sclerosis and a correlate of disease progression and cognitive decline. Astrocytes play a pivotal role in multiple sclerosis initiation and progression but astrocyte-neuronal network alterations contributing to gray matter pathology remain undefined. Here we unveil deregulation of astrocytic calcium signaling and astrocyte-to-neuron communication as key pathophysiological mechanisms of cortical dysfunction in the experimental autoimmune encephalomyelitis (EAE) model of multiple sclerosis. Using two-photon imaging ex vivo and fiber photometry in freely behaving mice, we found that acute EAE was associated with the emergence of spontaneously hyperactive cortical astrocytes exhibiting dysfunctional responses to cannabinoid, glutamate and purinoreceptor agonists. Abnormal astrocyte signaling by Gi and Gq protein coupled receptors was observed in the inflamed cortex. This was mirrored by treatments with pro-inflammatory factors both in vitro and ex vivo, suggesting cell-autonomous effects of the cortical neuroinflammatory environment. Finally, deregulated astrocyte calcium activity was associated with an enhancement of glutamatergic gliotransmission and a shift of astrocyte-mediated short-term and long-term plasticity mechanisms towards synaptic potentiation. Overall, our data identify astrocyte-neuronal network dysfunctions as key pathological features of gray matter inflammation in multiple sclerosis and potentially additional neuroimmunological disorders.

Primordial odontogenic tumour of the maxilla: case report and review of the literature.

Primordial odontogenic tumour (POT) is a relatively newly described entity with well-defined clinicopathological features. Since its initial description in 2014, 22 cases of POT have been reported in the literature. Only five cases of POT have arisen in the maxilla. This article describes an additional patient with a POT of the maxilla and provides a review of the literature on POT.

Efectos del entrenamiento en bicicleta con retroalimentación visual sobre la marcha en pacientes con esclerosis múltiple / Effect of visual biofeedback cycling training on gait in patients with multiple sclerosis

INTRODUCCIÓN: Las alteraciones de la marcha están presentes en un alto porcentaje en los pacientes con esclerosis múltiple (EM); aparece desde estadios iniciales pudiendo limitar la realización de las actividades básicas de la vida diaria y afectando a su calidad de vida. El entrenamiento en bicicleta con retroalimentación visual se presenta como una herramienta útil en el tratamiento de estas alteraciones. El objetivo del presente estudio es valorar el efecto a corto plazo del entrenamiento en bicicleta con retroalimentación visual sobre las alteraciones de la marcha en pacientes con EM. MATERIAL Y MÉTODOS: Sesenta y un pacientes con EM con afectación leve-moderada, distribuidos aleatoriamente en un grupo control y un grupo experimental participaron en el estudio. El grupo experimental fue sometido a entrenamiento con bicicleta con biofeedback visual (sistema MOTOmed Viva2) un día en semana durante 3 meses y un programa domiciliario de ejercicios. El grupo control tuvo solo el programa domiciliario de ejercicios. Valoración mediante el sistema de análisis de marcha GAITRite ® Walkway de ambos grupos, pre, al mes y postintervención. RESULTADOS: Resultados estadísticamente significativos en el parámetro FAP del grupo experimental entre el pre y al mes (p = 0,014) y el pre y postintervención (p = 0,002). Mejoró significativamente la diferencia de la longitud de paso del grupo experimental entre el pre y post (p = 0,001) y entre el mes y el postintervención (p = 0,004). CONCLUSIONES: El tratamiento con la bicicleta mejoró a corto plazo determinados parámetros de la marcha, pudiéndose mostrar como opción terapéutica en la reeducación de la marcha en pacientes con EM

INTRODUCTION: Gait alterations are present in a high percentage of patients with multiple sclerosis (MS). They appear from early stages of the disease and can limit patients' capacity to perform basic activities of daily living, affecting their quality of life. Visual biofeedback cycling training appears to be a useful tool in treating these impairments. This study aims to evaluate the short-term effect of visual biofeedback cycling training on gait in patients with MS. MATERIAL AND METHODS: A total of 61 patients with mild to moderate MS were randomly assigned to a control group and an intervention group. The intervention group received visual biofeedback cycling training (MOTOmed viva2 system) once per week for 3 months, and a home exercise program. The control group only received the home exercise program. Both groups were evaluated using the GAITRite ® Walkway gait assessment system before the intervention, during the first month of the programme, and after the intervention. RESULTS: In the intervention group, the analysis revealed statistically significant differences between Functional Ambulation Profile (FAP) scores before and during the intervention (P = .014), and before and after the intervention (P = .002). A statistically significant improvement was observed in step length in the intervention group between pre- and post-intervention scores (P = .001) and between first-month and post-intervention scores (P = .004). CONCLUSIONS: Visual biofeedback cycling training improved specific gait parameters in the short term and appears to be a therapeutic option for gait retraining in patients with MS

Effect of visual biofeedback cycling training on gait in patients with multiple sclerosis. / Efectos del entrenamiento en bicicleta con retroalimentación visual sobre la marcha en pacientes con esclerosis múltiple.

INTRODUCTION: Gait alterations are present in a high percentage of patients with multiple sclerosis (MS). They appear from early stages of the disease and can limit patients' capacity to perform basic activities of daily living, affecting their quality of life. Visual biofeedback cycling training appears to be a useful tool in treating these impairments. This study aims to evaluate the short-term effect of visual biofeedback cycling training on gait in patients with MS. MATERIAL AND METHODS: A total of 61 patients with mild to moderate MS were randomly assigned to a control group and an intervention group. The intervention group received visual biofeedback cycling training (MOTOmed viva2 system) once per week for 3 months, and a home exercise program. The control group only received the home exercise program. Both groups were evaluated using the GAITRite® Walkway gait assessment system before the intervention, during the first month of the programme, and after the intervention. RESULTS: In the intervention group, the analysis revealed statistically significant differences between Functional Ambulation Profile (FAP) scores before and during the intervention (P=.014), and before and after the intervention (P=.002). A statistically significant improvement was observed in step length in the intervention group between pre- and post-intervention scores (P=.001) and between first-month and post-intervention scores (P=.004). CONCLUSIONS: Visual biofeedback cycling training improved specific gait parameters in the short term and appears to be a therapeutic option for gait retraining in patients with MS.

Supervivencia y resultado funcional a largo plazo de prótesis de rodilla no cementadas / Uncemented knee arthroplasty: supervivorship and long-term functional outcome

Objetivo: Analizar la supervivencia a largo plazo y el resultado funcional de un modelo de prótesis de rodilla no cementada. Material y método: Realizamos un estudio prospectivo observacional de pacientes operados entre los años 1989 y 1996 con el modelo Low Contact Stress Mobile-Bearing Total Knee Replacement(R) (Depuy, Warsaw, IN, EE. UU.). Las variables estudiadas fueron edad, sexo, tiempo de seguimiento, puntuación del Knee Society Score (KSS), supervivencia del implante y motivos de la revisión. Un total de 96 artroplastias de 127 completaron el seguimiento. La media de edad fue de 79 años. La media de seguimiento fue de 14,5 años. Once prótesis se reintervinieron (6 por aflojamiento aséptico de implantes y 5 por problemas de componentes móviles). Se obtuvieron curvas de supervivencia al considerado el tiempo de seguimiento, el tiempo desde la cirugía primaria hasta la reintervención y el episodio «recambio por aflojamiento de componente metálico» y «necesidad de reintervención». Resultados: Las curvas de supervivencia arrojaron una supervivencia del 96,45% a los 9 años y del 92,78% a los 12 años, y se consideró la «necesidad de reintervención» como punto final. Al considerar la necesidad de recambio de componentes metálicos, la supervivencia a los 14 años y medio fue del 93,75%. La puntuación media del KSS funcional fue de 89,2. Conclusión: En nuestra experiencia y con el modelo protésico utilizado, las prótesis totales de rodilla no cementadas proporcionan un resultado clínico y funcional excelente, valorado por el KSS, y una supervivencia del 93,75% a los 14 años y medio al considerar la supervivencia del implante metálico (AU)

Purpose: To analyze the long term survivorship and functional results of a model of uncemented knee prosthesis. Materials and methods: We carried out a prospective observational study of patients implanted between 1989 and 1996 with the Low Contact Stress Mobile-Bearing Total Knee Replacement (Depuy, Warsaw, IN, EEUU). Variables studied included: age, gender, follow-up, Knee Society Score, implant survivorship and reasons for revision. A total of 96 arthroplasties out of 127 reached the end of follow-up Mean age was 79 years. Mean follow-up was 14 years. Eleven prostheses were revised (6 following aseptic loosening and 5 because of problems with the mobile bearings). Survivorship curves were obtained considering length of follow-up, time elapsed between the primary and the revision surgery and the “revision following loosening of a metal component” and “need for revision” events. Results: When "need for revision" was considered as the endpoint, survivorship curves revealed a survivorship rate of 96.45% at 9 years and 92.78% at 12 years. When the endpoint was the "need to revise metal components" 14.5-year survivorship was 93.75%. Mean Knee Society Score was 89.2 points. Conclusion: The use of the uncemented LCS knee has resulted in excellent clinical and functional results as measured by the Knee Society Score, as well as 93.75% survivorship at 14 years and a half, considering the survivorship of the metal implant (AU)

La prótesis de rodilla dolorosa: enfoque diagnóstico / The painful knee prosthesis: a diagnostic approach

Introducción. La historia clínica y la exploración física son fundamentales para el enfoque diagnóstico de la prótesis de rodilla dolorosa. A la hora de planificar una estrategia diagnóstica es útil diferenciar entre problemas extraarticulares e intraarticulares.Diagnóstico y conclusiones. La radiología simple es la primera prueba complementaria a considerar, aportando en la mayoría de los casos información suficiente para establecer un diagnóstico. La tomografía axial computarizada será de utilidad para la valoración de áreas de osteólisis y alteraciones rotacionales de los componentes. La ecografía tiene utilidad en el estudio de las partes blandas periarticulares. Estudiosrecientes destacan el valor de la resonanciamagnética nuclear para la valoración de la prótesis dolorosa. Desde el punto de vista analítico, la velocidad de sedimentación globular y la proteína C reactiva, pese a su baja especificidad, pueden ser de utilidad en el diagnóstico de la artroplastia total de rodilla infectada, especialmente si contamoscon niveles seriados. Los estudios de Medicina Nuclearpresentan una alta sensibilidad, aunque su especificidades escasa. El uso de estudios isotópicos combinados(tecnecio e indio) puede ayudarnos al diagnóstico diferencial del aflojamiento protésico

Introduction. Clinical history and physical examination are essential factors for the diagnosis of the painful knee prosthesis. It is useful to make a distinction between extra and intra-articular problems before setting about planning for a diagnostic strategy.Diagnosis and conclusions. Plain films should be seen asthe first supplementary imaging studies to be performed since in most cases they contribute enough information to make a diagnosis. Computed axial tomography will be useful to evaluate osteolytic areas and rotational alterations of the components. Ultrasound is useful for the analysis of periarticular soft tissues. Recent studies have emphasized the value of MRI for the assessment of the painful knee prosthesis.From the analytical viewpoint, the ESR and C-reactiveprotein, in spite of their low specificity, could be valuable tools in the diagnosis of infected total knee replacement, especially so if serial levels are available. Nuclear medicine studies are highly sensitive, but their specificity is low. Theuse of combined isotope studies (technetium and indium)might help us with the differential diagnosis of prosthetic loosening

La prótesis de rodilla dolorosa: enfoque diagnóstico / The painful knee prosthesis: a diagnostic approach

Introducción. La historia clínica y la exploración física son fundamentales para el enfoque diagnóstico de la prótesis de rodilla dolorosa. A la hora de planificar una estrategia diagnóstica es útil diferenciar entre problemas extraarticulares e intraarticulares.Diagnóstico y conclusiones. La radiología simple es la primera prueba complementaria a considerar, aportando en la mayoría de los casos información suficiente para establecer un diagnóstico. La tomografía axial computarizada será de utilidad para la valoración de áreas de osteólisis y alteracionesrotacionales de los componentes. La ecografía tiene utilidad en el estudio de las partes blandas periarticulares. Estudios recientes destacan el valor de la resonancia magnética nuclear para la valoración de la prótesis dolorosa. Desde el punto de vista analítico, la velocidad de sedimentación globular y la proteína C reactiva, pese a su baja especificidad, pueden ser de utilidad en el diagnóstico de laartroplastia total de rodilla infectada, especialmente si contamos con niveles seriados. Los estudios de Medicina Nuclear presentan una alta sensibilidad, aunque su especificidad es escasa. El uso de estudios isotópicos combinados (tecnecio e indio) puede ayudarnos al diagnóstico diferencial del aflojamiento protésico

Introduction. Clinical history and physical examination are essential factors for the diagnosis of the painful knee prosthesis. It is useful to make a distinction between extra andintra-articular problems before setting about planning for a diagnostic strategy. Diagnosis and conclusions. Plain films should be seen as the first supplementary imaging studies to be performed sincein most cases they contribute enough information to makea diagnosis. Computed axial tomography will be usefulto evaluate osteolytic areas and rotational alterations of the components. Ultrasound is useful for the analysis of periarticular soft tissues. Recent studies have emphasized the value of MRI for the assessment of the painful knee prosthesis. From the analytical viewpoint, the ESR and C-reactive protein, in spite of their low specificity, could be valuable tools in the diagnosis of infected total knee replacement, especiallyso if serial levels are available. Nuclear medicinestudies are highly sensitive, but their specificity is low. The use of combined isotope studies (technetium and indium) might help us with the differential diagnosis of prosthetic loosening

Rotura del tendón de Aquiles: a propósito de un esguince de mala evolución / Rupture of Achilles tendon: a case report on ankle sprain with unsatisfactory progress

La rotura del tendón de Aquiles puede ser una entidad difícil de diagnosticar inicialmente, sobre todo en las formas parciales, si no se tiene un alto grado de sospecha clínica. En ocasiones se confunde con otras patologías, como los esguinces de tobillo, por lo que ante un esguince que no evoluciona satisfactoriamente deberíamos pensar en descartar otras patologías no detectadas en un primer momento. Es importante su diagnóstico y derivación precoz al servicio de Traumatología donde se procederá a un tratamiento conservador o quirúrgico, dependiendo de cada caso, para evitar situaciones de incapacidad crónica (AU)

[Hypertransaminemia and methotrexate: not always a toxic effect?]. / Hipertransaminemia y metotrexato: es siempre un efecto tóxico?

Serial measurement of liver enzymes is useful to detect liver toxicity due to methotrexate in patients with rheumatoid arthritis or other rheumatic diseases. We have reviewed retrospectively 141 adult patients treated with methotrexate from 1988 to 1991. The more common diagnoses included rheumatoid arthritis (120 cases) and psoriatic arthritis (12 cases). In periodic studies carried our every 2-3 months, a transient increase in transaminase values associated with methotrexate in 13 patients (9.2%) was observed. Two patients developed a viral infection during therapy, one due to cytomegalovirus and the other due to the Epstein-Barr virus. Both patients had a favorable outcome once methotrexate was withdrawn.

[Intense icterus in the course of EBV infectious mononucleosis]. / Intensa ictericia en el curso de una mononucleosis infecciosa por EBV.

Infectious mononucleosis induced by the Epstein Barr Virus (EBV) is a benign illness that is frequently accompanied by a slight hepatic disfunction. On occasion it may be accompanied by autoimmune hemolytic anemia of little clinical importance. Nevertheless, this association can cause a serious set of symptoms that can put the patient's life in danger if it is not treated quickly. We present the case of a 21-year-old male with infectious mononucleosis and severe jaundice (total bilirubin 40 mg/dl) due to the combination of diseased liver and secondary autoimmune hemolytic anemia, caused by the EBV infection.

[Hepatic cirrhosis and alpha 1-antitrypsin deficit: a family study]. / Cirrosis hepática y déficit de alfa-1 antitripsina: estudio de una familia.

Hepatic cirrhosis secondary to deficit of alpha-1 antitrypsin is an entity rarely observed among the adult population. We describe the clinical and histological characteristics of a patient with PiZZ phenotype, affected by an hepatic cirrhosis of this etiology, as well as the analytical and phenotypical study of his close relatives, all of which presented a type-Z mutation.