[Moyamoya disease: clinical, neuroradiological, neuropsychological and genetic perspective]. / Enfermedad de moyamoya: aspectos clinicos, neurorradiologicos, neuropsicolologicos y geneticos.

INTRODUCTION: Moyamoya disease (MMD) is an occlusive cerebrovascular disease characterized by progressive stenosis or occlusion in the terminal portion of the bilateral internal carotid arteries, affecting both children and adults. AIM: To conduct a review and update on MMD from a clinical, neuroradiological, neuropsychological and genetic perspective. DEVELOPMENT: In this pathology, which occurs with ischemia or cerebral hemorrhage, an unusual compensatory vascular network (moyamoya vessels) develops at the base of the brain in the form of collateral channels. MMD can present clinically with hemiparesis, dysarthria, aphasia, headache, seizures, visual deficits, syncopes or changes in personality. At the neuropsychological level, and even in the absence of obvious strokes, patients usually present impairment of attention, memory, behavior and executive functions. High resolution angiography and magnetic resonance imaging have been a neuroradiological advance towards an early detection of this disease. At the genetic level, the RING (really interesting new gene) RNF213 has recently been identified, and it is considered the most important genetic risk factor known up to now in the MMD. CONCLUSIONS: MMD is a rare pathology that predominantly affects the frontal lobes. The genetic and neuroradiological advances, in addition to a cognitive profile, contribute to early diagnosis and treatment to improve the quality of life of these patients.

TITLE: Enfermedad de moyamoya: aspectos clinicos, neurorradiologicos, neuropsicolologicos y geneticos.Introduccion. La enfermedad de moyamoya (EMM) es una enfermedad cerebrovascular oclusiva caracterizada por estenosis progresiva o la oclusion en la porcion terminal de las arterias carotidas internas bilaterales, que afecta tanto a niños como a adultos. Objetivo. Realizar una revision y actualizacion sobre la EMM desde una perspectiva clinica, neurorradiologica, neuropsicologica y genetica. Desarrollo. En esta patologia, que cursa con isquemia o hemorragia cerebral, se desarrolla una red vascular inusual compensatoria (vasos moyamoya) en la base del cerebro en forma de canales colaterales. La EMM puede cursar clinicamente con hemiparesia, disartria, afasia, cefalea, convulsiones, deficits visuales, sincopes o cambios en la personalidad. Neuropsicologicamente, y aun en ausencia de ictus evidentes, los pacientes suelen presentar afectacion de la atencion, memoria, conducta y funciones ejecutivas. La angiografia y la resonancia magnetica de alta resolucion han supuesto un avance neurorradiologico hacia una deteccion precoz de esta enfermedad. Recientemente se ha identificado el RING (really interesting new gene) RNF213, que se considera el factor genetico de riesgo mas importante conocido hasta ahora en la EMM. Conclusiones. La EMM es una patologia rara que afecta de forma predominante a los lobulos frontales. Los avances geneticos y neurorradiologicos, ademas de un perfil cognitivo, contribuyen a un diagnostico y tratamiento tempranos para mejorar la calidad de vida de estos pacientes.

Development of new tolerant strains to hydrophilic and hydrophobic organic solvents by the yeast surface display methodology.

Yeast surface display is a research methodology based on anchoring functional proteins and peptides onto the surface of the cells of this eukaryotic organism. Its development has resulted in the construction of a good number of new whole-cell biocatalysts with diverse applications in biotechnology, pharmacy, and medicine. In this work, we describe the design of new yeast strains in which several proteins and peptides have been introduced at the N-terminal position of protein agglutinin Aga2p. In all cases, proteins were correctly expressed and displayed on the cell surface according to the western blot, fluorescence microscopy, and fluorescence-activated cell sorting (FACS) analyses. The introduction of a glycosylable, Ser/Thr-rich protein (S1) resulted in improved resistance to ethanol, nonane, and dimethyl sulfoxide (DMSO) stress. The protein with a very high hydrophobic content (S2d) proved to confer tolerance to acetonitrile, ethanol, nonane, salt, and sodium dodecyl sulfate (SDS). The introduction of five leucine residues at the N-terminal position of S1 and S2 resulted in similar or increased resistance to the above-mentioned stress conditions. The adverse effects described in a previous work, when these residues were introduced into the N-terminus of Aga2p, with no other protein acting as a spacer, were not observed. Indeed, these strains grew better in the presence of hydrophilic solvents such as acetonitrile and ethanol. The new strains reported in this work have biotechnological potentiality given their behavior under adverse conditions of interest for biocatalytic and industrial processes.

Eating-related environmental factors in underweight eating disorders and obesity: are there common vulnerabilities during childhood and early adolescence?

OBJECTIVE: This study aimed to examine whether there is an association between individual, social and family influences and dysfunctional eating patterns early in life and the likelihood of developing a subsequent underweight eating disorder (ED) or obesity. METHOD: The total sample comprised 152 individuals (underweight ED, n = 45; obese patients, n = 65; healthy controls; n = 42) from Barcelona, Spain. The Cross-Cultural Questionnaire (CCQ) was used to assess early eating influences as well as individual and family eating patterns and attitudes towards food. RESULTS: Even though a few shared eating influences emerged for both groups, unique factors were also observed. Whereas relationship with friends, teasing about eating habits by family members and the mass media were of specific relevance to the underweight ED group, the patient's own physical appearance, body dissatisfaction, teasing about eating habits by friends, teasing about body shape by family members and dysfunctional eating patterns were unique to obesity. CONCLUSIONS: Overlapping environmental risk factors provide evidence for integral prevention and intervention approaches that simultaneously tackle a range of weight-related problems. The unique factors might be important for targeting high-risk individuals.

Prevalencia del trastorno por atracón en una muestra clínica de obesos / Prevalence of binge eating disorder among a clinical sample of obese children

Introducción: El trastorno por atracón se caracteriza por presencia de episodios de sobreingesta recurrentes en un periodo corto, acompañados de pérdida de control. Este trastorno es el más frecuente de entre todos los trastornos de la conducta alimentaria en población obesa, tanto en adultos como en niños. Objetivo: El objetivo de este estudio fue obtener datos prevalencia del trastorno por atracón en una muestra de niños y adolescentes obesos, usuarios de una unidad de pediatría especializada en el tratamiento de la obesidad infantil. Material y métodos: Se contó con una muestra 70 niños y adolescentes con edades comprendidas entre los 9 y los 16 años, con una edad media de 12 años, que acudían a una unidad de pediatría en el Hospital General de Valencia. Para llevar a cabo la evaluación se utilizaron los siguientes instrumentos: entrevista diagnóstica para trastorno por atracón (SCID-IV), la escala de trastorno por atracón infantil (C-BED) y el cuestionario de patrones de ingesta y peso (QEWP). Resultados: Tras la evaluación, el 6% de la muestra clínica fue diagnosticada con trastorno por atracón siguiendo los criterios establecidos por el DSM-IV-TR, y un 14% manifestaban formas subclínicas de dicho diagnóstico. Conclusiones: Los resultados van en la línea de estudios previos que resaltan la necesidad de evaluar este tipo de trastornos en unidades especializadas en el tratamiento de la obesidad(AU)

Introduction: Binge eating disorder is characterised by the presence of recurrent binge eating episodes in a short period of time, accompanied by loss of control. This disorder is the most frequent of all eating disorders in obese people, both adults and children. Objective: The objective of this study was to obtain prevalence data for binge eating disorder in a sample of obese children who attended a paediatric unit specialised in the treatment of childhood obesity. Material and methods: A sample included 70 children and adolescents aged 9 to 16, with a mean age of 12 years attending a paediatric clinic in the General Hospital of Valencia. The following tools were used in the assessment: Diagnostic Interview for Binge Eating Disorder (SCID-IV), Binge Eating Disorder Scale Child (C-BED) and Questionnaire of eating patterns and weight (QEWP). Results: After the assessment, 6% of the clinical sample was diagnosed with binge eating disorder according to criteria established by the DSM-IV-TR, and 14% showed subclinical forms of the disorder. Conclusions: The results are in line with previous studies that highlight the necessity of assessing these disorders in units specialised in the treatment of obesity(AU)

[Prevalence of binge eating disorder among a clinical sample of obese children]. / Prevalencia del trastorno por atracón en una muestra clínica de obesos.

INTRODUCTION: Binge eating disorder is characterised by the presence of recurrent binge eating episodes in a short period of time, accompanied by loss of control. This disorder is the most frequent of all eating disorders in obese people, both adults and children. OBJECTIVE: The objective of this study was to obtain prevalence data for binge eating disorder in a sample of obese children who attended a paediatric unit specialised in the treatment of childhood obesity. MATERIAL AND METHODS: A sample included 70 children and adolescents aged 9 to 16, with a mean age of 12 years attending a paediatric clinic in the General Hospital of Valencia. The following tools were used in the assessment: Diagnostic Interview for Binge Eating Disorder (SCID-IV), Binge Eating Disorder Scale Child (C-BED) and Questionnaire of eating patterns and weight (QEWP). RESULTS: After the assessment, 6% of the clinical sample was diagnosed with binge eating disorder according to criteria established by the DSM-IV-TR, and 14% showed subclinical forms of the disorder. CONCLUSIONS: The results are in line with previous studies that highlight the necessity of assessing these disorders in units specialised in the treatment of obesity.

The VEPSY UPDATED Project: clinical rationale and technical approach.

More than 10 years ago, Tart (1990) described virtual reality (VR) as a technological model of consciousness offering intriguing possibilities for developing diagnostic, inductive, psychotherapeutic, and training techniques that can extend and supplement current ones. To exploit and understand this potential is the overall goal of the "Telemedicine and Portable Virtual Environment in Clinical Psychology"--VEPSY UPDATED--a European Community-funded research project (IST-2000-25323, www.cybertherapy.info). Particularly, its specific goal is the development of different PC-based virtual reality modules to be used in clinical assessment and treatment of social phobia, panic disorders, male sexual disorders, obesity, and eating disorders. The paper describes the clinical and technical rationale behind the clinical applications developed by the project. Moreover, the paper focuses its analysis on the possible role of VR in clinical psychology and how it can be used for therapeutic change.

The VEPSY UPDATED project: technical and clinical rationale.

The emergence of new shared media, such as the Internet and virtual reality are changing the ways in which people relate, communicate, and live. Health care, and in particular clinical psychology, is one of the areas that could be most dramatically reshaped by these new technologies. To exploit and understand this potential is the overall goal of the "Telemedicine and Portable Virtual Environment in Clinical Psychology"--VEPSY UPDATED--an European Community funded research project (IST-2000-25323, http://www.vepsy.com) whose specific goal is the development of different PC based virtual reality modules to be used in clinical assessment and treatment. In particular the developed modules have been using to address the following pathologies: anxiety disorders; male impotence and premature ejaculation; obesity, bulimia and binge-eating disorders. The chapter details the general technical and clinical characteristics of the developed modules.

The VEPSY updated project: virtual reality in clinical psychology.

Many of us grew up with the naive assumption that couches are the best used therapeutic tools in psychotherapy. But tools for psychotherapy are evolving in a much more complex environment than a designer's chaise lounge. In particular, virtual reality (VR) devices have the potential for appearing soon in many consulting rooms. The use of VR in medicine is not a novelty. Applications of virtual environments for health care have been developed in the following areas: surgical procedures (remote surgery or telepresence, augmented or enhanced surgery, and planning and simulation of procedures before surgery); preventive medicine and patient education; medical education and training; visualization of massive medical databases; and architectural design for health care facilities. However, there is a growing recognition that VR can play an important role in clinical psychology, too. To exploit and understand this potential is the main goal of the Telemedicine and Portable Virtual Environment in Clinical Psychology--VEPSY Updated--a European Community-funded research project (IST-2000-25323, http://www.vepsy.com). The project will provide innovative tools-telemedicine and portable-for the treatment of patients, clinical trials to verify their viability, and action plans for dissemination of its results to an extended audience-potential users and influential groups. The project will also develop different personal computer (PC)-based virtual reality modules to be used in clinical assessment and treatment. In particular, the developed modules will address the following pathologies: anxiety disorders; male impotence and premature ejaculation; and obesity, bulimia, and binge-eating disorders.

Tratamiento mediante realidad virtual para la fobia a volar: un estudio de caso / Treatment of fear of flying by means of virtual reality: a case report

La tecnología de la Realidad Virtual (RV) está teniendo un gran impacto en diferentes ámbitos de la salud, especialmente en el de los tratamientos psicológicos. Este trabajo se centra en su utilidad para el tratamiento de la fobia a volar. Las intervenciones psicológicas para este problema basadas en la terapia de la exposición han demostrado ser eficaces, pero dada la naturaleza de este trastorno tienen importantes limitaciones, pues resultan caras en términos de tiempo, dinero y esfuerzos. La RV ayuda a superar estas dificultades, ya que permite recrear diferentes ambientes en los que la persona puede interactuar con sus miedos mientras está en un medio seguro y protegido (la consulta del terapeuta). El presente trabajo tiene dos objetivos: mostrar los escenarios virtuales que nuestro equipo ha diseñado para el tratamiento del miedo a volar mediante RV y presentar los resultados de un estudio de caso que apoyan su eficacia (AU)

Virtual reality and psychopathology.

Progress in the development of Virtual Reality (VR) is faster than has been forecast, which makes deep reflection on its potential uses and abuses absolutely necessary. The current article focuses on the analysis of some of the applications and implications of VR on psychopathology. It is obvious that they could be many, but we are only focusing on: (a) VR as a model to answer some central questions that traditionally have intrigued psychopathologists; and (b) VR and possible psychopathological experiences. We believe that VR has the potential of becoming a tool that will allow psychopathology to challenge and modify theoretical positions already established, and to pose new ones. This new way of experience can help us to find the answers to old question, and, at the same time, it can make new answers arise on the psychopathological and psychological horizon. Such answers are not only related to empirical and theoretical issues, but to moral ones as well. This road of research has just started.

The treatment of claustrophobia with virtual reality: changes in other phobic behaviors not specifically treated.

This study was designed to determine the effectiveness of Virtual Reality (VR) exposure in the case of a patient with a diagnosis of two specific phobias (claustrophobia and storms) and panic disorder with agoraphobia. The treatment consisted of eight, individual, VR-graded exposure sessions designed specifically to treat claustrophobia. We obtained data at pretreatment, posttreatment, and 3-month follow-up on several clinical measures. Results point out the effectiveness of the VR procedure for the treatment of claustrophobia. An important change appeared in all measures after treatment completion. We also observed a generalization of improvement from claustrophobic situations to the other specific phobic and agoraphobic situations that were not treated. We can conclude that VR exposure was effective in reducing fear in closed spaces, in increasing self-efficacy in claustrophobic situations, and in improving other problems not specifically treated. Moreover, changes were maintained at 3 months after treatment.

Psychological variables and reality judgment in virtual environments: the roles of absorption and dissociation.

Literature on virtual reality (VR) and psychology has focused on the influence that some basic psychological processes have on VR. Although psychological processes may be defined as common to all humans, there are individual differences that might make it difficult to provide the same VR experience for everyone. Of the several personality and psychological variables that might be relevant to the VR field, this study focuses on two: absorption and dissociation. Both psychological dimensions are deeply interrelated and might play an important role in the immersion of subjects in virtual environments and in the reality attributions they make. Thus, the purpose of this study was to ascertain personality correlates on differences regarding the VR experience. The subjects were 39 psychology undergraduate students who were immersed in a VR environment for 15 minutes. Our data suggest that both absorption and dissociation influenced central issues regarding reality judgment in VR.

Body image and virtual reality in eating disorders: is exposure to virtual reality more effective than the classical body image treatment?

Body image (BI) disturbances are considered to be central in eating disorders (ED) psychopathology. There are few studies focused on the treatment of BI disturbances in ED, and most of them have used "traditional methods." The purpose of the present study was to probe the effectiveness of one specific component in the assessment and treatment of BI in ED by means of virtual reality (VR). Two treatment conditions were applied: (a) The Standard Body Image Treatment Condition (SBIT) and (b) the VR Condition. Thirteen eating disordered patients were randomly assigned to one of those conditions. No differences between both conditions were found in general ED measures, but patients treated in the VR condition showed a greater significant improvement in specific BI measures. These results suggest that BI treatment with VR could be more targeted to its disturbances. than traditional techniques are.

Differences on presence and reality judgment using a high impact workstation and a PC workstation.

The purpose of this study was to analyze differences in reality judgements made by subjects and their sense of presence when using the virtual reality (VR) settings of different VR workstations. The two workstations were (1) a high impact computer graphics workstation (Silicon Graphics) with a high quality head mounted display (FS5, Virtual Research) and a 3D joystick (Division) and (2) PC Pentium II-based platform with an AccelEclipse Graphical Card (AccelGraphics) with a medium quality head mounted display (V6, Virtual Research) and a 2D mouse. For measuring the sense of presence and reality, we used a 15-item questionnaire designed for this purpose that assesses the level of immersion and reality of the VR settings, availability of interaction with the VR environment, and emotions and bodily sensations experienced while immersed in the VR world. The subjects were 69 undergraduate students that volunteered for this study and were assigned at random to the two experimental workstations. Results indicated that there are no statistical differences in presence or reality judgment between both experimental conditions. This is an interesting finding because of the importance of reducing the cost of the equipment in the VR field.

Virtual reality treatment of claustrophobia: a case report.

The efficacy of a treatment for claustrophobia using only Virtual Reality (VR) exposure was examined. The subject was a 43-year-old female who suffered from clinically significant distress and impairment and sought psychological therapy. Eight individual VR graded exposure sessions were conducted. All self-report measures were reduced following VR exposure and were maintained at one month follow-up. The necessity of a theoretical framework for this new medium for exposure therapy is discussed.

Virtual reality: a new clinical setting lab.

Virtual Reality (VR) is a new technology halfway between television and computer. It constitutes another step in the evolution of our use of a tool that allows us to see, to hear and to feel in a world created graphically in three dimensions, and to interact with it. VR is, mainly, a mental experience which makes the user believe that "he is there", that he is present in the virtual world. With this new tool, the user is no longer a mere observer of that which is happening on a screen, but he "feels" that he is immersed in that world and participates in it, in spite of the fact that they are spaces and objects that only exist in the memory of the computer and in the user's mind. This chapter seeks to carry out different reflections at different levels. First, we will analyze the relationships between VR and Psychology, one of the disciplines that has made more efforts in order to understand how we obtain knowledge from the world and from ourselves. We will also analyze the impact VR can have in one of the applied disciplines of Psychology, which is Clinical Psychology. With regard to this application environment, VR becomes a tool which can generate useful models for Psychology (both normal and abnormal), and it is offered as a research context for Clinical Psychology; as a "realistic" laboratory where we can study behaviours, emotions, thoughts, etc.; and a new means to develop psychological treatments.

Is the selective information processing of food and body words specific to patients with eating disorders?

The selective processing of food- and body size-related information was investigated using a modified version of the Stroop task. Anorexic and bulimic patients and matched female controls were compared on the basis of categorical (diagnosis), dimensional (restraint and drive for thinness) criteria, or both. The findings suggest that the phenomenon assessed by the Stroop paradigm is not exclusive to patients with a clinical eating disorder, but patients and those control subjects who are restrained eaters with a high drive for thinness share a selective processing of information related to shape and eating. The discussion focuses on the implications of these findings.

[A mortality study in the Internal Medicine Emergency Service of October 12 Hospital during 1989]. / Estudio de mortalidad en el Servicio de Urgencias de Medicina Interna del Hospital 12 de Octubre durante 1989.

152,902 patients were attended at the Emergency Department of "12 de Octubre" Hospital during 1989; 48,701 of them were seen in the Internal Medicine area. 196 dead, 164 case histories were selected in order to fulfil the protocol. Several variants were analysed, such as age, sex, diagnosis, time spent at the hospital, quality of life, date, etc. 53.6% were male; the median age was 73 years and the overall median age of all patients seen was 55.9 years. Median Karnovsky was 52.50% of the patients died during their first 5 hours at the Emergency Department. The most frequent diagnoses for the area were neurological, followed by cardiovascular, oncological, digestive, etc. The most frequent diseases observed were cerebrovascular accident, cardiac insufficiency and acute infarction, oncological cases and death on arrival. Mortality was higher in winter. On the whole, mortality was higher in oncology patients followed way behind by neurology digestive and cardiovascular patients.

Schizophrenia and automatic processing: an exploratory study.

This study deals with the schizophrenic deficit as one of automatic processing. To test the idea, a special experimental task was designed on which 21 schizophrenics, 21 depressives, and 21 normal subjects had to complete a series of simple geometric figures. When the subjects had thoroughly learned this activity, another information source, a brief story, was introduced, and the subjects had to pay attention to the story while they did the task. Two dependent variables were considered, execution time and performance. There were no differences among the three groups in the first experimental condition; but in the second condition, when the distractor was introduced, schizophrenics needed more time to do the task and their performance was noticeably worse than those of both normals and depressives. This outcome is explained in terms of a failure in the internal mechanisms which regulate the automatic, parallel, and unconscious processing.