ABSTRACT
OBJECTIVES: To assess the safety and efficacy of percutaneous cryoablation (CA) of soft-tissue tumors (desmoid tumors (DT), vascular malformations (VM), and abdominal wall endometriosis (AWE)). METHODS: This systematic review of studies published before January 2024 encompassed a detailed analysis of CA techniques and technical aspects for the treatment of soft-tissue tumors. Data concerning CA efficacy, complication rates, and other relevant metrics was extracted and included for analysis. RESULTS: The analysis included 27 studies totaling 554 CA procedures. For DT (13 studies, 393 sessions), CA showed an average pain reduction of 79 ± 17% (range: 57-100) and a lesion volume decrease of 71.5 ± 9.8% (range: 44-97). VM (4 studies, 58 sessions) had a 100% technical success rate and an average pain reduction of 72 ± 25% (range: 63-85). The average pain reduction for AWE (6 studies, 103 sessions) was 82 ± 13% (range: 62-100). Overall, the complication rate for CA was low, with minor adverse events (AE) in about 20% of patients and major events in less than 5% of patients. CONCLUSION: Showing substantial efficacy in pain reduction and lesion volume decrease, as well as low incidence of severe AE, CA presents as a highly effective and safe alternative for the treatment of soft-tissue tumors. ADVANCES IN KNOWLEDGE: CA is effective and safe in treating soft-tissue tumors, particularly DT, VM, and AWE.
ABSTRACT
INTRODUCTION: Chest X-rays are commonly used to assess the severity in patients that present in the emergency department with suspected COVID-19 pneumonia, but in clinical practice quantitative scales are rarely employed. AIMS: To evaluate the reliability and validity of two semi-quantitative radiological scales in patients hospitalized for COVID-19 pneumonia (BRIXIA score and RALE score). METHODS: Patients hospitalized between October 2021 and March 2022 with confirmed COVID-19 pneumonia diagnosis were eligible for inclusion. All included patients had a chest X-ray taken in the ED before admission. Three raters that participated in the treatment and management of patients with COVID-19 during the pandemic independently assessed chest X-rays. RESULTS: Intraclass coefficients for BRIXΙA and RALES was 0.781 (0.729-0.826) and 0.825 (0.781-0.862) respectively, showing good to excellent reliability overall. Pairwise analysis was performed using quadratic weighted kappa showing significant variability in the inter-rater agreement. The prognostic accuracy of the two scores for in-hospital mortality for all raters was between 0.753 and 0.763 for BRIXIA and 0.737 and 0.790 for RALES, demonstrating good to excellent prognostic value. Both radiological scores were significantly associated with inhospital mortality after adjustment for 4C Mortality score. We found a consistent upwards trend with significant differences between severity groups in both radiological scores. CONCLUSION: Our findings suggest that BRIXIA and RALES are reliable and can be used to assess the prognosis of patients with COVID-19 requiring hospitalization. However, the inherent subjectivity of radiological scores might make it difficult to set a cut-off value suitable for all assessors.
Subject(s)
COVID-19 , Humans , X-Rays , Respiratory Sounds , SARS-CoV-2 , Reproducibility of Results , Retrospective StudiesABSTRACT
BACKGROUND: Liver fibrosis is often accompanied by steatosis, particularly in patients with non-alcoholic fatty liver disease (NAFLD), and its non-invasive characterisation is of utmost importance. Vibration-controlled transient elastography is the non-invasive method of choice; however, recent research suggests that steatosis may influence its diagnostic performance. Controlled Attenuation Parameter (CAP) added to transient elastography enables simultaneous assessment of steatosis and fibrosis. AIM: To determine how to use CAP in interpreting liver stiffness measurements. METHODS: This is a secondary analysis of data from an individual patient data meta-analysis on CAP. The main exclusion criteria for the current analysis were unknown aetiology, unreliable elastography measurement and data already used for the same research question. Aetiology-specific liver stiffness measurement cut-offs were determined and used to estimate positive and negative predictive values (PPV/NPV) with logistic regression as functions of CAP. RESULTS: Two thousand and fifty eight patients fulfilled the inclusion criteria (37% women, 18% NAFLD/NASH, 42% HBV, 40% HCV, 51% significant fibrosis ≥ F2). Youden optimised cut-offs were only sufficient for ruling out cirrhosis (NPV of 98%). With sensitivity and specificity-optimised cut-offs, NPV for ruling out significant fibrosis was moderate (70%) and could be improved slightly through consideration of CAP. PPV for significant fibrosis and cirrhosis were 68% and 55% respectively, despite specificity-optimised cut-offs for cirrhosis. CONCLUSIONS: Liver stiffness measurement values below aetiology-specific cut-offs are very useful for ruling out cirrhosis, and to a lesser extent for ruling out significant fibrosis. In the case of the latter, Controlled Attenuation Parameter can improve interpretation slightly. Even if cut-offs are very high, liver stiffness measurements are not very reliable for ruling in fibrosis or cirrhosis.
Subject(s)
Elasticity Imaging Techniques/methods , Liver Cirrhosis/diagnosis , Liver/diagnostic imaging , Adult , Biopsy , Elasticity , Female , Humans , Liver/pathology , Liver Cirrhosis/pathology , Liver Cirrhosis/physiopathology , Liver Function Tests/methods , Liver Function Tests/standards , Male , Middle Aged , Non-alcoholic Fatty Liver Disease/diagnosis , Non-alcoholic Fatty Liver Disease/pathology , Retrospective Studies , Sensitivity and SpecificityABSTRACT
Objetivo. Describir el estado actual de conocimiento sobre los principales déficits cognitivos que presentan los pacientes con narcolepsia con cataplejía o narcolepsia de tipo 1. Desarrollo. La mayoría de los estudios ha encontrado que las funciones cognitivas más afectadas son la atención (especialmente el mantenimiento de la atención o atención sostenida), la velocidad de procesamiento de la información y las funciones ejecutivas (en particular, la fluidez verbal y la resistencia a la interferencia de estímulos). Estos datos indican una dificultad para utilizar los recursos cognitivos de los que dispone el sujeto. Estas alteraciones son similares a las presentes en otras hipersomnias, aunque difieren en la intensidad. Por otra parte, la mayoría de los estudios destaca una elevada prevalencia de diferentes trastornos depresivos y ansiosos. Se ha sugerido que la predisposición a la ansiedad forma parte del fenotipo característico de estos pacientes. La ansiedad podría actuar como un factor desencadenante de la enfermedad y ser asimismo una consecuencia de la enfermedad. Conclusiones. Los déficits cognitivos en los pacientes con narcolepsia de tipo 1 se manifiestan en tareas de larga duración o monótonas y en tareas con alta demanda cognitiva, principalmente en tareas de atención sostenida. La presencia de sintomatología depresiva en estos pacientes, junto con la excesiva somnolencia diurna, parecen afectar a su rendimiento en las pruebas neuropsicológicas, y estar estrechamente relacionadas con la apreciación subjetiva de dificultades cognitivas (AU)
Aim. To describe the current state of the art about the main cognitive deficits that appear in patients affected with narcolepsy with cataplexy (NT1). Development. The majority of the studies have found that the most impaired cognitive functions are attention (especially maintenance of attention or sustained attention), speed of information processing and executive functions (in particular, verbal fluency and resistance to the stimuli interference). These data indicate the difficulty to use the available cognitive resources of the patient. These alterations are similar to those present in other hypersomnias, although they might differ in intensity. Moreover, most of the studies emphasize a high prevalence of different depressive and anxious disorders. It has been suggested that predisposition to anxiety could be part of the characteristic phenotype of these patients. Anxiety could act either as a trigger for the disease or a consequence of the disease. Conclusions. Cognitive deficits in patients with NT1 appear in long lasting and/or monotonous tasks and in high cognitive demanding tasks. The presence of depressive symptomatology, together with excessive daytime sleepiness in these patients could affect their performance in neuropsychological test, and it might be related to their subjective perception of the cognitive deficits (AU)
Subject(s)
Narcolepsy/etiology , Narcolepsy/complications , Cataplexy , Nervous System Diseases/psychology , Cognitive Dysfunction , Depression , Disorders of Excessive Somnolence , Affective Disorders, PsychoticABSTRACT
AIM: To describe the current state of the art about the main cognitive deficits that appear in patients affected with narcolepsy with cataplexy (NT1). DEVELOPMENT: The majority of the studies have found that the most impaired cognitive functions are attention (especially maintenance of attention or sustained attention), speed of information processing and executive functions (in particular, verbal fluency and resistance to the stimuli interference). These data indicate the difficulty to use the available cognitive resources of the patient. These alterations are similar to those present in other hypersomnias, although they might differ in intensity. Moreover, most of the studies emphasize a high prevalence of different depressive and anxious disorders. It has been suggested that predisposition to anxiety could be part of the characteristic phenotype of these patients. Anxiety could act either as a trigger for the disease or a consequence of the disease. CONCLUSIONS: Cognitive deficits in patients with NT1 appear in long lasting and/or monotonous tasks and in high cognitive demanding tasks. The presence of depressive symptomatology, together with excessive daytime sleepiness in these patients could affect their performance in neuropsychological test, and it might be related to their subjective perception of the cognitive deficits.
TITLE: Alteraciones neuropsicologicas en la narcolepsia con cataplejia: una revision.Objetivo. Describir el estado actual de conocimiento sobre los principales deficits cognitivos que presentan los pacientes con narcolepsia con cataplejia o narcolepsia de tipo 1. Desarrollo. La mayoria de los estudios ha encontrado que las funciones cognitivas mas afectadas son la atencion (especialmente el mantenimiento de la atencion o atencion sostenida), la velocidad de procesamiento de la informacion y las funciones ejecutivas (en particular, la fluidez verbal y la resistencia a la interferencia de estimulos). Estos datos indican una dificultad para utilizar los recursos cognitivos de los que dispone el sujeto. Estas alteraciones son similares a las presentes en otras hipersomnias, aunque difieren en la intensidad. Por otra parte, la mayoria de los estudios destaca una elevada prevalencia de diferentes trastornos depresivos y ansiosos. Se ha sugerido que la predisposicion a la ansiedad forma parte del fenotipo caracteristico de estos pacientes. La ansiedad podria actuar como un factor desencadenante de la enfermedad y ser asimismo una consecuencia de la enfermedad. Conclusiones. Los deficits cognitivos en los pacientes con narcolepsia de tipo 1 se manifiestan en tareas de larga duracion o monotonas y en tareas con alta demanda cognitiva, principalmente en tareas de atencion sostenida. La presencia de sintomatologia depresiva en estos pacientes, junto con la excesiva somnolencia diurna, parecen afectar a su rendimiento en las pruebas neuropsicologicas, y estar estrechamente relacionadas con la apreciacion subjetiva de dificultades cognitivas.
Subject(s)
Cataplexy/diagnosis , Cataplexy/complications , Cataplexy/psychology , Humans , Narcolepsy/complications , Neuropsychological TestsABSTRACT
INTRODUCTION: Over the last decade an ever-increasing number of articles have been published on dreams, which reflects the interest that several fields of neuroscience have in the topic. In this work we review the main scientific theories that have contributed to the body of knowledge on how they are produced and what function they serve. DEVELOPMENT: The article discusses the evolution of their scientific study, following a neurophysiological and neurocognitive approach. The first of these two methods seeks to determine the neurobiological mechanisms that generate them and the brain structures involved, while the second considers dreams to be a kind of cognition interacting with that of wake-fulness. Several different hypotheses about the function of dreams are examined, and more particularly those in which they are attributed with a role in the consolidation of memory and the regulation of emotional states. CONCLUSIONS: Although the exact mechanism underlying the generation of dreams has not been determined, neurobiological data highlight the importance of the pontine nuclei of the brainstem, several memory systems, the limbic system and the brain reward system and a number of neocortical areas. Neurocognitive data underline the relation between the cognitive and emotional processing that occurs during wakefulness and during sleep, as well as the influence of the surroundings on the content of dreams. With regard to their function, one point to be stressed is their adaptive value, since they contribute to the reprocessing of the information acquired in wakefulness and the control of the emotions. This suggests that dreams participate in the development of the cognitive capabilities.
TITLE: Generacion y funciones de los ensueños.Introduccion. En la ultima decada han aumentado considerablemente las publicaciones sobre los ensueños, lo que refleja el interes de varios campos de la neurociencia por el tema. En este trabajo se revisan las principales teorias cientificas que han contribuido al conocimiento de como se producen y cual es su funcion. Desarrollo. Se expone la evolucion de su estudio cientifico, siguiendo el enfoque neurofisiologico y el neurocognitivo. El primero busca determinar los mecanismos neurobiologicos que los generan y las estructuras cerebrales implicadas; el segundo considera los ensueños un tipo de cognicion en interaccion con el de vigilia. Se examinan diversas hipotesis sobre la funcion de los ensueños, en particular las que les atribuyen un papel en la consolidacion de la memoria y la regulacion del estado emocional. Conclusiones. Aunque no se ha determinado con exactitud como se generan los ensueños, los datos neurobiologicos resaltan la importancia de los nucleos pontinos del tronco cerebral, diversos sistemas de memoria, el sistema limbico y el sistema de recompensa cerebral y diversas areas neocorticales. Los datos neurocognitivos subrayan la relacion entre el procesamiento cognitivo y emocional que ocurre durante la vigilia y durante el sueño, asi como la influencia del entorno en el contenido de los ensueños. Respecto a su funcion, cabe destacar su valor adaptativo, al contribuir al reprocesamiento de la informacion adquirida en vigilia y al control de las emociones. Esto sugiere que los ensueños participan en el desarrollo de las capacidades cognitivas.
Subject(s)
Dreams/physiology , Adaptation, Psychological , Adolescent , Arousal/physiology , Brain Mapping , Child , Child, Preschool , Cognition/physiology , Emotions/physiology , Female , Humans , Male , Memory/physiology , Models, Neurological , Models, Psychological , Nerve Net/physiology , Neuroimaging , Sleep Stages/physiologyABSTRACT
Introducción. En la última década han aumentado considerablemente las publicaciones sobre los ensueños, lo que refleja el interés de varios campos de la neurociencia por el tema. En este trabajo se revisan las principales teorías científicas que han contribuido al conocimiento de cómo se producen y cuál es su función. Desarrollo. Se expone la evolución de su estudio científico, siguiendo el enfoque neurofisiológico y el neurocognitivo. El primero busca determinar los mecanismos neurobiológicos que los generan y las estructuras cerebrales implicadas; el segundo considera los ensueños un tipo de cognición en interacción con el de vigilia. Se examinan diversas hipótesis sobre la función de los ensueños, en particular las que les atribuyen un papel en la consolidación de la memoria y la regulación del estado emocional. Conclusiones. Aunque no se ha determinado con exactitud cómo se generan los ensueños, los datos neurobiológicos resaltan la importancia de los núcleos pontinos del tronco cerebral, diversos sistemas de memoria, el sistema límbico y el sistema de recompensa cerebral y diversas áreas neocorticales. Los datos neurocognitivos subrayan la relación entre el procesamiento cognitivo y emocional que ocurre durante la vigilia y durante el sueño, así como la influencia del entorno en el contenido de los ensueños. Respecto a su función, cabe destacar su valor adaptativo, al contribuir al reprocesamiento de la información adquirida en vigilia y al control de las emociones. Esto sugiere que los ensueños participan en el desarrollo de las capacidades cognitivas (AU)
Introduction. Over the last decade an ever-increasing number of articles have been published on dreams, which reflects the interest that several fields of neuroscience have in the topic. In this work we review the main scientific theories that have contributed to the body of knowledge on how they are produced and what function they serve. Development. The article discusses the evolution of their scientific study, following a neurophysiological and neurocognitive approach. The first of these two methods seeks to determine the neurobiological mechanisms that generate them and the brain structures involved, while the second considers dreams to be a kind of cognition interacting with that of wakefulness. Several different hypotheses about the function of dreams are examined, and more particularly those in which they are attributed with a role in the consolidation of memory and the regulation of emotional states. Conclusions. Although the exact mechanism underlying the generation of dreams has not been determined, neurobiological data highlight the importance of the pontine nuclei of the brainstem, several memory systems, the limbic system and the brain reward system and a number of neocortical areas. Neurocognitive data underline the relation between the cognitive and emotional processing that occurs during wakefulness and during sleep, as well as the influence of the surroundings on the content of dreams. With regard to their function, one point to be stressed is their adaptive value, since they contribute to the reprocessing of the information acquired in wakefulness and the control of the emotions. This suggests that dreams participate in the development of the cognitive capabilities (AU)
Subject(s)
Humans , Mental Processes , Sleep/physiology , Wakefulness/physiology , Memory/physiology , Cognition , Models, Neurological , Adaptation, PhysiologicalABSTRACT
En este trabajo se revisan los estudios más relevantes de la última década acerca de cómo se construyen los ensueños. Tras describir las características de éstos, se exponen los principales modelos de producción de ensueños (psicoanalíticos, neurobiológicos, psicofisiológicos y cognitivos). Se analizan en particular los modelos cognitivos, considerando el origen de los sueños, su composición, las diferencias de organización estructural entre los ensueños que se dan en sueño REM y los de sueño No REM, algunos de los factores que influyen en su recuerdo, las características de los ensueños del principio y del final de la noche y la evolución de éstos durante la infancia. Los datos existentes indican que la actividad mental existe a lo largo de todo el período de sueño, que sus características varían según la fase y el ciclo del sueño en que ocurran y su contenido depende del estilo cognitivo y el estado emocional del durmiente. En cuanto a cómo se construyen los ensueños, la mayoría de los investigadores opina que sólo hay un sistema de producción, responsable tanto de los ensueños de REM como de los de NREM, cuyas fuentes son la memoria episódica y la semántica y los estímulos previos al sueño. Su nivel de funcionamiento varía a lo largo del sueño así como la cantidad de recursos cognitivos disponibles para construir cada ensueño. Hay una continuidad temática en los ensueños sucesivos de distintas fases del sueño de una noche. Las diferencias cualitativas entre los ensueños de REM y los de NREM no parecen ser significativas. Estas podrían deberse ya sea a fallos en los procesos de codificación y recuperación de la información o a que el sistema de producción no dispone de la misma cantidad y tipo de recuerdos en REM que en NREM: los ensueños de REM se construyen principalmente con elementos de memoria semántica mientras que los de NREM se basan en la memoria autobiográfica (AU)
Subject(s)
Adolescent , Adult , Female , Male , Middle Aged , Child , Humans , Imagery, Psychotherapy/methods , Sleep, REM/physiology , Cognitive Science/methods , Semantics , Psychoanalysis/methods , Sleep/physiology , Memory/physiology , Neurobiology/methods , Neurobiology/trends , Memory/classification , Memory Disorders/complications , Memory Disorders/diagnosisABSTRACT
Los pacientes con síndrome de apnea obstructiva del sueño (SAOS) presentan diversos déficits cognitivos que disminuyen su rendimiento intelectual global y afectan en particular a su capacidad de atención, memoria y aprendizaje, habilidades visuomotoras y funciones cognitivas complejas. En su patogénesis interactúan diversos factores: la alteración del patrón de sueño nocturno, la excesiva somnolencia diurna (ESD), el índice de apneas y la hipoxemia nocturna. Los dos principales factores etiológicos, la ESD y la hipoxemia nocturna, parecen provocar déficits cognitivos diferentes: el primero repercutiría fundamentalmente en la atención y la memoria, mientras que el segundo provocaría un deterioro progresivo de las funciones ejecutivas. A medida que aumenta la gravedad del síndrome se intensifican los déficits existentes en el SAOS moderado y se manifiestan los más severos. Se ha sugerido que los pacientes con SAOS sufren un deterioro de las funciones frontales similar al de los pacientes con disfunción frontal: dificultad para inhibir los procesos mentales automatizados e iniciar otros nuevos, tendencia a la perseveración y disminución de la capacidad de atención y de la de aprendizaje/memoria. Los déficits cognitivos descritos en el SAOS se acompañan de trastornos psicopatológicos, consecuentes al síndrome, en especial de síntomas depresivos. El perfil de personalidad característico de estos pacientes es el de una reacción neurótica de ansiedad, con marcados signos de hipocondria, depresión y somatización. El conjunto de alteraciones neuropsicológicas perjudican su adaptación psicosocial, sobre todo en el área social y profesional, y aumentan su riesgo de sufrir accidentes. Diversos tratamientos del SAOS, en particular la presión positiva continua por vía nasal (CPAP nasal), mejoran el rendimiento cognitivo y los trastornos afectivos asociados. No obstante, los déficits relacionados con la disminución de las funciones frontales, atribuidos a la hipoxemia, persisten o remiten sólo parcialmente. Dada la gravedad de las consecuencias del síndrome, es importante evaluar, con pruebas específicas, las funciones cognitivo-ejecutivas de estos pacientes, así como su estado emocional, y comenzar el tratamiento en las fases iniciales de la enfermedad (AU)
Subject(s)
Adolescent , Adult , Female , Male , Child , Humans , Sleep Apnea Syndromes/complications , Sleep Apnea Syndromes/diagnosis , Sleep Apnea Syndromes/psychology , Psychopathology/methods , Somatoform Disorders/complications , Somatoform Disorders/diagnosis , Cognition Disorders/diagnosis , Cognition Disorders/psychology , Cognitive Science/methods , Sleep Stages/physiology , Hypoxia/complications , Hypoxia/diagnosis , Memory Disorders/complications , Memory Disorders/diagnosisSubject(s)
Disorders of Excessive Somnolence/diagnosis , Adult , Aged , Culture , Female , Humans , Male , Middle Aged , SpainABSTRACT
To evaluate the psychological disturbances associated with obstructive sleep apnea (OSA) and the effect of nasal continuous positive airway pressure (NCPAP) treatment on these alterations, personality patterns and psychosocial adjustment were assessed in patients hypnopolygraphically diagnosed with OSA before and after different periods of NCPAP therapy. Prior to treatment, MMPI results for 23 patients showed significant elevations (p < .01) on five clinical scales compared to those of 17 normal controls. Apneics' personality patterns were predominantly of a "neurotic-mixed" type, indicating an anxiety reaction with paranoid features. Depression, schizophrenia, and hypochondriasis were the highest scales. Most patients had severe psychosocial maladjustment. In the follow-up study during the NCPAP treatment, there was a progressive reduction of the psychopathological signs along with a generalized improvement in psychosocial adaptation. These changes were remarkably significant after about a year's treatment, in particular for depression (p < .01) and total adjustment degree (p < .01). It was concluded that severe OSA is associated with serious psychosocial alterations that improve gradually with NCPAP.
Subject(s)
Mental Disorders/diagnosis , Positive-Pressure Respiration , Sleep Apnea Syndromes/therapy , Adult , Aged , Airway Obstruction , Depressive Disorder/complications , Depressive Disorder/diagnosis , Depressive Disorder/psychology , Female , Follow-Up Studies , Humans , MMPI , Male , Mental Disorders/complications , Mental Disorders/psychology , Middle Aged , Personality Disorders/complications , Personality Disorders/diagnosis , Personality Disorders/psychology , Personality Inventory , Schizophrenia/complications , Schizophrenia/diagnosis , Sleep Apnea Syndromes/complications , Sleep Apnea Syndromes/psychology , Social AdjustmentABSTRACT
The sleep pattern of 13 prepubertal children, nonmedicated, rigourously diagnosed as Attention Deficit Disorder (ADD) was recorded for two consecutive nights. Analyses of sleep pattern variables revealed a marked reduction of sleep onset latency (p less than .01), a great number of nocturnal awakenings (p less than .01), and a high increase of Delta sleep percentage (p less than .01) for the ADD children compared to normals. In addition, the two subtypes of the disorder--ADD with hyperactivity (ADD/H) and ADD without hyperactivity (ADD/WO) or ADD undifferentiated--showed distinct hypnopolygraphic correlates. Those ADD/H children had a greater sleep fragmentation and a lesser degree of sleep efficiency. These findings would support the hypothesis that ADD is related to a deficient control of arousal level and, on the other hand, suggest that ADD/H and ADD/WO are different clinical entities.