Deep brain stimulation in Latin America in comparison with the US and Europe in a real-world population: indications, demographics, techniques, technology, and adverse events.

OBJECTIVE: The aim of this study was to provide geographic comparisons of deep brain stimulation (DBS) procedures in Latin America with the US and Europe regarding primary indications, demographic information, clinical and device-related adverse events, technology used, and patient outcomes using the Medtronic Product Surveillance Registry data as of July 31, 2021. METHODS: Two thousand nine hundred twelve patients were enrolled in the registry (2782 received DBS and 1580 are currently active). Fourteen countries contributed 44,100 years of device experience to the registry. DBS centers in Latin America are located in Colombia (n = 3), Argentina (n = 1), Brazil (n = 1), and Mexico (n = 1). Fisher's exact test was used to compare the difference in proportions of categorical variables between regions. The Wilcoxon signed-rank test was used for the EQ-5D index score change from baseline to follow-up. RESULTS: The most common indication for DBS was Parkinson's disease across all regions. In Latin America, dystonia was the second most common indication, compared to essential tremor in other regions. There was a striking finding with respect to age-patients were an average of 10 years younger at DBS implantation in Latin America. This difference was most likely due to the greater number of patients with dystonia receiving the device implants. The intraoperative techniques were quite similar, showing the same level of quality and covering the main principles of the surgeries with some variations in the brand of frames, planning software, and microrecording systems. Rechargeable batteries were significantly more common in Latin America (72.37%) than in the US (6.44%) and Europe (9.9%). Staging of the DBS procedure differed, with only 11.84% in Latin America staging the procedure compared with 97.58% and 34.86% in the US and Europe, respectively. The EQ-5D score showed significant improvements in all regions during the first 6-12 months (p < 0.0001). However, the 24-month follow-up only showed an improvement in the scale for Latin America (p < 0.0001). CONCLUSIONS: DBS was performed in Latin America with similar indications, techniques, and technology as in the US and Europe. Important differences were found, with Latin America implementing more regular use of rechargeable devices, including younger patients at the time of surgery, and showing more sustained quality of life improvements at 24 months of follow-up. The authors hypothesize that these disparities stem from differences in resources among regions. However, more studies are needed to standardize DBS practice across the world to improve patients' quality of life and provide high-quality care.

Modulation of neuronal activity in human centromedian nucleus during an auditory attention and working memory task.

Centromedian nucleus (CM) is one of several intralaminar nuclei of the thalamus and is thought to be involved in consciousness, arousal, and attention. CM has been suggested to play a key role in the control of attention, by regulating the flow of information to different brain regions such as the ascending reticular system, basal ganglia, and cortex. While the neurophysiology of attention in visual and auditory systems has been studied in animal models, combined single unit and LFP recordings in human have not, to our knowledge, been reported. Here, we recorded neuronal activity in the CM nucleus in 11 patients prior to insertion of deep brain stimulation electrodes for the treatment of epilepsy while subjects performed an auditory attention task. Patients were requested to attend and count the infrequent (p = 0.2) odd or "deviant" tones, ignore the frequent standard tones and report the total number of deviant tones at trial completion. Spikes were discriminated, and LFPs were band pass filtered (5-45 Hz). Average peri­stimulus time histograms and spectra were constructed by aligning on tone onsets and statistically compared. The firing rate of CM neurons showed selective, multi-phasic responses to deviant tones in 81% of the tested neurons. Local field potential analysis showed selective beta and low gamma (13-45 Hz) modulations in response to deviant tones, also in a multi-phasic pattern. The current study demonstrates that CM neurons are under top-down control and participate in the selective processing during auditory attention and working memory. These results, taken together, implicate the CM in selective auditory attention and working memory and support a role of beta and low gamma oscillatory activity in cognitive processes. It also has potential implications for DBS therapy for epilepsy and non-motor symptoms of PD, such as apathy and other disorders of attention.

Reduced covariation between brain morphometry and local spontaneous activity in young children with ASD.

While disruptions in brain maturation in the first years of life in ASD are well documented, little is known about how the brain structure and function are related in young children with ASD compared to typically developing peers. We applied a multivariate pattern analysis to examine the covariation patterns between brain morphometry and local brain spontaneous activity in 38 toddlers and preschoolers with ASD and 31 typically developing children using T1-weighted structural MRI and resting-state fMRI data acquired during natural sleep. The results revealed significantly reduced brain structure-function correlations in ASD. The resultant brain structure and function composite indices were associated with age among typically developing children, but not among those with ASD, suggesting mistiming of typical brain maturational trajectories early in life in autism. Additionally, the brain function composite indices were associated with the overall developmental and adaptive behavior skills in the ASD group, highlighting the neurodevelopmental significance of early local brain activity in autism.

Beta band oscillations in the motor thalamus are modulated by visuomotor coordination in essential tremor patients.

Introduction: Beta oscillations in sensorimotor structures contribute to the planning, sequencing, and stopping of movements, functions that are typically associated with the role of the basal ganglia. The presence of beta oscillations (13-30 Hz) in the cerebellar zone of the thalamus (the ventral intermediate nucleus - Vim) indicates that this rhythm may also be involved in cerebellar functions such as motor learning and visuomotor adaptation. Methods: To investigate the possible role of Vim beta oscillations in visuomotor coordination, we recorded local field potential (LFP) and multiunit activity from the Vim of essential tremor (ET) patients during neurosurgery for the implantation of deep brain stimulation (DBS) electrodes. Using a computer, patients performed a visuomotor adaptation task that required coordinating center-out movements with incongruent visual feedback imposed by inversion of the computer display. Results: The results show that, in ET, Vim beta oscillations of the LFP were lower during the incongruent center-out task than during the congruent orientation. Vim firing rates increased significantly during periods of low beta power, particularly on approach to the peripheral target. In contrast, beta power in the subthalamic nucleus of Parkinson's disease (PD) patients did not differ significantly between the incongruent and the congruent orientation of the center-out task. Discussion: The findings support the hypothesis that beta oscillations of the Vim are modulated by novel visuomotor tasks. The inverse relationship between the power of Vim-LFP beta oscillations and Vim firing rates suggest that the suppression of beta oscillations may facilitate information throughput to the thalamocortical circuit by modulation of Vim firing rates.

Multi-centre analysis of networks and genes modulated by hypothalamic stimulation in patients with aggressive behaviours.

Deep brain stimulation targeting the posterior hypothalamus (pHyp-DBS) is being investigated as a treatment for refractory aggressive behavior, but its mechanisms of action remain elusive. We conducted an integrated imaging analysis of a large multi-centre dataset, incorporating volume of activated tissue modeling, probabilistic mapping, normative connectomics, and atlas-derived transcriptomics. Ninety-one percent of the patients responded positively to treatment, with a more striking improvement recorded in the pediatric population. Probabilistic mapping revealed an optimized surgical target within the posterior-inferior-lateral region of the posterior hypothalamic area. Normative connectomic analyses identified fiber tracts and functionally connected with brain areas associated with sensorimotor function, emotional regulation, and monoamine production. Functional connectivity between the target, periaqueductal gray and key limbic areas - together with patient age - were highly predictive of treatment outcome. Transcriptomic analysis showed that genes involved in mechanisms of aggressive behavior, neuronal communication, plasticity and neuroinflammation might underlie this functional network.

Top-down control of human motor thalamic neuronal activity during the auditory oddball task.

The neurophysiology of selective attention in visual and auditory systems has been studied in animal models but not with single unit recordings in human. Here, we recorded neuronal activity in the ventral intermediate nucleus as well as the ventral oral anterior, and posterior nuclei of the motor thalamus in 25 patients with parkinsonian (n = 6) and non-parkinsonian tremors (n = 19) prior to insertion of deep brain stimulation electrodes while they performed an auditory oddball task. In this task, patients were requested to attend and count the randomly occurring odd or "deviant" tones, ignore the frequent standard tones and report the number of deviant tones at trial completion. The neuronal firing rate decreased compared to baseline during the oddball task. Inhibition was specific to auditory attention as incorrect counting or wrist flicking to the deviant tones did not produce such inhibition. Local field potential analysis showed beta (13-35 Hz) desynchronization in response to deviant tones. Parkinson's disease patients off medications had more beta power than the essential tremor group but less neuronal modulation of beta power to the attended tones, suggesting that dopamine modulates thalamic beta oscillations for selective attention. The current study demonstrated that ascending information to the motor thalamus can be suppressed during auditory attending tasks, providing indirect evidence for the searchlight hypothesis in humans. These results taken together implicate the ventral intermediate nucleus in non-motor cognitive functions, which has implications for the brain circuitry for attention and the pathophysiology of Parkinson's disease.

Long-Term Follow-Up on Bilateral Posterior Hypothalamic Deep Brain Stimulation for Treating Refractory Aggressive Behavior in a Patient with Cri du Chat Syndrome: Analysis of Clinical Data, Intraoperative Microdialysis, and Imaging Connectomics.

Posterior hypothalamic-deep brain stimulation (pHyp-DBS) has been reported as a successful treatment for reducing refractory aggressive behaviors in patients with distinct primary diagnoses. Here, we report on a patient with cri du chat syndrome presenting severe self-injury and aggressive behaviors toward others, who was treated with pHyp-DBS. Positive results were observed at long-term follow-up in aggressive behavior and quality of life. Intraoperative microdialysis and imaging connectomics analysis were performed to investigate possible mechanisms of action. Our results suggest the involvement of limbic and motor areas and alterations in main neurotransmitter levels in the targeted area that are associated with positive results following treatment.

Hearing screening analysis in children exposed to the Zika virus / Análise da triagem auditiva de crianças expostas ao vírus Zika

ABSTRACT Purpose: to analyze the results of neonatal hearing screening examinations in newborns with and without microcephaly, exposed to the Zika virus, without other risk indicators for hearing loss, and verify the association between screening results, sample characteristics, and the gestational trimester when exposure took place. Methods: a descriptive cross-sectional study. Subjects included in the study had no risk indicator for hearing loss other than microcephaly, and presented, along with their mothers, positive RT-PCR results, respectively at birth and during pregnancy. The transient evoked otoacoustic emission and brainstem auditory evoked potential examinations were applied by the researcher between March 2016 and December 2017. Newborns failed the screening when they failed at least one retest in at least one ear. The data were descriptively analyzed, using the Fisher exact test; p-values equal to or lower than 0.05 were considered significant. Results: out of the 45 subjects, 30 (66.7%) were females, 6.7% were likely to have sensorineural hearing loss, with or without auditory neuropathy spectrum disorder - which was possibly present in only one ear of one of these three subjects. Failure in the screening was statistically significant in subjects with at least one of the congenital Zika syndrome characteristics and subjects with subcortical calcification and brain cortex thinning, macular chorioretinal atrophy with focal pigmentary mottling, and hypertonia with symptoms of extrapyramidal involvement. The gestational trimester of exposure was associated with screening results. Conclusion: the responses in screening point to the possibility of hearing loss in newborns with and without microcephaly, whereas the presence of microcephaly was not significant to examination failures. Exposure in the first gestational trimester indicated a possible relationship with screening failures.

RESUMO Objetivo: analisar os resultados dos exames de triagem auditiva neonatal de recém-nascidos sem e com microcefalia expostos ao vírus Zika, que não apresentaram outros indicadores de risco para deficiência auditiva e verificar a associação entre o resultado da triagem, as características da amostra e o trimestre gestacional em que ocorreu a exposição. Métodos: estudo descritivo de corte transversal. Fizeram parte do estudo sujeitos sem indicadores de risco para deficiência auditiva, com exceção da microcefalia, cujas mães apresentaram na gestação o exame RT-PCR positivo e sujeitos que tiveram o RT-PCR positivo, ao nascimento. Os exames de Emissões Otoacústicas Transientes e Potencial Evocado Auditivo de Tronco Encefálico foram aplicados, pela pesquisadora, entre março de 2016 e dezembro de 2017. O recém-nato foi considerado reprovado na triagem quando apresentou falha em pelo menos um reteste, em ao menos uma orelha. Os dados foram analisados de forma descritiva e utilizando-se o teste estatístico exato de Fisher, p valor menor ou igual a 0,05 foi considerado significante. Resultados: dos 45 sujeitos, 30 (66,7%) eram do sexo feminino, 6,7% apresentaram a probabilidade de alteração do tipo sensorioneural, com ou sem espectro da neuropatia auditiva e somente um dentre esses três sujeitos apresentou uma das orelhas com chance do espectro da neuropatia auditiva, isoladamente. A falha na triagem foi estatisticamente significativa, nos sujeitos que apresentavam pelo menos uma característica da Síndrome da Zika Congênita e nos sujeitos com calcificação subcortical com afilamento do córtex cerebral, atrofia coriorretiniana macular com moteado pigmentar focal e hipertonia com sintomas de envolvimento extrapiramidal. Houve associação do trimestre gestacional da exposição com o resultado de triagem. Conclusão: as respostas verificadas pela triagem apontam para a possibilidade de alteração auditiva em recém-nascidos sem e com microcefalia, onde a presença da microcefalia não foi significante para falha nos exames. A exposição no primeiro trimestre gestacional indicou uma possível relação com falhas na triagem.

Single unit and beta oscillatory activities in subthalamic nucleus are modulated during visual choice preference.

Parkinson's disease is a neurodegenerative disease affecting the supply of dopamine to basal ganglia nuclei, leading to pathological beta band (13-35 Hz) oscillations in the subthalamic nucleus (STN). STN and beta activity are recognized in motoric functions but their role in cognitive functions remains elusive. We examined single unit and beta local field potential (LFP) activity in the STN during a visual choice preference task in PD patients (n = 12) undergoing deep brain stimulation surgery. Patients viewed 2 of 5 possible animal picture-pairs and were instructed to choose their favorite ("fav") picture by clicking the left or right mouse key. A block of trials consisted of 50-75 picture-pair presentations. Single unit histograms and LFP spectrograms were aligned to picture presentation and point of decision for pairs that included the fav and non-fav pictures, respectively. A total of 58 neurons from 26 blocks of trials were analyzed. Thirty of 58 neurons showed a selective change in spiking activity 0.20-0.65 s to fav picture presentation, which preceded the shortest recorded reaction time (=0.7 s), and 17/58 neurons showed no significant response in our task. Beta LFP significantly desynchronized in response to fav but not non-fav pictures in all trials, and in 14/26 blocks of trials, the desynchronization was followed by a "beta burst" and ramp-up to baseline activity. Neurons with choice preference responses were found throughout the dorsoventral extent of the STN. STN single units and beta activity are modulated during visual choice preference, and this suggests a role for STN beta activity in cognitive processing.

Análise da triagem auditiva de crianças expostas ao vírus Zika / Analysis of hearing screening in children exposed to the Zika virus

O vírus Zika, identificado no Brasil no ano de 2015, infectou um número significativo de pessoas. A sequela mais grave constatada pela doença foi a microcefalia, que chamou a atenção dos meios governamentais e acadêmicos pelo aumento expressivo do número de casos no país. Um elevado número de gestantes infectadas concebeu crianças com microcefalia, o que levou o país a decretar epidemia em 2015 e 2016. Com a epidemia da doença o Ministério da Saúde (MS) elaborou o protocolo de atendimento às crianças, com microcefalia, infectadas pelo vírus Zika, e dentre as orientações, consta a recomendação da avaliação da Triagem Auditiva Neonatal (TAN). Objetivo: analisar as respostas auditivas verificadas pela TAN, normal ou alterada, de crianças expostas ao vírus Zika que não apresentaram Indicadores de Risco para Deficiência Auditiva (IRDA); e associar essas respostas auditivas com o trimestre gestacional em que a infecção pelo vírus Zika foi adquirida. Materiais e Método: Trata-se de um estudo descritivo, de corte transversal retrospectivo, desenvolvido a partir da coorte prospectiva da infecção pelo vírus Zika do Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira / Fundação Oswaldo Cruz (IFF/FIOCRUZ), denominada "Exposição vertical ao Zika vírus e suas consequências para o neurodesenvolvimento infantil". A população alvo foi constituída de crianças incluídas no estudo da coorte no período de Março de 2016 a Dezembro de 2017, avaliadas pelos exames da TAN: Emissões Otoacústicas Evocadas Transiente (EOAT) e Potencial Evocado Auditivo de Tronco Encefálico (PEATE-A). Foram incluídas no estudo crianças com ou sem microcefalia, que apresentaram o exame laboratorial RT-PCR positivo para o vírus Zika, e também crianças cujas mães tiveram esse resultado positivo. Foram excluídos lactentes que não tiveram a TAN concluída (EOAT e PEATE-A), os que apresentaram resultados negativos do exame RT- PCR e os lactentes com IRDA. Os testes da triagem auditiva realizados foram as EOAT e o PEATE, ambos no modo automático. O lactente foi considerado reprovado na TAN quando apresentou alteração em pelo menos um reteste (EOAT ou PEATE-A), em ao menos uma orelha. Resultados: Foram analisados os dados de 45 crianças, sendo 30 (66,7%) do sexo feminino. A mediana da idade da realização do primeiro exame da TAN foi de 7 dias (IIQ 2-32dias). A prevalência de falha foi de 6,7%, incluindo teste e reteste, e os mesmos lactentes que apresentaram falha em EOAT falharam também no PEATE-A; dentre esses um paciente passou em EOAT e falhou em PEATE-A em uma das orelhas. Os resultados sugerem alteração sensorioneural com ou sem o Espectro da Neuropatia Auditiva (ENA) em 6,7% da amostra (3 pacientes/ 3 orelhas); e 2,2% da população (1 paciente/1 orelha) com a possibilidade de apresentar somente o ENA. Em relação ao trimestre gestacional da infecção, o estudo demonstra que há associação do trimestre em que a gestante adquiriu a doença com o resultado da TAN. Conclusão: dados revelam que a infecção adquirida no primeiro trimestre pode apresentar relação com a falha nos exames da TAN.

The Zika virus, identified in 2015, infected a considerable amount of people in Brazil. The disease´s most serious sequel was microcephaly, which attracted the attention of governmental agencies and academic circles because of the significant increase in the number of cases in the country. A high number of infected pregnant women generated children with microcephaly, which led the government to declare an epidemic in 2015 and 2016. Due to the epidemic, the National Health Service developed protocols to assist children with microcephaly infected by the Zika virus. The guidelines included the Universal Neonatal Hearing Screening test (UNHS). Objective: This study aims to analyze normal or altered auditory hearing responses in the UNHS test in children exposed to the Zika virus who did not present hearing impairment risk indicators and correlate these auditory responses with the gestational trimester in which the Zika virus infection was acquired. Materials and Methods: This is a retrospective, cross-sectional descriptive study developed from the prospective cohort of the Zika virus infection at the Fernandes Figueira National Institute of Women, Children and Adolescents Health/ Oswaldo Cruz Foundation (IFF / FIOCRUZ), denominated "Vertical exposure to the Zika virus and its consequences for children neurodevelopment". The target population consisted of children included in the cohort study from March 2016 to December 2017, assessed by the UNHS Transient Evoked Otoacoustic Emissions Test (TEOAE) and the Brainstem Auditory Evoked Potentials Test (BAEP-A). We included children with and without microcephaly, tested positive in the RT-PCR laboratory test for the Zika virus, and children whose mothers were tested positive in this exam. Infants who did not have a complete UNHS test (TEOAE and BAEP-A), infants with negative RT-PCR results, and infants with hearing impairment risk indicators were excluded. Both TEOAE and BAEP-A hearing screening tests were performed in automatic mode. An infant was considered to have a fail UNHS when he/she presented alteration in at least one retest (TEOAE or BAEP-A) in at least one ear. Results: From the 45 children analyzed, 30 (66.7%) were female. The average age of the first UNHS test was 7 days (IQR 2-32 days). The prevalence of failure was 6.7%, including test and retest. The same infants who presented a fail in TEOAE also presented a fail in BAEP- A; among them there was a patient who passed in TEOAE and failed in BAEP-A in one of the ears. The results suggest a sensorineural alteration with or without the Auditory Neuropathy Spectrum Disorder (ANSD) in 6.7% of the sample (3 patients / 3 ears); and 2.2% of the population (1 patient / 1 ear) with the possibility of presenting only ANSD. Regarding the gestational trimester of the infection, the study shows that there is an association between the trimester in which the pregnant woman acquired the disease and the UNHS test result. Conclusion: Data reveals that the infection acquired in the first trimester may be related to the fail in the UNHS tests.

Simulation-based Education for Endoscopic Third Ventriculostomy: A Comparison Between Virtual and Physical Training Models.

BACKGROUND: The relative educational benefits of virtual reality (VR) and physical simulation models for endoscopic third ventriculostomy (ETV) have not been evaluated "head to head." OBJECTIVE: To compare and identify the relative utility of a physical and VR ETV simulation model for use in neurosurgical training. METHODS: Twenty-three neurosurgical residents and 3 fellows performed an ETV on both a physical and VR simulation model. Trainees rated the models using 5-point Likert scales evaluating the domains of anatomy, instrument handling, procedural content, and the overall fidelity of the simulation. Paired t tests were performed for each domain's mean overall score and individual items. RESULTS: The VR model has relative benefits compared with the physical model with respect to realistic representation of intraventricular anatomy at the foramen of Monro (4.5, standard deviation [SD] = 0.7 vs 4.1, SD = 0.6; P = .04) and the third ventricle floor (4.4, SD = 0.6 vs 4.0, SD = 0.9; P = .03), although the overall anatomy score was similar (4.2, SD = 0.6 vs 4.0, SD = 0.6; P = .11). For overall instrument handling and procedural content, the physical simulator outperformed the VR model (3.7, SD = 0.8 vs 4.5; SD = 0.5, P < .001 and 3.9; SD = 0.8 vs 4.2, SD = 0.6; P = .02, respectively). Overall task fidelity across the 2 simulators was not perceived as significantly different. CONCLUSION: Simulation model selection should be based on educational objectives. Training focused on learning anatomy or decision-making for anatomic cues may be aided with the VR simulation model. A focus on developing manual dexterity and technical skills using endoscopic equipment in the operating room may be better learned on the physical simulation model.

Single-unit analysis of the human posterior hypothalamus and red nucleus during deep brain stimulation for aggressivity.

OBJECTIVE Deep brain stimulation (DBS) of the posterior hypothalamus (PH) has been reported to be effective for aggressive behavior in a number of isolated cases. Few of these case studies have analyzed single-unit recordings in the human PH and none have quantitatively analyzed single units in the red nucleus (RN). The authors report on the properties of ongoing neuronal discharges in bilateral trajectories targeting the PH and the effectiveness of DBS of the PH as a treatment for aggressive behavior. METHODS DBS electrodes were surgically implanted in the PH of 1 awake patient with Sotos syndrome and 3 other anesthetized patients with treatment-resistant aggressivity. Intraoperative extracellular recordings were obtained from the ventral thalamus, PH, and RN and analyzed offline to discriminate single units and measure firing rates and firing patterns. Target location was based on the stereotactic coordinates used by Sano et al. in their 1970 study and the location of the dorsal border of the RN. RESULTS A total of 138 units were analyzed from the 4 patients. Most of the PH units had a slow, irregular discharge (mean [± SD] 4.5 ± 2.7 Hz, n = 68) but some units also had a higher discharge rate (16.7 ± 4.7 Hz, n = 15). Two populations of neurons were observed in the ventral thalamic region as well, one with a high firing rate (mean 16.5 ± 6.5 Hz, n = 5) and one with a low firing rate (mean 4.6 ± 2.8 Hz, n = 6). RN units had a regular firing rate with a mean of 20.4 ± 9.9 Hz and displayed periods of oscillatory activity in the beta range. PH units displayed a prolonged period of inhibition following microstimulation compared with RN units that were not inhibited. Patients under anesthesia showed a trend for lower firing rates in the PH but not in the RN. All 4 patients displayed a reduction in their aggressive behavior after surgery. CONCLUSIONS During PH DBS, microelectrode recordings can provide an additional mechanism to help identify the PH target and surrounding structures to be avoided such as the RN. PH units can be distinguished from ventral thalamic units based on their response to focal microstimulation. The RN has a characteristic higher firing rate and a pattern of beta oscillations in the spike trains. The effect of the anesthetic administered should be considered when using microelectrode recordings. The results of this study, along with previous reports, suggest that PH DBS may be an effective treatment for aggression.

Estrategias para un envejecimiento exitoso / Strategies for successful ageing

En los últimos años ha habido un aumento en el interés por la medicina antienvejecimiento con un crecimiento de la industria de productos que prometen prolongar la vida y restaurar todo padecimiento o «defecto» producido por la edad. El entendimiento del envejecimiento ha evolucionado, dando cabida a la posibilidad de intervenir en diferentes vías metabólicas y celulares y así, retrasar la aparición de las enfermedades crónicas degenerativas que aparecen con la edad y que finalmente son las causantes de la vulnerabilidad que nos lleva a la muerte. Esperamos poder ayudar al clínico a orientar a sus pacientes, quienes ante la información abrumadora que reciben por Internet, acuden al consultorio llenos de preguntas, esperando recibir del médico la respuesta absoluta para aumentar su longevidad y calidad de vida. Este artículo analiza la actividad física, las dietas, los suplementos y fármacos que se están explorando como medidas antienvejecimiento y de los que múltiples estudios clínicos han arrojado resultados alentadores medibles y reproducibles (AU)

There has been an increase in the interest of anti-ageing medicine in the last few years, with a growth in the industry of products that promise to prolong life and restore all the suffering or «defects» produced by age. The understanding of ageing has changed over the years, giving rise to the possibility of intervening in different metabolic and cellular pathways, and thus, delaying the appearance of the degenerative chronic diseases that appear with age, and that are finally the causing factors of the vulnerability that leads to our death. It is hoped that we can help the clinician to orientate their patients, who, due to the overwhelming amount of information they receive by the Internet, arrive at the clinic full of questions, waiting to receive absolute answer from their physician in order to increase their longevity and quality of life. This article presents an analysis of the physical activity, diets, supplements and drugs that are being investigated as anti-ageing measures and of the many clinical studies that have produced encouraging, measurable and reproducible results (AU)

[Strategies for successful ageing]. / Estrategias para un envejecimiento exitoso.

There has been an increase in the interest of anti-ageing medicine in the last few years, with a growth in the industry of products that promise to prolong life and restore all the suffering or "defects" produced by age. The understanding of ageing has changed over the years, giving rise to the possibility of intervening in different metabolic and cellular pathways, and thus, delaying the appearance of the degenerative chronic diseases that appear with age, and that are finally the causing factors of the vulnerability that leads to our death. It is hoped that we can help the clinician to orientate their patients, who, due to the overwhelming amount of information they receive by the Internet, arrive at the clinic full of questions, waiting to receive absolute answer from their physician in order to increase their longevity and quality of life. This article presents an analysis of the physical activity, diets, supplements and drugs that are being investigated as anti-ageing measures and of the many clinical studies that have produced encouraging, measurable and reproducible results.

Expression of collagen in ovular membranes of pregnant smokers and non-smokers: a pilot study.

OBJECTIVE: Our study compared the amount of total collagen and type I collagen in ovular membranes of pregnant smokers and non-smokers. MATERIAL AND METHODS: The study group consisted of 14 pregnant smokers at 24-36 weeks of gestation; 39 pregnant non-smokers between 24-36 weeks of gestation comprised the control group. The expressions of total collagen and type I collagen were analyzed using two histological sections of the fetal membranes. The assessment of total collagen was performed using the Picro-Cirius red stain, and type I collagen expression was determined by means of immunohistochemistry The Mann-Whitney test was applied to verify possible differences between the groups. RESULT: The average area covered by total collagen was lower in smokers (20630.45 microm2) as compared to non-smokers (24058.61 microm2), although the difference was not statistically significant (p = 0.454). Comparison involving collagen type I deemed similar results (20001.33 microm2 vs. 25328.29 microm2, p = 0.158). CONCLUSION: The amount of total collagen and type I collagen was lower in ovular membranes of pregnant smokers as compared to non-smokers, although the difference was not statistically significant.

Beta oscillatory neurons in the motor thalamus of movement disorder and pain patients.

Excessive beta oscillations (15-25Hz) in the basal ganglia have been linked to the akineto-rigid symptoms of Parkinson's disease (PD) although it remains unclear whether the underlying mechanism is causative or associative. While a number of studies have reported beta activity in the subthalamic nucleus and globus pallidus internus, relatively little is known about the beta rhythm of the motor thalamus and its relation to movement disorders. To test whether thalamic beta oscillations are related to parkinsonian symptoms, we examined the spectral properties of neuronal activity in the ventral thalamic nuclei of five Parkinson's disease patients (two female, age range 50-72years) and compared them to five essential tremor (three female, aged 41-75) and four central pain patients (one female, aged 38-60). Spike and local field potential recordings were obtained during microelectrode-guided localization of thalamic nuclei prior to the implantation of deep brain stimulating electrodes. A total of 118 movement-related neurons in the region of the ventral intermediate nucleus (Vim) were analyzed across all patient groups. Eighty of these neurons (68%) displayed significant oscillatory firing in the beta range with the limbs at rest. In contrast, only 5.7% of the ventral oral posterior (Vop) (χ(2) test, p<0.05) and only 7.2% of the ventral caudal (Vc) neurons fired rhythmically at beta frequency (χ(2) test, p<0.05). Beta power was significantly decreased during limb movements (ANOVA, p<0.05) and was inversely related to tremor-frequency power during tremor epochs in ET and PD (r(2)=0.44). Comparison between patient groups showed that Vim beta power was significantly higher in ET patients versus pain and PD groups (ANOVA, p<0.05). The findings suggest that beta oscillations are found predominantly in Vim and are involved in movement but are not enhanced in tremor-dominant Parkinson's patients.

What factors are associated with the provision of assistive technologies: the Bogotá D.C. case.

AIM: To examine what demographics and clinical factors are associated with the provision of assistive technology (AT) devices in a low-income country. METHOD: Retrospective cross-sectional exploratory study design including 15 of the 20 localities across Bogotá D.C., Colombia, a city with 6,776,009 inhabitants. RESULTS: The type of AT device provided was significantly dependent (p < 0.001) on the client's diagnosis, impairment, age, and socio-economic strata, whether the client has a care giver, the geographical zone in which the client lives, the year of the AT provision, and the total number of AT delivered. In contrast, the client's gender (p > 0.05) and the client's affiliated type of healthcare service had no effect. In addition to that, the client's age, the client's socio-economic strata, the number of AT devices provided to the client, and the diagnostic type were the factors with the strongest level of association with the type of AT device provided. CONCLUSIONS: Our research showed that the provision of AT in Bogotá D.C. prioritizes both people who are at the highest levels of vulnerability, and as many people as possible with the budget. That is, the low socio-economic strata, younger and older people, and the provision of at least one AT device. IMPLICATIONS FOR REHABILITATION: Provision of AT is intended for equal opportunities for the social participation of people with a disability. Also, people with disabilities have the right to access AT regardless of the type of limitation, gender, race, age or region where they live. Research regarding AT in developing countries is scarce; thus, there is a need to conduct studies in such contexts. This study provides scientific evidence to support the development of models, approaches and strategies of AT provision in low-income countries where resources for rehabilitation are scarce.

Using virtual robot-mediated play activities to assess cognitive skills.

PURPOSE: To evaluate the feasibility of using virtual robot-mediated play activities to assess cognitive skills. METHOD: Children with and without disabilities utilized both a physical robot and a matching virtual robot to perform the same play activities. The activities were designed such that successfully performing them is an indication of understanding of the underlying cognitive skills. RESULTS: Participants' performance with both robots was similar when evaluated by the success rates in each of the activities. Session video analysis encompassing participants' behavioral, interaction and communication aspects revealed differences in sustained attention, visuospatial and temporal perception, and self-regulation, favoring the virtual robot. CONCLUSIONS: The study shows that virtual robots are a viable alternative to the use of physical robots for assessing children's cognitive skills, with the potential of overcoming limitations of physical robots such as cost, reliability and the need for on-site technical support. IMPLICATIONS FOR REHABILITATION: Virtual robots can provide a vehicle for children to demonstrate cognitive understanding. Virtual and physical robots can be used as augmentative manipulation tools allowing children with disabilities to actively participate in play, educational and therapeutic activities. Virtual robots have the potential of overcoming limitations of physical robots such as cost, reliability and the need for on-site technical support.

Bone marrow edema patterns in the ankle and hindfoot: distinguishing MRI features.

OBJECTIVE: Many disorders produce similar or overlapping patterns of bone marrow edema in the ankle. Bone marrow edema may present in a few hindfoot bones simultaneously or in a single bone. The purpose of this pictorial essay is to provide guidelines based on clinical history and specific MRI patterns and locations to accurately identify the cause of ankle bone marrow edema. We will first focus on bone marrow edema in general disease categories involving multiple bones, such as reactive processes, trauma, neuroarthropathy, and arthritides. A discussion of bone marrow edema in individual bones of the ankle and hindfoot including the tibia, fibula, talus, and calcaneus will follow. Helpful hints for arriving at the correct diagnosis will be provided in each section. CONCLUSION: After review of this article, radiologists should be able to use their knowledge of clinical history and specific MRI patterns and locations to accurately distinguish between the various causes of bone marrow edema in the ankle and hindfoot.

Deep brain stimulation of the ventral intermediate nucleus of the thalamus for tremor in patients with multiple sclerosis.

BACKGROUND: Tremor is an important cause of disability in patients with multiple sclerosis (MS). Deep brain stimulation (DBS) in the ventral intermediate nucleus (VIM) of the thalamus is said to be beneficial for MS tremor. OBJECTIVE: To assess the long-term efficacy of VIM DBS for MS disabling tumor. METHODS: We treated 10 patients (4 men and 6 women) with advanced MS-related medication-resistant tremor with DBS at the VIM thalamic nucleus. DBS was unilateral in 9 patients and bilateral in 1 patient in 2 stages. Contralateral arm tremor was assessed with the Fahn-Tolosa-Marin tremor rating scale. RESULTS: At 1 year, 5 of 10 patients (5 of 11 hemispheres) had a reduction in tremor scores with stimulation compared with baseline; in 3 patients, the reduction was > 50%. After 36 months, 3 patients continued benefiting from stimulation, 2 having > 50% improvement. Of the 6 symptomatic sides that did not benefit at 1 year, 3 failed to have even initial benefit, and 3 had a transient improvement lasting < 1 year. One patient stopped using stimulation because of a lack of improvement at 5 months after surgery and was lost to follow-up. CONCLUSION: Approximately one-half of the patients derived some benefit from VIM DBS 1 year after surgery, but this benefit reached a > 50% reduction in only 30% of the patients. This level of improvement may be related to the variability of the demyelinating lesions and the superimposition of ataxia in the MS patients. Developing better treatments for MS tremor continues to be a challenge.