The CAPN3 p.Lys 254del variant is not always associated with dominant CAPN3-related muscular dystrophy.

INTRODUCTION/AIMS: Limb-girdle muscular dystrophy R1 (LGMDR1) calpain 3-related usually presents as a recessively transmitted weakness of proximal limb-girdle muscles due to pathogenic variants in the CAPN3 gene. Pathogenic variants in this gene have also been found in patients with an autosomal dominantly inherited transmission pattern (LGMDD4). The mechanism underlying this difference in transmission patterns has not yet been elucidated. Camptocormia, progressive limb weakness, myalgia, back pain, and increased CK levels are common clinical features associated with dominant forms. The p.Lys254del pathogenic variant was associated with camptocormia in two LGMDD4 families. This study aimed to present carriers found in recessively transmitted LGMDR1 families bearing the p.Lys254del variant that do not show muscle weakness. METHODS: DNA sequencing was performed on exon 5 of CAPN3 in family members to establish the carrier status of the pathogenic variant. They were evaluated clinically and MRI was performed when available. RESULTS: Two families presented with the p.Lys254del pathogenic variant in a homozygous or compound heterozygous state. Family members carrying only the pathogenic variant in the heterozygous state did not demonstrate the myopathic characteristics described in dominant patients. Camptocormia and other severe clinical symptoms were not observed. DISCUSSION: We conclude that the p.Lys254del pathogenic variant per se cannot be solely responsible for camptocormia in dominant patients. Other undisclosed factors may regulate the phenotype associated with the dominant inheritance pattern in CAPN3 pathogenic variant carriers.

Sun-protective Properties of Technical Sportswear Fabrics 100% Polyester: The Influence of Moisture and Sweat on Protection against Different Biological Effects of Ultraviolet (UV) Radiation.

The use of technical sportswear is now widespread, but the degree of protection these fabrics offer against UV radiation is not known. We have analyzed the capacity of different types of technical sportswear fabrics to protect against different UV biological effects. A sample of 34 100% polyester t-shirts from different manufactures was classified by color, fabric structure, cover factor, and due to different tonalities, dark, and clear color. Ultraviolet protection factor was calculated according to UNE-EN13758. The protection factor for other biological effects as pre-vitamin D3 production, non-melanoma skin cancer, photoimmunosuppression, and photoaging was analyzed. The effects of moisture and sweat in protection were also evaluated. From the analyzed sample garments, more than 75% achieved an excellent protection value (protection factor 40-50+). Higher values were found in double-layer type (P < 0.05). Cover factor was the main determinant of biological protection factors with correlation coefficients of 0.81 for UPF (erythema), 0.77 for NMSC, and 0.63 for photoimmunosuppression. Water or sweat humidity saturation increased biological protection factors over a 20% (P < 0.05). The 83% of the fabrics analyzed showed less than 5% of transmittance with labeling as UVA protective elements. No effect of fabric color was found related to biological protection factors. The 100% polyester sports T-shirts of the analyzed sample offer general protection against UV for different biological effects that can be increased by humidity but no affected by fabric color.

Sunscreens effectiveness are not altered by concomitant use of moisturizing creams: An ultraviolet reflectance photography study.

BACKGROUND: Sunscreens are widely used to protect the skin against the harmful effects of solar radiation. It is not known whether solar protection factor of a sunscreen is altered by the concomitant use of other cosmetic products. OBJECTIVES: The aim of this study was to analyze changes in the protective effect of different commercial and ISO standards sunscreens with high SPF applied shortly before and after application of non-sunscreens galenic formulas type moisturizing creams. METHODS: ISO 24444:2019 standard sunscreens, which claimed SPF 16 and 63, as well as 4 different claimed SPF 50 and 50+ commercial sunscreens were prepared and applied in different sequential order to the back of 25 volunteers and compared with different commercial moisturizing formulas. Ultraviolet (UV) reflectance photography followed by image analysis was used to compare untreated skin and skin treated with moisturizing creams alone and combined with sunscreens. RESULTS: The UV reflectance analysis showed no significant changes of the skin color reflectance treated with moisturizing cream compared with untreated skin. Application of the sunscreen formulations were associated with a 35% - 70% decrease in color related to the in vivo expected SPF, indicating significant UV absorption for all sunscreen formulas. All standard and commercial sunscreens showed no significant differences in UV reflection color level when combined with the different moisturizing creams applied before or after the sunscreen. CONCLUSIONS: Effectiveness of low- and high-protection sunscreens were not altered by the concomitant use of a moisturizing creams applied shortly before and after the sunscreens.

Water-Filtered Infrared Radiation Decreases the Generation of Photodermatoses Dependent on Ultraviolet and Visible Radiation.

The potential role of infrared radiation in photodermatoses has received very little attention, even though the main sources of radiation used for photobiological studies (UVA, UVB and visible light) include infrared radiation. The objective of the work was to assess whether infrared radiation is involved in the development of skin lesions in patients with different types of photodermatoses. Twenty patients with different photodermatoses were exposed to UVA, UVB and visible radiation using a high-pressure mercury UVA lamp, a fluorescent broadband UVB lamp, a tungsten bulb and a slide projector for visible radiation. Part of the radiation emitted by these lamps was water-filtered to block infrared radiation above 1300 nm. All 20 patients developed lesions when exposed to different light sources used for phototest. When exposed to same sources without infrared radiation, 17 patients (85%) did not develop any lesions and the other three (15%) developed less severe lesions than in the area exposed to unfiltered light. Our results show that infrared radiation was necessary for the development of skin lesions in 85% of the patients with photodermatoses in our study. We believe that infrared radiation studies should be included in standard photobiology protocols.

Infrared radiation increases skin damage induced by other wavelengths in solar urticaria.

BACKGROUND: Photodermatoses are typically investigated by analyzing the individual or combined effects of ultraviolet A (UVA), ultraviolet B (UVB), and visible light using light sources that simulate portions of the solar spectrum. Infrared radiation (IRR), however, accounts for 53% of incident solar radiation, but its effects are not taken into account in standard phototest protocols. AIMS: The aim was to analyze the effects of IRR, alone and combined with UVA and visible light on solar urticaria lesions, with a distinction between infrared A (IRA) and infrared B (IRB). METHODS: We performed standard phototests with UVA and visible light in four patients with solar urticaria and also tested the effects after blocking IRB with a water filter. To analyze the direct effect of IRR, we performed phototests with IRA and IRB. RESULTS: Initial standard phototests that were all positive found the induction of erythema and whealing, while when IRR was blocked from the UVA and visible light sources, three of the patients developed no lesions, while the fourth developed a very small wheal. CONCLUSION: These results suggest that IRR has the potential to produce and exacerbate lesions caused by other types of radiation. Consideration of these effects during phototesting could help prevent diagnostic errors.

Human Hair as a Natural Sun Protection Agent: A Quantitative Study.

The rising incidence of skin cancers attributable to excessive sun exposure has become a major health concern worldwide. While numerous studies have analyzed the sun protective effect of sunscreens, clothing and antioxidants, none to date have measured the photoprotective effect of hair, despite clinical evidence that individuals with balding or thinning hair are at greater risk of skin lesions that can progress to cancer, hence the recommendation to use hats or umbrellas. We analyzed the level of protection offered by hair according to hair density, thickness and color using the spectral transmittance and corrected for relative erythema effectiveness. Our results show that hair provides a barrier against both UVB and UVA radiation which is significantly increased with respect to the hair density, thickness and the presence of melanins. This is the first study to quantify sun protection factor offered by hair, namely hair ultraviolet protection factor (HUPF). We believe that hair should be recognized as an important natural sun barrier in the prevention of UV-induced skin cancers.

Chemometric analysis for the evaluation of phenolic patterns in olive leaves from six cultivars at different growth stages.

Leaves from six important olive cultivars grown under the same agronomic conditions were collected at four different times from June to December and analyzed by high performance liquid chromatography-diode array detector-time-of-flight-mass spectrometry (HPLC-DAD-TOF-MS). Twenty-eight phenolic compounds were identified and quantified. No qualitative differences were detected among leaves. However, for all cultivars, total concentrations of phenolic compounds decreased from June to August, then increased from October on, and reached higher levels again in December. Principal component analysis provided a clear separation of the phenolic content in leaves for different sampling times and cultivars. Hence, the availability of phenolic compounds depends on both the season and the cultivar. June and December seem to be good times to collect leaves as a source of phenolic compounds. December coincides with the harvest period of olives in the Andalusian region. Thus, in December olive leaves could be valorized efficiently as olive byproducts.

CD4+CD45RO+CD25-/lowCD127+: CD4+CD45RO+CD25hiCD127-/low Ratio in Peripheral Blood: A Useful Biomarker to Detect Cardiac Allograft Vasculopathy in Heart Transplanted Patients.

BACKGROUND: Cardiac allograft vasculopathy (CAV) is a major limitation in long-term graft survival after heart transplantation (HTx). Its prediction and detection at an early stage is a challenge because an accurate, minimally invasive blood test is lacking. The aim of this study was to analyze the relationship of Tact (CD4CD45ROCD25-CD127) cells, Th1 cells, and thymus-derived regulatory (Treg) (CD4CD45ROCD25CD127) cells in peripheral blood with the development of CAV in HTx patients. METHODS: First, we performed a cross-sectional study in 29 patients at least 2 years after HTx, 17 with CAV and 12 without CAV. We then prospectively followed a group of 38 patients for 2 years immediately after HTx surgery. In both groups, we analyzed the relationship between CAV and the effector-to-regulatory T cell ratio. RESULTS: In the cross-sectional study, patients with CAV showed statistically significant higher values of Th1-to-FoxP3Treg and Tact-to-CD127Treg ratios than non-CAV patients, with P less than 0.01 and P less than 0.001, respectively. Receiver operating characteristic curve analysis showed that the Tact:CD127Treg ratio was a potential biomarker of CAV, clearly discriminating CAV and non-CAV patients (area under curve [AUC] = 0.955; P = 0.001). In the prospective part of the study, we monitored the Th1:FoxP3Treg and Tact:CD127Treg ratios using the best tradeoff between anterior receiver operating characteristic sensitivity and specificity as a cutoff. Changes in the Tact:CD127Treg ratio were detected earlier than changes in the Th1:FoxP3Treg ratio. Both ratios were higher in HTx patients with CAV. CONCLUSION: The Tact-to-Treg ratio is a valuable follow-up marker to detect HTx patients at risk of developing CAV.

New advances in protection against solar ultraviolet radiation in textiles for summer clothing.

Clothing is considered one of the most important tools for photoprotection against harmful solar ultraviolet radiation (UVR). The standard for sun-protective clothing is based on erythema despite other biological effects of UVR on the skin. We analyzed the potential protection against UVR in fabrics destined for summer clothing based on several action spectra. We examined 50 garments classified by type of fabric composition, structure of the fiber yarn and color. The ultraviolet protection factor was calculated based on fabric ultraviolet transmittance corrected for erythema according to the EU standard E-13758 as well as the UVA transmittance of fabrics. UVR protection was also analyzed in base of different action spectra as for previtamin D3, nonmelanoma skin cancer, photoimmunosuppression and photoaging. Most knitted fabrics used for sports T-shirts offered excellent ratings for ultraviolet protection while normal shirts showed very low ratings, particularly against photoaging. The cover is the most influential variable in fabric photoprotection, having an exponential relationship with the UPF. The relation between cover and UVA protection was linearly negative. Information about ultraviolet protection in textiles used for summer clothing should be included in labeling as some types of fabrics, especially those used for shirts, offer very low UVR protection.

Efficiency of a solid-phase chemiluminescence immunoassay for detection of antinuclear and cytoplasmic autoantibodies compared with gold standard immunoprecipitation.

PURPOSE: The aim of this study was to compare the degree of agreement of a novel Zenit RA chemiluminescent immunoassay (CLIA) from A. Menarini Diagnostics (Florence, Italy) and the gold standard immunoprecipitation assay to screen for the presence of specific anti-U1snRNP, anti-Sm, anti-Ro/SS-A, anti-La/SS-B, anti-Jo-1((his)tRNA-Synthetase) and anti-Scl-70(Topo I) antibodies. MATERIALS AND METHODS: We studied 114 sera, 98 from patients with well-defined autoimmune connective tissue diseases and 16 from blood donor volunteers. All samples were fully characterized using the new chemiluminescent immunoassay and immunoprecipitation. In addition, all the samples were analyzed by indirect immunofluorescence (IIF) and anti-Scl-70(Topo I) antibodies were analyzed by immunoblot (IB) assay. Discrepant samples were analyzed using a commercial dot blot technique (Recomline from Mikrogen). The simple Kappa coefficient was used to measure the level of agreement between the results of Zenit RA CLIA and the gold standard. RESULTS: The Kappa agreement between Zenit RA CLIA and gold standard immunoprecipitation, as well as IB and IIFassays for the presence of anti-Scl-70(Topo I)(0.948) was excellent. The concordance between Zenit RA CLIA and gold standard immunoprecipitation for the presence of anti-U1snRNP (0.883), anti-Ro/SS-A (0.878), anti-Jo-1((his)tRNA-Synthetase) (0.791) and anti-Sm (0.786) was good, and excellent when the cut-off was raised to 14 U/ml (arbitrary units/ml). Between Zenit RA CLIA and gold standard immunoprecipitation for the presence of anti-La/SS-B, the Kappa agreement had a value of 0.689, but this improved to 0.775 when the cut-off was raised to14 U/ml. Precision was good based on the evaluation of replicate samples. Inter-assay coefficient variation was lower than 3.4 % (CV in %) in all the kits and <1.2 % (CV in  %) for intra-assay measurements. CONCLUSION: Our findings show that Zenit RA CLIA was specific and sensitive to detect anti-U1snRNP, anti-Sm, anti-Ro/SS-A, anti-La/SS-B, anti-Jo-1((his)tRNA-Synthetase) and anti-Scl70(Topo I) autoantibodies. This simple, fast and precise method can be a suitable option to analyze these autoantibody specificities.

Percepción de riesgo en alumnos de Enfermería / Risk perception in nursing students

El objetivo de este estudio, es analizar la producción científica que existe sobre la relación entre la percepción de riesgo y los accidentes en la práctica clínica en alumnos/as de Enfermería. Se realizó una búsqueda sistemática en las bases de datos MEDLINE y CUIDEN, así como en el fondo documental del Instituto Nacional de Seguridad e Higiene en el Trabajo, recopilando publicaciones comprendidas entre 1992 y 2010. Se analizaron un total de 89 artículos. Entre los campos temáticos emergentes se encuentran: entorno laboral, medidas preventivas, factores psicosociales. Se llega a la conclusión de que existe una carencia de estudios que demuestren de forma explícita el papel que la percepción de riesgo juega en el riesgo real al que los alumnos de enfermería se ven expuestos, por lo que se plantea la necesidad de investigar en esta línea, para así poder mejorar la seguridad de los alumnos de enfermería (AU)

The objective of this study is to analyze the scientific production that exists about the relationship between the risk perception and the accidents during the clinical practice in nursing students. A systematic search was carried out in the data bases MEDLINE and CUIDEN, and also in the documentary heritage of the National Institute of Safety and Hygiene at Work, gathering publications from 1992 to 2010. A total of 89 articles were analyzed. Among the resulting thematic fields are: work setting, step measurements, psychosocial factors. As a conclusion, a lack of studies which prove in an explicit way the role that the real risk perception that the nursing students are exposed to exists. So, the necessity to go on in this line is set out, in order to improve the safety of nursing students (AU)

Analysis of electrical thresholds and maximum comfortable levels in cochlear implant patients.

OBJECTIVE: It is well known that a proper fitting of the cochlear implant processor is relevant to provide good quality in speech perception. The aim of this study is to extract statistical information to be applied for fitting the processor. METHODS: This study is based on the programming maps of 121 patients, aged from 18 months to 68 years at the moment of implantation. All subjects were implanted with the COMBI 40+ cochlear implant at San Cecilio University Hospital, Granada (Spain). The patients were classified into groups based on their age at implantation: younger than 5 years, between 5 and 16 years, and older than 16 years. The patients in each age-based group were divided into two subgroups, considering whether they had recent hearing experience or not. A special group including patients affected by severe damages in the cochlea was also defined. RESULTS: Relationships between the programming parameters and factors like the age at implantation, the hearing experience and the presence of severe cochlear damage were found. The THR levels for patients younger than 5 years were significantly lower than those for patients implanted between 5 and 16 years, and this group presented significantly lower THR levels than adults. The MCL levels were not significantly influenced by the age at implantation. A significant increment was observed for both, MCL and THR levels, when patients were affected by severe cochlear damage. A significant increment in the THR levels were observed for patients with no recent hearing experience, while no significant differences were found for MCL levels. This study also analyzes the distribution along the cochlea of the stimulation levels. In the case of patients not affected by severe cochlear damage, the most basal electrodes presented a significant increment in the stimulation levels with respect to the rest of electrodes. CONCLUSION: This work provides information of great value for programming the speech processors, particularly when the subjective responses of the patients are not sufficient. The application in our ENT Service has reduced substantially the average time needed to obtain an acceptable fitting of the processor, especially in children. Our study also shows that electrical thresholds are a good indicator of the functionality of the auditory nerve. The analysis of this parameter highlights the importance of an early intervention as well as a deep insertion of the electrode carrier in order to obtain the maximum functionality from the cochlear implant.

Identification of active compounds in vegetal extracts based on correlation between activity and HPLC-MS data.

We propose a method identifying candidates for active compounds in vegetal extracts. From a collection of samples, the method requires, for each sample, a HPLC-MS analysis and a measurement of the activity. By applying a correlation analysis between the activity and the chromatographic area for each interval of elution time and m/z ratio, the peaks corresponding to candidates for active compounds can be identified. Additionally, when peaks are identified, a model can be estimated to predict the activity in new samples. Both methods are evaluated in one experiment involving the phenolic extract (PE) from 22 samples of extra virgin olive oil (EVOO) where the activity is a cytotoxicity index against JIMT-1 breast cancer cells. In this experiment, the samples were separated into two disjunct partitions: one was used for training (identification of candidates and estimation of prediction model), while the other was used for validation (by comparing the predicted and the measured activities). Three compounds were identified as candidates to be responsible for the cytotoxicity of the EVOO-PE against JIMT-1 cells. The prediction model provided an accurate estimation of the activity.

Long-term evolution of the electrical stimulation levels for cochlear implant patients.

OBJECTIVES: The stimulation levels programmed in cochlear implant systems are affected by an evolution since the first switch-on of the processor. This study was designed to evaluate the changes in stimulation levels over time and the relationship between post-implantation physiological changes and with the hearing experience provided by the continuous use of the cochlear implant. METHODS: Sixty-two patients, ranging in age from 4 to 68 years at the moment of implantation participated in this study. All subjects were implanted with the 12 channels COMBI 40+ cochlear implant at San Cecilio University Hospital, Granada, Spain. Hearing loss etiology and progression characteristics varied across subjects. RESULTS: The analyzed programming maps show that the stimulation levels suffer a fast evolution during the first weeks after the first switch-on of the processor. Then, the evolution becomes slower and the programming parameters tend to be stable at about 6 months after the first switch-on. The evolution of the stimulation levels implies an increment of the electrical dynamic range, which is increased from 15.4 to 20.7 dB and improves the intensity resolution. A significant increment of the sensitivity to acoustic stimuli is also observed. For some patients, we have also observed transitory changes in the electrode impedances associated to secretory otitis media, which cause important changes in the programming maps. CONCLUSION: We have studied the long-term evolution of the stimulation levels in cochlear implant patients. Our results show the importance of systematic measurements of the electrode impedances before the revision of the programming map. This report also highlights that the evolution of the programming maps is an important factor to be considered in order to determine an adequate calendar fitting of the cochlear implant processor.

Interaction of cerebrovascular disease and contralateral carotid occlusion in prediction of shunt insertion during carotid endarterectomy.

INTRODUCTION: To assess the possible role and the interaction of cerebrovascular disease and vascular stenosis on the necessity of shunt insertion during carotid endarterectomy (CEA). MATERIAL AND METHODS: Eighty consecutive patients undergoing CEA under regional anaesthesia were prospectively enrolled. Patients were divided into two groups depending on whether they were shunted or not. The measured end-points were co-morbidities degree of contralateral and carotid stenosis and other intra- and postoperative outstanding parameters. ANOVA, Student's t and χ(2) tests were used (p<0.05). Variables differing significantly between groups and potential confounders were used in backward stepwise logistic regression to estimate the relative risk (RR, 95% CI) of shunt. In addition Wald's test (p<0.05) with and without adjustments for potential confounders was used with various different multivariate analysis models. RESULTS: Contralateral stenosis and cerebral vascular accidents (CVA) were more frequently observed in shunted patients. The RR for patients with contralateral stenosis ≥ 50% was 1.3 (95% CI 1.0-1.5) and for patients with previous CVA was 1.2 (95% CI 1.0-1.4). For contralateral stenosis and CVA together the RR increased to 7.7 (95% CI 1.0-14.4). A model based on contralateral stenosis and CVA was found to be statistically significant (p=0.003) for shunt (RR=1.1, 95% CI 1.0-2.1). Relative excess risk due to interaction of both factors was 6.2. CONCLUSIONS: The findings suggest that patients with contralateral stenosis ≥ 50% and previous CVA have a higher risk of requiring shunt use during CEA than patients with these risk factors separately.

A systematic study of the polyphenolic composition of aqueous extracts deriving from several Cistus genus species: evolutionary relationship.

INTRODUCTION: Cistaceae is a large family of shrubs widely spread over the Mediterranean area. It includes Helianthemum, Halimium and Cistus genus. Cistus genus contains approximately 20 species distributed in three subgenus. The essential oil of Cistus species has been thoroughly studied, but the polyphenolic composition of the aerial parts of the different Cistus species needs further characterisation. OBJECTIVE: To perform a comparative analysis of the qualitative and quantitative polyphenolic composition of the aerial parts of the most commonly distributed Spanish Cistus species in order to find a relationship between chemotype and subgenus. METHODOLOGY: Thirteen aqueous extracts derived from 10 different Cistus species were analysed by using HPLC with diode array-detection coupled to electrospray ion trap mass spectrometry technique (HPLC-DAD-ESI-MS/MS). Their major compounds were identified and ellagitannins were quantified. Principal component analysis (PCA) was performed on the most relevant compounds to find out the statistical association between chemotype and variety. RESULTS: Three main groups of compounds were found, i.e. ellagitannins, flavonoids and phenolic acids derivatives. The polyphenolic profile was specific for each species, although the abundance of some compounds also varied depending on the soil type. Whereas C. ladanifer, C. salviifolius, C. populifolius and C. libanotis were specially rich in ellagitannins, C. clusii, C. laurifolius and C. monspeliensis contained significant amounts of flavonoids and much less ellagitannins. In contrast, C. crispus, C. incanus and C. albidus showed a polyphenolic profile mostly based on flavonoids. PCA analysis showed a strong relationship between Cistus subgenus and its chemotype based on the most relevant water-soluble polyphenolic compounds. CONCLUSIONS: Chemical composition of the leaves' aqueous extracts from plants belonging to the Cistus genus is strongly related to their subgenus, in agreement to previous taxonomical and phylogenetic divisions. In contrast, soil and climate are less influencing factors. Leucocistus and Halimioides subgenus showed a higher content in ellagitannins. However, Cistus subgenus had higher flavonoid content.

Using evoked compound action potentials to assess activation of electrodes and predict C-levels in the Tempo+ cochlear implant speech processor.

OBJECTIVE: In this study, we analyze how electrically evoked compound action potential (ECAP) responses can be used to assess whether electrodes should be activated in the map and to estimate C levels in the Med-El Tempo+ Cochlear Implant Speech Processor. DESIGN: ECAP thresholds were measured using the ECAP Recording System of the Pulsar CI implant. Twenty-one postlingually and 28 prelingually deafened patients participated in this study. The relationship between ECAP responses and the activation of electrodes was analyzed. Because an error in the estimation of T levels (behavioral thresholds) has less effect on hearing quality than an error in the estimation of C levels in the Tempo+ cochlear implant speech processor (maximum comfort levels), correlation and regression analyses were performed between ECAP thresholds and C levels. RESULTS: The observation of an evoked potential generally implied that the electrode was activated because only 3.5% of electrodes that yielded measurable evoked responses were deactivated, because of collateral stimulations or an unpleasant hearing sensation. In contrast, the absence of an evoked potential did not imply that an electrode should be deactivated, because 20% of these electrodes provided a useful auditory sensation. ECAP responses did not predict the absolute behavioral comfort levels because of the excessive error between behavioral C levels and those derived from ECAP thresholds (the mean relative error is 43.78%). However, by applying a normalization procedure, ECAP measurements allowed the C-level profile to be predicted with a mean relative error of 6%; that is, they provided useful data to determine the C level of each electrode relative to the average C level of the patient. CONCLUSIONS: ECAP is a reliable and an useful objective measurement that can assist in the fitting of the Tempo+ cochlear implant speech processor. From results presented in this work, a protocol is proposed for fitting this cochlear implant system. This protocol facilitates appropriate cochlear implant fitting, particularly for children or uncooperative patients.

Bispectral index variations in patients with neurological deficits during awake carotid endarterectomy.

BACKGROUND AND OBJECTIVE: The bispectral index (BIS) is derived from the EEG and therefore may be useful to diagnose intraoperative cerebral ischaemia. This study was undertaken to investigate BIS changes in awake patients with and without neurological deficits during carotid endarterectomy under regional anaesthesia. METHODS: Seventy consecutive carotid endarterectomies under regional anaesthesia were divided into two surgical groups: patients with and patients without neurological deficits. Patients' neurological status was evaluated and neurological deficits were compared with BIS values. Measurements were made at different surgical stages: baseline, after sedation, at the beginning of surgery, at preclamping, at the 3 min clamping test, during shunt insertion, at declamping, 15 min after declamping and at the end of surgery. We performed intergroup and intragroup comparisons of BIS values. A decrease in BIS of at least 10 associated with neurological deficits was taken as the cut-off point for the classification of patients with logistic regression models (crude and adjusted for potential confounders). RESULTS: Thirteen patients (18.6% of the total) developed clinical cerebral ischaemia, though BIS values decreased in 10 of these patients (76.9%). The mean BIS values were 92.5+/-5.6 and 84.7+/-12.3 for patients without and with neurological deficits, respectively (P value<0.05). The odds ratios of a BIS decrease associated with neurological deficits were 8.5 (95% confidence interval 2.1-35.1) and 5.4 (95% confidence interval 1.2-24.3) adjusted for contralateral stenosis. CONCLUSION: Our results describe a relationship between BIS reductions and neurological deficits during carotid surgery in awake patients.