Efficient Cardiovascular Parameters Estimation for Fluid-Structure Simulations Using Gappy Proper Orthogonal Decomposition.

As full-scale detailed hemodynamic simulations of the entire vasculature are not feasible, numerical analysis should be focused on specific regions of the cardiovascular system, which requires the identification of lumped parameters to represent the patient behavior outside the simulated computational domain. We present a novel technique for estimating cardiovascular model parameters using gappy Proper Orthogonal Decomposition (g-POD). A POD basis is constructed with FSI simulations for different values of the lumped model parameters, and a linear operator is applied to retain information that can be compared to the available patient measurements. Then, the POD coefficients of the reconstructed solution are computed either by projecting patient measurements or by solving a minimization problem with constraints. The POD reconstruction is then used to estimate the model parameters. In the first test case, the parameter values of a 3-element Windkessel model are approximated using artificial patient measurements, obtaining a relative error of less than 4.2%. In the second case, 4 sets of 3-element Windkessel are approximated in a patient's aorta geometry, resulting in an error of less than 8% for the flow and less than 5% for the pressure. The method shows accurate results even with noisy patient data. It automatically calculates the delay between measurements and simulations and has flexibility in the types of patient measurements that can handle (at specific points, spatial or time averaged). The method is easy to implement and can be used in simulations performed in general-purpose FSI software.

A decade of diversity: using statistical indices to compare neurosurgery to other surgical specialties.

OBJECTIVE: Studies have demonstrated the benefits of diversity in neurosurgery. However, recruitment of minoritized groups within the neurosurgical workforce consistently lags other surgical specialties. While racial and gender demographics of neurosurgical residents are well documented, there has been minimal exploration into the multidimensional nature of diversity. The current study will evaluate the longitudinal diversity changes in neurosurgery residency programs compared with other surgical fields with validated diversity indices. METHODS: Nationwide reports including data about resident physicians were obtained from the American Medical Association and the Association of American Medical Colleges for the academic years 2008-2021. Self-reported race, biological sex, and medical school affiliation were recorded for surgical residents in the 10 commonly recognized surgical fields. The Gini-Simpson Diversity Index was used to calculate the effective counts (ECs) of races, sexes, and medical school types for each field. A Composite Diversity Index (CDI) comprising the aforementioned diversity traits was used to calculate the percentage of characteristics upon which two randomly selected residents within each specialty would differ. CDIs were calculated for each field in every year from 2008 to 2021. Median CDIs were compared between fields using Kruskal-Wallis testing, and p values < 0.05 were deemed statistically significant. RESULTS: Plastic surgery had the highest median sex EC (1.92, interquartile range [IQR] 1.78-1.95), indicating greater diversity, while neurosurgery had the third lowest sex EC (1.40, IQR 1.35-1.41). All surgical fields examined had fewer than 3 races effectively represented among their residents, despite there being 8 races present. Neurosurgery ranked among the top fields in effective racial diversity (EC 2.17, IQR 2.09-2.21) and medical school type diversity (EC 1.25, IQR 1.21-1.26). There were statistically significant differences in the sex, race, and school ECs between surgical specialties. While neurosurgery had a relatively low median overall diversity (CDI = 32.7, IQR 32.0-34.6), there was a consistent longitudinal increase in CDI from 2015 to 2021. CONCLUSIONS: Neurosurgery resident physicians have become increasingly diverse in the past decade but are more homogenous than residents in other surgical fields. The continued use of diversity indices to more accurately track diversity progress over time may better inform leaders in the field of how they may best focus their equity and inclusion efforts.

The epidemiology of crib-related head injuries: A ten-year nationwide analysis.

INTRODUCTION: Falls from cribs resulting in head injury are understudied and poorly characterized. The purpose of this study was to advance current understanding of the prevalence, descriptive characteristics of injury victims, and the types of crib fall-related head injuries (CFHI) using queried patient cases from the National Electronic Injury Surveillance System (NEISS) database. METHODS: Using the US Consumer Product Safety Commission's System NEISS database, we queried all CFHIs among children from over 100 emergency departments (EDs). Patient information regarding age, race, sex, location of the incident, diagnoses, ED disposition, and sequelae were analyzed. The number of CFHI from all US EDs during each year was also collected from the database. RESULTS: There were an estimated 54,799 (95% CI: 30,228-79,369) total visits to EDs for CFHIs between 2012 and 2021, with a decrease in incidence of approximately 20% during the onset of the COVID-19 pandemic (2019: 5616 cases, 2020: 4459 cases). The annual incidence of injuries showed no significant trend over the 10-year study period. An available subset of 1782 cases of head injuries from approximately 100 EDs was analyzed, and 1442 cases were included in final analysis. Injuries were sorted into three primary categories: unspecified closed head injury (e.g., closed head injury, blunt head trauma, or traumatic brain injury), concussion, or open head injury and skull fracture. Unspecified closed head injuries were the most common of all head injuries (95.4%, 1376/1442). Open head injuries (14/1442, 0.97%) and concussions 3.6% (52/1442, 3.6%) were rare. Most injuries involved children under the age of 1 (42.6%) compared to children who were 1, 2, 3, or 4-years old. About a fourth of patients had other diagnoses in addition to their primary injury including scalp/forehead hematomas, emesis, and contusions. Female patients were more likely to present with other diagnoses in addition to their primary head injury (Difference: 12.3%, 95% CI: 9.87%-15.4%, p < .0001). CONCLUSION: Despite minimum rail height requirements set by the Consumer Safety Product Commission (CPSC), head injuries associated with crib falls are prevalent in the United States. However, most injuries were minor with a vast majority of patients being released following examination and treatment.

Trap-nesting biology of an ectoparasitoid spider wasp, Auplopus subaurarius (Hymenoptera: Pompilidae): the importance of wooded environments for niche generalist species.

The insect group is one of the most diverse on the planet and due to habitat degradation, many of these species are becoming extinct, leaving a lack of information on the basic biology of each one. In this study, previously unseen information about nesting biology is revealed in Auplopus subaurarius trap nests. This is a solitary ectoparasitoid spider wasp that nests in preexisting cavities. We used a trap-nesting methodology to sample A. subaurarius in two different sampling periods (2017/2018 and 2020/2021) in three types of environment (forest, grassland and Eucalyptus plantation). In our study, the A. subaurarius nest building was more frequent during the hottest months of the year (November to March), with its highest abundance found within natural forest areas and in Eucalyptus plantation than in grassland areas. In addition, the species had two development times: a short one (three months) and a delayed one (up to one year). Moreover, females were larger than males (weight and size) and the species' sex ratio had a tendency toward female production. Auplopus subaurarius presented seven natural enemy species: Ceyxia longispina, Caenochrysis crotonis, Photochryptus sp.1, Photochryptus sp.2, Messatoporus sp., Ephuta icema and Sphaeropthalma sp. We emphasize the importance of wooded environments to maintain the A. subaurarius populations and their associated interactors, both spiders and natural enemies, as these environments can provide better life conditions than grassland areas. Furthermore, other solitary wasps that may have the same lifestyle of A. subaurarius can also be improved by natural forest conservation and by good silviculture plantation planning, which should consider ecological aspects of Atlantic Forest landscapes.

Pediatric all-terrain vehicle (ATV) related head injury rates and patterns: A 10-year nationwide analysis.

INTRODUCTION: The use of all-terrain vehicles (ATVs) carries significant risk of permanent injury and death, disproportionately affecting children. These injuries commonly affect the head and are especially severe among children as they are often unhelmeted and more likely than adults to experience rollover injuries. Many studies examining patients with ATV-related injuries are single-center cohort studies, with few focusing specifically on head injuries. In the present study, we aimed to characterize the annual incidence of ATV-related head injuries between 2012 and 2021, classify and compare head injury types, and identify descriptive characteristics of ATV-related head injury victims. METHODS: Using the US Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) database, we queried all head injuries associated with operating or riding an ATV in children under 18 years-old from over 100 emergency departments (EDs). Patient information regarding age, race, sex, location of incident, diagnoses, and sequelae were analyzed. We also collected the estimated number of ATV-related head injuries from all US EDs using the NEISS algorithm provided by the database. RESULTS: Using the NEISS algorithm we identified 67,957 (95% CI: 43,608 - 92,305) total pediatric ATV-related head injuries between 2012 and 2021. The annual incidence of ATV-related head injury was similar throughout this study period except for a 20% increase during the COVID-19 pandemic period of 2019-2021 (2019: 6382 injuries, 2020: 6757 injuries, 2021: 7600 injuries). A subset of 1890 cases from approximately 100 EDs were then analyzed. Unspecified closed head injuries were the prevailing type of injury (38%, 900/1890), followed by concussions (27%, 510/1890). More severe injuries included intracranial hemorrhages in 91 children (3.8%, 91/1890). Injuries of all types were predominantly seen in 14-17 year-old's (780/1890, 41%) and in males (64.1%, 1211/1890). In addition, ATV-associated injuries were significantly more common in those coded as white (58.0%, 1096/1890) than any other racial group. ATV-associated accidents among children younger than 9 more commonly occurred at the home compared to accidents involving children older than 9 (57% vs. 32%, p < 0.0001). CONCLUSION: ATV-related head injuries cause a significant annual burden among children, with growing incidence in recent years. Further research may wish to explore potential benefits of helmet use and supervision of younger children in possible prevention of these accidents and their associated economic and non-economic costs.

The burden of unhelmeted motorcycle injury: A nationwide scoring-based analysis of helmet safety legislation.

INTRODUCTION: Motorcycle collisions comprise a large portion of motor vehicle injuries and fatalities with over 80,000 injuries and 5,500 fatalities per year in the United States. Unhelmeted riders have poor medical outcomes and generate billions in costs. Despite helmet use having been shown to lower the risk of neurological injury and death, helmet compliance is not universal, and legislation concerning helmet use also varies widely across the United States. METHODS: In this study, we systematically reviewed helmet-related statutes from all US jurisdictions. We evaluated the stringency of these statutes using a legislative scoring system termed the Helmet Safety Score (HSS) ranging from 0-7 points, with higher scores denoting more stringent statutes. Regression modeling was used to predict unhelmeted mortality using our safety scores. RESULTS: The mean score across all jurisdictions was 4.73. We found jurisdictions with higher HSS's generally had lower percentages of unhelmeted fatalities in terms of total fatalities as well as per 100,000 people and 100,000 registered motorcycles. In contrast, some lower-scoring jurisdictions had over 100 times more unhelmeted fatalities than higher-scoring jurisdictions. Our HSS significantly predicted unhelmeted motorcycle fatalities per 100,000 people (ß = -0.228 per 1-point increase, 95% CI: -0.288 to -0.169, p < .0001) and per 100,000 registered motorcycles (ß = -6.17 per 1-point increase, 95% CI: -8.37 to -3.98, p < .0001) in each state. Aspects of our score concerning helmet exemptions for riders and motorcycle-type vehicles independently predicted higher fatalities (p < .0001). Higher safety scores predicted lower unhelmeted fatalities. CONCLUSION: Stringent helmet laws may be an effective mechanism for decreasing unhelmeted mortality. Therefore, universal helmet laws may be one such mechanism to decrease motorcycle-related neurological injury and fatality burden. In states with existing helmet laws, elimination of exemptions for certain riders and motorcycle-type vehicles may also decrease fatalities.

Evidence of Linear Bone Flap Resorption in Patients Undergoing Autologous Cranioplasty Following Decompressive Craniectomy: A 3D Slicer Segmented Analysis of Serial Computed Tomography Images.

OBJECTIVE: Autologous cranioplasty (CP) following decompressive craniectomy (DC) carries a risk of bone flap resorption (BFR). The current literature offers limited information regarding the natural progression of BFR and the rate at which it occurs. We aim to characterize the progression of BFR over time and elucidate risk factors for accelerated BFR. METHODS: A retrospective analysis was conducted on patients who underwent DC and autologous CP. Serial computed tomography (CT) images were used to quantify the degree of BFR over time. Risk factors included age, diabetes, smoking status, flap fragmentation, defect size, and DC-CP time interval. χ2 analyses and Student's t-tests were performed to examine differences between patients who experienced BFR and those who did not. RESULTS: Overall, 82% of patients demonstrated evidence of clinically relevant resorption on CT. On average, the bone flap decreased in volume by 36.7% within the first year, with a linear loss in volume after multiple years of follow-up. Individuals who developed greater BFR were significantly younger (43 ± 17 vs. 56 ± 12, P = 0.022), had a lower incidence of diabetes (5.9% vs. 43%, P = 0.037), and had more bone flap fragments (1.4 ± 0.67 vs. 1.00 ± 0, P < 0.001) than those who did not. CONCLUSIONS: Resorption following CP with cryopreserved bone appears to progress in a fairly linear and continuous fashion over time. Using serial CT images, we found a resorption rate of 82% at our institution. We identified several possible risk factors for resorption, including flap fragmentation, younger age, and absence of diabetes.

Cognitive profile following COVID-19 infection: Clinical predictors leading to neuropsychological impairment.

BACKGROUND: Cognitive manifestations associated with the severity of a novel coronavirus (COVID-19) infection are unknown. An early detection of neuropsychological manifestations could modify the risk of subsequent irreversible impairment and further neurocognitive decline. METHODS: In our single-center cohort study, we included all consecutive adult patients, aged between 20 and 60 years old with confirmed COVID-19 infection. Neuropsychological assessment was performed by the same trained neuropsychologist from April, 22nd through June 16th, 2020. Patients with previous known cognitive impairment, any central nervous system or psychiatric disease were excluded. Demographic, clinical, pharmacological and laboratory data were extracted from medical records. RESULTS: Thirty-five patients met inclusion criteria and were included in the study. Patients presenting headache, anosmia, dysgeusia, diarrhea and those who required oxygen therapy had lower scores in memory, attention and executive function subtests as compared to asymptomatic patients. Patients with headache and clinical hypoxia scored lower in the global Cognitive Index (P â€‹= â€‹0.002, P â€‹= â€‹0.010). A T score lower than 30 was observed in memory domains, attention and semantic fluency (2 [5.7%]) in working memory and mental flexibility (3 [8.6%]) and in phonetic fluency (4 [11.4%]). Higher scores in anxiety and depression (P â€‹= â€‹0.047, P â€‹= â€‹0.008) were found in patients with cognitive complaints. CONCLUSIONS: In our cohort of COVID-19 patients neurologic manifestations were frequent, including cognitive impairment. Neurological symptoms during infection, diarrhea and oxygen therapy were risk factors for neurocognitive impairment. Cognitive complaints were associated with anxiety and depression.

Nitric oxide modulates ATP-evoked currents in mouse Leydig cells.

Testosterone synthesis within Leydig cells is a calcium-dependent process. Intracellular calcium levels are regulated by different processes including ATP-activated P2X purinergic receptors, T-type Ca2+ channels modulated by the luteinizing hormone, and intracellular calcium storages recruited by a calcium-induced calcium release mechanism. On the other hand, nitric oxide (NO) is reported to have an inhibitory role in testosterone production. Based on these observations, we investigated the interaction between the purinergic and nitrergic systems in Leydig cells of adult mice. For this purpose, we recorded ATP-evoked currents in isolated Leydig cells using the whole cell patch clamp technique after treatment with L-NAME (300 µM and 1 mM), L-arginine (10, 100, 300, and 500 µM), ODQ (300 µM), and 8-Br-cGMP (100 µM). Our results show that NO produced by Leydig cells in basal conditions is insufficient to change the ATP-evoked currents and that extra NO provided by adding 300 µM L-arginine positively modulates the current through a mechanism involving the NO/cGMP signaling pathway. Thus, we report an interaction between the nitrergic and purinergic systems in Leydig cells and suggest that Ca2+ entry via the purinergic receptors can be regulated by NO.

Neuroimagen de la fibromialgia: una enfermedad del cerebro / No disponible

Introducción: La neuroimagen permite profundizar y comprender la neuropatofisiología del dolor crónico. La fibromialgia (FM) es un trastorno de dolor crónico difuso músculo-esquelético multisintomático y considerado como un síndrome de sensibilización central (SC). Actualmente, gracias a los estudios de neuroimagen, hay suficiente evidencia de que dichos pacientes presentan una clara alteración del procesamiento central del dolor. Objetivo: Recopilar y sintetizar las alteraciones funcionales y morfológicas cerebrales consensuadas y descritas en la FM mediante las distintas técnicas de estudio que ofrece la resonancia magnética (RM) craneal. Método: Revisión de estudios prospectivos, únicamente de RM craneal, registrados en PubMed y revisiones de Cochrane. Resultados: Los pacientes con FM, respecto a voluntarios sanos, muestran una hiperactivación funcional de la matriz neural del dolor ante diferentes estímulos no-nociceptivos. También muestran una alteración de la conectividad funcional del sistema inhibitorio descendente endógeno y del procesamiento sensorial, así como de los circuitos de auto-conciencia y atención hacia de dolor. Morfológicamente, se objetiva la combinación de una reducción o incremento del volumen de sustancia gris en varias regiones de la matriz neural del dolor, con pocos datos concluyentes respecto al volumen de sustancia blanca. Bioquímicamente se informa de una alteración del nivel de ciertos metabolitos cerebrales, actual y especialmente del complejo Glu/Glx, en varias regiones del circuito neural del dolor. Conclusiones: Específicamente la corteza somatosensorial secundaria, la corteza cingulada anterior y la ínsula parecen tener un importante papel en la patofisiología central de la FM, afianzándose el concepto de que un fallo en el sistema inhibitorio endógeno del dolor y/o en el procesamiento sensorial puede explicar el fenómeno de SC en la FM. Sin embargo, a pesar de las numerosas alteraciones cerebrales descritas en los pacientes con FM, se desconoce si las alteraciones funcionales

Introduction: Neuroimaging allows us to deepen and understand the neuropathology of chronic pain. Fibromyalgia (FM) is a multisymptomatic diffuse chronic musculoskeletal pain disorder considered as a Central sensitization syndrome (CS). Currently, thanks to neuroimaging studies, there is sufficient evidence that such patients present a clear alteration of central pain processing. Objective: To compile and synthesize the cerebral functional and morphological alterations agreed upon and described in FM, through the different study techniques offered by Cranial Magnetic Resonance (MRI). Method: Review of prospective studies, only cranial MRI, recorded in PubMed and Cochrane reviews. Results: Patients with FM, compared to healthy volunteers, show a functional hyperactivation of the neural matrix of pain before different non-nociceptive stimuli. They also show an alteration in the functional connectivity of the endogenous descending inhibitory system and sensory processing, as well as the circuits of self-awareness and attention towards pain. Morphologically refers to the combination of a reduction or increase in gray matter volume in several regions of the neural matrix of pain, with little conclusive data regarding the volume of white matter. Biochemically, an alteration in the level of certain brain metabolites, currently and especially the Glu/Glx complex, is reported in several regions of the neural circuit of pain. Conclusions: Specifically the secondary somatosensory cortex, anterior cingulate cortex and insula appear to play an important role in the central pathophysiology of FM, reinforcing the concept that a failure in the endogenous inhibitory system of pain and/or sensory processing may explain the phenomenon of CS in FM. However, despite the numerous brain alterations described in patients with FM, it is unknown whether the functional and structural alterations objectified with MRI could be a consequence of a chronic nociceptive entry or the cause of the pathogenesis of FM. Nevertheless, the set of neuroimaging results clearly suggest that FM is a disease of the brain

A single episode of high intensity sound inhibits long-term potentiation in the hippocampus of rats.

Exposure to loud sounds has become increasingly common. The most common consequences of loud sound exposure are deafness and tinnitus, but emotional and cognitive problems are also associated with loud sound exposure. Loud sounds can activate the hipothalamic-pituitary-adrenal axis resulting in the secretion of corticosterone, which affects hippocampal synaptic plasticity. Previously we have shown that long-term exposure to short episodes of high intensity sound inhibited hippocampal long-term potentiation (LTP) without affecting spatial learning and memory. Here we aimed to study the impact of short term loud sound exposure on hippocampal synaptic plasticity and function. We found that a single minute of 110 dB sound inhibits hippocampal Schaffer-CA1 LTP for 24 hours. This effect did not occur with an 80-dB sound exposure, was not correlated with corticosterone secretion and was also observed in the perforant-dentate gyrus synapse. We found that despite the deficit in the LTP these animals presented normal spatial learning and memory and fear conditioning. We conclude that a single episode of high-intensity sound impairs hippocampal LTP, without impairing memory and learning. Our results show that the hippocampus is very responsive to loud sounds which can have a potential, but not yet identified, impact on its function.

Radioguided surgery in Meckel's diverticulum / Cirugía radiodirigida en el divertículo de Meckel

We analyze the case of a patient with intermittent episodes of lower gastrointestinal bleeding and suspected Meckel’s diverticulum, whose presence was confirmed by 99mTc-pertechnetate scintigraphy. A previous exploratory laparotomy had been performed without finding the diverticulum. In spite of years of medical treatment, the patient presented a new episode of lower gastrointestinal bleeding with normal colonoscopy. A new 99mTc-pertechnetate scintigraphy (including SPECT/CT) was performed and allowed the anatomical location of a Meckel’s diverticulum and enabled its removal by laparoscopic radioguided surgery. The introduction of SPECT/CT in the scintigraphic diagnostic protocol in Meckel’s diverticulum increases diagnostic safety and improves lesion location. Furthermore, it favors the performance of radioguided surgery and facilitates the lesion resection, particularly when the patient has suffered previous abdominal surgery, with a more conservative procedure, reducing the morbidity associated with the surgical procedure (AU)

Analizamos el caso de un paciente con episodios intermitentes de hemorragia digestiva baja y sospecha de divertículo de Meckel, cuya presencia se confirmó mediante gammagrafía con 99mTc-pertecnetato. Anteriormente se había realizado laparotomía exploradora sin encontrarse el divertículo. Tras a˜nos de control con tratamiento médico, presenta un nuevo episodio de hemorragia digestiva baja con colonoscopía normal. La realización de una nueva gammagrafía con 99mTc-pertecnetato (incluyendo SPECT/TAC) permitió localizar anatómicamente el divertículo de Meckel y plantear su exéresis mediante cirugía laparoscópica radiodirigida. La introducción de la SPECT/TAC en el protocolo diagnóstico del divertículo de Meckel incrementa la seguridad diagnóstica y mejora la localización de la lesión permitiendo la realización de cirugía radiodirigida que facilita la resección de la misma, particularmente en el caso de una reintervención, con un procedimiento más conservador, reduciendo la morbilidad relacionada con la cirugía (AU)

Radioguided surgery in Meckel's diverticulum.

We analyze the case of a patient with intermittent episodes of lower gastrointestinal bleeding and suspected Meckel's diverticulum, whose presence was confirmed by (99m)Tc-pertechnetate scintigraphy. A previous exploratory laparotomy had been performed without finding the diverticulum. In spite of years of medical treatment, the patient presented a new episode of lower gastrointestinal bleeding with normal colonoscopy. A new (99m)Tc-pertechnetate scintigraphy (including SPECT/CT) was performed and allowed the anatomical location of a Meckel's diverticulum and enabled its removal by laparoscopic radioguided surgery. The introduction of SPECT/CT in the scintigraphic diagnostic protocol in Meckel's diverticulum increases diagnostic safety and improves lesion location. Furthermore, it favors the performance of radioguided surgery and facilitates the lesion resection, particularly when the patient has suffered previous abdominal surgery, with a more conservative procedure, reducing the morbidity associated with the surgical procedure.

Subungual squamous cell carcinoma and exostosis in third toe--case report and literature review.

BACKGROUND: Squamous cell carcinoma (SCC) in the ungual apparatus is a rare neoplasia. Although it is the most prevalent malignant tumour in this region, its diagnosis is often delayed because it is likened to benign or infectious processes. OBJECTIVES: Present a case of SCC with subungual location in a toe, and carry out a review of the literature in relation to the most important aspects of subungual SCC in toes. METHODS: We describe the case of a white woman aged 72, with SCC located in the pulp and in the distal area of the nail bed of the third toe, associated with subungual exostosis. The literature on SCC in the subungual area of toes, in all its forms under clinical or histopathological presentation, is reviewed by means of a search involving Medline, PubMed, and Google Academic, from January 1994 to December 2011. RESULTS: Only 36 cases of subungual SCC in toes were reported in the 18 years that were reviewed. The average age of cases reviewed was 58.92, and the male-to-female ratio was 2:1. The most affected toe is the hallux, in 69.4% of cases. In 50% of cases, aetiology is unknown or indeterminate; in 22.3% of cases, aetiology is metastatic; and in 19.5% of cases, it is associated with human papillomavirus (HPV). In 58.2% of cases, partial or total resection of the distal phalanx was carried out, of the entire toe, or of the osseous ray of the foot. CONCLUSIONS: Chronic tissue irritation caused by microtrauma associated with subungual exostosis is the most probable aetiology of the case presented.

Neural response to the observable self in social anxiety disorder.

BACKGROUND: Distorted images of the observable self are considered crucial in the development and maintenance of social anxiety. We generated an experimental situation in which participants viewed themselves from an observer's perspective when exposed to scrutiny and evaluation by others. Method Twenty patients with social anxiety disorder (SAD) and 20 control subjects were assessed using functional magnetic resonance imaging (fMRI) during the public exposure of pre-recorded videos in which they were each shown performing a verbal task. The examiners acted as the audience in the experiment and rated performance. Whole-brain functional maps were computed using Statistical Parametric Mapping. RESULTS: Robust activation was observed in regions related to self-face recognition, emotional response and general arousal in both study groups. Patients showed significantly greater activation only in the primary visual cortex. By contrast, they showed significant deactivation or smaller activation in dorsal frontoparietal and anterior cingulate cortices relevant to the cognitive control of negative emotion. Task-related anxiety ratings revealed a pattern of negative correlation with activation in this frontoparietal/cingulate network. Importantly, the relationship between social anxiety scores and neural response showed an inverted-U function with positive correlations in the lower score range and negative correlations in the higher range. CONCLUSIONS: Our findings suggest that exposure to scrutiny and evaluation in SAD may be associated with changes in cortical systems mediating the cognitive components of anxiety. Disorder severity seems to be relevant in shaping the neural response pattern, which is distinctively characterized by a reduced cortical response in the most severe cases.

Structural covariance of the neostriatum with regional gray matter volumes.

The caudate and putamen nuclei have been traditionally divided into dorsal and ventral territories based on their segregated patterns of functional and anatomical connectivity with distributed cortical regions. Activity-dependent structural plasticity may potentially lead to the development of regional volume correlations, or structural covariance, between the different components of each cortico-striatal circuit. Here, we studied the whole-brain structural covariance patterns of four neostriatal regions belonging to distinct cortico-striatal circuits. We also assessed the potential modulating influence of laterality, age and gender. T1-weighted three-dimensional magnetic resonance images were obtained from ninety healthy participants (50 females). Following data pre-processing, the mean signal value per hemisphere was calculated for the 'seed' regions of interest, located in the dorsal and ventral caudate and the dorsal-caudal and ventral-rostral putamen. Statistical parametric mapping was used to estimate whole-brain voxel-wise structural covariance patterns for each striatal region, controlling for the shared anatomical variance between regions in order to obtain maximally specific structural covariance patterns. As predicted, segregated covariance patterns were observed. Age was found to be a relevant modulator of the covariance patterns of the right caudate regions, while laterality effects were observed for the dorsal-caudal putamen. Gender effects were only observed via an interaction with age. The different patterns of structural covariance are discussed in detail, as well as their similarities with the functional and anatomical connectivity patterns reported for the same striatal regions in other studies. Finally, the potential mechanisms underpinning the phenomenon of volume correlations between distant cortico-striatal structures are also discussed.

Neuroma under the fifth metatarsal head. A retrospective study.

This retrospective study was carried out over 83 surgical cases at the distal portion of the fifth metatarsal, compromising the treatment of tailor's bunion, fifth metatarsal overload and the concomitant presence of both pathologies in some cases. Neuromas were founded under the fifth metatarsal head in 18 of the cases studied (21.7%). The results look at whether if there is an association between different fifth metatarsal pathologies and the presence of neuromas and found a significant association between the appearance of neuromas in patients with the same metatarsal overload, especially if it is accompanied by a tailor's bunion pathology.

[Intraoperative identification of the supplementary motor area in neurooncological surgery]. / Identificación intraoperatoria del área motora suplentaria en cirugía neurooncológica.

OBJECTIVES: The main objective of the present work was to identify, by means of intraoperative electrical stimulation, the supplementary motor area (SMA) region which is implicated in complex motor function. The functional prognostic relevance of the surgical preservation of this area was also analyzed. METHOD: Fifteen patients with tumors infiltrating the premotor cortex were selected. All patients were operated under awake conditions. Primary motor cortex was identified with intraoperative electrical stimulation (IES). To identify the SMA, patients were asked to do a finger opposition motor task with their hand contralateral to the lesion, that was blocked by electrically stimulating the premotor cerebral cortex. RESULTS: SMA was identified in all patients with IES. Complete surgical resection was achieved in 13 patients (86.6%) and subtotal in 2 patients (13.3%). SMA function was preserved in 14 patients (93.3%). In only one patient the SMA was partially resected because of tumor infiltration (6.6%). In the immediate postoperative period, 8 patients (53.3%) did not show changes in comparison to their preoperative clinical status, and 2 patients improved. At 6 months follow up, 5 patients (33.3%) were asymptomatic and 10 patients showed permanent deficits. In this last group, five patients (33.3%) showed mild deficits that did not interfere with a normal life. In the other 5 patients (33.3%), permanent deficits interfered with daily life activities: two patients presented severe hemiparesis 3/5 (same similar to their preoperative status with no improvement), one patient had motor aphasia, and two other patients (13.3%) showed permanent left SMA syndrome. In two patients with severe postoperative hemiparesis, tumor infiltration of primary motor cortex and piramidal pathway was observed; severe preoperative motor deficit (KPS <70) was associated with poor functional outcome. CONCLUSIONS: Intraoperative electrical cortical stimulation is useful to identify the SMA. Once identified, SMA preservation decreases the risk of postoperative symptoms and permanent SMA syndrome. When SMA is infiltrated by the tumor, radical resection may cause permanent neurological deficits, specially in the dominant hemisphere. Severe preoperative motor deficit was associated with poor outcome.

Identificación intraoperatoria del área motora suplementaria en cirugía neurooncológica / Intraoperative identification of the supplementary

Objetivos. El objetivo principal del estudio es conseguirla identificación intraoperatoria de la función delárea motora suplementaria (AMS) implicada en tareasmotoras complejas. El objetivo secundario es valorar elpronóstico funcional tras la preservación quirúrgica deeste área.Método. Se han seleccionado 15 pacientes con tumorescerebrales localizados en área premotora. Todoslos pacientes fueron intervenidos despiertos. El córtexmotor primario fue identificado mediante estimulacióncerebral directa. Para identificar el AMS, el pacienterealizó una tarea motora de oposición de dedos conla mano contralateral a la lesión que se bloqueabamediante la estimulación eléctrica del córtex cerebralpremotor.Resultados. El AMS pudo ser identificada en todoslos pacientes mediante este método.La resección fue macroscópicamente completa en 13pacientes (86.6%) y subtotal en 2 (13.3%). La funciónencontrada en el AMS se ha podido preservar en 14pacientes (93,3%) (..) (AU)

Objectives. The main objective of the present workwas to identify, by means of intraoperative electricalstimulation, the supplementary motor area (SMA)region which is implicated in complex motor function.The functional prognostic relevance of the surgical preservationof this area was also analyzed.Method. Fifteen patients with tumors infiltrating thepremotor cortex were selected. All patients were operatedunder awake conditions. Primary motor cortexwas identified with intraoperative electrical stimulation(IES). To identify the SMA, patients were askedto do a finger opposition motor task with their handcontralateral to the lesion, that was blocked by electricallystimulating the premotor cerebral cortex.Results. SMA was identified in all patients with (..) (AU)