Discapacidad y calidad de vida después de un accidente de tránsito en Medellín y su área metropolitana. Estudio de cohorte

Objetivo: Comparar al año, el funcionamiento, calidad de vida (cv), dolor y depresión entre adultos menores y mayores de 60 años que tuvieron lesiones moderadas y graves en accidentes de tránsito ocurridos en Medellín y su área metropolitana. Metodología: Análisis secundario de dos cohortes de pacientes con lesiones moderadas y graves ocurridas en Medellín y su área metropolitana en 2009-2010 y 2015-2016. Se hizo evaluación para el funcionamiento, la cv, depresión y el dolor, con instrumentos validados para ello. Las diferencias entre las cohortes 12 meses después del accidente se compararon con t-Student. Se hizo un análisis de regresión lineal múltiple para determinar los factores explicativos de discapacidad y cv. Resultados: Se incluyeron 837 pacientes, de los cuales el 84,8 % completó el seguimiento. La motocicleta fue el principal vehículo involucrado (86,1 y 60,7 %). Se observó mejor funcionamiento en mayores de 60 años en cuidado personal, y mayor compromiso en las actividades de la vida diaria, laborales y funcionamiento global. La cv fue significativamente mejor en menores, en desempeño emocional, desempeño físico y función física. En el análisis multivariado, el mayor compromiso en el funcionamiento fue explicado por ser mujer, tener más edad, lesión más grave, mayor dolor y depresión. La mejor cv fue explicada por ser hombre, menos edad, menor gravedad de la lesión, dolor y síntomas depresivos. Conclusiones: La edad, el sexo, la gravedad de la lesión, el dolor y la depresión explican la discapacidad y las dimensiones de la cv 12 meses después del accidente de tránsito.

Objective: To compare functioning, quality of life (QoL), pain, and depression at one year between adults under and over 60 years of age who had moderate and severe injuries in traffic accidents in Medellin and its metropolitan area. Methodology: Secondary analysis of two cohorts of patients with moderate and severe injuries that occurred in Medellín and its metropolitan area in 2009-2010 and 2015-2016. They were evaluated at baseline and 12 months with functioning (who-das ii), QoL (sf-36), pain (vas), and depression (phq-9). The differences between cohorts 12 months after the accident were compared with t-Student test. A multiple linear regression analysis was done to determine factors related to disability and QoL. Results: 837 patients were included, 84,8% completed the follow-up. The motorcycle was the main vehicle involved (86,1% vs. 60,7). Better functioning was observed in people over 60 years of age in personal care, and greater commitment in activities of daily living, work and global functioning. QoL was significantly better in minors, in emotional performance, physical performance and physical function. In the multivariate analysis, the greater compromise in functioning was explained by being female, older, more severe injury, greater pain, and depression. The best QoL was explained by being male, younger, less severe injury, pain, and depressive symptoms. Conclusions: Age, sex, injury severity, pain, and depression explain disability and QoL dimensions 12 months after the traffic accident.

Objetivo: Comparar a funcionalidade, qualidade de vida (QV), dor e depressão entre adultos com menos e mais de 60 anos de idade que sofreram lesões moderadas e graves em acidentes de trânsito ocorridos em Medellín e sua região metropolitana. Metodologia: Análise secundária de duas coortes de pacientes com lesões moderadas e graves que ocorreram em Medellín e sua área metropolitana em 2009-2010 e 2015-2016. Foi feita avaliação funcional, cv, depressão e dor, com instrumentos validados para isso. As diferenças entre as coortes 12 meses após o acidente foram comparadas com o teste t de Student. Uma análise de regressão linear múltipla foi realizada para determinar os fatores explicativos para deficiência e cv. Resultados: foram incluídos 837 pacientes, dos quais 84,8% completaram o seguimento. A motocicleta foi o principal veículo envolvido (86,1 e 60,7%). Melhor funcionamento foi observado em pessoas com mais de 60 anos nos cuidados pessoais e maior comprometimento nas atividades de vida diária, trabalho e funcionamento global. A QV foi significativamente melhor nos menores, no desempenho emocional, no desempenho físico e na função física. Na análise multivariada, o maior comprometimento funcional foi explicado por ser mulher, ser mais velho, lesão mais grave, maior dor e depressão. A melhor QV foi explicada por ser homem, menor idade, menor gravidade da lesão, dor e sintomas depressivos. Conclusões: Idade, sexo, gravidade da lesão, dor e depressão explicam as dimensões de incapacidade e QV 12 meses após o acidente de trânsito.

Country-level gender inequality is associated with structural differences in the brains of women and men.

Gender inequality across the world has been associated with a higher risk to mental health problems and lower academic achievement in women compared to men. We also know that the brain is shaped by nurturing and adverse socio-environmental experiences. Therefore, unequal exposure to harsher conditions for women compared to men in gender-unequal countries might be reflected in differences in their brain structure, and this could be the neural mechanism partly explaining women's worse outcomes in gender-unequal countries. We examined this through a random-effects meta-analysis on cortical thickness and surface area differences between adult healthy men and women, including a meta-regression in which country-level gender inequality acted as an explanatory variable for the observed differences. A total of 139 samples from 29 different countries, totaling 7,876 MRI scans, were included. Thickness of the right hemisphere, and particularly the right caudal anterior cingulate, right medial orbitofrontal, and left lateral occipital cortex, presented no differences or even thicker regional cortices in women compared to men in gender-equal countries, reversing to thinner cortices in countries with greater gender inequality. These results point to the potentially hazardous effect of gender inequality on women's brains and provide initial evidence for neuroscience-informed policies for gender equality.

Selective visuoconstructional impairment following mild COVID-19 with inflammatory and neuroimaging correlation findings.

People recovered from COVID-19 may still present complications including respiratory and neurological sequelae. In other viral infections, cognitive impairment occurs due to brain damage or dysfunction caused by vascular lesions and inflammatory processes. Persistent cognitive impairment compromises daily activities and psychosocial adaptation. Some level of neurological and psychiatric consequences were expected and described in severe cases of COVID-19. However, it is debatable whether neuropsychiatric complications are related to COVID-19 or to unfoldings from a severe infection. Nevertheless, the majority of cases recorded worldwide were mild to moderate self-limited illness in non-hospitalized people. Thus, it is important to understand what are the implications of mild COVID-19, which is the largest and understudied pool of COVID-19 cases. We aimed to investigate adults at least four months after recovering from mild COVID-19, which were assessed by neuropsychological, ocular and neurological tests, immune markers assay, and by structural MRI and 18FDG-PET neuroimaging to shed light on putative brain changes and clinical correlations. In approximately one-quarter of mild-COVID-19 individuals, we detected a specific visuoconstructive deficit, which was associated with changes in molecular and structural brain imaging, and correlated with upregulation of peripheral immune markers. Our findings provide evidence of neuroinflammatory burden causing cognitive deficit, in an already large and growing fraction of the world population. While living with a multitude of mild COVID-19 cases, action is required for a more comprehensive assessment and follow-up of the cognitive impairment, allowing to better understand symptom persistence and the necessity of rehabilitation of the affected individuals.

Mejoría del dolor, la función y la calidad de vida en dolor lumbar subagudo: ensayo clínico controlado con ejercicio vs. AINES / Improvement of pain, function and quality of life in subacute low back pain: controlled clinical trial with exercise vs. NSAIDs

Introducción. El dolor lumbar es una de las causas más frecuentes de consulta y discapacidad en pacientes, y según su evolución temporal se puede clasificar como agudo, subagudo y crónico. Objetivo. Estimar en pacientes con Dolor Lumbar Subagudo (DLS), la eficacia de un programa de ejercicio comparado con antiinflamatorios no esteroideos (AINES). Métodos. Se realizó un ensayo clínico controlado aleatorio, con enmascaramiento simple en 90 pacientes y DLS con o sin radiculopatía, 46 pacientes fueron asignados a un programa de ejercicio físico y 44 a tratamiento con AINES. El desenlace primario fue la mejoría del dolor y los secundarios mejoría en la función, calidad de vida, ausentismo laboral y depresión con seguimiento a 1, 3 y 6 meses. Resultados. Al mes, no se registró diferencias en el dolor entre los grupos de 8,16 (IC 95 % -2,19 a 18,51), sin embargo, en el grupo de ejercicios hubo una mejoría de 47,3 (SD: 19,8) a 28,8 (SD: 20,5), p <0,001, y en el grupo de AINES de 45,2 (SD: 22,6) a 34,9 (SD: 25,0), p = 0,018. Otras muestras de mejoría se observaron en la función medida por el Índice de Discapacidad de Oswestry (ODI), la cual mejoró al mes en el grupo de ejercicio (p<0,001), mientras,la función física también mejoró al mes en el grupo de ejercicio (p= 0,038). Otra mejoría se observó en el dolor, función y calidad de vida que se mantuvo a los 3 y 6 meses en ambos grupos. Finalmente, La recurrencia fue mayor en el grupo de AINES: 25,5 % vs. 7,1 % (p= 0,04) al mes; 25,5 % vs. 7,1 % (p= 0,04) y 20,5 % vs. 5 % (p= 0,04), a los 3 y 6 meses. Conclusión. El ejercicio supervisado fue más efectivo que los AINES para disminuir la discapacidad y las recurrencias y mejorar la función física en pacientes con DLS.

Introduction. Low back pain is one of the most frequent causes of consultation and disability in patients, and according to its temporal evolution it can be classified as acute, subacute and chronic. Objective. To estimate the efficacy of an exercise program compared to non-steroidal anti-inflammatory drugs (NSAIDs) in patients with subacute low back pain (LBP). Methods. A randomized, single-masked, controlled clinical trial was conducted in 90 patients and DLS with or without radiculopathy, 46 patients were assigned to a physical exercise program and 44 to NSAID treatment. The primary outcome was improvement in pain and the secondary outcomes were improvement in function, quality of life, work absenteeism and depression with follow-up at 1, 3 and 6 months. Results. At 1 month, there was no difference in pain between groups of 8.16 (95 % CI -2.19 to 18.51), however, in the exercise group there was an improvement from 47.3 (SD: 19.8) to 28.8 (SD: 20.5), p <0.001, and in the NSAID group from 45.2 (SD: 22.6) to 34.9 (SD: 25.0), p = 0.018. Other signs of improvement were seen in function as measured by the Oswestry Disability Index (ODI), which improved at 1 month in the exercise group (p<0.001), while physical function also improved at 1 month in the exercise group (p= 0.038). Another improvement was observed in pain, function and quality of life which was maintained at 3 and 6 months in both groups. Finally, recurrence was higher in the NSAID group: 25.5 % vs. 7.1 % (p= 0.04) at 1 month; 25.5 % (p= 0.04) at 1 month; 25.5 % (p= 0.038) in the exercise group (p= 0.038) at 1 month.

Evaluation of 10-minute post-injection 11C-PiB PET and its correlation with 18F-FDG PET in older adults who are cognitively healthy, mildly impaired, or with probable Alzheimer's disease.

OBJECTIVE: Positron emission tomography (PET) allows in vivo evaluation of molecular targets in neurodegenerative diseases, such as Alzheimer's disease. Mild cognitive impairment is an intermediate stage between normal cognition and Alzheimer-type dementia. In vivo fibrillar amyloid-beta can be detected in PET using [11C]-labeled Pittsburgh compound B (11C-PiB). In contrast, [18F]fluoro-2-deoxy-d-glucose (18F-FDG) is a neurodegeneration biomarker used to evaluate cerebral glucose metabolism, indicating neuronal injury and synaptic dysfunction. In addition, early cerebral uptake of amyloid-PET tracers can determine regional cerebral blood flow. The present study compared early-phase 11C-PiB and 18F-FDG in older adults without cognitive impairment, amnestic mild cognitive impairment, and clinical diagnosis of probable Alzheimer's disease. METHODS: We selected 90 older adults, clinically classified as healthy controls, with amnestic mild cognitive impairment, or with probable Alzheimer's disease, who underwent an 18F-FDG PET, early-phase 11C-PiB PET and magnetic resonance imaging. All participants were also classified as amyloid-positive or -negative in late-phase 11C-PiB. The data were analyzed using statistical parametric mapping. RESULTS: We found that the probable Alzheimer's disease and amnestic mild cognitive impairment group had lower early-phase 11C-PiB uptake in limbic structures than 18F-FDG uptake. The images showed significant interactions between amyloid-beta status (negative or positive). However, early-phase 11C-PiB appears to provide different information from 18F-FDG about neurodegeneration. CONCLUSIONS: Our study suggests that early-phase 11C-PiB uptake correlates with 18F-FDG, irrespective of the particular amyloid-beta status. In addition, we observed distinct regional distribution patterns between both biomarkers, reinforcing the need for more robust studies to investigate the real clinical value of early-phase amyloid-PET imaging.

Brain Perfusion Alterations Induced by Standalone and Combined Non-Invasive Brain Stimulation over the Dorsolateral Prefrontal Cortex.

Non-invasive brain stimulation (NIBS) interventions are promising for the treatment of psychiatric disorders. Notwithstanding, the NIBS mechanisms of action over the dorsolateral prefrontal cortex (DLPFC), a hub that modulates affective and cognitive processes, have not been completely mapped. We aimed to investigate regional cerebral blood flow (rCBF) changes over the DLPFC and the subgenual anterior cingulate cortex (sgACC) of different NIBS protocols using Single-Photon Emission Computed Tomography (SPECT). A factorial, within-subjects, double-blinded study was performed. Twenty-three healthy subjects randomly underwent four sessions of NIBS applied once a week: transcranial direct current stimulation (tDCS), intermittent theta-burst stimulation (iTBS), combined tDCS + iTBS and placebo. The radiotracer 99m-Technetium-ethylene-cysteine-dimer was injected intravenously during the NIBS session, and SPECT neuroimages were acquired after the session. Results revealed that the combination of tDCS + iTBS increased right sgACC rCBF. Cathodal and anodal tDCS increased and decreased DLPFC rCBF, respectively, while iTBS showed no significant changes compared to the placebo. Our findings suggest that the combined protocol might optimize the activity in the right sgACC and encourage future trials with neuropsychiatric populations. Moreover, mechanistic studies to investigate the effects of tDCS and iTBS over the DLPFC are required.

Evaluation of 10-minute post-injection 11C-PiB PET and its correlation with 18F-FDG PET in older adults who are cognitively healthy, mildly impaired, or with probable Alzheimer's disease

Objective: Positron emission tomography (PET) allows in vivo evaluation of molecular targets in neurodegenerative diseases, such as Alzheimer's disease. Mild cognitive impairment is an intermediate stage between normal cognition and Alzheimer-type dementia. In vivo fibrillar amyloid-beta can be detected in PET using [11C]-labeled Pittsburgh compound B (11C-PiB). In contrast, [18F]fluoro-2-deoxy-d-glucose (18F-FDG) is a neurodegeneration biomarker used to evaluate cerebral glucose metabolism, indicating neuronal injury and synaptic dysfunction. In addition, early cerebral uptake of amyloid-PET tracers can determine regional cerebral blood flow. The present study compared early-phase 11C-PiB and 18F-FDG in older adults without cognitive impairment, amnestic mild cognitive impairment, and clinical diagnosis of probable Alzheimer's disease. Methods: We selected 90 older adults, clinically classified as healthy controls, with amnestic mild cognitive impairment, or with probable Alzheimer's disease, who underwent an 18F-FDG PET, early-phase 11C-PiB PET and magnetic resonance imaging. All participants were also classified as amyloid-positive or -negative in late-phase 11C-PiB. The data were analyzed using statistical parametric mapping. Results: We found that the probable Alzheimer's disease and amnestic mild cognitive impairment group had lower early-phase 11C-PiB uptake in limbic structures than 18F-FDG uptake. The images showed significant interactions between amyloid-beta status (negative or positive). However, early-phase 11C-PiB appears to provide different information from 18F-FDG about neurodegeneration. Conclusions: Our study suggests that early-phase 11C-PiB uptake correlates with 18F-FDG, irrespective of the particular amyloid-beta status. In addition, we observed distinct regional distribution patterns between both biomarkers, reinforcing the need for more robust studies to investigate the real clinical value of early-phase amyloid-PET imaging.

Characterization of the Sensory Nerve Action Potential of the Sural Nerve in Patients Over 60 Years of Age without Peripheral Neuropathy.

Demonstration of the possibility to obtain the sensory nerve action potential (SNAP) of sural nerve in patients over 60 years old, without peripheral neuropathy. Prospective study on 101 patients older than 60 years of age. Stimulation was applied 12 cm proximal to the recording point. Two hundred and two SNAPs of the sural nerve were collected with an average peak latency of 3.2 ms, onset latency of 2.6 ms, peak-to-peak amplitude of 15.2 µV and velocity of 45.7 m/s. It was possible to obtain the sural nerve SNAP in all tested patients older than 60, without peripheral neuropathy. The values obtained in this study prove to be useful as a reference in the evaluation of patients older than 60 years of age.

Bilateral Martin-Gruber and Marinacci Anastomosis Associated with Carpal Tunnel and Guyon's Canal Syndrome: Case Report.

Anastomoses between the median and ulnar nerves are commonly found on electrodiagnostic studies. These anastomoses are usually asymptomatic and are not discovered until nerve injuries occur that lead to unusual motor or sensory deficits. Their presence can cause difficulties in the interpretation of electrophysiological findings for the diagnosis of neuropathies and suppose a risk of iatrogenic damage during surgical procedures. We describe a rare case of bilateral Martin Gruber and Marinacci anastomosis, associated with median and ulnar nerve injuries in the carpal tunnel and Guyon's canal, respectively. The detailed anatomical knowledge of these anastomosis allows the electromyographist to identify them correctly, facilitating the interpretation of the findings and, incidentally, preventing iatrogenic injuries.

Innate immune cells and myelin profile in multiple sclerosis: a multi-tracer PET/MR study.

PURPOSE: Neuropathological studies have demonstrated distinct profiles of microglia activation and myelin injury among different multiple sclerosis (MS) phenotypes and disability stages. PET imaging using specific tracers may uncover the in vivo molecular pathology and broaden the understanding of the disease heterogeneity. METHODS: We used the 18-kDa translocator protein (TSPO) tracer (R)-[11C]PK11195 and [11C]PIB PET images acquired in a hybrid PET/MR 3 T system to characterize, respectively, the profile of innate immune cells and myelin content in 47 patients with MS compared to 18 healthy controls (HC). For the volume of interest (VOI)-based analysis of the dynamic data, (R)-[11C]PK11195 distribution volume (VT) was determined for each subject using a metabolite-corrected arterial plasma input function while [11C]PIB distribution volume ratio (DVR) was estimated using a reference region extracted by a supervised clustering algorithm. A voxel-based analysis was also performed using Statistical Parametric Mapping. Functional disability was evaluated by the Expanded Disability Status Scale (EDSS), Multiple Sclerosis Functional Composite (MSFC), and Symbol Digit Modality Test (SDMT). RESULTS: In the VOI-based analysis, [11C]PIB DVR differed between patients and HC in the corpus callosum (P = 0.019) while no differences in (R)-[11C]PK11195 VT were observed in patients relative to HC. Furthermore, no correlations or associations were observed between both tracers within the VOI analyzed. In the voxel-based analysis, high (R)-[11C]PK11195 uptake was observed diffusively in the white matter (WM) when comparing the progressive phenotype and HC, and lower [11C]PIB uptake was observed in certain WM regions when comparing the relapsing-remitting phenotype and HC. None of the tracers were able to differentiate phenotypes at voxel or VOI level in our cohort. Linear regression models adjusted for age, sex, and phenotype demonstrated that higher EDSS was associated with an increased (R)-[11C]PK11195 VT and lower [11C]PIB DVR in corpus callosum (P = 0.001; P = 0.023), caudate (P = 0.015; P = 0.008), and total T2 lesion (P = 0.007; P = 0.012), while better cognitive scores in SDMT were associated with higher [11C]PIB DVR in the corpus callosum (P = 0.001), and lower (R)-[11C]PK11195 VT (P = 0.013). CONCLUSIONS: Widespread innate immune cells profile and marked loss of myelin in T2 lesions and regions close to the ventricles may occur independently and are associated with disability, in both WM and GM structures.

Effects of exercise training on brain metabolism and cognitive functioning in sleep apnea.

Impaired glucose metabolism reflects neuronal/synaptic dysfunction and cognitive function decline in patients with obstructive sleep apnea (OSA). The study investigated the extent to which exercise training (ET) improves cerebral metabolic glucose rate (CMRgl) and cognitive function in patients with OSA. Patients with moderate to severe OSA were randomly assigned to ET (3 times/week, n = 23) or no intervention (control, n = 24). Echocardiography and apolipoprotein ε4 (APOEε4) genotyping were obtained at baseline. Both groups underwent cardiopulmonary exercise testing, polysomnography, cognitive tests, brain magnetic resonance imaging, and 18F-fluoro-2-deoxy-D-Glucose positron emission tomography (18FDG-PET) at baseline and study end. Compared with control, exercise-trained group had improved exercise capacity, decreased apnea-hypopnea index (AHI), oxygen desaturation and arousal index; increased attention/executive functioning, increased CMRgl in the right frontal lobe (P < 0.05). After ET an inverse relationships occurred between CMRgl and obstructive AHI (r = - 0.43, P < 0.05) and apnea arousal index (r = - 0.53, P < 0.05), and between the changes in CMRgl and changes in mean O2 saturation during sleep and non-rapid eye movement sleep (r = - 0.43, P < 0.05), desaturation during arousal (r = - 0.44, P < 0.05), and time to attention function testing (r = - 0.46, P < 0.05). ET improves OSA severity and CMRg in the frontal lobe, which helps explain the improvement in attention/executive functioning. Our study provides promising data that reinforce the growing idea that ET may be a valuable tool to prevent hypoxia associated with decreased brain metabolism and cognitive functioning in patients with moderate to severe OSA.Trial registration: NCT02289625 (13/11/2014).

The Association Between Acquired Color Deficiency and PET Imaging of Neurodegeneration in Mild Cognitive Impairment and Alzheimer Disease.

Purpose: To evaluate color vision changes and retinal processing of chromatic and luminance pathways in subjects with Alzheimer disease (AD) and mild cognitive impairment (MCI) compared with a matched control group and whether such changes are associated with impaired brain glucose metabolism and ß-amyloid deposition in the brain. Methods: We evaluated 13 patients with AD (72.4 ± 7.7 years), 23 patients with MCI (72.5 ± 5.5 years), and 18 controls of comparable age (P = 0.44) using Cambridge color test and the heterochromatic flicker ERG (HF-ERG). The Cambridge color test was performed using the trivector protocol to estimate the protan, deutan and tritan color confusion axes. HF-ERG responses were measured at a frequency of 12 Hz, which ERGs reflect chromatic activity, and at 36 Hz, reflecting luminance pathway. A study subsample was performed using neuropsychological assessments and positron emission tomography. Results: Patients with AD presented higher mean values indicating poorer color discrimination for protan (P = 0.04) and deutan (P = 0.001) axes compared with the controls. Along the tritan axis, both patients with AD and patients with MCI showed decreased color vision (P = 0.001 and P = 0.001) compared with controls. The analyses from the HF-ERG protocol revealed no differences between the groups (P = 0.31 and P = 0.41). Diffuse color vision loss was found in individuals with signs of neurodegeneration (protan P = 0.002, deutan P = 0.003 and tritan P = 0.01), but not in individuals with signs of ß-amyloid deposition only (protan P = 0.39, deutan P = 0.48, tritan P = 0.63), regardless of their clinical classification. Conclusions: Here, patients with AD and patients with MCI present acquired color vision deficiency that may be linked with impaired brain metabolism.

Subtly altered topological asymmetry of brain structural covariance networks in autism spectrum disorder across 43 datasets from the ENIGMA consortium.

Small average differences in the left-right asymmetry of cerebral cortical thickness have been reported in individuals with autism spectrum disorder (ASD) compared to typically developing controls, affecting widespread cortical regions. The possible impacts of these regional alterations in terms of structural network effects have not previously been characterized. Inter-regional morphological covariance analysis can capture network connectivity between different cortical areas at the macroscale level. Here, we used cortical thickness data from 1455 individuals with ASD and 1560 controls, across 43 independent datasets of the ENIGMA consortium's ASD Working Group, to assess hemispheric asymmetries of intra-individual structural covariance networks, using graph theory-based topological metrics. Compared with typical features of small-world architecture in controls, the ASD sample showed significantly altered average asymmetry of networks involving the fusiform, rostral middle frontal, and medial orbitofrontal cortex, involving higher randomization of the corresponding right-hemispheric networks in ASD. A network involving the superior frontal cortex showed decreased right-hemisphere randomization. Based on comparisons with meta-analyzed functional neuroimaging data, the altered connectivity asymmetry particularly affected networks that subserve executive functions, language-related and sensorimotor processes. These findings provide a network-level characterization of altered left-right brain asymmetry in ASD, based on a large combined sample. Altered asymmetrical brain development in ASD may be partly propagated among spatially distant regions through structural connectivity.

Cannabidiol Treatment Improves Glucose Metabolism and Memory in Streptozotocin-Induced Alzheimer's Disease Rat Model: A Proof-of-Concept Study.

An early and persistent sign of Alzheimer's disease (AD) is glucose hypometabolism, which can be evaluated by positron emission tomography (PET) with 18F-2-fluoro-2-deoxy-D-glucose ([18F]FDG). Cannabidiol has demonstrated neuroprotective and anti-inflammatory properties but has not been evaluated by PET imaging in an AD model. Intracerebroventricular (icv) injection of streptozotocin (STZ) is a validated model for hypometabolism observed in AD. This proof-of-concept study evaluated the effect of cannabidiol treatment in the brain glucose metabolism of an icv-STZ AD model by PET imaging. Wistar male rats received 3 mg/kg of STZ and [18F]FDG PET images were acquired before and 7 days after STZ injection. Animals were treated with intraperitoneal cannabidiol (20 mg/kg-STZ-cannabidiol) or saline (STZ-saline) for one week. Novel object recognition was performed to evaluate short-term and long-term memory. [18F]FDG uptake in the whole brain was significantly lower in the STZ-saline group. Voxel-based analysis revealed a hypometabolism cluster close to the lateral ventricle, which was smaller in STZ-cannabidiol animals. The brain regions with more evident hypometabolism were the striatum, motor cortex, hippocampus, and thalamus, which was not observed in STZ-cannabidiol animals. In addition, STZ-cannabidiol animals revealed no changes in memory index. Thus, this study suggests that cannabidiol could be an early treatment for the neurodegenerative process observed in AD.

Inverse Association Between Hypothalamic N-Acetyl Aspartate/Creatine Ratio and Indices of Body Mass in Adolescents with Obesity.

BACKGROUND: Approximately 10% of adolescents worldwide are overweight or obese, hence the urgent and universal need to elucidate possible mechanisms that lead to obesity in the adolescent population. OBJECTIVES: We examined the hypothalamic metabolism and its relationship with physical development in obese and eutrophic adolescents. METHODS: We performed a case-control study with 115 adolescents between 11 and 18 years of age, to compare obese (BMI z-score ≥ 2) and nonobese individuals (eutrophic controls; BMI z-score ≤ 1). The following hypothalamic metabolite ratios were examined as primary outcomes: glutamate/creatine (Cr), the sum of glutamate and glutamine/Cr, N-acetylaspartate (NAA)/Cr, myoinositol/Cr, and total choline/Cr (glycerophosphocholine +  phosphocholine/Cr), quantified by magnetic resonance spectroscopy. BMI z-scores, pubertal status, and scores on the Yale Food Addiction Scale, the Binge Eating Scale, and the Child Depression Inventory were assessed as secondary outcomes. Pearson coefficients (r) or nonparametric Spearman correlation (rho) analyses were performed between hypothalamic metabolite ratios and other parameters, such as BMI z-scores, physical development, food habits, depression symptoms, and serum protein concentrations (cytokines, hormones, and neuropeptides). RESULTS: Adolescents with obesity showed a lower hypothalamic NAA/Cr ratio (0.70 ± 0.19) compared to their eutrophic counterparts (0.84 ± 0.20; P = 0.004). The NAA/Cr ratio was negatively correlated with BMI z-scores (r = -0.25; P = 0.03) and serum insulin (rho = -0.27; P = 0.04), C-peptide (rho = -0.26; P = 0.04), amylin (r = -0.27; P = 0.04), ghrelin (rho = -0.30; P = 0.02), and neuropeptide Y (r = -0.27; P = 0.04). Also, the NAA/Cr ratio was positively correlated with circulating IL-8 levels (rho = 0.26; P = 0.04). CONCLUSIONS: High BMI z-scores are associated with lower hypothalamic NAA/Cr ratios. The negative correlations found between the NAA/Cr ratio and serum cytokines, hormones, and neuropeptides suggest a broad cross-talk linking hormonal imbalances, neurohumoral alterations, and hypothalamic functions in adolescents with obesity.

Dolor en la persona con lesión medular / Pain in the patient with spinal cordinjury

El dolor es una complicación frecuente luego de una lesión medular y afecta la calidad de vida de la persona que lo sufre. Puede ser de causa musculoesquelética, visceral o, el más difícil de tratar, el neuropático. Este artículo resume los distintos tipos de dolor, su fisiopatología y las opciones terapéuticas, tanto farmacológicas como de otros tipos, que se le pueden ofrecer al paciente

Pain is a frequent complication after a spinal cord injury and affects the quality of life of the person who suffers it. It can be musculoskeletal, visceral or, the most difficult to treat, neuropathic. This article summarizes the different types of pain, its pathophysiology and the therapeutic options, both pharmacological and other, that can be offered to the patient.

Cortical surface abnormalities are different depending on the stage of schizophrenia: A cross-sectional vertexwise mega-analysis of thickness, area and gyrification.

BACKGROUND: Brain magnetic resonance imaging studies have not investigated the cortical surface comprehensively in schizophrenia subjects by assessing thickness, surface area and gyrification separately during the first-episode of psychosis (FEP) or chronic schizophrenia (ChSch). METHODS: We investigated cortical surface abnormalities in 137 FEP patients and 240 ChSch subjects compared to 297 Healthy Controls (HC) contributed by five cohorts. Maps showing results of vertexwise between-group comparisons of cortical thickness, area, and gyrification were produced using T1-weighted datasets processed using FreeSurfer 5.3, followed by validated quality control protocols. RESULTS: FEP subjects showed large clusters of increased area and gyrification relative to HC in prefrontal and insuli cortices (Cohen's d: 0.049 to 0.28). These between-group differences occurred partially beyond the effect of sample. ChSch subjects displayed reduced cortical thickness relative to HC in smaller fronto-temporal foci (d: -0.73 to -0.35), but not beyond the effect of sample. Differences between FEP and HC subjects were associated with male gender, younger age, and earlier illness onset, while differences between ChSch and HC were associated with treatment-resistance and first-generation antipsychotic (FGA) intake independently of sample effect. CONCLUSIONS: Separate assessments of FEP and ChSch revealed abnormalities that differed in regional distribution, phenotypes affected and effect size. In FEP, associations of greater cortical area and gyrification abnormalities with earlier age of onset suggest an origin on anomalous neurodevelopment, while thickness reductions in ChSch are at least partially explained by treatment-resistance and FGA intake. Associations of between-group differences with clinical variables retained statistical significance beyond the effect of sample.

Deficits in short-term memory binding are detectable in individuals with brain amyloid deposition in the absence of overt neurodegeneration in the Alzheimer's disease continuum.

The short-term memory binding (STMB) test involves the ability to hold in memory the integration between surface features, such as shapes and colours. The STMB test has been used to detect Alzheimer's disease (AD) at different stages, from preclinical to dementia, showing promising results. The objective of the present study was to verify whether the STMB test could differentiate patients with distinct biomarker profiles in the AD continuum. The sample comprised 18 cognitively unimpaired (CU) participants, 30 mild cognitive impairment (MCI) and 23 AD patients. All participants underwent positron emission tomography (PET) with Pittsburgh compound-B labelled with carbon-11 ([11C]PIB) assessing amyloid beta (Aß) aggregation (A) and 18fluorine-fluorodeoxyglucose ([18F]FDG)-PET assessing neurodegeneration (N) (A-N- [n = 35]); A+N- [n = 11]; A+ N+ [n = 19]). Participants who were negative and positive for amyloid deposition were compared in the absence (A-N- vs. A+N-) of neurodegeneration. When compared with the RAVLT and SKT memory tests, the STMB was the only cognitive task that differentiated these groups, predicting the group outcome in logistic regression analyses. The STMB test showed to be sensitive to the signs of AD pathology and may represent a cognitive marker within the AD continuum.