Frontal white and gray matter abnormality in gambling disorder: A multimodal MRI study.

Background: Changes in brain structural connections appear to be important in the pathophysiology of substance use disorders, but their role in behavioral addictions, such as gambling disorder (GD), is unclear. GD also offers a model to study addiction mechanisms without pharmacological confounding factors. Here, we used multimodal MRI data to examine the integrity of white matter connections in individuals with GD. We hypothesized that the affected areas would be in the fronto-striatal-thalamic circuit. Methods: Twenty individuals with GD (mean age: 64 years, GD duration: 15.7 years) and 40 age- and sex-matched healthy controls (HCs) underwent detailed clinical examinations together with brain 3T MRI scans (T1, T2, FLAIR and DWI). White matter (WM) analysis involved fractional anisotropy and lesion load, while gray matter (GM) analysis included voxel- and surface-based morphometry. These measures were compared between groups, and correlations with GD-related behavioral characteristics were examined. Results: Individuals with GD showed reduced WM integrity in the left and right frontal parts of the corona radiata and corpus callosum (pFWE < 0.05). WM gambling symptom severity (SOGS score) was negatively associated to WM integrity in these areas within the left hemisphere (p < 0.05). Individuals with GD also exhibited higher WM lesion load in the left anterior corona radiata (pFWE < 0.05). GM volume in the left thalamus and GM thickness in the left orbitofrontal cortex were reduced in the GD group (pFWE < 0.05). Conclusions: Similar to substance addictions, the fronto-striatal-thalamic circuit is also affected in GD, suggesting that this circuitry may have a crucial role in addictions, independent of pharmacological substances.

Asociación de la gamma glutamil transferasa con la presencia y progresión de calcificaciones aórticas abdominales y con cambios en densidad mineral ósea / Association of gamma glutamyl transferase in the presence and progression of abdominal aortic calcifications and changes to bone mineral density

Introducción y objetivo: la calcificación aórtica abdominal (CAA) es predictora de eventos cardiovasculares. El objetivo de este trabajo fue valorar la asociación de la gamma glutamil transferasa (GGT) con presencia y progresión de CAA y los cambios en densidad mineral ósea (DMO) en columna lumbar y cuello femoral. Material y métodos: se seleccionaron 326 hombres y mujeres mayores de 50 años que realizaron un cuestionario, dos radiografías laterales dorso-lumbares y DMO, repitiendo a los 4 años las mismas pruebas y un estudio analítico. Resultados: la presencia y progresión de CAA (nuevas o mayor severidad) fue inferior en el cuartil 1 (Q1) de GGT respecto a los otros cuartiles (40 % vs. 58 %, p = 0,021; 24 % vs. 44 %, p = 0,022). Comparado con Q1, el análisis de regresión logística ajustado por confusores mostró que los Q2 y Q4 se asociaron con aumentos en la presencia de CAA [odds ratio (OR) = 2,53, intervalo de confianza del 95 % (IC 96 %) = (1,22-5,25) y OR = 3,04, IC 95 % = (1,36-6,77)] y Q2, Q3 y Q4 se asociaron con aumentos en progresión de CAA [OR = 2,24, IC 95 % = (1,07-4,67); OR = 2,35, IC 95 % = (1,09-5,07) y OR = 3,47, IC 95 % = (1,56-7,70)]. El análisis multivariante por sexos mostró que tanto en hombres como mujeres el Q4 de GGT se asoció con progresión de CAA [OR = 3,27, IC 95 % = (1,14-9,36) y OR = 3,26, IC 95 % = (1,03-10,29) respectivamente] y en mujeres con mayores pérdidas de DMO a nivel lumbar. No hubo efecto con respecto a la prevalencia de CAA. Conclusiones: valores elevados de GGT podrían ser un indicador de presencia y progresión de CAA en población mayor de 50 años. De forma separada por sexo, los mayores niveles de GGT se asociaron con progresión de CAA, siendo un marcador pronóstico de daño cardiovascular.(AU)

Introduction and objective: abdominal aortic calcification (AAC) is a predictor of cardiovascular events. This study aimedto assess the association of gamma glutamyl transferase (GGT) in the presence and progression of AAC, as well as changesto bone mineral density (BMD) in the lumbar spine and femoral neck.Materials and methods: a total of 326 men and women over 50 years of age were selected for this study. They completeda questionnaire, underwent two lateral dorso-lumbar spine X-rays, and BMD measurements. The same tests and 1 analyticalassessment were repeated after 4 years.Results: the presence and progression of AAC (new occurrences or increased severity) were lower in GGT quartile 1 (Q1)compared with the other quartiles (40 % vs 58 %; p = 0.021; 24 % vs 44 %; p = 0.022). Compared with Q1, the confound -ers-adjusted logistic regression analysis showed that Q2 and Q4 were associated with more presence of AAC [odds ratio(OR), 2.53; 95 % confidence interval (95 % CI), 1.22-5.25 and OR, 3.04; 95 % CI, 1.36-6.77]. Additionally, Q2, Q3, and Q4were associated with more AAC progression [OR, 2.24; 95 % CI, 1.07-4.67; OR, 2.35; 95 % CI, 1.09-5.07; and OR, 3.47;95 % CI, 1.56-7.70]. The gender-stratified multivariate analysis revealed that in both men and women, the Q4 of GGT wasassociated with AAC progression [OR, 3.27; 95 % CI, 1.14-9.36, and OR, 3.26; 95 % CI, 1.03-10.29, respectively], and inwomen alone, with greater lumbar BMD losses. There were no effects regarding the prevalence of AAC.Conclusions: elevated GGT levels could serve as an indicator of the presence and progression of AAC in individuals olderthan 50 years. When analyzed separately by gender, higher GGT levels were associated with AAC progression, which actedas a prognostic marker for cardiovascular disease.(AU)

Abnormal frontostriatal connectivity and serotonin function in gambling disorder: A preliminary exploratory study.

Background: The neurobiological mechanisms of gambling disorder are not yet fully characterized, limiting the development of treatments. Defects in frontostriatal connections have been shown to play a major role in substance use disorders, but data on behavioral addictions, such as gambling disorder, are scarce. The aim of this study was to 1) investigate whether gambling disorder is associated with abnormal frontostriatal connectivity and 2) characterize the key neurotransmitter systems underlying the connectivity abnormalities. Methods: Fifteen individuals with gambling disorder and 17 matched healthy controls were studied with resting-state functional connectivity MRI and three brain positron emission tomography scans, investigating dopamine (18F-FDOPA), opioid (11C-carfentanil) and serotonin (11C-MADAM) function. Frontostriatal connectivity was investigated using striatal seed-to-voxel connectivity and compared between the groups. Neurotransmitter systems underlying the identified connectivity differences were investigated using region-of-interest and voxelwise approaches. Results: Individuals with gambling disorder showed loss of functional connectivity between the right nucleus accumbens (NAcc) and a region in the right dorsolateral prefrontal cortex (DLPFC) (PFWE <0.05). Similarly, there was a significant Group x right NAcc interaction in right DLPFC 11C-MADAM binding (p = 0.03) but not in 18F-FDOPA uptake or 11C-carfentanil binding. This was confirmed in voxelwise analyses showing a widespread Group x right NAcc interaction in the prefrontal cortex 11C-MADAM binding (PFWE <0.05). Right NAcc 11C-MADAM binding potential correlated with attentional impulsivity in individuals with gambling disorder (r = -0.73, p = 0.005). Discussion: Gambling disorder is associated with right hemisphere abnormal frontostriatal connectivity and serotonergic function. These findings will contribute to understanding the neurobiological mechanism and may help identify potential treatment targets for gambling disorder.

WITHDRAWN: Dealing With the Right Side: Carcinoid Heart Disease.

The Publisher regrets that this article is an accidental duplication of an article that has already been published in Journal of Cardiothoracic and Vascular Anesthesia, 36 (2022) 2793-2802, http://dx.doi.org/10.1053/j.jvca.2021.10.030. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal.

Asociación de parámetros bioquímicos del metabolismo óseo con progresión y/o desarrollo de nuevas calcificaciones aórticas / Association of biochemical parameters of bone metabolism with progression and/or development of new aortic calcifications

Objetivo: Los parámetros bioquímicos siguen siendo la opción más utilizada para el seguimiento de pacientes con alteraciones metabólicas óseas. El objetivo del estudio fue valorar la asociación de algunos marcadores bioquímicos del metabolismo óseo con aparición y progresión de calcificaciones aórticas. Material y métodos: Se seleccionaron aleatoriamente 624 hombres y mujeres mayores de 50 años que cumplimentaron un cuestionario y a los que se realizaron dos radiografías laterales dorso?lumbares y densitometría ósea. Cuatro años más tarde, en 402 sujetos se repitieron los mismos estudios junto con un estudio bioquímico. Resultados: La edad y la proporción hombres fue superior en los que tuvieron “progresión global” de calcificación aórtica (progresión de las ya existentes más las nuevas). Los niveles séricos de calcio y calcitriol fueron significativamente superiores y los de osteocalcina significativamente inferiores en los que se observó “progresión global” de calcificación aórtica. El análisis multivariante mostró que únicamente la osteocalcina se asoció de forma independiente con “progresión global” de calcificación aórtica, con una disminución del 18% por cada incremento de 1 ng/mL en los niveles de osteocalcina (odds ratio (OR)=0,82; intervalo de confianza del 95% (IC 95%): 0,71-0,92). La categorización de la osteocalcina en terciles mostró que los sujetos del primer tercil (<4,84 ng/mL) se asociaron con mayor proporción de nuevas calcificaciones aórticas: (OR=2,45; IC 95%: 1,03-3,56) respecto al tercer tercil (>6,40 ng/mL). Conclusión: Los niveles séricos de osteocalcina podrían ser un marcador bioquímico para evaluar la aparición y/o a evolución de la calcificación aórtica. No obstante, se necesita determinar con mayor precisión como podría ejercer este efecto protector en el proceso de calcificación vascular (AU)

Objetive: Biochemical parameters continue to be the most widely used option for the follow-up of patients with bone metabolic disorders. The objective of our study was to assess the association of some biochemical markers of bone metabolism with the appearance and progression of aortic calcifications. Material and methods: In this study, 624 men and women older than 50 years were selected at random. The participants completed a questionnaire and underwent two lateral dorsal-lumbar x-rays and bone densitometry. Four years later, the same studies were repeated in 402 subjects along with a biochemical study. Results: Age and the proportion of men were higher in those who had “global progression” of aortic calcification (progression of the existing ones plus new ones). The serum levels of calcium and calcitriol were significantly higher and those of osteocalcin significantly lower in which “global progression” of aortic calcification was observed. Multivariate analysis showed that only osteocalcin was independently associated with “global progression” of aortic calcification, with an 18% decrease for each 1 ng/mL increase in osteocalcin levels (odds ratio (OR)=0, 82; 95% confidence interval (95% CI): 0.71-0.92). The categorization of osteocalcin into tertiles showed that the subjects of the first tertile (<4.84 ng/mL) were associated with a higher proportion of new aortic calcifications: (OR=2.45; 95% CI: 1.03-3, 56) with respect to the third tertile (>6.40 ng/mL). Conclusion: Serum levels of osteocalcin could be a biochemical marker to evaluate the appearance and/or evolution of aortic calcification. However, it is necessary to determine with greater precision how it could exert this protective effect in the process of vascular calcification. (AU)

Effects of calcitriol and paricalcitol on renal fibrosis in CKD.

BACKGROUND: In chronic kidney disease, the activation of the renin-angiotensin-aldosterone system (RAAS) and renal inflammation stimulates renal fibrosis and the progression to end-stage renal disease. The low levels of vitamin D receptor (VDR) and its activators (VDRAs) contribute to worsen secondary hyperparathyroidism and renal fibrosis. METHODS: The 7/8 nephrectomy model of experimental chronic renal failure (CRF) was used to examine the anti-fibrotic effects of treatment with two VDRAs, paricalcitol and calcitriol, at equivalent doses (3/1 dose ratio) during 4 weeks. RESULTS: CRF increased the activation of the RAAS, renal inflammation and interstitial fibrosis. Paricalcitol treatment reduced renal collagen I and renal interstitial fibrosis by decreasing the activation of the RAAS through renal changes in renin, angiotensin receptor 1 (ATR1) and ATR2 mRNAs levels and renal inflammation by decreasing renal inflammatory leucocytes (CD45), a desintegrin and metaloproteinase mRNA, transforming growth factor beta mRNA and protein, and maintaining E-cadherin mRNA levels. Calcitriol showed similar trends without significant changes in most of these biomarkers. CONCLUSIONS: Paricalcitol effectively attenuated the renal interstitial fibrosis induced by CRF through a combination of inhibitory actions on the RAAS, inflammation and epithelial/mesenchymal transition.

Monitoring of the intraoperative analgesia by pupillometry during laparoscopic splenectomy for splenic hydatid cyst.

Echinococcosis causes a hydatid cyst, a worldwide disease. Human beings are intermediate hosts, but dogs complete the life cycle of the cestode. The most common presentation sites are the liver and lungs. We present an unusual case of a primary splenic hydatid cyst. Open splenectomy has traditionally been the treatment of choice for splenic hydatid cysts. In recent years, minimally invasive laparoscopic surgery has been used in appropriate cases. A healthy 48-year-old woman was scheduled for laparoscopic splenectomy. We controlled the intraoperative analgesia using pupillometry. We used it as a method to evaluate the depth of analgesia and to guide opioid administration based on the pupillary dilation reflex. This is regulated by the autonomous sympathetic system. It appears to be more sensitive and reliable than using simple variations in heart rate and blood pressure. It is an easy and safe to use method that might allow a reduction in postoperative analgesic requirements.

Síndrome de Meigs / Meigs’ syndrome

No disponible

Falso incremento de la hormona estimulante del tiroides asociado a la presencia de macro-TSH / Falsely elevated levels of thyrotropin caused by macro-TSH

Mujer que presentó un importante incremento de la hormona estimulante del tiroides (TSH) (62,2 mU/L) con hormonas tiroideas dentro de los intervalos de referencia. La paciente se encontraba eutiroidea y no presentaba bocio. Se realizó un estudio inicial para determinar la posible causa del incremento en la concentración de TSH. La recuperación de TSH tras precipitación con polietilenglicol fue del 1%, sugiriendo la presencia de alguna molécula de elevado peso molecular que podría interferir en la determinación. Mediante cromatografía de exclusión, se confirmó la presencia de macro-TSH, un complejo autoinmune formado por TSH unido a una Inmunoglobulina G que es inmunorreactivo pero biológicamente inactivo, por lo que, si no se detecta, induce a una interpretación errónea de la concentración de TSH (AU)

Woman showing an important increase of serum TSH (62.2 mU/L) with thyroid hormones within the reference interval. The patient was clinically euthyroid and without goitre. Investigations were carried out to determine the origin of the unexpected high TSH. Polyethylene glycol precipitation test showed low TSH recovery (1%), indicating the presence of large molecules that could interfere with the measurement. The serum sample was fractionated by gel filtration chromatography and the presence of a macro-TSH form was confirmed, an immunoreactive but biologically inactive TSH-Immunoglobulin G autoantibody complex. Its detection is important to avoid a misleading interpretation of the TSH concentration (AU)