How Europeans move: a moderate-to-vigorous physical activity and sitting time paradox in the European Union.

OBJECTIVES: This study aimed to assess the interactions between physical activity (PA) and sedentary behaviour in a large population taking account of major sociodemographic characteristics. STUDY DESIGN: Cross-sectional population-based study. METHODS: Data from 28,031 individuals living in the European Union who were aged ≥15 years were retrieved from a cross-sectional survey, the Eurobarometer 2017. Interactions among the four mobility components (vigorous, moderate, walking activity and sitting time) were assessed at the individual level across age, gender and place of residence, and at the country level by compositional data analysis, hierarchical linear regressions and principal component analysis. RESULTS: The most frequently reported PA was walking; however, sitting time represented >95% of the reported weekly times, whereas moderate-to-vigorous PA (MVPA) represented <1%. Women reported less PA and sitting time, age decreased total PA and increased sitting time, and individuals living in large urban areas reported lower PA and higher sitting times. MVPA decreased with age (ß = -0.047, P < 0.001) and was lower in women (ß = -0.760, P < 0.001) and those living in large urban areas (ß = -0.581, P < 0.001), while walking and sitting times increased with age, being higher in women and lower in those living in rural areas. At the country level, sitting time was positively associated with moderate activity (ß = 0.389, P = 0.041) and marginally non-significant with MVPA (ß = 0.330, P = 0.087). CONCLUSIONS: Walking was the highest contributor to weekly PA, whereas sitting time was paradoxically associated with higher MVPA. Specific measures to reduce sitting time are required to achieve an active lifestyle.

Actualización en el tratamiento de la enfermedad pulmonar en fibrosis quística / Update in the treatment of lung disease in cystic fibrosis

La fibrosis quística (FQ) es una enfermedad autosómica recesiva que afecta, aproximadamente, a 1 de cada 4.500 recién nacidos vivos en las personas de raza caucásica. Está causada por mutaciones de un solo gen, localizado en el brazo largo del cromosoma 7, que codifica una proteína de 1.480 aminoácidos llamada proteína reguladora de la conducción de iones en las membranas (CFTR). Esta proteína se comporta como un canal de cloro e indirectamente controla los movimientos del sodio, bicarbonato y agua a través de las membranas celulares. Hasta el momento actual, se han identificado alrededor de 1.800 mutaciones en esta enfermedad. El descubrimiento del gen de FQ, el aislamiento de la proteína CFTR y el mejor en rendimiento de los mecanismos moleculares que determinan las manifestaciones clínicas de la FQ han sido trasladados a nuevos tratamientos. Los tratamientos para la FQ y sus manifestaciones clínicas, que son discutidos en este artículo, incluyen antibióticos inhalados, terapias de hidratación, agentes anti-inflamatorios y modificadores de proteínas. También se discuten nueves tratamientos en experimentación y desarrollo. Los objetivos de estas terapias son la mejoría del flujo espiratorio forzado en el primer segundo (FEV1), la mejoría de la calidad de vida y la disminución del uso de antibióticos y del número de exacerbaciones pulmonares (AU)

Cystic fibrosis (CF) is an autosomal recessive disorder that affects, approximately, 1 in 4,500 Caucasian births. Is caused by mutations in one gene localized in large arm of 7 chromosome which encoded a 1,480 aminoacid protein called cystic fibrosis transmembrane conductance regulator (CFTR). This protein is a channel of chloride and indirectly controlled the transport of sodium, bicarbonate and water between the cellular membranes. The discovery of the CF gene, isolation of the CFTR protein and the better understanding of molecular mechanisms behind the clinical expression of CF are being translated into new treatments. Treatments for CF and its manifestations are discussed in this article including inhaled antibiotics. Hydrator therapies, anti-inflammatory agents and protein modifiers. New and experimental treatments that are development are also discussed. Outcomes for these treatments are Forced Expiratory Volume in one second (FEV1), improvement CF-related quality of life, use of intravenous antibiotics and frequency of exacerbations and hospitalizations (AU)

[The amygdaloid complex and its implication in psychiatric disorders]. / El complejo amigdalino humano y su implicación en los trastornos psiquiátricos.

The amygdaloid complex is a group of nuclei located deep in the temporal lobe and closely involved in the limbic system. Its alteration has been associated with some psychiatric processes. In this article, an overall review was made of the published data concerning the amygdaloid complex in the most common psychiatric diseases. A damaged amygdaloid complex is commonly observed, that in the Klüver-Bucy syndrome presents the fullest expression. A decrease in the amygdaloid complex of schizophrenic patients has been observed. This finding was found bilaterally in men whereas in women it was only located in one hemisphere. This finding suggests that morphometric alterations in the amygdaloid complex are more diffuse and more severe in men with schizophrenia. This subcortical complex is larger in children with autism, but not in adolescents, in whom the amygdaloid complex volume matches the normal volume of an adolescent or an adult without this pathology. However, neuroanatomical studies have shown microscopic alterations. In patients with mood disorders, it has been reported that the left amygdaloid complex presents a lesser volume. Moreover, in frontotemporal dementia and Alzheimer disease a slight amygdaloid atrophia was found related to the healthy controls. It can be concluded that the amygdaloid complex is involved in several psychiatric processes, due to structural or functional damage. However, more studies are still needed in order to delimitate the real influence of the amygdaloid complex in these disorders.

El complejo amigdalino humano y su implicación en los trastornos psiquiátricos / The amygdaloid complex and its implication in psychiatric disorders

El complejo amigdalino es un conjunto de núcleos que se localizan en la profundidad del lóbulo temporal, y que guardan estrecha relación con el sistema límbico. Su alteración se ha asociado a un gran número de procesos psiquiátricos. En este artículo se pretende hacer una revisión de lo publicado en referencia a la implicación amigdalina en trastornos psiquiátricos comunes. En ellos se observa un complejo amigdalino alterado, siendo su máxima expresión el síndrome de Klüver-Bucy. En pacientes esquizofrénicos se ha observado una reducción del volumen amigdalino, bilateral en varones y unilateral en mujeres. Esto sugiere que las alteraciones morfométricas del complejo amigdalino están más extendidas en varones esquizofrénicos. El complejo amigdalino está aumentado en niños autistas, no siendo así en adolescentes, donde se iguala al volumen de cualquier adolescente o adulto sano. Sin embargo, estudios neuroanatómicos han demostrado patología microscópica. En los pacientes con trastornos en el estado de ánimo, se observa una cierta tendencia a presentar un complejo amigdalino izquierdo de menor volumen. El volumen amigdalino de los grupos con demencia frontotemporal y enfermedad de Alzheimer era diferente a los del grupo de control, y se ha visto una predisposición al incremento de la atrofia amigdalina. Se puede afirmar que el complejo amigdalino está implicado en numerosos procesos psiquiátricos, tanto por daño estructural de dicho complejo como por daño funcional. Sin embargo, hacen falta más estudios para delimitar la influencia real del complejo amigdalino en dichos trastornos

The amygdaloid complex is a group of nuclei located deep in the temporal lobe and closely involved in the limbic system. Its alteration has been associated with some psychiatric processes. In this article, an overall review was made of the published data concerning the amygdaloid complex in the most common psychiatric diseases. A damaged amygdaloid complex is commonly observed, that in the Klüver-Bucy syndrome presents the fullest expression. A decrease in the amygdaloid complex of schizophrenic patients has been observed. This finding was found bilaterally in men whereas in women it was only located in one hemisphere. This finding suggests that morphometric alterations in the amygdaloid complex are more diffuse and more severe in men with schizophrenia. This subcortical complex is larger in children with autism, but not in adolescents, in whom the amygdaloid complex volume matches the normal volume of an adolescent or an adult without this pathology. However, neuroanatomical studies have shown microscopic alterations. In patients with mood disorders, it has been reported that the left amygdaloid complex presents a lesser volume. Moreover, in frontotemporal dementia and Alzheimer disease a slight amygdaloid atrophia was found related to the healthy controls. It can be concluded that the amygdaloid complex is involved in several psychiatric processes, due to structural or functional damage. However, more studies are still needed in order to delimitate the real influence of the amygdaloid complex in these disorders

Tumor de la granulosa del adulto: caso clínico de presentación en la ancianidad y revisión bibliográfica / Granulosa tumour of the adult: the presentation of a case in old age and a bibliography review

Los tumores de células de la granulosa ovárica del adulto son interesantes, debido a su comportamiento impredecible y a su capacidad de producir hormonas, que puede originar alteraciones en otros órganos del aparato genital. El curso clínico de los tumores de células de la granulosa ovárica se caracteriza por su curso indolente, que tiende a la recurrencia tardía. Presentamos el caso de una paciente de 82 años con un gran tumor primario de células de la granulosa, complicado con shock hipovolémico causado por episodio metrorrágico y sangrado de metástasis pleurales. En este artículo se discuten el caso y la bibliografía relativa a las características clínicas y epidemiología de estos tumores, así como su diagnóstico, pronóstico y modalidades terapéuticas (AU)

[Risk factor prevalence and drug treatment in coronary patients at hospital discharge. Results of a national multicenter registry (3C Program)]. / Prevalencia de los factores de riesgo y tratamiento farmacológico al alta hospitalaria en el paciente coronario. Resultados de un registro multicéntrico nacional (Programa 3C).

INTRODUCTION AND OBJECTIVES: Based on the results of clinical trials the guidelines of international societies recommend secondary prevention in patients. Several surveys have shown that the application of these guidelines in clinical practice is not adequate. The aim of this study was to determine the practical application of the recommendations of these guidelines and drug prescription in patients with coronary heart disease on hospital discharge. METHODS: We included 3,215 coronary patients (myocardial infarction, angina and post-revascularization) discharged from 25 Spanish hospitals. We studied the prevalence of risk factors and the medical treatment on discharge in relation to gender, age, and clinical diagnosis. RESULTS: We found a significantly higher prevalence of risk factors, except for smoking, in women. With regards to age and diagnosis neither was, the prevalence uniform, with an increase in hypertension and diabetes being predominantly seen in the elderly as well as angina patients. Fifty-six point three percent of the patients showed a total cholesterol greater than 200 mg/dl and 88% demonstrated a LDL-cholesterol greater than 100 mg/dl. The prevalence of hypercholesterolemia and low HDL was higher among women. The prescription of betablockers and lipid-lowering drugs is low, especially in women and in patients over the age of 64 years. CONCLUSIONS: The registry of data concerning some risk factors in patient clinical files is poor. The prevalence of risk factors is higher in women. The prescription of betablockers and lipid-lowering drugs was lower than recommended, mainly among women and patients older than 64 years. There is a need for improvement in secondary prevention in coronary patients on hospital discharge.

Cortical connections of the insular and adjacent parieto-temporal fields in the cat.

We present a comprehensive analysis of the cortical connections of the insular and adjacent cortical areas in the domestic cat by using microinjections of wheat-germ agglutinin conjugated to horseradish peroxidase. We examined the identity and extent of the cortical fields connected to each area, the relative anatomical weights of the various connections, their laminar origin, and their paths across the cerebral commissures. Our main finding is that despite their relatively small size and close apposition, the connections of the insular and adjacent areas are far more widespread and more specific to each area than previously realized, suggesting that each area is involved in disparate aspects of cortical integration. The granular insular area is linked to a constellation of somatosensory, motor, premotor and prefrontal districts. The dysgranular insular area is chiefly associated with lateral prefrontal and premotor, lateral somatosensory and perirhinal cortices. The dorsal agranular insular area is connected with limbic neocortical fields, while the ventral agranular insular area is associated with an array of olfactory allocortical fields. The anterior sylvian area is associated with visual, auditory and multimodal areas, with the dorsolateral prefrontal cortex, and with perirhinal area 36. The parainsular area is linked to non-tonotopic auditory and ventromedial frontal areas. Trajectories followed by the callosal axons of each of the investigated areas are extremely divergent. As a whole, the picture of the insular region that emerges from this and a parallel study (Clascá et al., J Comp Neurol 384:456-482, 1997) is that of an extreme heterogeneity, both in terms of histological architecture and neural connections. Comparison with earlier published reports on primates suggests that most, but not all, of the areas we investigated in cats may have an direct counterpart within the insula of Old World monkeys.

Insular cortex and neighboring fields in the cat: a redefinition based on cortical microarchitecture and connections with the thalamus.

The insular areas of the cerebral cortex in carnivores remain vaguely defined and fragmentarily characterized. We have examined the cortical microarchitecture and thalamic connections of the insular region in cats, as a part of a broader study aimed to clarify their subdivisions, functional affiliations, and eventual similarities with other mammals. We report that cortical areas, which resemble the insular fields of other mammals, are located in the cat's orbital gyrus and anterior rhinal sulcus. Our data suggest four such areas: (a) a "ventral agranular insular area" in the lower bank of the anterior rhinal sulcus, architectonically transitional between iso- and allocortex and sparsely connected to the thalamus, mainly with midline nuclei; (b) a "dorsal agranular insular area" in the upper bank of the anterior rhinal sulcus, linked to the mediodorsal, ventromedial, parafascicular and midline nuclei; (c) a "dysgranular insular area" in the anteroventral half of the orbital gyrus, characterized by its connections with gustatory and viscerosensory portions of the ventroposterior complex and with the ventrolateral nucleus; and (d) a "granular insular area", dorsocaudal in the orbital gyrus, which is chiefly bound to spinothalamic-recipient thalamic nuclei such as the posterior medial and the ventroposterior inferior. Three further fields are situated caudally to the insular areas. The anterior sylvian gyrus and dorsal lip of the pseudosylvian sulcus, which we designate "anterior sylvian area", is connected to the ventromedial, suprageniculate, and lateralis medialis nuclei. The fundus and ventral bank of the pseudosylvian sulcus, or "parainsular area", is associated with caudal portions of the medial geniculate complex. The rostral part of the ventral bank of the anterior ectosylvian sulcus, referred to as "ventral anterior ectosylvian area", is heavily interconnected with the lateral posterior-pulvinar complex and the ventromedial nucleus. Present results reveal that these areas interact with a wide array of sensory, motor, and limbic thalamic nuclei. In addition, these data provide a consistent basis for comparisons with cortical fields in other mammals.

[Chronic asymptomatic intrahepatic cholestasis associated with Turner's syndrome]. / Colestasis intrahepática crónica asintomática asociada a síndrome de Turner.

Turner syndrome or the gonadal dysgenesis syndrome which is monosomic because of the lack of an X chromosome (45 X) is associated to a greater incidence of autoimmune, particularly thyroidal, disorders and inflammatory intestinal disease, but is rarely associated to hepatic disorders. A female patient with chronic asymptomatic intrahepatic cholestasis which, to our knowledge, is the first reported in Spain, is herein presented. The 40-year old patient with a 45 X karyotype, feminine phenotype was accidently found to have a chronic alteration in the hepatic profile. Hepatic biochemical tests revealed AST 59 U/L, ALT 90 U/L, GGT 201 U/L and alkaline phosphatase 320 U/L. Hepatic echography was normal. Percutaneous liver biopsy was performed demonstrating minimum changes consisting of sinusoidal dilatation and pigment accumulation in the hepatocyte biliary pole. Treatment with ursodeoxycholic acid 15 mg/kg/day was administered showing a marked decrease in the laboratory parameters during follow up. Different hypothesis which may explain the association between chronic asymptomatic intrahepatic cholestasis and Turner syndrome are discussed.

Innervation from the claustrum of the frontal association and motor areas: axonal transport studies in the cat.

The anatomical organization of the projections from the claustrum to the motor and prefrontal cortical areas of the cat's brain was investigated. Both retrograde (single horseradish peroxidase or double fluorochrome deposits in the cortex) and anterograde (peroxidase-labeled wheat germ agglutinin deposits in the claustrum) tracing techniques were used. Within the claustrum, the neurons projecting to each sector of the frontal cortex were found to be distributed according to specific patterns of segregation and overlap. Spatial segregation was particularly marked between the cell populations projecting to the various sectors of area 4. The cells projecting to the subareas of area 6 and prefrontal cortex displayed a less marked but definite segregation. The neuronal populations projecting to some sectors of areas 4, 5, and the primary somatosensory cortex known to contain homotopical representations of the body map were found intermingled in the same small claustral portions. The few double-labeled neurons found after closely adjacent fluorochrome injections indicates that, in spite of their profuse intracortical branching, claustral axons spread little within the boundaries of a single architectonic area. Anterograde transport experiments showed that claustral fibers end primarily in layers IIIb/IV, VI, and I, whereas layer V is spared. This pattern is homogeneous throughout the frontal cortex. The possible role of the claustrum as a subcortical site for organized interactions amongst wide arrays of functionally related zones of the cerebral cortex is thereby suggested.

[Percutaneous mitral valvuloplasty. Immediate results with the 30 mm diameter dilatation balloon]. / Valvuloplastia mitral percutánea. Resultados inmediatos con balón de dilatación de 30 mm de diámetro.

Percutaneous balloon dilatation of the mitral valve is a promising alternative to surgical treatment for patients with mitral stenosis. We analysed echocardiographic and haemodynamic results in 62 consecutive patients who underwent mitral dilatation with a big and one chamber balloon (30 mm diameter). The relationship between the dilatation balloon area and body surface was 4.2 (in 98% of patients it was bigger than 3.5). In the whole series we get significant improvements in the haemodynamic parameters and mitral areas (0.91 cm2 versus 1.78 cm2)(p < 0.005). According to the echocardiographic score, patients were divided in two groups. Good results (mitral area > 1.5 cm2, and final, valve area 50% greater than the initial area), were obtained in 93% of patients with a score of 8 or less, and in 45% of patients with a score bigger than 8. Seventy-five percent of patients with bad results (mitral area < 1.5 cm2) were in atrial fibrillation versus 37% of patients where we get a good results. Mortality of procedure was nulle, and two patients required surgery because of procedure failure for mitral insufficiency. We can conclude: percutaneous mitral valvuloplasty with single balloon is valid alternative, and good results can be expected if there is a good relationship between the area of balloon and patient's body-surface. The echocardiographic score and presence of atrial fibrillation can predict immediate results of this technique.

Hypothalamic connections of the insular cortex in the cat.

We have investigated the anatomical organization of the connections between the hypothalamus and the insular cortex of the cat by using retrograde and anterograde transport of horseradish peroxidase-wheat germ agglutinin. The rostroventral sectors of the insular cortex are strongly interconnected with the supramammillary and caudal lateral hypothalamic areas. The possible relationship of these connections with the well-known participation of the insular cortex in visceral and autonomic integration is discussed.

[Amygdaloid innervation of the frontal cortex in cats]. / Inervación amigdalina de la corteza frontal en el gato.

The amygdaloid complex has been reported to innervate the frontal cortex (prefrontal, premotor and motor cortex) in a variety of mammal species. We have investigated the topographic and laminar distribution of such projections in the cat by using anterograde and retrograde axonal transport of HRP and WGA-HRP. Premotor and medial prefrontal cortices, receive abundant projections from the basal magnocellular amygdaloid nucleus, while rostrolateral prefrontal or caudodorsal motor cortices are almost spared by amygdaloid projections. Striking differences are observed in the laminar patterns of distribution of amygdaloid axons in the various frontal areas. This selective areal and laminar distribution may entail noticeable functional dissimilarities. Possible roles of these neural networks and the concept of "limbic cortex" are discussed in view of these findings.

General plan of the thalamic projections to the prefrontal cortex in the cat.

This study elucidates the general pattern of the thalamocortical neurons which project to the prefrontal cortex (PfC) in the cat, on the basis of the findings obtained using different retrograde labeling techniques in a large number of animals. The injections of the retrograde tracers covered the whole extent of the PfC, and did not invade gray or white matter outside the intended targets. The labeled neurons formed a vertical paramedian band throughout the rostrocaudal extent of the thalamus. This band was densest at the mediodorsal and ventromedial nuclei regions, encroached upon neurons located more medially and laterally, and largely spared the intralaminar nuclei. There were overlaps between neuron populations projecting to different subdivisions of the PfC, or to the PfC and sectors of the motor, insular, limbic and anterior ectosylvian sulcus cortices. However, these projections to separate cortical subdivisions apparently arise from different neuron clusters, with little collateralization of the axons arising from a single thalamocortical neuron. Only the neurons of the ventromedial nucleus, seem to possess somewhat more widespread terminal axons in the cortex.

Amygdaloid projections to the motor, premotor and prefrontal areas of the cat's cerebral cortex: a topographical study using retrograde transport of horseradish peroxidase.

The topographic organization of the projections from the amygdaloid complex to the frontal (motor, premotor and prefrontal) cortex has been investigated in the cat by means of the horseradish peroxidase retrograde transport technique. While most of these projections arise from the magnocellular component of the basal nucleus, some arise also from other nuclei, such as the parvocellular basal nucleus, the corticoamygdaloid transition area and the cortical nucleus. The projections from the latter nuclei are directed to the central portions of the prefrontal cortex, both laterally and medially. No clear-cut topographic segregation appeared to exist in the distribution within the magnocellular basal nucleus of the cells of origin of projections to the motor, premotor and prefrontal cortex. The gross topographic arrangement of the amygdalocortical projections seems to reciprocate, to some extent at least, the organization of corticoamygdaloid projections from high-order sensory and polymodal association areas.

Allocortical afferent connections of the prefrontal cortex in the cat.

Afferent connections of the prefrontal cortex of the cat arising in allocortical regions have been investigated using the horseradish peroxidase retrograde transport technique. Our results demonstrate the existence of projections from the olfactory peduncle, anterior and posterior prepiriform cortices, cortico-amygdaloid transition area, entorhinal cortex, ventral, caudal and dorsal subiculum and postsubiculum to the prefrontal cortex.