Frailty and brain changes in older adults without cognitive impairment: A scoping review.

Little is known about changes in the brain associated with frailty, in particular, which brain areas could be related to frailty in older people without cognitive impairment. This scoping review mapped evidence on functional and/or structural brain changes in frail older adults without cognitive impairment. The methodology proposed by the JBI® was used in this study. The search in PubMed, PubMed PMC, BVS/BIREME, EBSCOHOST, Scopus, Web of Science, Embase, and PROQUEST was conducted up to January 2023. Studies included following the population, concepts, context and the screening and data extraction were performed by two independent reviewers. A total of 9,912 records were identified, 5,676 were duplicates and were excluded. The remaining articles were screened; 31 were read in full and 17 articles were included. The results showed that lesions in white matter hyperintensities, reduced volume of the hippocampus, cerebellum, middle frontal gyrus, low gray matter volume, cortical atrophy, decreased connectivity of the supplementary motor area, presence of amyloid-beta peptide (aß) in the anterior and posterior putamen and precuneus regions were more frequently observed in frail older adults, compared with non-frail individuals. Studies have suggested that such findings may be of neurodegenerative or cerebrovascular origin. The identification of these brain alterations in frail older adults through neuroimaging studies contributes to our understanding of the underlying mechanisms of frailty. Such findings may have implications for the early detection of frailty and implementation of intervention strategies.

Biochanin A restored the blood-brain barrier in cerebral ischemia-reperfusion in rats

SUMMARY OBJECTIVE: Blood-brain barrier is a protective layer that regulates the influx and efflux of biological materials for cerebral tissue. The aim of this study was to investigate the effects of Biochanin A on cerebral histopathology and blood-brain barrier immunohistochemically. METHODS: A total of 24 rats were assigned to three groups: sham, ischemia-reperfusion, and ischemia-reperfusion+Biochanin A. Ischemia-reperfusion was performed by occluding the left carotid artery for 2/24 h. Notably, 20 mg/kg Biochanin A was administered to rats for 7 days after ischemia-reperfusion. Blood was collected for malondialdehyde and total oxidant/antioxidant status analysis. Cerebral tissues were processed for histopathology and further for immunohistochemical analysis. RESULTS: Malondialdehyde content with total oxidant status value was significantly increased and total antioxidant status values were significantly decreased in the ischemia-reperfusion group compared with the sham group. Biochanin A treatment significantly improved scores in the ischemia-reperfusion+Biochanin A group. The normal histological appearance was recorded in the cerebral sections of the sham group. Degenerated neurons and vascular structures with disrupted integrity of the cerebral cortex were observed after ischemia-reperfusion. Biochanin A alleviated the histopathology in the cerebrum in the ischemia-reperfusion+Biochanin A group. Ischemia-reperfusion injury decreased the expression of blood-brain barrier in the ischemia-reperfusion group compared to the sham group. Administration of Biochanin A upregulated the blood-brain barrier immunoreactivity in the cerebrum by restoring blood-brain barrier. CONCLUSION: Cerebral ischemia-reperfusion caused an increase in oxidative stress and pathological lesions in the cerebrum. Biochanin A treatment restored the adverse effects of ischemia-reperfusion injury by restoring blood-brain barrier.

Factores pronósticos del deterioro cognitivo en pacientes adictos a sustancias psicoactivas / Prognostic factors of cognitive impairment in patients addicted to psychoactive substances

Introducción: Es importante considerar los daños que el consumo de sustancias psicoactivas produce al cerebro, para entender el pronóstico y la evolución del paciente, ya que puede causar deterioro cognitivo y llegar a la demencia. Objetivo: Determinar los factores pronósticos del deterioro cognitivo en pacientes adictos a sustancias psicoactivas. Método: Se desarrolló un estudio observacional, analítico y transversal. Se trabajó con los pacientes atendidos por consumos de sustancias, en un servicio de psicología, del año 2016 al 2019. Las variables estudiadas fueron: función ejecutiva, edad, ideación suicida, sexo, características clínicas del consumo, sustancia consumida, coeficiente intelectual, deterioro cognitivo, ansiedad, depresión y tiempo de consumo. Se utilizaron técnicas tanto de la estadística descriptiva, como de la estadística inferencial. Resultados: Se estudiaron 257 pacientes, con consumo fundamentalmente de alcohol y marihuana, edad promedio de 34 años, predominó el sexo masculino (89 por ciento) y una media de 17 años de consumo. El 47 por ciento de los pacientes presentó deterioro cognitivo leve y 9,34 por ciento deterioro cognitivo moderado. El deterioro cognitivo se asoció con tener tolerancia invertida (odd ratio - OR= 6,4), disfunción ejecutiva (OR= 4,2), depresión (OR= 4,1), ansiedad (OR= 2,4), consumir otras sustancias diferentes al alcohol (OR= 2,6), tener necesidad subjetiva de consumo (OR= 2,5), alterada capacidad de abstención (OR= 2,3) e ideación suicida (OR= 2,0). Conclusiones: Los factores pronósticos del deterioro cognitivo en los pacientes adictos son: tolerancia invertida, alteraciones ejecutivas, depresión, ansiedad, consumir otras drogas diferentes al alcohol, tener alterada la capacidad de abstención y presentar ideas suicidas(AU)

Introduction: It is important to consider the damage that the consumption of psychoactive substances produces to the brain, in order to understand the prognosis and evolution of the patient, since it can cause cognitive impairment and reach dementia. Objective: To determine the prognostic factors of cognitive impairment in patients addicted to psychoactive substances. Methods: An observational, analytical and cross-sectional study was developed. We worked with patients treated for substance use, in a psychology service, from 2016 to 2019. The variables studied were: executive function, age, suicidal ideation, sex, clinical characteristics of consumption, substance consumed, intelligence quotient, cognitive impairment, anxiety, depression and time of consumption. Both descriptive and inferential statistical techniques were used. Results: 257 patients were studied, with consumption mainly of alcohol and marijuana, average age of 34 years, predominantly male (89 percent) and an average of 17 years of consumption. 47 percent of the patients had mild cognitive impairment and 9.34 percent had moderate cognitive impairment. Cognitive impairment was associated with having inverted tolerance (odd ratio OR= 6.4), executive dysfunction (OR= 4.2), depression (OR= 4.1), anxiety (OR= 2.4), consuming substances other than alcohol (OR= 2.6), having subjective need for consumption (OR= 2.5), altered abstinence capacity (OR= 2.3) and suicidal ideation (OR= 2.0). Conclusions: The prognostic factors of cognitive impairment in addicted patients are: inverted tolerance, executive alterations, depression, anxiety, consuming drugs other than alcohol, having altered abstinence capacity and presenting suicidal ideation(AU)

El enigma del coronavirus - Consecuencias de la infección por el SARS-CoV-2 en el ser humano El cerebro - Gestante y recién nacido

El virus SARS-CoV-2 sigue replicándose. Sus nuevas variantes no estarían causando las muertes y hospitalizaciones graves de los años 2020 a 2022, por lo que la Organización Mundial de la Salud (OMS) ha declarado el final del estado de emergencia sanitaria. Hasta el 24 de mayo de 2023, el tablero de coronavirus de la OMS señala más de 766 millones de casos confirmados, y cerca de 7 millones de muertes en el mundo, con mayor concentración en Europa, Pacífico Occidental y América (especialmente en los E.E. U.U. y Brasil). Europa y China se preparan para los nuevos avances del virus. Por ello se recomienda precaución sanitaria y cumplir con la vacunación y refuerzos, así como elaborar nuevas vacunas. Se comenta sobre la fragilidad de los ensayos aleatorios publicados en los primeros dos años de la pandemia, así como los recientes hallazgos de cuáles enfermos con COVID podrían desarrollar COVID prolongado. Es de importancia conocer los nuevos alcances sobre la afectación del coronavirus sobre la gestante, el feto y neonato y el seguimiento inicial de los últimos.

The SARS-CoV-2 virus continues to replicate. Its new variants would not be causing the deaths and serious hospitalizations of the years 2020-2022, so the World Health Organization (WHO) has declared the end of the state of health emergency. Until May 24, 2023, the WHO coronavirus dashboard shows more than 766 million confirmed cases, and about 7 million deaths in the world, with greater concentration in Europe, Western Pacific, and America (especially the U.S.A. and Brazil). Europe and China prepare for new virus breakthroughs. Therefore, health precaution is recommended, as well as compliance with vaccination and boosters, and the development of new vaccines. We comment on the fragility of randomized trials published in the first two years of the pandemic, as well as recent findings of which patients with COVID could develop long COVID. It is important to know the new scopes on the affectation of the coronavirus on the pregnant woman, the fetus and the neonate and the initial follow-up of the latter.

Association of Transcranial Direct Current Stimulation and Neurofeedback With Declarative Memory and Cerebral Arterial Flow in University Students: Protocol for a Double-blind Randomized Controlled Study.

BACKGROUND: The performance of a task depends on ongoing brain activity, which can be influenced by attention, excitement, or motivation. Scientific studies have confirmed that mindfulness leads to better performance, health, and well-being. However, these cognitive efficiency modulating factors are nonspecific, can be difficult to control, and are not suitable to specifically facilitate neural processing. OBJECTIVE: The aim of this study is to evaluate the effects of transcranial direct current stimulation associated with neurofeedback on declarative memory and cerebral blood flow in university students. METHODS: In this study, we will use transcranial direct current stimulation, a low-cost physical resource that is easy to apply, has few adverse effects, and is associated with a neurofeedback resource. This, in turn, has been shown to be a training program capable of improving working memory function. RESULTS: Participants will be recruited between July 2022 and December 2022. This study is expected to conclude in July 2023. CONCLUSIONS: This study will provide preliminary results on the benefits of using the direct current neurostimulation and neurofeedback tools on the participants being analyzed. TRIAL REGISTRATION: Brazilian Clinical Trials Registry RBR-7zs8b5; https://ensaiosclinicos.gov.br/rg/RBR-7zs8b5. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/36294.

Hemispheric lateralization, endothelial function, and arterial compliance in chronic post-stroke individuals: A cross-sectional exploratory study.

Purpose/Aim: Cardiovascular function is controlled and regulated by a functional brain-heart axis. Although the exact mechanism is not fully understood, several studies suggest a hemispheric asymmetry in the neural control of cardiovascular function. Thus, the purpose of this study was to examine whether endothelial function and arterial compliance differ between individuals with left- and right-sided strokes.Materials and Methods: This was a cross-sectional exploratory study. Thirty individuals more than 6 months after stroke participated in the study. The endothelial function was assessed by ultrasound-measured flow-mediated dilation of the nonparetic arm brachial artery (baFMD). The arterial stiffness was assessed by measuring carotid-femoral pulse wave velocity (cfPWV) and central aortic pulse wave analysis [augmentation index (AIx), augmentation index normalized to a heart rate of 75 bpm (AIx@75) and reflection magnitude (RM)] using applanation tonometry. Results: Participants with right-sided stroke had worse endothelial function than those with left-sided stroke. This difference (baFMD = 2.51%) was significant (p = 0.037), and it represented a medium effect size (r = 0.38). Likewise, they had higher arterial stiffness than those with left-sided stroke. This difference (AIx = 10%; RM = 7%) was significant (p = 0.011; p = 0.012), and it represented a medium effect size (r = 0.48; r = 0.47).Conclusions: Our findings suggest that individuals with right-sided stroke have reduced endothelial function and arterial compliance compared to those with left-sided stroke. These data may indicate that those with right-sided strokes are more susceptible to cardiovascular events.

Anatomo-comparative study of formaldehyde, alcohol, and saturated salt solution as fixatives in Wistar rat brains.

Although formaldehyde is the most widely used and largely available fixative for preserving cadavers through decomposition prevention, it promotes darkening and weight gain, in addition to being considered carcinogenic. Ethyl alcohol has been proven a potential substitute to formaldehyde due to its effectiveness in tissue penetration, thus preventing proliferation of microorganisms; however, it can only be used alone for fixation of small parts. In view of such fixatives limitations, saturated salt solution has been widely employed based on its antimicrobial effect and ability to maintain tissue similar to the original one, in addition to exerting no hazardous effects as there is no evaporation of harmful substances. This research aimed to observe anatomical brain behaviour submitted to formaldehyde, alcohol, and saturated salt solution as fixatives. Fixatives were tested in 15 adult Wistar rats' brain, submerged in 10 ml of intended solution after removal for 4 weeks. Weight of the brains fixed in saturated salt did not change over the weeks. However, the weight of formaldehyde-fixed brains increased and the weight in alcohol-fixed brains decreased; in addition, modifications in all solutions measures were also observed. Alcohol provides a peculiar dehydrating effect as formaldehyde clearly increases the length of the pieces. Thus, since the saturated salt solution showed no important adjustment over the experimental time, it proved an efficient alternative for replacing formaldehyde and alcohol as fixative solutions of anatomical study of the brain.

Diagnóstico prenatal de síndrome de Delleman-Oorthuys

El síndrome de Delleman-Oorthuys (síndrome oculocerebrocutáneo) es un trastorno esporádico, congénito y poco frecuente caracterizado por microftalmia / anoftalmia con o sin quistes orbitales, defectos cutáneos focales y alteraciones intracraneales. Debido a la distribución asimétrica de las características clínico-radiológicas, ausencia de recurrencia dentro de la familia y su mayor frecuencia en el sexo masculino, se ha propuesto la posibilidad de mosaicismo somático o mutaciones esporádicas en la quinta o sexta semana de desarrollo fetal. Los criterios diagnósticos mínimos sugeridos incluyen microftalmia o quistes orbitales, quistes del sistema nervioso central o hidrocefalia y defectos focales de piel. Dada la variabilidad en las manifestaciones y la superposición con otros síndromes, el diagnóstico puede ser difícil, pero la detección prenatal de esta rara anomalía congénita con malformaciones cerebrales es crucial en el manejo de los recién nacidos. Los estudios por imágenes para la evaluación de las características son útiles en la identificación y diferenciación de los casos. Se presenta un caso de diagnóstico prenatal de síndrome de Delleman-Oorthuys.

Delleman-Oorthuys syndrome (oculocerebrocutaneous syndrome) is a rare, congenital, sporadic disorder characterized by microphthalmia/anophthalmia with or without orbital cysts, focal skin defects, and intracranial alterations. Due to an asymmetric distribution of the clinico-radiological features, absence of recurrence within the family and its higher frequency in males, the possibility of somatic mosaicism or sporadic mutations in the fifth or sixth week of fetal development has been proposed. Suggested minimal diagnostic criteria include microphthalmia or orbital cysts, central nervous system cysts or hydrocephalus, and focal skin defects. Given the variability of manifestations and overlap with other syndromes, diagnosis can be difficult, but prenatal detection of this rare congenital anomaly with cerebral malformations is crucial in the management of newborns. Imaging studies for evaluation of features are helpful in the identification and differentiation of cases. A case of prenatal diagnosis of Delleman-Oorthuys syndrome is presented.

Microbiota, probióticos y el comportamiento humano / Microbiota, probiotics, and the human behavior / Microbiota, probióticos e comportamento humano

En la actualidad, ha cobrado una gran importancia la relación que la microbiota intestinal mantiene con varios órganos y sistemas del cuerpo humano. Particularmente importante, son las relaciones de la microbiota con el Sistema Nervioso Central, el comportamiento y el desarrollo y tratamiento de varias enfermedades. La relación existente entre la microbiota intestinal y el cerebro se produce gracias a la actividad de estímulos neuroendocrinos y neuroinmunes que pueden actuar de forma bilateral, llegando incluso a generar modificaciones en el comportamiento del ser humano. Del mismo modo, a través de la realización de estudios clínicos y paraclínicos, se ha conseguido demostrar la asociación entre el eje microbiota-intestino-cerebro y trastornos neurológicos como la enfermedad de Parkinson o el trastorno depresivo. El objetivo del presente artículo es realizar un análisis de los principales estudios identificados en relación a la función del eje microbiota-intestino-cerebro (MIC) así como identificar la nueva evidencia acerca del uso de probióticos en el tratamiento coadyuvante de varios trastornos neuro-psiquiátricos. Se realizó una búsqueda sistemática de la bibliografía utilizando palabras claves y términos MeSH y se presentó en formato de discusión de acuerdo a los subtemas: eje microbiota-intestino-cerebro, mecanismos de acción, microbiota y su relación con el comportamiento y regulación sobre probióticos. Se concluyó que existe evidencia que demuestra la relación entre el eje microbiota-intestino-cerebro y varios trastornos neuropsiquiátricos en el ser humano. Además, que la administración de probióticos puede modificar el eje MIC y pueden constituir una alternativa de terapia coadyuvante en estos trastornos del comportamiento.

Nowadays, the relationship that the intestinal microbiota maintains with various organs and systems of the human body has gained more importance. Especially relevant are the relationships of the microbiota with the Central Nervous System, behavior, and the development and treatment of various diseases. The relationship between the intestinal microbiota and the brain is a product of neuroendocrine and neuroimmune stimuli that can act bilaterally, even generating changes in human behavior. Moreover, clinical and paraclinical studies have demonstrated the association between the microbiota-gut-brain axis and neurological disorders such as Parkinson's disease or depressive disorder. The objective of this article is to carry out an analysis of the studies concerning the function of the microbiota-gut-brain (MGB) axis, as well as to identify new evidence about the use of probiotics in the adjunctive treatment of several neuropsychiatric disorders. A systematic search of the bibliography was carried out using keywords and MeSH terms and presented in a discussion format according to the subtopics: microbiota-gut-brain axis, mechanisms of action, microbiota, and its relationship with behavior and regulation on probiotics. The conclusion was that the evidence demonstrates the relationship between the microbiota-gut-brain axis and several neuropsychiatric disorders in humans. In addition, the administration of probiotics can modify the MGB axis and constitute an alternative for adjuvant therapy in these behavioral disorders.

A relação da microbiota intestinal com vários órgãos e sistemas do corpo humano tem se tornado cada vez mais importante. Particularmente importantes são as relações da microbiota com o sistema nervoso central, o comportamento e o desenvolvimento e tratamento de várias doenças. A relação entre a microbiota intestinal e o cérebro ocorre através da atividade de estímulos neuroendócrinos e neuroimunes que podem agir bilateralmente, levando até mesmo a mudanças no comportamento humano. Da mesma forma, estudos clínicos e paraclínicos demonstraram a associação entre o eixo microbiota-cérebro-cérebro e desordens neurológicas, como a doença de Parkinson ou desordem depressiva. O objetivo deste artigo é rever os principais estudos identificados em relação ao papel do eixo microbiota-cérebro-cérebro (MIC) e identificar novas evidências sobre o uso de probióticos no tratamento adjuvante de vários distúrbios neuropsiquiátricos. Uma pesquisa sistemática da literatura foi realizada usando palavras-chave e termos MeSH e apresentada em formato de discussão de acordo com os subtemas: eixo microbiota-cérebro-cérebro, mecanismos de ação, microbiota e sua relação com o comportamento e regulamentação sobre probióticos. Concluiu-se que há evidência de uma relação entre o eixo microbiota-cérebro-cérebro e vários distúrbios neuropsiquiátricos em humanos. Além disso, a administração de probióticos pode modificar o eixo MIC e pode constituir uma terapia adjuvante alternativa nestes distúrbios comportamentais.

Neurocovid-19: efectos del COVID-19 en el cerebro / Neurocovid-19: effects of COVID-19 on the brain / Neurocovid-19: efeitos da COVID-19 no cérebro

RESUMEN En la pandemia por COVID-19 se han reportado efectos directos e indirectos sobre la salud mental, inclusive sintomatología neurológica, neuropsiquiátrica y neuropsicológica con posibles efectos a largo plazo, y se sospecha que en los próximos años podría haber un aumento de las tasas de incidencia de trastornos neurodegenerativos a nivel mundial. El objetivo de este artículo es revisar la información más actualizada sobre el daño cerebral asociado al COVID-19 y su sintomatología neuropsiquiátrica. Los mecanismos exactos del daño cerebral aún no se han esclarecido, y se requiere continuar con investigaciones longitudinales e internacionales —inclusive estudios que incluyan variables epidemiológicas, clínicas y diagnósticas— para definirlos y establecer su implicación en la salud mental, así como sus consecuencias a largo plazo.

ABSTRACT In the COVID-19 pandemic, direct and indirect effects on mental health have been reported, including neurological, neuropsychiatric, and neuropsychological symptoms with possible long-term effects. Also, it is suspected that in the coming years there could be a worldwide increase in the incidence of neurodegenerative disorders. The objective of this article is to review the most up-to-date information on brain damage associated with COVID-19, as well as the neuropsychiatric symptoms of the disease. The exact mechanisms of brain damage have not yet been clarified, and further longitudinal and international research—including studies that incorporate epidemiological, clinical, and diagnostic variables—is required to define these mechanisms and establish their impact on mental health, as well as their long-term consequences.

RESUMO Durante a pandemia de COVID-19 foram relatados efeitos diretos e indiretos na saúde mental, incluindo sintomas neurológicos, neuropsiquiátricos e neuropsicológicos com possíveis efeitos no longo prazo, e suspeita-se que nos próximos anos poderá haver um aumento nas taxas de incidência de doenças neurodegenerativas em todo o mundo. O objetivo deste artigo é revisar as informações mais atualizadas sobre os danos cerebrais associados à COVID-19 e seus sintomas neuropsiquiátricos. Os mecanismos exatos desses danos ainda não foram esclarecidos, sendo necessário continuar com pesquisas longitudinais e internacionais - incluindo estudos que contenham variáveis - epidemiológicas, clínicas e diagnósticas - para defini-los e estabelecer sua repercussão na saúde mental, bem como suas consequências no longo prazo.

Evaluación del cerebro fetal: nuevas herramientas / Fetal brain assessment: new tools

RESUMEN La evaluación del cerebro fetal es un punto imprescindible en el ultrasonido obstétrico, por la gran cantidad de malformaciones que pueden ser diagnosticadas. La guía de ISUOG nos brinda los cortes elementales para la sospecha de la patología cerebral; pero, podemos ampliar y mejorar nuestro ultrasonido con la visualización de estructuras fácilmente reproducibles, tales como el complejo anterior, cuerpo calloso, cisura de Silvio y el cuarto ventrículo. Presentamos algunas herramientas para complementar la evaluación del cerebro fetal.

ABSTRACT The evaluation of the fetal brain is an essential point in obstetric ultrasound due to the large number of malformations that can be diagnosed. The ISUOG guide provides us with the elementary sections for the suspicion of brain pathology; but we can extend and improve our ultrasound with the visualization of easily reproducible structures, such as the anterior complex, corpus callosum, Sylvian fissure and the fourth ventricle. We present some tools to complement the assessment of the fetal brain.

Effects of resveratrol on alterations in cerebrum energy metabolism caused by metabolites accumulated in type I citrullinemia in rats.

We investigated the in vitro effects of citrulline (0.1, 2.5 and 5.0 mM) and ammonia (0.01, 0.1 and 1.0 mM), and the influence of resveratrol (0.01 mM, 0.1 mM and 0.5 mM) on pyruvate kinase, citrate synthase, succinate dehydrogenase (SDH), complex II, and cytochrome c oxidase activities in cerebral cortex, cerebellum and hippocampus homogenates of 60-day-old male Wistar rats. Results showed that 2.5 and 5.0 mM citrulline decreased pyruvate kinase activity in cerebral cortex and, at a concentration of 5.0 mM, increased its activity in hippocampus. Additionally, 5.0 mM citrulline increased citrate synthase activity in the cerebellum of rats. Citrulline (5.0 mM) reduced complex II and cytochrome c oxidase activities in cerebral cortex and hippocampus. With regard to ammonia, at 0.1 and 1.0 mM, decreased complex II activity in cerebral cortex and at 1.0 mM decreased its activity in cerebellum and hippocampus. Ammonia (1.0 mM) also decreased cytochrome c oxidase activity in cerebral cortex and cerebellum of rats. Resveratrol was able to prevent most of the alterations caused by these metabolites in the biomarkers of energy metabolism measured in the cerebrum of rats. Data suggest that these alterations in energy metabolism, caused by citrulline and ammonia, are probably mediated by the generation of free radicals, which can in turn be scavenged by resveratrol.

Tratamiento con CyberKnife®: descripción de la respuesta y los efectos adversos en las metástasis cerebrales / Description of brain metastasis response and adverse effects to CyberKnife® treatment

RESUMEN Introducción: la primera causa de muerte por cáncer son las metástasis. La supervivencia media, para pacientes no tratados, es máximo de tres meses, que pueden extenderse de seis a doce con radioterapia y quimioterapia, dependiendo del tumor. La radiocirugía estereotáctica dirige la radiación ionizante a una metástasis guiada por tomografía computarizada o resonancia magnética, reduciendo así la radiación en el tejido normal y los efectos adversos. Su principal objetivo es lograr el control tumoral en los pacientes con oligometástasis. Métodos: estudio observacional, retrospectivo, con fuente mixta; se describen los resultados del tratamiento con CyberKnife® en metástasis cerebrales. Resultados: se evaluaron 31 pacientes con 62 metástasis, la edad media fue de 54 años y 74,2 % fueron mujeres. El cáncer de pulmón fue el origen más frecuente (54,8 %), La mitad de los casos tenía más de dos metástasis. La ubicación más común fue en los lóbulos frontales (33,9 %), siendo necróticas el 48,4 % de las lesiones. Hubo tratamiento previo en el 69,4 % de los tumores. Hubo radionecrosis en el 19,4 % de las lesiones, edema vasogénico en 77,4 % de ellas y recaída en 59,7 %. Se redujo el tamaño del tumor en el 80,7 % de las lesiones y se alcanzó el control tumoral en el 83,9 % de estas. Conclusión: el tratamiento con CyberKnife® logró el control en, por lo menos, cuatro quintas partes de las lesiones, con influencia de la ubicación de las metástasis en el sistema nervioso central y una aceptable prevalencia de la radionecrosis como complicación.

SUMMARY Background: Cancer ́s first cause of death are metastases. Mean survival for untreated patients is 3 months, which can extend to six or twelve months with conventional radiotherapy or chemotherapy, depending on the tumor. Stereotactic radiosurgery is a method which aims an ionizing radiation dose towards an intracranial target, guided by computarized tomography or magnetic resonance, reducing radiation on healthy brain tissue, as well as adverse effects. Its main indication is to achieve tumor control in patients with oligometastases. Methods: Retrospective, observational study, with primary and secondary sources for data, for describing results of CyberKnife® treatment. Results: Data were available for 31 patients and 62 metastases. Mean age was 54 years, 74,19% were women. Lung cancer was the most frequent primary tumor (54,8%); half of the cases had more than two metastases; most common location was frontal lobes (33,9%), being 48,4% of the tumors morphologically necrotic. There was a previous treatment in 69,4% of the tumors. There was radionecrosis in 19,4% of the metastases, vasogenic edema in 77,4% of them and relapses in 59,7% of the tumors. Tumor size was reduced in 80,7% of the metastases and tumor control was achieved in 83,9% of them. Conclusions: CyberKnife® was able to achieve control in at least four fifths of the treated metastases, with a relevant influence of metastases ́ location in central nervous and an acceptable prevalence of radionecrosis as a complication.

Reporte de un caso atípico de esquizencefalia de labio abierto / Report of an atypical case of open lip schizencephaly

RESUMEN Fundamento: la esquizencefalia de labio abierto, es una malformación del grupo de los trastornos de migración cerebral, la cual se considera como una enfermedad poco común en todo el mundo y cursa con lesiones estructurales graves, dentro de las manifestaciones clínicas más comunes se encuentran las crisis epilépticas de difícil manejo, las alteraciones en el desarrollo del lenguaje, los defectos visuales y la microcefalia. Objetivo: presentar un caso poco común de malformación cerebral, diagnosticada como consecuencia de una complicación aguda, donde se encontraron otras características atípicas neurológicas, psicológicas y oftalmológicas. Presentación del caso: mujer de 19 años, con antecedentes prenatales de una malformación congénita del sistema nervioso central que presentaba una hemiparesia espástica desde el nacimiento, pero sin convulsiones ni retraso mental. Fue admitida en servicio de urgencia por signos de hipertensión intracraneal agudos, durante su estancia se realizó tomografía axial computarizada que mostró una esquizencefalia de labio abierto. Fue operada y luego de su recuperación se realizaron exámenes neuropsicológicos y oftalmológicos que mostraron características inusuales en la paciente. Conclusiones: la presencia de un defecto motor desde el nacimiento necesita de una evaluación imagenológica para estimación estructural de las posibles malformaciones existentes, que permitirá anticiparnos a la aparición de otros síntomas o de complicaciones. La estimulación neuropsicológica precoz activará los mecanismos de plasticidad cerebral con mejora de la calidad de vida.

ABSTRACT Background: open-lip schizencephaly is a cerebral malformation of the group of cerebral migration disorders, which is considered a rare disease worldwide and has serious structural lesions, and within the most common clinical manifestations find epileptic seizures that are difficult to manage, alterations in language development, visual defects and microcephaly. Objective: to present an unusual case of brain malformation, diagnosed as a consequence of an acute complication, where other atypical neurological, psychological and ophthalmological features were found. Clinical case: 19 years old woman; with a prenatal history of a congenital malformation of the central nervous system due to a spastic hemiparesis from birth, but without seizures or mental retardation. She was admitted to the emergency department for signs of acute intracranial hypertension, and during her stay, computed tomography was performed, which showed an open lip schizencephaly. She underwent surgery and after her recovery, neuropsychological and ophthalmological exams were performed which showed unusual characteristics in the patient. Conclusions: the presence of a motor defect from birth requires an imaging evaluation for structural estimation of the possible existing malformations, which will allow us to anticipate the appearance of other symptoms or complications. The early neuropsychological stimulation will activate the mechanisms of cerebral plasticity with improvement of the quality of life.

Transtorno do espectro autista: uma revisão sistemática sobre aspectos nutricionais e eixo intestino-cérebro / Autism spectrum disorder: a systematic review about nutritional aspects and gut-brain axis

O número de indivíduos diagnosticados com o transtorno do espectro autista (TEA) registrou aumento evidente na última década. Os principais sintomas, apresentados pelo portador, são neurológicos e digestórios, estando às intervenções nutricionais dentre as terapêuticas mais promissoras para amenizar a sintomatologia clínica. Assim, objetivou-se revisar sistematicamente os estudos sobre distúrbios alimentares e do trato gastrointestinal apresentado pelo indivíduo portador do TEA, a fim de compreender como o comportamento alimentar influência na etiopatogênese e manifestações clínicas da doença, com foco no eixo intestinocérebro. Para isso realizou-se uma revisão sistemática, seguindo as diretrizes PRISMA. A partir de uma busca estruturada e abrangente em bases de dados eletrônicas, 23 estudos foram recuperados e incluídos na revisão. Os critérios de inclusão definiam ser artigos originais relacionando o TEA com alterações nutricionais e/ou com o eixo intestino-cérebro. Após análise da composição da microbiota intestinal, os estudos mostraram um quadro de desequilíbrio. Foram encontradas, também, alterações na barreira de muco e permeabilidade intestinal e alterações em proteínas envolvidas na digestão e absorção de alimentos. Dietas restritivas e a modulação da microbiota, com uso de probióticos e de antibióticos específicos, são apresentadas como estratégias terapêuticas adjuvantes promissoras. Conclui-se que o eixo intestino-cérebro está envolvido tanto na etiologia, quanto nas manifestações clínicas do TEA. Porém, não sendo certo se alterações intestinais são causa ou consequência das alterações neurológicas. Até o presente momento, a comunidade científica não tem conclusões suficientes para indicar o uso de dietas restritivas, e uso de probióticos e de antibióticos como terapêutica para o TEA.

The number of individuals diagnosed with autism spectrum disorder (ASD) had an evident increase in the last decade. The primary symptoms exhibited amongst these patients were mostly digestive and neurological disorders; with nutritional interventions being one of the most promising therapies to assuage this clinical symptomology. As such, following the PRISMA guidelines, we systematically reviewed the research studies apropos of the ASD patients manifesting said digestive disorders, to comprehend how dietary behavior can influence the etiopathogenesis and clinical manifestations of the disease, with primary focus on the gut-brain axis. From a comprehensive and structured search through electronic databases, 23 studies were retrieved and admitted in this review. The inclusion criteria defined that there be original articles consociating ASD with nutritional disorders and/or with the gut-brain axis. These studies analyzed the composition of the intestinal flora of diagnosed patients, subsequently discerning cases of varying imbalances. Alterations in the gene expression of the proteins involved in the digestion and absorption of food, the mucous barrier and the intestinal permeability were described. Accordingly, restrictive diets and the modulation of the microbiota by administering specific anti- & probiotics were initially identified as promissory therapies. In conclusion, the gut-brain axis was observed to be a determinant factor in both the etiology and clinical symptomology of ASD - though it is still debatable the correlation of intestinal alterations with neurological changes. At present, there is no concrete scientific proof accrediting to restrictive diets and the use of specific anti- & probiotics, as successful treatments for ASD.

Plasticidad cerebral, una realidad neuronal / Brain Plasticity: a neuronal reality

RESUMEN Introducción: el objeto más complejo descubierto hasta ahora en cualquier parte del universo es el órgano que ocupa el espacio comprendido entre nuestras orejas: el cerebro. No es el elevado número de neuronas individuales lo más relevante del cerebro, sino cómo están organizadas e interconectadas. Objetivo: analizar elementos teóricos y experimentales expuestos en la literatura consultada acerca de los mecanismos de plasticidad cerebral. Métodos: se realizó un estudio descriptivo a partir de una revisión bibliográfica, desde el punto de vista teórico se utilizaron los métodos histórico-lógico, análisis-síntesis e inductivo-deductivo que permitieron el análisis de las principales teorías generadas por diversos estudios experimentales acera del tema en cuestión. Desarrollo: neurocientíficos han estudiado desde entonces este enigma demostrando la existencia por diversos mecanismos de fenómenos que permiten el reordenamiento neuronal y la suplencia de funciones cerebrales en respuesta a diversos eventos patológicos o como resultado del proceso de aprendizaje y memoria. Conclusiones: tanto la experimentación animal como los estudios realizados en humanos con el empleo de modernas técnicas no invasivas respaldan las ideas de plasticidad neuronal.

ABSTRACT Introduction: brain is the most complex organ discovered up to date, due to the organization and interconnection of its individual neurons. Objective: to analyze theoretical and experimental elements stated in the medical literature reviewed about cerebral plasticity mechanisms. Methods: a descriptive study was carried out based on a bibliographic review. From the theoretical point of view historical-logical, analysis-synthesis and inductive-deductive methods were applied, which allowed the analysis of the main theories generated by different experimental studies. Development: it has been demonstrated the existence of diverse mechanisms that allocate the neuronal rearrangement and replacement of cerebral functions, in response to diverse pathological events or as a result of learning and memory process. Conclusions: both animal testing and studies carried out in human being using modern non-invasive techniques support the ideas of neuronal plasticity.

Congenital cerebral toxoplasmosis, Zika and chikungunya virus infections: a case report

We report a case of intrauterine infection by Toxoplasma gondii, Chikungunya and Zika viruses in a Colombian woman from the southern part of the country. The patient attended prenatal care in the second trimester of her pregnancy and she informed that in the first trimester she had presented with clinical symptoms compatible with Zika virus infection. Amniotic fluid PCR assays showed infection by T. gondii, chikungunya and Zika viruses. Diagnostic imaging showed fetal malformation of the central nervous system. At 29 weeks of gestation, pregnancy was terminated medically.

Toxoplasmosis cerebral congénita e infección por el virus del Zika y del chikunguña: reporte de un caso / Congenital cerebral toxoplasmosis, Zika and chikungunya virus infections: A case report

Resumen En este artículo se describe el caso clínico de una mujer colombiana del sur del país con diagnóstico de infección intrauterina por Toxoplasma gondii y por los virus del chikungunya y del Zika. La mujer acudió al control prenatal en el segundo trimestre de su embarazo e informó que durante el primer trimestre había presentado síntomas indicativos de infección por el virus del Zika. Mediante reacción en cadena de la polimerasa (PCR) en líquido amniótico, se demostró infección por Toxoplasma gondii así como por los virus del chikungunya y del Zika. En las imágenes diagnósticas se observaron malformaciones del sistema nervioso central en el feto. A las 29 semanas de gestación se dio por terminado el embarazo mediante procedimiento médico.

Abstract We report a case of intrauterine infection by Toxoplasma gondii, Chikungunya and Zika viruses in a Colombian woman from the southern part of the country. The patient attended prenatal care in the second trimester of her pregnancy and she informed that in the first trimester she had presented with clinical symptoms compatible with Zika virus infection. Amniotic fluid PCR assays showed infection by T. gondii, chikungunya and Zika viruses. Diagnostic imaging showed fetal malformation of the central nervous system. At 29 weeks of gestation, pregnancy was terminated medically.

A historical approach to the ventricular system of the brain / Una aproximación histórica del sistema ventricular en el sistema nervioso central

Abstract Introduction: The ventricular system of the brain was first described, partially, in the third century BC. Since then, several researchers have contributed to better understand this system, unraveling its position in the central nervous system, and relating it with certain functional aspects following philosophical concepts that have allowed a clearer approach to cavitations regarding the formation of the cerebrospinal fluid. Objective: To describe the most relevant concepts of the history of the ventricular encephalic system of the brain. Materials and methods: Various literature sources related to the ventricular system were consulted, and then chronologically organized, so that a more concrete approximation of the functional morphology of the ventricular system could be provided. Conclusion: Aristotle was the first to approach the ventricular system of the brain. Over time, his knowledge on the organization, function and number of cavities was debugged to the point of proposing the existence of eight ventricles. Today, five ventricles are recognized, four of which are encephalic components: two in the brain, one in the diencephalon, other in the brainstem, and a fifth in the terminal part of the spinal cord.

Resumen Introducción. El sistema ventricular encefálico se conoció, con parcialidad, en el siglo III a.C., fecha desde la que diversos investigadores contribuyeron a una mejor comprensión de dicho sistema, desentrañando sus ubicaciones en el sistema nervioso central y relacionándolos con ciertos aspectos funcionales que surgieron de conceptos filosóficos. Esto permitió un acercamiento más objetivo hacia las cavitaciones relacionadas con la formación de líquido cerebroespinal. Objetivo. Referenciar, de forma cronológica, los conceptos más trascendentes de la historia del sistema ventricular encefálico. Materiales y métodos. Se consultaron diversas fuentes bibliográficas relacionadas con el sistema ventricular, para después ordenarlas según su cronología, de modo que se concluyera con una aproximación más concreta de la morfología funcional del sistema ventricular. Conclusión. Aristóteles fue el primero en abordar el sistema ventricular encefálico, de modo que, conforme el paso de los años, su conocimiento se fue depurando en cuanto a organización, función y número de cavidades, hasta llegar a proponer la existencia de ocho ventrículos. En la actualidad se reconocen cinco ventrículos, de los cuales cuatro son componentes encefálicos: dos en cerebro, uno en diencéfalo, otro en tronco encefálico y un quinto en la parte terminal de la médula espinal.

Galactose alters markers of oxidative stress and acetylcholinesterase activity in the cerebrum of rats: protective role of antioxidants.

We evaluated the in vitro effects of galactose at 0.1, 3.0, 5.0 and 10.0 mM on thiobarbituric acid-reactive substances (TBA-RS), total sulfhydryl content, protein carbonyl content, on the activities of the antioxidant enzymes catalase (CAT), superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) and on acetylcholinesterase (AChE) activity in the cerebral cortex, cerebellum and hippocampus of rats. We also investigated the influence of the antioxidants (each at 1 mM), α-tocopherol, ascorbic acid and glutathione, on the effects elicited by galactose on the parameters tested. Results showed that galactose, at a concentration of 3.0 mM, enhanced TBA-RS levels in the hippocampus, cerebral cortex and cerebellum of rats. In the cerebral cortex, galactose at concentrations of 5.0 and 10.0 mM increased TBA-RS and protein carbonyl content, and at 10.0 mM increased CAT activity and decreased AChE activity. In the cerebellum, galactose at concentrations of 5.0 and 10.0 mM increased TBA-RS, SOD and GSH-Px activities. In the hippocampus, galactose at concentrations of 5.0 and 10.0 mM increased TBA-RS and CAT activity and at 10.0 mM decreased GSH-Px. Data showed that at the pathologically high concentration (greater than 5.0 mM), galactose induces lipid peroxidation, protein carbonylation, alters antioxidant defenses in the cerebrum, and also alters cholinesterase activity. Trolox, ascorbic acid and glutathione addition prevented the majority of alterations in oxidative stress parameters and the decrease in AChE activity that were caused by galactose. Our findings lend support to a potential therapeutic strategy for this condition, which may include the use of appropriate antioxidants for ameliorating the damage caused by galactose.