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Since 1st light in 2002, HARPS has been setting the standard in the exo-planet detection by radial velocity (RV) measurements[1]. Based on this experience, our consortium is developing a high accuracy near-infrared RV spectrograph covering YJH bands to detect and characterize low-mass planets in the habitable zone of M dwarfs. It will allow RV measurements at the 1-m/s level and will look for habitable planets around M- type stars by following up the candidates found by the upcoming space missions TESS, CHEOPS and later PLATO. NIRPS and HARPS, working simultaneously on the ESO 3.6m are bound to become a single powerful high-resolution, high-fidelity spectrograph covering from 0.4 to 1.8 micron. NIRPS will complement HARPS in validating earth-like planets found around G and K-type stars whose signal is at the same order of magnitude than the stellar noise. Because at equal resolving power the overall dimensions of a spectrograph vary linearly with the input beam etendue, spectrograph designed for seeing-limited observations are large and expensive. NIRPS will use a high order adaptive optics system to couple the starlight into a fiber corresponding to 0.4” on the sky as efficiently or better than HARPS or ESPRESSO couple the light 0.9” fiber. This allows the spectrograph to be very compact, more thermally stable and less costly. Using a custom tan(θ)=4 dispersion grating in combination with a start-of-the-art Hawaii4RG detector makes NIRPS very efficient with complete coverage of the YJH bands at 110’000 resolution. NIRPS works in a regime that is in-between the usual multi-mode (MM) where 1000’s of modes propagates in the fiber and the single mode well suited for perfect optical systems. This regime called few-modes regime is prone to modal noise- Results from a significant R and D effort made to characterize and circumvent the modal noise show that this contribution to the performance budget shall not preclude the RV performance to be achieved.

Editors: Amanda Harris.

Objective: To update the Spanish Society of Neurology's guidelines for subarachnoid haemorrhage diagnosis and treatment. Material and methods: A review and analysis of the existing literature. Recommendations are given based on the level of evidence for each study reviewed. Results: The most common cause of spontaneous subarachnoid haemorrhage (SAN) is cerebral aneurysm rupture. Its estimated incidence in Spain is 9/100 000 inhabitants/year with a relative frequency of approximately 5% of all strokes. Hypertension and smoking are the main risk factors. Stroke patients require treatment in a specialised centre. Admission to a stroke unit should be considered for SAH patients whose initial clinical condition is good (Grades I or II on the Hunt and Hess scale). We recommend early exclusion of aneurysms from the circulation. The diagnostic study of choice for SAH is brain CT (computed tomography) without contrast. If the test is negative and SAH is still suspected, a lumbar puncture should then be performed. The diagnostic tests recommended in order to determine the source of the haemorrhage are MRI (magnetic resonance imaging) and angiography. Doppler ultrasonography studies are very useful for diagnosing and monitoring vasospasm. Nimodipine is recommended for preventing delayed cerebral ischaemia. Blood pressure treatment and neurovascular intervention may be considered in treating refractory vasospasm. Conclusions: SAH is a severe and complex disease which must be managed in specialised centres by professionals with ample experience in relevant diagnostic and therapeutic processes. (C) 2012 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L. All rights reserved.

El objetivo de estudio fue analizar la metodología de enseñanza de los deportes de invasión en Educación Primaria. Para ello, se validó y diseñó un cuestionario con las siguientes dimensiones: cuantificación de la programación sobre deportes invasión y disciplinas impartidas, metodología horizontal o vertical, situaciones de aprendizaje utilizadas y creencias metodológicas. El cuestionario fue respondido por 151 maestros de Educación Física de Sevilla. Los resultados reflejan que los maestros dedican una gran cantidad de su programación a los deportes de invasión. Baloncesto, fútbol y balonmano son las disciplinas más impartidas. Los maestros de Educación Física utilizan mayormente una metodología vertical. Las situaciones de aprendizaje de igualdad numérica son las más utilizadas para enseñar deportes invasión. Por último, las creencias metodológicas de los maestros se orientan hacia un aprendizaje activo. The aim of this study was to analyze teaching methodology in invasion games in Primary Education. For this purpose, a questionnaire with the following parameters was drawn up and validated: Quantification of the programs involving invasion games and disciplines taught, horizontal or vertical methodologies, learning situations and learning situations and methodological approaches used. The questionnaire was answered by 151 physical education teachers in Seville. The results show that teachers the teachers devote a large proportion of their teaching programs to invasion games. Basketball, football and handball are the most taught. A vertical approach is generally applied by physical education teachers. Learning situations of numerical equality are the most used for the teaching of invasion games. Finally, the methodological approaches of the teachers are focused on active learning.

Introduction: Update of Acute Ischaemic Stroke Treatment Guidelines of the Spanish Neurological Society based on a critical review of the literature. Recommendations are made based on levels of evidence from published data and studies. Development: Organized systems of care should be implemented to ensure access to the optimal management of all acute stroke patients in stroke units. Standard of care should include treatment of blood pressure (should only be treated if values are over 185/105 mmHg), treatment of hyperglycaemia over 155 mg/dl, and treatment of body temperature with antipyretic drugs if it rises above 37.5 degrees C. Neurological and systemic complications must be prevented and promptly treated. Decompressive hemicraniectomy should be considered in cases of malignant cerebral oedema. Intravenous thrombolysis with rtPA should be administered within 4.5 hours from symptom onset, except when there are contraindications. Intra-arterial pharmacological thrombolysis can be considered within 6 hours, and mechanical thrombectomy within 8 hours from onset, for anterior circulation strokes, while a wider window of opportunity up to 12-24 hours is feasible for posterior strokes. There is not enough evidence to recommend routine use of the so called neuroprotective drugs. Anticoagulation should be administered to patients with cerebral vein thrombosis. Rehabilitation should be started as early as possible. Conclusion: Treatment of acute ischaemic stroke includes management of patients in stroke units. Systemic thrombolysis should be considered within 4.5 hours from symptom onset. Intraarterial approaches with a wider window of opportunity can be an option in certain cases. Protective and restorative therapies are being investigated (C) 2011 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L. All rights reserved.

Introduction: Update of Acute Ischaemic Stroke Treatment Guidelines of the Spanish Neurological Society based on a critical review of the literature. Recommendations are made based on levels of evidence from published data and studies. Development: Organized systems of care should be implemented to ensure access to the optimal management of all acute stroke patients in stroke units. Standard of care should include treatment of blood pressure (should only be treated if values are over 185/105 mmHg), treatment of hyperglycaemia over 155 mg/dl, and treatment of body temperature with antipyretic drugs if it rises above 37.5 degrees C. Neurological and systemic complications must be prevented and promptly treated. Decompressive hemicraniectomy should be considered in cases of malignant cerebral oedema. Intravenous thrombolysis with rtPA should be administered within 4.5 hours from symptom onset, except when there are contraindications. Intra-arterial pharmacological thrombolysis can be considered within 6 hours, and mechanical thrombectomy within 8 hours from onset, for anterior circulation strokes, while a wider window of opportunity up to 12-24 hours is feasible for posterior strokes. There is not enough evidence to recommend routine use of the so called neuroprotective drugs. Anticoagulation should be administered to patients with cerebral vein thrombosis. Rehabilitation should be started as early as possible. Conclusion: Treatment of acute ischaemic stroke includes management of patients in stroke units. Systemic thrombolysis should be considered within 4.5 hours from symptom onset. Intraarterial approaches with a wider window of opportunity can be an option in certain cases. Protective and restorative therapies are being investigated (C) 2011 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L. All rights reserved.

Background and Objective: To update the ad hoc Committee of the Cerebrovascular Diseases Study Group of The Spanish Neurological Society guidelines on prevention of ischaemic stroke (IS) and Transient Ischaemic Attack (TIA). Methods: We reviewed the available evidence on ischaemic stroke and TIA prevention according to aetiological subtype. Levels of evidence and recommendation levels are based on the classification of the Centre for Evidence-Based Medicine. Results: In atherothrombotic IS, antiplatelet therapy and revascularization procedures in selected cases of ipsilateral carotid stenosis (70%-90%) reduce the risk of recurrences. In cardioembolic IS (atrial fibrillation, valvular diseases, prosthetic valves and myocardial infarction with mural thrombus) prevention is based on the use of oral anticoagulants. Preventive therapies for uncommon causes of IS will depend on the aetiology. In the case of cerebral venous thrombosis oral anticoagulation is effective. Conclusions: We conclude with recommendations for clinical practice in prevention of IS according to the aetiological subtype presented by the patient. (c) 2011 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L. All rights reserved.

Intracerebral haemorrhage accounts for 10%-15% of all strokes; however it has a poor prognisis with higher rates of morbidity and mortality. Neurological deterioration is often observed during the first hours after onset and determines poor prognosis. Intracerebral. haemorrhage, therefore, is a neurological emergency which must be diagnosed and treated properly as soon as possible. In this guide we review the diagnostic procedures and factors that influence the prognosis of patients with intracerebral haemorrhage and we establish recommendations for the therapeutic strategy, systematic diagnosis, acute treatment and secondary prevention for this condition. (C) 2011 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L. All rights reserved.

Objective: To update the ad hoc Committee of the Cerebrovascular Diseases Study Group of The Spanish Neurological Society guidelines on prevention of ischaemic stroke (IS) and transient ischaemic attack (TIA). Methods: We reviewed available evidence on risk factors and means of modifying them to prevent ischaemic stroke and TIA. Levels of evidence and recommendation grades are based on the classification of the Centre for Evidence-Based Medicine. Results: This first section summarises the recommendations for action on the following factors: blood pressure, diabetes, lipids, tobacco and alcohol consumption, diet and physical activity, cardio-embolic diseases, asymptomatic carotid stenosis, hormone replacement therapy and contraceptives, hyperhomocysteinemia, prothrombotic states and sleep apnea syndrome. Conclusions: Changes in lifestyle and pharmacological treatment for hypertension, diabetes mellitus and dyslipidemia, according to criteria of primary and secondary prevention, are recommended for preventing ischemic stroke. (C) 2011 Sociedad Espanola de Neurologia. Published by Elsevier Espana, S.L. All rights reserved.

Intracranial stenoses (IS) are known to be a manifestation of atherosclerosis and a cause of cerebral ischemia, although very few clinical reports have appeared describing such patients in our milieu.The aim of this study was to describe the vascular risk factors, clinical presentation, radiological characteristics, aetiological role played in strokes and the vessels affected in a series of Spanish patients suffering from stroke and IS.We conducted a retrospective descriptive study of patients admitted to the Cerebrovascular Pathology Unit with strokes and IS between 1990 and 2001. Data collected included: age, sex, arterial hypertension (AHT), diabetes (Db), hypercholesterolemia (HC), smoking (Sm), ischemic or emboligenic heart disease, intermittent claudication, carotid atheromatosis, clinical presentation of stroke and earlier lesions in computerised axial tomography (CAT) scans of the brain.132 patients; 187 stenotic vessels: 65.7% males, mean age 68.3 years. AHT 65%, Db 39%, HC 40%, Sm 43%, ischemic heart disease 22%, emboligenic heart disease 17%, intermittent claudication 13%.TIA 16%, LACI 33%; PACI 25%, TACI 4%, POCI 19%. Significant carotid atheromatosis 26.5%. Symptomatic IS 50%: mean age 63.3 years, 64% females. Arteries affected: vertebral (VA) 28%; middle cerebral (MCA) 27%; carotid siphon 21%; basilar (BA) 10% (65% symptomatic); anterior cerebral (ACA) 5% and posterior cerebral (CPA) 4%. Normal cranial CAT scan 24%, lacunar infarcts 42%, territorial 32%; leukoaraiosis 17%.Patients with stroke and IS display different clinical profiles according to their sex (males: a higher number of vascular risk factors and clinical involvement of other territories; females are more symptomatic, AHT and HC); they usually present clinically as lacunar syndromes, with a scarce amount of significant atheromatous carotid involvement, except IS of the VA, and IS of the BA are the most symptomatic.

It has been postulated that serotonin may play a more important role in hypertension in the elderly than in younger patients (Hansson & Hedner 1986). Ketanserin is predominantly an S2-serotonergic antagonist that inhibits serotonin-induced vasoconstriction and platelet aggregation in patients with arterial hypertension and other cardiovascular diseases such as peripheral arterial obstructive pathology (De Cree et al. 1985a). Furthermore, ketanserin seems to be more effective in elderly hypertensive patients than in younger patients. This age-related antihypertensive effect could be compatible with some serotonergic component which is more manifest in older patients (De Cree et al. 1985b). The earliest apparent haemodynamic abnormality in hypertension, aside from increased total peripheral resistance, is related to a decreased left ventricular diastolic function (Inouye et al. 1984). Ketanserin does not appear to alter this important determinant of cardiac function at rest when evaluated in a 2-month treatment period (Sanchez et al. 1986a). The aim of the present study was to evaluate the effects of ketanserin in elderly hypertensives during I year's treatment, with special emphasis on left ventricular function. 1. Methods

Thrombolysis in acute ischemic stroke (IS) is limited by the short time window. However, this can be improved with adequate coordination of all the professionals and procedures involved in acute stroke treatment.A multicenter, observational, prospective study conducted in IS patients treated with intravenous recombinant tissue plasminogen activator between January 2003 and May 2007 was performed. A descriptive analysis of epidemiologic and clinical variables was conducted. Temporal analysis of safety, efficacy and quality parameters was carried out with the Auto-Regressive Integrated Moving Average (ARIMA) (p, d, q) models.From January 2003 to 2007, 324 patients were included (56% males; median age: 65.6). A total of 53.6 % became independent at 3 months (score 0-2 on the Modified Rankin Scale). Mortality rate 3 months after treatment was 15.7% and 3.7% suffered symptomatic intracranial bleeding. The temporal analysis showed a significant increase of thrombolysis, from a mean of 2 procedures per month to 20 (p0.0001). There was a significant increase in the percentage of 3-month independent patients (0.83% [ARIMA] (1, 0, 1) p0.0001).Intravenous thrombolysis is a safe and effective procedure for the treatment of IS in the clinical practice. As the experience of all the professionals involved in IS treatment increases, the number of patients who receive iv rtPA increases, with better outcome. Temporal analysis by ARIMA models is useful in planning health policies.

The hemodynamic effects of a new drug: molsidomine (M) were evaluated in 9 patients with congestive myocardiopathy. To that end, with a 4-channel Swan-Ganz catheter and cardiac output computer, the following hemodynamic parameters were measured in the control condition (CC) and 5, 15 and 30 minutes after sublingual administration of 4 mg of M: heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), cardiac index (CI), stroke volume index (SVI), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR) and the stroke work index (SWI). Comparing the data in CC and at the end of the study, we found a decrease of 80 +/- 5 to 76 +/- 5 b/m (p less than 0.01) in HR, of 91 +/- 4 to 84 +/- 4 mmHg (p less than 0.01) in MAP and of 3087 +/- 151 to 2758 +/- 131 d/c/s-5 in SVR (p less than 0.02); a drop in PWP of 27 +/- 3 to 20 +/- 3 mmHg (p less than 0.001) and in PVR of 1367 +/- 293 to 1115 +/- 256 d/c/s-5 (p less than 0.001); an increase in SVI of 31 +/- 3 to 34 +/- 2 ml/b/m2 (p less than 0.05) and non-significant changes in CI of 2380 +/- 96 to 2459 +/- 82 ml/m2 (p less than 0.03) and in the SWI of 34 +/- 4 to 37 +/- 4 gm/m2 (p less than 0.1). We conclude that in patients with severe heart failure, the fundamental effects of M appears to be vasodilation in both pulmonary and systemic circulations demonstrated by a fall in PWP, PVR, MAP and SVR together with a mild increase in SVI without significant changes in CI and SWI.

The appearance of transient ischemic attacks (TIA) is an important sign of vascular risk. The maximum time the deficit lasts has been set arbitrarily at 24 hours. It is assumed that TIA does not entail permanent vascular lesions.A retrospective review of the clinical records of patients diagnosed as suffering from TIA in our centre between 1996 and 1997. Analysis of associated risk factors (RF), duration and findings in neuroimaging.The clinical records of 173 patients (106 males) were examined. The RF identified were similar to those described for ischemic strokes. 45.6% of patients with a history of vascular pathologies received no preventative treatment. 58% of the TIA were resolved within the first 30 minutes and 71% within the first hour. Cranial CT was normal in 69%, showed old lesions in 26% and lesions that were compatible with the clinical signs of TIA in 5% (in the latter case the duration of the episodes was greater).TIA shares the same RF and aetiopathogenic mechanisms as ischemic stroke and should, therefore, be considered as such. There is a need to revise the concept of TIA paying special attention to the findings of neuroimaging or to establish duration limits that are better matched to the practical reality. TIA maintains a practical interest since it provides a simple method of identifying patients with a high vascular risk.

Stroke is the main cause of admission to Neurology departments and cardioembolic stroke (CS) is one of the most common subtypes of stroke.A multicentre prospective observational study was performed in 5 Neurology departments in public hospitals in the Region of Madrid (Spain). The objective was to estimate the use of healthcare resources and costs of acute CS management. Patients with acute CS at48h from onset were recruited. Patients' socio-demographic, clinical, and healthcare resource use data were collected during hospitalisation and at discharge up to 30 days after admission, including data for rehabilitation treatment after discharge.During an 8-month recruitment period, 128 patients were recruited: mean age, 75.3±11.25; 46.9% women; mortality rate, 4.7%. All patients met the CS diagnostic criteria established by GEENCV-SEN, based on medical history or diagnostic tests. Fifty per cent of the patients had a history of atrial fibrillation and 18.8% presented other major cardioembolic sources. Non-valvular atrial fibrillation was the most frequent cause of CS (33.6%). Data for healthcare resource use, given a mean total hospital stay of 10.3±9.3 days, are as follows: rehabilitation therapy during hospital stay (46.9%, mean 4.5 days) and after discharge (56.3%, mean 26.8 days), complications (32%), specific interventions (19.5%), and laboratory and diagnostic tests (100%). Head CT (98.4%), duplex ultrasound of supra-aortic trunks (87.5%), and electrocardiogram (85.9%) were the most frequently performed diagnostic procedures. Average total cost per patient during acute-phase management and rehabilitation was €13,139. Hospital stay (45.0%) and rehabilitation at discharge (29.2%) accounted for the largest part of resources used.Acute CS management in the Region of Madrid resulted consumes large amounts of resources (€13,139), mainly due to hospital stays and rehabilitation.