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Chronic migraine (CM) with medication overuse (MO) develops in patients with a pre-existing primary headache after a regular overuse of symptomatic medication. In these patients, headache crisis may occur together with other painful pathologies which can increase the frequency and intensity of the pain episodes. Such comorbidities need to be assessed as they influence the clinical evolution of the patients. A cohort of 102 patients (89 women and 13 men) with a diagnosis of chronic migraine (CM) with medication overuse (MO) was retrospectively analysed. Patients enrolled in the study were actively followed up 23 months in the Neurology Service of the University Hospital Virgen del Rocio in Seville, Spain. We observed that most of the patients overused multiple symptomatic drugs (34.3%) and NSAIDs (26.5%). In this cohort, the most effective treatments were topiramate and the combination of multiple prophylactic drugs with an effectiveness of 41.6% and 53.8%, respectively, at the end of the study. We observed the ratio of patients reducing their headache crisis was significantly higher among patients abandoning their medication overuse. Detoxification, or withdrawal of medication overuse, is linked to the reduction of the frequency and intensity of 50% or more of the headache crisis in these patients.

The aim of this study was to implement the Robson Ten Groups Classification System (RTGCS) to identify the main contributors to the caesarean section (CS) rate and to evaluate whether the introduction of a plan of obstetrical interventions reduced this rate. An observational retrospective cross-sectional study was conducted during two time periods at Alicante University General Hospital. In the pre-implementation period (2009-2012), RTGCS was applied to identify the main groups contributing to the overall CS rate. In the post-implementation period (2013-2017), RTGCS was applied again to identify changing trends in CS rates. In all, 11,034 deliveries during the pre-intervention period and 11,453 during the post-intervention period were analysed. The overall CS rate was 23.9% and 20.9%, respectively. There were no changes in perinatal outcomes. In the post-intervention period, there was a significant decrease of the CS rate in the groups of targeted interventions 1, 2, 3, 4, 5, and 8B.Impact statementWhat is already known on this subject? High CS rates are becoming a public health problem because of risks, costs, excessive medicalisation, and abuse of resources. RTGCS provides a framework for auditing and analysing CS rates.What do the results of this study add? RTGCS can identify the groups that have the greatest impact on the CS rate and monitor changes in it consequent to policy changes.What are the implications of these findings for clinical practice? The introduction of a strategic plan with evidence-based clinical interventions may have a greater effect on the CS rate than other features justifying the increase in the incidence of CS.

One of the currently biggest challenges in NLP is to develop multilingual language technology. Lack of data in low-resources languages poses great difficulty to NLP researchers and limits NLP technology's availability to a small number of resource-rich languages. It has been shown that linguistic typology and the knowledge of language universals can help NLP in the development of multilingual resources. To contribute to this research area, we present a fuzzy approach to language universals. Our proposal combines a constraint-based formalism with fuzzy logic to define a fuzzy-gradient model to characterize linguistic universals. This model will allow us to evaluate linguistic universals and to define a universal grammar. This universal grammar will be integrated into an automatic technique to infer from linguistic data the particular grammar of any understudied natural language.

Introduction: In recent decades, mortality rates for cerebrovascular diseases (CVD) have declined significantly in many countries. This study analyses changes in CVD mortality rates in Spain (1980-2011) to determine if previously observed trends remain. Patients and methods: Data on CVD mortality rates and the population data needed for the analysis were provided by Spain's National Statistics Institute. We calculated age-specific mortality rate, age-standardised overall mortality, and age-truncated mortality (35-64 years) using the direct method and standard European population structure. Joinpoint analysis was used to estimate the percentage of annual change in rates and identify significant changes in trends. Results: CVD mortality rate decreased considerably and continuously over the last 32 years in all age groups and in both sexes in Spain. For both sexes, joinpoint analysis identifies a final period with more marked decline: 2005-2011 in women (−6.3%) and 2007-2011 in men (−7.2%). Conclusions: CVD mortality rates displayed a marked and continuous decline in Spain between 1980 and 2011. Due to the ageing of the population, doctors expect an increase in CVD prevalence and therefore its magnitude in terms of disability and healthcare costs, which poses a challenge to our health system. Resumen: Introducción: En las últimas décadas las tasas de mortalidad por enfermedades cerebrovasculares (ECV) han descendido de forma importante en muchos países. En este estudio se analizan los cambios recientes en la evolución de la mortalidad por ECV en España (1980-2011) para verificar si las tendencias observadas previamente continúan. Pacientes y métodos: Los datos de mortalidad por ECV y las poblaciones necesarias para el cálculo de los indicadores fueron facilitados por el Instituto Nacional de Estadística. Se calcularon las tasas específicas por grupos de edad y estandarizadas globales y truncadas (35-64 años) mediante el método directo (población estándar europea). Mediante análisis de regresión «joinpoint» estimamos el porcentaje de cambio anual de las tasas e identificamos puntos de cambio significativos en la tendencia. Resultados: La mortalidad por ECV se ha reducido de forma contundente y sostenida en los últimos 32 años en todos los grupos de edad y sexo en España. En ambos sexos el análisis joinpoint identifica un periodo final de mayor descenso (2005-2011 [−6,3%] en mujeres y 2007-2011 en varones [−7,2%]). Conclusiones: Existe un marcado y continuo descenso en la mortalidad por ECV en España (1980-2011). Teniendo en cuenta el proceso de envejecimiento de la población, es esperable un incremento de la prevalencia y, por ello, de la magnitud de las ECV medida en términos de discapacidad y costes de salud, lo que representará un gran reto para nuestro sistema sanitario. Keywords: Regression analysis, Cerebrovascular diseases, Epidemiology, Spain, Mortality, Trends, Palabras clave: Análisis de regresión, Enfermedad cerebrovascular, Epidemiología, España, Mortalidad, Tendencia

This paper aims to establish a link between linguistics and fuzzy phenomena. Throughout the history, linguistics has been relying on discrete descriptions to explain Natural Language Processing. This fact has a negative impact in various areas of language and technology since linguistics rejects all the inputs which are out from a discrete rule. Although this paper might approach the subject more from a linguistic than from a mathematical point of view, we present the theoretical considerations and reasoning used in elaborating a formal characterization of fuzziness in natural language grammars. Property Grammars will be used as the formal theory in order to explain Natural Language fuzziness and variability.

Rationale No neuroprotective or neurorestorative therapies have been approved for ischemic stroke. Bone marrow mononuclear cell intra-arterial transplantation improves recovery in experimental models of ischemic stroke. Aims This trial aims to test safety and efficacy of intra-arterial injection of autologous bone marrow mononuclear cell in ischemic stroke patients. Design Multicenter, prospective, phase II, randomized, controlled (non-treated group as control), assessor-blinded clinical trial. Seventy-six stroke patients will be enrolled. Patients fulfilling clinical and radiological criteria (e.g. age between 18 and 80 years, middle cerebral artery ischemic stroke with a National Institutes of Health Stroke Scale score of 6–20 within one- to seven-days from stroke onset and no lacunar stroke) will be randomized to intervention or control group (1 : 1). Bone marrow harvest and intra-arterial injection of autologous bone marrow mononuclear cell will be done in the intervention group with two different doses (2 × 106/kg or 5 × 106/kg in 1 : 1 proportion). Patients will be stratified at randomization by National Institutes of Health Stroke Scale score. Patients will be followed up for two-years. Study outcomes The primary outcome is the proportion of patients with modified Rankin Scale scores of 0–2 at 180 days. Secondary outcomes include National Institutes of Health Stroke Scale and Barthel scores at six-months, infarct volume, mortality, and seizures. Discussion This is the first trial to explore efficacy of different doses of intra-arterial bone marrow mononuclear cell in moderate-to-severe acute ischemic stroke patients. The trial is registered as NCT02178657.

Background and Purpose— Bone marrow mononuclear cell (BM-MNC) intra-arterial transplantation improves recovery in experimental models of ischemic stroke. We aimed to assess the safety, feasibility, and biological effects of autologous BM-MNC transplantation in patients with stroke. Methods— A single-blind (outcomes assessor) controlled Phase I/II trial was conducted in patients with middle cerebral artery stroke. Autologous BM-MNCs were injected intra-arterially between 5 and 9 days after stroke. Follow-up was done for up to 6 months and blood samples were collected for biological markers. The primary outcome was safety and feasibility of the procedure. The secondary outcome was improvement in neurological function. Results— Ten cases (BM-MNC-treated) and 10 control subjects (BM-MNC-nontreated) were consecutively included. Mean National Institutes of Health Stroke Scale before the procedure was 15.6. Mean BM-MNCs injected were 1.59×10 8 . There was no death, stroke recurrence, or tumor formation during follow-up, although 2 cases had an isolate partial seizure at 3 months. After transplantation, higher plasma levels of beta nerve growth factor (β-nerve growth factor) were found compared with control subjects ( P =0.02). There were no significant differences in neurological function at 180 days. A trend to positive correlation between number of CD34+ cells injected and Barthel Index was found ( r =0.56, P =0.09). Conclusions— Intra-arterial BM-MNC transplantation in subacute ischemic stroke is feasible and seems to be safe. Larger randomized trials are needed to confirm the safety and elucidate the efficacy of BM-MNC transplantation. Clinical Trial Registration-URL— www.clinicaltrials.gov . Unique identifier: NCT00761982.