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Purpose: Ulcerative colitis (UC) can be managed with immunomodulation or surgery. We aimed to understand whether these strategies had a different impact on patients’ health-related quality of life (HRQoL). Methods: This was a retrospective, cross-sectional study: patients who had a moderate to severe UC episode that prompted the utilization of immunomodulatory drugs or surgery were invited to complete a generic (short form [36] health survey [SF-36]) and a disease-specific (inflammatory bowel disease questionnaire [IBDQ]) survey. Results: We included 157 patients, 65 (41.4%) surgically treated. The therapeutic procedure had a minimal impact on HRQoL: only the social dimension of the IBDQ and the physical function component of the SF-36 were significantly different between the study arms – lower for the surgically treated patients. The type of surgery had no impact, but the occurrence of pouchitis, namely, in a chronic form, was associated with a lower HRQoL. Regression analysis confirmed surgery as an independent predictor of lower scores in the social dimension of the IBDQ (–4.646, 95% CI –6.953 to –2.339) and in the physical functioning (–9.622, 95% CI –17.061 to –2.183) and physical role functioning (–3.669, 95% CI –7.339 to 0.001) dimensions of the SF36. Conclusions: Although usually feared by patients, surgery has a limited impact on UC patients HRQoL when compared to medical management with immunomodulatory drugs.

BackgroundChronic pain related to knee osteoarthritis (KOA) is a common health problem and functional magnetic resonance imaging (fMRI) is a useful technique which can determine different brain activation (1).ObjectivesThe main purpose of our study was to observe whether there is different risk to central sensitization and different brain activation in patients with KOA according to the treatment followed (conservative (CNV) Vs. total knee replacement (TKR))MethodsPatients diagnosed of primary KOA following a CNV treatment or undergoing TKR were recruited. The two groups were matched by age, sex and BMI. Clinical central sensitization was considered if patients presented spread tenderness, evaluated with an algometer, in more than 1 site of the extended peripatellar map (2) (notice that pain at points 3, 7 and 8 were not counted) fMRI testing involved pressure painful stimulation to the articular interline and to a commonly sensitized site (tibial surface, point 10).To evaluate the associations between central sensitization and the risk to undergo a TKR; logistic regression was performed to estimate OR and 95% confidence intervals (95%CI). Models were adjusted by sex, age and BMI (R (R v.3.5.2).Whole-brain activation maps were compared between groups using Statistical Parametric Mapping software (SPM12 http://www.fil.ion.ucl.ac.uk/spm).ResultsWomen have a significant higher risk to present central sensitization than men (OD 12,11 (95% CI 4,32-33,95) p-value:2,09*106), but no differences were observed between CNV and TKR group (OR TKR 0,69 (95% CI 0,24-1,98)) (Table 1). The differences observed in brain activation between the treatment groups in the interline fMRI test (point 7) did not correspond to any specific brain area. However, TKR group showed a higher activation that implicated the region of the amygdala and anterior hippocampus during the tibial fMRI test (point 10).Table 1.Central sensitization Odds Ratio (OR) with 95% Confidence Interval (95%CI)O.R. (95% CI)p-valueTreatment0.69 (0.24- 1.98)0,494Sex12.11 (4.32- 33.95)2,09*10-6Age0.72 (0.26- 1.97)0,525BMI1.88 (0.69- 5.17)0,219ConclusionPresenting central sensitization is not a risk for KOA patients to undergo a TKR, but the mechanism underlaying sensitization in both treatment groups might be different, with amygdala playing an important role in TKR patients. The amygdala is an important element of the brain systems that both express emotions and modulate pain. The activation of the amygdala in response to pressure stimulation on a sensitized knee site is interpreted as a failure of the descending pain inhibitory systems, and the occurrence of a major emotional response during the painful experience in patients that ultimately received TKR.References[1]Pujol, J. et al., 2017. Brain imaging of pain sensitization in patients with knee osteoarthritis. Pain, 158(9), pp.1831–1838.[2]Arendt-Nielsen L, Nie H, Laursen MB, Laursen BS, Madeleine P, Simonsen OH, Graven-Nielsen T. Sensitization in patients with painful knee osteoarthritis. Pain 2010;149:573-8Extended peripatellar map including the points tested for tenderness, and brain areas differently activated between both treatments groups during painful stimulation to point 7 (interline) and point 10 (tibial surface, a commonly sensitized site).Disclosure of InterestsNone declared

Background: Anaemia is the most common complication in patients with inflammatory bowel disease (IBD). This study aims to assess the prevalence of anaemia in IBD patients and to know its characteristics with regard to the main IBD clinical features. Methods: An observational cross-sectional multicentre study was conducted. We included all patients who had an appointment at the 15 participating centres during the period of 1 month, and who met the following selection criteria: age ≥18, diagnosis of IBD. Disease activity was evaluated by Harvey-Bradshaw Index (HBI) for Crohn's disease (CD), and by Simple Clinical Colitis Activity Index (SCCAI) for ulcerative colitis (UC). Results: One thousand three hundred and thirteen patients, were included: 54.8% female, mean age 42.8 (interquartile range (25th-75th): 31-53 years), 59% had a diagnosis of CD, 39% of UC and 2% IBD unclassified. The median follow-up since diagnosis was 7 years. The ongoing treatment was aminosalicylates (63.1%), corticosteroids (11.6%), immunomodulators (36.4%) and anti-tumour necrosis factor (27.3%). Anaemia was identified in 244 patients, representing a prevalence of 18.6% (95% CI 16.6-20.9). A majority of cases (90%) have mild/moderate anaemia (mean haemoglobin 11.3 ± 0.8 g/dl). Anaemia was significantly higher in females (p = 0.006), but there were no differences between CDs (19.1%) and UCs (17.7%; p = 0.688). Anaemia was more frequent in patients with active disease (HBI >4; SCCAI >2) than in those in clinical remission (33.6 vs. 15.6%, p < 0.001) and in patients on steroids (36.8%) vs. other treatments (p < 0.001). Only 47% of patients with anaemia were under any specific treatment (oral iron 67%; intravenous iron 41%). Conclusion: Anaemia was more frequent in patients with active disease and in those on corticosteroids. The treatment of anaemia still seems undervalued, whereas more than half of anaemic patients were not receiving any specific treatment and the use of oral iron prevails contrarily to current recommendations.

Fibromyalgia is a multisymptomatic diffuse chronic musculoskeletal pain syndrome with evidence of central nervous system dysfunction. Accordingly, non-invasive brain stimulation techniques such as transcranial direct current stimulation (tDCS) may be a complementary therapeutic resource to reduce pain perception.To review the potential effectiveness of tDCS to reduce pain in fibromyalgia, to identify the most effective neurostimulation parameters and to delimit its safety.Systematic review of prospective studies reported in PubMed and Cochrane reviews.The anodal tDCS of the left primary motor cortex, at 2mA for 20 minutes with 35 cm2 electrodes on five consecutive days, provides better results in reducing pain (14-59%), and improving sleep quality, with greater accentuation on the fifth day. The clinical improvement persists up to a minimum of 60 days (11-20% reduction of pain). Adverse effects are well tolerated and few.The experience with tDCS in fibromyalgia is still limited. However, the anodal tDCS in the left primary motor cortex can be recommended with level B (probable therapeutic efficacy) and appears to act through the modification of the sensorial processing of the pain of thalamic inhibitory circuitry.Estimulacion transcraneal por corriente directa en la fibromialgia: revision sistematica.Introduccion. La fibromialgia es un sindrome de dolor cronico difuso musculoesqueletico multisintomatico, con evidencias de una disfuncion del sistema nervioso central. Consecuentemente, tecnicas de estimulacion cerebral no invasiva, como la estimulacion transcraneal con corriente directa (tDCS), pueden ser un recurso terapeutico complementario para reducir la percepcion de dolor. Objetivos. Revisar la potencial efectividad de la tDCS para reducir el dolor en la fibromialgia, identificar los parametros mas efectivos de neuroestimulacion y delimitar su seguridad. Pacientes y metodos. Revision sistematica de estudios prospectivos registrados en PubMed y revisiones Cochrane. Resultados. La tDCS anodica de la corteza motora primaria izquierda, a 2 mA durante 20 minutos con electrodos de 35 cm2 durante cinco dias consecutivos, es la que proporciona mejores resultados en la reduccion del dolor (14-59%) y mejora de la calidad del sueño, con mayor acentuacion en el quinto dia. La mejora clinica persiste hasta un minimo de 60 dias (11-20% de reduccion del dolor). Se tolera bien y tiene escasos efectos adversos. Conclusiones. La experiencia con la tDCS en fibromialgia es todavia limitada. No obstante, la tDCS anodica en la corteza motora primaria izquierda puede recomendarse con un nivel B (probable eficacia terapeutica) y podria actuar mediante la modificacion del procesamiento sensorial del dolor de circuitos inhibitorios talamicos.

Neuropsychological assessment in individuals with intellectual disability is of utmost importance in order to determine the cognitive deficits underlying brain dysfunction and limiting intellectual functioning and adaptive behavior. However, no neuropsychological batteries in Spanish language have been created and validated for this population.To adapt the 'programa integrado de exploracion neuropsicologica-test Barcelona' and to validate the new version, the Barcelona Test for Intellectual Disability (TB-DI). To create normative data for its clinical use.The original test was modified based on data from a pilot sample of 65 individuals with intellectual disability. In order to study the psychometric properties of the TB-DI, it was administered to a sample of 170 individuals with intellectual disability and to a group of 60 individuals without it. The relevant variables for stratification of normative data were determined by means of regression models.The TB-DI was finally composed by 67 subtests grouped in eight cognitive domains and it showed good psychometric properties. Normative data were created for five groups taking into account intellectual disability level, age and acquired curricular competence. These data were organized in percentiles in a way that allows the creation of cognitive profiles in the clinical and experimental fields.The TB-DI constitutes a tool of high applicability in the population with intellectual disability. It shows adequate validity and reliability, and it has good psychometric properties. The cognitive profiles obtained by the TB-DI will provide valuable information for the treatment of adult adults with mild and moderate intellectual disability.Test Barcelona para discapacidad intelectual: un nuevo instrumento para la valoracion neuropsicologica clinica de adultos con discapacidad intelectual.Introduccion. La evaluacion neuropsicologica en las personas con discapacidad intelectual es importante para determinar los deficits cognitivos especificos que subyacen a la afectacion cerebral, limitan el funcionamiento intelectual y afectan al comportamiento adaptativo. A pesar de ello, no existen baterias neuropsicologicas en castellano adaptadas y validadas para esta poblacion. Objetivo. Adaptar el programa integrado de exploracion neuropsicologica-test Barcelona y validar la nueva version, el test Barcelona para discapacidad intelectual (TB-DI), estableciendo datos normativos para el empleo clinico. Sujetos y metodos. A partir de los datos obtenidos en una muestra piloto de 65 personas con discapacidad intelectual, se realizaron cambios en el test original. Para estudiar las propiedades psicometricas del TB-DI, se administro a una muestra de 170 personas con discapacidad intelectual y a un grupo de 60 personas sin ella. Mediante modelos de regresion, se determino que variables eran importantes para la estratificacion de los datos normativos. Resultados. El TB-DI, compuesto de 67 subtests agrupados en ocho dominios cognitivos, muestra unas buenas propiedades psicometricas. Se crean datos normativos para cinco grupos en funcion del nivel de discapacidad intelectual, la edad y la competencia curricular. Estos datos se organizan en percentiles, lo que permite trazar perfiles cognitivos en el ambito clinico y experimental. Conclusion. El TB-DI es un instrumento de alta aplicabilidad para la poblacion con discapacidad intelectual, y muestra una validez y una fiabilidad adecuadas, y con buenas propiedades psicometricas. Los perfiles cognitivos determinados mediante el TB-DI proporcionaran informacion valiosa para el tratamiento integral de las personas adultas con discapacidad intelectual leve y moderada.

This paper sets out to investigate the relevant passages in sura 2 of the Koran and to ask whether there might be a reason as to why orientations of mosques changed inside a city’s walls or with additions to mosques. The discoveries in this paper demonstrate that orientations of mosques provide ample archaeological evidence for the evolution of Islam. They have fundamental consequences for the approach to the history of the beginnings of Islam, the Koran, and beyond. Some of the discoveries are as following: 1) The Koran speaks of two qibla changes. 2) The Koran neither commands a change from Jerusalem, nor to Mecca, but instead to Al-Haram in present day Israel (as confirmed with orientations from various mosques). 3) Babylonian Pharisee qiblas show a consistent prayer orientation to the location of the Exilarch (not to the Temple in Jerusalem). 4) The pattern of directing places of worship toward the Exilarch continues through all three mosques of Medina and beyond. 5) For the first time, the Ethiopian kernel of the early Muslim story can be confirmed with archaeology. There may indeed have been two ‘Muslim’ stations in that country: With surprising accuracy and with conversion points from multiple directions, – the Quba Mosque in Medina is precisely oriented toward Axum – the Mosque of the Prophet is precisely oriented toward the Imam Mesgid in Negash. 6) Levite-Sadducee qiblas show a consistent prayer orientation to the location of the Nasi (also not to the Temple Mount). 7) There are many qibla changes that can be attributed to ‘Muslim’ structures. The pattern follows the dynastic paraclete leadership from which follows that each town can reveal its individual story about dynastic expansions and contractions through the archaeology of the mosques. Similar to changes in dynastic territories, the stories told through mosques in multiple towns are interlinked and overlap. 8) Since none of the early structures point to Mecca, the Muslims have arrived there much later than is assumed in the traditional accounts. Even after the first appearance in the historical record, the practice of orienting places of worship toward the dynastic leadership would persist for centuries. 9) Jacob of Edessa’s comment that the Jews were praying toward Jerusalem implies that the Exilarch or the Nasi was occupying the Temple Mount at that time. 10) The Al-Askari Shrine and mosque in Samarra was built by Seljuks over one and a half century after the disappearance of the Mahdi, and it would be expanded by Ismailis thereafter. 11) Abu Lahab in Sura 111 is identified as the Babylonian Exilarch Abu-Lu’lu’ah.

Resumen Objetivo Determinar el valor de la gammagrafia de paratiroides con 99mTc-MIBI y de la cirugia radiodirigida en el diagnostico y tratamiento del hiperparatiroidismo primario (HPP) por adenoma ectopico. Material y metodos Se han revisado 105 paratiroidectomias radiodirigidas practicadas entre marzo de 2004 y diciembre de 2008. Para el presente trabajo se han incluido 20 pacientes (19%) operados por adenoma ectopico. Los pacientes tenian diagnostico de HPP, gammagrafia positiva, deteccion radiodirigida de adenoma ectopico, confirmacion anatomopatologica de adenoma y seguimiento clinico de al menos 1 ano desde la cirugia. La gammagrafia con 99mTc-MIBI consistio en imagenes planares en doble fase y tomograficas (SPECT o SPECT/TAC). Durante la paratiroidectomia se determino PTH basal y a los 7, 15 y 30 minutos de la exeresis. El seguimiento se realizo mediante determinaciones de PTH, calcio, fosforo y vitamina D sericos y funcion renal. Resultados La gammagrafia detecto todos los adenomas. La localizacion gammagrafica coincidio con la quirurgica en 18 pacientes (90%). La localizacion definitiva fue: 9 paraesofagicos, 5 timicocervicales, 4 cervicomediastinicos posteriores, 1 mediastinico anterior y 1 paratimo. La paratiroidectomia radiodirigida identifico todos los adenomas y se efectuo mediante cirugia minimamente invasiva en 12 pacientes, cervicotomia unilateral en 2, cervicotomia bilateral en 4 y esternotomia en 2. No se observo persistencia/recurrencia del HPP durante el seguimiento clinico. Conclusiones La gammagrafia (SPECT/TAC) y la cirugia radiodirigida son metodos de gran eficacia en la localizacion y tratamiento del HPP debido a adenoma ectopico de paratiroides. En nuestra serie se detectaron y extirparon todos los adenomas, sin observarse hiperparatiroidismo persistente o recurrente.

Aim The aim of this study was to evaluate the role of 99mTc-MIBI parathyroid scintigraphy and radioguided parathyroidectomy on the diagnosis and treatment of primary hyperparathyroidism (PHP) due to ectopic adenomas.

We analyze the case of a patient with intermittent episodes of lower gastrointestinal bleeding and suspected Meckel's diverticulum, whose presence was confirmed by (99m)Tc-pertechnetate scintigraphy. A previous exploratory laparotomy had been performed without finding the diverticulum. In spite of years of medical treatment, the patient presented a new episode of lower gastrointestinal bleeding with normal colonoscopy. A new (99m)Tc-pertechnetate scintigraphy (including SPECT/CT) was performed and allowed the anatomical location of a Meckel's diverticulum and enabled its removal by laparoscopic radioguided surgery. The introduction of SPECT/CT in the scintigraphic diagnostic protocol in Meckel's diverticulum increases diagnostic safety and improves lesion location. Furthermore, it favors the performance of radioguided surgery and facilitates the lesion resection, particularly when the patient has suffered previous abdominal surgery, with a more conservative procedure, reducing the morbidity associated with the surgical procedure.

Background: The incidence, prevalence, and even the clinical behavior of ulcerative colitis (UC) are highly variable in different world regions. In previous studies, Portugal was reported as having a milder clinical behavior. The aim of this study was to apply the Montreal Classification in a large group of UC Portuguese patients in order to describe their clinical characteristics and evaluate variables potentially useful for outcome prediction. Methods: A cross-sectional study based on data collected from a nationwide online registry was undertaken. Results: In all, 2863 patients with UC were included. Twenty-one percent had ulcerative proctitis, 52% left-sided colitis, and 28% extensive colitis. Sixty percent of patients had taken steroids, 14% immunosuppressors, 1% biologicals, and 4.5% were submitted to surgery. Patients with extensive colitis had more severe activity, needing more steroids, immunosuppressors, and surgery. At the time of diagnosis 61% were less than 40 years old and 5% less than 16. Younger patients also had a more aggressive initial course. Thirty-eight percent of patients had only taken salicylates during the disease course and were characterized by a lower incidence of systemic symptoms at presentation (3.8% versus 8.8%, P < 0.001), fewer extraintestinal manifestations (7.7% versus 24.0%, P < 0.001), and a higher prevalence of proctitis (32.1% versus 10.0%). Conclusions: A more aggressive phenotype was found in extensive colitis and in the initial course of younger patients, with an increased need for steroids and immunosuppressors. In addition, a significant percentage of patients, particularly with proctitis, showed a milder clinical evolution and were maintained in remission only with salicylates. (Inflamm Bowel Dis 2009)

SUMMARY Purpose To estimate inflammatory bowel disease (IBD) prevalence in Portugal from 2003 to 2007, and to obtain disease, sex and age specific estimates. Methods A pharmaco-epidemiological approach based on intestinal anti-inflammatory (IAI) drugs consumption was used. Proportion of patients taking IAI drugs and mean prescribed daily dose (PDD) were estimated from a sample of 513 IBD patients. Assumptions were made about unknown parameters and sensitivity analysis performed: drug compliance (80% in base case; range 70‐85%) and proportion of sulphasalazine used in IBD (52%; range 40‐80%). Sex and age specific estimates were based on a proposed methodological extension and results from a nationwide (n ¼5893) cross-sectional study. Results IBD prevalence increased from 86 patients per 100000 in 2003 to 146 in 2007. Regions more affected were Lisboa and Porto (173 and 163 per 100000 in 2007, respectively). Prevalence increased from 42 and 43 per 100000 in 2003 to 71 and 73 in 2007, respectively for ulcerative colitis (UC) and Crohn’s disease (CD). In 2007, prevalence was higher in the 40‐64 age stratum for UC (99 per 100000) and in the 17‐39 stratum for CD (121). Prevalence was consistently higher in females. Conclusions PortugalishalfwaybetweencountrieswiththehighestandlowestIBDprevalence,butissteeplymakingtheroadtothehighestlevel group. Despite limitations of the proposed methods, assumptions were reasonable and estimates seem to be valid. Feasibility and comparabilityofthismethodologymakesitaninterestingtoolforfuturestudiesonIBDepidemiology.Copyright#2010JohnWileyS epidemiologic methods; inflammatory bowel disease; intestinal anti-inflammatory drugs; pharmacoepidemiology; prevalence

Aims - To further delimit the specific verbal operations occurring in the dorsolateral frontal cortex during the generation of words, methods - different verbal fluency tasks guided by distinct specifications (phonological, semantic, or automatic production of words) were used in a functional magnetic resonance study. The study group comprised 10 right-handed normal subjects ranging in age from 23 to 27 years. Functional magnetic resonance images were obtained in a 1.5-Tesla magnet using a spoiled GRASS sequence. Results - Noticeable activation was found during the word generation tasks in the dorsolateral frontal cortex. The region showing the most prominent activation was the posterior part of the left middle frontal gyrus. Nevertheless, the different tasks each had a different activation effect. The phonologically guided generation of words produced the most consistent activation of the middle frontal gyrus, which mainly involved the premotor cortex. Conclusion - The results suggest that operations concerned with the generation of sound sequences, rather than the amount of produced words or their semantics, are responsible for sustained focal activity observed in the frontal lobes during verbal fluency tasks.

Prader Willi syndrome is a genetic disorder with a behavioural expression characterized by the presence of obsessive-compulsive phenomena ranging from elaborate obsessive eating behaviour to repetitive skin picking. Obsessive-compulsive disorder (OCD) has been recently associated with abnormal functional coupling between the frontal cortex and basal ganglia. We have tested the potential association of functional connectivity anomalies in basal ganglia circuits with obsessive-compulsive behaviour in patients with Prader Willi syndrome.We analyzed resting-state functional MRI in adult patients and healthy controls. Whole-brain functional connectivity maps were generated for the dorsal and ventral aspects of the caudate nucleus and putamen. A selected obsessive-compulsive behaviour assessment included typical OCD compulsions, self picking and obsessive eating behaviour.We included 24 adults with Prader Willi syndrome and 29 controls in our study. Patients with Prader Willi syndrome showed abnormal functional connectivity between the prefrontal cortex and basal ganglia and within subcortical structures that correlated with the presence and severity of obsessive-compulsive behaviours. In addition, abnormally heightened functional connectivity was identified in the primary sensorimotor cortex-putamen loop, which was strongly associated with self picking. Finally, obsessive eating behaviour correlated with abnormal functional connectivity both within the basal ganglia loops and between the striatum and the hypothalamus and the amygdala.Limitations of the study include the difficulty in evaluating the nature of content of obsessions in patients with Prader Willi Syndrome and the risk of excessive head motion artifact on brain imaging.Patients with Prader Willi syndrome showed broad functional connectivity anomalies combining prefrontal loop alterations characteristic of OCD with 1) enhanced coupling in the primary sensorimotor loop that correlated with the most impulsive aspects of the behaviour and 2) reduced coupling of the ventral striatum with limbic structures for basic internal homeostasis that correlated with the obsession to eat.

Background: Psychopathy is characterized by a distinctive interpersonal style that combines callous-unemotional traits with inflexible and antisocial behavior. Traditional emotion-based perspectives link emotional impairment mostly to alterations in amygdala-ventromedial frontal circuits. However, these models alone cannot explain why individuals with psychopathy can regularly benefit from emotional information when placed on their focus of attention and why they are more resistant to interference from nonaffective contextual cues. The present study aimed to identify abnormal or distinctive functional links between and within emotional and cognitive brain systems in the psychopathic brain to characterize further the neural bases of psychopathy. Methods: High-resolution anatomic magnetic resonance imaging with a functional sequence acquired in the resting state was used to assess 22 subjects with psychopathy and 22 control subjects. Anatomic and functional connectivity alterations were investigated first using a whole-brain analysis. Brain regions showing overlapping anatomic and functional changes were examined further using seed-based functional connectivity mapping. Results: Subjects with psychopathy showed gray matter reduction involving prefrontal cortex, paralimbic, and limbic structures. Anatomic changes overlapped with areas showing increased degree of functional connectivity at the medial-dorsal frontal cortex. Subsequent functional seed-based connectivity mapping revealed a pattern of reduced functional connectivity of prefrontal areas with limbic-paralimbic structures and enhanced connectivity within the dorsal frontal lobe in subjects with psychopathy. Conclusions: Our results suggest that a weakened link between emotional and cognitive domains in the psychopathic brain may combine with enhanced functional connections within frontal executive areas. The identified functional alterations are discussed in the context of potential contributors to the inflexible behavior displayed by individuals with psychopathy.

The paper A Seed of the Koran defines the terms MHMT and MHMD, generally believed to refer to Prophet Muhammad. It demonstrates how MHMT was an institution and MHMD a title for a religious leadership. The Jerusalem Talmud contains precise predictions for the timeframe that overlaps with the interests of the modern research community that attempts to understand the beginnings of Islam and the Koran. The following is a summarizing ‘table of content’ of this working paper in the chronological order of the Berakhoth in the Jerusalem Talmud:The keys to ParadiseA Synod of the Great AssemblyAn Inter-Sectarian Alliance with IshmaelIncursion from the NorthConquering the Promised LandThe Wars of Gog and MagogThe Son of God is BornThe Djin in a renewed SchismMHMT/MHMD on the Temple MountRededication of the TempleTerritorial ExpansionAgainst IntercessorsThe Birth of Islam?Jihad against Babylon?The Night JourneyThis working paper follows the order of the Jerusalem Talmud meticulously, and it guides the reader through selected text passages, step-by-step. A chronology for the beginnings of Islam and the Koran is presented, which includes the identification of key leaders of the Muslim narrative.

This paper focuses on an objection to Gallez’s conclusion to eliminate the Nasara from the original Koranic body of texts and expects the reader to be familiar with his material. With the help of the Jerusalem Talmud, this answer proposes that the Nasara constitutes a continuance of Judeo-Christian Babylonians. The timing of the addition of the Nasara reveals important clues to the expansion of an alliance.This update includes the revelation from the Jerusalem Talmud of the arrival of a messiah in the seventh century, Ahmet, the Son of God. The Nasara may have regarded this messiah as the Son of God (also).

A.J. Deus’s paper investigates the historicity of Prophet Muhammad and the Koran as well as the Prophet’s possible relationship with the Umayyads. By limiting the evidence to pre-692 documents and artifacts, Deus brings forth a hypothesis that Prophet Muhammad did not appear in the primary evidence until after 631 AD. He is connected to a sermon based on Mosaic Law that cannot be identified in the Koran. His first and isolated sign of having passed away appears in 691 AD in Egypt. He may indeed have still been alive in the 650s, if not in the 680s, and no evidence exists of a prophet Muhammad that died in 632 AD. In that timeframe, a shift from a MHMT institution to an individual MHMD can be observed, and the two could be distinct. There seems to have been a progression from Elijah bar Kabsha, the chief of the Tayyi’ MHMT, to Muhammad being the spiritual leader of the Mhaggraye, and later to the Tayyi’ Mhaggraye, through the MHMD Mahdi, and finally to Islam. Nevertheless, in the 680s, the ‘adversaries’ of the Byzantine Orthodox Church were viewed as a like-Arian form of Judaic thought that reintroduced Jewish Messiahnism from an expanding territory of the Tayyi’. The Byzantines neither recognized Muhammad nor Islam. The earlier Saracen and Ishmaelite incursions must have been unaware of Islam and the Koran. It appears that the Jews from Edessa carried the seed (Sebeos), and the Tayyi’ represent the sprout of what eventually evolved into Muhammadeans. Their goal seems to have been to occupy Jerusalem, as was of other groups, certainly also in the first wave of attacks. However, the temple building activities in Jerusalem were attributed first to Saracens from the Caspian Sea in the Caucasus region, or in Sebeos to Jews who were driven away by the Ishmaelites. The next temple that went up was in Fusted under Amr, but from Mecca there was no sign of activity. The traditional narratives might contain several parallel “histories” and perhaps more than one Muhammad or a chain of Muhammads. The primary evidence also suggests, according to Deus, that the Muslim timescale may be connected to Heraclius’s advances and later alliance with three Persian rebel factions, establishing a growing confederation in competition with the Persian Empire. Deus makes a case that primary evidence should not be incorporated into traditions since the latter may have been inserted into real history with an agenda. In order to avoid circular arguments, contemporary primary evidence must take precedence, and tradition can only help to support it or clarify certain aspects.

Background: The rapid development of language abilities in early childhood coincides with a similarly accelerated progression in brain maturation. Objective: To quantitate myelination in the lateral part of the verbal left hemisphere from birth to 3 years in the living human brain. Methods: One hundred children (mean age 16.6 months) were examined using three-dimensional MRI, and a subgroup of 40 children were also evaluated behaviorally. The volume of myelinated white matter was measured in language-related temporal and frontal regions and in the central sensorimotor region. A method was developed to compose a movie sequence for all the myelination process using volumetric data. Results: A plot of age against relative volume of myelinated white matter graphically detailed the myelination progress in the lateral brain. The changes started in sensorimotor white matter and the Heschl gyrus and ultimately extended to the language-related areas. Both comprehension and production regions showed a very similar myelination course, suggesting simultaneous maturation of the temporofrontal language network. The movie sequence of white matter images dynamically displayed the anatomic details of myelin deposition in this part of the brain. The analysis of language performance showed acceleration in children9s vocabulary after 18 months, once a rapid myelination phase was attained in the language brain. Conclusions: This volumetric study may contribute to further characterize the early stages of brain maturation by showing the fine progression of myelin deposition in the language domains and illustrating its relationship to children9s vocabulary acquisition.

Introduccion. La evaluacion neuropsicologica en las personas con discapacidad intelectual es importante para determinar los deficits cognitivos especificos que subyacen a la afectacion cerebral, limitan el funcionamiento intelectual y afectan al comportamiento adaptativo. A pesar de ello, no existen baterias neuropsicologicas en castellano adaptadas y validadas para esta poblacion. Objetivo. Adaptar el programa integrado de exploracion neuropsicologica-test Barcelona y validar la nueva version, el test Barcelona para discapacidad intelectual (TB-DI), estableciendo datos normativos para el empleo clinico. Sujetos y metodos. A partir de los datos obtenidos en una muestra piloto de 65 personas con discapacidad intelectual, se realizaron cambios en el test original. Para estudiar las propiedades psicometricas del TB-DI, se administro a una muestra de 170 personas con discapacidad intelectual y a un grupo de 60 personas sin ella. Mediante modelos de regresion, se determino que variables eran importantes para la estratificacion de los datos normativos. Resultados. El TB-DI, compuesto de 67 subtests agrupados en ocho dominios cognitivos, muestra unas buenas propiedades psicometricas. Se crean datos normativos para cinco grupos en funcion del nivel de discapacidad intelectual, la edad y la competencia curricular. Estos datos se organizan en percentiles, lo que permite trazar perfiles cognitivos en el ambito clinico y experimental. Conclusion. El TB-DI es un instrumento de alta aplicabilidad para la poblacion con discapacidad intelectual, y muestra una validez y una fiabilidad adecuadas, y con buenas propiedades psicometricas. Los perfiles cognitivos determinados mediante el TB-DI proporcionaran informacion valiosa para el tratamiento integral de las personas adultas con discapacidad intelectual leve y moderada.

Most peroxisomal matrix proteins possess a C-terminal targeting signal type 1 (PTS1). Accurate prediction of functional PTS1 sequences and their relative strength by computational methods is essential for determination of peroxisomal proteomes in silico but has proved challenging due to high levels of sequence variability of non-canonical targeting signals, particularly in higher plants, and low levels of availability of experimentally validated non-canonical examples. In this study, in silico predictions were compared with in vivo targeting analyses and in vitro thermodynamic binding of mutated variants within the context of one model targeting sequence. There was broad agreement between the methods for entire PTS1 domains and position-specific single amino acid residues, including residues upstream of the PTS1 tripeptide. The hierarchy Leu>Met>Ile>Val at the C-terminal position was determined for all methods but both experimental approaches suggest that Tyr is underweighted in the prediction algorithm due to the absence of this residue in the positive training dataset. A combination of methods better defines the score range that discriminates a functional PTS1. In vitro binding to the PEX5 receptor could discriminate among strong targeting signals while in vivo targeting assays were more sensitive, allowing detection of weak functional import signals that were below the limit of detection in the binding assay. Together, the data provide a comprehensive assessment of the factors driving PTS1 efficacy and provide a framework for the more quantitative assessment of the protein import pathway in higher plants.

Resumen Introduccion Los autores llevan a cabo un analisis retrospectivo de los resultados obtenidos en el tratamiento quirurgico de 650 bocios multinodulares: el 77% (522) eutiroideos y 23% toxicos. Pacientes y metodos Se analizan las indicaciones quirurgicas, el tipo de operacion realizada, las complicaciones y el seguimiento postoperatorio (8 anos de media), controlado en el 70% de los casos de la serie mediante la valoracion morfologica y funcional del remanente. Resultados La mortalidad fue del 0,8% y la morbilidad global del 18%. La afectacion del recurrente se produjo en el 3,8% de los casos y un hipoparatiroidismo transitorio en el 9,4%, sin que existieran diferencias entre bocios normofuncionales y toxicos. Se establece una relacion entre edad y tipo de operacion realizada, observandose que la extension de la exeresis es mas amplia cuanto mayor es la edad y el grado de hiperfuncion. Por otra parte, la correlacion entre complicaciones y tipo de operacion demuestra que el hipoparatiroidismo es mas frecuente despues de una tiroidectomia subtotal (9,6%) que de una tiroidectomia total (5,2%), asi como la afectacion del recurrente (el 3,9% despues de una tiroidectomia subtotal y el 2,6% despues de una total). En el seguimiento postoperatorio, en ausencia de recidivas, se presento un hipotiroidismo en el 32,5% de los casos en que se realizo algun tipo de exeresis bilateral, sin diferencias segun el tipo de bocio ni la exeresis realizada. Conclusiones En la cirugia del bocio multinodular no es obvio que la morbilidad postoperatoria sea mas grave en los hiperfuncionales que en los eutiroideos, pese a que los pacientes suelen tener mas edad, una situacion cardiorrespiratoria mas inestable y son sometidos a una cirugia mas agresiva. La frecuencia del hipotiroidismo postoperatorio es elevada e impone, en el seguimiento de los pacientes, un control clinico y de la funcion glandular dado que con facilidad pasa inadvertida.

In patients with chronic hepatic encephalopathy, proton magnetic resonance spectroscopy can be used to detect specific metabolic abnormalities in the brain; MRI shows a hyperintense globus pallidus on T1-weighted sequences. We investigated the relationship between these two MR findings in a series of 25 patients with the use of quantitative data and a multiple regression analysis model. The cerebral increase in glutamine compounds and the decrease in myoinositol and choline correlated separately with globus pallidus hyperintensity, and each was complementary in accounting for this imaging finding. Such as association suggests that spectroscopic and imaging alterations are two different expressions of the reversible events that occur in the brain of patients with hepatic encephalopathy in that both disappear after liver transplantation. Globus pallidus hyperintensity seems to be a global indicator of the cerebral metabolic disorder, and the spectroscopic pattern denotes the specific metabolic alterations.

Introducción. El ictus es una de las principales causas de discapacidad en la población adulta. El desarrollo de síntomas depresivos es la complicación afectiva más frecuente. Hasta ahora, en la mayoría de los estudios sobre depresión postictus se ha excluido a los pacientes que han sufrido un ictus minor o un ataque isquémico transitorio (AIT), si bien es un subgrupo igualmente vulnerable a esta enfermedad. Objetivo. Revisar los estudios publicados de depresión postictus para dilucidar los aspectos que ya se han demostrado ampliamente y los que necesitan mayor evidencia. Desarrollo. La depresión postictus es frecuente tanto en los pacientes con ictus establecido como en los pacientes con ictus minor o AIT. Aunque existen discrepancias en la definición utilizada, aproximadamente uno de cada tres pacientes desarrollará esta complicación. Se han identificado factores de riesgo de depresión postictus con un amplio respaldo científico (sexo femenino, antecedentes de depresión u otros trastornos psiquiátricos, gravedad del ictus y afectación funcional) y otros sin él (calidad de vida, deterioro cognitivo y biomarcadores de neuroimagen). Las principales limitaciones metodológicas halladas son la confusión entre depresión postictus y sintomatología depresiva, la variabilidad en las escalas de evaluación usadas y la variabilidad en el momento temporal de la evaluación del estado de ánimo. Hasta ahora son muy pocos los estudios en el ictus minor o el AIT. Conclusiones. Se necesitan nuevos estudios con mejor diseño que ayuden a establecer el riesgo de depresión postictus a diferentes tiempos tras el ictus, el ictus minor o el AIT, y establecer la importancia de los factores descritos previamente.

This retrospective study was carried out over 83 surgical cases at the distal portion of the fifth metatarsal, compromising the treatment of tailor's bunion, fifth metatarsal overload and the concomitant presence of both pathologies in some cases. Neuromas were founded under the fifth metatarsal head in 18 of the cases studied (21.7%). The results look at whether if there is an association between different fifth metatarsal pathologies and the presence of neuromas and found a significant association between the appearance of neuromas in patients with the same metatarsal overload, especially if it is accompanied by a tailor's bunion pathology.

Background: About 70 loci are associated with susceptibility to Crohn's disease (CD), particularly in pathways of innate immunity, autophagy, and pathogen recognition. Phenotype–genotype associations are inconsistent. Methods: CD susceptibility polymorphisms ATG16L1 rs2241880, ICAM1 rs5498, IL4 rs2070874, IL17F rs763780, IRGM rs13361189, ITLN1 rs2274910, LRRK2 rs11175593, and TLR4 rs4986790 were genotyped in a Portuguese population (511 CD patients, 626 controls) and assessed for association with CD clinical characteristics. Results: There is a significant association of CD with the single nucleotide polymorphisms (SNPs) in ATG16L1 (odds ratio [OR] 1.36 [1.15–1.60], P = 2.7 × 10−4 for allele G), IRGM (OR 1.56 [1.21–1.93], P = 3.9 × 10−4 for allele C), and ITLN1 (OR 1.55 [1.28–1.88], P = 4.9 × 10−6 for allele C). These SNPs are associated with ileal location (OR, respectively, 1.49, 1.52, and 1.70), ileocolonic location (OR, respectively, 1.31, 1.57, and 1.68), and involvement of the upper digestive tract (OR, respectively for ATG16L1 and IRGM, 1.96 and 1.95). The risk genotype GG in ATG16L1 is associated with patients who respond to steroids (OR 1.89), respond to immunosuppressants (OR 1.77), and to biologic therapy (OR 1.89). The SNPs in ITLN1 and IRGM are both associated with a positive response to biologic therapy. The risk for ileal, ileocolonic, and upper digestive tract locations increases with the number of risk alleles (OR for three alleles, respectively, 7.10, 3.54, and 12.07); the OR for positive response to biologic therapy is 3.66. Conclusions: A multilocus approach using autophagy-related genes provides insight into CD phenotype–genotype associations and genetic markers for predicting therapeutic responses. (Inflamm Bowel Dis 2012;)

During recent years different procedures have been used to assist in diagnosis of questionable cases of appendicitis. Among these methods, there are few scoring systems that have been shown to be effective. The aim of this study was to create a scoring system and to test its accuracy in the preoperative diagnosis of acute appendicitis. Clinical data from 360 patients who had undergone appendicectomy were collected to identify attributes that distinguished patients having a negative laparotomy from those with appendicitis. Seven independent criteria were identified. Using Bayesian methodology a weight was given to each criterion and an overall score calculated. A cut-off point was identified to separate patients for surgery and those for observation. The scoring system was applied prospectively to 166 consecutive patients; 134 had appendicitis and 32 a normal appendix (19·3 per cent error diagnosis). For the 166 patients the method suggested surgery in 113, 107 (94·7 per cent) of whom were found to have appendicitis. The system suggested observation in hospital in 38 cases. For the whole group the scoring system showed a sensitivity of 80 per cent and specificity of 81 per cent. Scoring systems from a local database could become the ideal complementary method in the diagnosis of suspected acute appendicitis.

The main objective of the present work was to identify, by means of intraoperative electrical stimulation, the supplementary motor area (SMA) region which is implicated in complex motor function. The functional prognostic relevance of the surgical preservation of this area was also analyzed.Fifteen patients with tumors infiltrating the premotor cortex were selected. All patients were operated under awake conditions. Primary motor cortex was identified with intraoperative electrical stimulation (IES). To identify the SMA, patients were asked to do a finger opposition motor task with their hand contralateral to the lesion, that was blocked by electrically stimulating the premotor cerebral cortex.SMA was identified in all patients with IES. Complete surgical resection was achieved in 13 patients (86.6%) and subtotal in 2 patients (13.3%). SMA function was preserved in 14 patients (93.3%). In only one patient the SMA was partially resected because of tumor infiltration (6.6%). In the immediate postoperative period, 8 patients (53.3%) did not show changes in comparison to their preoperative clinical status, and 2 patients improved. At 6 months follow up, 5 patients (33.3%) were asymptomatic and 10 patients showed permanent deficits. In this last group, five patients (33.3%) showed mild deficits that did not interfere with a normal life. In the other 5 patients (33.3%), permanent deficits interfered with daily life activities: two patients presented severe hemiparesis 3/5 (same similar to their preoperative status with no improvement), one patient had motor aphasia, and two other patients (13.3%) showed permanent left SMA syndrome. In two patients with severe postoperative hemiparesis, tumor infiltration of primary motor cortex and piramidal pathway was observed; severe preoperative motor deficit (KPS70) was associated with poor functional outcome.Intraoperative electrical cortical stimulation is useful to identify the SMA. Once identified, SMA preservation decreases the risk of postoperative symptoms and permanent SMA syndrome. When SMA is infiltrated by the tumor, radical resection may cause permanent neurological deficits, specially in the dominant hemisphere. Severe preoperative motor deficit was associated with poor outcome.

The aim of this study was to evaluate the role of (99m)Tc-MIBI parathyroid scintigraphy and radioguided parathyroidectomy on the diagnosis and treatment of primary hyperparathyroidism (PHP) due to ectopic adenomas.We reviewed 105 consecutive patients who underwent radioguided parathyroidectomy due to adenomas between March 2004 and December 2008. Of this group we studied 20 patients (19%) with ectopic adenomas. All patients had biochemical evidence of PHP, a positive parathyroid scintigraphy, radioguided detection with histolopathological confirmation of adenoma and at least 1 year-follow up. The parathyroid scintigraphy consisted on dual-phase planar and tomographic images (SPECT or SPECT/CT). During the parathyroidectomy, intraoperative PTH determinations (0, 7, 15 and 30 min after the parathyroidectomy) were done. The follow up consisted on blood examinations of PTH, calcium, phosphorus and vitamin D and assessment of renal function.Parathyroid scintigraphy detected all adenomas. Scintigraphic and surgical findings were coincident in 18 cases (90%). The final adenoma localization was paraesophagic in 9 patients, cervicothymic in 5, posterior cervicomediastinal in 4, anterior mediastinal in 1 and parathymic in 1. The parathyroidectomy consisted on 12 minimally invasive surgeries, 2 unilateral cervicotomies, 4 bilateral cervicotomies and 2 sternotomies. No case of persistent or recurrent PHP was observed during the follow up.Parathyroid scintigraphy (SPECT/CT) and radioguided surgery are effective methods on the localization and treatment of PHP due to ectopic adenomas. In our study the radioguided parathyroidectomy was successful in all cases and there was no evidence of persistent or recurrent hyperparathyroidism on the follow up.

To estimate inflammatory bowel disease (IBD) prevalence in Portugal from 2003 to 2007, and to obtain disease, sex and age specific estimates.A pharmaco-epidemiological approach based on intestinal anti-inflammatory (IAI) drugs consumption was used. Proportion of patients taking IAI drugs and mean prescribed daily dose (PDD) were estimated from a sample of 513 IBD patients. Assumptions were made about unknown parameters and sensitivity analysis performed: drug compliance (80% in base case; range 70-85%) and proportion of sulphasalazine used in IBD (52%; range 40-80%). Sex and age specific estimates were based on a proposed methodological extension and results from a nationwide (n = 5893) cross-sectional study.IBD prevalence increased from 86 patients per 100 000 in 2003 to 146 in 2007. Regions more affected were Lisboa and Porto (173 and 163 per 100 000 in 2007, respectively). Prevalence increased from 42 and 43 per 100 000 in 2003 to 71 and 73 in 2007, respectively for ulcerative colitis (UC) and Crohn's disease (CD). In 2007, prevalence was higher in the 40-64 age stratum for UC (99 per 100 000) and in the 17-39 stratum for CD (121). Prevalence was consistently higher in females.Portugal is half way between countries with the highest and lowest IBD prevalence, but is steeply making the road to the highest-level group. Despite limitations of the proposed methods, assumptions were reasonable and estimates seem to be valid. Feasibility and comparability of this methodology makes it an interesting tool for future studies on IBD epidemiology.

The purpose of this study was to conduct a survey examining the impact of inflammatory bowel disease (IBD) on patients’ and their caregivers’ daily activities. Questionnaires were distributed to patients registered in the APDI (Portuguese Association for IBD) database and their respective caregivers in 2007. Of 422 patient respondents, 251 had Crohn’s disease (CD) and 171 had ulcerative colitis (UC), with the majority of patients being women (58.1%) and aged over 40 years (37.4%). The number of disease flares experienced by IBD patients was slightly higher for patients with CD than for patients with UC (2.64 vs. 2.34), and surgery was more often required in CD patients as compared to UC patients (42.4 vs. 7%). Sixty percent (60%) of patients reported having no problems with mobility, daily activities, or personal hygiene; however, over half of all patients experienced some pain and anxiety. Adult patients and children and adolescents respectively experienced time off work or school due to their disease but caregivers were not affected in this regard. The caregivers life (N = 324) was affected by anxiety, with the major concern reported as the risk of the patient developing cancer. Both IBD patients and caregivers thought that the provision of information on new drugs and contact time with a doctor would have the biggest impact on improving care. The symptoms and complications of IBD have a considerable impact on the lives of patients and their caregivers, and several actions could be taken to improve their care.

The election of the treatment in the pyloric-duodenal perforations pursues a double objective: to reduce the operative mortality and to reduce the risk of ulcerous relapse in the long run. The authors carry out a retrospective study of 100 pyloric-duodenal perforations treated in 12 years. Three risk factors of immediate mortality are demonstrated: the age, 70 years or older; elapsed time, equal or superior to 24 hours and the existence of a situation of preoperative hemodynamic shock. The global mortality of the series was of 12% and the index of relapses of 12%. The authors outline a therapeutic management in which the election of the treatment was modulated for the factors of mortality risk. Thus, the presence of one of these factors must lead to the accomplishment of single treatment in treating only the perforation. The absence of risk factors must lead to accomplish a definitive treatment through the resection or the suture of the perforation followed by any type of vagotomy and eventually a drainage operation. The results obtained with Taylor's vagotomy, as well as with laparoscopic methods have not yet been validated although, probably, in a near future they will be integrated in the first management of pyloric-duodenal perforations.

Depression is a common mood disturbance in multiple sclerosis (MS) patients. Epidemiologic data suggest a causative relationship between depressive symptoms and cerebral demyelination, although a specific lesion site responsible for depressed mood has not been identified. Given that depression in neurologic disease is closely related to frontal and temporal lobe damage, we focused our study on investigating the extent to which lesions in the white matter connecting both cerebral lobes may account for depressive symptoms in MS. Forty-five patients were assessed using the Beck Depression Inventory and an MRI protocol conceived to quantify lesions separately in the basal, medial, and lateral frontotemporal white matter. The presence of lesions in the left suprainsular white matter, the region that mainly includes the arcuate fasciculus, was specifically associated with depressive symptoms, accounting for a significant 17% of the depression score variance. Although a multifactorial origin is suspected for depression in MS, this finding gives support to the existence of a direct negative effect of demyelination on mood.

Huntington's disease (HD) is a neurodegenerative illness, autosomal dominantly inherited, that produces characteristic involuntary muscle movements (chorea) with cognitive abnormalities and personality.Neuropathological studies report premature cell death principally affecting the basal ganglia. The disease most commonly begins in the fourth or fifth decade of life, although in some cases, abnormalities have been documented in early childhood and as late as 50 years of age. Early cognitive deterioration in HD is not uniform, and patients with recently diagnosed HD may evidence selective deficits in learning and visuospatial/visuomotor ability, along with a relatively consistent pattern of impairment on subtests of the Wechsler Adult Intelligence Scale (WAIS). Neuroimaging reports of basal ganglia function have described striatal abnormality in HD and related with neuropsychological impairment.This paper provides the clinical-phenomenologic definition of the neuropsychological impairment and its associated features related with its neuropathological significance and to review the subject in the light of present day reports.

In patients with chronic hepatic encephalopathy, proton magnetic resonance spectroscopy can be used to detect specific metabolic abnormalities in the brain; MRI shows a hyperintense globus pallidus on T1-weighted sequences. We investigated the relationship between these two MR findings in a series of 25 patients with the use of quantitative data and a multiple regression analysis model. The cerebral increase in glutamine compounds and the decrease in myoinositol and choline correlated separately with globus pallidus hyperintensity, and each was complementary in accounting for this imaging finding. Such as association suggests that spectroscopic and imaging alterations are two different expressions of the reversible events that occur in the brain of patients with hepatic encephalopathy in that both disappear after liver transplantation. Globus pallidus hyperintensity seems to be a global indicator of the cerebral metabolic disorder, and the spectroscopic pattern denotes the specific metabolic alterations.

Functional magnetic resonance is a new imaging method which allows the incruent observation of human cerebral activity. The authors describe their method of functional magnetic resonance and the results of cerebral activation.A total of 364 functional sequences were performed in 52 volunteers with a magnetic resonance system of 1.5 Tesla. A gradient echo sequence with a long echo time sensitive to the changes in oxygenation of venous blood was used. Different cortical areas were stimulated by visual, motor and language maneuvers and by complex mental operations.Different cerebral areas representative of different levels of cerebral functional complexity were consistently activated and reproduced. Experiments of activation of primary cerebral cortex (visual and motor), premotor regions, specific area of language and areas of cortical association for cognitive operations are described.Functional magnetic resonance imaging is a sensitive method for the observation of cerebral activity and provides functional images with great spatial and temporal resolution. This may be useful in both clinical and basic investigation.