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Cocaine abuse is associated with multiple cardiovascular events, including myocardial infarction, arrhythmias, and sudden death. A total of 40 hearts were studied. The purpose of this study was to compare the cardiac conduction tissue and its vascularization in 20 young adults without a history of drug use and/or arrhythmias and 20 hearts of young adults with a history of chronic cocaine use who have died of sudden unexpected death, in which toxicological analyzes were performed in blood and urine as a means to establish chronic cocaine use. We have applied serial histological sections, techniques of morphometry, and image analysis to quantify the density and affectation of connective/adipose tissue of the conduction system and intramyocardial vessels. The conduction system after chronic cocaine use showed potentially lethal changes with an increase in connective/adipose tissue at the level of the intranodal or perinodal tissue of the sinus node in 35% (7 hearts) and the atrioventricular node in 75% (15 hearts), with the most affected structure being the left bundle branch and the AV nodal artery (100%, 20 hearts). In conclusion, the histopathologic changes in nodes, the perinodal area, and small vessels may be a morphological substrate that offers an explanation about the mechanism of arrhythmias and sudden death in this population.

Aims Seeking to account for accessory atrioventricular conduction potentially leading to ventricular pre-excitation, Mahaim in the mid-20th century had described pathways between the atrioventricular conduction axis and the muscular ventricular septum. We aimed to look for such ‘paraspecific’ connections in adult human hearts. Methods and results We serially sectioned 21 hearts, covering the triangle of Koch and the aortic root, and assessing the atrioventricular node, the penetration of the conduction axis, and the bundle branches in our search for fasciculo-ventricular connections. We also calculated the length of the non-branching bundle, and if present the origin of the fasciculo-ventricular connections. The non-branching bundle was 3.6 ± 1.7 mmin length, varying from 1.7 mm to 7.2 mm. Fasciculo-ventricular connections were found in more than half of the hearts, making direct contact with the muscular septum at an average of 3.5 ± 1.7 mm from the origin of the left bundle branch, with the site of origin varying from 1.1 mm to 5.5 mm from the first fascicle of the left bundle branch. In three hearts, additional fasciculo-fascicular connections were observed in the left bundle branch. Two loops were small, but one loop extended over 9.5 mm. Conclusion We endorse the finding of Mahaim that fasciculo-ventricular pathways exist in most human hearts. We presume the identified connections had the capability of producing ventricular pre-excitation. More studies are needed to determine the potential clinical manifestations.

Aims The arrangement of the conduction axis is markedly different in various mammalian species. Knowledge of such variation may serve to question the validity of using animals as prospective models for design of systems for clinical use. Methods and results We compared the arrangement of the atrioventricular conduction axis in human, murine, canine, porcine, and bovine hearts, examining serially sectioned datasets from 20 human, 16 murine, 3 porcine, 5 canine, and 1 bovine hearts. We also analysed computed tomographic datasets obtained from bovines and one human heart. Unlike the situation in the human heart, there is no formation of an atrioventricular fibrous membranous septum in the murine, canine, porcine, nor bovine hearts. Canine, porcine, and bovine hearts also lack an infero-septal recess, when defined as a fibrous plate supporting the buttress of the atrial septum. In these species, half of the non-coronary leaflet is directly opposed to the ventricular septal surface. Conclusion There is a long right-sided non-branching component of the axis, which skirts the attachment of the non-coronary sinus of the aortic root. In the bovine heart, moreover, the left bundle branch usually extends intramyocardially as a solitary tape before surfacing and ramifying on the left ventricular septal surface. The difference in the atrioventricular conduction axis between species may influence the anatomical substrates for atrioventricular re-entry tachycardia, as well as providing inferences for assessing the risks of transcatheter implantation of the aortic valve. Further studies are now needed to assess these possibilities.

The pathways for excitation of the atrioventricular node enter either superiorly, as the so-called ‘fast’ pathway, or inferiorly as the ‘slow’ pathway. However, knowledge of the specific anatomical details of these pathways is limited. Most of the experimental studies that established the existence of these pathways were conducted in mammalian hearts, which have subtle differences to human hearts. In this review, the authors summarise their recent experiences investigating human cardiac development, correlating these results with the arrangement of the connections between the atrial myocardium and the compact atrioventricular node as revealed by serial sectioning of adult human hearts. They discuss the contributions made from the atrioventricular canal myocardium, as opposed to the primary ring. Both these rings are incorporated into the atrial vestibules, albeit with the primary ring contributing only to the tricuspid vestibule. The atrial septal cardiomyocytes are relatively late contributors to the nodal inputs. Finally, they relate our findings of human cardiac development to the postnatal arrangement.

This pilot study aimed to assess the diagnostic accuracy of CBCT in identifying peri-implantitis-like bone defects in cadavers. Three cadaver dental arches treated with the Thiel embalming method were used. Three different types of peri-implant bone defects (buccal dehiscence, two- to three-wall defects, and circumferential defects) were prepared on 15 implants. Defect depths and lengths were identified clinically using a periodontal probe, radiologically by means of CBCT images, and histologically with a micrometer using an optic microscope. Peri-implant bone defect morphology evaluated using CBCT images matched the clinical defect configuration (100% accuracy). CBCT assessment demonstrated lower values in defect depth and defect length when compared with the clinical evaluation. A statistically significant difference in defect depth (0.35 ± 0.45 mm; P = .037) was recorded between the clinical and CBCT data. Regarding defect length, a statistically significant mean difference of 0.81 ± 0.83 mm (P = .003) was noted between the clinical and CBCT data. Similarly, a mean difference of 1.09 ± 1.52 mm was recorded between the defect length assessed histologically and the CBCT data (P = .031). No statistically significant differences were observed between the other evaluated variables. CBCT is a reliable tool for peri-implantitis diagnosis and treatment planning, though the underestimation of defect severity may affect the prognosis and clinical decision-making. Clinicians need to be flexible in establishing prognoses and treatment based on CBCT assessment.

Conduction problems still occur following transcatheter aortic valvar replacement. With this in mind, we have assessed the relationship of the conduction axis to the aortic root. We used serial histological sections, made perpendicular to the base of the triangle of Koch in nine hearts, and perpendicular to the aortic root in 11 hearts. We first defined the extent of the fibrous tissues forming the boundaries of an infero-septal recess of the subaortic outflow tract, found in all datasets but one. When the recess was present, the axis penetrated through its rightward wall, giving rise to the left bundle branch prior to entering the outflow tract. The axis itself was usually on the crest of the ventricular septum, but could be deviated leftward or rightward. Its proximity to the virtual basal plane reflected the angulation of the muscular septum. On average, the superior edge of the left bundle was within 3.3 mm of the hinge of the right coronary leaflet, with a range from 0.4 to 10.2 mm. The arrangement was markedly different in the case lacking an infero-septal recess. Our findings necessitated a redefinition of the right fibrous trigone and the central fibrous body. The atrioventricular conduction axis, having entered the aortic root, is usually closest at the hinge of the right coronary leaflet. Knowledge of the depth of the infero-septal recess, and the angulation of the muscular ventricular septal, may help to avoid conduction problems following transcatheter implantation of the aortic valve.

Non-steroidal anti-inflammatory drugs and opioids are widely prescribed for the treatment of mild to severe pain. Wide interindividual variability regarding the analgesic efficacy and adverse reactions to these drugs (ADRs) exist although the mechanisms responsible for these ADRs are not well understood.We provide an overview of the clinical impact of variants in genes related to the pharmacokinetics and pharmacodynamics of painkillers, as well as those associated with the susceptibility to ADRs. In addition, we discuss the current pharmacogenetic-guided treatment recommendations for the therapeutic use of non-steroidal anti-inflammatory drugs and opioids.In the light of the data analyzed, common variants in genes involved in pharmacokinetic and pharmacodynamic processes may partially explain the lack of response to painkiller treatment and the occurrence of adverse drug reactions. The implementation of high-throughput sequencing technologies may help to unveil the role of rare variants as considerable contributors to explaining the interindividual variability in drug response. Furthermore, a consensus between the diverse pharmacogenetic guidelines is necessary to extend the implementation of pharmacogenetic-guided prescription in daily clinical practice. Additionally, the physiologically based pharmacokinetic and pharmacodynamic modeling techniques may contribute to the improvement of these guidelines and facilitate clinician drug dose adjustment.

Objectives This study sought to describe, in detail, the angiographic, gross macroscopy, and histological dissection of the conduction axis in humans. Background The recent upsurge of interest in specific pacing of the atrioventricular conduction axis has emphasized the need for precise knowledge of the location of the atrial and penetrating components of the atrioventricular conduction axis. Methods A total of 41 human hearts were studied by serial histological sectioning and an additional 3 hearts by gross dissection. One of the hearts studied histologically was also dissected to show the location of the conduction axis prior to serial sectioning. The anatomical findings were then compared with the results of angiography undertaken in the catheter laboratory in 60 patients undergoing electrophysiological studies. Results Marked variation of the location of the transition from atrioventricular conduction axis to the penetrating atrioventricular bundle, or the bundle of His, relative to the landmarks of the triangle of Koch was observed. In just over one-half of both the specimens and the patients, the site of penetration was on the atrial aspect of the hinge of the septal leaflet of the tricuspid valve, with further variation noted relative to the apex of the triangle of Koch. Based on measurements of the histological sections, marked variation in the dimensions of the axis and its adjacency to the right-sided endocardium were also found. In almost three-fifths of hearts, an interventricular component of the fibrous membranous septum was not able to be identified. The significance of these findings to those who seek to perform selective pacing of the atrioventricular conduction axis are discussed. Conclusions Marked variability of the location of the conduction axis within the triangle of Koch is reported. In three-fifths of hearts, the interventricular component of the fibrous membranous septum is nonexistent.

Despite years of research, many details of the formation of the atrioventricular conduction axis remain uncertain. In this study, we aimed to clarify the situation. We studied three-dimensional reconstructions of serial histological sections and episcopic datasets of human embryos, supplementing these findings with assessment of material housed at the Human Developmental Biological Resource. We also examined serially sectioned human foetal hearts between 10 and 30 weeks of gestation. The conduction axis originates from the primary interventricular ring, which is initially at right angles to the plane of the atrioventricular canal, with which it co-localizes in the lesser curvature of the heart loop. With rightward expansion of the atrioventricular canal, the primary ring bends rightward, encircling the newly forming right atrioventricular junction. Subsequent to remodelling of the outflow tract, part of the primary ring remains localized on the crest of the muscular ventricular septum. By 7 weeks, its atrioventricular part has extended perpendicular to the septal parts. The atrioventricular node is formed at the inferior transition between the ventricular and atrial parts, with the transition itself marking the site of the penetrating atrioventricular bundle. Only subsequent to muscularization of the true second atrial septum does it become possible to recognize the definitive node. The conversion of the developmental arrangement into the definitive situation as seen postnatally requires additional remodelling in the first month of foetal development, concomitant with formation of the inferior pyramidal space and the infero-septal recess of the subaortic outflow tract.

This chapter aims to bring to the fore cutting-edge research on how globalization is changing medical education by e-learning, remote simulation, and new emerging technologies. In particular, the authors wish to contribute to critical thinking about the conceptualization, investigation, and theorization of how medical education is changing and how medical schools and residency programs in different countries are being transformed according to health and educational needs. In this chapter, the authors reviewed telemedicine and remote simulation and how globalization plays an essential role in it.

Extensive knowledge of the anatomy of the atrioventricular conduction axis, and its branches, is key to the success of permanent physiological pacing, either by capturing the His bundle, the left bundle branch or the adjacent septal regions. The inter-individual variability of the axis plays an important role in underscoring the technical difficulties known to exist in achieving a stable position of the stimulating leads. In this review, the key anatomical features of the location of the axis relative to the triangle of Koch, the aortic root, the inferior pyramidal space and the inferoseptal recess are summarised. In keeping with the increasing number of implants aimed at targeting the environs of the left bundle branch, an extensive review of the known variability in the pattern of ramification of the left bundle branch from the axis is included. This permits the authors to summarise in a pragmatic fashion the most relevant aspects to be taken into account when seeking to successfully deploy a permanent pacing lead. Sin financiación No data JCR 2021 1.035 Q1 SJR 2021 No data IDR 2021 UEM

Background Subtle differences exist between dog and human, despite use of the dog as a model for cardiac surgical and electrophysiological research. Objective The purpose of this study was to investigate the differences in the atrioventricular conduction axis and adjacent structures between dogs and humans. Methods We prepared 33 human and 5 canine hearts for serial histologic sections of the atrioventricular conduction axis, making correlations with gross anatomic findings. We additionally examined and photographed 15 intact normal human hearts obtained from infants undergoing autopsy. Furthermore, we interrogated a computed tomographic dataset from a human adolescent and from 2 autopsied canine hearts, both with normal cardiac anatomy. Results All canine hearts lacked an inferoseptal recess, with the noncoronary leaflet of the aortic valve and the right fibrous trigone having direct attachments to the septal surface of the left ventricular outflow tract. This correlated with an extensive nonbranching component of the ventricular conduction axis, which skirted half of the noncoronary aortic sinus. This anatomic arrangement was observed in 2 of 15 of autopsied infant hearts. In the human hearts with an inferoseptal recess, the relatively shorter nonbranching bundle is embedded within the fibrous tissue forming its right wall. Conclusion We found a major difference between canine and the majority of human hearts, namely, the presence or absence of an inferoseptal recess. When this recess is absent, as in the canine heart and in some human hearts, a greater proportion of the atrioventricular conduction axis is found within the circumference of the subaortic outflow tract.

To provide a review for general practitioners and medical specialists about the most common eye complaints and ocular manifestations in a COVID-19 patient.Reviewed 50 articles referenced in 4 databases from 20 December 2019 to 16 September 2020.Of the 50 articles reviewed, 26 met the criteria for analysis and were included in the study. Among them were 5 reviews, 6 case series, 7 case reports, 4 cross-sectional studies, 2 systematic reviews, 1 cohort study and 1 correspondence. We found that the prevalence of ocular manifestations in patients during the course of COVID-19 varied between 0.8% and 31.6%, depending on the study design. Symptoms of acute conjunctivitis were the most frequent clinical findings. Acute phase reactants were also correlated to ocular manifestations and the severity of the systemic disease in many reports.Ocular manifestations are not uncommon in COVID-19 patients and have been associated with higher levels of acute phase reactants as well as a higher degree of severity of the systemic disease. We recommend that all physicians consider COVID-19 as a differential diagnosis in the presence of acute conjunctivitis with or without systemic symptoms.

Introduction: Several reports suggest a possible association between polymorphisms in the cytochrome P450 2C9 (CYP2C9) gene and the risk for non-steroidal anti-inflammatory drug (NSAID)-related adv...

Background: People with Parkinson&rsquo, s disease (PD) present deficits of the active range of motion (ROM), prominently in their trunk. However, if these deficits are associated with axial rigidity, the functional mobility or health related quality of life (HRQoL), remains unknown. The aim of this paper is to study the relationship between axial ROM and axial rigidity, the functional mobility and HRQoL in patients with mild to moderate PD. Methods: An exploratory study was conducted. Non-probabilistic sampling of consecutive cases was used. Active trunk ROM was assessed by a universal goniometer. A Biodex System isokinetic dynamometer was used to measure the rigidity of the trunk. Functional mobility was determined by the Get Up and Go (GUG) test, and HRQoL was assessed with the PDQ-39 and EuroQol-5D questionnaires. Results: Thirty-six mild to moderate patients with PD were evaluated. Significant correlations were observed between trunk extensors rigidity and trunk flexion and extension ROM. Significant correlations were observed between trunk flexion, extension and rotation ROM and GUG. Moreover, significant correlations were observed between trunk ROM for flexion, extension and rotations (both sides) and PDQ-39 total score. However, these correlations were considered poor. Conclusions: Trunk ROM for flexion and extension movements, measured by a universal goniometer, were correlated with axial extensors rigidity, evaluated by a technological device at 30&deg, /s and 45&deg, /s, and functional mobility. Moreover, trunk ROM for trunk flexion, extension and rotations were correlated with HRQoL in patients with mild to moderate PD.

To report the therapeutic efficacy and safety of topical 0.1% lodoxamide in the long-term treatment of superior limbic keratoconjunctivitis. Sixty-seven eyes of 34 patients with active SLK were studied. Therapeutic response was analyzed according to modified-Ohashi parameters. All eyes were treated with 0.1% lodoxamide twice daily, and those with moderate or severe inflammation received a short course (7–14 days) of 0.1% fluorometholone acetate at presentation and during a relapse. Patients were evaluated at regular intervals and followed up for ≥3 months on continuous therapy. Primary endpoints included inflammatory response; rates of inflammatory control and remission; relapses while on therapy or on remission; and therapeutic failure rate. The mean follow-up time on lodoxamide therapy was 15.3 months. The majority of eyes (82.0%) achieved control of inflammation in a mean time of 2.2 months. Of these, 42 (76.3%) eyes remained under control while on therapy for 13.8 months. There was a significant improvement of SLK-related signs by the third month on therapy (p

Rigidity is a cardinal symptom of Parkinson's disease (PD) and is often clinically assessed by passively flexing and extending a patient's limb. Objective measurements had been employed to examine rigidity in PD subjects, including wrist, elbow or knee.This study aimed to investigate the relationship between an objective measurement of trunk rigidity and risk of falls in patients with mild to moderate PD.An isokinetic dynamometer Biodex System 3 was employed to assess trunk rigidity in 36 patients with mild to moderate PD at a University Department in a cross-sectional study. Risk of falls was measured by the Get UpGo test (GUG). Disease severity (Hoehn and Yahr staging score and the Unified Parkinson's Disease Rating Scale III), disease duration and functional status (SchwabEngland activities of daily living scale) were also evaluated.Significant correlations between trunk extensors rigidity at 45°/s and 60°/s and risk of falls were obtained. A correlation between trunk extensors tone at 30°/s and the GUG test almost reached significant almost reached statistical significance (r = 0.306; p = 0,066). Significant correlations between trunk flexors-extensors tone and clinical status, disease duration and functional status at 30°/s, 45°/s and 60°/s were also obtained.The results from this study suggest that the axial rigidity is related to the risk of falls in patients with mild to moderate PD. Further studies are needed with quantitative devices for axial rigidity assessment to determine the relationship between trunk rigidity in PD patients with higher disease severity and risk of falls.

Introduction Permanent and irreversible damage to the conduction tissue is one of the most common complications of TAVI. Detailed knowledge of the anatomy of the atrioventricular (AV) bundle is crucial to minimize the potential for injury to the His bundle branch block or complete AV block. Purpose Preexisting anatomic location and damage of the right bundle branch (RBB) may have important unrecognized clinical implications. Methods The myocardial arrangement and the presence of fibrous and fatty tissue infiltration of the AV conduction axis and right bundle branch were examined by dissection techniques and histological sections in 57 structurally normal human heart specimens (48 males, 77±7 years). Results The AV conduction axis enters the AV component of the membranous septum and is encircled by the fibrous tissue of the central fibrous body. The AV bundle is divided in a non-branching portion and a branching portion. After a short distance of the non-branching component along the septal crest, the RBB arises at the end of the branching portion of the conduction axis and is located superficially in the muscular ventricular septum. The RBB takes off from the bundle at the level of origin of the superior fascicle of the left bundle, passing then through the thickness of the ventricular septum to emerge beneath the medial papillary muscle of the tricuspid valve. In 22 hearts (49%) in which we found to have a relatively left-sided deviation of the AV bundle in relation to the interventricular membranous septum the RBB runs intramyocardial along the muscular interventricular septum. In the remaining 51% of the hearts the RBB runs subendocardially in the crest of the interventricular muscular septum. We found connective tissue and fatty infiltration along the right bundle branch in 23 hearts (40%) from its origin to its distal part. A significant correlation was found between age and the presence of RBB fibrosis (85% of hearts from individuals with age >80 years). These 2 conditions may make the RBB very vulnerable to self-expanding aortic valves during or after TAVI (figure). RBB and its critical region Conclusions The presence of an intramyocardial location of the RBB with a lef-sided deviation and the fibro-fatty infiltration found in the mayority of senescent hearts are relevant anatomic determinants that may increase the risk of complete AV block following a TAVI procedure.

This study sought to describe, in detail, the angiographic, gross macroscopy, and histological dissection of the conduction axis in humans.The recent upsurge of interest in specific pacing of the atrioventricular conduction axis has emphasized the need for precise knowledge of the location of the atrial and penetrating components of the atrioventricular conduction axis.A total of 41 human hearts were studied by serial histological sectioning and an additional 3 hearts by gross dissection. One of the hearts studied histologically was also dissected to show the location of the conduction axis prior to serial sectioning. The anatomical findings were then compared with the results of angiography undertaken in the catheter laboratory in 60 patients undergoing electrophysiological studies.Marked variation of the location of the transition from atrioventricular conduction axis to the penetrating atrioventricular bundle, or the bundle of His, relative to the landmarks of the triangle of Koch was observed. In just over one-half of both the specimens and the patients, the site of penetration was on the atrial aspect of the hinge of the septal leaflet of the tricuspid valve, with further variation noted relative to the apex of the triangle of Koch. Based on measurements of the histological sections, marked variation in the dimensions of the axis and its adjacency to the right-sided endocardium were also found. In almost three-fifths of hearts, an interventricular component of the fibrous membranous septum was not able to be identified. The significance of these findings to those who seek to perform selective pacing of the atrioventricular conduction axis are discussed.Marked variability of the location of the conduction axis within the triangle of Koch is reported. In three-fifths of hearts, the interventricular component of the fibrous membranous septum is nonexistent.

Background/Introduction The deleterious effects of long-term RV apical pacing have been well recognized. Permament His bundle (HB) pacing has emerged as a promising technique for patients who need ventricular pacing. Purpose To describe the anatomy of the HB region and its variations for successfully approaching HB pacing in a safer and more efficient way and to understand selective vs non-selective HB pacing and to avoid permanent damage to it. Methods In 57 structurally normal human heart specimens (48 males, 77±7 years) we examined by dissection techniques and histological sections the course of the penetrating and non-branching His bundle in relation with the membranous septum and the tricuspid valve (TV) annulus. We correlated these anatomic findings with a series of angiographic studies in 60 patients (47% males, 45±16 years old) by recording the largest His electrogram sites within the limits of the triangle of Koch (TK) and the plane of the TV. Results The membranous septum is divided by the attachment on its right side of the septal leaflet of the tricuspid valve into atrioventricular (AV) and interventricular components. The AV component of the membranous septum forms the anterosuperior apex of the TK and showed in cadaveric hearts variable dimensions in length (4.6±1.5 mm, range 1–9 mm). The AV node becomes the His bundle as the AV conduction axis enters the AV component of the membranous septum and is encircled by the fibrous tissue of the central fibrous body in 100% of hearts with none of them having a “naked” entrance to it. In 30 hearts (53%) the HB penetrates the AV membranous septum at the apex of the TK at the hinge point of the septal leaflet of the TV near its commissure with the anterosuperior leaflet. However in 47% of cases the HB crossed the fibrous tissue of the central fibrous body in a lower position in the medial area of the paraseptal right atrial region of the TK with a mean distance to the AV membranous septum of 4±1.4 mm (range 1.5–8 mm) above and behind the TV annulus. These findings correlate with those obtained in patients in which the site of recording of the largest His bundle deflection does not always coincide with the anterosuperior vertex of the triangle as judged angiographically. In 51% of patients the site of the largest His bundle electrograms was found in the medial area of the triangle above (posterior-inferior) the TV annulus while in 49% of patients the His was recorded at the same level (15%) or below (anterior-inferior) the TV annulus (34% of patients) (figure). Histology of HB and catheter locations Conclusions Knowledge of the marked variability in the location of the AV conduction bundle within the paraseptal right atrial region is crucial for approaching permanent HB pacing. An anterior-inferior and ventricular HB location could yield to restriction of the septal leaflet of the tricuspid valve if a lead is to be deployed in the area.

Human anatomy is a core subject that students of all health degrees are required to pass. Practical classes with human cadavers are a widely used educational resource in medicine, but are less frequent in other health degrees. Determining how first-year podiatry, nursing, and physiotherapy students cope with human anatomy practical classes and identifying the presence of physical reactions and possible causes of distress they experience in the dissection room are essential steps in designing a guidance plan to address students’ needs. A questionnaire was distributed to 172 first-year students in non-medical health degrees immediately after their first visit to the dissection room. The questionnaire comprised 29 Yes/No questions to determine students’ physical reactions, causes of distress and coping methods. The most frequent physical reactions were disgust, uneasiness and nausea. The main causes of distress were the smell of the cadavers, the smell of the dissection room and the sight of the cadavers. The coping methods used were being with friends, eating before the practical class and practicing beforehand with anatomical atlases and CDs. No significant differences were found between gender and the three variables analyzed (number of physical reactions, number of causes of distress and number of coping methods) (p-value >0.216), although differences were found between the type of health degree and the number of physical reactions and causes of distress (p-values = 0.028 and 0.001, respectively).

Background The earliest activation site (EAS) location in the septal right ventricular outflow tract (RVOT) could be an additional mapping data predictor of left ventricular outflow tract (LVOT) vs RVOT origin of idiopathic ventricular arrhythmias (VAs). Objective The purpose of this study was to assess the impact of EAS location in predicting LVOT vs RVOT origin. Methods Macroscopic and histologic study was performed in 12 postmortem hearts. Electroanatomic maps (EAMs) from 37 patients with outflow tract (OT) VA with the EAS in the septal RVOT were analyzed. Pulmonary valve (PV) was defined by voltage scanning after validation of voltage thresholds by image integration. EAM measurements were correlated with those of macroscopic/histologic study. Results A cutoff value of 1.9 mV discriminated between subvalvular and supravalvular positions (90% sensitivity, 96% specificity). EAS ≥1 cm below PV excluded RVOT site of origin (SOO). According to anatomic findings (distance PV–left coronary cusp=5 ± 3 vs PV–right coronary cusp=11 ± 5 mm), EAS–PV distance was significantly shorter in VAs arising from left coronary cusp than from the other LVOT locations (4.2 ± 5.4 mm vs 9.2 ± 7 mm; P = .034). The 10-ms isochronal longitudinal/perpendicular diameter ratio was higher in the RVOT vs the LVOT SOO group (1.97 ± 1.2 vs 0.79 ± 0.49; P = .001). An algorithm based on EAS–PV distance and the 10-ms isochronal longitudinal/perpendicular diameter ratio predicted LVOT SOO with 91% sensitivity and 100% specificity. Conclusion An algorithm based on the EAS–PV distance and the 10-ms isochronal longitudinal/perpendicular diameter ratio accurately predicts LVOT vs RVOT SOO in outflow tract VAs with EAS in the septal RVOT.

BACKGROUND Rigidity is a cardinal symptom of Parkinson's disease (PD). There are few studies that have assessed rigidity with objective tools in PD patients. OBJECTIVE This study aimed to develop an objective measurement to quantify trunk rigidity in PD patients with a technology device and to investigate the relationship between this objective assessment and to examine its relationship with disease severity (Hoehn and Yahr staging score and the Unified Parkinson's Disease Rating Scale III) disease duration, functional status (Schwab & England activities of daily living scale) and health related quality of life (European Quality of Life-5 Dimensions and Parkinson's Disease Questionnaire-39 items) in patients with mild to moderate PD. METHODS An isokinetic dynamometer Biodex System 3 was employed to assess trunk rigidity in 36 PD patients. Passive trunk flexion and extension at 3 angular velocities, 30°/s, 45°/s and 60°/s were applied and resistive torques were recorded as trunk flexor and extensors rigidity. RESULTS Significant correlations between trunk flexors-extensors tone and clinical status, disease duration and functional status at 30°/s, 45°/s and 60°/s were obtained. No correlations were found among trunk muscle tone assessed with the isokinetic dynamometer and the EuroQoL-5D. Trunk rigidity was correlated with the HRQoL assessed with the mobility, cognition and stigma PDQ-39 domains and the total PDQ-39 scores. CONCLUSION Our results suggest that the 30°/s, 45°/s and 60°/s angular velocities of this objective technology method were a valid assessment for trunk rigidity and were correlated with disease severity, disease duration, functional status and HRQoL in PD patients.

The rapid development of interventional procedures for the treatment of arrhythmias in humans, especially the use of catheter ablation techniques, has renewed interest in cardiac anatomy. Although the substrates of atrial fibrillation (AF), its initiation and maintenance, remain to be fully elucidated, catheter ablation in the left atrium (LA) has become a common therapeutic option for patients with this arrhythmia. Using ablation catheters, various isolation lines and focal targets are created, the majority of which are based on gross anatomical, electroanatomical, and myoarchitectual patterns of the left atrial wall. Our aim was therefore to review the gross morphological and architectural features of the LA and their relations to extracardiac structures. The latter have also become relevant because extracardiac complications of AF ablation can occur, due to injuries to the phrenic and vagal plexus nerves, adjacent coronary arteries, or the esophageal wall causing devastating consequences. Ministerio de Economía y Competitividad (TIN2012-37546-C03-02) 0.763 SJR (2014) Q2, 11/340 Cardiology and cardiovascular medicine UEM

Study results evaluating pain thresholds in patients with Parkinson's disease (PD) vary widely. Thus, we designed our study to determine the effects of levodopa on the thresholds of pressure (PPT), heat (HPT) and cold pain (CPT) in PD patients with motor fluctuations (18 patients: 10 men, 8 women; age: 65 ± 10 years; mean disease duration: 11.6 ± 6 years), six of whom (33%) reported pain related to their disease. We compared these thresholds in patients in the ON and OFF states with those in 18 age- and sex-matched controls. Pain thresholds were assessed over: the frontal bones, C5-C6 zygapophyseal joints and second metacarpals (PPT); the dorsal aspect of the hand (HPT and CPT); and the tibialis anterior (TA) muscles. PD patients in the OFF state had lower PPT thresholds at all sites (P 0.001) than healthy controls. Moreover, HPT and CPT thresholds were lower at all sites except over the TA muscle (P 0.01). In the ON state, the PPT and CPT thresholds in PD patients were lower than in controls at all points, except over the TA (CPT) and the second metacarpals (PPT) P 0.01. Pain thresholds were no different in PD patients in the ON or OFF state (P 0.10), and the existence of pain did not influence the results. We detected mechanical and thermal pain hypersensitivity in PD patients in the OFF state, and levodopa administration did not increase these thresholds. Thus, while dopamine may modulate pain responses, other mechanisms are likely to be implicated in the modulation of these pain responses in PD patients.

La enfermedad de Parkinson (EP) es un trastorno neurológico, discapacitante y progresivo caracterizado por múltiples síntomas motores y no motores que contribuyen al deterioro en la calidad de vida del paciente. La diversidad de síntomas asociados a la enfermedad y su manejo afectan a la funcionalidad y las expectativas del individuo sobre su bienestar físico, social y mental, que son los componentes fundamentales de la calidad de vida relacionada con la salud (CVRS). El objetivo del presente trabajo fue identificar las principales dimensiones de la CVRS afectadas en una población con EP con un grado de afectación leve-moderado. Treinta y seis pacientes con EP completaron este estudio transversal. Se emplearon el estadio de Hoehn y Yarh, el Unified Parkinson's Disease Rate Scale, la escala de actividades de la vida diaria de Schwab y England y el Test Get Up & Go. La calidad de vida fue valorada con el EuroQoL-5D y con el cuestionario Parkinson's Disease Questionnaire-39 items. Las dimensiones del PDQ-39, excepto el dominio PDQ-39 Dolor, así como el cuestionario EuroQoL-5D se correlacionaron de manera significativa con la gravedad de la enfermedad. La CVRS se correlacionó con el estado funcional de los pacientes. Únicamente el dominio PDQ-39 Dolor se correlacionó con el riesgo de caídas. Nuestros resultados sugieren que la CVRS de los pacientes con EP, en un estado leve-moderado de afectación, está muy influenciada por la gravedad de la enfermedad y el estado funcional.

UNLABELLED Cognitive-psychiatric features of Parkinson's disease (PD) are common and they may be as disabling as the motor features of the disease. PD has been associated with stoic and inflexible personality traits. While many features of personality have been studied in PD, a systematic study of anger trait and anger expression in PD has not been performed. We used the Spanish adapted version of the state-trait anger Expression Inventory-2 (STAXI-2), comprised of six scales and an anger expression index, to measure anger trait and anger expression. There were 126 PD patients with depressive symptoms and 126 age- and gender-matched controls. PD patients had lower levels of state anger (15.8 +/- 3.1 vs. 17.9 +/- 5.3, P < 0.001), trait anger (19.2 +/- 5.3 vs. 20.7 +/- 6.0, P < 0.05), anger expression-out (9.0 +/- 2.5 vs. 10.5 +/- 3.0, P < 0.001), and anger expression index (26.1 +/- 8.8 vs. 29.6 +/- 9.4, P = 0.002); and higher levels in anger expression-in (14.0 +/- 3.4 vs. 12.2 +/- 3.2, P < 0.001), anger control-out (18.6 +/- 5.0 vs. 16.1 +/- 5.0, P < 0.001), and anger control-in (14.3 +/- 4.7 vs. 13.0 +/- 4.5, P < 0.05) than controls. These differences persisted in analyses adjusting for age, gender, and depressive symptoms. CONCLUSIONS PD patients showed lower levels of external expression of anger and higher levels of control of anger. Our results demonstrate another dimension to the stoic personality trait seen in PD.

The establishment of radiofrequency catheter ablation techniques as the mainstay in the treatment of tachycardia has renewed new interest in cardiac anatomy. The interventional arrhythmologist has drawn attention not only to the gross anatomic details of the heart but also to architectural and histological characteristics of various cardiac regions that are relevant to the development or recurrence of tachyarrhythmias and procedural related complications of catheter ablation. In this review, therefore, we discuss some anatomic landmarks commonly used in catheter ablations including the terminal crest, sinus node region, Koch’s triangle, cavotricuspid isthmus, Eustachian ridge and valve, pulmonary venous orifices, venoatrial junctions, and ventricular outflow tracts. We also discuss the anatomical features of important structures in the vicinity of the atria and pulmonary veins, such as the esophagus and phrenic nerves. This paper provides basic anatomic information to improve understanding of the mapping and ablative procedures for cardiac interventional electrophysiologists. Ministerio de Economía y Competitividad (TIN2012–37546-C03-02) 2.134 JCR (2015) Q3, 82/161 Biotechnology and applied microbiology, 72/124 Medicine, research and experimental UEM

Objetivos. La rigidez es uno de los síntomas motores de la enfermedad de Parkinson. Escasos estudios han valorado la rigidez axial mediante métodos objetivos en dicha enfermedad. El objetivo del presente estudio fue realizar una valoración objetiva de la rigidez del tronco en pacientes con Parkinson y examinar su correlación con la severidad de la enfermedad, la funcionalidad y la calidad de vida relacionada con la salud (CVRS). Método. Un dinamómetro isocinético tipo Biodex System fue empleado para valorar la rigidez de tronco en 36 pacientes. Se realizaron movilizaciones pasivas hacia la flexo-extensión a 30º/s, 45º/s y 60º/s. El estadio de Hoehn and Yahr (H&Y), la Unified Parkinson's Disease Rating Scale (UPDRS) III, la escala de Schwab & England, el EuroQoL y el Parkinson's Disease Questionnaire-39 (PDQ-39) fueron administrados. Resultados. La edad media fue de 67±7 años. El 88,8% presentaba afectación bilateral. El tiempo medio desde el diagnóstico fue de 55,4 ± 30,1 meses. Un 97,2% tomaba medicación relacionada con su enfermedad. Todos presentaban una respuesta estable para con la misma. El valor medio de la UPDRS III fue de 22. Un 66,7% se encontraba en estadio II, un 22,2% en un estadio I-IB y un 11,1% en estadio III de H&Y. Se encontraron correlaciones significativas entre la rigidez hallada en la musculatura extensora y flexora del tronco y la escala de H&Y (r = .538, p = 0,001), la UPDRS III (r = .384, p = 0,021), los años desde el diagnóstico (r =.446, p = 0,006; r =.413, p = 0,012 respectivamente), el estado funcional a 30º/s, 45º/s y 60º/s (r = -.393, p =0,018; r = -.443, p = 0,007; r = -.336, p = 0,045 respectivamente), así como con diversos dominios del PDQ-39. No encontramos correlaciones entre la rigidez axial y los resultados del EuroQoL. Conclusiones. Nuestros resultados sugieren que las velocidades angulares utilizadas con esta metodología objetiva de valoración fueron válidas para evaluar rigidez axial y se correlacionaron con la severidad de la enfermedad, los años desde el diagnóstico, el estado funcional y la CVRS en los pacientes con Parkinson. Fisioterapia, Terapia Ocupacional, Rehabilitación y Medicina Física

Parkinson's disease is a disabling and progressive neurological condition characterized by multiple motor and non motor symptoms that contribute to deterioration in quality of life. The diversity of symptoms associated with the disease and its management affect the patients on their physical, social and mental quality of life. The aim of this study was to identify key dimensions of health related quality of life (HRQOL) in a population affected with Parkinson's disease with a degree of mild-moderate impairment. Thirty six patients with Parkinson were recruited. The Hoehn and Yarh scale, the Unified Parkinson's Disease Rate Scale, the scale of activities of daily life and SchwabEngland Get UpGo Test were applied. HRQOL was assessed with the EuroQol-5D and the specific questionnaire Parkinson's Disease Questionnaire-39 items. The dimensions of the PDQ-39, except the PDQ-39 Pain domain and the EuroQol-5D correlated significantly with the severity of the disease. HRQOL was correlated with the functional status of patients. Only the PDQ-39 pain domain correlated with the risk of falls. Our results suggest that the HRQOL of patients with PD, in a state of mild-moderate impairment, is strongly influenced by disease severity and functional status.

Rigidity is a cardinal symptom of Parkinson’s disease (PD) and is often clinically assessed by passively flexing and extending a patient’s limb. Objective measurements had been employed to examine rigidity in PD subjects, including wrist, elbow, knee and trunk. This study aimed to investigate the relationship between an objective measurement of trunk rigidity and health-related quality of life (HRQoL) and functional status in patients with mild to moderate PD. An isokinetic dynamometer Biodex System 3 was employed to assess trunk rigidity in 36 PD patients. HRQoL was assessed with the EuroQol-5D and Parkinson’s Disease Questionnaire-39 items (PDQ-39). Functional status was measured with the Schwab and England scale. Trunk rigidity was correlated with the HRQoL assessed with the mobility, cognition and stigma PDQ-39 domains and the total PDQ-39 scores. No correlations were found among trunk muscle tone assessed with the isokinetic dynamometer and the EuroQoL-5D. Functional status was correlated with the trunk extensors rigidity at all angular velocities. The results from this study suggest that the axial motor impairments impact on QoL and functional status in patients with PD. Further studies are needed with quantitative devices for axial rigidity assessment to determine the relationship between trunk rigidity in PD patients with higher disease severity and HRQoL scales.

Rigidity is a cardinal symptom of Parkinson's disease (PD). Clinically, rigidity is usually assessed by passively flexing and extending a patient's limb. Few studies have assessed rigidity in trunk muscles in PD patients.To develop an objective measurement to quantify trunk rigidity in PD patients, and to examine its relationship with disease severity using the Hoehn and Yahr staging score (HY) and the Unified Parkinson's Disease Rating Scale III (UPDRS-III), disease duration, functional status with the SchwabEngland activities of daily living scale and health related quality of life (HRQoL) was assessed with the European Quality of Life-5 Dimensions and Parkinson's Disease Questionnaire-39 items (PDQ-39).An isokinetic dynamometer Biodex System 3 was employed to assess trunk rigidity in 36 PD patients. Passive trunk flexion and extension at 3 angular velocities, 30 degrees/s, 45 degrees/s and 60 degrees /s were applied and resistive torques were recorded as trunk flexor and extensors rigidity.Significant correlations between trunk flexors-extensors tone and HY staging score, UPDRS-III, disease duration and functional status at 30 degrees/s, 45 degrees/s and 60 degrees/s were obtained. Trunk rigidity was correlated with the HRQoL assessed with the PDQ-39.Our results suggest that the 30 degrees/s, 45 degrees/s and 60 degrees/s angular velocities of this objective method was valid to assess trunk rigidity and was correlated with disease severity, disease duration, functional status and HRQoL in PD patients.

Los medios de comunicación, cada vez más presentes en la sociedad, parecen estar perdiendo el sentido social y de formación de la ciudadanía de éstos, en beneficio de la lógica empresarial y el mercado. Cada vez se desdibuja más el servicio público de la televisión y urge potenciar canales de vocación ciudadana que recuperen el papel social y formativo de los medios. La televisión universitaria es una magnífica vía para el fomento de esta televisión. En esta comunicación se hace un análisis de la situación española y se realizan propuestas para una televisión universitaria de servicio público., The mass media, increasingly more present in the society, seem to be losing their social sense and their function of citizenship formation, for the benefit of business logic and market. The public use of television is becoming blurred, so there is an urgent need to promote channels of civic vocation that recovers the social and formative role of media. The University television is a wonderful way for the promotion of this television. In this article an analysis of the Spanish situation is done and proposals for a University television of public utility are carried out

Cognitive-psychiatric features of Parkinson's disease (PD) are common and they may be as disabling as the motor features of the disease. PD has been associated with stoic and inflexible personality traits. While many features of personality have been studied in PD, a systematic study of anger trait and anger expression in PD has not been performed. We used the Spanish adapted version of the state-trait anger Expression Inventory-2 (STAXI-2), comprised of six scales and an anger expression index, to measure anger trait and anger expression. There were 126 PD patients with depressive symptoms and 126 age- and gender-matched controls. PD patients had lower levels of state anger (15.8 +/- 3.1 vs. 17.9 +/- 5.3, P0.001), trait anger (19.2 +/- 5.3 vs. 20.7 +/- 6.0, P0.05), anger expression-out (9.0 +/- 2.5 vs. 10.5 +/- 3.0, P0.001), and anger expression index (26.1 +/- 8.8 vs. 29.6 +/- 9.4, P = 0.002); and higher levels in anger expression-in (14.0 +/- 3.4 vs. 12.2 +/- 3.2, P0.001), anger control-out (18.6 +/- 5.0 vs. 16.1 +/- 5.0, P0.001), and anger control-in (14.3 +/- 4.7 vs. 13.0 +/- 4.5, P0.05) than controls. These differences persisted in analyses adjusting for age, gender, and depressive symptoms.PD patients showed lower levels of external expression of anger and higher levels of control of anger. Our results demonstrate another dimension to the stoic personality trait seen in PD.