[SARS-COV-2 myocarditis. An update]. / Myocardite et maladie à COVID-19 : où en est-on ?

The outbreak of the SARS-CoV-2 virus responsible for the COVID-19 disease has given rise to a new disease whose boundaries are still to be discovered. While the first data suggested a purely respiratory infection, the most recent publications highlight a large pleomorphism of the disease, responsible for multiple organ damage, of which cardiac injury seems to be the most represented. This cardiac injury can present as acute myocarditis. Our aim was to discuss the pathophysiological rationale underlying the existence of SARS-CoV-2 myocarditis and to analyze the literature data regarding the diagnosis and treatment of this particular entity.

Scratches and grazes: a detailed microscopic analysis of trampling phenomena.

Sedimentary abrasion and postdepositional damage to fossil remains are of great interest if considering the possible distortion they could produce in the archaeological and paleontological record. Since their discovery, natural agents such as trampling phenomena have been a topic of great taphonomic interest. Nevertheless, the majority of investigation into these traces has focused almost exclusively on their differentiation from other anthropic agents such as cut marks. In recent years, advances into bone surface modification analysis via geometric morphometrics have proven useful for in-depth characterization of different taphonomic traces; including cut, tooth and percussion marks. Through this, a preliminary study of trampling marks using advanced 3D digital microscopy was able to detect differences between what have since been known as scratch and graze marks. The present study expands from this, developing a more detailed analysis of these traces. Here, we use advanced data science techniques to provide a means of understanding trampling mark variations, contributing to our knowledge of site formation processes. Our results show how scratch and graze marks are a product of progressional decay and changes in cortical hardness, providing a new means of understanding taphonomic processes. LAY DESCRIPTION: The study of microscopic bone surface modifications in archaeology and palaeontology is of great importance, allowing for a detailed reconstruction of the formation of a site and providing a means of interpreting the fossil register. The damage that sedimentary abrasion can produce, however, is likely to distort and influence these studies, thus requiring a detailed understanding of the different traces that can be found on different materials. Here, we use advanced 3D digital microscopy and pattern recognition algorithms to analyse the different marks produced in different sedimentological contexts, also controlling for other variables such as the state of the bone when buried, the type of bone and the time exposed to these types of damages. Through this detailed microscopic analysis of these types of damages, we are able to conclude that morphological variations in trampling marks are product of the state of decay when the bones are buried.

Skeletal Anomalies in The Neandertal Family of El Sidrón (Spain) Support A Role of Inbreeding in Neandertal Extinction.

Neandertals disappeared from the fossil record around 40,000 bp, after a demographic history of small and isolated groups with high but variable levels of inbreeding, and episodes of interbreeding with other Paleolithic hominins. It is reasonable to expect that high levels of endogamy could be expressed in the skeleton of at least some Neandertal groups. Genetic studies indicate that the 13 individuals from the site of El Sidrón, Spain, dated around 49,000 bp, constituted a closely related kin group, making these Neandertals an appropriate case study for the observation of skeletal signs of inbreeding. We present the complete study of the 1674 identified skeletal specimens from El Sidrón. Altogether, 17 congenital anomalies were observed (narrowing of the internal nasal fossa, retained deciduous canine, clefts of the first cervical vertebra, unilateral hypoplasia of the second cervical vertebra, clefting of the twelfth thoracic vertebra, diminutive thoracic or lumbar rib, os centrale carpi and bipartite scaphoid, tripartite patella, left foot anomaly and cuboid-navicular coalition), with at least four individuals presenting congenital conditions (clefts of the first cervical vertebra). At 49,000 years ago, the Neandertals from El Sidrón, with genetic and skeletal evidence of inbreeding, could be representative of the beginning of the demographic collapse of this hominin phenotype.

Evaluation of the PREVI® Isola automated seeder system compared to reference manual inoculation for antibiotic susceptibility testing by the disk diffusion method.

The disk diffusion (DD) method remains the most popular manual technique for antibiotic susceptibility testing (AST) in clinical microbiology laboratories. This is because of its simplicity, reproducibility, and limited cost compared to (automated) microdilution systems, which are usually less sensitive at detecting certain important mechanisms of resistance. Here, we evaluate the PREVI® Isola automated seeder system using a new protocol for spreading bacterial suspensions (eight deposits of calibrated inocula of bacteria, followed by two rounds of rotation) in comparison with manual DD reference testing on a large series of clinical and reference strains. The average time required for seeding one agar plate for DD with this new protocol was 51 s per plate, i.e., 70 agar plates/h. Reproducibility and repeatability was assessed on three reference and three randomly chosen clinical strains, as usually requested by the European Committee on Antimicrobial Susceptibility Testing (EUCAST), and was excellent compared to the manual method. The standard deviations of zones of growth inhibition showed no statistical discrimination. The correlation between the two methods, assessed using 294 clinical isolates and a panel of six antibiotics (n = 3,528 zones of growth inhibition measured), was excellent, with a correlation coefficient of 0.977. The new PREVI® Isola protocol adapted for DD had a sensitivity of 99 % and a specificity of 100 % compared to the manual technique for interpreting DD as recommended by the EUCAST.

Longstanding dental pathology in Neandertals from El Sidrón (Asturias, Spain) with a probable familial basis.

Two Neandertal specimens from El Sidrón, northern Spain, show evidence of retained left mandibular deciduous canines. These individuals share the same mitochondrial (mtDNA) haplotype, indicating they are maternally related and suggesting a potential heritable basis for these dental anomalies. Radiographs and medical CT scans provide evidence of further, more extensive dental pathology in one of these specimens. An anomalous deciduous canine crown morphology that developed before birth subsequently suffered a fracture of the crown exposing the pulp sometime after eruption into functional occlusion. This led to death of the tooth, periapical granuloma formation and arrested deciduous canine root growth at an estimated age of 2.5 years. At some point the underlying permanent canine tooth became horizontally displaced and came to lie low in the trabecular bone of the mandibular corpus. A dentigerous cyst then developed around the crown. Anterior growth displacement of the mandible continued around the stationary permanent canine, leaving it posteriorly positioned in the mandibular corpus by the end of the growth period beneath the third permanent molar roots, which, in turn, suggests a largely horizontal growth vector. Subsequent longstanding repeated infections of the expanding cyst cavity are evidenced by bouts of bone deposition and resorption of the boundary walls of the cyst cavity. This resulted in the establishment of two permanent bony drainage sinuses, one through the buccal plate of the alveolar bone anteriorly, immediately beneath the infected deciduous canine root, and the other through the buccal plate anterior to the mesial root of the first permanent molar. It is probable that this complicated temporal sequence of dental pathologies had an initial heritable trigger that progressed in an unusually complex way in one of these individuals. During life, this individual may have been largely unaware of this ongoing pathology.

Matuyama-age lithic tools from the Sima del Elefante site, Atapuerca (northern Spain).

Paleomagnetic results obtained from the sedimentary fill at the Sima del Elefante site in Atapuerca, Spain, reveal a geomagnetic reversal, interpreted as the Matuyama-Brunhes boundary (0.78 Ma). The uppermost lithostratigraphic units (E17 through E19), which contain Mode II and III archaeological assemblages, display normal polarity magnetization, whereas the six lowermost units (E9 through E16) yield negative latitudinal virtual geomagnetic pole positions. Units E9 through E13, all of which display reverse magnetic polarity, contain Mode I (Oldowan) lithic tools, testifying to the presence of humans in the early Pleistocene (0.78-1.77 Ma).

Short human occupations in the Middle Palaeolithic level I of the Abric Romani rock-shelter (Capellades, Barcelona, Spain).

This paper presents a multidisciplinary study on the size of the occupied surfaces, provisioning strategies and behaviour planning at the Romani rock-shelter, using the Middle Palaeolithic record of the level i. This level is dated around 46.000 BP through U/Th ages. A behavioural interpretation is proposed, which emphasises the activities and the systemic value of the archaeological artefacts and structures. Occupation patterns are identified on the basis of the accumulations formed by human activities. These archaeological accumulations, consisting of artefacts and hearths, are easily defined visually as spatial units. The relationships between these accumulations, established by means of refitted remains, indicate that differences can be established between: 1) small and medium-sized occupation surfaces; 2) restricted and diversified provisioning strategies. This variability suggests that different modes of occupation are represented in the same archaeological level. The human activities reveal the generalization of fire technology. In almost all sizes of the occupation surfaces, the exploitation of vegetal resources near the Abric Romani marks the threshold of the restricted provisioning strategy. Limited use and fragmented knapping activities are recorded in the lithic assemblage. Faunal remains show differential transport. The exploitation of lithic, faunal and vegetal resources characterizes the diversified provisioning strategy. The small occupation surfaces and restricted provisioning strategies suggest short settlements in the Abric Romani. This shorter occupation model complements the longer diversified provisioning strategy recorded in both small and medium-sized occupied surfaces. The selection of precise elements for transport and the possible deferred consumption in the diversified provision strategy suggest an individual supply. In this respect, Neanderthal occupations in the Romani rock-shelter show a direct relation to: 1) hunting strategic resources; 2) high, linear mobility.

Infantile idiopathic scoliosis in the newborn.

We have reviewed 7 patients (5 boys and 2 girls) with infantile idiopathic scoliosis which was present at birth and was diagnosed at ages from 1 day to 1 month. The mean follow up was 16 years. The objectives were to discover whether intrauterine forces play a role in the aetiology and to determine whether early treatment of a potentially progressive curve can induce resolution. Two infants were male conjoined twins and were united by skin over the posterior sacrum. Six infants had a rib vertebral angle difference greater than 20 degrees in the first radiograph and 5 had stiff curves. In 2 with flexible curves, the deformity disappeared by the end of the first year. The 5 with stiff curves were treated conservatively for 6 to 24 months. Growth has now been completed in 5; 4 have a straight spine and one developed an adolescent curve of 26 degrees. The 2 who are still growing have no scoliosis. Intrauterine moulding was only demonstrated in the conjoined twins. There was a correlation between the rib vertebral angle difference above 20 degrees and the rigidity of the curve. Early treatment of a potentially progressive curve can lead to resolution.

Experience with a lead fixation/suture sleeve.

Current anchoring systems on pacemaker leads are crude in comparison to the lead technology. Poor anchoring technique may cause damage to the lead or early displacement from incorrect suture tension. We describe experience with a locking anchoring sleeve that applies a constant gripping force to the lead body. This can be locked and unlocked to allow optimal positioning after fixation of the sleeve to underlying tissues. The sleeve was fitted to a 55D polyurethane lead (Medtronic 4024, 7 Fr, bipolar, steroid eluting) implanted in the ventricular position in 22 patients at four European centers. All implants were uncomplicated; data were collected on handling and ease of use. Assessments were made using a scale of 1-10 (10 = excellent, 5 = equivalent to conventional sleeve). Overall ease of use compared to conventional sleeve was 7.79 +/- 0.62 (mean +/- SD). Mean scoring of flexibility of the lead at the transition points was 7.92 +/- 0.72; ability to lock/unlock the sleeve scored 6.28 +/- 1.78. Ease of suturing around the sleeve scored 8.07 +/- 0.77, and ability to slide the sleeve along the lead body scored 6.48 +/- 1.99. Chest X rays at 6 weeks showed no change in lead position with respect to postimplant films, and all leads showed a straight path on either side of the sleeve with no evidence of conductor distortion. Follow-up to 3 years has been without problem. All leads remain intact and in place, with stable thresholds and no evidence of erosion. There have been no complaints of patient discomfort. We conclude that this device is safe and effective and offers a significant advance in lead fixation.

[Primary angioplasty in acute myocardial infarction. A one-year experience in a small urban community]. / Angioplastie primaire à la phase aiguë de l'infarctus du myocarde. Expérience d'une année d'activité dans une ville de moyenne importance.

The aim of this study was to assess the feasibility, safety and efficacy of primary angioplasty in acute myocardial infarction in a cardiology centre of a small urban community without on-site cardiac surgery. During 1995, 50 patients underwent angioplasty for MI in the first 12 hours. The average age was 66.7 +/- 12.6 years. Eighty six per cent of patients had at least one poor prognostic criteria (32% over 75 years of age, 70% anterior wall infarcts, 30% with heart rates > 100 min on admission). The angiographic result was successful in 45 patients (90%). The time between onset of pain and reopening the vessel was 240 +/- 116 min and between admission to the catheter laboratory and reopening 31 +/- 8 min. A coronary stent was implanted in 24 cases (48%) and intra-aortic balloon pumping was necessary in 14 cases (28%). Ischaemia recurred during the hospital phase in 7 cases (14%), 4 of which (8%) were caused by rethrombosis of the dilated artery: in 3 cases, the ischaemia was in another zone. No emergency coronary bypass surgery was required. The hospital mortality was 10%, always in patients over 80 years of age. The average duration of the hospital stay was 5.8 +/- 2.6 days with 15.7 +/- 7.3 days of convalescence. The average global cost was 61850 +/- 20686 F. These results were comparable to previously reported figures and confirm that primary angioplasty in acute infarction is possible and effective with an acceptable risk in a small urban community without on-site cardiac surgery.

Intervertebral disc calcification in childhood.

Nine children with calcified intervertebral discs are described. Seven were boys and 2 were girls. The average age at diagnosis was 8.6 years (range 5 to 14 years). Follow up was from 2 to 10 years. Only one child gave a history of trauma. In all twelve discs were involved with more than one disc being affected in 2 children; there were 7 in the cervical spine, 4 in the thoracic and one in the lumbar spine. Every child with cervical calcification had an acute onset with pain and limited movement, and disappeared during the following months. The calcified discs in the thoracic and lumbar regions did not cause symptoms and did not change. Calcification of cervical discs is self-limiting and has an excellent prognosis.

[Diabetologic education at a general hospital in Cataluna: methodology and short-term indicators of effectiveness]. / Educación diabetológica en un hospital general de Cataluña: metodología e indicadores de efectividad a corto plazo.

In order to carry out an initial evaluation of an intrahospital diabetes education programme after its first year, the methods used are described and some previously established short term effectiveness indicators are analyzed: 1) knowledge of the theory, 2) insulinization, 3) blood glucose self testing at home, 4) metabolic control, 5) readmission in hospital, and 6) detection of chronic complications. An analysis of the previous situation was carried out resulting in a mean hospital stay of 10.8 days/patient/year during 1985, being the mean hospital stay for the general population of 8.1 days. 222 diabetic patients (63 type I and 159 type II) were included in the programme during the first year, and their cultural background, diabetes education, place of origin and participation were evaluated. 358 written tests were examined. The scores obtained after the educational sessions (75.6 +/- 17.5) were significantly higher than the initial scores (47.4 +/- 23.1; p less than 0.001). Prior the programme, 93 patients (41.9%) were on insulin. At the time of the evaluation 156 (70.2%) were on insulin treatment, of which 86 (38.7%) were on rapid insulin. Furthermore, 141 patients (66.1%) were carrying out periodic (over 10 tests/week) blood glucose determinations at home. In a 96 patient follow up group (36 type I and 60 type II) a significant improvement in baseline glucose levels (8.6 +/- 2.7 vs 12.6 +/- 4.2 mmol/l; p less than 0.001) as well as glycosylated hemoglobin levels (9.3 + 1.2% vs 11.0 + 2.0%; p greater than 0.001) was confirmed; this improvement was maintained throughout the time period considered.(ABSTRACT TRUNCATED AT 250 WORDS)

[Value of the esophageal approach in the diagnosis, treatment and therapeutic surveillance of arrhythmia in children]. / Intérêt de la voie oesophagienne dans le diagnostic, le traitement et la surveillance thérapeutique des troubles du rythme de l'enfant.

For the past few years, a new method for the investigation and treatment of arrhythmias has been used: transoesophageal atrial pacing and recording (TAPR). In the light of 6 cases observed recently, we review the technical aspects and the indications for TAPR. A bipolar stimulation catheter is inserted in the oesophagus and positioned in the area where the atrial wave of greater amplitude is recorded. Atrial stimulation is done with impulses of long duration obtained with a special stimulator. Two cases validated this technique which was effective to correct atrial flutter in a neonate with heart failure resistant to medical treatment as well as in a 5 year-old child. The value of TAPR as a diagnostic tool in cases of tachycardia is discussed in the context of 2 cases: a 5 week-old with wide QRS and a 14 month-old with narrow QRS. Finally, the value of TAPR for monitoring the efficacy of anti-arrhythmia medications is illustrated by 4 cases of supraventricular tachycardia, in whom the optimal dosage of the anti-arrhythmic drug used was determined with the help of TAPR-induced tachycardia. The current literature concerning the technique, indications and results of TAPR are reviewed. This method is likely to take a great importance for the study and treatment of supraventricular arrhythmias in children.

[Pre- and postoperative study of arrhythmia in atrial septal defects (ostium secundum and sinus venosus)]. / Etude pré et postopératoire des troubles du rythme et de la conduction au cours de la communication interauriculaire (ostium secundum et sinus venosus).

An electrophysiological study was carried out pre- and postoperatively in 25 patients (children and adults) presenting with an atrial septal defect of the ostium secundum type (OSASD). The purposes of the study were to find out whether early electrophysiological abnormalities were present in children, to compare the results obtained in children and in adults and to evaluate the impact of surgery by comparing preoperative and late postoperative electrophysiological data. Patients were divided into two groups. Group I was composed of 11 children (mean age 8.18 +/- 1.03 years) with a mean pulmonary/systemic blood flow ratio of 2.33 +/- 0.24. Group II comprised 14 adults (mean age 36.79 +/- 4.89 years) with a mean pulmonary/systemic blood flow ratio of 3.42 +/- 0.24. Preoperatively, in group I 55 p. 100 of the patients (6/11) had sinus node dysfunction, 18 p. 100 (2/11) had disturbances of atrioventricular conduction, and none had atrial dysrhythmia. Preoperatively, in group II 43 p. 100 of the patients (6/14) had sinus node dysfunction, 36 p. 100 (5/14) had disturbances of atrioventricular conduction, and 36 p. 100 (5/14) had sustained atrial dysrhythmia (flutter or paroxysmal atrial fibrillation). The frequency of sustained atrial dysrhythmia correlated positively with the patient's age and with the presence of sinus node dysfunction. Following surgical closure of the atrial septal defect, the electrophysiological parameters were not significantly modified in both groups. This study confirmed the presence of early electrophysiological abnormalities of sinus node function and atrioventricular conduction in children with OSASD. The most significant finding in adults was the occurrence of atrial dysrhythmias in the oldest patients.(ABSTRACT TRUNCATED AT 250 WORDS)

[Control of the patency of coronary-internal mammary artery bypasses by non-selective angiography]. / Contrôle de la perméabilité des pontages coronaires-artères mammaires internes par angiographie non sélective.

98 successive coronary bypasses using the internal mammary artery were controlled systematically, at an early stage, about the 17th postoperative day, by non selective brachial angiography using a retrograde injection. This control method, simple, quick, reliable and non-aggressive, enables to visualize the internal mammary artery and the bypassed coronary vessel, over its entire length. There were no failure in the control, nor any local or general complication during this examination. The overall patency of such bypasses, evaluated with this method, is 98 p. cent in our series, with however, 12 p. cent of angiographic aspects of a poorly functional bypass. These aspects are related to a slow flow in the by-pass (spindly internal mammary artery, anastomotic stenosis or thin distal bed of the bypassed coronary artery), or to a competitive flow (non significant coronary stenosis). The perfusion of the bypassed coronary, which is not so well studied in the literature, is important to analyze and difficult to evaluate with our technique because of the static views that are used. A similar non-selective angiographic method using a dynamic recording (radio-cinema with dual incidence) is currently being evaluated.

[Isotope angiocardiographic study of 30 cases of ventricular tachycardia with Fourier phase analysis]. / Etude de 30 tachycardies ventriculaires par angiocardiographie isotopique avec analyse de phase de Fourier.

Twenty-seven patients (15 men, 12 women; mean age 48.9 years) suffering from ventricular tachycardia (VT) (n = 30) were studied by radionuclide angiocardiography with Fourier phase analysis, both in sinus rhythm and during tachycardia. VT was spontaneous, electrically inducible, sustained, haemodynamically stable and monomorphous, with a mean rate of 174 beats/min (range: 115-260 beats). Heart diseases responsible for VT were: non-obstructive cardiomyopathy (n = 7), hypertrophic cardiomyopathy (n = 1), ischaemic heart disease (n = 5), probable right ventricular arrhythmogenic dysplasia (n = 4), congenital left ventricular aneurysm (n = 2), sequela of myocarditis (n = 2) and aortic valve regurgitation (n = 1); no heart disease was detectable in 5 patients. On surface electrocardiogram there was good concordance between the initial radionuclide site of VT activation and the configuration and electrical axis of QRS. At Fourier phase analysis all 17 VT of the right lag type originated in the left ventricle, arising from the apical septum (n = 7) or lateral segment (n = 2) in case of left axis, from the basal segment (n = 6) or the lateral segment (n = 1) in case of vertical or right axis, and from the middle left septum (n = 1) in case of normal axis. Nine VT of the left lag type originated in the right ventricle, arising from the basal septum or the latero-basal region in case of vertical or right axis (n = 6), from the apical septum or the inferior-apical region in case of left axis (n = 2) and from the middle septum in case of normal axis (n = 1). Four of our patients (3 with coronary disease and 1 with congenital left ventricular aneurysm) had VT of the left lag type and an initial radionuclide site of activation in the middle part of the left septum in case of left axis (n = 2) and in the basal part of that septum in case of right axis (n = 2). Seven patients were operated upon for recurrent VT: 4 had intra-operative mapping which in every case confirmed the results of radionuclide angiocardiography, a method which in the other 3 patients was the only surgeon's guide. Correlations between the site of origin of VT at radionuclide mapping and kinetic abnormalities visualized at radiological angiography and gamma-ray angiocardiography were common in our study. In one of our patients the same lesion gave birth to 2 VT of different morphologies.(ABSTRACT TRUNCATED AT 400 WORDS)

Characterization of right or left ventricular contraction heterogeneity using Fourier phase analysis. Application to a group of patients with severe ventricular arrhythmias.

The standard deviation of the first harmonic Fourier phase histogram is an indicator of the contraction heterogeneity of the heart ventricles. This approach has been applied to analyse tomographic blood pool (99mTc) examinations in a group of 32 patients with angiographically verified mainly right (RV) but also left (LV) kinetic disorders in relation to severe ventricular arrhythmias and suspicion of arrhythmogenic right ventricular dysplasia (ARVD). The reference group consisted of ten patients with low probability of cardiac kinetic abnormalities. Thick tomographic slices including both ventricles have been reconstructed in the horizontal long axis orientation from a series of 32 gated projections recorded over a 360 degrees rotation. Separately for each ventricle the Fourier phase histograms have been computed and characterized by their standard deviations (PSD). Normal values (mean +/- standard deviation, LV = 11 degrees +/- 5 degrees, RV = 12 degrees +/- 5 degrees) were significantly lower (P less than 0.01 and P less than 0.001) than those measured in abnormal cases (LV = 19 degrees +/- 10 degrees and RV = 31 degrees +/- 17 degrees). Detailed analysis of the data supports the hypothesis of a primary RV disease in ARVD, with secondary LV extension. PSD seems to be a good predictor of an organic cardiac disease underlying ventricular arrhythmias and may be used for screening the patients.