Long-term clinical impact of permanent cardiac pacing after transcatheter aortic valve implantation with the CoreValve prosthesis: a single center experience.

Aims: To determine the impact of permanent cardiac pacing after transcatheter aortic valve implantation (TAVI) with the CoreValveTM prosthesis in terms of all-cause mortality and morbidity [rehospitalizations for heart failure (HF) or stroke] at the long-term follow-up. Methods and results: The prospective analysis comprised 259 patients (138 women, 53.3%, age 78 ± 6 years) treated by a CoreValveTM prosthesis from April 2008 to December 2015. Forty-two patients were excluded for analysis: 9 with pre-existing permanent pacemaker (PPM) implantation, 19 who required a PPM during the follow-up and 14 patients because of hospital mortality during or after the CoreValveTM prosthesis implantation procedure. The remaining 217 patients were divided in two groups: Group-1 included those patients who required a PPM immediately after TAVI, and Group-2 included those patients who did not require permanent cardiac pacing at the long-term follow-up. Patients received follow-up at 1-month, 6-months, 12-months, and yearly thereafter. A total of 39 patients required a PPM immediately after TAVI (15.0%), but 178 patients (68.7%) did not. The mean follow-up was 37 ± 27 months (range 3-99 months) in both groups. There was no difference between the two groups in terms of all-cause mortality (52.6% vs. 56.8%, P = 0.125; HR 1.22 [0.87-1.77, 95% CI]), or stroke (13.3% vs. 15.1% P = 0.842; HR 1.12 [0.37-3.32, 95% CI]). However, patients who underwent PPM implantation developed an increase in readmissions for HF (21.1% vs. 31.9%, P = 0.015; HR 1.82 [1.23-3.92, 95% CI]). Conclusion: Patients requiring a PPM after TAVI did not have an increase in mortality, or an increase in the likelihood of developing a stroke at a long-term follow-up. However, this subgroup of patients showed an increase in rehospitalization due to HF at medium- and long-term follow-up.

Rheumatic diseases of the spine: imaging diagnosis. / Enfermedades reumatológicas en la columna vertebral: diagnóstico radiológico.

Spinal involvement is common both in the spondyloarthritides and in rheumatoid arthritis, in which the cervical segment is selectively affected. Rheumatoid involvement of the cervical spine has characteristic radiologic manifestations, fundamentally different patterns of atlantoaxial instability. Magnetic resonance imaging (MRI) is the technique of choice for evaluating the possible repercussions of atlantoaxial instability on the spinal cord and/or nerve roots in patients with rheumatoid arthritis as well as for evaluating parameters indicative of active inflammation, such as bone edema and synovitis. Axial involvement is characteristic in the spondyloarthritides and has distinctive manifestations on plain-film X-rays, which reflect destructive and reparative phenomena. The use of MRI has changed the conception of spondyloarthritis because it is able to directly detect the inflammatory changes that form part of the disease, making it possible to establish the diagnosis early in the disease process, when plain-film X-ray findings are normal (non-radiographic axial spondyloarthritis), to assess the prognosis of the disease, and to contribute to treatment planning.

Development of a process for efficient use of CO2 from flue gases in the production of photosynthetic microorganisms.

A new methodology to use efficiently flue gases as CO(2) source in the production of photosynthetic microorganisms is proposed. The CO(2) is absorbed in an aqueous phase that is then regenerated by microalgae. Carbonated solutions could absorb up to 80% of the CO(2) from diluted gas reaching total inorganic carbon (TIC) concentrations up to 2.0 g/L. The pH of the solution was maintained at 8.0-10.0 by the bicarbonate/carbonate buffer, so it is compatible with biological regeneration. The absorption process was modeled and the kinetic parameters were determined. Anabaena sp. demonstrated to tolerate pH (8.0-10.0) and TIC (up to 2.0 g/L) conditions imposed by the absorption step. Experiments of regeneration of the liquid phase demonstrated the feasibility of the overall process, converting CO(2) into organic matter. The developed process avoids heating to regenerate the liquid whereas maximizing the efficiency of CO(2) use, which is relevant to achieve the commercial production of biofuels from microalgae.

Utilization of Anabaena sp. in CO2 removal processes: modelling of biomass, exopolysaccharides productivities and CO2 fixation rate.

This paper focuses on modelling the growth rate and exopolysaccharides production of Anabaena sp. ATCC 33047, to be used in carbon dioxide removal and biofuels production. For this, the influence of dilution rate, irradiance and aeration rate on the biomass and exopolysaccharides productivity, as well as on the CO(2) fixation rate, have been studied. The productivity of the cultures was maximum at the highest irradiance and dilution rate assayed, resulting to 0.5 g(bio) l(-1) day(-1) and 0.2 g(eps) l(-1) day(-1), and the CO(2) fixation rate measured was 1.0 gCO(2) l(-1) day(-1). The results showed that although Anabaena sp. was partially photo-inhibited at irradiances higher than 1,300 µE m(-2) s(-1), its growth rate increases hyperbolically with the average irradiance inside the culture, and so does the specific exopolysaccharides production rate. The latter, on the other hand, decreases under high external irradiances, indicating that the exopolysaccharides metabolism hindered by photo-damage. Mathematical models that consider these phenomena have been proposed. Regarding aeration, the yield of the cultures decreased at rates over 0.5 v/v/min or when shear rates were higher than 60 s(-1), demonstrating the existence of thus existence of stress damage by aeration. The behaviour of the cultures has been verified outdoors in a pilot-scale airlift tubular photobioreactor. From this study it is concluded that Anabaena sp. is highly recommended to transform CO(2) into valuable products as has been proved capable of metabolizing carbon dioxide at rates of 1.2 gCO(2) l(-1) day(-1) outdoors. The adequacy of the proposed equations is demonstrated, resulting to a useful tool in the design and operation of photobioreactors using this strain.

[Celedonio Calatayud-Costa and the birth of the specialty, the Spanish Society of Medical Radiology, and the journal: the beginning of a century of Spanish radiology]. / Celedonio Calatayud Costa y el nacimiento de la especialidad, la Sociedad Española de Radiología Médica y la revista: el comienzo de un siglo de Radiología española.

Dr. Celedonio Calatayud-Costa, an eminent Spanish radiologist, electrical engineer, researcher, and co-founder of the Spanish Society of Electrical Engineering and Medical Radiology, was also the founder of the Spanish Journal of Electrical Engineering and Medical Radiology. The journal, the first journal dedicated specifically to the incipient specialty of electrology, from which radiology would later develop, was the official publication of that primordial Society, and was thus the first antecessor of Radiología, which is today the official journal of the Spanish Society of Medical Radiology. This article analyzes the figure of Dr. Calatayud, based on the scant information available about him, in the centennial of the publication of his journal. Criticized by some and eulogized by others, knowledge about this controversial figure is essential to any understanding of the beginnings of the specialty and its scientific publication in Spain.

The supporting role of the teres major muscle, an additional component in glenohumeral stability? An anatomical and radiological study.

Muscle coordination plays an important role in glenohumeral stability. The rotator cuff and the long head of the biceps are considered the primary dynamic stabilizers muscles. However, the fact that a subgroup of patients with a massive tear in the rotator cuff were able to keep a normal function, should make us question this traditional view. We hypothesize that the teres major which is also a monoarticular scapulohumeral muscle, although it is not part of the conjoined tendon of the rotator cuff, can play a role in glenohumeral stability by a direct support of the humeral head generated by the particular posteroanterior location of this muscle under the humeral head and which, as far as we know, has not been written up previously. This particular effect could appear while the arm is being lifted and the humeral head could be leaning on against the teres major muscle belly underneath it. An anatomical a radiological study was carried out to substantiate our hypothesis. Two cadaver specimens were used for the anatomical study. Frist body was studied through conventional dissection. The second body was analysed through sectional anatomy. Then a radiological study was carried out using magnetic resonance imaging in a healthy male volunteer. Both anatomically and radiologically, the anteroinferior surface of the humeral head was showed firmly resting against the muscle belly of the teres major, to the point of misshaping it from 110 degrees of arm elevation with external rotation. The specific contribution of this effect to the glenohumeral stability needs to be confirmed by further studies and can help us to prevent the high incidence of glenohumeral dislocations.

Long-term Prognosis After Lung Transplantation: A Monocentric Study in 510 Patients.

INTRODUCTION: Lung transplantation is the final treatment option in patients with respiratory failure. Morbidity and mortality rates associated with the management of complications is high despite advances. Postoperative complications include acute transplant rejection, bronchiolitis obliterans, and infections. Because of that, the success of this treatment option depends on the correct choice of donor and candidates to receive a transplant. OBJECTIVE: This study aims to perform a survival analysis of transplanted patients in our center and determine predictive variables of mortality. PATIENTS AND METHODS: This study is a retrospective assessment of data collected from 510 patients at the Hospital University Reina Sofía from October 1993 to December 31, 2016. Patients who were retransplanted were excluded. We collected data regarding basal characteristics of the donors and candidates to receive a transplant. We analyzed the impact in terms of future survival of basal variables from donor and donor recipients. RESULTS: Five hundred ten patients were included (average age 44 ± 17 years, 69% male), with a maximum follow-up period of 21.6 years (average follow-up 4.52 years, interquartile ratio: 0.13 to 6.97 years). Two hundred twenty-seven patients died (54.3% of the total amount). The influence of donor's basal characteristics on mortality was analyzed; moreover, the relationship between basal variables and survival were analyzed using univariate analysis. Available variables were analyzed through multivariate analysis. CONCLUSION: Lung transplantation is a treatment option with an acceptable risk of morbidity and mortality. Increased awareness of features of evolution could help to reduce postoperative complications.

Diagnosing neuroleukemiosis: Is there a role for 18F-FDG-PET/CT?

An imaging case is presented on a patient referred to our department for an 18F-FDG-PET/CT, as a paraneoplastic syndrome was suspected due to his clinical situation. He had a history of acute myeloid leukemia (AML) treated two years earlier, with sustained complete remission to date. 18F-FDG-PET/CT findings revealed hypermetabolism in almost all nerve roots, suggesting meningeal spread, consistent with the subsequent MRI findings. Cerebrospinal fluid (CSF) findings confirmed a leptomeningeal reactivation of AML. Although not many studies have evaluated the role of 18F-FDG-PET/CT in leukemia, it is a noninvasive tool for detecting extramedullary sites of disease and a good imaging alternative for those patients on whom an MRI cannot be performed.

The assessment of surgical skills as a complement to the training method. Revision.

CONTEXT AND OBJECTIVE: The acquisition and improvement of surgical skills constitute a fundamental element in the training of any practitioner. At present, however, the assessment of these skills is a scarcely developed area of research. The aim of this study was to analyse the peculiarities of the various assessment systems and establish the minimum criteria that a skills and knowledge assessment system should meet as a method for assessing surgical skills in urological surgery. ACQUISITION OF EVIDENCE: Scientific literature review aimed at the various currently available assessment systems for skills and competencies (technical and nontechnical), with a special focus on the systematic reviews and prospective studies. SUMMARY OF THE EVIDENCE: After conducting the review, we found that the various assessment systems for surgical competence have, in our opinion, a number of shortcomings. There is a certain degree of subjectivity in the assessment of surgeons by the evaluators. The assessment of nontechnical competencies is not formally recorded. There is no description of a follow-up assessment or any basic parameters associated with healthcare quality. There is no registration of associated competencies associated with the various surgical techniques. There is also no ranking of these competencies and the specific peculiarities for their application. CONCLUSIONS: We believe that the development of a new assessment system for surgical competencies (technical and nontechnical) aimed at assessing urologists in the various surgical techniques is necessary. To this end, our team has worked on developing the Evaluation System for Surgical Competencies on Laparoscopy, which is based on the definition, ranking and assessment of competencies demonstrated by surgeons.

Slow femoral venous flow and venous thromboembolism following inguinal hernioplasty in patients without or with low molecular weight heparin prophylaxis.

BACKGROUND: Prosthetic material (mesh) is commonly used to repair inguinal hernias. Its implantation close to the common femoral vein (CFV) can induce slow flow and favor the appearance of venous thromboembolism (VTE) events. AIM: To investigate the speed of flow, diameter and area of the CFV after inguinal hernioplasty. METHODS: Two hundred and fifty patients receiving open hernioplasty with a non-resorbable mesh for the repair of a unilateral, primary, simple inguinal hernia were prospectively investigated. Patients were stratified, by consensus, into a low or a moderate risk of VTE group. The moderate-risk group (n = 163) received low molecular weight heparin. On day 10 post-operation a blinded Echo-Doppler was carried out, and repeated 7 days later in patients with a venous flow of <15 cm/s. The speed of flow (cm/s), diameter (cm), and area (cm(2)) of the ipsilateral and contralateral CFV of the groin operated upon were measured. RESULTS: No event symptomatic of VTE was documented. One case of asymptomatic deep vein thrombosis (1/163, 0.6%) was found in the moderate-risk group. In 29 patients (2 and 27 in the low- and moderate-risk groups, respectively; p < 0.001) a maximum blood flow velocity of <15 cm/s was found in the ipsilateral CFV; these flows were close to normal in the second measurement. Taking the entire sample into account, the maximum venous blood flow found in the ipsilateral CFV of the operated groin was less than that measured in the contralateral CFV (20.88 vs. 24.01 cm/s; p < 0.001); this difference was significant in both VTE risk groups. The diameter and area of the CFV were both greater in the ipsilateral than the contralateral CFV (p < 0.01); this finding proved to be significant only in hernias of the left groin (p < 0.001). CONCLUSIONS: In the immediate postoperative period, inguinal hernioplasty with mesh induces a temporarily slow venous flow in the ipsilateral CFV. However, this does not lead to an increase in the incidence of VTE.

Growth and metabolic activity of Shewanella putrefaciens maintained under different CO2 and O2 concentrations.

Growth, trimethylamine (TMA), off-odour and biogenic amine production by a strain of Shewanella putrefaciens isolated from spoiled hake (Merlucius merluccius L.) and cultured in a model system, were tested under four different gas compositions (60% CO2/40% O2, 60% CO2/15% O2/25% N2, 40% CO2/60% O2, 40% CO2/40% O2/20% N2) and under air. After 3 weeks of incubation, the control (air) batch showed the highest microbial counts (> 9 log cfu/ml) and TMA concentrations (45 mg N-TMA/100 ml), and strong putrid off-odours were detected from day 15. High amounts of putrescine and cadaverine were produced in this batch, but histamine increased only slightly. Batches under controlled atmospheres showed reduced growth, TMA, off-odour and biogenic amine production. The 40% CO2/60% O2 mixture had the strongest inhibitory effect on bacterial growth, while the 60% CO2/15% O2/25% N2 mixture was less effective. Putrescine and histamine production was lowest in S. putrefaciens under the 40% CO2/60% O2 mixture. However, the level of histamine in S. putrefaciens was higher under 40% CO2/40% O2/20% N2 than when the bacteria was incubated in air. Under the gas mixtures, there was a similar decrease in the production of cadaverine and agmatine by S. putrefaciens, irrespective of the gas concentrations. The production of 2-phenylethylamine appeared to be inhibited under any atmospheric condition.

Ruptured aneurysm of the deep femoral artery. Case report and historical review.

The exceptional characteristics of the case are put forward and commented on. The patient was a 96-year-old man with an arteriosclerotic aneurysm of the deep femoral artery, which became urgently apparent on bursting. The surgical resolution was simple and satisfactory. Later investigation showed that the aneurysm was unilateral and only in the deep femoral artery. Deep femoral artery continues to be an exceptional location of true arteriosclerotic aneurysms, above all when they arise in an isolated fashion. However, in recent years the available information has changed two substantial aspects: 1) these peripheral aneurysms have the greatest risk of rupture, and 2) on many occasions it is possible, when the superficial femoral artery is permeable, to give simple and satisfactory treatment (exclusion of the aneurysms without revascularization).

Study of the mesenchymal clearance factor and its importance in the middle ear pneumatization process in rat and in man.

An histological study on human and rat embryos and foetuses is presented. In all specimens middle ear pneumatization depended on the correlation between the tubal epithelium development and the mesenchymal absorption. The study of the mastoid pneumatization implies a conceptual development of the chronic otitis media pathogenesis and therefore represents a problem as old as otology itself. It is interesting to recall that the first otologist reached a conceptual idea of chronic otitis media long before the acute one. The initial differentiation was established depending on the duration of the discharge. It is evident that this finding was not sufficient to define chronic otitis, and as R. Bartual (1970) points out, the persistence of a tympanic membrane perforation was later used by the early otologist to differentiate the chronic otitis from the acute one.

Ultrastructural study of the human utricular macula and vestibular nerve in meniére's disease.

The authors have carried out an ultrastructural study of the human utricular macula and the vestibular nerve in the internal acoustic meatus of four patients suffering from Meniere's disease. They confirm the presence of degenerative alterations in the utricular sensory epithelium. The nervous fibers situated in the supporting connective tissue of the neuro-epithelium showed modifications in the Schwann cell cytoplasm and in the arrangement of the myelin sheaths. The same alterations appear in the vestibular nerve in the internal acoustic meatus in 2 of our cases. In the other 2, the vestibular nerve was formed by a granular matrix with several myelin figures in the proximity of possible Schwann cell nucleus debris.

A scanning electron microscopy study on human otoconia genesis.

The genesis of the otoconia was studied with SEM in several human fetuses. The results of the present paper together with previous reports (1, 2, 13) support the hypothesis that otoconia genesis may develop according the following stages: (1) calcification of some sensory and supporting cells; (2) extrusion of the calcified cellular material and some organic substances in "sponge-like bodies"; (3) deposition of diverse core seeds in these areas giving rise to a random calcium carbonate crystallization and incorporation of matrix organic material; (4) growth of otoconia developing linearly with a gradual change in shape from spherical to ovoid, rhombohedral, and cylindrical forms; (5) inhibition of crystal growth occurring once a critical unsaturated calcium endolymph state and an adequate size of statoconial membranous chambers are reached.

Ciliogenesis in human vestibular epithelia. A scanning electron microscopic study.

Ciliogenesis events in human vestibular epithelia develop as an asynchronous process between neighbouring cells, but it is a synchronous one within each sensory cell, presenting the following stages. Initially, the cilia buds appear as stubby cylinders well aligned on the cuticular plate of the presumptive sensory cell. In the next stage, ciliary growth occurs at one pole of the cuticular plate where elongation of the kinocilium and the nearby stereocilia can be observed. Posteriorly, the elongation of the kinocilium and the nearby stereocilia continues, remaining shorter than the other emerging stereocilia buds. Finally, the staircase height pattern of the mature sensory hair bundle is reached by means of a ciliary buds differential elongation.

Histochemical and morphometrical ageing changes in human vocal cord muscles.

A histochemical and morphometrical study of thyroarytenoid and posterior cricoarytenoid human muscles was done in 43 human adults (38 males, 5 females) with ages ranging from 46 to 87 years. Vocal cord muscles were taken from laryngectomy specimens with carcinoma (25) and from autopsies (18), excluding those with neuromuscular diseases. In all cases the studied vocal cords were clinically and histologically normal in appearance. Only 2 patients received radiotherapy or chemotherapy. Posterior cricoarytenoid muscle was studied in 6 patients with larynx cancer. Mean diameter of thyroarytenoid muscle type I fibers (n = 128) was 38.46 microns and for type II 39.68 microns; fiber percentage values (n = 127) were 44.16% for type I and 55.84% for type II. Mean diameter (n = 6) of posterior cricoarytenoid muscle type I fibers was 42.69 microns and of type II 46.56 microns; type I fibers percentage was 66.15% and type II 33.85%. Statistical regression analysis revealed a progressive decrease in thickness of the mucosa and lamina propria in the right vocal cord along the ageing process. A low increase of endomysial tissue with a low decrease in perimysium in both vocal cords was noticed. In thyroarytenoid muscle, a low increase in type I fiber percentage and a decrease in type II fiber percentage were found. Posterior cricoarytenoid muscle showed a significant decrease in type I fiber percentage and diameter, corresponding to the same increase in variables of type II fibers.

A microanalytical study on human auditory ossicles in normal and pathological conditions.

A microanalytical study of human auditory ossicles was performed in 11 normal adults, 13 infants, 13 foetuses, 7 middle ear cholesteatoma, 7 chronic otitis and 1 facial nerve schwannoma. Malleus and incus ossification is initiated in the foetal period, the Ca/P ratio reaching a value of 1.8-1.9 in the 29-gestation-week foetus and continues in the infant period until adult, except for the marginal area of the malleus head which appears mineralized in the infant. The normal Ca/P ratio for malleus is 2.10, and 2.19 for incus. In the stapes, mature Ca/P ratio values (2.11) appear in the footplate of the 23-gestation-weeks foetus. Stapes ossification continues in its head and crura, but never reaches malleus and incus values. We have confirmed that there is a relationship between Ca/P ratio and sulphur values in the ossification process; so when the first increases the second decreases. Finally, in our pathological material we have not found any significant alteration of Ca/P ratio, sulphur or other elements studied.

Early aspects of human cochlea development and tectorial membrane histogenesis.

Several human embryos and foetuses cochlea from the first half of pregnancy were studied by light, transmission and scanning electron microscopy. Cochlea development in man is the result of three coexisting processes: First, coiling and maturation of the cartilaginous otic capsule. Second, resorption of the periodic mesenchymal reticulum with the appearance of the labyrinthine fluids. Third, differentiation of the sensory epithelium. Tectorial membrane morphogenesis is closely related to the apocrine secretory activity of the greater and lesser epithelial ridges in the 50 mm c.r.l. specimen. In the 70, 110 and 120 mm c.r.l. specimens the secretory activity rests on the interdental cells of the spiral limbus, the undifferentiated cells of Corti's primordium and in the most external cells of the lesser epithelial ridge.

Morphometric study of the paranasal sinuses in normal and pathological conditions.

Prospective and retrospective morphometric CT (axial and coronal) research was performed with 100 healthy persons and 163 patients (145 males, 118 females, mean age 50 years, range 1-88 years). The patients were classified into the following groups: chronic sinusitis (n = 85), polyposis (n = 25), mucoceles (n = 13), benign tumors (n = 20) and malignant tumors (n = 20). After initial calibration with the scale (in cm) displayed on the CT image, each paranasal sinus was outlined following its bone inner surface. The data were processed with a high-resolution analysis system, and volumes were calculated using an integration areas rule. The ethmoid, maxillary and sphenoid sinuses exhibited an increase in volume for a period of up to 15 years, afterwards maintaining similar values. The frontal sinus grows in a monomodal pattern (peak at 30 years). The volumetric results (mean and standard deviation) in the normal adult group were as follows: maxillary sinus 13.07 cm3 (6.8), ethmoid 5.5 cm3 (2.0), sphenoid 3.5 cm3 (2.6) and frontal 3.7 cm3 (3.6). Primary frontal and maxillary sinus hypoplasia appeared in 3.9% and 1.3% of cases, respectively. The anatomic variations were as follows: concha bullosa 8.3%, Haller cells 3.2% and Onodi cells 8.3%. The sinusitis values (adults) were greater than those in the normal group: 14.4 cm3 (7.3), 6.8 cm3 (2.9), 2.9 cm3 (1.9) and 4.2 cm3 (5.2), with the exception of the sphenoid, but the difference was not statistically significant. Finally, we propose a new classification for paranasal sinus tumors (benign and malignant), volumetric T (vT), taking into account the morphometric tumoral volume and the mean volumetric value of normal sinuses.