Neck pounding during sinus rhythm: a new clinical manifestation of dual atrioventricular nodal pathways

Objective To determine the clinical and electrophysiological characteristics of patients with paroxysmal palpitations and neck pounding during sinus rhythm. Methods Clinical, electrocardiographic, and electrophysiological characteristics of six patients with paroxysmal palpitations and neck pounding during sinus rhythm were studied in basal conditions and when symptomatic. Response to treatment was observed. Results Baseline ECGs were normal (four patients) or had first degree atrioventricular block with intermittent PR shortening. During symptoms, narrow QRS rhythms were seen without visible P waves (three patients) or with P waves partially hidden in the QRS complex (three patients). Dual atrioventricular nodal pathways were found in all five patients who had electrophysiological studies. In these patients the slow pathway conduction time was long enough (mean (SD), 425 (121)¿ms) for ventricular activation after slow pathway conduction during sinus rhythm to coincide with the next atrial depolarisation, causing neck pounding during exercise (four patients) or at rest (two patients). Tachycardia was not induced in any patient. Medical treatment aggravated symptoms in three patients. A pacemaker was successfully used in two. Conclusions Neck pounding during sinus rhythm is a clinical manifestation of dual atrioventricular nodal pathways. Medical treatment may aggravate symptoms but a pacemaker may offer definitive relief.

Caracterització i conservació d’una població de tortuga de rierol (Mauremys Leprosa) a l’ein del riu Llobregat al terme d’Abrera

S'ha estudiat una població de tortuga de rierol (Mauremys leprosa) present al curs principal del riu Llobregat, al seu pas pel municipi d'Abrera (Baix Llobregat). El tram té una longitud de 4.140 metres de recorregut sinuós, inclòs a l'EIN Riu Llobregat, amb predomini d'albaredes i pollancredes. S'ha caracteritzat el tram de riu segons el tipus de secció que presenta al llarg de l'àrea d'estudi. L'activitat de les tortugues comprèn de mitjans de febrer a mitjans de novembre, sense que s'hagi detectat una disminució a l'estiu. L'ús de l'espai no és uniforme amb una marcada preferència per trams del riu amb una certa fondària i velocitat de l'aigua alentida. S’han capturat 68 tortugues de rierol mitjançant nanses de pesca adaptades i, un cop marcades, s'han alliberat al mateix lloc. Per a cada animal es van obtenir les dades biomètriques i es va determinar el sexe. Mitjançant el mètode de captura-recaptura s'ha estimat la mida de la població en 100 ± 11 individus. La ràtio de sexes de la població és de 2:1 a favor dels mascles. La distribució de classes d'edats permet comprovar que la població està ben estructurada. No s'ha comprovat la reproducció, tot i que el nombre de femelles reproductores és elevat. La falta de captures de nounats i d’individus d'un hivern d’edat, i el baix nombre de juvenils capturats fa pensar que la taxa de reclutament és baixa. La mobilitat dels animals aigües amunt està limitada per la presència de dos assuts a l'àrea d'estudi, la qual cosa compromet la connectivitat de la població dins i fora de l'àrea d'estudi. També s'ha detectat la presència de tortuga de Florida (Trachemys scripta spp.) sense que s'hagi observat cap interacció entre ambdues espècies. Es proposen un seguit de mesures per afavorir la conservació de la tortuga de rierol.

Estimation of zero-sequence impedance of undergrounds cables for single-phase fault location in distribution systems with electric arc

This paper focus on the problem of locating single-phase faults in mixed distribution electric systems, with overhead lines and underground cables, using voltage and current measurements at the sending-end and sequence model of the network. Since calculating series impedance for underground cables is not as simple as in the case of overhead lines, the paper proposes a methodology to obtain an estimation of zero-sequence impedance of underground cables starting from previous single-faults occurred in the system, in which an electric arc occurred at the fault location. For this reason, the signal is previously pretreated to eliminate its peaks voltage and the analysis can be done working with a signal as close as a sinus wave as possible

Programació d'una aplicació gràfica per l'anàlisi de senyals usant LDB (Local Discriminant Bases) i MLDB (Modified LDB)

Tot seguit presentem un entorn per analitzar senyals de tot tipus amb LDB (Local Discriminant Bases) i MLDB (Modified Local Discriminant Bases). Aquest entorn utilitza funcions desenvolupades en el marc d’una tesi en fase de desenvolupament. Per entendre part d’aquestes funcions es requereix un nivell de coneixement avançat de processament de senyals. S’han extret dels treballs realitzats per Naoki Saito [3], que s’han agafat com a punt de partida per la realització de l’algorisme de la tesi doctoral no finalitzada de Jose Antonio Soria. Aquesta interfície desenvolupada accepta la incorporació de nous paquets i funcions. Hem deixat un menú preparat per integrar Sinus IV packet transform i Cosine IV packet transform, tot i que també podem incorporar-n’hi altres. L’aplicació consta de dues interfícies, un Assistent i una interfície principal. També hem creat una finestra per importar i exportar les variables desitjades a diferents entorns. Per fer aquesta aplicació s’han programat tots els elements de les finestres, en lloc d’utilitzar el GUIDE (Graphical User Interface Development Enviroment) de MATLAB, per tal que sigui compatible entre les diferents versions d’aquest programa. En total hem fet 73 funcions en la interfície principal (d’aquestes, 10 pertanyen a la finestra d’importar i exportar) i 23 en la de l’Assistent. En aquest treball només explicarem 6 funcions i les 3 de creació d’aquestes interfícies per no fer-lo excessivament extens. Les funcions que explicarem són les més importants, ja sigui perquè s’utilitzen sovint, perquè, segons la complexitat McCabe, són les més complicades o perquè són necessàries pel processament del senyal. Passem cada entrada de dades per part de l’usuari per funcions que ens detectaran errors en aquesta entrada, com eliminació de zeros o de caràcters que no siguin números, com comprovar que són enters o que estan dins dels límits màxims i mínims que li pertoquen.

Application of ultrasound in bone surgery: two case reports

The present study describes some of the applications of ultrasound in bone surgery, based on the presentation of two clinical cases. The Piezosurgery® ultrasound device was used (Tecnología Mectron Medical, Carasco, Italy). In one case the instrument was used to harvest a chin bone graft for placement in a bone defect at level 1.2, while in the other case a bony window osteotomy was made in the external wall of the maxillary sinus, in the context of a sinus membrane lift procedure. The Piezosurgery® device produces specific ultrasound frequency modulation (25-29 kHz), and has been designed to secure increased precision in application to bone surgery. This instrument produces selective sectioning of the mineralized bone structures, and causes less intra- and postoperative bleeding. One of the advantages of the Piezosurgery® device is that it can be used for maxillary sinus lift procedures in dental implant placement. In this context it considerably lessens the risk of sinus mucosa laceration by preparing the bony window in the external wall of the upper maxilla, and can be used to complete the lifting maneuver. The use of ultrasound in application to hard tissues can be regarded as a slow technique compared with the conventional rotary instruments, since it requires special surgical skill and involves a certain learning curve.

Rehabilitation of atrophic maxilla: a review of 101 zygomatic implants

Introduction: Zygomatic implants are a good rehabilitation alternative for upper maxilla with severe bone reabsorption. These implants reduce the need for onlay-type bone grafting in the posterior sectors and for maxillary sinus lift procedures - limiting the use of bone grafts to the anterior zone of the upper jaw in those cases where grafting is considered necessary. Objective: To evaluate the survival of 101 zygomatic implants placed in upper maxilla presenting important bone reabsorption, with a follow-up of 1-72 months. Patients and methods: A retrospective study was made of 101 Zygoma® implants (Nobel Biocare, Göteborg, Sweden) placed in 54 patients with totally edentulous and atrophic upper maxilla, in the period between 1998-2004. There were 35 women and 19 men, subjected to rehabilitation in the form of fixed prostheses and overdentures using 1-2 zygomatic implants and 2-7 implants in the anterior maxillary zone. The principal study variables were smoking, a history of sinusitis, the degree of bone reabsorption, and peri-implant bone loss, among others. Results: The descriptive analysis of the 101 zygomatic implants placed in 54 patients with a mean age of 56 years (range 38-75) yielded a percentage survival of 96.04%, with four failed implants that were removed (two before and two after prosthetic loading). Nine patients were smokers, and none of the 54 subjects reported a history of sinus disorders. Discussion and conclusions: Zygomatic implants are designed for use in compromised upper maxilla. They allow the clinician to shorten the treatment time, affording an interesting alternative for fixed prosthetic rehabilitation. This study confirms that zygomatic bone offers predictable anchorage and acceptable support function for prostheses in atrophic jaws. However, these implants are not without complications. Longer-term evaluations are needed of zygomatic implant survival in order to establish a correct clinical prognosis

Orofacial pain of cardiac origin: review literature and clinical cases

The most common types of orofacial pain originate at the dental or periodontal level or in the musculoskeletal structures. However, the patient may present pain in this region even though the source is located elsewhere in the body. One possible source of heterotopic pain is of cardiac origin. Objectives: Report two cases of orofacial pain of cardiac origin and review the clinical cases described in the literature. Study Design: Description of clinical cases and review of clinical cases. Results and conclusions: Nine cases of atypical pain of cardiac origin are recorded, which include 5 females and 4 males. In craniofacial structures, pain of cardiac origin is usually bilateral. At the craniofacial level, the most frequent location described is in the throat and jaw. Pain of cardiac origin is considered atypical due to its location, although roughly 10% of the cases of cardiac ischemia manifest primarily in craniofacial structures. Finally, the differential diagnosis of pain of odontogenic origin must be taken into account with pain of non-odontogenic origin (muscle, psychogenic, neuronal, cardiac, sinus and neurovascular pain) in order to avoid diagnostic errors in the dental practice as well as unnecessary treatments.

Proteasome inhibition reduces proliferation, collagen expression, and inflammatory cytokine production in nasal mucosa and polyp fibroblasts

Proteasome inhibitors, used in cancer treatment for their proapoptotic effects, have anti-inflammatory and antifibrotic effects on animal models of various inflammatory and fibrotic diseases. Their effects in cells from patients affected by either inflammatory or fibrotic diseases have been poorly investigated. Nasal polyposis is a chronic inflammatory disease of the sinus mucosa characterized by tissue inflammation and remodeling. We tested the hypothesis that proteasome inhibition of nasal polyp fibroblasts might reduce their proliferation and inflammatory and fibrotic response. Accordingly, we investigated the effect of the proteasome inhibitor Z-Leu-Leu-Leu-B(OH)2 (MG262) on cell viability and proliferation and on the production of collagen and inflammatory cytokines in nasal polyp and nasal mucosa fibroblasts obtained from surgery specimens. MG262 reduced the viability of nasal mucosa and polyp fibroblasts concentration- and time-dependently, with marked effects after 48 h of treatment. The proteasome inhibitor bortezomib provoked a similar effect. MG262-induced cell death involved loss of mitochondrial membrane potential, caspase-3 and poly(ADP-ribose) polymerase activation, induction of c-Jun phosphorylation, and mitogen-activated protein kinase phosphatase-1 expression. Low concentrations of MG262 provoked growth arrest, inhibited DNA replication and retinoblastoma phosphorylation, and increased expression of the cell cycle inhibitors p21 and p27. MG262 concentration-dependently inhibited basal and transforming growth factor-β-induced collagen mRNA expression and interleukin (IL)-1β-induced production of IL-6, IL-8, monocyte chemoattractant protein-1, regulated on activation normal T cell expressed and secreted, and granulocyte/macrophage colony-stimulating factor in both fibroblast types. MG262 inhibited IL-1β/tumor necrosis factor-α-induced activation of nuclear factor-κB. We conclude that noncytotoxic treatment with MG262 reduces the proliferative, fibrotic, and inflammatory response of nasal fibroblasts, whereas high MG262 concentrations induce apoptosis.

Proteasome inhibition reduces proliferation, collagen expression, and inflammatory cytokine production in nasal mucosa and polyp fibroblasts

Proteasome inhibitors, used in cancer treatment for their proapoptotic effects, have anti-inflammatory and antifibrotic effects on animal models of various inflammatory and fibrotic diseases. Their effects in cells from patients affected by either inflammatory or fibrotic diseases have been poorly investigated. Nasal polyposis is a chronic inflammatory disease of the sinus mucosa characterized by tissue inflammation and remodeling. We tested the hypothesis that proteasome inhibition of nasal polyp fibroblasts might reduce their proliferation and inflammatory and fibrotic response. Accordingly, we investigated the effect of the proteasome inhibitor Z-Leu-Leu-Leu-B(OH)2 (MG262) on cell viability and proliferation and on the production of collagen and inflammatory cytokines in nasal polyp and nasal mucosa fibroblasts obtained from surgery specimens. MG262 reduced the viability of nasal mucosa and polyp fibroblasts concentration- and time-dependently, with marked effects after 48 h of treatment. The proteasome inhibitor bortezomib provoked a similar effect. MG262-induced cell death involved loss of mitochondrial membrane potential, caspase-3 and poly(ADP-ribose) polymerase activation, induction of c-Jun phosphorylation, and mitogen-activated protein kinase phosphatase-1 expression. Low concentrations of MG262 provoked growth arrest, inhibited DNA replication and retinoblastoma phosphorylation, and increased expression of the cell cycle inhibitors p21 and p27. MG262 concentration-dependently inhibited basal and transforming growth factor-β-induced collagen mRNA expression and interleukin (IL)-1β-induced production of IL-6, IL-8, monocyte chemoattractant protein-1, regulated on activation normal T cell expressed and secreted, and granulocyte/macrophage colony-stimulating factor in both fibroblast types. MG262 inhibited IL-1β/tumor necrosis factor-α-induced activation of nuclear factor-κB. We conclude that noncytotoxic treatment with MG262 reduces the proliferative, fibrotic, and inflammatory response of nasal fibroblasts, whereas high MG262 concentrations induce apoptosis.

Programació d'una aplicació gràfica per l'anàlisi de senyals usant LDB (Local Discriminant Bases) i MLDB (Modified LDB)

Tot seguit presentem un entorn per analitzar senyals de tot tipus amb LDB (Local Discriminant Bases) i MLDB (Modified Local Discriminant Bases). Aquest entorn utilitza funcions desenvolupades en el marc d’una tesi en fase de desenvolupament. Per entendre part d’aquestes funcions es requereix un nivell de coneixement avançat de processament de senyals. S’han extret dels treballs realitzats per Naoki Saito [3], que s’han agafat com a punt de partida per la realització de l’algorisme de la tesi doctoral no finalitzada de Jose Antonio Soria. Aquesta interfície desenvolupada accepta la incorporació de nous paquets i funcions. Hem deixat un menú preparat per integrar Sinus IV packet transform i Cosine IV packet transform, tot i que també podem incorporar-n’hi altres. L’aplicació consta de dues interfícies, un Assistent i una interfície principal. També hem creat una finestra per importar i exportar les variables desitjades a diferents entorns. Per fer aquesta aplicació s’han programat tots els elements de les finestres, en lloc d’utilitzar el GUIDE (Graphical User Interface Development Enviroment) de MATLAB, per tal que sigui compatible entre les diferents versions d’aquest programa. En total hem fet 73 funcions en la interfície principal (d’aquestes, 10 pertanyen a la finestra d’importar i exportar) i 23 en la de l’Assistent. En aquest treball només explicarem 6 funcions i les 3 de creació d’aquestes interfícies per no fer-lo excessivament extens. Les funcions que explicarem són les més importants, ja sigui perquè s’utilitzen sovint, perquè, segons la complexitat McCabe, són les més complicades o perquè són necessàries pel processament del senyal. Passem cada entrada de dades per part de l’usuari per funcions que ens detectaran errors en aquesta entrada, com eliminació de zeros o de caràcters que no siguin números, com comprovar que són enters o que estan dins dels límits màxims i mínims que li pertoquen.