Magnetoencephalography Atlas Viewer for Dipole Localization and Viewing.

Magnetoencephalography (MEG) is a noninvasive neuroimaging technique widely recognized for epilepsy and tumor mapping. MEG clinical reporting requires a multidisciplinary team, including expert input regarding each dipole's anatomic localization. Here, we introduce a novel tool, the "Magnetoencephalography Atlas Viewer" (MAV), which streamlines this anatomical analysis. The MAV normalizes the patient's Magnetic Resonance Imaging (MRI) to the Montreal Neurological Institute (MNI) space, reverse-normalizes MNI atlases to the native MRI, identifies MEG dipole files, and matches dipoles' coordinates to their spatial location in atlas files. It offers a user-friendly and interactive graphical user interface (GUI) for displaying individual dipoles, groups, coordinates, anatomical labels, and a tri-planar MRI view of the patient with dipole overlays. It evaluated over 273 dipoles obtained in clinical epilepsy subjects. Consensus-based ground truth was established by three neuroradiologists, with a minimum agreement threshold of two. The concordance between the ground truth and MAV labeling ranged from 79% to 84%, depending on the normalization method. Higher concordance rates were observed in subjects with minimal or no structural abnormalities on the MRI, ranging from 80% to 90%. The MAV provides a straightforward MEG dipole anatomic localization method, allowing a nonspecialist to prepopulate a report, thereby facilitating and reducing the time of clinical reporting.

Effects of supplementation with corn distillers' dried grains on animal performance, nitrogen balance, and enteric CH4 emissions of young Nellore bulls fed a high-tropical forage diet.

The inclusion of corn-dried distillers' grains (DDG) could be an alternative supplement to increase animal performance, nitrogen efficiency usage (NEU), and decrease enteric methane (CH4) emissions. Our goal was to determine whether DDG could replace a traditional supplement (cottonseed meal) without affecting animal performance, N balance, and CH4 emissions. The experiment was conducted during the forage growing season (December to April), with 15 d adaptation, and a 112 d experimental period. The experimental design was completely randomized with four treatments: a mineral supplement (MS), cottonseed meal supplement (CS), 50% replacement of CS by DDG (50DDG), and 100% replacement of CS by DDG (100DDG). Cottonseed meal and DDG were used as protein supplement. A total of 12 paddocks, 3 per treatment, were used to measure forage mass: morphological and chemical composition of forage, forage allowance, and animal performance. Six animals per treatment were used to evaluate DM intake, digestibility, CH4 emissions, microbial protein production (MCP), and NEU of each treatment. Eighty-one Young Nellore bulls (48 testers, 12 per treatments and 33 adjusters) with initial BW of 255 ±â€¯5 kg (10-12 months old) were supplemented with each supplement type at a level of 0.3% of BW. Pasture management was continuous stocking with a variable stocking rate (put-and-take). Enteric CH4 was measured using the gas tracer technique. The MCP was quantified using purine derivatives and the NEU mass balance. No differences were found in nutrient intake (P > 0.228). Individual animal performance and gain per area were higher in the treatments with concentrates compared with that of MS; however, there was no difference among treatments CS, 50DDG, and 100DDG. The ADG was 0.83 for MS and 1.08 kg/animal/d when supplemented (P < 0.05). Gain per hectare was 709 kg/ha for MS and 915 kg/ha when supplemented with concentrates (P < 0.05). There was no difference in CH4 production among treatments that average 180 g/animal/d; however, CH4 per kg of gain was reduced with CS. The CH4 conversion factor averaged 5.91%. There was no difference in the synthesis of MCP and NEU. Corn DDG can replace 100% of cottonseed meal as a protein source for supplementation of young Nellore bulls grazing in tropical pastures without affecting animal performance, NEU, MCP, and CH4 emissions.

CONAN: a web application to detect specificity determinants and functional sites by amino acids co-variation network analysis.

SUMMARY: CONAN is a web application developed to detect specificity determinants and function-related sites by amino acids co-variation networks analysis, emphasizing local coevolutionary constraints. The software allows the characterization of structurally and functionally relevant groups of residues and their relationship with subsets of sequences by automatic cross-referencing with GO terms, UniprotKb annotations and INTERPRO. AVAILABILITY AND IMPLEMENTATION: CONAN is free and open-source, being distributed in the terms of the GPLV3 license. The software is available as a web application and python script versions and can be accessed at http://bioinfo.icb.ufmg.br/conan. We also provide running instructions, the source code and a user guide.

Resposta inflamatória peritoneal de asininos (Equus asinus) submetidos à ovariectomia por laparotomia e laparoscopia / Peritoneal inflammatory response of the donkeys (Equus asinus) submitted ovariectomy by laparotomy and laparoscopy

Objetivou-se avaliar resposta inflamatória e concentrações de proteínas em líquido peritonealde asininas submetidas à ovariectomia por laparotomia e laparoscopia. Foram utilizadas 18 fêmeas adultas, pesando em média 100kg, as quais foram divididas em dois grupos, de nove animais cada: o grupo I, em que foram ovariectomizadas por laparotomia, e o grupo II por laparoscopia. Após as cirurgias, em ambos os grupos foram avaliadas as seguintes variáveis no líquido peritoneal: pH, densidade, número de hemácias, leucócitos e proteínas de fase aguda (fibrinogênio, haptoglobina, albumina, antitripsina, alfa-1 glicoproteína ácida, ceruloplasmina, transferrina, imunoglobulinas A e G). Todas as variáveis foram analisadas antes das cirurgias, 12, 24, 48, 72 horas, oito e 16 dias após os procedimentos cirúrgicos. O número de hemácias e leucócitos aumentou 24 horas depois das cirurgias nos dois grupos. Haptoglobina, alfa-1 glicoproteína ácida,albumina, transferrina, gamaglobulinas A, G e proteínas totais aumentaram nos dois grupos. As concentrações de ceruloplasmina não variaram enquanto a antitripsina não foi detectada no líquido peritoneal de asininos.Foi identificada uma proteína com23.000kD, que não tem denominação nem descrição no líquido peritoneal de asininos.(AU)

The aim of this study was to evaluate the inflammatory response and protein concentrations in the peritoneal fluid of donkeys submitted to laparotomy and laparoscopic ovariectomy. Eighteen adult females, weighing on average 100kg, were divided into two groups, of 09 animals each, where in group I, they were ovariectomized by laparotomy and group II by laparoscopy. Following the surgeries, the following variables were evaluated in the peritoneal fluid: pH, density, number of red cells, leukocytes and acute phase proteins (fibrinogen, haptoglobin, albumin, antitrypsin, alpha-1 acid glycoprotein, ceruloplasmin, transferrin, Immunoglobulins A and G). All variables were analyzed before the surgeries, 12, 24, 48, 72 hours, 8 and 16 days after the surgical procedures. The number of red cells and leukocytes increased 24 hours after the surgeries in both groups. Haptoglobin, alpha-1 acid glycoprotein, albumin, transferrin, gammaglobulins A and G, and total proteins increased in both groups. Concentrations of ceruloplasmin did not change while antitrypsin was not detected in the asinine peritoneal fluid. A protein of 23,000kD, which has no name or description in the peritoneal liquid of donkeys, has been identified.(AU)

5-hydroxytryptamine1A receptor density in the hippocampus of patients with temporal lobe epilepsy is associated with disease duration.

BACKGROUND AND PURPOSE: To date, no study has evaluated the association between serotonin receptor density and clinical variables in patients with temporal lobe epilepsy caused by hippocampal sclerosis (TLE-HS) using hippocampal tissue. We evaluated 5-hydroxytryptamine1A receptor (5-HT1AR) density in hippocampal tissue from patients with TLE-HS. METHODS: We analyzed the hippocampal tissue of 34 patients with pharmacoresistant unilateral TLE-HS. 5-HT1AR density was measured using semiquantitative western blotting. RESULTS: There was an association between higher density of 5-HT1AR and longer duration of epilepsy (Spearman correlation: P = 0.040; generalized linear model: P = 0.026). CONCLUSIONS: This study demonstrated that hippocampal 5-HT1AR density is associated with epilepsy duration in patients with TLE-HS. The authors postulate that this may represent a potential regulatory enhancement of endogenous serotonergic neurotransmission in response to prolonged and enduring epileptiform activity in the hippocampal tissue of patients with pharmacoresistant TLE-HS.

Genetic divergence of common bean cultivars.

The aim of this study was to evaluate genetic divergence in the 'Carioca' (beige with brown stripes) common bean cultivar used by different institutions and in 16 other common bean cultivars used in the Rede Cooperativa de Pesquisa de Feijão (Cooperative Network of Common Bean Research), by using simple sequence repeats associated with agronomic traits that are highly distributed in the common bean genome. We evaluated 22 polymorphic loci using bulks containing DNA from 30 plants. There was genetic divergence among the Carioca cultivar provided by the institutions. Nevertheless, there was lower divergence among them than among the other cultivars. The cultivar used by Instituto Agronômico do Paraná was the most divergent in relation to the Carioca samples. The least divergence was observed among the samples used by Universidade Federal de Lavras and by Embrapa Arroz e Feijão. Of all the cultivars, 'CNFP 10104' and 'BRSMG Realce' showed the greatest dissimilarity. The cultivars were separated in two groups of greatest similarity using the Structure software. Genetic variation among cultivars was greater than the variation within or between the groups formed. This fact, together with the high estimate of heterozygosity observed and the genetic divergence of the samples of the Carioca cultivar in relation to the original provided by Instituto Agronômico de Campinas, indicates a mixture of cultivars. The high divergence among cultivars provides potential for the utilization of this genetic variability in plant breeding.

Trends and Disparities in Mortality Among Spanish-Born and Foreign-Born Populations Residing in Spain, 1999-2008.

Spain's immigrant population has increased 380% in the last decade, accounting for 13.1% of the total population. This fact has led her to become during 2009 the eighth recipient country of international immigrants in the world. The aim of this article is to describe the evolution of mortality and the main causes of death among the Spanish-born and foreign-born populations residing in Spain between 1999 and 2008. Age-standardised mortality rates (ASRs), average age and comparative mortality ratios among foreign-born and Spanish-born populations residing in Spain were computed for every year and sub-period by sex, cause of death and place of birth as well as by the ASR percentage change. During 1999-2008 the ASR showed a progressive decrease in the risk of death in the Spanish-born population (-17.8% for men and -16.6% for women) as well as in the foreign-born one (-45.9% for men and -35.7% for women). ASR also showed a progressive decrease for practically all the causes of death, in both populations. It has been observed that the risk of death due to neoplasms and respiratory diseases among immigrants is lower than that of their Spanish-born counterparts, but risk due to external causes is higher. Places of birth with the greater decreases are Northern Europe, Eastern Europe, Western Europe, Southern Europe, and Latin America and the Caribbean. The research shows the differences in the reduction of death risk between Spanish-born and immigrant inhabitants between 1999 and 2008. These results could contribute to the ability of central and local governments to create effective health policy. Further research is necessary to examine changes in mortality trends among immigrant populations as a consequence of the economic crisis and the reforms in the Spanish health system. Spanish data sources should incorporate into their records information that enables them to find out the immigrant duration of permanence and the possible impact of this on mortality indicators.

Uniform step-by-step observer for aerobic bioreactor based on super-twisting algorithm.

This paper describes a fixed-time convergent step-by-step high order sliding mode observer for a certain type of aerobic bioreactor system. The observer was developed using a hierarchical structure based on a modified super-twisting algorithm. The modification included nonlinear gains of the output error that were used to prove uniform convergence of the estimation error. An energetic function similar to a Lyapunov one was used for proving the convergence between the observer and the bioreactor variables. A nonsmooth analysis was proposed to prove the fixed-time convergence of the observer states to the bioreactor variables. The observer was tested to solve the state estimation problem of an aerobic bioreactor described by the time evolution of biomass, substrate and dissolved oxygen. This last variable was used as the output information because it is feasible to measure it online by regular sensors. Numerical simulations showed the superior behavior of this observer compared to the one having linear output error injection terms (high-gain type) and one having an output injection obtaining first-order sliding mode structure. A set of numerical simulations was developed to demonstrate how the proposed observer served to estimate real information obtained from a real aerobic process with substrate inhibition.

Protection and pathology during parasite infection: IL-10 strikes the balance.

The host response to infection requires an immune response to be strong enough to control the pathogen but also restrained, to minimize immune-mediated pathology. The conflicting pressures of immune activation and immune suppression are particularly apparent in parasite infections, where co-evolution of host and pathogen has selected many different compromises between protection and pathology. Cytokine signals are critical determinants of both protective immunity and immunopathology, and, in this review, we focus on the regulatory cytokine IL-10 and its role in protozoan and helminth infections. We discuss the sources and targets of IL-10 during parasite infection, the signals that initiate and reinforce its action, and its impact on the invading parasite, on the host tissue, and on coincident immune responses.

Self-rated health and mortality: a follow-up study of a Spanish population.

OBJECTIVES: Self-rated health (SRH) is known to be a valid indicator for the prediction of health outcomes. The aims of this study were to describe and analyse the associations between SRH and health status, socio-economic and demographic characteristics; and between SRH and mortality in a Spanish population. STUDY DESIGN: Longitudinal study. METHODS: A sample of 5275 adults (age ≥21 years) residing in the Valencian Community (Spanish Mediterranean region) was surveyed in 2005 and followed for four years. SRH was categorized into good and poor health. The response variable was mortality (dead/alive), obtained from the local mortality register. Logistic regression models were adjusted in order to analyse the associations between SRH and health status, socio-economic and demographic characteristics; odds ratios were calculated to measure the associations. Poisson regression models were adjusted in order to analyse the associations between mortality and explanatory variables; the relative risk of death was calculated to measure the associations. RESULTS: Poor SRH was reported by 25.9% of respondents, and the mortality rate after four years of follow-up was 3.6%. An association was found between SRH and the presence of chronic disease and disability in men and women. A perception of poor health vs good health led to a mortality risk of 3.0 in men and 2.7 in women. SRH was predictive of mortality, even after adjusting for all other variables. In men and women, the presence of disability provided additional predictive ability. CONCLUSIONS: SRH was predictive of mortality in both men and women, and acted as a mediator between socio-economic, demographic and health conditions and mortality.

Mitochondrial analysis sheds light on the origin of hair sheep.

A total of 180 mtDNA sequences from hair Caribbean (93), West African (73) and Canarian-wooled (14) sheep were analysed to shed light on the origin of hair sheep. A comparison of 360 Iberian sheep sequences retrieved from GenBank was performed to assess a possible European origin of the Caribbean hair sheep. These 180 sequences gave 48 different haplotypes (16 in Caribbean sheep). All Caribbean and Canarian-wooled sequences and 91.8% of the West African samples belonged to haplogroup B. The sheep analysed showed wide haplotypic identity. Caribbean sheep shared roughly two-thirds of their samples with Canarian-wooled and West African samples, respectively. Principal component analysis showed that the Caribbean and the Canarian-wooled sheep clustered together. Additional analyses showed that hair and Iberian sheep had wide genetic identity. It was not possible to ascertain a single Canarian, African or European origin of the Caribbean hair sheep using mtDNA markers only. European, African and Caribbean hair sheep maternal genetic backgrounds likely result from related domestication events.

Effect of holding medium, temperature and time on structural integrity of equine ovarian follicles during the non-breeding season.

The objective was to evaluate the efficiency of phosphate-buffered saline (PBS) and Minimum Essential Medium (MEM) during the transport of equine preantral and antral follicles at various temperatures and incubation interval. Equine ovaries (n = 10) from an abattoir were cut into 19 fragments; one was immediately fixed in Bouin's solution (control) and the other fragments were placed in PBS or MEM solution at 4, 20, or 39 °C for 4, 12, or 24 h. After the respective incubation periods, all fragments were fixed in Bouin's solution for 24 h and then submitted to standard histologic analysis. In total, 2567 ovarian follicles were analyzed, including 1752 primordial, 764 primary, 34 secondary and seven antral follicles. Relative to the control group, the transport of equine ovarian fragments in both solutions significantly reduced the percentage of morphologically normal follicles with increasing time and temperature. At 4 °C for 4 h, considering primordial and developing follicles, PBS had a higher (P < 0.05) rate (98.9%) of morphologically normal follicles than MEM, 48.7%. At 39 °C for 12 h, all follicles in both solutions were degenerated. Regarding the stage of follicular development, primordial follicles were less (P < 0.05) affected by preservation than primary and secondary follicles in all media, times and temperatures tested, except at 4 °C for 12 h in PBS, in which the primary and secondary follicles were less (P < 0.05) affected. Overall, 43% of antral follicles were morphologically normal when maintained in MEM at 4 °C for 4 h. In conclusion, equine follicles were successfully preserved in ovarian fragments at 4 °C in phosphate-buffered saline for up to 4 h.

Autoimmune rheumatic diseases in the intensive care unit: experience from a tertiary referral hospital and review of the literature.

Autoimmune rheumatic diseases (AIRD) are not uncommon in the general population and up to one third of hospitalized patients with AIRD may need admission to intensive care unit (ICU). This paper describes the causes of admission, the clinical features and outcome of 24 AIRD patients admitted to a medical ICU from a third level hospital. Thirteen patients had systemic lupus erythematosus (54.2%), three rheumatoid arthritis (12.5%), three pulmonary renal syndrome (12.5%), two dermatopolymyositis (8.3%), two scleroderma (8.3%) and one antiphospholipid syndrome (4.2%). The main causes for ICU admission were rheumatic disease flare-up (37.5%), infection (37.5%) and complications derived from rheumatic disease (29.1%). Mortality during ICU stay was 16.7% (four patients). Excluding shock requiring vasopressor support, no statistical difference was found between survivors and nonsurvivors; although there was a trend to higher test severity scores (APACHE II, ODIN) in nonsurvivors. Our results reveal a lower mortality rate in AIRD patients admitted to the ICU than reported previously. Severity scores such as APACHE II are predictors of mortality in patients with AIRD in the ICU.

Pneumococcal surface protein A of invasive Streptococcus pneumoniae isolates from Colombian children.

Pneumococcal surface protein A (PspA) elicits protection in mice against fatal bacteremia and sepsis caused by genetically diverse pneumococci and protects against carriage and lung infection. We determined the PspA families of invasive isolates of Streptococcus pneumoniae recovered from Colombian children <5 years of age. That 97.5% of Colombian isolates belong to PspA families 1 and 2 supports the hypothesis that a human PspA vaccine covering a few PspA families could be broadly effective.

Oral-disease prevention in children with cancer: testing preventive protocol effectiveness.

UNLABELLED: Mucositis, gingivitis, herpetic stomatitis and candidiasis are a potential source of systemic infection in patients undergoing chemotherapy. Their severity and incidence may be reduced with procedures based on the prevention and elimination of sources causing oral infection and irritation. OBJECTIVE: The purpose of this investigation was to evaluate the effectiveness of an Oral Disease Preventive Protocol in children with cancer, subjected to chemotherapy and prior to application of dentobacterial infection control. MATERIAL AND METHODS: A controlled clinical test was run, with random assignations, on twelve 5-to-12-year-old patients diagnosed with Acute Lymphoblastic Leukemia (ALL) or Lymphoma, evaluated for twelve months, with a total of 154 evaluations. Five patients were boosted with oral physiotherapy, with non-alcoholic 0.05% fluoride mouthwashes, with topical application of myconazole oral gel; seven patients were given instructions on oral physiotherapy. RESULTS: There were no significant differences between the groups under evaluation (p>0.05). Of the oral complications evaluated, gingivitis registered the highest percentage (60%), followed by mucositis (18%) and candida albicans infection (7%). Most affected were the submandibular and cervical ganglions (59% and 41%, respectively). CONCLUSIONS: Prior control of sources causing oral infection and irritation effectively prevents complications during non-surgical cancer therapy.

Atrial flutter ablation with a new radiofrequency catheter.

OBJECTIVE: To assess the performance of a new radiofrequency catheter, specially designed for inferior vena cava-tricuspid annulus (IVC-TA) isthmus ablation, in the treatment of atrial flutter. PATIENTS: IVC-TA isthmus ablation was performed in thirteen patients, eleven men and two women, aged 60 +/- 12, with a diagnosis of typical atrial flutter, symptomatic despite anti-arrhythmic therapy. The flutter was present for more than one year in seven patients and was paroxysmal in the remainder. The echocardiogram showed atrial enlargement in six patients. Atrial flutter was an isolated phenomenon in seven patients and in the remainder was associated with arterial hypertension (two patients), ischemic heart disease (two patients) and dilated cardiomyopathy (two patients). METHODS: In the electrophysiologic study four diagnostic catheters were used, including one duodecapolar for mapping the tricuspid annulus. In the patients who presented with sinus rhythm, atrial flutter was induced with programmed atrial stimulation, and then the atrial activation circuit was mapped. To demonstrate the entrainment phenomenon the IVC-TA isthmus was over-stimulated, to prove that this was the slow zone of the circuit. The radiofrequency energy was applied in the IVC-TA isthmus with the Medtronic Cosio-Fluttr ablation catheter, for 60 sec per application, with temperature control and with a maximum energy output of 50 W. Criteria for success were not only the disappearance of the atrial flutter during the application of radiofrequency energy, but also the demonstration of bi-directional IVC-TA isthmus block. RESULTS: The primary success rate was 100%. The mean procedure time was 110 +/- 22 min, mean fluoroscopy time was 23 +/- 4 min and the number of radiofrequency energy pulses was 9 +/- 3. There were no complications. The patients were followed for a mean time of 8 +/- 4 months and atrial flutter recurred in only one patient (8%). CONCLUSIONS: Atrial flutter ablation with the new Medtronic Cosio-Fluttr catheter, specially designed for the application of radiofrequency at the IVC-TA isthmus, is a safe procedure and has a high success rate. It simplifies ablation, decreasing the number of radiofrequency energy pulses, without using long sheaths and keeping short procedure and fluoroscopy times.

Presence of international multiresistant clones of Streptococcus pneumoniae in Colombia.

In Colombia, penicillin resistance of Streptococcus pneumoniae invasive isolates recovered from children less than 5 years old has increased from 10% in 1994 to 49.4% in 1999, suggesting the circulation of international resistant clones in the country. A total of 167 S. pneumoniae invasive isolates with diminished susceptibility to penicillin (DSP) were studied. The techniques used were pulsed-field gel electrophoresis (PFGE) and restriction fragment length polymorphism (RFLP) of penicillin-binding proteins (PBPs) genes (2B, 2X, and 1A). Forty-nine serotype 23F isolates were grouped in two clusters: 15 (31%) multiresistant isolates showed PFGE pattern A and PBP I profile, thus making them indistinguishable from Spain23F-1 clone, and 34 (69%) with PFGE pattern C, PBP II profile, and intermediate level resistance (ILR) to penicillin and TMP-SMX, features unique to a Colombian clone. Fifty-five serotype 14 isolates were assigned to PFGE B pattern, PBP III profile, having high-level resistance to penicillin, and TMP-SMX, similar to the France9V variant 14. This same pattern was present in five capsular type 9V isolates. Four serotype 14 isolates were assigned to PFGE pattern F, and appeared to be similar to Slovakia(14)-10 PFGE pattern, although they had different PBP profiles. Nine capsular type 6B and one 6A isolates belonged to PFGE pattern M, similar to Spain6B-2, although they showed different PBP profiles. The remaining 44 isolates, corresponding to serotypes 14, 6B, 19F, and 34, showed variable PFGE and PBP patterns. These results show that as many as two international clones may be circulating in Colombia as well as a unique, widely distributed 23F clone with ILR to penicillin. Additionally, some Colombian isolates capsular type 14 and 6B might be related to Slovakia(14)-10 Spain6B-2 clones, respectively.

[Deciding about pacing mode in sinus node dysfunction: should carotid sinus massage be performed and in which circumstances?]. / Decisão do modo de pacing na doença do nódulo sinusal: será a massagem do seio carotídeo pertinente e em que circunstâncias?

OBJECTIVE: To state the incidence of carotid sinus syndrome (CSS) with atrioventricular node manifestation in patients with sinus node dysfunction (SND) and indication for a definitive pacemaker (PM), we propose a new protocol between atrial pacing AAI and double chamber DDD. POPULATION AND METHODS: 69 patients (PTS) (male 71%), median age 65 +/- 10 years, with SND (normal PQ and no intraventricular conduction defect), that had a PM implant following the protocol that included carotid sinus massage for the pacing decision, were followed prospectively between December 1995 and November 1999. During the protocol we implanted DDD PM in PTS with Wenckebach less than 130 or Wenckebach equal/over 130 and CSS. At least, in PTS with Wenckebach equal/over 130 and no CSS we implanted AAI PM. The follow-up was between 4 months and 4 years, with clinical evaluation in the first and fourth months and then half yearly, with carotid sinus massage in the first evaluation. RESULTS: About 1/4 of the 69 patients followed had SND without carotid sinus syndrome, or atrioventricular node repercussion; the SND involved the atrioventricular node in 56% of the patients, and there was a relation between the SND and carotid sinus syndrome in 18.8%. The follow-up revealed, in all patients, a complete remission of the symptoms, and when we repeated the carotid sinus massage in the first evaluation, there was a response like in the surgery room, in all patients. CONCLUSIONS: There is a significant number of patients with SND and carotid sinus syndrome. The carotid sinus massage performed in the surgery room does not influence the test sensitivity and specificity in the diagnosis of carotid sinus syndrome. The authors think that carotid sinus massage should be considered in the protocol that defines the pacing mode, in patients with SND, and that influence the choice of pacemaker in 18.8% of patients.