[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.

Long-term results of the Spanish Protocol SO-95 for the treatment of non-metastatic high-grade osteosarcoma of the extremities in children

INTRODUCTION: The long-term results of the Spanish Study Protocol SEOP-SO-95 for treatment of localised osteosarcoma of the extremities in children were evaluated. PATIENTS AND METHODS: One hundred consecutive patients under 18 years of age from 22 institutions were enrolled from January 1995 to December 2000. Immunohistochemical expression of p53, HER/erbB-2 and P-glycoprotein were retrospectively studied in 27 patients. Treatment consisted of: preoperative chemotherapy with doxorubicin, cisplatin, high-dose methotrexate with leucovorin rescue and ifosfamide for 14 weeks; surgery of primary tumour in week 16; postoperative chemotherapy with the above-mentioned drugs for 25 weeks. RESULTS: With a median follow-up of 124 months (range 84-158 months), 69 patients (69%) were continuously event-free survivors; the 10-year probability of event-free survival (EFS) was 62%. Conservative surgery was performed in 85% of patients. Twenty-six patients had local recurrence or distant relapse. The median time to recurrence/ relapse was 27 months (range 17-93 months). The local recurrence rate was 7% (7 of the 100 patients); 4 had wide surgical margins, 2 marginal and 1 intralesional. Four patients died as a result of chemotherapy-related toxicity and 1 developed a second neoplasia (acute myeloid leukaemia). p53 expression and HER2/erbB-2 expression showed no effect on survival or EFS. CONCLUSIONS: This therapeutic protocol achieved good oncologic and orthopaedic results. We observed a significant treatment-related toxicity (AU)

Tratamiento de las fracturas de odontoides con halo-chaleco / Halo-vest treatment of odontoid fractures

Objetivo. El tratamiento de las fracturas de odontoides es controvertido, y no existe un único método terapéutico universalmente aceptado. El objetivo del presente trabajo es revisar retrospectivamente las fracturas de odontoides tratadas ortopédicamente con halo-chaleco. Material y método. Se estudiaron retrospectivamente 18 pacientes que presentaron una fractura de odontoides y que fueron tratadas en el período 1987-2001 mediante halo-chaleco. La edad media fue de 38 años (rango 16-75 años). El seguimiento medio fue de 5 años (rango 1-15 años). El mecanismo lesional más frecuente fue, en 11 casos, el accidente de tráfico. Según la clasificación de Anderson y D'Alonzo, en 8 casos la fractura fue del tipo III y en 10 casos del tipo II. En todos los casos se realizó un estudio radiográfico estándar y mediante tomografía axial computarizada (TAC) (excepto en 3 casos). La consolidación se documentó mediante radiografía y tomografía simple (en algunos casos mediante TAC). Según la escala de Smiley-Webster, se evaluó: el dolor, la movilidad cervical, el retorno a la actividad y la situación neurológica. Resultados. La tasa global de consolidación fue del 89% (16 casos). En 9 casos se obtuvieron resultados excelentes (50%); en 4, buenos (22,2%); en 3, regulares (16,6%); y en 2, malos (11,1%). Se obtuvieron buenos resultados en 6 casos de fracturas del tipo II (60%) y en 7 casos del tipo III (87,5%). En 7 casos se consiguió mejorar la reducción una media de 6 mm. En 2 casos el desplazamiento inicial hasta la consolidación aumentó 2 mm. Los malos resultados, por fracaso del tratamiento, precisaron de artrodesis cervical posterior mediante la técnica de Brooks y Gallie (11,1%). En 2 de los cinco pacientes mayores de 60 años (40%) fracasó el tratamiento y se precisó de intervención quirúrgica para estabilizar la fractura. Entre las complicaciones más importantes destacaron 5 casos de aflojamiento del halo (27,7%), un caso de neuroma sensitivo y un caso de siringomielia postraumática secundaria. Conclusiones. El tratamiento ortopédico con halo-chaleco nos ha permitido reducir y estabilizar la fractura de odontoides hasta la consolidación en el 89% de los casos, obteniendo un 66,5% de buenos resultados

Purpose. Treatment of odontoid fractures is controversial and there is no single therapeutic method that is universally accepted. The purpose of this paper is to retrospectively review odontoid fractures treated orthopedically with a halo-vest. Materials and methods. Eighteen patients were retrospectively studied who presented with an odontoid fracture; fractures were treated between 1987 and 2001 by means of a halo vest. Mean age was 38 years (range 16-75 years). Mean follow-up was 5 years (range: 1-15 years). The most usual mechanism of injury (11 cases) was a road accident. Eight of the fractures were type III and 3 were type II according to Anderson and D'Alonzo's classification. In all cases but three, a standard and CT-scan imaging study was performed. Incorporation was documented by means of plain x-rays and tomographs (in some cases CT-scans were used). Pain, cervical mobility, return to previous activities and neurological status were assessed using the Smiley-Webster scale. Results. Global incorporation rate was 89% (16 cases). In 9 cases (50%) results were excellent, in 4 (22%) they were good, in 3 (16.6%) they were fair and in 2 (11%) poor. Results were good in 6 cases of type II fractures (60%) and 7 cases of type III fractures (87.5%). In 7 cases it was possible to improve reduction by an average 6 mm. In two cases, initial displacement until incorporation increased by 2 mm. Poor results (11.1%) resulted from treatment failure and required a posterior cervical arthrodesis performed with Brooks and Gallie's technique. In 2 of the 5 patients over 60 (40%), treatment failed and a surgical procedure was required to stabilize the fracture. The most significant complications were 5 cases of halo loosening (27.7%), one case of a sensory nerve neuroma and one case of secondary post-traumatic syringomyelia. Conclusions. Orthopedic treatment with a halo-vest allowed us to reduce and stabilize odontoid fractures up to incorporation in 89% of cases, with 66.5% of good results (AU)

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.

Lesiones traumáticas cervicales tratadas con artrodesis anterior con placa / Traumatic cervical spine injuries treated with anterior plate fusion

Objetivo. Se estudia la evolución del tratamiento mediante injerto autólogo y placa anterior de las lesiones traumáticas cervicales, incluyendo las que presentan lesión de las estructuras posteriores. Material y método. Estudio retrospectivo de 40 casos de lesiones traumáticas cervicales del raquis inferior (desde C3 a C7), con un seguimiento medio de dos años. La serie consta de 31 varones (77,5 por ciento) y 9 mujeres (22,5 por ciento), con una edad media de 33 años (de 15 a 77 años). El tratamiento realizado ha sido la reducción y osteosíntesis con placa anterior e injerto tricortical de cresta ilíaca. Se realiza una valoración clínica del dolor residual cervical y cervicobraquial en 4 grados y una valoración radiológica del resultado final, analizando la consolidación, la alineación y la presencia de listesis residual. Resultados. Se ha obtenido la consolidación de la artrodesis en 39 pacientes (97,5 por ciento), con una buena alineación final del raquis cervical. La evolución clínica ha sido favorable y la tasa de complicaciones muy baja. Conclusiones. La fijación anterior con placa es un tratamiento válido para las lesiones traumáticas cervicales, incluidas aquéllas con afectación de las estructuras posteriores (AU)

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.

[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.