Cambios en el examen clínico objetivo y estructurado (ECOE) de las facultades de Medicina durante la COVID-19. Experiencia de una ECOE de casos-clínicos computarizados simulados (ECOE-CCS) conjunta / Changes in the Objective Structured Clinical Examination (OSCE) of University Schools of Medicine during COVID-19. Experience with a computer-based case simulation OSCE (CCS-OSCE)

Antecedentes y objetivos La pandemia de la COVID-19 ha obligado a completar los estudios universitarios online. La Conferencia Nacional de Decanos de Facultades de Medicina coordina una prueba de evaluación de competencias clínicas objetiva y estructurada (ECOE) de 20 estaciones presenciales a los estudiantes de sexto del grado. Como consecuencia de la pandemia se ha diseñado una ECOE sustitutoria con casos-clínicos computarizados simulados (ECOE-CCS). El objetivo del artículo es describir la elaboración, la ejecución y el desarrollo de la prueba. Materiales y métodos Estudio descriptivo de la ECOE-CCS conjunta desde su gestación en abril 2020 hasta su ejecución en junio 2020. Resultados La ECOE-CCS evaluó las competencias de anamnesis, exploración, juicio clínico, aspectos éticos, relaciones interprofesionales, prevención y promoción de la salud. No se evaluaron habilidades técnicas ni de comunicación. La ECOE-CCS consistió en 10 estaciones de 12 minutos de duración, con un número de preguntas de seis a 21 (media: 1,1 minutos/pregunta). En la ECOE-CCS se utilizó la plataforma virtual del campus de cada una de las 16 facultades de Medicina que participaron, con un total de 2.829 estudiantes de sexto curso. Se realizó de una forma conjunta en dos fechas de junio del 2020. Conclusiones La experiencia de la ECOE-CCS permitió llevar a cabo una integración y el trabajo interdisciplinar de las diferentes facultades de Medicina. La ECOE-CCS realizada podría asemejarse al Step 3 CCS de la United States Medical Licensing Examination (AU)

Background and objectives The COVID-19 pandemic has forced universities to move the completion of university studies online. Spain's National Conference of Medical School Deans coordinates an objective, structured clinical competency assessment called the Objective Structured Clinical Examination (OSCE), which consists of 20 face-to-face test sections for students in their sixth year of study. As a result of the pandemic, a computer-based case simulation OSCE (CCS-OSCE) has been designed. The objective of this article is to describe the creation, administration, and development of the test. Materials and methods This work is a descriptive study of the CCS-OSCE from its planning stages in April 2020 to its administration in June 2020. Results The CCS-OSCE evaluated the competences of anamnesis, exploration, clinical judgment, ethical aspects, interprofessional relations, prevention, and health promotion. No technical or communication skills were evaluated. The CCS-OSCE consisted of ten test sections, each of which had a 12-minutes time limit and ranged from six to 21 questions (mean: 1.1 minutes/question). The CCS-OSCE used the virtual campus platform of each of the 16 participating medical schools, which had a total of 2,829 students in their sixth year of study. It was jointly held on two dates in June 2020. Conclusions The CCS-OSCE made it possible to bring together the various medical schools and carry out interdisciplinary work. The CCS-OSCE conducted may be similar to Step 3 of the United States Medical Licensing Examination (AU)

Changes in the Objective Structured Clinical Examination (OSCE) of University Schools of Medicine during COVID-19. Experience with a computer-based case simulation OSCE (CCS-OSCE).

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has forced universities to move the completion of university studies online. Spain's National Conference of Medical School Deans coordinates an objective, structured clinical competency assessment called the Objective Structured Clinical Examination (OSCE), which consists of 20 face-to-face test sections for students in their sixth year of study. As a result of the pandemic, a computer-based case simulation OSCE (CCS-OSCE) has been designed. The objective of this article is to describe the creation, administration, and development of the test. MATERIALS AND METHODS: This work is a descriptive study of the CCS-OSCE from its planning stages in April 2020 to its administration in June 2020. RESULTS: The CCS-OSCE evaluated the competences of anamnesis, exploration, clinical judgment, ethical aspects, interprofessional relations, prevention, and health promotion. No technical or communication skills were evaluated. The CCS-OSCE consisted of ten test sections, each of which had a 12-min time limit and ranged from six to 21 questions (mean: 1.1 min/question). The CCS-OSCE used the virtual campus platform of each of the 16 participating medical schools, which had a total of 2829 students in their sixth year of study. It was jointly held on two dates in June 2020. CONCLUSIONS: The CCS-OSCE made it possible to bring together the various medical schools and carry out interdisciplinary work. The CCS-OSCE conducted may be similar to Step 3 of the United States Medical Licensing Examination.

[Changes in the Objective Structured Clinical Examination (OSCE) of University Schools of Medicine during COVID-19. Experience with a computer-based case simulation OSCE (CCS-OSCE)]. / Cambios en el examen clínico objetivo y estructurado (ECOE) de las facultades de Medicina durante la COVID-19. Experiencia de una ECOE de casos-clínicos computarizados simulados (ECOE-CCS) conjunta.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has forced universities to move the completion of university studies online. Spain's National Conference of Medical School Deans coordinates an objective, structured clinical competency assessment called the Objective Structured Clinical Examination (OSCE), which consists of 20 face-to-face test sections for students in their sixth year of study. As a result of the pandemic, a computer-based case simulation OSCE (CCS-OSCE) has been designed. The objective of this article is to describe the creation, administration, and development of the test. MATERIALS AND METHODS: This work is a descriptive study of the CCS-OSCE from its planning stages in April 2020 to its administration in June 2020. RESULTS: The CCS-OSCE evaluated the competences of anamnesis, exploration, clinical judgment, ethical aspects, interprofessional relations, prevention, and health promotion. No technical or communication skills were evaluated. The CCS-OSCE consisted of ten test sections, each of which had a 12-minutes time limit and ranged from six to 21 questions (mean: 1.1 minutes/question). The CCS-OSCE used the virtual campus platform of each of the 16 participating medical schools, which had a total of 2,829 students in their sixth year of study. It was jointly held on two dates in June 2020. CONCLUSIONS: The CCS-OSCE made it possible to bring together the various medical schools and carry out interdisciplinary work. The CCS-OSCE conducted may be similar to Step 3 of the United States Medical Licensing Examination.

Objetivo cumplido: la evaluación de competencias en la Facultad de Medicina de la Universidad Complutense de Madrid / Goal achieved: the evaluation of abilities at the Universidad Complutense de Madrid’s Faculty of Medicine

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Frontal and temporal functional connections of the living human brain.

Connections between human temporal and frontal cortices were investigated by intracranial electroencephalographic responses to electrical stimulation with 1-ms single pulses in 51 patients assessed for surgery for treatment of epilepsy. The areas studied were medial temporal, entorhinal, lateral temporal, medial frontal, lateral frontal and orbital frontal cortices. Findings were assumed to be representative of human brain as no differences were found between epileptogenic and non-epileptogenic hemispheres. Connections between intralobar temporal and frontal regions were common (43-95%). Connections from temporal to ipsilateral frontal regions were relatively uncommon (seen in 0-25% of hemispheres). Connections from frontal to ipsilateral temporal cortices were more common, particularly from orbital to ipsilateral medial temporal regions (40%). Contralateral temporal connections were rare (< 9%) whereas contralateral frontal connections were frequent and faster, particularly from medial frontal to contralateral medial frontal (61%) and orbital frontal cortices (57%), and between both orbital cortices (67%). Orbital cortex receives profuse connections from the ipsilateral medial (78%) and lateral (88%) frontal cortices, and from the contralateral medial (57%) and orbital (67%) frontal cortices. The high incidence of intralobar temporal connections supports the presence of temporal reverberating circuits. Frontal cortex projects within the lobe and beyond, to ipsilateral and contralateral structures.

Single-pulse electrical stimulation identifies epileptogenic frontal cortex in the human brain.

OBJECTIVE: To assess the value of single-pulse electrical stimulation (SPES) to identify frontal epileptogenic cortex during presurgical assessment. METHODS: SPES (1-millisecond pulses, 4 to 8 mA, 0.1 Hz) has been used during chronic recordings in 30 patients with intracranial electrodes in the frontal lobes. As a result of presurgical assessment, 17 patients were considered to have frontal epilepsy and 13 extrafrontal epilepsy. RESULTS: Two types of responses to SPES were seen: 1) early responses: starting immediately after the stimulus and considered as normal responses; 2) late responses: two types of responses seen in some areas after the initial early response: a) delayed responses: spikes or sharp waves occurring between 100 milliseconds and 1 second after stimulation. Frontal delayed responses were seen in 11 frontal patients and 1 extrafrontal patient, whereas extrafrontal delayed responses were seen in 1 frontal and 10 extrafrontal patients. b) Repetitive responses: two or more consecutive sharp-and-slow-wave complexes, each resembling the initial early response. Repetitive responses were seen only when stimulating the frontal lobes of 10 frontal patients. Among the 17 frontal patients, 13 had late responses exclusively in the epileptogenic frontal lobe, whereas only 3 showed them in both frontal lobes. Frontal late responses were associated with neuropathologic abnormalities, and complete resection of abnormal SPES areas was associated with good postsurgical seizure outcome. CONCLUSIONS: Single-pulse electrical stimulation (SPES) could be an important additional investigation during presurgical assessment to identify frontal epileptogenicity. SPES can be useful in patients who have widespread or multiple epileptogenic areas, normal neuroimaging, or few seizures during telemetry.

Action potential broadening induced by lithium may cause a presynaptic enhancement of excitatory synaptic transmission in neonatal rat hippocampus.

Lithium enhances excitatory synaptic transmission in CA1 pyramidal cells, but the mechanisms remain unclear. The present study demonstrates that lithium enhances the N-methyl-D-aspartate (NMDA) and alpha-amino-3-hydroxy-5-methyl-isoxazole propionic acid (AMPA) receptor-mediated components of the excitatory postsynaptic current (EPSC). Lithium decreased the magnitude of paired-pulse facilitation and presented an inverse correlation between the lithium-induced enhancement of synaptic transmission and initial paired-pulse facilitation, which is consistent with a presynaptic mode of action. The enhancement of synaptic strength is likely to act, at least in part, by increasing the amplitude of the presynaptic Ca2+ transient. One mechanism which could account for this change of the presynaptic Ca2+ transient is an increase in the duration of the action potential. We investigated action potential in hippocampal pyramidal neurons and found that lithium (0.5-6 mM) increased the half-amplitude duration and reduced the rate of repolarization, whereas the rate of depolarization remained similar. To find out whether the lithium synaptic effects might be explained by spike broadening, we investigated the field recording of the excitatory postsynaptic potential (EPSP) in hippocampal slices and found three lines of evidence. First, the prolongation of the presynaptic action potential with 4-aminopyridine and tetraethylammonium blocked or reduced the synaptic effects of lithium. Second, the lithium-induced synaptic enhancement was modulated when presynaptic Ca2+ influx was varied by changing the external Ca2+ concentration. Finally, both effects, the synaptic transmission increment and the action potential broadening, were independent of inositol depletion. These results suggest that lithium enhances synaptic transmission in the hippocampus via a presynaptic site of action: the mechanism underlying the potentiating effect may be attributable to an increased Ca2+ influx consequent to the broadening effect of lithium on the action potential.

Lithium enhances synaptic transmission in neonatal rat hippocampus.

The effects of lithium on excitatory synaptic transmission were studied in the CA1 region of hippocampal slices taken from 14- to 30-day-old rats using extracellular recording techniques. Lithium (2-18 mM) reversibly increased the field excitatory postsynaptic potentials in a concentration-dependent manner. Application of lithium for 6-15 min had no effect on the synaptic input-output function, while application of lithium for 20-35 min shifted this curve to the left. Lithium reversibly increased the amplitude of the presynaptic fibre volley in a concentration- and calcium-dependent manner. Lithium decreased paired-pulse facilitation measured at 50-ms interstimulus intervals. The results indicate that lithium enhances excitatory synaptic transmission in CA1 pyramidal cells by at least two different actions.

Origin and propagation of interictal discharges in the acute electrocorticogram. Implications for pathophysiology and surgical treatment of temporal lobe epilepsy.

Although acute electrocorticography (ECoG) is routinely performed during epilepsy surgery there is little evidence that the extent of the discharging regions is a useful guide to tailoring the resection or that the findings are predictive of outcome or pathology. Patterns of discharge propagation have, however, rarely been considered in assessing the ECoG. We hypothesize that regions where discharges show earliest peaks ('leading regions') are located in the epileptogenic zone, whereas sites in which late, secondary, propagated activity occurs have less epileptogenic potential and do not need to be excised. To allow intraoperative topographic ECoG analysis, a computer program has been developed to identify leading regions and the sites showing greatest rates or amplitudes of spikes. Their topography has been compared retrospectively with pathology and seizure control in 42 consecutive patients following temporal lobe surgery. Leading regions were most often found in the hippocampus, the subtemporal cortex and the superior temporal gyrus. The most common propagation patterns were from hippocampus to subtemporal cortex and vice versa. There was no association between seizure outcome and the location of regions with greatest incidence or amplitude of spikes or location of leading regions. There was, however, a strong and significant association between poor outcome and non-removal of leading regions other than those in the posterior subtemporal cortex. All leading regions (other than posterior subtemporal) were resected in 27 patients of whom 25 had a favourable outcome. Leading regions (other than posterior subtemporal) remained in 14 patients of whom only four had a good outcome. One patient had no epileptiform activity in the ECoG and good outcome. Persistent posterior subtemporal leading regions remained in nine subjects; all had favourable outcome (Grades I or II) but only three were seizure free. These results suggest that: (i) interictal epileptiform discharges may originate from a complex interaction between separate regions, resulting in propagation and recruitment of neuronal activity along specific neural pathways; (ii) removal of all discharging areas appears unnecessary to achieve seizure control provided that leading regions (other than posterior subtemporal) are removed; and (iii) identification of such leading regions could be used to tailor resections in order to improve seizure control and reduce neurological, neuropsychological and psychiatric post-surgical morbidity.

[Effect of the amplitude and frequency of sinusoidal stimulation on the harmonic distortion of the response of sensory terminations of muscle spindles]. / Efecto de la amplitud y frecuencia de la estimulación sinusoidal sobre la distorsión armónica de la respuesta de las terminaciones sensoriales del huso muscular.

Harmonic distortion (HD) from 1,055 responses of muscle spindles sensory endings to sinusoidal stretches (frequency range 0.0008 to 0.8333 Hz, amplitude range 0.019 to 3.09 mm) has been studied in the cat soleus muscle. Sixty-six per cent were primary afferents (Ia) and 34% secondary (II). HD mean value (0.28) did not show any significant differences between both types of endings. Analysis of variance for HD versus stimulation amplitude showed a greater HD when stretch amplitudes were beyond 1.599 mm or less than 0.031 mm on primary afferents (p less than 0.001) and less than 0.070 mm on secondary (p less than 0.001). The effect of stimulus frequency was also significant (p less than 0.01 Ia and p less than 0.001 II), however only at 0.8333 Hz and in secondary endings HD was significantly higher. The silent period in the response, at release of stretch, caused by half wave rectification could explain about 50% of measured HD.

A fast data acquisition system for neurophysiological signals based on a personal microcomputer.

A general purpose analog-to-digital conversion system and its interface for a low-cost personal computer (Commodore 64) are described. Special emphasis has been put on achieving a high sampling frequency rate (up to 20,000 samples/s) and a high discrimination (12 bits). It has likewise been attempted to increase the number of input channels (up to 8, by means of a multiplexer) and averaging capability since such features may be useful in a great number of neurobiological studies. Commercially available hardware elements have been employed and software has been developed in BASIC and 6510 Machine Code.