Pocket Size Ultra-Sound versus Cardiac Auscultation in Diagnosing Cardiac Valve Pathologies: A Prospective Cohort

Background: Pocket-size ultrasound devices are used to perform focused ultrasound studies (POCUS). We compared valve malfunction diagnosis rate by cardiac auscultation to POCUS (insonation), both conducted by medical students. Methods: A prospective cohort study was conducted among subjects with and without clinically relevant valve dysfunction. Inclusion criteria for subjects with a clinically relevant valve dysfunction was based on the presence of at least one moderate severity valve pathology identified by echocardiography. Three final-year medical students examined the patients. Each subject underwent auscultation and a POCUS using a pocket-size ultrasound machine. Sensitivity and specificity were calculated. Results: The study included 56 patients. In 18 patients (32%) no valve pathology was found. Nineteen patients (34%) had at least two valvular pathologies. Sixty valve lesions were present in the entire cohort. Students' sensitivity for detecting any valve lesion was 32% and 64% for auscultation and insonation, respectively, and specificity was similar. The sensitivity for diagnosing mitral regurgitation, mitral stenosis, and aortic regurgitation rose significantly by using POCUS compared to auscultation alone. When using POCUS, students identified valvular pathologies in 22 cases (39%) from the patients with at least two valve dysfunctions, and none when using auscultation. Conclusions: Final-year medical students' competency to detect valve dysfunction by performing cardiac auscultation is poor. Cardiac ultrasound-focused training significantly improved medical students' sensitivity for diagnosing a variety of valve pathologies

Unanesthetized Rodents Demonstrate Insensitivity of QT Interval and Ventricular Refractory Period to Pacing Cycle Length

Aim: The cardiac electrophysiology of mice and rats has been analyzed extensively, often in the context of pathological manipulations. However, the effects of beating rate on the basic electrical properties of the rodent heart remain unclear. Due to technical challenges, reported electrophysiological studies in rodents are mainly from ex vivo preparations or under deep anesthesia, conditions that might be quite far from the normal physiological state. The aim of the current study was to characterize the ventricular rate-adaptation properties of unanesthetized rats and mice.Methods: An implanted device was chronically implanted in rodents for atrial or ventricular pacing studies. Following recovery from surgery, QT interval was evaluated in rodents exposed to atrial pacing at various frequencies. In addition, the frequency dependence of ventricular refractoriness was tested by conventional ventricular programmed stimulation protocols.Results: Our findings indicate total absence of conventional rate-adaptation properties for both QT interval and ventricular refractoriness. Using monophasic action potential recordings in isolated mice hearts we could confirm the previously reported shortening of the action potential duration at fast pacing rates. However, we found that this mild shortening did not result in similar decrease of ventricular refractory period.Conclusion: Our findings indicate that unanesthetized rodents exhibit flat QT interval and ventricular refractory period rate-dependence. This data argue against empirical use of QT interval correction methods in rodent studies. Our new methodology allowing atrial and ventricular pacing of unanesthetized freely moving rodents may facilitate more appropriate utility of these important animal models in the context of cardiac electrophysiology studies

The feasibility and efficacy of implementing a focused cardiac ultrasound course into a medical school curriculum

Abstract Background Teaching cardiac ultrasound to medical students in a brief course is a challenge. We aimed to evaluate the feasibility of teaching large groups of medical students the acquisition and interpretation of cardiac ultrasound images using a pocket ultrasound device (PUD) in a short, specially designed course. Methods Thirty-one medical students in their first clinical year participated in the study. All were novices in the use of cardiac ultrasound. The training consisted of 4 hours of frontal lectures and 4 hours of hands-on training. Students were encouraged to use PUD for individual practice. Finally, the students’ proficiency in the acquisition of ultrasound images and their ability to recognize normal and pathological states were evaluated. Results Sixteen of 27 (59%) students were able to demonstrate all main ultrasound views (parasternal, apical, and subcostal views) in a six-minute test. The most obtainable view was the parasternal long-axis view (89%) and the least obtainable was the subcostal view (58%). Ninety-seven percent of students correctly differentiated normal from severely reduced left ventricular function, 100% correctly differentiated a normal right ventricle from a severely hypokinetic one, 100% correctly differentiated a normal mitral valve from a rheumatic one, and 88% correctly differentiated a normal aortic valve from a calcified one, while 95% of them correctly identified the presence of pericardial effusion. Conclusions Training of medical students in cardiac ultrasound during the first clinical year using a short, focused course is feasible and enables students with modest ability to acquire the main transthoracic ultrasound views and gain proficiency in the diagnosis of a limited number of cardiac pathologies

Additional file 1: of The feasibility and efficacy of implementing a focused cardiac ultrasound course into a medical school curriculum

Appendix A. (DOCX 92 kb

Hacia una formación europea de la medicina china: su incorporación en el sistema universitario español

L'Acupuntura i la Medicina Tradicional Xina existeixen des de fa milers d'anys al seu país d'origen i àrea d'influència. A occident, aquestes disciplines s’han anat introduint gradualment, tot i així no és fins els últims 40 anys que la seva implantació ha aconseguit gran notorietat. Aquest fet ha generat una controvèrsia que va des de els seus més acèrrims defensors fins als detractors més entossudits, basant-se uns en les seves bondats i els altres en la seva falta d'evidència científica. L'Estratègia de l'OMS 2014-2023 sobre Medicina tradicional insta als països membres a la seva regulació, com a pas previ a la seva incorporació als Sistemes Nacionals de Salut de cada país. Encara així, la controvèrsia persisteix, si bé en els últims anys hem vist com es regulava en països com els EUA, Austràlia, Xile, Portugal, etc., en altres països està en procés de regulació més o menys avançada. En la present recerca es pretén, des de l'anàlisi de l'estat de la qüestió als diferents països del món i a Espanya, poder verificar si, com pensem, existeix una tendència a la regulació de la MTC de manera autònoma respecte de la medicina al·lopàtica occidental, al mateix temps que avança la pràctica de la denominada “medicina xinesa integrativa” (combinació de la medicina xinesa i la medicina al·lopàtica occidental) i els projectes d’investigació sobre aquest tema. 5 Aquest anàlisis ens ha de permetre inferir quin hauria de ser la seva ubicació en el sistema Universitari espanyol, en el marc del sistema educatiu europeu. A més a més, hem realitzat una recopilació i anàlisi comparada de la normativa existent en aquells països en els quals existeix regulació sobre aquest tema. Una revisió de la bibliografia existent (fonamentalment articles en revistes especialitzades, ponències en Congressos, estudis del sector i dades qualitatives i quantitatives publicades per organismes públics i organitzacions locals, nacionals i internacionals). Una revisió de sentències per intrusisme i de l'ordre contenciós administratiu a Espanya. I, finalment, una revisió d'estudis indicatius de la utilització de la MTC per la ciutadania. El treball s'ha dividit en vuit apartats: introducció, interdisciplinarietat de la recerca, anàlisi històrica-antropològica de la MTC a Xina, definicions i conceptes bàsics, evidències científiques, situació legal i real de l'exercici professional i els estudis de medicina xinesa als diferents països i a Espanya, situació dels estudis oficials sanitaris a Espanya, i conclusions i noves línies de recerca. La present recerca no pot ser més oportuna, ja que al moment de finalitzar la mateixa, s'acaba d'obrir a Espanya un debat sobre les medicines naturals, conseqüència de la presentació d'un Projecte No de Llei per part del partit polític Ciutadans sobre la necessitat de controlar el que ells criden “pseudociències”, posant en el mateix sac tot tipus de teràpies. Aquest fet sens dubte hauria d'acabar potenciant la regulació dels estudis (i per tant la pràctica professional) d'aquelles medicines naturals que acreditin la seva utilitat com a únic mecanisme de control eficaç per assegurar l'eficàcia, eficiència i seguretat dels seus tractaments per a la ciutadania.La Acupuntura y la Medicina Tradicional China existen desde hace miles de años en su país de origen y área de influencia. En occidente, se han ido introduciendo gradualmente, sin embargo, no es hasta los últimos 40 años que su implantación ha alcanzado gran notoriedad. Este hecho ha generado una controversia que va desde sus más acérrimos defensores hasta los detractores más empecinados, basándose unos en sus bondades y los otros en su falta de evidencia científica. La Estrategia de la OMS 2014-2023 sobre Medicina tradicional insta a los países miembros a su regulación, como paso previo a su incorporación en los Sistemas Nacionales de Salud de cada país. Aun así, la controversia persiste, si bien en los últimos años hemos visto como se regulaba en países como EEUU, Australia, Chile, Portugal, etc., en otros países está en proceso de regulación más o menos avanzada. En la presente investigación se pretende, desde el análisis del estado de la cuestión en los diferentes países del mundo y en España, poder verificar si, como pensamos, existe una tendencia a la regulación de las MTC de manera autónoma respecto de la medicina alopática occidental, al tiempo que avanza la práctica de la denominada “medicina china integrativa” (combinación de la medicina china y la medicina alopática occidental) y los proyectos de investigación al respecto. Este análisis nos ha de permitir inferir cuál debería ser su ubicación en el sistema Universitario español, en el marco del sistema educativo europeo. Además, hemos realizado una recopilación y análisis comparado de la normativa existente en aquellos países en los que existe regulación al respecto. Una revisión de la bibliografía existente (fundamentalmente artículos en revistas especializadas, ponencias en Congresos, estudios del sector y datos cualitativos y cuantitativos publicados por organismos públicos y organizaciones locales, nacionales e internacionales). Una revisión de sentencias por intrusismo y del orden contencioso administrativo en España. Y, por último, una revisión de estudios indicativos de la utilización de la MTC por la ciudadanía. El trabajo se ha dividido en ocho apartados: introducción, interdisciplinariedad de la investigación, análisis histórico-antropológico de la MTC en China, definiciones y conceptos básicos, evidencias científicas, situación legal y real del ejercicio profesional y 4 los estudios de medicina china en los diferentes países y en España, situación de los estudios oficiales sanitarios en España, y conclusiones y nuevas líneas de investigación. La presente investigación no puede ser más oportuna puesto que en el momento de finalizar la misma se acaba de abrir en España un debate sobre las medicinas naturales, consecuencia de la presentación de un Proyecto No de Ley por parte del partido político Ciudadanos, sobre la necesidad de controlar lo que ellos llaman “pseudociencias”, poniendo en el mismo saco todo tipo de terapias. Este hecho sin duda debería acabar potenciando la regulación de los estudios (y por ende la práctica profesional) de aquellas medicinas naturales que acrediten su utilidad como único mecanismo de control eficaz para asegurar la eficacia, eficiencia y seguridad de sus tratamientos para la ciudadanía.Acupuncture and Traditional Chinese Medicine have existed for thousands of years in their country of origin and area of influence. In the West, they have been introduced gradually, however it is not until the last 40 years that its implementation has achieved great notoriety. This fact has generated a controversy that goes from its most staunch defenders to the most stubborn detractors, the former based on its benefits and the latter based on its lack of scientific evidence. The WHO Strategy 2014-2023 on Traditional Medicine urges member countries to regulate it, as a step prior to their incorporation into the National Health Systems of each country. Even so, the controversy persists, although in recent years we have seen how it was regulated in countries like USA, Australia, Chile, Portugal, etc., in other countries it is in process of regulation more or less advanced. In the present investigation, it is intended, from the analysis of the situation of the topic in the different countries of the world and in Spain, to verify if, as we thought, there is a tendency to regulate TCM independently of Western allopathic medicine, at the same time as the practice of so-called "integrative Chinese medicine" (a combination of Chinese medicine and Western allopathic medicine) is progressing and the research projects on the subject. This analysis should allow us to infer what should be its location in the Spanish university system, within the framework of the European educational system. In addition, we have compiled and compared the existing regulations in those countries where there is regulation in this regard. A review of the existing bibliography (mainly articles in specialized journals, papers in Congresses, studies of the sector and qualitative and quantitative data published by public organisms and local, national and international organizations). A revision of sentences by professional intrusion and of the administrative contentious order in Spain. And, finally, a review of studies indicative of the use of the MTC by the citizenship. The work has been divided into eight sections: introduction, interdisciplinary research, historical-anthropological analysis of TCM in China, basic definitions and concepts, scientific evidence, legal and real situation of professional practice and studies of Chinese medicine in different Countries and in Spain, status of official health studies in Spain, and conclusions and new lines of research. This research could not be timelier because at the end of its completion, there has just opened in Spain a debate on natural medicines, a consequence of the presentation of a non-binding motion by the political party Citizens, on the necessity to control what they call "pseudoscience", putting in the same bag all kinds of therapies. This fact should undoubtedly strengthen the regulation of studies (and therefore the professional practice) of those natural medicines that prove their utility as the only effective control mechanism to ensure the effectiveness, efficiency and safety of their treatments for citizen

Speckle-Tracking Echocardiography Elucidates the Effect of Pacing Site on Left Ventricular Synchronization in the Normal and Infarcted Rat Myocardium

<div><p>Background</p><p>Right ventricular (RV) pacing generates regional disparities in electrical activation and mechanical function (ventricular dyssynchrony). In contrast, left ventricular (LV) or biventricular (BIV) pacing can improve cardiac efficiency in the setting of ventricular dyssynchrony, constituting the rationale for cardiac resynchronization therapy (CRT). Animal models of ventricular dyssynchrony and CRT currently relay on large mammals which are expensive and not readily available to most researchers. We developed a methodology for double-site epicardial pacing in conscious rats. Here, following post-operative recovery, we compared the effects of various pacing modes on LV dyssynchrony in normal rats and in rats with ischemic cardiomyopathy.</p><p>Methods</p><p>Two bipolar electrodes were implanted in rats as follows: Group A (n = 6) right atrial (RA) and RV sites; Group B (n = 7) RV and LV sites; Group C (n = 8) as in group B in combination with left coronary artery ligation. Electrodes were exteriorized through the back. Following post-operative recovery, two-dimensional transthoracic echocardiography was performed during pacing through the different electrodes. Segmental systolic circumferential strain (Ecc) was used to evaluate LV dyssynchrony.</p><p>Results</p><p>In normal rats, RV pacing induced marked LV dyssynchrony compared to RA pacing or sinus rhythm, as measured by the standard deviation (SD) of segmental time to peak Ecc, SD of peak Ecc, and the average delay between opposing ventricular segments. LV pacing and, to a greater extend BIV pacing diminished the LV dyssynchrony compared to RV pacing. In rats with extensive MI, the effects of LV and BIV pacing were markedly attenuated, and the response of individual animals was variable.</p><p>Conclusions</p><p>Rodent cardiac pacing mimics important features seen in humans. This model may be developed as a simple new tool to study the pathophysiology of ventricular dyssynchrony and CRT.</p></div

Attenuated effects of pacing in rats subjected to extensive MI.

<p>Summary of echocardiographic parameters in five rats with ischemic heart failure subjected to no pacing, RV pacing, LV pacing, and BIV pacing. <b>A</b>: Average time to peak Ecc of all six segments (global). <b>B</b>: Average peak Ecc of all six segments (global) <b>C</b>: LV fractional area shortening <b>D</b>: Standard deviation of the time to peak Ecc of different segments. <b>E</b>: Standard deviation of the peak Ecc of different segments. <b>F</b>: Average time difference between the peak Ecc of opposing segments (‘delta TP opposing segments’, see <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0099191#pone-0099191-g003" target="_blank">Figure 3</a> for details). Kruskal-Wallis test did not reveal a significant difference between the different pacing modes for any of the presented parameters.</p

RV pacing induces marked LV dyssynchrony compared to RA pacing.

<p>Summary of echocardiographic parameters in group A subjected to no pacing, RA pacing, and RV pacing. <b>A</b>: Average time to peak Ecc of all six segments (global). <b>B</b>: Average peak Ecc of all six segments (global). <b>C</b>: LV fractional area shortening. <b>D</b>: Standard deviation of the time to peak Ecc of different segments. <b>E</b>: Standard deviation of the peak Ecc of different segments. <b>F</b>: Analysis of ‘delta TP opposing segments’, i.e., the average time difference between the peak Ecc of opposing segments. <b>*</b> P<0.05, <b>**</b> P<0.01. Horizontal lines above\below the bar graphs indicate significant differences between pacing modes in the post-hoc analysis. Note that in <b>D</b> the Kruskal-Wallis test was significant. However, the post-hoc analysis could not reveal the source of difference between the groups.</p