Pacemapping

Pacemapping (PM) is an electrophysiologic technique designed to help locating tachycardia sources by stimulating at different endocardial sites in order to reproduce the clinical tachycardia characteristics. A recorded electrocardiogram (ECG) during the clinical tachycardia has been conventionally used as reference. Yet, endocardial activation pattern during tachycardia may be utilized as well to guide the procedure. In focal tachycardia ablation, PM guide has consistently provided remarkable outcomes1, while outcomes in reentrant tachycardia ablation are less favourabl

El aprendizaje de la lectura y escritura en la Escuela Infantil.

Este artículo refleja sencillamente una apuesta por la infancia y una confianza en las insospechadas capacidades de los niños. Ellos han demostrado que pueden aprender a leer antes de los 6 años, de la misma manera que aprenden a hablar En una civilización tecnológica sofisticada, las formas escritas del lenguaje nos envuelven por todas partes y nos brindan amplias posibilidades de conocer. Por lo tanto, leer, escribir, hablar y escuchar, deberían ser actos tratados de forma natural como integrantes de un proceso de comumeacton.It is a fact that children can learn to read before they are six years oíd; therefore, not only speaking, but also reading --and writing-- should be treated as integral elements of a communication process

Catálogo-Archivo Rubén Darío

Biblioteca Histórica Marqués de ValdecillaUCM. BibliotecaTRUEpu

Evaluación de las técnicas de imagen en el diagnóstico de carcinoma hepatocelular en pacientes candidatos a trasplante hepático

Introducción: El hepatocarcinoma (CHC) es una complicación frecuente de la cirrosis. El trasplante hepático (TH) es una opción terapéutica válida si se cumplen unos criterios restringidos en el tamaño y número de lesiones detectadas con las técnicas de imagen en el estudio pre-trasplante. (Criterios de Milán). Objetivo: Evaluar las técnicas de imagen (US, TC, RM y TC postembolización con lipiodol) en la detección y estadificación de CHC en los pacientes candidatos a trasplante hepático mediante la correlación de sus hallazgos con los del explante. Pacientes y método: Estudio retrospectivo de 273 pacientes trasplantados de hígado en los que se confirmó la presencia de 218 nódulos de CHC. Comparamos el diagnóstico radiológico preoperatorio de CHC con el anatomo-patológico definitivo, lo que permite evaluar la precisión diagnóstica de las diferentes pruebas e identificar la concordancia entre la estadificación tumoral preoperatoria y la postoperatoria. Resultados: Encontramos 218 nódulos de CHC en 109 pacientes (prevalencia 39,9%), con un tamaño medio de 20,5mm ±12,8mm. El CHC es más frecuente en varones que en mujeres (44,6%/23,3%), su incidencia aumenta con la edad y es más frecuente en pacientes con cirrosis de etiología vírica (B o C). En el análisis por pacientes la sensibilidad del US, TC, RM y TC postlipiodol fueron del 80,4%, 81,1%, 90,5% y 92,8%. La especificidad de estas técnicas fue respectivamente del 96,3%, 96,2%, 82,1% y 62,5%. Se obtienen beneficios en términos de sensibilidad sin detrimento significativo de la especificidad al sumar las técnicas de manera secuencial El mayor beneficio lo hemos observado al añadir US y TC con S de 88% y E de 95,7%. Con las pruebas de imagen obtenemos un correcto estadiaje en el 83,4% de los pacientes, un subestadiaje del 11,7% y un sobreestadiaje del 5,5%. En el análisis por nódulos la sensibilidad de las técnicas es del 55,6%, 52,4%, 65,9% y 60,1% respectivamente. Los datos son inferiores a los del análisis por pacientes, hecho que parece estar principalmente determinado por el tamaño tumoral. Las cifras de sensibilidad mejoran muy significativamente cuando el nódulo es mayor de 2cm de diámetro. Todas las pruebas infraestiman el tamaño tumoral. Esta diferencia se reduce en nódulos tratados con quimioembolización o técnicas de ablación en el tiempo de intervalo entre la técnica de imagen y el trasplante, por lo que la diferencia puede deberse al crecimiento del tumor en este periodo de intervalo.Departamento de Medicína, Dermatología y Toxicologí

Definición de patrones electrocardiográficos para su reconocimiento en una aplicación informática

Aprendizaje de la electrocardiografía para los alumnos de 3º y 4º de Medicina a partir de una biblioteca de electrocardiografía tutelada, creada en un proyecto de innovación y mejora de la calidad docente de 2013. Se trata de detallar los patrones electrocardiográficos reales de todas las alteraciones electrocardiográficas descritas para que puedan ser llevados a una aplicación gráfica de identificación para dispositivos móviles que diagnostique los electrocardiogramas mediante su escaneo

Pulmonary Vein Activity Organization to Determine Atrial Fibrillation Recurrence: Preliminary Data from a Pilot Study

[EN] Ablation of pulmonary veins has emerged as a key procedure for normal rhythm restoration in atrial fibrillation patients. However, up to half of ablated Atrial fibrillation (AF) patients suffer recurrences during the first year. In this article, simultaneous intra-atrial recordings registered at pulmonary veins previous to the ablation procedure were analyzed. Spatial cross-correlation and transfer entropy were computed in order to estimate spatial organization. Results showed that, in patients with arrhythmia recurrence, pulmonary vein electrical activity was less correlated than in patients that maintained sinus rhythm. Moreover, correlation function between dipoles showed higher delays in patients with AF recurrence. Results with transfer entropy were consistent with spatial cross-correlation measurements. These results show that arrhythmia drivers located at the pulmonary veins are associated with a higher organization of the electrical activations after the ablation of these sites.This research was funded by Spanish Ministry of Research and Innovation : PID2019-109547RB-I00. This research was supported by the PID2019-109547RB-I00 National Research Program RETOS from the Spanish Ministry of Research and Innovation and partialy by GVA (PROMETEO/2018/078) & ISCIII (CB16/11/00486). Thanks to Michael Charles Willoughby for English language and scientific editing services.Cervigón, R.; Moreno, J.; Millet Roig, J.; Pérez-Villacastín, J.; Castells, F. (2020). Pulmonary Vein Activity Organization to Determine Atrial Fibrillation Recurrence: Preliminary Data from a Pilot Study. Mathematics. 8(10):1-13. https://doi.org/10.3390/math8101813S113810Andrade, J., Khairy, P., Dobrev, D., & Nattel, S. (2014). The Clinical Profile and Pathophysiology of Atrial Fibrillation. Circulation Research, 114(9), 1453-1468. doi:10.1161/circresaha.114.303211Kim, M. H., Johnston, S. S., Chu, B.-C., Dalal, M. R., & Schulman, K. L. (2011). Estimation of Total Incremental Health Care Costs in Patients With Atrial Fibrillation in the United States. Circulation: Cardiovascular Quality and Outcomes, 4(3), 313-320. doi:10.1161/circoutcomes.110.958165Andersson, T., Magnuson, A., Bryngelsson, I.-L., Frøbert, O., Henriksson, K. M., Edvardsson, N., & Poçi, D. (2013). All-cause mortality in 272 186 patients hospitalized with incident atrial fibrillation 1995–2008: a Swedish nationwide long-term case–control study. European Heart Journal, 34(14), 1061-1067. doi:10.1093/eurheartj/ehs469Chugh, S. S., Havmoeller, R., Narayanan, K., Singh, D., Rienstra, M., Benjamin, E. J., … Murray, C. J. L. (2014). Worldwide Epidemiology of Atrial Fibrillation. Circulation, 129(8), 837-847. doi:10.1161/circulationaha.113.005119Saglietto, A., Matta, M., Gaita, F., Jacobs, V., Bunch, T. J., & Anselmino, M. (2019). Stroke-independent contribution of atrial fibrillation to dementia: a meta-analysis. Open Heart, 6(1), e000984. doi:10.1136/openhrt-2018-000984Wattigney, W. A. (2002). Increased Atrial Fibrillation Mortality: United States, 1980-1998. American Journal of Epidemiology, 155(9), 819-826. doi:10.1093/aje/155.9.819Krijthe, B. P., Kunst, A., Benjamin, E. J., Lip, G. Y. H., Franco, O. H., Hofman, A., … Heeringa, J. (2013). Projections on the number of individuals with atrial fibrillation in the European Union, from 2000 to 2060. European Heart Journal, 34(35), 2746-2751. doi:10.1093/eurheartj/eht280January, C. T., Wann, L. S., Calkins, H., Chen, L. Y., Cigarroa, J. E., Cleveland, J. C., … Yancy, C. W. (2019). 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. Heart Rhythm, 16(8), e66-e93. doi:10.1016/j.hrthm.2019.01.024Haïssaguerre, M., Jaïs, P., Shah, D. C., Takahashi, A., Hocini, M., Quiniou, G., … Clémenty, J. (1998). Spontaneous Initiation of Atrial Fibrillation by Ectopic Beats Originating in the Pulmonary Veins. New England Journal of Medicine, 339(10), 659-666. doi:10.1056/nejm199809033391003Allessie, M. A., Bonke, F. I., & Schopman, F. J. (1976). Circus movement in rabbit atrial muscle as a mechanism of tachycardia. II. The role of nonuniform recovery of excitability in the occurrence of unidirectional block, as studied with multiple microelectrodes. Circulation Research, 39(2), 168-177. doi:10.1161/01.res.39.2.168Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., … Zeppenfeld, K. (2016). 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace, 18(11), 1609-1678. doi:10.1093/europace/euw295Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S.-A., … Wilber, D. (2012). 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design. Heart Rhythm, 9(4), 632-696.e21. doi:10.1016/j.hrthm.2011.12.016Ganesan, A. N., Shipp, N. J., Brooks, A. G., Kuklik, P., Lau, D. H., Lim, H. S., … Sanders, P. (2013). Long‐term Outcomes of Catheter Ablation of Atrial Fibrillation: A Systematic Review and Meta‐analysis. Journal of the American Heart Association, 2(2). doi:10.1161/jaha.112.004549Pison, L., Tilz, R., Jalife, J., & Haïssaguerre, M. (2016). Pulmonary vein triggers, focal sources, rotors and atrial cardiomyopathy: implications for the choice of the most effective ablation therapy. Journal of Internal Medicine, 279(5), 449-456. doi:10.1111/joim.12490Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., … Vardas, P. (2017). 2016 ESC Guidelines for the Management of Atrial Fibrillation Developed in Collaboration With EACTS. Revista Española de Cardiología (English Edition), 70(1), 50. doi:10.1016/j.rec.2016.11.033Botteron, G. W., & Smith, J. M. (1995). A technique for measurement of the extent of spatial organization of atrial activation during atrial fibrillation in the intact human heart. IEEE Transactions on Biomedical Engineering, 42(6), 579-586. doi:10.1109/10.387197Cervigón, R., Moreno, J., Millet, J., Pérez-Villacastín, J., & Castells, F. (2010). Propofol Effects on Atrial Fibrillation Wavefront Delays. IEEE Transactions on Biomedical Engineering, 57(8), 1877-1885. doi:10.1109/tbme.2009.2037312Cervigón, R., Castells, F., Gómez-Pulido, J., Pérez-Villacastín, J., & Moreno, J. (2018). Granger Causality and Jensen–Shannon Divergence to Determine Dominant Atrial Area in Atrial Fibrillation. Entropy, 20(1), 57. doi:10.3390/e20010057CASTELLS, F., CERVIGÓN, R., & MILLET, J. (2013). On the Preprocessing of Atrial Electrograms in Atrial Fibrillation: Understanding Botteron’s Approach. Pacing and Clinical Electrophysiology, 37(2), 133-143. doi:10.1111/pace.12288Botteron, G. W., & Smith, J. M. (1996). Quantitative Assessment of the Spatial Organization of Atrial Fibrillation in the Intact Human Heart. Circulation, 93(3), 513-518. doi:10.1161/01.cir.93.3.513Wu, X., & Lu, W. (2019). Four Constructions of Asymptotically Optimal Codebooks via Additive Characters and Multiplicative Characters. Mathematics, 7(12), 1144. doi:10.3390/math7121144Wei, X., Zhang, H., Gong, X., Wei, X., Dang, C., & Zhi, T. (2020). Intrinsic Cross-Correlation Analysis of Hydro-Meteorological Data in the Loess Plateau, China. International Journal of Environmental Research and Public Health, 17(7), 2410. doi:10.3390/ijerph17072410Wang, J., Wang, L., Xi, X., Miran, S. M., & Xue, A. (2020). Estimation and Correlation Analysis of Lower Limb Joint Angles Based on Surface Electromyography. Electronics, 9(4), 556. doi:10.3390/electronics9040556Schreiber, T. (2000). Measuring Information Transfer. Physical Review Letters, 85(2), 461-464. doi:10.1103/physrevlett.85.461Tehrani-Saleh, A., & Adami, C. (2020). Can Transfer Entropy Infer Information Flow in Neuronal Circuits for Cognitive Processing? Entropy, 22(4), 385. doi:10.3390/e22040385Overbey, L. A., & Todd, M. D. (2009). Dynamic system change detection using a modification of the transfer entropy. Journal of Sound and Vibration, 322(1-2), 438-453. doi:10.1016/j.jsv.2008.11.025Calkins, H., Reynolds, M. R., Spector, P., Sondhi, M., Xu, Y., Martin, A., … Sledge, I. (2009). Treatment of Atrial Fibrillation With Antiarrhythmic Drugs or Radiofrequency Ablation. Circulation: Arrhythmia and Electrophysiology, 2(4), 349-361. doi:10.1161/circep.108.824789Ouyang, F., Bänsch, D., Ernst, S., Schaumann, A., Hachiya, H., Chen, M., … Kuck, K.-H. (2004). Complete Isolation of Left Atrium Surrounding the Pulmonary Veins. Circulation, 110(15), 2090-2096. doi:10.1161/01.cir.0000144459.37455.eeChen, S.-A., Hsieh, M.-H., Tai, C.-T., Tsai, C.-F., Prakash, V. S., Yu, W.-C., … Chang, M.-S. (1999). Initiation of Atrial Fibrillation by Ectopic Beats Originating From the Pulmonary Veins. Circulation, 100(18), 1879-1886. doi:10.1161/01.cir.100.18.1879SOTOMI, Y., KIKKAWA, T., INOUE, K., TANAKA, K., TOYOSHIMA, Y., OKA, T., … FUJII, K. (2014). Regional Difference of Optimal Contact Force to Prevent Acute Pulmonary Vein Reconnection During Radiofrequency Catheter Ablation for Atrial Fibrillation. Journal of Cardiovascular Electrophysiology, 25(9), 941-947. doi:10.1111/jce.12443BALK, E. M., GARLITSKI, A. C., ALSHEIKH-ALI, A. A., TERASAWA, T., CHUNG, M., & IP, S. (2010). Predictors of Atrial Fibrillation Recurrence After Radiofrequency Catheter Ablation: A Systematic Review. Journal of Cardiovascular Electrophysiology, 21(11), 1208-1216. doi:10.1111/j.1540-8167.2010.01798.xAd, N., Holmes, S. D., Patel, J., Je, H. G., & Shuman, D. J. (2017). The Need for Consistent Predictors of Success for Surgical Ablation of Atrial Fibrillation. Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 12(6), 421-429. doi:10.1097/imi.0000000000000426Njoku, A., Kannabhiran, M., Arora, R., Reddy, P., Gopinathannair, R., Lakkireddy, D., & Dominic, P. (2017). Left atrial volume predicts atrial fibrillation recurrence after radiofrequency ablation: a meta-analysis. EP Europace, 20(1), 33-42. doi:10.1093/europace/eux013Ropella, K. M., Sahakian, A. V., Baerman, J. M., & Swiryn, S. (1989). The coherence spectrum. A quantitative discriminator of fibrillatory and nonfibrillatory cardiac rhythms. Circulation, 80(1), 112-119. doi:10.1161/01.cir.80.1.112Cervigón, R., Moreno, J., Sánchez, C., Reilly, R. B., Villacastín, J., Millet, J., & Castells, F. (2008). Atrial fibrillation organization: quantification of propofol effects. 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Manual de exercicios espirituales para tener oración mental

Copia digital. Valladolid : Junta de Castilla y León. Consejería de Cultura y Turismo, 201

Exercices spirituels pour aider les ames devotes à la pratique de l'oraison y de la meditation ...

Copia digital : Junta de Castilla y León. Consejería de Cultura y Turismo, 2014Sign: ã-é12, A-Z1

Uso y viabilidad de herramientas TIC en el aula

Uso y viabilidad de herramientas TIC en el aula

Instantaneous Amplitude and Frequency Modulations Detect the Footprint of Rotational Activity and Reveal Stable Driver Regions as Targets for Persistent Atrial Fibrillation Ablation

RATIONALE: Costly proprietary panoramic multielectrode (64-256) acquisition systems are being increasingly used together with conventional electroanatomical mapping systems for persistent atrial fibrillation (PersAF) ablation. However, such approaches target alleged drivers (rotational/focal) regardless of their activation frequency dynamics. OBJECTIVES: To test the hypothesis that stable regions of higher than surrounding instantaneous frequency modulation (iFM) drive PersAF and determine whether rotational activity is specific for such regions. METHODS AND RESULTS: First, novel single-signal algorithms based on instantaneous amplitude modulation (iAM) and iFM to detect rotational-footprints without panoramic multielectrode acquisition systems were tested in 125 optical movies from 5 ex vivo Langendorff-perfused PersAF sheep hearts (sensitivity/specificity, 92.6/97.5%; accuracy, 2.5-mm) and in computer simulations. Then, 16 pigs underwent high-rate atrial pacing to develop PersAF. After a median (interquartile range [IQR]) of 4.4 (IQR, 2.5-9.9) months of high-rate atrial pacing followed by 4.1 (IQR, 2.7-5.4) months of self-sustained PersAF, pigs underwent in vivo high-density electroanatomical atrial mapping (4920 [IQR, 4435-5855] 8-second unipolar signals per map). The first 4 out of 16 pigs were used to adapt ex vivo optical proccessing of iFM/iAM to in vivo electrical signals. In the remaining 12 out of 16 pigs, regions of higher than surrounding average iFM were considered leading-drivers. Two leading-driver + rotational-footprint maps were generated 2.6 (IQR, 2.4-2.9) hours apart to test leading-driver spatiotemporal stability and guide ablation. Leading-driver regions (2.5 [IQR, 2.0-4.0] regions/map) exactly colocalized (95.7%) in the 2 maps, and their ablation terminated PersAF in 92.3% of procedures (radiofrequency until termination, 16.9 [IQR, 9.2-35.8] minutes; until nonsustainability, 20.4 [IQR, 12.8-44.0] minutes). Rotational-footprints were found at every leading-driver region, albeit most (76.8% [IQR, 70.5%-83.6%]) were located outside. Finally, the translational ability of this approach was tested in 3 PersAF redo patients. CONCLUSIONS: Both rotational-footprints and spatiotemporally stable leading-driver regions can be located using iFM/iAM algorithms without panoramic multielectrode acquisition systems. In pigs, ablation of leading-driver regions usually terminates PersAF and prevents its sustainability. Rotational activations are sensitive but not specific to such regions. Single-signal iFM/iAM algorithms could be integrated into conventional electroanatomical mapping systems to improve driver detection accuracy and reduce the cost of patient-tailored/mechanistic approaches.This study was supported by the European Regional Development Fund and the Spanish Ministry of Science, Innovation and Universities (SAF2016-80324-R). The CNIC is supported by the Spanish Ministry of Science, Innovation and Universities and the Pro-CNIC Foundation, and is a Severo Ochoa Center of Excellence (SEV-2015-0505).S