Informed consent in cardiology. The Committee on Informed Consent of the Commission on Professional Matters of the Sociedad Espa?ola de Cardiología

In the last thirty years, the clinical relationship between physicians and patients has been rather modified. There are several factors that have contributed to this change: a) New ways to execute medical practises, specially referred to the development of new techniques; b) Cultural changes in our western society, mainly in the mediterranean area, where there has been progress in the recognition of patients' autonomy to decide about their own lives, health and their own bodies; c) The increasing number of lawsuits, complaints and judgements about the problems that clinical information involves, particularly the informed consent in clinical practise. We consider it necessary to make an extensive and deep discussion from all of the areas in Medicine and Law, to analyze the different ethical and legal parts of the informed consent. For that reason the Spanish Society of Cardiology offers their members a basic document in order to reflect about these facts, developing arguments, justifications and supports. This document has also considered models, conditions to their applicability according to Spanish law, and the experience we have had. Finally, there is a list of diagnostic procedures and interventional practises in cardiology that might be preceded by a written informed consent document. We considered them by the name of Spanish Society of Cardiology recommendations.     

Plant tolerance to diesel minimizes its impact on soil microbial characteristics during rhizoremediation of diesel-contaminated soils

Soil contamination due to petroleum-derived products is an important environmental problem. We assessed the impacts of diesel oil on plants (Trifolium repens and Lolium perenne) and soil microbial community characteristics within the context of the rhizoremediation of contaminated soils. For this purpose, a diesel fuel spill on a grassland soil was simulated under pot conditions at a dose of 12,000 mg diesel kg^− 1 DW soil. Thirty days after diesel addition, T. repens (white clover) and L. perenne (perennial ryegrass) were sown in the pots and grown under greenhouse conditions (temperature 25/18 °C day/night, relative humidity 60/80% day/night and a photosynthetic photon flux density of 400 μmol photon m^− 2 s^− 1) for 5 months. A parallel set of unplanted pots was also included. Concentrations of n-alkanes in soil were determined as an indicator of diesel degradation. Seedling germination, plant growth, maximal photochemical efficiency of photosystem II (F_v/F_m), pigment composition and lipophylic antioxidant content were determined to assess the impacts of diesel on the studied plants. Soil microbial community characteristics, such as enzyme and community-level physiological profiles, were also determined and used to calculate the soil quality index (SQI). The presence of plants had a stimulatory effect on soil microbial activity. L. perenne was far more tolerant to diesel contamination than T. repens. Diesel contamination affected soil microbial characteristics, although its impact was less pronounced in the rhizosphere of L. perenne. Rhizoremediation with T. repens and L. perenne resulted in a similar reduction of total n-alkanes concentration. However, values of the soil microbial parameters and the SQI showed that the more tolerant species (L. perenne) was able to better maintain its rhizosphere characteristics when growing in diesel-contaminated soil, suggesting a better soil health. We concluded that plant tolerance is of crucial importance for the recovery of soil health during rhizoremediation of contaminated soils.     

Conserving Properties in Constrained Dynamics of Flexible Multibody Systems

The context of this work is the non-linear dynamics ofmultibody systems (MBS). The approach followed for parametrisation ofrigid bodies is the use of inertial coordinates, forming a dependent setof parameters. This approach mixes naturally with nodal coordinates in adisplacement-based finite element discretisation of flexible bodies,allowing an efficient simulation for MBS dynamics. An energy-momentumtime integration algorithm is developed within the context of MBSconstraints enforced through penalty methods. The approach follows theconcept of a discrete derivative for Hamiltonian systems proposed byGonzalez, achieving exact preservation of energy and momentum. Thealgorithm displays considerable stability, overcoming the traditionaldrawback of the penalty method, namely numerical ill-conditioning thatleads to stiff equation systems. Additionally, excellent performance isachieved in long-term simulations with rather large time-steps.     

Coronary angioscopy: initial experience during coronary interventions

BACKGROUND AND OBJECTIVE: Percutaneous coronary angioscopy (CAG) provides in vivo visual information about the luminal aspect of the vessel. In this report we describe our initial experience with CAG during coronary angioplasty (PTCA). METHODS: Fifty-five patients (age 60 +/- 9 years), 8 female, were included. Most patients, 42 (76%) were treated for unstable angina. RESULTS: In 49 patients (89%) CAG was performed prior to PTCA, and in all cases the intraluminal material responsible of the stenosis was recognized. This included plaque associated to thrombus in 29 patients (59%), isolated plaque in 15 (31%) and isolated thrombus in 5 (10%). Of these plaques, 25 (57%) were yellow, 14 (32%) were yellow and white and 5 (11%) were white. Of the 34 thrombi, 23 (68%) were mural and 11 (32%) protruding. CAG post-PTCA was performed in 43 patients (78%). CAG visualized residual plaque in 41 patients (95%) and residual thrombus in 34 (79%). In addition, CAG recognized dissections in 30 patients (70%). CAG was more sensitive than angiography for the detection of thrombus (pre-PTCA 34 [69%] vs 11 [22%]; p < 0.05, and post-PTCA 34 [79%] vs 5 [12%]; p < 0.05]) and coronary dissections (post-PTCA 30 [70%] vs 19 [44%]; p < 0.05). CAG before intervention caused angina in 39 patients (80%), ventricular fibrillation (successfully managed with DC cardioversion) in 1, and AV block in another patient. The angiographic result deteriorated in 4 patients (9%) immediately after the CAG performed following PTCA. A repeat balloon PTCA was required in these patients. CONCLUSIONS: CAG provides unique information on coronary lumen surface that complements angiographic data. As compared with angiography, CAG is more sensitive in the detection of intracoronary thrombi and dissections. Further studies are required to determine whether the additional information provided by CAG may be used, to select coronary interventions according to specific lesion characteristics, to optimize dilation results and, eventually, to improve the clinical outcome of these patients.     

Unambiguous characterization of gunshot residue particles using scanning laser ablation and inductively coupled plasma-mass spectrometry

A new method based on scanning laser ablation and inductively coupled plasma-mass spectrometry (LA-ICPMS) for the detection and identification of gunshot residue (GSR) particles from firearms discharges has been developed. Tape lifts were used to collect inorganic residues from skin surfaces. The laser ablation pattern and ICPMS conditions were optimized for the detection of metals present in GSR, such as (121)Sb, (137)Ba, and (208)Pb. Other isotopes ((27)Al, (29)Si, (31)P, (33)S, (35)Cl, (39)K, (44)Ca, (57)Fe, (60)Ni, (63)Cu, (66)Zn, and (118)Sn) were monitored during the ICPMS analyses to obtain additional information to possibly classify the GSR particles as either characteristic of GSR or consistent with GSR. In experiments with real samples, different firearms, calibers, and ammunitions were used. The performed method evaluation confirms that the developed methodology can be used as an alternative to the standard scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS) technique, with the significant advantage of drastically reducing the analysis time to less than 66 min.     

Quadratic and Higher-Order Constraints in Energy-Conserving Formulations of Flexible Multibody Systems

The treatment of constraints is considered here within the framework ofenergy-momentum conserving formulations for flexible multibody systems.Constraint equations of various types are an inherent component of multibodysystems, their treatment being one of the key performance features ofmathematical formulations and numerical solution schemes.Here we employ rotation-free inertial Cartesian coordinates of points tocharacterise such systems, producing a formulation which easily couples rigidbody dynamics with nonlinear finite element techniques for the flexiblebodies. This gives rise to additional internal constraints in rigid bodies topreserve distances. Constraints are enforced via a penalty method, which givesrise to a simple yet powerful formulation. Energy-momentum time integrationschemes enable robust long term simulations for highly nonlinear dynamicproblems.The main contribution of this paper focuses on the integration of constraintequations within energy-momentum conserving numerical schemes. It is shownthat the solution for constraints which may be expressed directly in terms ofquadratic invariants is fairly straightforward. Higher-order constraints mayalso be solved, however in this case for exact conservation an iterativeprocedure is needed in the integration scheme. This approach, together withsome simplified alternatives, is discussed.Representative numerical simulations are presented, comparing the performanceof various integration procedures in long-term simulations of practicalmultibody systems.     

Determination of the insecticide pyridafenthion in river water, soils and wine by adsorptive stripping voltammetry.

Solid-phase extraction or liquid-liquid extraction has been combined with adsorptive stripping voltammetry at a hanging mercury drop electrode to isolate, determine, quantify and recover trace concentrations of pyridafenthion in water, wine and soil. A systematic study of the experimental parameters affecting the stripping response was carried out by differential pulse voltammetry. By using an accumulation potential of 400 mV and an accumulation time of 540 s, the limit of detection was 0.17 microgram l-1 and the relative standard deviation (n = 10) was 1.9% at a concentration level of 8.5 micrograms l-1. Different methods are proposed which eliminate matrix interferences. These results have been applied to the systematic study of this compound in water, wine and soil. The lowest detectable concentration for pyridafenthion is 34 micrograms l-1 in water, 102 micrograms l-1 in wine and 80 micrograms kg-1 in soil. Recoveries of the pyridafenthion from supplied environmental samples were in all cases higher than 92% with a relative standard deviation lower than 3%.     

A method based on DIMOND quality criteria to evaluate imaging in diagnostic and interventional cardiology

Image quality criteria (IQC) for cine-angiography were recently settled. The aim of this study was to test whether these criteria allow a measurement of the quality of cine-angiograms. A questionnaire was derived from IQC where a binary response was required regarding the degree of visibility of anatomic or pathologic structures. Scores were given on a ranking scale. Two quality scores were defined (total score and minimum score) and standard deviation (SD) was assumed to be an indicator of the method's reproducibility. Data of the total score are presented for the first nine angiograms. Six experts obtained thirty-nine readings. The total scores ranged between 83 and 99% (SD 0.8-18.7%); 89% of the readings were within 4% of SD. This preliminary experience indicates that quality criteria can be translated into a scoring system that yields reproducible data in most instances. The analysis of the remaining angiograms will help in understanding how to improve these results.     

A national programme for patient and staff dose monitoring in interventional cardiology

A national programme on patient and staff dose evaluation in interventional cardiology made in cooperation with the haemodynamic section of the Spanish Society of Cardiology has recently been launched. Its aim is to propose a set of national diagnostic reference levels (DRLs) for patients as recommended by the International Commission on Radiological Protection and to initiate several optimisation actions to improve radiological protection of both patients and staff. Six hospitals have joined the programme and accepted to submit their data to a central database. First to be acquired were the quality control data of the X-ray systems and radiation doses of patients and professionals. The results from 9 X-ray systems, 1467 procedures and staff doses from 43 professionals were gathered. Provisional DRLs resulted in 44 Gy cm(2) for coronary angiography and 78 Gy cm(2) for interventions. The X-ray systems varied up to a factor of 5 for dose rates in reference conditions. Staff doses showed that 50 % of interventional cardiologists do not use their personal dosemeters correctly.