Open Access
Quantitative measurements in the human hippocampus and related areas: correspondence between ex-vivo MRI and histological preparations
(Public Library of Science, 2015) Delgado González, José Carlos; Mansilla Legorburo, Francisco; Florensa Vila, José; Insausti Serrano, Ana María; Viñuela, Antonio; Tuñón Álvarez, Teresa; Cruz, Marcos; Mohedano Moriano, Alicia; Insausti, Ricardo; Artacho Pérula, Emilio; Ciencias de la Salud; Osasun Zientziak
The decrease of volume estimates in different structures of the medial temporal lobe related to memory correlate with the decline of cognitive functions in neurodegenerative diseases. This study presents data on the association between MRI quantitative parameters of medial temporal lobe structures and their quantitative estimate in microscopic examination. Twelve control cases had ex-vivo MRI, and thereafter, the temporal lobe of both hemispheres was sectioned from the pole as far as the level of the splenium of the corpus callosum. Nissl stain was used to establish anatomical boundaries between structures in the medial temporal lobe. The study included morphometrical and stereological estimates of the amygdaloid complex, hippocampus, and temporal horn of the lateral ventricle, as well as different regions of grey and white matter in the temporal lobe. Data showed a close association between morphometric MRI images values and those based on the histological determination of boundaries. Only values in perimeter and circularity of the piamater were different. This correspondence is also revealed by the stereological study, although irregular compartments resulted in a lesser agreement. Neither age (< 65 yr and > 65yr) nor hemisphere had any effect. Our results indicate that ex-vivo MRI is highly associated with quantitative information gathered by histological examination, and these data could be used as structural MRI biomarker in neurodegenerative diseases.
Open Access
The CA2 hippocampal subfield in humans: a review
(Wiley, 2023) Insausti, Ricardo; Muñoz López, Mónica; Insausti Serrano, Ana María; Ciencias de la Salud; Osasun Zientziak
CA2 is probably the most enigmatic of the hippocampal fields. It is small in size (in humans about 500 μm across the mediolateral axis), and yet, it is involved in important functions, such as in social memory and anxiety. This study offers a glimpse of several significant aspects of the anatomical organization of CA2. We present an overview of the anatomical structure of CA2, imbued in the general organization of the human hippocampal formation. The location and distinctiveness of CA2 is presented in relation with CA3 and CA1, based in a total of 23 human control cases serially sectioned throughout the whole longitudinal axis of the hippocampus, examined every 500 μm in Nissl-stained sections. The longitudinal extent of CA2 is close to 30 mm, starting in the hippocampal head, 2.5 mm caudal to the DG and 3.5 mm caudal to the start of CA3, approximately 10 mm from the hippocampus rostral end. The connectional information of human CA2 is very scarce, thereby we relied on nonhuman primate tract tracing studies of the hippocampal formation, given its resemblance to the human brain. Human CA2 is subject of neuropathological studies, and we chose to present Alzheimer's disease, schizophrenia, and Mesial Temporal Lobe Epilepsy with hippocampal sclerosis in those aspects that impinge directly into CA2.
Open Access
Adherencia al tratamiento con adalimumab, golimumab y ustekinumab en pacientes con enfermedad inflamatoria intestinal
(Aula Médica Ediciones, 2020) Calvo Arbeloa, María; Insausti Serrano, Ana María; Arrondo Velasco, Amaya; Sarobe Carricas, María Teresa; Ciencias de la Salud; Osasun Zientziak
Objetivo: La enfermedad inflamatoria intestinal es un grupo de trastornos crónicos, inflamatorios y recidivantes que afectan al intestino. En la última década, los fármacos biológicos han supuesto un gran cambio en la terapia de esta enfermedad. Adalimumab, golimumab y ustekinumab son tres de ellos que se administran por vía subcutánea tras su dispensación en los servicios de farmacia de los hospitales. Para que se alcance la efectividad del tratamiento es necesaria una adecuada adherencia al mismo. El objetivo del presente trabajo fue evaluar la adherencia en pacientes que recogían los tres fármacos en el servicio de farmacia de un hospital de tercer nivel. Método: Se realizó un estudio analítico observacional de corte transversal en el que se incluyó a pacientes que recibían tratamiento con los anteriores fármacos durante al menos cuatro meses. Se recogió la tasa de posesión de la medicación proporcionada por el registro de dispensaciones y se seleccionó a los pacientes que presentaron un valor inferior o igual al 85%. A estos pacientes se les aplicó el cuestionario de medida del cumplimiento terapéutico de Morisky-Green. Resultados: Se incluyeron 178 pacientes, de los cuales el 60,1% (107) fueron hombres y el 30,9% (55) habían sido tratados con otros fármacos biológicos previamente. La adherencia media, según el registro de dispensaciones, fue del 91,79% y se clasificó a 45 pacientes (25,28%) como mal adherentes (≤ 85%). La no administración en la fecha indicada y el olvido se identificaron como principales razones de la falta de cumplimiento terapéutico según el resultado del test de Morisky-Green. El sexo femenino (odds ratio 0,42; p = 0,013) y la duración del tratamiento (p = 0,002) se asociaron a una peor adherencia a la medicación. Conclusiones: El porcentaje de adherencia obtenido resultó elevado en la población de estudio, pero se identificaron pacientes mal cumplidores susceptibles de recibir intervenciones para mejorar su adherencia. No obstante, se debería aumentar la potencia estadística para mejorar la validez de los resultados obtenidos.
Open Access
Modelo en papel de anatomía de la región inguinal
(2023) Blázquez Lautre, Lucas; Malón Insausti, Emilia; Insausti Serrano, Ana María; Yárnoz Irazábal, María Concepción; Brady, John; Ciencias de la Salud; Osasun Zientziak
Open Access
The human periallocortex: layer pattern in presubiculum, parasubiculum and entorhinal cortex. A review
(Frontiers Media, 2017) Insausti, Ricardo; Muñoz López, Mónica; Insausti Serrano, Ana María; Artacho Pérula, Emilio; Ciencias de la Salud; Osasun Zientziak
The cortical mantle is not homogeneous, so that three types of cortex can be distinguished: allocortex, periallocortex and isocortex. The main distinction among those three types is based on morphological differences, in particular the number of layers, overall organization, appearance, etc., as well as its connectivity. Additionally, in the phylogenetic scale, this classification is conserved among different mammals. The most primitive and simple cortex is the allocortex, which is characterized by the presence of three layers, with one cellular main layer; it is continued by the periallocortex, which presents six layers, although with enough differences in the layer pattern to separate three different fields: presubiculum (PrS), parasubiculum (PaS), and entorhinal cortex (EC). The closest part to the allocortex (represented by the subiculum) is the PrS, which shows outer (layers I–III) and inner (V–VI) principal layers (lamina principalis externa and lamina principalis interna), both separated by a cell poor band, parallel to the pial surface (layer IV or lamina dissecans). This layer organization is present throughout the anterior-posterior axis. The PaS continues the PrS, but its rostrocaudal extent is shorter than the PrS. The organization of the PaS shows the layer pattern more clearly than in the PrS. Up to six layers are recognizable in the PaS, with layer IV as lamina dissecans between superficial (layers I–III) and deep (V–VI) layers, as in the PrS. The EC presents even more clearly the layer pattern along both mediolateral and rostrocaudal extent. The layer pattern is a thick layer I, layer II in islands, layer III medium pyramids, layer IV as lamina dissecans (not present throughout the EC extent), layer V with dark and big pyramids and a multiform layer VI. The EC borders laterally the proisocortex (incomplete type of isocortex). Variations in the appearance of its layers justify the distinction of subfields in the EC, in particular in human and nonhuman primates. EC layers are not similar to those in the neocortex. The transition between the periallocortical EC and isocortex is not sharp, so that the proisocortex forms an intervening cortex, which fills the gap between the periallocortex and the isocortex.
Open Access
La inteligencia emocional en el Grado de Enfermería
(Fundación Index, 2024) Jiménez Marcos, María Anunciación; Insausti Serrano, Ana María; Zubeldia Etxeberria, Josune; Bays Moneo, Ana Beatriz; Trandafir, Paula Camelia; Ciencias de la Salud; Osasun Zientziak
Objetivo: Describir una intervención para abordar la Inteligencia Emocional en el Grado de Enfermería. Metodología: relato de una experiencia en la asignatura Enfermería Clínica del Grado de Enfermería, en la que 32 alumnos recibieron una intervención teórica y práctica de Inteligencia Emocional con el modelo de Mayer y Saloy. Al finalizar se realizó una evaluación sobre la intervención. Resultados: en comparación a cursos previos se observó una mejoría considerable en valoraciones como la comunicación, la actitud reflexiva y la motivación; en las preguntas abiertas más de la mitad respondieron que aprendieron a relajarse, a conocerse mejor y; más de la cuarta parte, les pareció muy útil para su vida personal y profesional. Conclusiones: la Inteligencia Emocional demostró ser beneficiosa para la salud de alumnado y su propio aprendizaje. Por ello sería interesante la inclusión del manejo de las emociones, durante la formación universitaria en el Grado de Enfermería.
Open Access
A teaching experience aimed at health professionals during the second wave pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
(Lippincott, 2021-02-19) Jiménez Marcos, María Anunciación; Insausti Serrano, Ana María; Trandafir, Paula Camelia; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Ciencias de la Salud; Osasun Zientziak; Institute for Advanced Materials and Mathematics - INAMAT2
In a master's level course in a university in Spain with 9 students, 4 physical therapists, 2 nurses, 2 sports professionals and 1 social worker, due to the situation created by the SARS-CoV-2 virus, the class started by sharing the experiences they had had in the first and second waves of the pandemic. Out of a group of 9 participants, 6 work in the area of healthcare or social healthcare: in primary care, in elderly care homes, hospital wards converted into areas for patients with SARS-CoV- 2, or healthcare service workers in private homes. During the class they expressed an explosion of emotions such as frustration, powerlessness, fear, tension, anxiety, rage, and anger. 2 of them had lost close relatives, and were therefore still grieving, 2 needed psychological attention, and a third one became aware that he/she needed professional help. Upon sharing their experiences, they identified their emotions, understood them, and talked about how they were handling them. They were introduced to a model of Emotional Intelligence, and they evaluated their own levels of anxiety and their way of handling emotions using 2 validated tools The group asked for more time for this type of training, particularly during the difficult time of the pandemic, concluding that sharing emotions, helping to redirect them, is a type of Emotional Intelligence that is effective for handling emotional crises.
Open Access
Identificación y manejo de situaciones emocionales vividas por los estudiantes de enfermería durante las prácticas clínicas
(Universidad de Murcia Servicio de Publicaciones, 2024) Jiménez Marcos, María Anunciación; Insausti Serrano, Ana María; Zubeldia Etxeberria, Josune; Berasain Erro, Itziar; Trandafir, Paula Camelia; Estadística, Informática y Matemáticas; Estatistika, Informatika eta Matematika; Ciencias de la Salud; Osasun Zientziak
Introducción: La Enfermería es una profesión en la que se viven situaciones emocionales muy complejas y difíciles, por lo que adquiere especial importancia el saber gestionar de forma adecuada las emociones para poder evitar estados de estrés crónico. Objetivo: Identificar las situaciones emocionales que experimentan los estudiantes de enfermería durante su experiencia clínica y la relación de ésta con las habilidades de la profesión enfermera, así como su gestión emocional. Método: Estudio de diseño mixto cualitativo/cuantitativo. La parte cualitativa se basa en el estudio de las situaciones emocionales percibidas por el alumnado en las prácticas clínicas, recabado a través de una pregunta abierta sobre situaciones que le habrían generado une emoción intensa. La cuantitativa, por su parte, se centra en la IEP (Inteligencia Emocional Percibida) del alumnado medido por cuestionario Trait Meta-Mood Scale (TMMS-24). Resultados: En la primera parte se identifican dos categorías principales: Las habilidades y la falta de habilidades, entre las cuales, la categoría más identificada es la de las “habilidades”, siendo la subcategoría más representativa la de “empatía”, seguida del “autoconocimiento”. En ambas, la situación emocional primordialmente identificada es la muerte. En la segunda parte, se examinan los resultados y se infiere una asociación entre la dimensión Comprensión de la IEP y las habilidades de la profesión enfermera. Conclusión: La muerte está muy presente en las emociones del alumnado de prácticas clínicas siendo la empatía, la habilidad más presente. La comprensión emocional puede ayudar a estimular la empatía y promover el autoconocimiento.
Open Access
Ex vivo, in situ perfusion protocol for human brain fixation compatible with microscopy, MRI techniques, and anatomical studies
(Frontiers Media, 2023) Insausti, Ricardo; Insausti Serrano, Ana María; Muñoz López, Mónica; Medina Lorenzo, Isidro; Arroyo-Jiménez, María del Mar; Marcos Rabal, Pilar; Rosa-Prieto, Carlos de la; Delgado González, José Carlos; Montón Etxeberria, Javier; Cebada Sánchez, Sandra; Raspeño-García, Juan Francisco; Iñiguez de Onzoño, María Mercedes; Molina Romero, Francisco Javier; Benavides-Piccione, Ruth; Tapia-González, Silvia; Wisse, Laura E. M.; Ravikumar, Sadhana; Wolk, David A.; DeFelipe, Javier; Yushkevich, Paul; Artacho Pérula, Emilio; Ciencias de la Salud; Osasun Zientziak
We present a method for human brain fixation based on simultaneous perfusion of 4% paraformaldehyde through carotids after a flush with saline. The left carotid cannula is used to perfuse the body with 10% formalin, to allow further use of the body for anatomical research or teaching. The aim of our method is to develop a vascular fixation protocol for the human brain, by adapting protocols that are commonly used in experimental animal studies. We show that a variety of histological procedures can be carried out (cyto- and myeloarchitectonics, histochemistry, immunohistochemistry, intracellular cell injection, and electron microscopy). In addition, ex vivo, ex situ high-resolution MRI (9.4T) can be obtained in the same specimens. This procedure resulted in similar morphological features to those obtained by intravascular perfusion in experimental animals, provided that the postmortem interval was under 10 h for several of the techniques used and under 4 h in the case of intracellular injections and electron microscopy. The use of intravascular fixation of the brain inside the skull provides a fixed whole human brain, perfectly fitted to the skull, with negligible deformation compared to conventional techniques. Given this characteristic of ex vivo, in situ fixation, this procedure can probably be considered the most suitable one available for ex vivo MRI scans of the brain. We describe the compatibility of the method proposed for intravascular fixation of the human brain and fixation of the donor’s body for anatomical purposes. Thus, body donor programs can provide human brain tissue, while the remainder of the body can also be fixed for anatomical studies. Therefore, this method of human brain fixation through the carotid system optimizes the procurement of human brain tissue, allowing a greater understanding of human neurological diseases, while benefiting anatomy departments by making the remainder of the body available for teaching purposes.
Open Access
Postnatal development of NPY and somatostatin-28 peptidergic populations in the human angular bundle
(Frontiers Media, 2019) Cebada Sánchez, Sandra; Marcos Rabal, Pilar; Insausti Serrano, Ana María; Insausti, Ricardo; Ciencias de la Salud; Osasun Zientziak
The angular bundle is a white matter fiber fascicle, which runs longitudinally along the parahippocampal gyrus. It is best known for carrying fibers from the entorhinal cortex (EC) to the hippocampus through the perforant and alvear pathways, as well as for carrying hippocampal output to the neocortex, and distributing fibers to polysensory cortex. The angular bundle is already present prenatally at the beginning of the fetal period. Connections between the EC and the hippocampus are established by the 20th gestational week (gw). In the postnatal period, it shows increasing myelination. The angular bundle, as well as other white matter portions of gyral surfaces in the brain, presents interstitial neurons, a remnant of subplate neurons. Those interstitial neurons show neurochemical phenotypes both prenatally and postnatally, among which, neuropeptide Y (NPY) and Somatostatin-28 (SOM-28) peptidergic populations are noticeable, and accompany the fiber connections in the maturation of the hippocampal formation. We sought to investigate the topography of the postnatal distribution and relative density of neurons immunoreactive for NPY or SOM in the angular bundle along the rostrocaudal axis of the hippocampus. The study was carried out in 15 cases, ranging from 35 gws, up to 14 year old. All cases showed positive neurons showing a polygonal or spindle shaped morphology for both peptides, scattered throughout the angular bundle. The highest number of positive neurons appeared around birth and the ensuing weeks. Up to one and a half years, the density of both peptidergic populations decreased slightly. However, cases older than 2 years of age showed a substantial decrease in density of immunolabeled neurons, density that did not showed a minor decrease in density of positive neurons in cases older than 2 years. In addition, a topography from caudal to rostral levels of the angular bundle was detected at all ages. The functional significance of interstitial cells is unknown, but the existence of SOM and NPY peptidergic neurons, presumably inhibitory, in the white matter of the angular bundle, could contribute to the basic wiring of the hippocampal formation, through which autobiographical and spatial memories can begin to be stored in the infant brain.