Intervención coronaria en pacientes con fibrilación auricular / Percutaneous coronary intervention in patients with atrial fibrillation

El paciente con fibrilación auricular y enfermedad coronaria combina a menudo altos riesgos isquémico y hemorrágico. En el contexto de la anticoagulación oral, el clopidogrel es el inhibidor del P2Y12 con mejor perfil de seguridad y, aunque recomendado para los pacientes con síndrome coronario agudo, el pretratamiento antes de un procedimiento invasivo continúa siendo objeto de debate. Para los pacientes electivos que van a someterse a una intervención coronaria, no se recomienda la terapia puente con heparina periprocedimiento, dado que esta estrategia se ha relacionado con una mayor incidencia de eventos adversos. El acceso radial debería ser de elección en la mayoría de los casos, siempre que la situación hemodinámica y la anatomía coronaria lo permitan. Aunque la evidencia es aún escasa, se recomienda administrar dosis bajas de heparina no fraccionada durante el procedimiento. Información sobre el suplemento: este artículo forma parte del suplemento titulado «Actualización en el tratamiento de los pacientes con fibrilación auricular sometidos a intervención coronaria», que ha sido patrocinado por Boehringer Ingelheim

Patients with atrial fibrillation and coronary artery disease often have an elevated risk of both ischemia and bleeding. In the context of oral anticoagulation, clopidogrel is the P2Y12 inhibitor with the best safety profile. However, although it is recommended for patients with acute coronary syndromes, there is still some debate today about whether it should be used for pretreatment before invasive procedures. In patients scheduled to undergo an elective percutaneous coronary intervention, heparin bridging before the procedure is not recommended because this approach has been associated with an increased incidence of adverse events. Radial access should be preferred in the majority of cases when hemodynamics and the coronary anatomy permit. Although the evidence is still limited, it is recommended that low-dose unfractionated heparin should be administered during the procedure. Supplement information: this article is part of a supplement entitled "Treatment of patients with atrial fibrillation undergoing percutaneous coronary intervention: an update", which is sponsored by Boehringer Ingelheim

Kaempferol inhibits the production of ROS to modulate OPN-alfavbeta3 integrin pathway in HUVECs

In the present study, we tested the hypothesis that aldosterone regulates osteopontin (OPN)-related signaling pathways to promote nuclear factor κB (NF-κB) activation in primary human umbilical vein endothelial cells (HUVECs) and that kaempferol, a flavonoid compound, blocks those changes. Aldosterone induced productions of reactive oxygen species (ROS), OPN, interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α) and expression of nicotinamide adenine dinucleotide phosphate-oxidase 4 (Nox4), NF-κB, OPN, alphavbeta3 (αvβ3) integrin, and inhibitor of NF-κB alpha phosphorylation (P-IκBα) in HUVEC. HUVECs were pretreated with kaempferol (0, 1, 3, or 10 μM) for 1 h and exposed to aldosterone (10−6 M) for 24 h. Kaempferol reduced ROS, OPN, NF-κB, IL-6, and TNF-α levels; Nox4, αvβ3 integrin; and P-IκBα expressions. The effect of aldosterone was also abrogated by spironolactone (10−6 M). In addition, vitamin C (20 mmol/L) reduced ROS production. Vitamin C and LM609 (10 μg/mL) treatment decreased expressions of OPN, αvβ3 integrin, and NF-κB (P < 0.05 or P < 0.01). The present results suggest that kaempferol may modulate OPN-αvβ3 integrin pathway to inhibit NF-κB activation in HUVECs (AU)

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suPAR y glomeruloesclerosis segmentaria y focal / suPAR and focal segmental glomerulosclerosis

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