Very long-term follow-up after aortic stenting for coarctation of the aorta.

INTRODUCTION AND OBJECTIVES: Stent implantation is the preferred treatment in older children and adults with aortic coarctation (CoA). We aimed to determine the incidence of very late events after CoA stenting. METHODS: We analyzed a cohort of CoA patients who underwent stent implantation at our center between 1993 and 2018. Patients were periodically followed up in outpatient clinics, including computed tomography (CT) and fluoroscopy assessment. RESULTS: A total of 167 patients with CT and fluoroscopy data were included: 83 (49.7%) were aged ≤ 12 years and 46 (28%) were female. The mean clinical follow-up time was 17±8 (range 4-30) years and the mean time to CT/fluoroscopy was 11±7 years. Aortic aneurysm was present in 13% and was associated with the PALMAZ stent (OR, 3.09; 95%CI, 1.11-9.49; P=.036) and the stented length (OR, 0.94; 95%CI, 0.89-0.99; P=.039). Stent fracture was frequent (34%), but was not related to the presence of aneurysm. Stent fracture was associated with young age (OR, 3.57; 95%CI, 1.54-8.33; P=.003), male sex (OR, 4.00; 95%CI, 1.51-12.5, P=.008) and inversely with the PALMAZ stent (OR, 0.29; 95%CI, 0.12-0.67, P=.005). Reintervention was lower in adults (10%), mainly related to aneurysms. Those treated when aged ≤ 12 years had higher reintervention rates (43%) due to recoarctation somatic growth. CONCLUSIONS: This long-term follow-up study of CoA patients treated with stenting revealed a significant incidence of late events. Reintervention rates were higher in patients treated at younger ages. Periodic imaging surveillance appears to be advisable.

Complete vs. incomplete percutaneous revascularization in patients with chronic total coronary artery occlusion.

Introduction: There is current controversy surrounding the benefits of percutaneous coronary intervention (PCI) of chronic total coronary occlusions (CTO). We aimed to evaluate the impact of complete percutaneous revascularization on major adverse cardiovascular events (MACE) in patients with CTO. Methods: A retrospective observational study was conducted of consecutive patients referred for invasive coronary angiography at a single center between January 2018 and December 2019 and at least a CTO. The patients were divided into two groups according to the result of the procedure: complete revascularization of CTO (CR-CTO) versus incomplete revascularization (ICR-CTO) (patients with at least one non-recanalized CTO). Short- and mid-term clinical outcomes were evaluated. The primary endpoint was a composite of MACE that included all-cause death, non-fatal myocardial infarction, non-fatal stroke, or unplanned revascularization. Results: In total, 359 patients with CTO were included. The median age was 68 years [interquartile range (IQR) 60-77 years], 66 (18%) were women and 169 (47.3%) had diabetes mellitus. In all, 167 (46.5%) patients received complete revascularization. After a median follow-up of 42 months (IQR 46-50 months), the primary endpoint occurred in 39 (23.4%) patients in the CR-CTO group and in 75 (39.1%) in the ICR-CTO group (HR 0.50, 95% CI 0.34-0.74; p < 0.001). This association remained significant in an inverse probability weighted model considering prognostic factors (adjusted HR 0.61, 95% CI 0.41-0.92; p = 0.018) and was driven by lower rates of all-cause death (adjusted OR 0.50, 95% CI 0.23-0.84; p = 0.01). Conclusions: Complete revascularization of CTO was associated with a lower risk of MACE in the midterm follow up.

The Usefulness of Coregistration with iFR in Tandem or Long Diffuse Coronary Lesions: The iLARDI Randomized Clinical Trial.

Background. Despite technical advancements, patients with sequential or diffuse coronary lesions undergoing percutaneous coronary intervention (PCI) have an increased risk of cardiovascular events at follow-up. We aimed to analyze the utility of a SyncVision/iFR (S-iFR)-guided PCI strategy versus an angiography-guided strategy in patients with this type of lesions. Methods. Randomized, multicenter, controlled, and open-label trial to compare S-iFR versus angiography-guided PCI in patients with sequential or diffuse angiographic coronary stenosis (ClinicalTrials.gov identifier: NCT04283734). The primary endpoint was the implanted stent length. The main secondary endpoint was targeting vessel failure (TVF) at one year. Results. A total of 100 patients underwent randomization, with 49 patients assigned to the S-iFR group and 51 to the angiography-guided PCI group. There were no differences between groups regarding clinical and anatomical characteristics. The baseline iFR was 0.71 ± 0.16 vs. 0.67 ± 0.19 (p = 0.279) in the S-iFR and angiography group, respectively. The mean lesion length was 42.3 ± 12 mm and 39.8 ± 12 (p = 0.297). The implanted stent length was 32.7 ± 17.2 mm in the S-iFR group and 43.1 ± 14.9 mm in the angiography group (mean difference, -10.4 mm; 95% confidence interval [CI], -16.9 to -4.0; p = 0.002). At one year, target vessel failure (TVF) occurred in four patients: three (6.1%) in the S-iFR group vs. one (1.9%) in the angiography group (p = 0.319). Conclusions. Among patients with sequential or long diffuse coronary lesions, a S-iFR-guided PCI strategy resulted in a reduction of the total stent length compared to an angiography-guided PCI strategy. A nonsignificant increase in TVF was observed in the S-iFR group.

Tree species differ in plant economic spectrum traits in the tropical dry forest of Mexico.

In tropical dry forests, studies on wood anatomical traits have concentrated mainly on variations in vessel diameter and frequency. Recent research suggests that parenchyma and fibers also play an important role in water conduction and in xylem hydraulic safety. However, these relationships are not fully understood, and wood trait variation among different functional profiles as well as their variation under different water availability scenarios have been little studied. In this work, we aim to (1) characterize a set of wood anatomical traits among six selected tree species that represent the economic spectrum of tropical dry forests, (2) assess the variation in these traits under three different rainfall regimes, and (3) determine the relationships between wood anatomical traits and possible functional trade-offs. Differences among species and sites in wood traits were explored. Linear mixed models were fitted, and model comparison was performed. Most variation occurred among species along the economic spectrum. Obligate deciduous, low wood density species were characterized by wood with wide vessels and low frequency, suggesting high water transport capacity but sensitivity to drought. Moreover, high cell fractions of carbon and water storage were also found in these tree species related to the occurrence of abundant parenchyma or septate fibers. Contrary to what most studies show, Cochlospermum vitifolium, a succulent tree species, presented the greatest variation in wood traits. Facultative deciduous, high wood density species were characterized by a sturdy vascular system that may favor resistance to cavitation and low reserve storage. Contrary to our expectations, variation among the rainfall regimes was generally low in all species and was mostly related to vessel traits, while fiber and parenchyma traits presented little variation among species. Strong functional associations between wood anatomical traits and functional trade-offs were found for the six tree species studied along the economic spectrum of tropical dry forests.

Seguimiento a muy largo plazo tras implante de stent en la coartación de aorta / Very long-term follow-up after aortic stenting for coarctation of the aorta

Introducción y objetivos: El implante de stent es el tratamiento de elección en niños mayores y adultos con coartación aórtica (CoA). El objetivo fue determinar la incidencia de eventos tardíos después del tratamiento con stent. Métodos: Se analizó una cohorte de pacientes con CoA tratados en el centro entre 1993 y 2018 a los que se siguió periódicamente, incluyendo evaluación mediante tomografía computarizada (TC) y fluoroscopia. Resultados: Se incluyó a 167 pacientes con TC y fluoroscopia: 83 (49,7%) ≤ 12 años y 46 (28%) mujeres. El tiempo medio de seguimiento clínico fue de 17±8 años (rango 4-30) y de 11±7 años hasta la TC/fluoroscopia. Se detectó aneurisma en un 13% y se asoció al stent PALMAZ (OR=3,09; IC95%, 1,11-9,49; p=0,036) y a la longitud del stent (OR=0,94; IC95%, 0,89-0,99; p=0,039). La fractura del stent fue frecuente (34%) pero no asociada a la presencia de aneurisma. Se asoció con edad joven (OR=3,57; IC95%, 1,54-8,33; p=0,003), sexo masculino (OR=4,00; IC95%, 1,51-12,50; p=0,008) e inversamente con el stent PALMAZ (OR=0,29; IC95%, 0,12-0,67; p=0,005). La reintervención fue menor en adultos (10%), principalmente por aneurismas. Los pacientes que recibieron tratamiento cuando tenían 12 años o menos presentaron tasas de reintervención más altas (43%) debido al crecimiento somático. Conclusiones: Se observó una incidencia notable de eventos tardíos a largo plazo en pacientes con CoA tratados mediante stent. La reintervención fue más frecuente en pacientes tratados a edades más jóvenes. Parece aconsejable una vigilancia periódica mediante pruebas de imagen. (AU)

Introduction and objectives: Stent implantation is the preferred treatment in older children and adults with aortic coarctation (CoA). We aimed to determine the incidence of very late events after CoA stenting. Methods: We analyzed a cohort of CoA patients who underwent stent implantation at our center between 1993 and 2018. Patients were periodically followed up in outpatient clinics, including computed tomography (CT) and fluoroscopy assessment. Results: A total of 167 patients with CT and fluoroscopy data were included: 83 (49.7%) were aged ≤ 12 years and 46 (28%) were female. The mean clinical follow-up time was 17±8 (range 4-30) years and the mean time to CT/fluoroscopy was 11±7 years. Aortic aneurysm was present in 13% and was associated with the PALMAZ stent (OR, 3.09; 95%CI, 1.11-9.49; P=.036) and the stented length (OR, 0.94; 95%CI, 0.89-0.99; P=.039). Stent fracture was frequent (34%), but was not related to the presence of aneurysm. Stent fracture was associated with young age (OR, 3.57; 95%CI, 1.54-8.33; P=.003), male sex (OR, 4.00; 95%CI, 1.51-12.5, P=.008) and inversely with the PALMAZ stent (OR, 0.29; 95%CI, 0.12-0.67, P=.005). Reintervention was lower in adults (10%), mainly related to aneurysms. Those treated when aged ≤ 12 years had higher reintervention rates (43%) due to recoarctation somatic growth. Conclusions: This long-term follow-up study of CoA patients treated with stenting revealed a significant incidence of late events. Reintervention rates were higher in patients treated at younger ages. Periodic imaging surveillance appears to be advisable. (AU)

Estructura y diversidad de la vegetación en un matorral espinoso prístino de Tamaulipas, México / Structure and diversity of the vegetation of pristine scrubland in Tamaulipas, Mexico

Resumen El matorral espinoso tamaulipeco es un tipo de vegetación arbustiva endémica del noreste de México y el Sur de Texas en E.U. En el estudio se evaluó la estructura del matorral espinoso tamaulipeco, estableciendo el área mínima con parcelas de 256 m2 mediante la determinación de la curva especies-área. La composición y diversidad de los estratos de las especies vegetales (arbóreas, arbustivas, subarbustivo, semiarbustivo, herbáceas y epífitas) se valoraron y se establecieron tres sitios de muestreo de 16×16 m. Se registró información dasométrica de altura, diámetro y cobertura de copa para determinar las variables estructurales de cobertura, densidad, densidad relativa, dominancia, dominancia relativa, frecuencia, frecuencia relativa e Índice de Valor de Importancia, así como la estimación del índice de riqueza de Margalef, índice de diversidad de Shannon-Wiener, de Menhinick, Simpson y el de Equidad de Pielou. La riqueza florística fue de 33 especies, distribuidas en 30 géneros y 19 familias, quedando con el valor de predominancia más altos las especies de Leguminosas (Fabaceae). Se reconocieron seis estratos para la vegetación estudiada, en el estrato arbustivo se encontraron 14 especies, la de mayor IVI fue Helietta parvifolia con 17.68 % y dentro de la comunidad vegetal del MET el IVI fue de 8.53 %. Para el estrato subarbustivo con ocho especies la de mayor IVI fue Bernardia myricifolia con 39.20 % y dentro de la comunidad vegetal 7.74 %. Para el semiarbustivo se presentaron siete especies donde Lantana canescens tiene un IVI de 60.38 % y dentro de la comunidad 13.09 %, para el estrato herbáceo con dos especies domina Wissadula sp., con 54.20 % y 2.06 % para la comunidad. En el estrato arbóreo la especie con mayor IVI fue Celtis laevigata con el 100 % e integrado a la comunidad vegetal presentó un valor de 1.98 % y para el estrato formado por las epífitas la especie Adiantum capillus-veneris tuvo un IVI del 100 % y dentro de la comunidad vegetal presentó un IVI de 1.55 %. Para la comunidad vegetal del MET se obtuvo un valor H´ de 2.42 y un DMg de 4.34.(AU)

Abstract Tamaulipan scrubland is a type of shrub vegetation endemic to Northeastern Mexico and Southern Texas in the U.S. The structure of the Tamaulipan scrubland was evaluated in the study, establishing the minimum area with plots of 256 m2 by determining the species-area curve, valuing the composition and diversity of the strata of the plant species (arboreal, shrub, low forest, semi shrubby, herbaceous and epiphytes); three sampling sites of 16×16 m were established. Dasometric information such as height, diameter and cup coverage was recorded to determine the structural variables of coverage, density, relative density, dominance, relative dominance, frequency, relative frequency and Importance Value Index, as well as estimation of the Margalef richness index, Shannon-Wiener diversity index, Menhinick, Simpson and Pielou's evenness index. The floristic richness was of 33 species distributed in 30 genera and 19 families, leaving the predominance value of the highest species of Leguminosae (Fabaceae). Six strata were recognized for the studied vegetation from which the highest IVI was Helietta parvifolia with 17.68 % for the shrubby stratum with 14 species and within the plant community of the MET the IVI was 8.53 %; for the low forest stratum with 8 species, the one with the highest IVI was Bernardia myricifolia with 39.20 %; and within the vegetal community 7.74 % for the semi shrubby there were 7 species where Lantana canescens has an IVI of 60.38 % and of 13.09 % inside the community. For the herbaceous stratum with 2 species, Wissadula sp. dominates with 54.20 % and 2.06 % for the community. In the arboreal stratum, the species with the highest IVI was Celtis laevigata with 100.00 % and when integrated to the plant community, it presented a value of 1.98 %. For the stratum formed by the epiphytes, the species Adiantum capillus-veneris had an IVI of 100 % and inside the plant community presented an IVI of 1.55 %. For the MET plant community studied, an H' value of 2.42 and a DMg value of 4.34 was obtained.(AU)

Estado nutricional de mujeres con sobrepeso y obesidad del área de cobertura del programa de atención integral en salud (PAIS) 2006 / Nutritional status of overweight and obese women attended at the comprehensive health care program (PAIS) 2006

El objetivo de la presente investigación fue evaluar el estado nutricional de mujeres con sobrepeso y obesidad del área de atracción del Programa de Atención Integral en Salud, PAIS. Métodos: Se trabajó con un total de 90 mujeres, 30 mujeres de cada una de los distritos que conforman el área de cobertura PAIS (Curridabat, La Unión y Montes de Oca), con edades comprendidas entre los 18-53 años, diagnosticadas todas con sobrepeso y obesidad. Las variables estudiadas fueron características: antropométricas, clínicas, bioquímicas y dietéticas de este grupo de mujeres. Resultados: Casi la totalidad de estas mujeres con sobrepeso y obesidad presentaron obesidad abdominal y alteraciones en el perfil lipídico, no presentan anemia y la mayoría presentó niveles normales de glicemia en ayunas y postprandial. La evaluación dietética mostró una ingesta promedio de 1851 más menos 691 Kcal con un aporte de 52 por ciento de carbohidratos, 13.8 por ciento de proteína y 34 por ciento de grasa. La ingesta promedio de vitamina A, C fueron adecuadas de acuerdo a las recomendaciones dietéticas diarias y el consumo de fibra fue bajo. La exploración física de estas mujeres evidenció problemas de hipertensión arterial, trastornos osteomusculares, presencia de estrías. El 87.6 por ciento de las mujeres presentó antecedentes familiares de obesidad y el 54 por ciento mencionó que el sobrepeso inició desde la infancia y adolescencia. Conclusión: La presente investigación permitió identificar características nutricionales relevantes que podrían ser tomadas en cuenta para futuras intervenciones en este grupo poblacional.

The objective of this research was to assess the nutritional status of women with overweight and obesity in the area of attraction of the Comprehensive Health Care Program, PAIS. Methods: Study participants included ninety overweight/obese adult females with ages between 18-49 years: 30 women from each of the three areas of PAIS (Curridabat, La Union and Montes de Oca). The study included anthropometric, clinical, biochemical and dietary characteristics. Results: Almost all of these women have abdominal obesity and alteration in their lipid profile, but they did not have anemia and most of them had normal fasting and postprandial blood glucoselevels. Dietary assessment showed an average intake of 1851 ± 691 Kcal (52% carbohydrates, 13.8%protein and 34% fat). The average intake of vitamin A and C were adequate according to the dietary recommendations, but daily consumption of fiber was low.Physical examination showed hypertension, musculoskeletal disorders and stretch marks. 87.6% showed a family history of obesity and 54% mentioned that their overweight began since childhood and adolescence.Conclusion: The study has allowed the identification of relevant nutritional characteristics that could be considered for future interventions in this group.

A severe form of amyloidotic polyneuropathy in a Costa Rican family with a rare transthyretin mutation (Glu54Lys).

Four affected siblings in a Costa Rican family presented an aggressive polyneuropathy with widespread involvement of many visceral organs and onset during the third decade of life with rapid loss of muscle mass in the lower limbs and severe dysautonomy. The medical histories include vitreous opacity, cardiac enlargement, dermal and gastrointestinal infiltration, and autonomic dysfunction including circulatory compromise and gastrointestinal disturbances. Histological studies using Congo red stain and immunohistochemical assays with antibodies against the transthyretin (TTR) protein showed widespread deposition of amyloid in extracellular areas, including dermis and gastrointestinal lamina propia, endo- and perineural spaces, and vascular walls. A mutation search in the transthyretin (ttr) gene was performed seeking the cause of this severe form of familial amyloidotic polyneuropathy (FAP). We applied single-stranded conformational polymorphism (SSCP)-analyses followed by sequencing of the four exons of the ttr gene, revealing a point mutation in exon 3, a G to A transition that causes a Glu54Lys codon change. Western blots of plasma proteins incubated with anti-transthyretin antibodies after gel electrophoresis provided separation of wild-type and mutant TTR protein in affected family members.

Factores de riesgo cardiovascular en un grupo de mujeres con sobrepeso y obesidad / Cardiovascular risk factors in a group of women with overweight and obesity

Justificación y objetivo: La enfermedad isquémica cardiovascular es definida por la Organización Mundial de la Salud como la incapacidad cardiaca aguda y crónica, resultante de la reducción o suspensión del flujo sanguíneo del miocardio, asociado con procesos patológicos en el sistema arterial coronario. Es una de las principales causas de muerte entre los individuos adultos de Costa Rica y el mundo. El presente trabajo describe los factores de riesgo de enfermedad cardiovascular hallados en un grupo de mujeres con sobrepeso y obesidad residentes del área de atracción de salud del programa de Atención Integral en Salud, PAIS, correspondientes a los distritos de La Unión, Curridabat y Montes de Oca. Métodos: Se estudiaron un total de 90 mujeres diagnosticadas con sobrepeso u obesidad, con edades comprendidas entre los 18-49 años, 30 de cada uno de los distritos que conforman el área de cobertura PAIS, Curridabat, La Unión y Montes de Oca, durante 2007. Se evaluaron los factores de riesgo cardiovascular recomendados por el ATPIII establecidos por la Asociación Americana del Corazón. Resultados: Un 75 por ciento de las mujeres del estudio mostraron niveles de LDL colesterol fuera del rango aceptable, el 50 por ciento presentó niveles no deseables del colesterol total y el 51.3 por ciento presentó hipertensión. Los factores de riesgo predisponentes más prevalentes fueron la obesidad, 64 por ciento, y el 61 por ciento gastó menos de 2000 kcal por semana en actividad física que las clasifica como sedentarias. El único factor de riesgo condicionante que se evaluó fue la hipertrigliceridemia, presentada en el 25.3 por ciento de las mujeres. Conclusión: Las mujeres en estudio presentaron al menos dos factores de riesgo cardiovascular; son un grupo de especial atención, de manera que sean sujeto de intervenciones de tipo integral que aborden la promoción de la salud, tanto en las mujeres como en sus familias y comunidades.

Estudio de la incubabilidad y crianza en aves criollas de traspatio / Study of incubability and breeding in creole backyard fowls

El objetivo de este trabajo fue estudiar los indicadores de incubabilidad del huevo de gallinas criollas: fertilidad, eclosión y muerte embrionaria, así como los indicadores de eficiencia alimentaria: consumo de alimento, ganancia de peso y conversión alimentaria. Para ello se recolectaron huevos en comunidades rurales de los municipios de Morelia y Tarímbaro, del estado de Michoacán, México. Los resultados fueron: 1 162 (100 por ciento) huevos recolectados, 56.8 por ciento de huevos seleccionados para incubar, 43.2 por ciento de huevos discriminados, 60.6 por ciento de huevos eclosionados, 6.7 por ciento de muerte embrionaria temprana, 8.3 por ciento de muerte embrionaria tardía, 4.5 por ciento con vitelo roto, 5.7 por ciento picados no eclosionados y 82.2 por ciento de fertilidad total. El consumo promedio de alimento a las cuatro, ocho y doce semanas de edad fue de 34, 48 y 72 g por animal por día y la eficiencia alimentaria fue de 3 650:1, 3 250:1 y 4 030:1 para las mismas edades, respectivamente. Se discute que los problemas de incubabilidad del huevo de gallinas criollas radica tanto en la mala calidad del cascarón, como en mortalidad embrionaria e infertilidad y que el mejor índice de eficiencia alimentaria se registra a las ocho semanas de edad.

Incidencia parasitaria referida al Centro de Salud de Coronado / Incidence parasyte referida at Centre of Health of Coronado

Se estudiaron 475 muestras de heces tanto de niños como de adultos, pertenecientes a los distritos del Cantón de Vásquez de Coronado tal com Jesús, San Rafael, Patalillo, San Isidro; además Ipis y Rancho Redondo, todos de la provincia de San José, en donde encontramos una positividad promedio del 44 por ciento}165{ siendo el parásito intestinal la Lamblia Intestinalis como el de mayor frecuencia con un promedio del 25.4 por ciento. El nemátodo más frecuente fue el Ascaris lumbricoides con un 6.4 por ciento en el distrito de Jesús y de un 6 por ciento en el distrito de Ipis Rancho Redondo.