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AIMS: The ESC-EHRA Atrial Fibrillation Ablation Long-Term registry is a prospective, multinational study that aims at providing an accurate picture of contemporary real-world ablation for atrial fibrillation (AFib) and its outcome. METHODS AND RESULTS: A total of 104 centres in 27 European countries participated and were asked to enrol 20-50 consecutive patients scheduled for first and re-do AFib ablation. Pre-procedural, procedural and 1-year follow-up data were captured on a web-based electronic case record form. Overall, 3630 patients were included, of which 3593 underwent an AFib ablation (98.9%). Median age was 59 years and 32.4% patients had lone atrial fibrillation. Pulmonary vein isolation was attempted in 98.8% of patients and achieved in 95-97%. AFib-related symptoms were present in 97%. In-hospital complications occurred in 7.8% and one patient died due to an atrioesophageal fistula. One-year follow-up was performed in 3180 (88.6%) at a median of 12.4 months (11.9-13.4) after ablation: 52.8% by clinical visit, 44.2% by telephone contact and 3.0% by contact with the general practitioner. At 12-months, the success rate with or without antiarrhythmic drugs (AADs) was 73.6%. A significant portion (46%) was still on AADs. Late complications included 14 additional deaths (4 cardiac, 4 vascular, 6 other causes) and 333 (10.7%) other complications. CONCLUSION: AFib ablation in clinical practice is mostly performed in symptomatic, relatively young and otherwise healthy patients. Overall success rate is satisfactory, but complication rate remains considerable and a significant portion of patients remain on AADs. Monitoring after ablation shows wide variations. Antithrombotic treatment after ablation shows insufficient guideline-adherence.
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Fibrilación Atrial/cirugía , Ablación por Catéter/métodos , Anticoagulantes/uso terapéutico , Ablación por Catéter/efectos adversos , Ablación por Catéter/estadística & datos numéricos , Europa (Continente) , Femenino , Estudios de Seguimiento , Hospitalización/estadística & datos numéricos , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Cuidados Preoperatorios , Estudios Prospectivos , Sistema de RegistrosRESUMEN
BACKGROUND: First-line endoepicardial ventricular tachycardia (VT) ablation has been proposed for patients with arrhythmogenic cardiomyopathy (AC). This study reports procedural safety, outcomes, and predictors of recurrence. METHODS AND RESULTS: Forty-one consecutive patients [12 with left ventricle (LV) involvement, 7 left-dominant] underwent first-line endoepicardial VT substrate ablation. Standard bipolar and unipolar thresholds were used to define low-voltage areas (LVA). Arrhythmogenic substrate area (ASA) was defined as the area containing electrograms with delayed components. Implantable cardioverter defibrillator interrogations were evaluated for VT recurrence. Epicardial LVA was larger in all cases (102.5 ± 78.6 vs. 19.3 ± 24.4 cm2; P< 0.001). Consistent with an epicardium-to-endocardium arrhythmogenic substrate progression pattern, epicardial ASA (epi-ASA) was negatively correlated with bipolar endocardial LVA (r = -0.368; P= 0.035) and with endocardial bipolar/unipolar-LVA (Bi/Uni-LVA) ratio (r= -0.38; P= 0.037). A Bi/Uni-LVA ratio >0.23 predicted an epi-ASA ≤10 cm2 (100% sensitivity, 84% specificity). Patients showing an epi-ASA < 10 cm2 required less epicardial (8.4 ± 5.8 vs. 25.3 ± 16; P= 0.045) and more endocardial (16.5 ± 8.6 vs. 7.5 ± 8.2; P= 0.047) radiofrequency applications. One patient with epi-ASA < 10 cm2 died of cardiac tamponade after epicardial puncture. Acute success (no VT inducibility after procedure) was achieved in 36 patients (90%). After 32.2 ± 21.8 months, 11 (26.8%) patients had VT recurrences. Left-dominant AC was associated with an increased risk of recurrence (HR = 3.41 [1.1-11.2], P= 0.044; log-rank P= 0.021). CONCLUSION: First-line endoepicardial VT substrate ablation achieves good long-term results in AC. Left-dominant AC is associated with an increased risk of recurrence. The Bi/Uni-LVA ratio identifies patients with limited epicardial arrhythmogenic substrate in whom the indication of epicardial approach should be more cautiously assessed.
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Displasia Ventricular Derecha Arritmogénica/mortalidad , Displasia Ventricular Derecha Arritmogénica/cirugía , Ablación por Catéter/mortalidad , Ablación por Catéter/estadística & datos numéricos , Taquicardia Ventricular/mortalidad , Taquicardia Ventricular/prevención & control , Adulto , Displasia Ventricular Derecha Arritmogénica/diagnóstico , Causalidad , Terapia Combinada/mortalidad , Terapia Combinada/estadística & datos numéricos , Comorbilidad , Endocardio/cirugía , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pericardio/cirugía , Prevalencia , Recurrencia , Factores de Riesgo , Prevención Secundaria/estadística & datos numéricos , España/epidemiología , Tasa de Supervivencia , Taquicardia Ventricular/diagnóstico , Resultado del TratamientoRESUMEN
AIMS: Interleukin-2 has a significant antitumor activity in some types of cancer, and has been associated with the development of atrial fibrillation (AF). In addition, IL-2 serum levels in recent onset AF have been related with pharmaceutical cardioversion outcomes. We evaluated the hypothesis that a relationship exists between inflammation and the outcome of catheter ablation of AF. METHODS: We studied 44 patients with paroxysmal AF who underwent catheter ablation. Patients with structural heart disease, coronary artery or valve disease, active inflammatory disease, known or suspected neoplasm, endocrinopathies, or exposure to anti-inflammatory drugs were excluded. All study participants underwent evaluation with a standardized protocol, including echocardiography, and cytokine levels of interleukin-2, interleukin-4, interleukin-6, interleukin-10, tumour necrosis factor-alpha, and gamma-interferon determination before procedure. Clinical and electrocardiographic follow-up were performed with Holter-ECG at 3, 6 and 12months in order to know if sinus rhythm was maintained. RESULTS: After catheter ablation of the 44 patients included (53±10years, 27.3% female), all patients returned to sinus rhythm. During the first year of follow-up seven patients (15.9%) experienced recurrence of AF. The demographics, clinical and echocardiographic features, and pharmacological treatments of these patients were similar to those who maintained sinus rhythm. The only independent factor predictive of recurrence of AF was an elevated level of IL-2 (OR 1.18, 95% CI 1.12-1.38). CONCLUSIONS: High serum levels of interleukin-2, a pro-inflammatory non-vascular cytokine, are associated with the recurrence of AF in patients undergoing catheter ablation.
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Fibrilación Atrial/sangre , Fibrilación Atrial/etiología , Ablación por Catéter/efectos adversos , Interleucina-2/sangre , Venas Pulmonares/cirugía , Fibrilación Atrial/diagnóstico por imagen , Estudios de Casos y Controles , Demografía , Femenino , Estudios de Seguimiento , Humanos , Límite de Detección , Masculino , Persona de Mediana Edad , Recurrencia , UltrasonografíaRESUMEN
Leukemia cells produce acidic metabolites due to their high metabolic condition. An alkaline pHi (intracellular pH) shift, caused by activation of the Na+/H+ exchange, is an important event in the mechanism of growth factor activity. However, the role of the Na(+)/H(+) exchanger in the survival of erythroleukemia TF-1 cells has not yet been studied in detail. The aim of this study was to identify the effects of 5-(N-ethyl-N-isopropyl) amiloride (EIPA), a highly specific blocker of the Na(+)/H(+) exchanger, on the survival of SCF-dependent TF-1 cells. The effects of EIPA on survival and mitochondrial membrane potential were studied when exposing wild type TF-1 cells and TF-1 cells expressing bcl-2 to EIPA for 48h. Ectopic expression of the bcl-2 gene maintained a mildly alkaline pH and prevented the simultaneous appearance of apoptosis and autophagy (typically displayed by TF-1 cells) in the presence of EIPA. Consistent with Stem Cell Factor (SCF) function, we found that this molecule rescued TF-1 cells during autophagy but not apoptosis, allowing these cells to subsequently respond to GM-CSF. Serum deprivation or SCF withdrawal induced cell death at 36h in TF-1 and TF-1 neo cells, whereas TF-1/bcl-2 cells tended to undergo apoptosis and show acidic vacuoles after 96h, pointing to a transient anti-apoptotic effect. The present study shows the suppressive effect of EIPA on the proliferation of leukemia cell line stimulated with SCF, apparently by decreasing the mitochondria membrane potential and averting alkalinization. Through the constitutive expression of bcl-2, TF-1 cells were survival factor independent. Proliferation in these cells was not affected by EIPA at the concentrations used against parental TF-1 cells, indicating that the inhibitory effect in SCF-stimulated cells can be attributed to specific blocking of the Na(+)/H(+) exchanger.
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Regulación Leucémica de la Expresión Génica , Leucemia Eritroblástica Aguda/metabolismo , Leucemia/tratamiento farmacológico , Intercambiadores de Sodio-Hidrógeno/antagonistas & inhibidores , Intercambiadores de Sodio-Hidrógeno/química , Factor de Células Madre/metabolismo , Amilorida/análogos & derivados , Amilorida/química , Apoptosis , Autofagia , Ciclo Celular , Línea Celular Tumoral , Proliferación Celular , Separación Celular , Supervivencia Celular , Colorantes Fluorescentes/química , Humanos , Concentración de Iones de Hidrógeno , Leucemia/metabolismo , Leucemia Eritroblástica Aguda/patología , Potenciales de la Membrana , Membranas Mitocondriales/metabolismo , Proteínas Proto-Oncogénicas c-bcl-2/metabolismoRESUMEN
BACKGROUND: Freezing rate of second-generation cryoballoon (CB) is a biophysical parameter that could assist pulmonary vein isolation. The aim of this study is to assess freezing rate (time to reach -30°C ([TT-30C]) as an early predictor of acute pulmonary vein isolation using the CB. METHODS: Biophysical data from CB freeze applications within a multicenter, nation-wide CB ablation registry were gathered. Successful application (SA), was defined as achieving durable intraprocedural vein isolation. And SA with time to isolation under 60 s (SA-TTI<60) as achieving durable vein isolation in under 60 s. Logistic regressions were performed and predictive models were built for the data set. RESULTS: 12,488 CB applications from 1,733 atrial fibrillation (AF) ablation procedures were included within 27 centers from a Spanish CB AF ablation registry. SA was achieved in 6,349 of 9,178 (69.2%) total freeze applications, and SA-TTI<60 was obtained in 2,673 of 4,784 (55.9%) freezes where electrogram monitoring was present. TT-30C was shorter in the SA group (33.4 ± 9.2 vs 39.3 ± 12.1 s; p < 0.001) and SA-TTI<60 group (31.8 ± 7.6 vs. 38.5 ± 11.5 s; p < 0.001). Also, a 10 s increase in TT-30C was associated with a 41% reduction in the odds for an SA (odds ratio [OR] 0.59; 95% confidence interval [CI] 0.56-0.63) and a 57% reduction in the odds for achieving SA-TTI<60 (OR 0.43; 95% CI 0.39-0.49), when corrected for electrogram visualization, vein position, and application order. CONCLUSIONS: Time to reach -30°C is an early predictor of the quality of a CB application and can be used to guide the ablation procedure even in the absence of electrogram monitoring.
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Fibrilación Atrial , Ablación por Catéter , Criocirugía , Venas Pulmonares , Humanos , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/cirugía , Criocirugía/efectos adversos , Criocirugía/métodos , Resultado del Tratamiento , Factores de Tiempo , Venas Pulmonares/cirugía , Ablación por Catéter/métodos , RecurrenciaRESUMEN
Introduction: Cryoballoon ablation (CBA) has become a standard treatment for paroxysmal atrial fibrillation (PaAF) but limited data is available for outcomes in patients with persistent atrial fibrillation (PeAF). Methods: We analyzed the first 944 patients included in the Spanish Prospective Multi-center Observation Post-market Registry to compare characteristics and outcomes of patients undergoing CBA for PeAF versus PaAF. Results: A total of 944 patients (57.8 ± 10.4 years; 70.1% male) with AF (27.9% persistent) were prospectively included from 25 centers. PeAF patients were more likely to have structural heart disease (67.7 vs. 11.4%; p < 0.001) and left atrium dilation (72.6 vs. 43.3%; p < 0.001). CBA of PeAF was less likely to be performed under general anesthesia (10.7 vs. 22.2%; p < 0.001), with an arterial line (32.2 vs. 44.6%; p < 0.001) and assisted transeptal puncture (11.9 vs. 17.9%; p = 0.025). During an application, PeAF patients had a longer time to −30 °C (35.91 ± 14.20 vs. 34.93 ± 12.87 s; p = 0.021) and a colder balloon nadir temperature during vein isolation (−35.04 ± 9.58 vs. −33.61 ± 10.32 °C; p = 0.004), but received fewer bonus freeze applications (30.7 vs. 41.1%; p < 0.001). There were no differences in acute pulmonary vein isolation and procedure-related complications. Overall, 76.7% of patients were free from AF recurrences at 15-month follow-up (78.9% in PaAF vs. 70.9% in PeAF; p = 0.09). Conclusions: Patients with PeAF have a more diseased substrate, and CBA procedures performed in such patients were more simplified, although longer/colder freeze applications were often applied. The acute efficacy/safety profile of CBA was similar between PaAF and PeAF patients, but long-term results were better in PaAF patients.
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Cryoablation is safe and effective for the treatment of atrial fibrillation (AF) in controlled clinical trials, but contemporary real-world usage and outcomes are limited. The Report of the Spanish Cryoballoon Ablation Registry (RECABA) was designed to evaluate acute and 12-month outcomes of cryoballoon ablation for the treatment of AF in Spain. Patients from 27 Spanish centers were prospectively enrolled. Patients were treated with cryoballoon ablation and managed according to standard of care protocols at each center. The primary endpoint was ≥ 30 s freedom from AF at 12-month after a 3-month blanking period. Secondary endpoints included a description of patient characteristics, cryoablation procedural strategy and safety, and predictors of efficacy. In total, 1742 patients (71.4% PAF, 68.8% male, mean age 58.02 ± 10.40 years, 76.1% overweight or obese, CHA2DS2-VASc index 1.40 ± 1.28) were enrolled. Patients received 7.2 ± 2.67 cryo-applications. PV potentials could be detected in 61% of the PVs during ablation, with a mean time to block of 52.9 ± 37.02 s. Acute PVI was observed in 97% of PVs with 75.8% isolated with the first cryo-application. Mean procedural time was 113 ± 41 min. Acute complications occurred in 4.4% of the cases. With follow-up in 1628 patients, AF-free survival was 78.5% (PAF: 80.6% vs PersAF 73.3%; p < 0.001). Left atrium enlargement, female sex, non-PAF, and early recurrence were independent predictors of AF recurrence (p < 0.05). RECABA provides detailed insight into current dosing practices and demonstrates cryoablation is safe and effective in real-world use.ClinicalTrials.gov number: NCT02785991.
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Fibrilación Atrial/cirugía , Criocirugía/métodos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Fibrilación Atrial/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud/métodos , Estudios Prospectivos , Recurrencia , España , Factores de Tiempo , Adulto JovenRESUMEN
BACKGROUND: Cardiovascular disease is more frequent in menopausal women, which has been related to factor such as weight gain, altered fat distribution, and increased inflammation markers including adipokines (MCP-1, TNF-α, IL-6) and cytokines (IL-1, IL-6, TNF-α) produced by macrophages. In addition to their phagocytic activity, macrophages secrete cytokines and chemokines that induces cell recruitment, which is a process related to vascular damage that favors the formation of atheromatous plaques. Tibolone (Tb) therapy is used to reduce the symptoms of menopause as well as osteoporosis and it has been shown to decreases the risk of fractures. METHODS: To investigate the effect of tibolone in macrophage enzymatic activity, gene expression of cytokines, and its effect on foam cells formation. We use phorbol-12-myristate-13-acetate (PMA)-differentiated THP-1 cells. The cells were incubated 24 h and 48 h using pre and post-treatment schemes. We evaluated total ROS determination by NBT assay, expression of cytokines (IL-1ß, IL-6, TNF-α, NOS2, ARG1, TGFß) by RT-qPCR and foam cell formation in THP-1 differentiated macrophages stimulated with PMA. RESULTS: It was observed that the minor levels of total ROS determination were obtained with tibolone at 48 h in post-treatment scheme. Also, in a long term we found decrease the proinflammatory cytokines (IL-1ß, IL-6 and TNF-α). Finally, with treatment for 24 h with P4 y Tb we observed fewer LDL vesicles into macrophages cytoplasm. CONCLUSIONS: These results suggest that tibolone reduces the inflammatory process, also inhibits the foam cells formation; suggesting a possible role in reducing cardiovascular risk.
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Citocinas , Lipoproteínas LDL , Especies Reactivas de Oxígeno , Células Espumosas , Humanos , Células THP-1RESUMEN
AIMS: The combined use of an automatic defibrillator in resynchronization therapy for primary prevention in patients with idiopathic dilated cardiomyopathy is controversial. METHODS AND RESULTS: We assessed a series of 46 patients (61 +/- 10 years, 64% male) with idiopathic dilated cardiomyopathy undergoing resynchronization therapy combined with a defibrillator in primary prevention and the potential relationship between baseline characteristics and the onset of ventricular arrhythmic events. Of the 46 patients included, eight (17%) presented episodes of ventricular tachycardia/fibrillation during follow-up (19 +/- 12 months). There were no baseline differences among these patients, except the proportion of males (57.9 vs. 100%, P = 0.02) and QRS width (162 +/- 24 vs. 189 +/- 26 ms, P = 0.008), which was the only independent predictor of arrhythmic events (OR 1.42, 95% CI 1.12-1.68; P = 0.03). CONCLUSION: In patients with idiopathic dilated cardiomyopathy undergoing resynchronization therapy combined with a defibrillator, baseline QRS is an independent predictor of arrhythmic events.
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Estimulación Cardíaca Artificial/métodos , Cardioversión Eléctrica/métodos , Electrocardiografía/métodos , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/prevención & control , Terapia Asistida por Computador/métodos , Terapia Combinada , Femenino , Insuficiencia Cardíaca/etiología , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/complicaciones , Isquemia Miocárdica/diagnóstico , Isquemia Miocárdica/prevención & control , Pronóstico , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
AIMS: Cardiac resynchronization therapy (CRT) improves survival and quality of life in advanced heart failure (HF). Although mitral regurgitation (MR) reduction has been reported, its presence has been associated with non-response to CRT. This study was undertaken to assess the potential role of significant mitral regurgitation (SMR) persistence after CRT on clinical outcome, major arrhythmic events, and echocardiographic response in the mid-long term. METHODS AND RESULTS: Seventy-six patients (28.9% women, 63 +/- 11 years) with dilated cardiomyopathy in advanced HF were included. SMR, defined as regurgitant orifice area > or =0.20 cm(2), was assessed at baseline and its evolution 6 months after CRT. Clinical outcome (cardiovascular death/HF readmission), major arrhythmic events, and echocardiographic response (reverse remodelling) were recorded on follow-up. Thirty-two patients (42.1%) presented baseline SMR, becoming non-significant in 11 of the 32 patients (34.3%) 6 months after CRT. Its persistence was associated with higher rates of clinical events (46.4 vs. 18.7%, P = 0.011), arrhythmic events (35.7 vs. 14.5%, P = 0.034), and less reverse remodelling (28.5 vs. 83.3%, P < 0.001). CONCLUSION: CRT can reduce moderate or severe baseline MR to non-significant in one-third of patients. However, its persistence was associated with worse clinical evolution, greater incidence of arrhythmic events, and less reverse remodelling.
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Estimulación Cardíaca Artificial , Cardiomiopatía Dilatada/fisiopatología , Insuficiencia Cardíaca/fisiopatología , Insuficiencia de la Válvula Mitral/terapia , Cardiomiopatía Dilatada/diagnóstico por imagen , Intervalos de Confianza , Progresión de la Enfermedad , Ecocardiografía Doppler , Femenino , Indicadores de Salud , Atrios Cardíacos/diagnóstico por imagen , Insuficiencia Cardíaca/diagnóstico por imagen , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/mortalidad , Análisis Multivariante , Oportunidad Relativa , Valor Predictivo de las Pruebas , Pronóstico , Calidad de Vida , Estudios Retrospectivos , Sensibilidad y Especificidad , Factores de Tiempo , Resultado del TratamientoRESUMEN
AIMS: Implantable cardioverter defibrillators (ICDs) are increasingly being used for treatment of ventricular tachycardia (VT)/fibrillation. Inappropriate therapy delivery remains the most frequent complication in patients with ICDs, resulting in psychological distress, proarrhythmia, and battery life reduction. We aim to determine if inappropriate therapies could be reduced by using a morphology discrimination criterion. METHODS AND RESULTS: We evaluated the performance of the Wavelet morphology discrimination algorithm (Medtronic, Inc.) independently from other discrimination enhancements (rate onset and interval stability). A non-randomized, prospective, multicenter, and observational study was designed to determine the sensitivity and specificity of the new morphology criterion. Sensitivity and specificity in slow tachycardia with cycle length (CL) between 340 and 500 ms were analysed as a pre-specified secondary endpoint. A total of 771 spontaneous episodes in 106 patients were analysed. Five hundred and twenty-two episodes corresponded to true supraventricular tachycardia (SVT) with ventricular CL in the VT or FVT zone, of which 473 had therapy appropriately withheld. Of the 249 episodes of true VT/FVT, 21 were classified according to the Wavelet criteria as SVT (specificity: 90.6%; sensitivity: 91.6%). All of them were spontaneously terminated with no adverse clinical consequences. No syncopal episodes occurred. For VTs in the slowest analysed range (CL: 340-500 ms), a total of 235 episodes were studied, yielding a specificity of 95.9% and sensitivity of 83.2%. CONCLUSION: Wavelet discrimination criteria in single-chamber ICDs as the sole discriminator can significantly reduce inappropriate therapy for SVT, not only in the range of VTs in the slowest analysed range (340-500 ms for this study) but also for faster VTs. No significant clinical consequences were found when the algorithm was used, but final data should prompt the use of the algorithm in combination with a high rate time-out feature.
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Algoritmos , Desfibriladores Implantables , Diagnóstico por Computador/métodos , Electrocardiografía/métodos , Sistema de Registros , Taquicardia Ventricular/diagnóstico , Taquicardia Ventricular/prevención & control , Anciano , Electrocardiografía/instrumentación , Femenino , Humanos , Masculino , Reconocimiento de Normas Patrones Automatizadas/métodos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , EspañaRESUMEN
The Sustainable Development Goals (SDGs) are a call for action to governments, organizations and civil society, a call for addressing the environmental and social problems of the 21st century. However, the 2030 Agenda does not focus on animal ethics as one of the keys to addressing these critical issues. The different ethical approaches to the moral status of non-human animals justify the transition to plant-based diets, not only because of the ecological and geological consequences of animal-product consumption but also in accordance with the principles of justice. This work highlights the consequences of animal-product consumption in the Anthropocene. The human being has become a geological force: The Anthropocene is the new geological epoch triggered by human activity that replaces the Holocene. Its effects have a major impact on biodiversity, deforestation, water resources, climate and health. This paper explores the need to develop a normative criterion for technology use to protect the moral status of non-human animals: technological innovation should be focused on the development of animal source foods alternatives.(AU)
Los Objetivos de Desarrollo Sostenible (ODS) son un llamado a la acción para los gobiernos, organizaciones y sociedad civil; un llamamiento para abordar los problemas ambientales y sociales del siglo XXI. Sin embargo, la Agenda 2030 no se centra en la ética animal como una de las claves para tratar estos temas tan críticos. Los diferentes enfoques éticos sobre el estatus moral de los animales no-humanos justifican la transición hacia dietas basadas en alimentos vegetales, no solo por las consecuencias ecológicas y geológicas del consumo de productos animales, sino también en concordancia con los principios de justicia. Este trabajo pretende destacar las consecuencias del consumo de productos animales en el Antropoceno. El ser humano se ha convertido en una fuerza geológica: El Antropoceno es la nueva época geológica desencadenada por la actividad humana que reemplaza al Holoceno. Sus efectos tienen un gran impacto sobrela biodiversidad, la deforestación, los recursos hídricos, el clima y la salud. Las siguientes líneas exploran la necesidad de desarrollar un criterio normativo para el uso de la tecnología para proteger el estado moral de los animales no-humanos: la innovación tecnológica debe centrarse en el desarrollo de alternativas para los alimentos de origen animal.(AU)
Els Objectius de Desenvolupament Sostenible (ODS) són una crida a l'acció per als governs, les organitzacions i la societat civil; una crida per abordar els problemes ambientals i socials del segle XXI. Tot i això, l'Agenda 2030 no secentra en l'ètica animal com una de les claus per tractar aquests temes tan crítics. Els diferents enfocaments ètics sobre l'estatus moral dels animals no humans justifiquen la transició cap a dietes basades en aliments vegetals, no només per les conseqüències ecològiques i geològiques del consum de productes animals, sinó també en concordança amb els principis de justícia. Aquest treball pretén destacar les conseqüències del consum de productes animals a l'Antropocè. L'ésser humà ha esdevingut una força geològica: L'Antropocè és la nova època geològica desencadenada per l'activitat humana que reemplaça l'Holocè. Els seus efectes tenen un gran impacte sobre la biodiversitat, la desforestació, els recursos hídrics, el clima i la salut. Les línies següents exploren la necessitat de desenvolupar uncriteri normatiu per a l'ús de la tecnologia per protegir l'estat moral dels animals no humans: la innovació tecnològica s'ha de centrar en el desenvolupament d'alternatives per als aliments d'origen animal.(AU)
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Animales , Derechos del Animal , Desarrollo Sostenible/legislación & jurisprudencia , Desarrollo Sostenible/tendencias , Veganos , Conducta Alimentaria , Industria de Alimentos , Bienestar del Animal , Bioética , Discusiones BioéticasRESUMEN
BACKGROUND: This study sought to assess payer costs following cryoballoon or radiofrequency current (RFC) catheter ablation of paroxysmal atrial fibrillation in the randomized FIRE AND ICE trial. METHODS AND RESULTS: A trial period analysis of healthcare costs evaluated the impact of ablation modality (cryoballoon versus RFC) on differences in resource use and associated payer costs. Analyses were based on repeat interventions, rehospitalizations, and cardioversions during the trial, with unit costs based on 3 national healthcare systems (Germany [], the United Kingdom [£], and the United States [$]). Total payer costs were calculated by applying standard unit costs to hospital stays, using International Classification of Diseases, 10th Revision diagnoses and procedure codes that were mapped to country-specific diagnosis-related groups. Patients (N=750) randomized 1:1 to cryoballoon (n=374) or RFC (n=376) ablation were followed for a mean of 1.5 years. Resource use was lower in the cryoballoon than the RFC group (205 hospitalizations and/or interventions in 122 patients versus 268 events in 154 patients). The cost differences per patient in mean total payer costs during follow-up were 640, £364, and $925 in favor of cryoballoon ablation (P=0.012, 0.013, and 0.016, respectively). This resulted in trial period total cost savings of 245 000, £140 000, and $355 000. CONCLUSIONS: When compared with RFC ablation, cryoballoon ablation was associated with a reduction in resource use and payer costs. In all 3 national healthcare systems analyzed, this reduction resulted in substantial trial period cost savings, primarily attributable to fewer repeat ablations and a reduction in cardiovascular rehospitalizations with cryoballoon ablation. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Identifier: NCT01490814.
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Fibrilación Atrial/economía , Fibrilación Atrial/cirugía , Cateterismo Cardíaco/economía , Ablación por Catéter/economía , Criocirugía/economía , Costos de Hospital , Fibrilación Atrial/diagnóstico , Cateterismo Cardíaco/efectos adversos , Cateterismo Cardíaco/instrumentación , Catéteres Cardíacos/economía , Ablación por Catéter/efectos adversos , Ahorro de Costo , Análisis Costo-Beneficio , Criocirugía/efectos adversos , Criocirugía/instrumentación , Cardioversión Eléctrica/economía , Europa (Continente) , Humanos , Tiempo de Internación/economía , Readmisión del Paciente/economía , Retratamiento/economía , Medicina Estatal/economía , Factores de Tiempo , Resultado del Tratamiento , Estados UnidosRESUMEN
Acute leukemia is the most common pediatric cancer, representing one-third of all cancers that occurs in under 15 year olds, with a varied incidence worldwide. Although a number of advances have increased the knowledge of leukemia pathophysiology, its etiology remains less well understood. The role of infectious agents, such as viruses, bacteria, or parasites, in the pathogenesis of leukemia has been discussed. To date, several cellular mechanisms involving infectious agents have been proposed to cause leukemia following infections. However, although leukemia can be triggered by contact with such agents, they can also be beneficial in developing immune stimulation and protection despite the risk of leukemic clones. In this review, we analyze the proposed hypotheses concerning how infectious agents may play a role in the origin and development of leukemia, as well as in a possible mechanism of protection following infections. We review reported clinical observations associated with vaccination or breastfeeding, that support hypotheses such as early life exposure and the resulting early immune stimulation that lead to protection.
Asunto(s)
Leucemia/microbiología , Leucemia/parasitología , Enfermedad Aguda , Lactancia Materna , Niño , Susceptibilidad a Enfermedades , Humanos , Leucemia/inmunología , Leucemia/prevención & control , Riesgo , VacunaciónRESUMEN
INTRODUCTION AND OBJECTIVES: We present the results of the Spanish Implantable Cardioverter-defibrillator Registry for 2015, as compiled by the Electrophysiology and Arrhythmia Section of the Spanish Society of Cardiology. METHODS: Data collection sheets were voluntarily completed by each implantation team and prospectively sent to the Spanish Society of Cardiology. RESULTS: The number of reported implantations was 5465 (85% of the estimated total number of implantations). The implantation rate was 118 per million population while the estimated rate was 138. First implantations comprised 71.8%. Data were obtained from 169 hospitals (7 more than in 2014). Most implantations (82.7%) were performed in men. The mean patient age was 62.8±13.3 years. Most patients showed severe or moderate-to-severe ventricular dysfunction and were in New York Heart Association function class II. The most frequent cardiac condition was ischemic heart disease, followed by dilated cardiomyopathy. Implantations for primary prevention indications comprised 58.2%. Electrophysiologists performed 79.6% of the implantations. CONCLUSIONS: The 2015 Spanish Implantable Cardioverter-defibrillator Registry received information on 85% of the implantations performed in Spain. The number of implantations has grown from previous years. The percentage of implantations for primary prevention indications has slightly decreased from the previous registry.
Asunto(s)
Cardiomiopatía Dilatada/terapia , Muerte Súbita Cardíaca/prevención & control , Desfibriladores Implantables , Isquemia Miocárdica/terapia , Implantación de Prótesis/estadística & datos numéricos , Sistema de Registros , Disfunción Ventricular/terapia , Anciano , Terapia de Resincronización Cardíaca/métodos , Cardiomiopatía Dilatada/complicaciones , Muerte Súbita Cardíaca/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/complicaciones , Prevención Primaria , España , Disfunción Ventricular/complicacionesRESUMEN
BACKGROUND: Diabetes mellitus 2 has become a global problem. It is estimated that 15% to 25% of patients could develop a chronic ulcer in their life, and nearly 33% of direct care costs of the diabetes mellitus 2 is spent on treating these ulcers. Mesenchymal stem cells have emerged as a promising cell source for the treatment of these ulcers. CLINICAL CASE: The case is presented of a 67 year-old male with a history of diabetes mellitus, acute myocardial infarction, and food ulcer chronic involving right foot and part of his leg. He was treated with mesenchymal stem cell management, resulting in skin graft integration and full coverage of the lesion. CONCLUSION: The implementation of mesenchymal stem cell techniques for treatment of chronic ulcer is feasible. The impact on the population would lead to a significant improvement in their quality of life and reduce healthcare spending.
Asunto(s)
Diabetes Mellitus Tipo 2/complicaciones , Pie Diabético/cirugía , Úlcera del Pie/cirugía , Úlcera de la Pierna/cirugía , Trasplante de Células Madre Mesenquimatosas , Trasplante de Piel , Anciano , Amputación Quirúrgica , Antibacterianos/uso terapéutico , Células de la Médula Ósea , Desbridamiento , Pie Diabético/etiología , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones por Escherichia coli/etiología , Infecciones por Escherichia coli/cirugía , Úlcera del Pie/etiología , Úlcera del Pie/microbiología , Humanos , Úlcera de la Pierna/etiología , Úlcera de la Pierna/microbiología , Masculino , Infecciones Cutáneas Estafilocócicas/tratamiento farmacológico , Infecciones Cutáneas Estafilocócicas/etiología , Infecciones Cutáneas Estafilocócicas/cirugía , Recolección de Tejidos y Órganos/métodos , Dedos del Pie/cirugía , Trasplante Autólogo , Infección de Heridas/etiologíaRESUMEN
INTRODUCTION AND OBJECTIVES: We report the results of the first Catheter Ablation Registry of the Arrhythmia Working Group of the Andalusian Society of Cardiology (AWGASC) for 2000. METHODS: The register includes information about the ablation procedures performed in 2000, which was collected retrospectively and submitted voluntarily by four out of six cardiac electrophysiology laboratories of the AWGASC. A total of 424 patients (mean age 45 18 years; 50% men) were included. Twelve patients underwent two different ablation procedures, bringing the total number of procedures to 436. The overall success rate (based on current criteria), success rate by procedure, in-hospital mortality, and major complications are reported. RESULTS: The type and distribution of the ablation procedures were atrioventricular nodal re-entry tachycardia ablation, 34%; accessory pathway ablation, 39%; ventricular tachycardia ablation, 8%; atrial tachycardia ablation, 3%; atrioventricular junctional ablation, 9%, and cavo-tricuspid isthmus ablation, 9%. The overall success rate was 94% (range 97.8% to 87.4% in different laboratories), rate of major complications 1.1% (range 0% to 3.7%), and overall mortality 0.23% (1 patient). CONCLUSIONS: These findings summarize the indications and results of catheter ablation procedures performed in 2000 at four cardiac electrophysiology laboratories in Andalusia. This is the first multicenter registry in Spain.
Asunto(s)
Arritmias Cardíacas/cirugía , Ablación por Catéter , Sistema de Registros , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Ablación por Catéter/efectos adversos , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores Sexuales , España , Taquicardia/cirugía , Taquicardia por Reentrada en el Nodo Atrioventricular/cirugía , Taquicardia Ventricular/cirugíaRESUMEN
Introducción y objetivos: Se presentan los resultados del Registro Español de Desfibrilador Automático Implantable de 2015, elaborado por la Sección de Electrofisiología y Arritmias de la Sociedad Española de Cardiología. Métodos: Se envió de forma prospectiva a la Sociedad Española de Cardiología la hoja de recogida de datos cumplimentada voluntariamente por cada equipo implantador. Resultados: El número de implantes comunicados fue 5.465 (el 85% del total de implantes estimado). La tasa de implantes fue 118 por millón de habitantes y la estimada, 138. Los primoimplantes fueron el 71,8%. Se obtuvieron datos de 169 hospitales (7 más que en 2014). La mayoría de los implantes (82,7%) se realizaron en varones. La media de edad fue 62,8 ± 13,3 años. La mayoría de los pacientes presentaban una disfunción ventricular grave o grave-moderada y clase funcional II de la New York Heart Association. La cardiopatía más frecuente fue la isquémica, seguida de la dilatada. Las indicaciones por prevención primaria han sido el 58,2%. Los implantes realizados por electrofisiólogos fueron el 79,6%. Conclusiones: El Registro Español de Desfibrilador Automático Implantable de 2015 recoge información del 85% de los implantes realizados en España. El número de implantes ha crecido respecto a los datos de los últimos años. El porcentaje de indicación por prevención primaria ha disminuido ligeramente con respecto al registro anterior (AU)
Introduction and objectives: We present the results of the Spanish Implantable Cardioverter-defibrillator Registry for 2015, as compiled by the Electrophysiology and Arrhythmia Section of the Spanish Society of Cardiology. Methods: Data collection sheets were voluntarily completed by each implantation team and prospectively sent to the Spanish Society of Cardiology. Results: The number of reported implantations was 5465 (85% of the estimated total number of implantations). The implantation rate was 118 per million population while the estimated rate was 138. First implantations comprised 71.8%. Data were obtained from 169 hospitals (7 more than in 2014). Most implantations (82.7%) were performed in men. The mean patient age was 62.8 ± 13.3 years. Most patients showed severe or moderate-to-severe ventricular dysfunction and were in New York Heart Association function class II. The most frequent cardiac condition was ischemic heart disease, followed by dilated cardiomyopathy. Implantations for primary prevention indications comprised 58.2%. Electrophysiologists performed 79.6% of the implantations. Conclusions: The 2015 Spanish Implantable Cardioverter-defibrillator Registry received information on 85% of the implantations performed in Spain. The number of implantations has grown from previous years. The percentage of implantations for primary prevention indications has slightly decreased from the previous registry (AU)
Asunto(s)
Humanos , Cardioversión Eléctrica/estadística & datos numéricos , Desfibriladores Implantables , Arritmias Cardíacas/terapia , Sistema de Registros/estadística & datos numéricos , Electrofisiología Cardíaca/tendenciasRESUMEN
INTRODUCTION AND OBJECTIVES: This article describes the findings of the 2009 Spanish Implantable Cardioverter-Defibrillator (ICD) Registry compiled by the Working Group on Implantable Cardioverter-Defibrillators of the Spanish Society of Cardiology's Electrophysiology and Arrhythmias Section. METHODS: Each implantation team voluntarily sent prospective data recorded on a single-page document to the Spanish Society of Cardiology. RESULTS: In total, 4108 device implantations were reported, which comprised 88.6% of the estimated total number of implantations carried out. The number of implants reported corresponded to 89 per million population and the estimated total number was 100.2 per million. The proportion of first implantations among those reported was 71.3%. Data were received from 134 centers, 17 more than in 2008. There continued to be significant regional variations between the various Spanish autonomous regions. The highest implantation rate (81%) was in men (mean age 62 years) who had severe or moderate-to-severe ventricular dysfunction and were in New York Heart Association functional class II. The most common heart condition was ischemic heart disease, followed by dilated cardiomyopathy. Indications for primary prevention accounted for 55.9% of first implantations; this figure was lower than the previous year's for the first time since 2003. The most significant increase observed was in patients with ischemic heart disease. CONCLUSIONS: The 2009 Spanish ICD registry included data on almost 89% of all ICD implantations performed in the country. Although the number of implantations has continued to increase, it still remains far from the European average. The percentage of implantations performed for primary prevention was observed to have stabilized.