Diurnal High Temperatures Affect the Physiological Performance and Fruit Quality of Highbush Blueberry (Vaccinium corymbosum L.) cv. Legacy.

In this study, the physiological performance and fruit quality responses of the highbush blueberry (Vaccinium corymbosum) cultivar Legacy to high temperatures (HTs) were evaluated in a field experiment. Three-year-old V. corymbosum plants were exposed to two temperature treatments between fruit load set and harvest during the 2022/2023 season: (i) ambient temperature (AT) and (ii) high temperature (HT) (5 °C ± 1 °C above ambient temperature). A chamber covered with transparent polyethylene (100 µm thick) was used to apply the HT treatment. In our study, the diurnal temperature was maintained with a difference of 5.03 °C ± 0.12 °C between the AT and HT treatments. Our findings indicated that HT significantly decreased CO2 assimilation (Pn) by 45% and stomatal conductance (gs) by 35.2% compared to the AT treatment. By contrast, the intercellular CO2 concentration (Ci) showed higher levels (about 6%) in HT plants than in AT plants. Fruit quality analyses revealed that the fruit weight and equatorial diameter decreased by 39% and 13%, respectively, in the HT treatment compared to the AT treatment. By contrast, the firmness and total soluble solids (TSS) were higher in the HT treatment than in the AT treatment. Meanwhile, the titratable acidity showed no changes between temperature treatments. In our study, Pn reduction could be associated with stomatal and non-stomatal limitations under HT treatment. Although these findings improve our understanding of the impact of HTs on fruit growth and quality in V. corymbosum, further biochemical and molecular studies are need.

First national registry on the effectiveness and safety of evolocumab in clinical practice in patients attended in cardiology in Spain. The RETOSS-CARDIO study. / Primer registro nacional sobre la efectividad y seguridad de evolocumab en la práctica clínica en pacientes atendidos en cardiología en España. Estudio RETOSS-CARDIO.

OBJECTIVE: To present the first registry used to analyse the clinical profile of patients treated with evolocumab in Spain, including the effectiveness on the lipid profile and safety in the «real world¼ setting. METHODS: Multicentre, retrospective, and observational study of patients starting treatment with evolocumab from February 2016 to May 2017 in clinical practice in Spanish cardiology units. RESULTS: A total of 186 patients (mean age 60.3 ± 9.8 years were included, 35.5% with familial hypercholesterolaemia, and 94.1% with a previous cardiovascular event) from 31 cardiology units. Baseline lipid profile: Total cholesterol 219.4 ± 52.2 mg/dL, LDL-cholesterol 144.0 ± 49.0mg/dL, HDL-cholesterol 47.7 ± 13.0mg/dL, and triglycerides 151.0 ± 76.2mg/dL. At the time of initiating evolocumab, 53.8% of patients were taking statins (50% had partial or total intolerance to statins), and 51.1% ezetimibe. In all cases, the dose of evolocumab used was 140 mg, mainly every 2 weeks (97.3%). Evolocumab compliance was high (92.3%). Treatment with evolocumab was interrupted in 6 patients (3.2%), with only 1 (0.5%) due to a probable side effect. Evolocumab significantly reduced total cholesterol (30.9% at week 2, and 39.3% at week 12; P<.001), LDL cholesterol (44.4% and 57.6%, respectively; P<.001), and triglycerides (14.8% and 5.2%, respectively; P<001), with no significant changes in HDL-cholesterol (6.7% and 2.0%; P=.14). CONCLUSIONS: In clinical practice, evolocumab is associated with reductions in LDL cholesterol, with nearly 60% after 12 weeks of treatment, and with low rates of interruptions due to side effects and high medication compliance. These results are consistent with those reported in randomised clinical trials.

Primer registro nacional de evolocumab en la práctica clínica en unidades de cardiología en España. Estudio RETOSS-CARDIO / First national registry of evolocumab in clinical practice in cardiology units in Spain. The RETOSS-CARDIO study

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Primer registro nacional sobre la efectividad y seguridad de evolocumab en la práctica clínica en pacientes atendidos en cardiología en España. Estudio RETOSS-CARDIO / First national registry on the effectiveness and safety of evolocumab in clinical practice in patients attended in cardiology in Spain. The RETOSS-CARDIO study

OBJETIVO: Presentar el primer registro que analiza el perfil clínico de los pacientes tratados en España con evolocumab y la efectividad sobre el perfil lipídico y su seguridad en el «mundo real». MÉTODOS: Estudio multicéntrico, retrospectivo, observacional, de los pacientes que empezaron tratamiento con evolocumab entre febrero de 2016 y mayo de 2017 en la práctica clínica en unidades de cardiología en España. RESULTADOS: Se incluyó a 186 pacientes de 31 unidades de cardiología (edad media 60,3 ± 9,8 años; 35,5% con hipercolesterolemia familiar y 94,1% con evento cardiovascular previo). Perfil lipídico basal: colesterol total 219,4 ± 52,2mg/dL, colesterol-LDL 144,0 ± 49,0mg/dL, colesterol-HDL 47,7 ± 13,0mg/dL y triglicéridos 151,0 ± 76,2mg/dL. En el momento del inicio de evolocumab, el 53,8% estaba tomando estatinas (el 50% presentaba intolerancia a las estatinas, total o parcial) y el 51,1% ezetimiba. En todos los casos se empleó la dosis de evolocumab de 140mg y, principalmente, cada 2 semanas (97,3%). El cumplimiento terapéutico fue elevado (92,3%). En 6 pacientes (3,2%) se interrumpió el tratamiento, pero solo en uno (0,5%), por posible efecto adverso. Evolocumab redujo significativamente el colesterol total (30,9% a las 2 semanas y 39,3% a las 12 semanas; p < 0,001), colesterol-LDL (44,4 y 57,6%, respectivamente; p < 0,001) y triglicéridos (14,8 y 5,2%; p < 0,001), sin modificar significativamente el colesterol-HDL (6,7 y 2,0%; p = 0,14). CONCLUSIONES: En la práctica clínica, evolocumab se asocia con reducciones del colesterol-LDL cercanas al 60% tras 12 semanas de tratamiento, con una tasa de retiradas por efectos adversos muy baja y con un elevado cumplimiento terapéutico. Estos resultados son consistentes con los obtenidos en los ensayos clínicos aleatorizados

OBJECTIVE: To present the first registry used to analyse the clinical profile of patients treated with evolocumab in Spain, including the effectiveness on the lipid profile and safety in the «real world» setting. METHODS: Multicentre, retrospective, and observational study of patients starting treatment with evolocumab from February 2016 to May 2017 in clinical practice in Spanish cardiology units. RESULTS: A total of 186 patients (mean age 60.3 ± 9.8 years were included, 35.5% with familial hypercholesterolaemia, and 94.1% with a previous cardiovascular event) from 31 cardiology units. Baseline lipid profile: Total cholesterol 219.4 ± 52.2 mg/dL, LDL-cholesterol 144.0 ± 49.0mg/dL, HDL-cholesterol 47.7 ± 13.0mg/dL, and triglycerides 151.0 ± 76.2mg/dL. At the time of initiating evolocumab, 53.8% of patients were taking statins (50% had partial or total intolerance to statins), and 51.1% ezetimibe. In all cases, the dose of evolocumab used was 140 mg, mainly every 2 weeks (97.3%). Evolocumab compliance was high (92.3%). Treatment with evolocumab was interrupted in 6 patients (3.2%), with only 1 (0.5%) due to a probable side effect. Evolocumab significantly reduced total cholesterol (30.9% at week 2, and 39.3% at week 12; P<.001), LDL cholesterol (44.4% and 57.6%, respectively; P<.001), and triglycerides (14.8% and 5.2%, respectively; P<001), with no significant changes in HDL-cholesterol (6.7% and 2.0%; P=.14). CONCLUSIONS: In clinical practice, evolocumab is associated with reductions in LDL cholesterol, with nearly 60% after 12 weeks of treatment, and with low rates of interruptions due to side effects and high medication compliance. These results are consistent with those reported in randomised clinical trials

What Do Spanish physicians believe and expect about telemedicine? Results of a Delphi-based survey.

The aim of this Delphi-based study was to evaluate the intention of Spanish physicians to accept and use telemedicine as a future useful tool in daily practice. An online Delphi questionnaire was answered by 985 physicians (966 in the second round), representatives from rural and urban areas of the entire country (generalists, internists, cardiologists, endocrinologists, and nephrologists). The participants were 65% males, with a mean age of 46.7 years old and 20.3 years in the profession, mostly coming from primary care centers (91.8%) of urban Spanish areas (72.8%). Some responders (56.4%) reported lack of Internet use at work and 80.2% never participated in a telemedicine project, but 80.9% said they would be interested in participating in the future. As for the benefits of telemedicine, the specialties perceived as the most benefited were cardiology, followed by general medicine, pediatrics, and emergency services. The main reported difficulty for telemedicine implementation was the opinion that patients prefer the physical contact with physicians (77.8% of responders). Interviewed participants expressed strong interest in future telemedicine projects related to online training, distance control of chronic diseases, online communication among specialists, and real-time transmission of images and information. Most Spanish physicians have not implemented telemedicine in clinical practice, but they would be interested in future applications such as on-line training or disease control, although they still prefer physical patient contact.

Análisis sobre los motivos de derivación de pacientes con diabetes mellitus tipo 2 entre atención primaria y atención especializada. Estudio Pathways / Analysis of criteria for referral of type 2 diabetes patients from primary care to specialized care in spain. A Pathways Study

OBJETIVOS: Conocer los motivos de derivación de pacientes con diabetes tipo 2 (DM2) entre atención primaria (AP) y atención especializada (AE). Analizar el grado de cumplimiento de las recomendaciones nacionales sobre motivos de derivación de pacientes con DM2. MATERIAL Y MÉTODOS: Estudio observacional, transversal, multicéntrico nacional en AP y AE. Cada investigador debía aportar, mediante un cuaderno de recogida de datos estructurado, información sobre su práctica habitual en derivación de pacientes con DM2 y datos sobre derivación de 6 pacientes concretos. Los documentos de referencia para el análisis del cumplimiento fueron: Recomendaciones de la Sociedad Española de Endocrinología y Nutrición (SEEN) y Guía de Práctica Clínica del Ministerio de Sanidad y Consumo (MSC). Se analizaron datos sobre práctica habitual de 143 médicos de AE y 641 de AP y sobre derivaciones de 805 pacientes de AE y 3.624 de AP. RESULTADOS: El 31,8% de los profesionales de AP y el 46,2% de AE declaran existencia de un protocolo de coordinación con el otro nivel asistencial. El método de comunicación más frecuentemente declarado para derivaciones hacia AE fue el parte interconsulta (89,2%) y hacia AP la historia clínica (53,5%). El criterio de derivación hacia AE más manejado en la práctica habitual fue «inestabilidad metabólica» (80,5%), y hacia AP, «consecución de objetivos» (96,5%). El motivo más frecuente en derivaciones concretas hacia AE fue «re-evaluación» (48,4%) y hacia AP «consecución de objetivos» (91,6%). El 46,8% de los profesionales de AP aplicaban todos los criterios MSC y el 3,9% todos los criterios SEEN. CONCLUSIONES: Se observa una escasa implementación de protocolos de coordinación entre niveles asistenciales y un bajo grado de cumplimiento de las recomendaciones nacionales

OBJECTIVES: To assess the reasons for referral of type 2 diabetes (T2DM) patients from primary care (PC) to specialized care (SC) in Spain. To assess the level of compliance with referral criteria established in national recommendations. METHODS: Observational, cross-sectional, multi-centre national study, in PC and SC. Each physician provided, using a structured case report form, data on usual practice for T2DM patient referral and data about referral of 6 patients. Recommendations of the Spanish Society for Endocrinology and Nutrition (SEEN) and the National Health System (NHS) were used as reference documents to assess compliance. Data from clinical practice of 143 professionals of SC/641 general practitioners (GPs) and from referrals of 805 patients to PC/3,624 to SC are presented. RESULTS: Almost one-third (31.8%) of GPs and 46.2% of SC professionals reported the existence of a coordination protocol with the other healthcare level. The most frequent communication tool for referrals to SC was a Consultation Report (89.2%), and the Medical History for referrals to PC. The referral criterion to SC most frequently declared was Metabolic Instability (80.5%) and to PC was Goal Achievement (96.5%). The most frequent cause for referral to SC among the patients studied was Reassessment (48.4%) and to PC Goal Achievement (91.6%). Almost half (46.8%) of GPs applied all NHS criteria in usual practice, and 3.9% all SEEN referral criteria. CONCLUSIONS: The number of reported coordination protocols is low, and the compliance with national guidelines is poor

Development of chronic kidney disease and cardiovascular prognosis in essential hypertensive patients.

The existence of a significant percentage of treated hypertensive patients presenting a diminished renal function has been recently described. Mild renal function abnormalities are recognized as powerful predictors of cardiovascular morbidity and mortality. However, longitudinal data demonstrating this association are lacking. The objectives of this study have been analysis of the evolution of GFR, assessed as creatinine clearance (CrCl), during long-term follow-up of hypertensive patients and evaluation of the impact of the development of chronic kidney disease (CKD) on cardiovascular prognosis. A historical cohort of 281 patients attending our Hypertension Unit was selected according to the following criteria: essential hypertension, more than 5 yr of follow-up, and normal GFR at baseline (CrCl > 90 ml/min per 1.73 m(2)). Patients had an average follow-up of 13.2 +/- 4.8 yr. Forty-one patients (14.6%) developed CKD (CrCl < 60 ml/min per 1.73 m(2)) attributed to hypertensive nephrosclerosis. Initial serum creatinine, age, systolic BP at baseline, and average total cholesterol during follow-up were independent predictors of CKD development. Forty-nine (17.4%) of 281 patients presented a cardiovascular event during follow-up: 17 patients (40.6%) who developed CKD and 32 patients (13.3%) with preserved renal function (log rank test P < 0.001). After adjustment in a Cox multivariate analysis, age, development of CKD during follow-up, and male gender were independent predictors of the appearance of cardiovascular events. In essential hypertensive patients with normal renal function at baseline, the development of CKD during the follow-up is strongly and independently related with poor cardiovascular prognosis.

Doxazosin GITS versus hydrochlorothiazide as add-on therapy in patients with uncontrolled hypertension.

The objective of this prospective, randomized, open-label, parallel-arm comparative study, with a 4-month follow-up, was to assess the antihypertensive efficacy, tolerability and metabolic safety of doxazosin GITS (gastrointestinal therapeutic system) 4-8 mg/day vs hydrochlorothiazide (HCTZ) 12.5-25 mg/day as add-on therapy in patients not controlled with monotherapy with other drugs. Ninety-eight patients completed the study (mean age 57.4 +/- 15 years, 53% female). Mean systolic/diastolic blood pressure reduction was 8.2/4.5 mmHg in the HCTZ group and 8.9/5.0 mmHg in the doxazosin GITS group, and a strict blood pressure control was achieved in 79% and 83% of the patients, respectively. The incidence rates of adverse events were low and similar in both groups. However, metabolic differences were seen between the groups, doxazosin GITS vs HCTZ, respectively: total cholesterol (mg/dl) 210 +/- 53 vs 231 +/- 62 (p < 0.05), low-density lipoprotein (LDL) cholesterol (mg/dl) 139 +/- 40 vs 161 +/- 57 (p < 0.01), high-density lipoprotein (HDL) cholesterol (mg/dl) 58 +/- 16 vs 48 +/- 13 (p < 0.01), HDL/total cholesterol ratio 27.6 +/- 8 vs 21.2 +/- 7 (p < 0.001), plasma uric acid (mg/dl) 5.3 +/- 2.6 vs 6.8 +/- 3.1 (p < 0.05) and serum potassium (mEq/l) 4.1 +/- 1.3 vs. 3.7 +/- 1.2 (p < 0.01). In conclusion, doxazosin GITS has a tolerability and efficacy profile similar to low doses of thiazide diuretics, with a better evolution of metabolic and electrolyte parameters. Therefore, in patients not controlled with monotherapy, doxazosin GITS can be considered an alternative to the addition of thiazide diuretics.

Hypertensive renal damage in metabolic syndrome is associated with glucose metabolism disturbances.

Recent evidence highlights the relationship between metabolic syndrome (MS) and increased risk of cardiovascular (CV) diseases. Mild renal function abnormalities are associated with an enhanced CV risk, considered to be due to the presence of associated risk factors. Hence, MS and renal abnormalities could be linked and contribute to augment CV risk. For estimating the prevalence of diminished creatinine clearance (CC; <60 ml/min per 1.73 m(2)) in hypertensive patients with or without MS and for investigating the factors accompanying this abnormality, 1625 hypertensive patients, aged 18 yr or older, were included. The presence of MS was defined according to the Adult Treatment Panel III criteria. The overall prevalence of MS was 49.4% (n = 802). No significant difference was found for CC between those with and without MS, albeit the presence of MS was accompanied by greater urinary albumin excretion (P = 0.01). The prevalence of a diminished CC was also similar in the two groups. MS-positive patients presented a progressive decay in CC when classified as normoglycemic (n = 319), impaired fasting glucose (n = 237), and diabetic patients (n = 246; 85.9 +/- 30.2, 81.8 +/- 26.8, and 75.2 +/- 25.7 ml/min per 1.73 m(2), respectively; P = 0.0007 linearity test) and the opposite for microalbuminuria (29.5 +/- 45.5, 45.0 +/- 96.6, and 74.1 +/- 146.3 mg/24 h, respectively; P = 0.001 linearity test). In multiple regression analysis, factors related to the finding of a diminished CC in MS and non-MS patients were similar. Hypertensive patients at a relatively young age present with an elevated prevalence of minor abnormalities of renal function that is mostly related to the presence of metabolic alteration of glucose together with age and BP.

Prevalencia de Vasculopatía Periférica Subclínica evaluada mediante el índice tobillo/brazo en pacientes con hipertensión arterial / No disponible

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