Sex-Related Differences in Heart Failure Diagnosis.

PURPOSE OF REVIEW: The literature on the importance of sex in heart failure diagnosis is scarce. This review aims to summarize current knowledge on sex differences regarding the diagnosis of heart failure. RECENT FINDINGS: Comorbidities are frequent in patients with heart failure, and their prevalence differs between sexes; some differences in symptomatology and diagnostic imaging techniques were also found. Biomarkers also usually show differences between sexes but are not significant enough to establish sex-specific ranges. This article outlines current information related to sex differences in HF diagnosis. Research in this field remains to be done. Maintaining a high diagnostic suspicion, actively searching for the disease, and considering the sex is relevant for early diagnosis and better prognosis. In addition, more studies with equal representation are needed.

[The long and winding road of the clinical pharmacy in Chile]. / El largo y sinuoso camino de la farmacia clinica en Chile.

Clinical pharmacy is a health discipline in which pharmacists provide patient care that optimizes rational medication use and promotes health, wellness and disease prevention. The beginnings of clinical pharmacy in Chile were inspired by the origin in the School of Pharmacy of the University of California, San Francisco (UCSF), in the mid-1960s. However, the historical development in our country, both in teaching and in the professional field, was accompanied by difficulties and success, which became a long and winding road. This article shares the events that gave rise to its beginnings in Chile, first through teaching, then in pharmacovigilance and clinical pharmacokinetics, to later describe its professional expansion and recognition as a specialty of pharmacy. This article briefly recounts the history of the Chilean clinical pharmacy to this day. Some names of people or institutions were not mentioned. Therefore the authors apologize in advance to pharmacists and organizations whose contribution cannot be recognized in this way. However, we know that this specialty has not been forged only by the names that appear, but by all those who love and respect the work of the clinical pharmacy.

Treatment of steroid-refractory chronic graft-versus-host disease with imatinib: Real-life experience of the Spanish group of hematopoietic transplantation (GETH).

Treatment of steroid-refractory chronic graft-versus-host disease (cGVHD) is a challenge. Here, we describe a retrospective analysis of 66 patients with steroid-refractory cGVHD treated with imatinib (starting dose of 100 mg in 70% of patients; maximum dose of 100-200 mg in 74%). Most patients had multi-organ involvement (≥2 organs, 83%), with the most affected being skin (85%), oral mucosa (55%), eyes (42%), and lungs (33%). The overall response rate was 41% (21 partial and three complete responses). The organ with the best response rate was the skin (46%), followed by gastrointestinal tract (43%), liver (41%), the oral mucosa (36%), eyes (29%), and lungs (18%). Imatinib led to steroid tapering in 17/38 patients. Twenty-five (38%) patients experienced imatinib-related adverse events, comprising extra-hematologic toxicity (n = 24, 36%) and hematologic toxicity (n = 6, 9%). No cases of grade 4-5 toxicity were reported. The main causes of imatinib discontinuation were treatment failure (52%) and toxicity (9%). After a median follow-up of 41 months, the 3-year overall survival was 81%, with no difference between imatinib responders and non-responders. These real-life results show that imatinib is safe and has moderate efficacy in patients with heavily pre-treated cutaneous sclerotic cGVHD; however, activity against lung cGVHD is very limited.

Near IR stationary wave Fourier transform lambda meter in lithium niobate: multiplexing and improving optical sampling using spatially shifted nanogroove antenna.

Several integrated optics solutions currently exist to develop monolithic, robust, and lightweight high-resolution spectrometers for spatial applications. An interesting option is generating a stationary wave inside a single-mode waveguide, and sampling the interference fringes using dielectric discontinuities on the surface of the waveguide. This allows the recording of the signal on a detector on top of the waveguide, and using dedicated Fourier transform methods to recover the spectrum of the source. All the difficulty is then linked to the length of the interferogram that is sampled. This determines the spectral resolution and the spacing between sampling centers, which are ultimately limited by the pixel pitch, and that will determine the spectral range of the spectrum. In addition, the dielectric discontinuities that will extract the flux from the waveguide have a relatively wide angular emission, resulting in crosstalk between pixels, and reducing the effective sampling step. Finally, the optical sensitivity of these systems is limited since the waveguides are single mode. Therefore, improving the efficiency of stationary wave Fourier transform spectrometers will require reducing the angular divergence of the sampled signal, reducing the sampling step, and increasing the optical input collection capacity. To achieve the two latest conditions, one interesting approach is spatial multiplexing. In this paper, we present the proof of concept of a multiplexed integrated optics Fourier transform spectrometer based on lithium niobate waveguides, using focused ion beam nanogrooves as sampling centers. The spatially shifted position of the antennas between consecutive waveguides will allow us to determine an unknown wavelength with tens of picometer resolution. The extraction efficiency and bandwidth of the antennas will be theoretically studied to optimize their periodicity and match a given pixel pitch. Finally, the ability to develop this concept on an electro-optic material will be of great interest to achieve further active phase modulation and increase the spectral bandwidth.

Automatic Ankle Angle Detection by Integrated RGB and Depth Camera System.

Depth cameras are developing widely. One of their main virtues is that, based on their data and by applying machine learning algorithms and techniques, it is possible to perform body tracking and make an accurate three-dimensional representation of body movement. Specifically, this paper will use the Kinect v2 device, which incorporates a random forest algorithm for 25 joints detection in the human body. However, although Kinect v2 is a powerful tool, there are circumstances in which the device's design does not allow the extraction of such data or the accuracy of the data is low, as is usually the case with foot position. We propose a method of acquiring this data in circumstances where the Kinect v2 device does not recognize the body when only the lower limbs are visible, improving the ankle angle's precision employing projection lines. Using a region-based convolutional neural network (Mask RCNN) for body recognition, raw data extraction for automatic ankle angle measurement has been achieved. All angles have been evaluated by inertial measurement units (IMUs) as gold standard. For the six tests carried out at different fixed distances between 0.5 and 4 m to the Kinect, we have obtained (mean ± SD) a Pearson's coefficient, r = 0.89 ± 0.04, a Spearman's coefficient, ρ = 0.83 ± 0.09, a root mean square error, RMSE = 10.7 ± 2.6 deg and a mean absolute error, MAE = 7.5 ± 1.8 deg. For the walking test, or variable distance test, we have obtained a Pearson's coefficient, r = 0.74, a Spearman's coefficient, ρ = 0.72, an RMSE = 6.4 deg and an MAE = 4.7 deg.

Improving the vertical radiation pattern issued from multiple nano-groove scattering centers acting as an antenna for future integrated optics Fourier transform spectrometers in the near IR.

The stationary wave integrated Fourier transform spectrometer (SWIFTS) is based on the sampling of a stationary wave using nano-scattering centers on the surface of a channel waveguide. Single nano-scale scattering centers above the waveguide surface will radiate the sampled signal with wide angular distribution, which is not compatible with the buried detection area of infrared (IR) detectors, resulting in crosstalk between pixels. An implementation of multiple diffraction nano-grooves (antenna) for each sampling center is proposed as an alternative solution to improve directivity towards the detector pixel by narrowing the scattering angle of the extracted light. Its efficiency is demonstrated from both simulated and measured far-field radiative patterns exhibiting a promising method to be used for the future integrated IR-SWIFTS.

Low-loss 3D-laser-written mid-infrared LiNbO3 depressed-index cladding waveguides for both TE and TM polarizations.

We report mid-infrared LiNbO3 depressed-index microstructured cladding waveguides fabricated by three-dimensional laser writing showing low propagation losses (~1.5 dB/cm) at 3.68 µm wavelength for both the transverse electric and magnetic polarized modes, a feature previously unachieved due to the strong anisotropic properties of this type of laser microstructured waveguides and which is of fundamental importance for many photonic applications. Using a heuristic modeling-testing iteration design approach which takes into account cladding induced stress-optic index changes, the fabricated cladding microstructure provides low-loss single mode operation for the mid-IR for both orthogonal polarizations. The dependence of the localized refractive index changes within the cladding microstructure with post-fabrication thermal annealing processes was also investigated, revealing its complex dependence of the laser induced refractive index changes on laser fabrication conditions and thermal post-processing steps. The waveguide modes properties and their dependence on thermal post-processing were numerically modeled and fitted to the experimental values by systematically varying three fundamental parameters of this type of waveguides: depressed refractive index values at sub-micron laser-written tracks, track size changes, and piezo-optic induced refractive index changes.

Effect of intra-alveolar placement of 0.2% chlorhexidine bioadhesive gel on the incidence of alveolar osteitis following the extraction of mandibular third molars. A double-blind randomized clinical trial.

UNLABELLED: Alveolar osteitis (AO) is a common complication after third molar surgery. One of the most studied agents in its prevention is chlorhexidine (CHX), which has proved to be effective. OBJECTIVES: The aim of this randomized double-blind clinical trial was to evaluate the efficacy of 0.2% bioadhesive chlorhexidine gel placed intra-alveolar in the prevention of AO after the extraction of mandibular third molars and to analyze the impact of risk factors such as smoking and oral contraceptives in the development of AO. STUDY DESIGN: The study was a randomized, double-blind, clinical trial performed in the Ambulatory Surgery Unit of Hospital Vall d'Hebron and was approved by the Ethics Committee. A total of 160 patients randomly received 0.2% bioadhesive gel (80 patients) or bioadhesive placebo (80 patients). RESULTS: 0.2% bioadhesive chlorhexidine gel applied in the alveolus after third molar extraction reduced the incidence of dry socket by 22% compared to placebo with differences that were not statistically significant. Smoking and the use of oral contraceptives were not related to higher incidence of dry socket. Female patients and the difficulty of the surgery were associated with a higher incidence of AO with statistically significant differences. 0.2% bioadhesive chlorhexidine gel did not produce any of the side effects related to chlorhexidine rinses. CONCLUSIONS: A 22% reduction of the incidence of alveolar osteitis with the application of 0.2% bioadhesive chlorhexidine gel compared to placebo with differences that were not statistically significant was found in this clinical trial. The lack of adverse reactions and complications related to chlorhexidine gel supports its clinical use specially in simple extractions and adds some advantages compared to the rinses in terms of duration of the treatment and reduction of staining and taste disturbance.

Impact on outcomes of human leukocyte antigen matching by allele-level typing in adults with acute myeloid leukemia undergoing umbilical cord blood transplantation.

This retrospective study analyzed the impact of directional donor-recipient human leukocyte antigen (HLA) disparity using allele-level typing at HLA-A, -B, -C, and -DRB1 in 79 adults with acute myeloid leukemia (AML) who received single-unit umbilical cord blood (UCB) transplant at a single institution. With extended high-resolution HLA typing, the donor-recipient compatibility ranged from 2/8 to 8/8. HLA disparity showed no negative impact on nonrelapse mortality (NRM), graft-versus-host (GVH) disease or engraftment. Considering disparities in the GVH direction, the 5-year cumulative incidence of relapse was 44% and 22% for patients receiving an UCB unit matched ≥ 6/8 and < 6/8, respectively (P = .04). In multivariable analysis, a higher HLA disparity in the GVH direction using extended high-resolution typing (Risk ratio [RR] 2.8; 95% confidence interval [CI], 1.5 to 5.1; P = .0009) and first complete remission at time of transplantation (RR 2.1; 95% CI, 1.2 to 3.8; P = .01) were the only variables significantly associated with an improved disease-free survival. In conclusion, we found that in adults with AML undergoing single-unit UCBT, an increased number of HLA disparities at allele-level typing improved disease-free survival by decreasing the relapse rate without a negative effect on NRM.

Effect of CD8⁺ cell content on umbilical cord blood transplantation in adults with hematological malignancies.

Total nucleated (TNCs) and CD34(+) cells are considered major determinants of outcome after umbilical cord blood (UCB) transplantation but the effect of other cell subtypes present in the graft is unknown. This single-center cohort study included patients with hematological malignancies who received UCB transplantation after a myeloablative conditioning regimen. UCB units were primarily selected according to cell content, both TNCs and CD34(+) cells, and also according to the degree of HLA matching. Counts of several cell subtypes of the infused UCB unit, together with HLA disparities and other patient- and transplantation-related characteristics, were analyzed by multivariable methodology for their association with myeloid and platelet engraftment, graft-versus-host disease, nonrelapse mortality (NRM), disease-free survival (DFS), and overall survival (OS). Two hundred patients (median age, 32 years) were included in the study. In multivariable analyses, a greater number of CD8(+) cells was significantly associated with better results for myeloid (P = .001) and platelet (P = .008) engraftment, NRM (P = .02), DFS (P = .007), and OS (P = .01). CD34(+) cell content was predictive of myeloid engraftment (P < .001). This study suggests that the outcome after UCB transplantation in adults with hematological malignancies could be better when UCB grafts had a greater CD8(+) cell content.

Effect of surfactants on the self-assembly of a model elastin-like block corecombinamer: from micelles to an aqueous two-phase system.

Recent advances in genetic engineering now allow the synthesis of protein-based block corecombinamers derived from elastin-like peptide sequences with complete control of chemistry and molecular weight, thereby resulting in unique physical and biological properties. The individual blocks of the elastin-like block corecombinamers (ELbcR's) display different phase behaviors in aqueous solution, which leads to the thermally triggered self-assembly of nano-objects ranging from micelles to vesicles. Herein, the interaction of cationic surfactant dodecyl trimethylammonium bromide (DTAB), anionic surfactant dodecyl sodium sulfate (SDS), and nonionic surfactant octyl-ß-glucopyranoside (OG) with an ELbcR has been investigated by dynamic light scattering (DLS), the ζ potential and cryo-transmission electron microscopy (cryo-TEM). At 65 °C and neutral pH in aqueous solution, the ELbcR (E50A40) is associated into micelles with a diameter of 150 nm comprising a hydrophobic (A) core and a hydrophilic (E) anionic (from the glutamic acid residues) corona. The size of these self-assemblies can be controlled by adjusting the cosurfactant concentrations. Although the effects of surfactants on the self-assembly behavior of ELbcR's depend on the hydrocarbon chain length and headgroup of the surfactants, a general tendency to increase in size, which in some cases leads to flocculation and a phase-separated state, is observed. These results support the use of surfactants as a highly interesting means of controlling the self-assembly of ELbcR's in aqueous solution as well as their use in drug delivery and purification processes.

Inflammation as a New Therapeutic Target among Older Patients with Ischemic Heart Disease.

Cardiovascular (CV) diseases remain a global health challenge, with ischemic heart disease (IHD) being the primary cause of both morbidity and mortality. Despite optimal pharmacological therapy, older patients with IHD exhibit an increased susceptibility to recurrent ischemic events, significantly impacting their prognosis. Inflammation is intricately linked with the aging process and plays a pivotal role in the evolution of atherosclerosis. Emerging anti-inflammatory therapies have shown promise in reducing ischemic events among high-risk populations. This review aims to explore the potential of targeted anti-inflammatory interventions in improving clinical outcomes and the quality of life for older patients with IHD.

A new species and new record of the commensal genus Alcyonosyllis Glasby & Watson, 2001 and a new species of Parahaplosyllis Hartmann-Schröder, 1990, (Annelida: Syllidae: Syllinae) from Philippines Islands.

A new species of Alcyonosyllis (Annelida: Syllidae), A. aidae n.sp. is described from Luzón island, Philippines, associated with the alcyonacean Dendronephthya sp. (Nephthydae). This is the sixth known species of this genus living in the Indo-Pacific region. The new species differs from other Alcyonosyllis in having long and slender cirri with the first pair of dorsal cirri slightly thicker than remaining, bidentate chaetae with distal tooth larger than proximal one, and a distinct colour pattern, with a median longitudinal, slender reddish line, and two wider lateral bands, giving a tri-lineate appearance. A new report of the recently described species, A. hinterkircheri, previously known only from an area close to Bohol, in Philippines, is also included, being the first report of this species in Luzón Island. A new species of the genus Parahaplosyllis Hartmann-Schröder, 1990, is also described. Up to now, only the type species of the genus was known, from New South Wales, Australia; this is the second known species of this genus. It differs from P. brevicirra Hartmann-Schröder, 1990 by having unidentate dorsal simple chaetae (instead of bidentate ones as in P. brevicirra), ventral simple chaeta with shorter and less curved basal spur, more distinctly articulated dorsal cirri, with a long distal article, and a shorter proventricle. Finally, new different types of stolons are described for both genera.

Revision of the genus Eusyllis Malmgren, 1867 (Annelida: Phyllodocida: Syllidae: Eusyllinae), with the description of a new species from the eastern Pacific Ocean.

Eusyllis Malmgren, 1867 (Annelida, Syllidae) is revised, with 7 species considered as valid (Eusyllis assimilis Marenzeller, 1875; Eusyllis blomstrandi Malmgren, 1867; Eusyllis kupfferi Langerhans, 1879; Eusyllis lamelligera Marion & Bobretzky, 1875; Eusyllis longicirrata Imajima, 1966; Eusyllis maxima (Monro, 1930); and Eusyllis nuchalata Hartmann-Schröder, 1965) plus a newly described species (Eusyllis grandmarie n. sp.) the only species of the genus recorded from a whale carcass, lying at more than 600 m deep in the eastern Pacific Ocean off the California coast. The new species is characterized by elongated compound chaetae, with blades almost unidentate, and a thin, spine-like proximal tooth. It differs from Eusyllis longicirrata Imajima, 1966, from Japan, in having shorter dorsal cirri and blades of compound chaetae. Additionally, Eusyllis nuchalata Hartmann-Schröder, 1965 is re-described. A key to the species of the genus is included.

Species of Odontosyllis Claparède, 1863 (Annelida: Polychaeta: Syllidae) occurring along the Brazlian coast.

Two new species of Odontosyllis were found in samples collected mainly on rocky shores off the states of São Paulo (SE Brazil) and Paraíba (NE Brazil). Odontosyllis aracaensis sp. nov., and O. guarauensis sp. nov., are herein described and compared to their most similar congeners. A key for the species found in Brazil is provided, and relevant morphological characters of similar species of the genus, based on falcigers morphology, are summarized and compared with those of the newly described species. The current state of knowledge on the genus is briefly discussed.

The genus Syllis Savigny in Lamarck, 1881 (Annelida: Syllidae: Syllinae) from Australia (Part 3): new species and redescription of previously described species.

Syllis Savigny in Lamarck, 1818, the type genus of Syllidae, is the largest and most diverse within the family. This genus presents many taxonomic, biogeographic, and phylogenetic problems due mainly to the lack of molecular data and morphological synapomorphies for many of the species, but also due to poor or inadequate descriptions. In order to improve the knowledge of the genus, we have undertaken a morphological revision of Australian species, based on type material and material collected over years by the Australian Museum. This is the third paper dealing with this family. Eighteen species are herein described, of which five are new and twelve are redescriptions of already known species, with four new combinations: Syllis imajimai, n. sp.; S. narranuk, n. sp.; S. noolinga, n. sp.; S. similisunzima, n. sp.; S. thylacine, n. sp.; S. busseltonensis (Hartmann-Schröder, 1982) n. comb.; S. patriciae (Hartmann-Schröder, 1981) n. comb.; S. pharobroomensis (Hartmann-Schröder, 1979) n. comb., S. pharynxcircunfusata (Hartmann-Schröder, 1979) n. comb, S. armillaris (O. F. Müller, 1771); S. augeneri Haswell, 1920; S. benelihauae (Campoy & Alquézar, 1982); S. hyalina Grube, 1863; S. cf. nigrescens Grube, 1878; S. profunda Cognetti, 1955; S. truncata Haswell, 1920; and S. variegata Grube, 1860.

The role of bioimpedance analysis in overweight and obese patients with acute heart failure: a pilot study.

AIMS: Residual congestion at the time of hospital discharge is an important readmission risk factor, and its detection with physical examination and usual diagnostic techniques have strong limitations in overweight and obese patients. New tools like bioelectrical impedance analysis (BIA) could help to determine when euvolaemia is reached. The aim of this study was to investigate the usefulness of BIA in management of heart failure (HF) in overweight and obese patients. METHODS AND RESULTS: Our study is a single-centre, single-blind, randomized controlled trial that included 48 overweight and obese patients admitted for acute HF. The study population was randomized into two arms: BIA-guided group and standard care. Serum electrolytes, kidney function, and natriuretic peptides were followed up during their hospital stay and at 90 days after discharge. The primary endpoint was development of severe acute kidney injury (AKI) defined as an increase in serum creatinine by >0.5 mg/dL during hospitalization, and the main secondary endpoint was the reduction of N-terminal pro-brain natriuretic peptide (NT-proBNP) levels during hospitalization and within 90 days after discharge. The BIA-guided group showed a remarkable lower incidence of severe AKI, although no significant differences were found (41.4% vs. 16.7%; P = 0.057). The proportion of patients who achieved levels of NT-proBNP < 1000 pg/mL at 90 days was significantly higher in the BIA-guided group than in the standard group (58.8% vs. 25%; P = 0.049). No differences were observed in the incidence of adverse outcomes at 90 days. CONCLUSIONS: Among overweight and obese patients with HF, BIA reduces NT-proBNP levels at 90 days compared with standard care. In addition, there is a trend towards lower incidence of AKI in the BIA-guided group. Although more studies are required, BIA could be a useful tool in decompensated HF management in overweight and obese patients.

Significance of increased blastic-appearing cells in bone marrow following myeloablative unrelated cord blood transplantation in adult patients.

An abnormal increase of nonleukemic blastic-appearing lymphocytes in bone marrow (BM) specimens has been reported after unrelated cord blood transplantation (UCBT). This study analyzed the incidence, chronology, biological features, and clinical significance of elevated numbers of these cells in a series of 165 consecutive adult patients demonstrating myeloid engraftment after myeloablative UCBT in a single institution. The patients' BM samples were routinely evaluated by cytomorphology at different time points after UCBT. When ≥5% of blastic-appearing cells were detected by cytomorphology in the BM, samples were also evaluated by multiparametric flow cytometry to characterize these cells. Systematic chimerism analyses of BM samples using PCR amplification of short tandem repeat markers were performed. Forty-three patients (cumulative incidence, 26.1%) demonstrated ≥5% of nonmalignant blastic-appearing cells in BM after a median of 101 days after UCBT (range, 28-377 days). All of these patients had full-donor chimerism and a clinical course without leukemic relapse. Multiparametric flow cytometry analyses performed in 36 of the 43 patients showed a polyclonal expansion of B lymphocytes with a broad spectrum of maturation stages. An increased number of nonmalignant blastic-appearing cells was significantly associated with a high number of lymphocytes infused at the time of UCBT and with low rates of acute and chronic extensive graft-versus-host disease, suggesting a potential immunoregulatory role of these cells. The observation of ≥5% nonmalignant blastic-appearing cells in BM samples after myeloablative UCBT is frequent, and these should be distinguished from malignant blasts.

Double polarization active Y junctions in the L band, based on Ti:LiNbO3 lithium niobate waveguides: polarization and contrast performances.

Double polarization electro-optic beam combiners based on a Ti:diffusion lithium niobate waveguide have been developed for mid-infrared applications. A monochromatic rejection ratio of up to 33 dB at λ=3.39 µm was obtained, as well as wideband fringes showing low dispersion. In a first part, studying the fringe contrast as a function of waveguide width, we found a compromise among transmission, signal-to-noise ratio, and fringe contrast, depending on the single-mode behavior of the waveguides. We will show that both polarizations are guided, and at least 70% and 90% contrast is achieved, respectively, in TE and TM with a 400 nm wideband light centered at 3.39 µm. After choosing the optimal combiner and designing the electrodes, we studied the electro-optic response of the device, using a monochromatic source and scanning the fringe, by external as well as internal modulation, in order to determine the rejection ratio and the voltage needed to cover half a fringe (V(π)) voltage for both TE and TM polarizations.

Three-dimensional mid-infrared photonic circuits in chalcogenide glass.

We report the fabrication of single-mode buried channel waveguides for the whole mid-IR transparency range of chalcogenide sulphide glasses (λ ≤ 11 µm), by means of direct laser writing. We have explored the potential of this technology by fabricating a prototype three-dimensional three-beam combiner for future application in stellar interferometry that delivers a monochromatic interference visibility of 99.89% at 10.6 µm and an ultrahigh bandwidth (3-11 µm) interference visibility of 21.3%. These results demonstrate that it is possible to harness the whole transparency range offered by chalcogenide glasses on a single on-chip instrument by means of direct laser writing, a finding that may be of key significance in future technologies such as astrophotonics and biochemical sensing.