Update on the major imported helminth infections in travelers and migrants.

Helminth infections cause considerable morbidity worldwide and may be frequently underdiagnosed especially in areas of lower endemicity. Patients may harbor latent infections that may become symptomatic years or decades after the initial exposure and timely diagnosis may be critical to prevent complications and improve outcomes. In this context, disease in special populations, such as immunosuppressed patients, may be of particular concern. Heightened awareness and recent diagnostic developments may contribute to the correct management of helminth infections in nonendemic regions. A review of the main helminth infections in travelers and migrants (strongyloidiasis, taeniasis-neurocysticercosis and schistosomiasis) is presented, focusing on epidemiology, developments in diagnosis, treatment and prevention.

Addition of fermented and unfermented grape skin in broilers' diets: effect on digestion, growth performance, intestinal microbiota and oxidative stability of meat.

Grape skin is a source of polyphenols with antioxidant and antimicrobial properties. Little information is available regarding its application in animal feeding. The present study investigated the effect of inclusion of fermented (FS) and unfermented (UFS) grape skin at two different doses (30 g/kg, FS30 and UFS30, and 60 g/kg, FS60 and UFS60) and 200 mg/kg vitamin E (α-tocopheryl acetate) in a corn-soybean diet on growth performance, ileal protein digestibility, ileal and excreta total extractable polyphenols content and digestibility, intestinal microbiota and thigh meat oxidation in broiler chickens. Growth performance was depressed in chickens fed UFS and FS diets. A reduction in ileal protein digestibility was also observed in birds fed UFS, being this effect more pronounced in those fed 60 g/kg. The dietary inclusion of grape skin increased both ileal and excreta polyphenols contents, being higher in birds fed UFS than in those fed FS. Excreta moisture content increased in birds fed UFS and FS diets. No effect of dietary inclusion of grape skin was observed on ileal counts of lactic-acid bacteria and Clostridium, but UFS inclusion in the diet reduced ileal count of Escherichia coli as compared with FS dietary inclusion. After 7 days of refrigerated storage, values of thiobarbituric acid reactive substances (TBARS) were lower in chicken meat when grape skin was added in the diet at 60 g/kg instead of 30 g/kg, and meat from birds fed 60 g/kg of grape skin reached TBARS values similar to those of birds supplemented with vitamin E. In conclusion, high doses of grape skin polyphenols depressed growth performance and protein digestibility, and increased excreta moisture content. Unfermented grape skin contained more polyphenols than FS, and its inclusion in the diet led to higher ileal and excreta polyphenols contents and to a lower ileal count of E. coli. Furthermore, the antioxidant potential of the polyphenols present in grape skin was observed after 7 days of meat storage, with the dose of 60 g/kg of grape skin being as effective as vitamin E supplementation in maintaining oxidative stability of meat.

Addition of exogenous enzymes to diets containing grape pomace: Effects on intestinal utilization of catechins and antioxidant status of chickens.

Grape pomace (GP) is a rich source of polyphenols with antioxidant capacity. An experiment was conducted to study the effect of GP phenolic compounds included at 5 and 10%, and the addition (individually or combined) of hydrolyzing enzymes (carbohydrase enzyme complex and tannase at 500ppm) on intestinal utilization of catechins and antioxidant status in broiler chickens. A diet supplemented with 200ppm of α-tocopheryl acetate was also used. Our findings demonstrate the capacity of chickens to digest the monomeric (catechin, epicatechin, gallic acid, and epicatechin-O-gallate) and dimeric (procyanidin B1 and procyanidin B2) catechins present in grape pomace. The addition of enzymes (mainly tannase) hydrolyzed the polymeric structures into smaller catechins, but also promoted a lower digestibility of the monomeric and dimeric catechins suggesting that polymeric structures might favour the intestinal utilization of these catechins. The intestinal accumulation of phenolic compounds generated with tannase and with 10% GP reversed the antimicrobial effect against Clostridium perfringens observed with 5% of GP. Grape pomace improved the antioxidant status of the bird, increasing the α-tocopherol and reducing the iron content on plasma, not affecting the plasma gluthatione. Enzymes modified the intestinal utilization of catechins but not additional protective effect was detected on any of the parameters analyzed to evaluate the antioxidant status.

CNS myelin induces regulatory functions of DC-SIGN-expressing, antigen-presenting cells via cognate interaction with MOG.

Myelin oligodendrocyte glycoprotein (MOG), a constituent of central nervous system myelin, is an important autoantigen in the neuroinflammatory disease multiple sclerosis (MS). However, its function remains unknown. Here, we show that, in healthy human myelin, MOG is decorated with fucosylated N-glycans that support recognition by the C-type lectin receptor (CLR) DC-specific intercellular adhesion molecule-3-grabbing nonintegrin (DC-SIGN) on microglia and DCs. The interaction of MOG with DC-SIGN in the context of simultaneous TLR4 activation resulted in enhanced IL-10 secretion and decreased T cell proliferation in a DC-SIGN-, glycosylation-, and Raf1-dependent manner. Exposure of oligodendrocytes to proinflammatory factors resulted in the down-regulation of fucosyltransferase expression, reflected by altered glycosylation at the MS lesion site. Indeed, removal of fucose on myelin reduced DC-SIGN-dependent homeostatic control, and resulted in inflammasome activation, increased T cell proliferation, and differentiation toward a Th17-prone phenotype. These data demonstrate a new role for myelin glycosylation in the control of immune homeostasis in the healthy human brain through the MOG-DC-SIGN homeostatic regulatory axis, which is comprised by inflammatory insults that affect glycosylation. This phenomenon should be considered as a basis to restore immune tolerance in MS.

Effects of dietary grape seed extract on growth performance, amino acid digestibility and plasma lipids and mineral content in broiler chicks.

Polyphenols are chemically and biologically active compounds. Grape seed extracts (GSEs) have been widely used as a human food supplement for health promotion and disease prevention. However, there is little information regarding its application in animal feeds. An experiment was conducted to investigate the effect of inclusion of GSE at 0.025, 0.25, 2.5 and 5.0 g/kg in a wheat soya bean control diet on growth performance, protein and amino acid (AA) digestibility and plasma lipid and mineral concentrations in broiler chickens at 21 days of age. Performance was not affected by dietary treatment except in the case of birds fed the diet with the highest GSE concentration, which showed a worsening of weight gain and feed conversion. Apparent ileal digestibility (AID) of protein was significantly reduced in the birds fed the highest concentration of GSE, which also had a reduction on the AID of arginine, histidine, phenylalanine, cystine, glutamic acid and proline compared with those fed control diet. The inclusion of graded concentration of GSE in the chicken diets caused a significant linear decrease in the concentrations of plasma copper, iron and zinc. Plasma cholesterol, triglycerides and lipoproteins (high-density lipoprotein, low-density lipoprotein and very-low-density lipoprotein) concentrations were not affected by dietary GSE. In conclusion, this study demonstrated that incorporation of GSE in chicken diets up to 2.5 g/kg had no adverse effect on growth performance or protein and AA digestibility. Feed conversion was reduced and growth rate was retarded, when chickens were fed 5 g/kg of GSE. This study also indicated that grape polyphenols reduce the free plasma minerals.

[Percutaneous gastrostomy complicated with abdominal wall hematoma; severe anemia secondary to percutaneous endoscopic gastrostomy]. / Gastrostomía percutánea complicada con hematoma de pared abdominal; anemización severa secundaria a gastrostomía endoscópica percutánea.

Endoscopic percutaneous gastrostomy (PEG) is a safe and effective procedure that offers clear advantages over nasogastric tube feeding to ensure adequate nutrition in patients with swallowing problems who have an intact digestive tract. With proper placement and monitoring methodology there are few complications in both the peritrack procedure as in the long run. However, despite being considered a safe technique it is not devoided of serious complications. We report a patient with dysphagia, requiring percutaneous endoscopic gastrostomy placement developing a severe anemia with severe subcutaneous hematoma, given the exceptional case and literature review.

Changes in polyphenol and polysaccharide content of grape seed extract and grape pomace after enzymatic treatment.

Grape seed extract and grape pomace are rich sources of polyphenols. The aim of this study was to evaluate the release of polyphenols, the solubilisation of carbohydrate, and the antioxidant capacity of these grape by-products after enzymatic reaction with carbohydrases (cellulolytic and pectinolytic activities) and tannase for 24h. The use of tannase in these by-products, and pectinase in grape pomace changed the galloylated form of catechin to its free form, releasing gallic acid and increasing the antioxidant activity. In grape pomace, cellulase treatment was not efficient for phenolic release and antioxidant activity improvement. The addition of carbohydrases to grape pomace, either alone or in combination, degraded the cell wall polysaccharides, increasing the content of monosaccharides. These results provide relevant data about the potential of pectinase, tannase and combinations of enzymes on the release of polyphenols and monosaccharides from grape by-products, improving the antioxidant capacity and the nutritional value.

Effects of dietary polyphenol-rich grape products on intestinal microflora and gut morphology in broiler chicks.

Grapes have high amounts of phenolic compounds, which can modulate the gut activity as well as modify the structure and function of the gastrointestinal tract. The microbiological activity of avoparcin, grape pomace concentrate, and grape seed extract was evaluated in an in vitro study. An in vivo experiment was also conducted to study the effect of the inclusion of grape pomace concentrate and grape seed extract in the diet of broiler chicks on performance, intestinal microflora (by cultured and terminal restriction fragment length polymorphism methodology), and gut morphology at 21 d of age. Dietary treatments included an antibiotic-free diet (CON), a positive control (AVP; 50 mg/kg of avoparcin), and antibiotic-free diets containing grape pomace concentrate (GPC; 60 g/kg) or grape seed extract (GSE; 7.2 g/kg). Performance was not affected by dietary treatment except in the case of birds fed the GSE diet, which showed decreased weight gain. In the ileal content, birds fed CON and GSE diets had the highest populations of Lactobacillus. Compared with the CON diet, the AVP, GPC, and GSE diets increased the populations of Enterococcus and decreased the counts of Clostridium in the ileal content. In the cecal digesta, birds fed GPC and GSE diets had higher populations of Escherichia coli, Lactobacillus, Enterococcus, and Clostridium than birds in any other treatment group. Animals fed GPC and GSE diets showed a higher biodiversity degree than those fed control diets. The frequency of detection of several potential phenol-degrading bacteria as well as unidentified and uncultured organisms was increased in animals fed GPC and GSE diets. Birds fed the CON diet had longer villi and deeper crypt depth than birds in any other treatment group. The highest villi height:crypt depth ratio corresponded to birds fed GPC and AVP diets and the lowest to those fed CON and GSE diets. In conclusion, dietary polyphenol-rich grape products modify the gut morphology and intestinal microflora and increase the biodiversity degree of intestinal bacteria in broiler chicks.

Monitoring endocrine activity in kraft mill effluent treated by aerobic moving bed bioreactor system.

A Moving Bed Bioreactor (MBBR) was operated at three different hydraulic retention times for a period of 414 days. The fate of the extractive compounds and the estrogenic activity of the Pinus radiata kraft mill effluents were evaluated using Yeast Estrogen Screen (YES) and gas chromatography - mass spectrometry (GC-MS) detection. Results show that the MBBR reactor is able to remove between 80-83% of estrogenic activity present in the kraft mill Pinus radiata influent, where the values of the effluent's estrogenic activity ranged between 0.123-0.411 ng L(-1), expressed as estrogenic equivalent (EEqs) of 17-a-ethynylestradiol (EE2 eq.). Additionally, the biomass of the MBBR reactor accumulated estrogenic activity ranging between 0.29-0.37 ng EEqs EE2 during the different Hydraulic Retention Time (HRT) operations. The main groups present in pulp mills effluents, corresponding to fatty acids, hydrocarbons, phenols, sterols and triterpenes, were detected by solid phase extraction (SPE) and gas chromatography - mass spectrometry (GC-MS). The results suggest that the sterols produce the estrogenic activity in the evaluated effluent.

[Fighting the coronary artery disease epidemic in Chile: caveats in the control of cardiovascular risk factors]. / Combatiendo la epidemia de enfermedad coronaria en Chile: Potencialidades y problemas en el control de los factores de riesgo.

In this issue of the journal Lanas et al report an estimation of population attributable risk (PAR) for myocardial infarction (MI) derived from different risk factors in Chile. Cigarette smoking, dyslipidemia and hypertension accounted for 71% of total PAR. Mortality from MI has decreased in Chile, but epidemiologic surveys carried out in different hospitals across the country, strongly support that most of this effect comes from better treatment of MI. Recent changes in public health policies, favoring the treatment of hypertension and diabetes may help control cardiovascular morbidity and mortality. However, a really significant impact will be obtained when the development of the disease may be halted. To evaluate this possibility, newer methods to diagnose atherosclerosis non invasively may come to our rescue. On the other hand, pharmacologic treatment of dyslipidemia and hypertension continue to offer the most powerful way to decrease levels of cardiovascular risk factors. According to current knowledge, wise balance of non pharmacologic and pharmacologic means of primary prevention, with due respect for ethic aspects, is the most effective way to curve the epidemic of coronary artery disease in Chile.

Rotura de válvula tricúspide con insuficiencia masiva secundaria a traumatismo torácico cerrado: caso clínico / Massive tricuspid valve insufficiency after blunt chest trauma: report of one case

Cardiac valve lesions after a blunt chest trauma are rare and less than 1 percent of cardiac lesions because of chest trauma affect the tricuspid valve. We report a 70 year-old female that suffered a severe chest trauma in a car accident. Duríng the repair of the múltiple skeletal lesions, the patient had a severe hemodynamic decompensation. A myocardial trauma with pericardial effusion and massive tricuspid insufficiency, due to anterior leaflet prolapse, was diagnosed on echocardiography. After discharge the patient remained in functional class II, with hepatomegaly, jugular ingurgitation and lower limb edema. A control echocardiogram, perfomed six months after the accident, showed dilatation of right heart chambers and massive tricuspid insufficiency. The patient was operated, and a tricuspid valve repair was performed suturing the ruptured papillary muscle to the ventricular wall and performing a triscuspid annuloplasty with a prosthetic ring. After 15 months of follow up, the patient remains asymptomatic.

Combatiendo la epidemia de enfermedad coronaria en Chile: Potencialidades y problemas en el control de los factores de riesgo: [editorial] / Fighting the coronary artery disease epidemic in Chile: Caveats in the control of cardiovascular risk factors: [editorial]

In this issue of the journal Lanas et al report an estimation of population attributable risk (PAR) for myocardial infarction (MI) derived from different risk factors in Chile. Cigarette smoking, dyslipidemia and hypertension accounted for 71 percent of total PAR. Mortality from MI has decreased in Chile, but epidemiologic surveys carried out in different hospitals across the country, strongly support that most of this effect comes from better treatment of MI. Recent changes in public health policies, favoring the treatment of hypertension and diabetes may help control cardiovascular morbidity and mortality. However, a really significant impact will be obtained when the development of the disease may be halted. To evaluate this possibility, newer methods to diagnose atherosclerosis non invasively may come to our rescue. On the other hand, pharmacologic treatment of dyslipidemia and hypertension continue to offer the most powerful way to decrease levels of cardiovascular risk factors. According to current knowledge, wise balance of non pharmacologic and pharmacologic means of primary prevention, with due respect for ethic aspects, is the most effective way to curve the epidemic of coronary artery disease in Chile.

Effect on digestion and performance of dietary protein content and of increased substitution of lucerne hay with soya-bean protein concentrate in starter diets for young rabbits.

The aim of this work was to study the effect of protein source / availability on the intestinal microbiota, digestive traits and nutritional performance of early-weaned rabbits. The effects of supplemental antibiotics in the drinking water were also evaluated. Four isoenergetic and isofibrous diets were formulated: a control diet with a high protein (207 g/kg dry matter (DM)) and lucerne hay content (HPHL), a diet with low crude protein (CP) (179 g/kg DM) and high lucerne hay content (LPHL) and low protein diets in which the lucerne hay in diet LPHL was replaced partially (LPML) or totally (LPLL) with soya-bean protein concentrate. Rabbits, weaned at 25 days (52 per diet), were fed the experimental diets for a 2-week period and thereafter received a commercial diet until 56 days of age. The incidence of mortality was investigated using 70 animals per diet without supplemental medication. The profile of the ileal microbiota was studied at 35 days of age in rabbits treated (18 per diet) or not (12 per diet) with antibiotic. As expected, supplementation with antibiotics effectively reduced fattening mortality rate and microbial biodiversity. However, lowering of also the dietary CP content led to a reduction in the mortality rate ( P < 0.05), both in animals treated with (by 80%) or without (by 39%) antibiotics. In addition, there was a reduction ( P < 0.05) in the frequency of Clostridium perfringens in non-medicated animals. Neither jejunal morphology nor growth performance, over the whole fattening period, was affected by dietary CP content of the experimental diets. However, with HPHL, feed efficiency was higher (by 4.8%; P < 0.01) than with LPHL diets. Substitution of lucerne hay with soya-bean meal in low protein diets did not affect apparent faecal or ileal digestibility of DM and CP. However, the ileal digestibility of cystine, alanine, aspartic acid, and proline was lowered ( P < 0.05) with increasing substitution by soya bean. Nevertheless, ileal CP flow, incidence of mortality and presence of C. perfringens were unaffected. Our results suggest that a reduction in dietary CP, resulting in reduced lumenal flows of nitrogen through the ileum, may be beneficial for young rabbits and limit the numbers of potentially harmful bacteria in the lower gut. Modulation of dietary CP should be contemplated as a strategy to increase the intestinal health in rabbits.

Phenotypic and functional characterization of porcine granulocyte developmental stages using two new markers.

Here, we describe two new surface antigens, named 6D10 and 2B2, whose expression is restricted to porcine granulocytes. 6D10 is only detected in neutrophils and its expression decreases from promyelocytes to mature cells. By contrast, 2B2 antigen is selectively expressed in mature neutrophils, eosinophils and basophils. The expression of these antigens along granulocyte maturation allows the discrimination of several developmental stages of granulocytes based on phenotypic, morphological and functional characteristics previously established. Moreover, these new markers are useful tools to easily characterize the different granulocytes lineages (neutrophils, eosinophils and basophils). By using multiparameter flow cytometric analysis, we have performed a phenotypic and functional characterization of the granulocyte subsets identified by the combination of 6D10 and 2B2 antigens.

[Partial or total replacement of the aortic arch. Experience in 23 patients]. / Reemplazo parcial o total del arco aórtico. Experiencia en 23 pacientes.

BACKGROUND: Surgery of the aortic arch is a very complex procedure since it requires protective strategies for the brain, heart and rest of the body. AIM: To communicate our experience in the first 23 total or partial replacements of aortic arch. MATERIAL AND METHODS: Retrospective search in the database of the Cardiovascular Surgery Unit for patients subjected to partial or total replacement of the aortic arch since 1998. RESULTS: Between 1988 and 2002, 23 patients were operated. Seventeen had aortic dissection (10 acute and 7 chronic), five had an atherosclerotic aneurysm and one had a traumatic lesion. Thirteen patients were subjected to a replacement of the arch plus ascending aorta, six to a replacement of the arch plus descending aorta and four to a replacement of the arch, ascending and descending aorta. Seven patients had previous operation of the thoracic aorta. Arterial perfusion was done via the femoral artery, axillary artery or a combination of both. A hypothermic circulatory arrest was induced in 22; it was associated with cerebral retro perfusion alone in 8 patients, antegrade cerebral perfusion in 5; isolated or associated axillary perfusion was used in five patients. In seven, procedures on the aortic or mitral valve, or coronary artery operations were added. Operative mortality was 26%, 3 of the 8 patients operated as an emergency and 3 of 15 elective operations. There was no mortality among those without dissection and of 7 chronic dissections, one died. All patients were followed for an average of 45 months. Two patients required reinterventions on the aorta and one for colon cancer. There was one late death of unknown cause. Postoperative complications were agitation, bleeding and temporary vocal cord dysfunction. CONCLUSIONS: There is a learning curve, where more extensive operations, particularly those done as emergency or for dissections, had an increased operative risk.

estudio preliminar: Orégano como promotor de crecimiento en lechones destetados / Preliminary study: Oregano as a crowth promoter in weaned pigs

A pesar de la comprobada capacidad de mejorar el desempeño en los cerdos, el uso de antimicrobianos como promotores de crecimiento viene siendo progresivamente restringido en diversos países. Las nuevas reglamentaciones tienden a buscar nuevas alternativas al uso de antibióticos y quimioterapéuticos como promotores de crecimiento. Una de estas alternativas son los nutraceúticos que constituyen una de las opciones investigadas. El objetivo del trabajo fue evaluar los efectos antimicrobianos del orégano sobre la digestibilidad aparente de los nutrientes, en la ganancia diaria de peso, conversión alimenticia y presentación de diarreas en lechones recién destetados. Fueron estudiados tres grupos de lechones de 21 días de edad de la raza F1 (Landrace x Large White), durante cuatro semanas de los cuales uno de dichos grupos fue tomado como grupo control (alimento comercial), y los otros dos grupos con alimento fabricado en la granja a diferentes concentraciones de orégano (0,03 y 0,06 % respectivamente). Las dietas fabricadas son a base de harina de maíz y soya suplementados con los aminoácidos y minerales esenciales para la dieta del lechón. El proyecto tuvo duración de un mes en el cuales se midió semanalmente el peso ganado por los animales y la conversión alimenticia de los mismos; de igual forma se comparó la eficacia del orégano con respecto a una dieta normal de concentrado. Los resultados del estudio mostraron diferencias significativas entre los grupos estudiados, en cuanto a las variables ganancia diaria de peso, índice de conversión y presentación de diarreas. Se llegó a una conclusión muy significativa donde las alternativas para los antibióticos promotores de crecimiento mejoran los parámetros productivos en lechones además, del efecto antimicrobiano que poseen.

Reemplazo parcial o total del arco aórtico: Experiencia en 23 pacientes / Partial or total replacement of the aortic arch: Experience in 23 patients

Background: Surgery of the aortic arch is a very complex procedure since it requires protective strategies for the brain, heart and rest of the body. Aim: To communicate our experience in the first 23 total or partial replacements of aortic arch. Material and methods: Retrospective search in the database of the Cardiovascular Surgery Unit for patients subjected to partial or total replacement of the aortic arch since 1998. Results: Between 1988 and 2002, 23 patients were operated. Seventeen had aortic dissection (10 acute and 7 chronic), five had an atherosclerotic aneurysm and one had a traumatic lesion. Thirteen patients were subjected to a replacement of the arch plus ascending aorta, six to a replacement of the arch plus descending aorta and four to a replacement of the arch, ascending and descending aorta. Seven patients had previous operation of the thoracic aorta. Arterial perfusion was done via the femoral artery, axillary artery or a combination of both. A hypothermic circulatory arrest was induced in 22; it was associated with cerebral retro perfusion alone in 8 patients, antegrade cerebral perfusion in 5; isolated or associated axillary perfusion was used in five patients. In seven, procedures on the aortic or mitral valve, or coronary artery operations were added. Operative mortality was 26%, 3 of the 8 patients operated as an emergency and 3 of 15 elective operations. There was no mortality among those without dissection and of 7 chronic dissections, one died. All patients were followed for an average of 45 months. Two patients required reinterventions on the aorta and one for colon cancer. There was one late death of unknown cause. Postoperative complications were agitation, bleeding and temporary vocal cord dysfunction. Conclusions: There is a learning curve, where more extensive operations, particularly those done as emergency or for dissections, had an increased operative risk.

Resultados alejados de la reparación versus reemplazo en insuficiencia mitral degenerativa / Long-term results of repair versus replacement for degenerative mitral valve regurgitation

Background: Mitral valve repair is considered better than mitral valve replacement for degenerative mitral regurgitation. Aim: To evaluate late clinical results of mitral valve repair as compared to mitral valve replacement in patients with degenerative mitral regurgitation. Patients and methods: All patients subjected to open heart surgery for degenerative mitral regurgitation between 1990 and 2002 were assessed for surgical mortality, late cardiac and overall mortality, reoperation, readmission to hospital, functional capacity and anticoagulant therapy. Eighty eight patients (48 males) had mitral valve repair and 28 (19 males) had mitral valve replacement (23 with a mechanical prosthesis). Mean age was 59.9 ± 14.8 (SD) and 61.3 ± 14.6 years, respectively. Sixty three percent of patients with repair and 50% of those with valve replacement were in functional class III or IV before surgery. Results: Operative mortality was 2.3% for mitral valve repair and 3.6% for mitral valve replacement (NS). Also, there was no statistical difference in the need of reoperation during the follow-up period between both procedures (2.3% and 0%, respectively). Ninety four percent of the replacement patients but only 26% of the repair patients were in anticoagulant therapy at the end of the follow-up period (p <0.001). Ten years survival rates were 82 ± 6% for mitral valve repair and 54 ± 11% for replacement. The corresponding cardiac related survival rates were 89 ± 6% and 79 ± 10%. At the end of follow-up, all surviving patients were in functional class I or II. Ten years freedom from cardiac event rates (death, cardiac related rehospitalization and reoperation) were 90 ± 3% for mitral valve repair and 84 ± 6% for replacement. Conclusion: Repair of the mitral valve offers a better overall survival and a better chance of freedom from cardiac events as well as need for anticoagulation 10 years after surgery.

Insuficiente control de factores de riesgo en prevención secundaria cardiovascular / Prevalence of cardiovascular risk factors among patients suffering vascular events on admission and one year later

Background: International studies show a low compliance with norms for the management of cardiovascular risk factors. Aim: To assess the prevalence of risk factors in patients admitted for a coronary or vascular event and to evaluate the proportion of patients that normalize these factors after one year of follow up. Material and Methods: Three hundred and fifty seven patients aged 64±13 years (264 males), admitted to a University Clinical Hospital for a coronary or vascular event were studied. They were educated about cardiovascular risk factors and followed by their treating physicians for a mean of 11.9±2 months. During this period, smoking habits, body mass index. blood pressure, serum lipid levels, blood glucose and the appearance of new cardiovascular events were registered. Results: One year survival was 96% (all 13 deaths were of cardiac origin). Eighty seven percent of patients were free of major cardiovascular events. At discharge from hospital and at the end of follow up 49% and 44% had a total cholesterol over 200 mg/dl respectively, 9,6% and 20,8% had systolic pressure over 140 mmHg. There was no diastolic hypertension in these patients, 27% and 31% had a body mass index over 25 kg/m2 and 2% smoked (versus 32% before the event). Conclusions: After one year of follow up, the prevalence of risk factors in patients that had suffered a cardiovascular event, continues to be high.

Differential expression of chemokine receptors and CD95 in porcine CD4(+) T cell subsets.

Among other differences, naïve and memory T cells show distinct migratory patterns and susceptibility to CD95-mediated cell death. We have recently characterised in the pig two subsets of CD4(+) T cells, based on the expression of the 2E3 marker, that display phenotypic and functional features of naïve (CD4(+)2E3(+)) and effector/memory (CD4(+)2E3(-)) T cells. In this study, we have analysed the expression of several chemokine receptors, as well as the distribution of CD95 antigen (APO-1/Fas) in these CD4(+) T cell subsets. CD4(+)2E3(-) T cells express high levels of CXCR3 and CCR4 transcripts but not of CCR7. On the contrary, CCR7 is clearly detected in CD4(+)2E3(+) T cells, whereas CXCR3 and CCR4 are negative or present at trace levels. These subsets also differ in the expression of CD95 antigen, being CD95 positive cells significantly more abundant in the CD4(+)2E3(-) cell subset. These findings, although based on a small number of animals, fit well with those reported for naïve and memory CD4(+) T cells in humans.