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1.
Oecologia ; 186(1): 185-194, 2018 01.
Artículo en Inglés | MEDLINE | ID: mdl-29164371

RESUMEN

Although most studies of mutualisms focus on a single partner at a time, host species often associate with multiple mutualist partners simultaneously. Because of potential interactions between mutualists, only studying a single type of mutualism could lead to a biased perspective of mutualism benefit and how mutualisms may scale-up to affect communities. The legume Chamaecrista fasciculata engages in a resource mutualism with nitrogen-fixing rhizobia and also forms symbiotic interactions with ants by providing nectar in exchange for defense against herbivores. Although they provide very different benefits to the plant, both mutualists receive carbon resources from the plant. As a result, these two mutualists are likely to interact, potentially competing for carbon resources or mutually benefitting each other via their positive effects on plant hosts. In a full-factorial field experiment, we explored how rhizobia and ants influence one another, C. fasciculata fitness, and the associated arthropod community. Ants reduced plant allocation to rhizobia, but ants also increased rhizobia contamination of uninoculated plants, suggesting that ants may disperse rhizobia. In turn, rhizobia increased ant abundances, with ants preferentially tending plants with rhizobia. Chamaecrista fasciculata received substantial fitness benefits from rhizobia; in contrast, associating with ants reduced fitness. Additionally, the mutualists interacted to influence the abundance of other arthropods found on the plants. Rhizobia increased arthropod abundances, likely because more nitrogen-rich leaf tissue was more attractive to arthropod herbivores, but ants negated these increases. As these results illustrate, multiple mutualists may interact, influencing each other's abundance and the abundance of other community members.


Asunto(s)
Hormigas , Artrópodos , Chamaecrista , Rhizobium , Animales , Simbiosis
3.
Front Sociol ; 9: 1368104, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38659715

RESUMEN

Introduction: This paper explores older adults' perceptions on sexuality and affectivity in Chile, according to class and sex. Methods: The study is based on computer-assisted telephonic interviews with people aged 60 and over, men and women (n = 481). Data were analyzed using chi-squared tests and binary logistic regressions. Results and discussion: Maintaining an active sex life is important for older adults of both sexes, contradicting the commonsense view according to which the relevance allocated to sex decreases significantly with age. However, the data show significant differences in perceptions by sex, suggesting that gendered conceptions regarding sexuality are influential along the entire life cycle. There are also relevant differences according to class, revealing the inequalities present in the expression of sexuality in Chile.

4.
Int J Sex Health ; 36(1): 46-58, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38600899

RESUMEN

This article analyzes some aspects of Chilean young people's (aged 15-29) sex life according to sex and socioeconomic background. Using data from the Tenth National Youth Survey, descriptive and inferential analyses were carried out to test possible differences in sexual practices according to these variables. Results show that young Chileans are increasingly diversifying sexual practices. Differences in age at the first sexual relationship between men and women are also becoming less clear; likewise, differences found by socioeconomic background were also weak, suggesting that some practices are common across different groups of youth. The most significant differences found concern certain practices (oral and anal sex), the number of sexual partners men and women have, and the type of relationship (romantic partner, friend, acquaintance) in which sexual encounters take place. We conclude that young people's sexual practices are increasingly being oriented toward self-exploration and personal satisfaction, and less toward the (traditional) goal of forming a family. Nonetheless, the existence of a "double standard" regarding sexual morals can still account for contrasting behaviors according to sex, suggesting the persistence of a gendered normativity. Also, sexual exploration often occurs without adequate information, reducing youngsters' ability to reduce risks or prevent undesired consequences.

5.
J Am Heart Assoc ; 13(17): e032901, 2024 Sep 03.
Artículo en Inglés | MEDLINE | ID: mdl-39190595

RESUMEN

BACKGROUND: Cerebrovascular events remain one of the most devastating complications of transcatheter aortic valve implantation (TAVI). Data from real-world contemporary cohorts on longitudinal trends and outcomes remain limited. The aim of this study was to assess incidence, temporal trends, predictors, and outcomes of cerebrovascular events following transfemoral TAVI. METHODS AND RESULTS: The CENTER2 (Cerebrovascular Events in Patients Undergoing Transcatheter Aortic Valve Implantation With Balloon-Expandable Valves Versus Self-Expandable Valves 2) study includes patients undergoing TAVI between 2007 and 2022. The database contains pooled patient-level data from 10 clinical studies. A total of 24 305 patients underwent transfemoral TAVI (mean age 81.5±6.7 years, 56% women, median Society of Thoracic Surgeon Predicted Risk of Mortality 4.9% [3.1%-8.5%]). Of these patients, 2.2% (n=534) experienced stroke in the first 30 days after TAVI, and 40 (0.4%) had a transient ischemic attack. Stroke rates remained stable during the treatment period (2007-2010: 2.1%, 2011-2014: 2.5%, 2015-2018: 2.1%, 2019-2022: 2.1%; Ptrend=0.28). Moreover, 30-day cerebrovascular event rates were similar across Society of Thoracic Surgeon Predicted Risk of Mortality risk categories: 2.1% in low-risk, 2.6% in intermediate-risk, and 2.5% in high-risk patients (P=0.21). Mortality was higher in patients with 30-day stroke than without at 30 days (20.3% versus 4.7%; odds ratio, 5.1 [95% CI, 4.1-6.5]; P<0.001) and at 1 year (44.1% versus 15.0%; hazard ratio, 3.5 [95% CI, 3.0-4.2]; P<0.001). One-year mortality rates for stroke did not decline over time (2007-2010: 46.9%, 2011-2014: 46.0%, 2015-2018: 43.0%, 2019-2022: 39.1%; Ptrend=0.32). At 1 year, 7.0% of patients undergoing TAVI had a stroke. CONCLUSIONS: In 24 305 patients who underwent transfemoral TAVI, 30-day cerebrovascular event incidence remained ≈ 2.2% between 2007 and 2022. Thirty-day stroke rates were similar throughout Society of Thoracic Surgeon Predicted Risk of Mortality risk categories. Mortality rates after stroke remain high. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03588247.


Asunto(s)
Estenosis de la Válvula Aórtica , Reemplazo de la Válvula Aórtica Transcatéter , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/mortalidad , Arteria Femoral , Incidencia , Ataque Isquémico Transitorio/epidemiología , Ataque Isquémico Transitorio/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/etiología , Medición de Riesgo/métodos , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Factores de Tiempo , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Reemplazo de la Válvula Aórtica Transcatéter/mortalidad , Resultado del Tratamiento
6.
Sci Data ; 10(1): 164, 2023 03 23.
Artículo en Inglés | MEDLINE | ID: mdl-36959253

RESUMEN

Supervised analysis using spectral data requires a well-informed characterisation of the response variables and abundant spectral data points. The presented hyperspectral dataset comes from five sets of geometallurgical samples, each characterised by different methods. To provide the spectral data, all mineral samples were scanned with SPECIM VNIR and SWIR hyperspectral cameras. For each subset the following data are provided 1) hyperspectral reflectance images in the VNIR spectral range (400-1000 nm wavelength); 2) hyperspectral reflectance images in the SWIR spectral range (900-2500 nm wavelength); 3) hyperspectral reflectance images in the VNIR-SWIR range (merged to SWIR spatial resolution); 4) RGB images constructed from hyperspectral data using a Bilateral Filter based sensor fusion method; 5) response variables representing mineral sample characterisation results, provided as training and validation data. This dataset is intended for use in general regression and classification research and experiments. All subsets were validated using machine learning models with satisfactory results.

7.
Cardiol J ; 29(2): 216-227, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-32329041

RESUMEN

BACKGROUND: Heart failure (HF) with preserved ejection fraction (HFpEF) and monoclonal gammopathy of uncertain significance (MGUS) are two entities that share pathophysiological mechanisms. The aim herein, was to assess the prevalence of MGUS in patients with HFpEF and no left ventricular (LV) hypertrophy, as well as its association with a pre-specified clinical endpoint at 12 months. METHODS: The present study prospectively enrolled 69 patients admitted with HF, with ejection fraction ≥ 50%, and LV wall thickness < 12 mm. All patients were screened for MGUS. Clinical events were determined over a 12 month follow-up. The pre-specified composite clinical endpoint was readmission for HF or death. RESULTS: The prevalence of MGUS in this population was 13%. There were no differences in the incidence of the composite clinical endpoint between patients with and without MGUS. Multivariate analysis showed that treatment with angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) was associated with fewer clinical events (HR: 0.153, 95% CI: 0.037-0.622, p = 0.009) and indicated a trend to lower risk of readmission for HF and death. Beta-blockers were associated with lower rates of the composite clinical endpoint (HR: 0.192, 95% CI: 0.05-0.736, p = 0.016), readmission for HF (HR: 0.272, 95% CI: 0.087-0.851, p = 0.025) and indicated a trend to lower mortality. Moreover, potassium serum levels > 5 mEq/L were associated with higher rates of the composite endpoint (HR: 6.074, 95% CI: 1.6-22.65, p = 0.007). CONCLUSIONS: The prevalence of MGUS in patients with HFpEF without hypertrophy was 3-fold that of the general population. There was no significant correlation between clinical outcomes and the presence of MGUS. Beta-blockers and ACEIs/ARBs reduced the composite of mortality and readmissions for HF in HFpEF patients. Hyperpotassemia was related to worse prognosis.


Asunto(s)
Insuficiencia Cardíaca , Paraproteinemias , Antagonistas Adrenérgicos beta/uso terapéutico , Antagonistas de Receptores de Angiotensina/uso terapéutico , Inhibidores de la Enzima Convertidora de Angiotensina/uso terapéutico , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/epidemiología , Humanos , Hipertrofia/tratamiento farmacológico , Paraproteinemias/tratamiento farmacológico , Prevalencia , Pronóstico , Estudios Prospectivos , Volumen Sistólico/fisiología , Función Ventricular Izquierda/fisiología
8.
Am J Cardiol ; 162: 31-40, 2022 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-34903344

RESUMEN

Currently, both drug-eluting stents (DES) and drug-eluting balloons are recommended in patients with in-stent restenosis (ISR) of metallic stents. However, the clinical results of repeated interventions in patients with restenosis of bioresorbable vascular scaffolds (BVS) remain unsettled. We sought to assess the results of interventions in patients with BVS-ISR as compared with those obtained in patients with ISR of DES and bare-metal stents (BMS). Restenosis Intrastent: Treatment of Bioresorbable Vascular Scaffolds Restenosis (RIBS VII) is a prospective multicenter study (23 Spanish sites) that included 117 consecutive patients treated for BVS-ISR. Inclusion/exclusion criteria were similar to those of previous RIBS studies. Patients in the RIBS IV (DES-ISR, n = 309) and RIBS V (BMS - ISR, n = 189) randomized trials, were used as controls. Most patients with BVS-ISR were treated with DES (76%). Patients with BVS-ISR were younger, had larger vessels, and after interventions had higher in-segment residual diameter stenosis (19 ± 13%, 15 ± 11%, 15 ± 12%, p <0.001) than those treated for DES-ISR and BMS-ISR, respectively. At 1-year clinical follow-up (obtained in 100% of patients) target lesion revascularization (6%) was similar to that seen in patients with DES-ISR and BMS-ISR (8.7% and 3.7%, p = 0.32). Freedom from death, myocardial infarction, and target vessel revascularization (primary clinical end point) was 8.5%, also similar to that found in patients with DES-ISR and BMS-ISR (14.2% and 7.4%, p = 0.09). Results were also similar when only patients treated with DES in each group were compared and remained unchanged after adjusting for potential confounders in baseline characteristics. Time to BVS-ISR did not influence angiographic or clinical results. This study demonstrates the safety and efficacy of coronary interventions for patients presenting with BVS-ISR. One-year clinical results in these patients are comparable to those seen in patients with ISR of metallic stents (ClinicalTrials.gov ID:NCT03167424).


Asunto(s)
Implantes Absorbibles/efectos adversos , Enfermedad de la Arteria Coronaria/cirugía , Reestenosis Coronaria/cirugía , Oclusión de Injerto Vascular/cirugía , Intervención Coronaria Percutánea/efectos adversos , Stents/efectos adversos , Anciano , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/mortalidad , Reestenosis Coronaria/diagnóstico , Reestenosis Coronaria/epidemiología , Femenino , Oclusión de Injerto Vascular/diagnóstico , Oclusión de Injerto Vascular/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/instrumentación , Estudios Prospectivos , Reoperación , Factores de Tiempo , Resultado del Tratamiento
9.
Psychiatry Res ; 186(2-3): 315-9, 2011 Apr 30.
Artículo en Inglés | MEDLINE | ID: mdl-20858567

RESUMEN

There is agreement in that strengthening the sets of neurobiological data would reinforce the diagnostic objectivity of many psychiatric entities. This article attempts to use this approach in borderline personality disorder (BPD). Assuming that most of the biological findings in BPD reflect common underlying pathophysiological processes we hypothesized that most of the data involved in the findings would be statistically interconnected and interdependent, indicating biological consistency for this diagnosis. Prospectively obtained data on scalp and sleep electroencephalography (EEG), clinical neurologic soft signs, the dexamethasone suppression and thyrotropin-releasing hormone stimulation tests of 20 consecutive BPD patients were used to generate a Bayesian network model, an artificial intelligence paradigm that visually illustrates eventual associations (or inter-dependencies) between otherwise seemingly unrelated variables. The Bayesian network model identified relationships among most of the variables. EEG and TSH were the variables that influence most of the others, especially sleep parameters. Neurological soft signs were linked with EEG, TSH, and sleep parameters. The results suggest the possibility of using objective neurobiological variables to strengthen the validity of future diagnostic criteria and nosological characterization of BPD.


Asunto(s)
Teorema de Bayes , Trastorno de Personalidad Limítrofe/diagnóstico , Trastorno de Personalidad Limítrofe/fisiopatología , Adulto , Inteligencia Artificial , Dexametasona , Electroencefalografía , Electrorretinografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Examen Neurológico , Trastornos del Sueño-Vigilia , Hormona Liberadora de Tirotropina/metabolismo , Adulto Joven
10.
JACC Cardiovasc Imaging ; 14(9): 1742-1754, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-33865783

RESUMEN

OBJECTIVES: This study sought to clinically validate a novel 3-dimensional (3D) ultrafast cardiac magnetic resonance (CMR) protocol including cine (anatomy and function) and late gadolinium enhancement (LGE), each in a single breath-hold. BACKGROUND: CMR is the reference tool for cardiac imaging but is time-consuming. METHODS: A protocol comprising isotropic 3D cine (Enhanced sensitivity encoding [SENSE] by Static Outer volume Subtraction [ESSOS]) and isotropic 3D LGE sequences was compared with a standard cine+LGE protocol in a prospective study of 107 patients (age 58 ± 11 years; 24% female). Left ventricular (LV) mass, volumes, and LV and right ventricular (RV) ejection fraction (LVEF, RVEF) were assessed by 3D ESSOS and 2D cine CMR. LGE (% LV) was assessed using 3D and 2D sequences. RESULTS: Three-dimensional and LGE acquisitions lasted 24 and 22 s, respectively. Three-dimensional and LGE images were of good quality and allowed quantification in all cases. Mean LVEF by 3D and 2D CMR were 51 ± 12% and 52 ± 12%, respectively, with excellent intermethod agreement (intraclass correlation coefficient [ICC]: 0.96; 95% confidence interval [CI]: 0.94 to 0.97) and insignificant bias. Mean RVEF 3D and 2D CMR were 60.4 ± 5.4% and 59.7 ± 5.2%, respectively, with acceptable intermethod agreement (ICC: 0.73; 95% CI: 0.63 to 0.81) and insignificant bias. Both 2D and 3D LGE showed excellent agreement, and intraobserver and interobserver agreement were excellent for 3D LGE. CONCLUSIONS: ESSOS single breath-hold 3D CMR allows accurate assessment of heart anatomy and function. Combining ESSOS with 3D LGE allows complete cardiac examination in <1 min of acquisition time. This protocol expands the indication for CMR, reduces costs, and increases patient comfort.


Asunto(s)
Medios de Contraste , Imagen por Resonancia Cinemagnética , Anciano , Femenino , Gadolinio , Humanos , Imagenología Tridimensional , Espectroscopía de Resonancia Magnética , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Reproducibilidad de los Resultados
11.
Cardiol J ; 26(4): 310-321, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31257567

RESUMEN

BACKGROUND: A simplified formula to calculate the predicted fractional flow reserve (FFR) in sequen-tial coronary stenosis without balloon inflation is hereby proposed. METHODS: In patients with an indication for FFR and sequential coronary stenosis, FFR was recorded distally and between the lesions. The predicted FFR for each stenosis was calculated with a novel formu-la. While treating one of the lesions, wedge pressure was measured during balloon inflation to calculate Pijls' formula. FFR of the remaining lesion was finally recorded (measured FFR). RESULTS: Forty patients were enrolled in the study, 4 (10.0%) had a distal FFR > 0.80 and were excluded from the main analysis. In the remaining 36 patients, the novel formula and Pijls' formula showed virtually absolute agreement (ICCa 0.999, R2 = 0.997 for the proximal lesion, R2 = 0.999 for the distal lesion, kappa 1.000, Se 100%, Sp 100%). The agreement between predicted and measured FFR was good (ICCa 0.820; 0.640-0.909, R2 = 0.717, intercept = 0.05, slope = 0.92, kappa 0.748, Se 75%, Sp 96%). In 19 (47.5%) cases the use of the formula enabled the operator to freely decide which lesion should be treated first, an option not available if the percutaneous coronary intervention (PCI) were guided by the largest pressure drop across each lesion. CONCLUSIONS: The predicted FFR for each lesion in sequential coronary stenosis can be accurately calculated by a simplified formula circumventing the need for balloon inflation. This approach provides the operator upfront, with detailed information on physiology, thus having a potentially high impact on the corresponding PCI strategy.


Asunto(s)
Cateterismo Cardíaco , Enfermedad de la Arteria Coronaria/diagnóstico , Estenosis Coronaria/diagnóstico , Vasos Coronarios/fisiopatología , Reserva del Flujo Fraccional Miocárdico , Modelos Cardiovasculares , Anciano , Toma de Decisiones Clínicas , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/fisiopatología , Enfermedad de la Arteria Coronaria/terapia , Estenosis Coronaria/fisiopatología , Vasos Coronarios/diagnóstico por imagen , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea , Proyectos Piloto , Valor Predictivo de las Pruebas , Estudios Prospectivos , Reproducibilidad de los Resultados
12.
Europace ; 9(12): 1196-201, 2007 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-17965013

RESUMEN

AIMS: Cardiac remote telemetry (CR-TEL) is in wide use in cardiac units, but its diagnostic value in the setting of unexplained syncope is unknown. METHODS: One hundred and two consecutive patients (73 +/- 14 years) arriving to the emergency department due to an unexplained syncope were admitted under CR-TEL. Heart rhythm was continuously monitored from a central station by trained nurses. Events included all causes of mortality and arrhythmias unnoticed on emergency department. RESULTS: Thirty patients (29.4%) presented events. There were no deaths during the time of monitoring (4.8 +/- 2.7 days). Events requiring transfer to the coronary care units (CCU) occurred in 15 patients (14.7%), principally due to AV-block and extreme bradycardia. Cardiac remote telemetry was diagnostic in 18 patients (17.6%) in whom the arrhythmic event occurred simultaneously with the syncopal episode. Multivariate analysis showed that age > or =86 years (P < 0.01) and heart failure on admission (P < 0.04) were the strongest predictors of events. All transfers to the CCU were documented within the first 4 days. The best cut-off point as a threshold for CR-TEL monitoring time was 72 hours (sensitivity 73%, specificity 86%). CONCLUSION: Cardiac remote telemetry appears to be a useful tool in the management of patients with unexplained syncope, especially in those older and presenting heart failure on admission.


Asunto(s)
Unidades de Cuidados Coronarios/métodos , Electrocardiografía/métodos , Síncope/etiología , Síncope/fisiopatología , Telemetría/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Arritmias Cardíacas/complicaciones , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/fisiopatología , Determinación de Punto Final , Femenino , Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Frecuencia Cardíaca/fisiología , Humanos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Selección de Paciente , Estudios Prospectivos
13.
PLoS One ; 11(5): e0152816, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27171378

RESUMEN

BACKGROUND AND OBJECTIVES: We investigated the relationship of the Syntax Score (SS) and coronary artery calcification (CAC), with plasma levels of biomarkers related to cardiovascular damage and mineral metabolism, as there is sparse information in this field. METHODS: We studied 270 patients with coronary disease that had an acute coronary syndrome (ACS) six months before. Calcidiol, fibroblast growth factor-23, parathormone, phosphate and monocyte chemoattractant protein-1 [MCP-1], high-sensitivity C-reactive protein, galectin-3, and N-terminal pro-brain natriuretic peptide [NT-proBNP] levels, among other biomarkers, were determined. CAC was assessed by coronary angiogram as low-grade (0-1) and high-grade (2-3) calcification, measured with a semiquantitative scale ranging from 0 (none) to 3 (severe). For the SS study patients were divided in SS<14 and SS≥14. Multivariate linear and logistic regression analyses were performed. RESULTS: MCP-1 predicted independently the SS (RC = 1.73 [95%CI = 0.08-3.39]; p = 0.040), along with NT-proBNP (RC = 0.17 [95%CI = 0.05-0.28]; p = 0.004), male sex (RC = 4.15 [95%CI = 1.47-6.83]; p = 0.003), age (RC = 0.13 [95%CI = 0.02-0.24]; p = 0.020), hypertension (RC = 3.64, [95%CI = 0.77-6.50]; p = 0.013), hyperlipidemia (RC = 2.78, [95%CI = 0.28-5.29]; p = 0.030), and statins (RC = 6.12 [95%CI = 1.28-10.96]; p = 0.013). Low calcidiol predicted high-grade calcification independently (OR = 0.57 [95% CI = 0.36-0.90]; p = 0.013) along with ST-elevation myocardial infarction (OR = 0.38 [95%CI = 0.19-0.78]; p = 0.006), diabetes (OR = 2.35 [95%CI = 1.11-4.98]; p = 0.028) and age (OR = 1.37 [95%CI = 1.18-1.59]; p<0.001). During follow-up (1.79 [0.94-2.86] years), 27 patients developed ACS, stroke, or transient ischemic attack. A combined score using SS and CAC predicted independently the development of the outcome. CONCLUSIONS: MCP-1 and NT-proBNP are independent predictors of SS, while low calcidiol plasma levels are associated with CAC. More studies are needed to confirm these data.


Asunto(s)
Calcifediol/sangre , Quimiocina CCL2/sangre , Enfermedad de la Arteria Coronaria/sangre , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Anciano , Biomarcadores/sangre , Calcinosis , Enfermedad de la Arteria Coronaria/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Calcificación Vascular/metabolismo , Calcificación Vascular/patología
14.
Am J Cardiol ; 118(4): 578-84, 2016 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-27378142

RESUMEN

Vascular complications in transcatheter aortic valve implantation using transfemoral approach are related to higher mortality. Complete percutaneous approach is currently the preferred technique for vascular access. However, some centers still perform surgical cutdown. Our purpose was to determine complications related to vascular access technique in the population of the Spanish TAVI National Registry. From January 2010 to July 2015, 3,046 patients were included in this Registry. Of them, 2,465 underwent transfemoral approach and were treated with either surgical cutdown and closure (cutdown group, n = 632) or percutaneous approach (puncture group, n = 1,833). Valve Academic Research Consortium-2 definitions were used to assess vascular and bleeding complications. Propensity matching resulted in 615 matched pairs. Overall, 30-day vascular complications were significantly higher in the puncture group (109 [18%] vs 42 [6.9%]; relative risk [RR] 2.60; 95% confidence interval [CI] 1.85 to 3.64, p <0.001) due mostly by minor vascular events (89 [15%] vs 25 [4.1%], RR 3.56, 95% CI 2.32 to 5.47, p <0.001). Bleeding rates were lower in the puncture group (18 [3%] vs 40 [6.6%], RR 0.45, 95% CI 0.26 to 0.78, p = 0.003) mainly driven by major bleeding (9 [1.5%] vs 21 [3.4%], RR 0.43, 95% CI 0.20 to 0.93, p = 0.03). At a mean follow-up of 323 days, complication rates remained significantly different between groups (minor vascular complications 90 [15%] vs 31 [5.1%], hazard ratio 2.99, 95% CI 1.99 to 4.50, p <0.001 and major bleeding 10 [1.6%] vs 21 [3.4%], hazard ratio 0.47, 95% CI 0.22 to 1.0, p = 0.04, puncture versus cutdown group, respectively). In conclusion, percutaneous approach yielded higher rates of minor vascular complications but lower rates of major bleeding compared with the surgical cutdown, both at 30-day and at mid-term follow-up in our population.


Asunto(s)
Estenosis de la Válvula Aórtica/cirugía , Disección/métodos , Arteria Femoral , Infarto del Miocardio/epidemiología , Hemorragia Posoperatoria/epidemiología , Punciones/métodos , Sistema de Registros , Reemplazo de la Válvula Aórtica Transcatéter/métodos , Anciano , Anciano de 80 o más Años , Medios de Contraste , Femenino , Fluoroscopía , Humanos , Estimación de Kaplan-Meier , Tiempo de Internación , Masculino , Tempo Operativo , Complicaciones Posoperatorias/epidemiología , Modelos de Riesgos Proporcionales , España
15.
J Am Coll Cardiol ; 67(23): 2705-2715, 2016 Jun 14.
Artículo en Inglés | MEDLINE | ID: mdl-27050189

RESUMEN

BACKGROUND: The impact of intravenous (IV) beta-blockers before primary percutaneous coronary intervention (PPCI) on infarct size and clinical outcomes is not well established. OBJECTIVES: This study sought to conduct the first double-blind, placebo-controlled international multicenter study testing the effect of early IV beta-blockers before PPCI in a general ST-segment elevation myocardial infarction (STEMI) population. METHODS: STEMI patients presenting <12 h from symptom onset in Killip class I to II without atrioventricular block were randomized 1:1 to IV metoprolol (2 × 5-mg bolus) or matched placebo before PPCI. Primary endpoint was myocardial infarct size as assessed by cardiac magnetic resonance imaging (CMR) at 30 days. Secondary endpoints were enzymatic infarct size and incidence of ventricular arrhythmias. Safety endpoints included symptomatic bradycardia, symptomatic hypotension, and cardiogenic shock. RESULTS: A total of 683 patients (mean age 62 ± 12 years; 75% male) were randomized to metoprolol (n = 336) or placebo (n = 346). CMR was performed in 342 patients (54.8%). Infarct size (percent of left ventricle [LV]) by CMR did not differ between the metoprolol (15.3 ± 11.0%) and placebo groups (14.9 ± 11.5%; p = 0.616). Peak and area under the creatine kinase curve did not differ between both groups. LV ejection fraction by CMR was 51.0 ± 10.9% in the metoprolol group and 51.6 ± 10.8% in the placebo group (p = 0.68). The incidence of malignant arrhythmias was 3.6% in the metoprolol group versus 6.9% in placebo (p = 0.050). The incidence of adverse events was not different between groups. CONCLUSIONS: In a nonrestricted STEMI population, early intravenous metoprolol before PPCI was not associated with a reduction in infarct size. Metoprolol reduced the incidence of malignant arrhythmias in the acute phase and was not associated with an increase in adverse events. (Early-Beta blocker Administration before reperfusion primary PCI in patients with ST-elevation Myocardial Infarction [EARLY-BAMI]; EudraCT no: 2010-023394-19).


Asunto(s)
Antagonistas Adrenérgicos beta/administración & dosificación , Metoprolol/administración & dosificación , Intervención Coronaria Percutánea , Premedicación , Infarto del Miocardio con Elevación del ST/terapia , Arritmias Cardíacas/epidemiología , Creatina Quinasa/análisis , Método Doble Ciego , Servicios Médicos de Urgencia , Femenino , Humanos , Inyecciones Intravenosas , Imagen por Resonancia Cinemagnética , Masculino , Persona de Mediana Edad , Países Bajos/epidemiología , Infarto del Miocardio con Elevación del ST/diagnóstico por imagen , España/epidemiología , Volumen Sistólico
16.
Circulation ; 106(8): 968-73, 2002 Aug 20.
Artículo en Inglés | MEDLINE | ID: mdl-12186802

RESUMEN

BACKGROUND: Pulmonary vein isolation with radiofrequency catheter ablation techniques is used to prevent recurrences of human atrial fibrillation. Visualization of the architecture at the venoatrial junction could be crucial for these ablative techniques. Our study assesses the potential for intravascular ultrasound to provide this information. METHODS AND RESULTS: We retrieved 32 pulmonary veins from 8 patients dying from noncardiac causes. We obtained cross-sectional intravascular ultrasound (IVUS) images with a 3.2F, 30-MHz ultrasound catheter at intervals on each vein. Histological cross-sections at the intervals allowed comparisons with ultrasonic images. The pulmonary venous wall at the venoatrial junction revealed a 3-layered ultrasonic pattern. The inner echogenic layer represents both endothelium and connective tissue of the media (mean maximal thickness, 1.4+/-0.3 mm). The middle hypoechogenic stratum corresponds to the sleeves of left atrial myocardium surrounding the external aspect of the venous media. This layer was thickest at the venoatrial junction (mean maximal thickness, 2.6+/-0.8 mm) and decreased toward the lung hilum. The outer echodense layer corresponds to fibro-fatty adventitial tissue (mean maximal thickness, 2.15+/-0.36 mm). We found a close agreement among the IVUS and histological measurements for maximal luminal diameter (mean difference, -0.12+/-1.3 mm) and maximal muscular thickness (mean difference, 0.17+/-0.13 mm) using the Bland and Altman method. CONCLUSIONS: Our experimental study demonstrates for the first time that IVUS images of the pulmonary veins can provide information on the distal limits and thickness of the myocardial sleeves and can be a valuable tool to help accurate targeting during ablative procedures.


Asunto(s)
Venas Pulmonares/anatomía & histología , Venas Pulmonares/diagnóstico por imagen , Ultrasonografía/métodos , Adulto , Anciano , Anatomía Transversal , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/cirugía , Ablación por Catéter/métodos , Ecocardiografía , Femenino , Corazón/anatomía & histología , Humanos , Masculino , Persona de Mediana Edad
17.
Cardiovasc Res ; 57(1): 109-18, 2003 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-12504820

RESUMEN

AIM: To assess whether endothelin-1 (ET-1) induces the in vivo expression of inflammatory-related proteins, namely cyclooxygenase-2 (COX-2) and tissue factor, in the myocardium and circulating leukocytes of guinea-pigs. The involvement of platelets was also analyzed. METHODS: ET-1 (0.013 microg/min) was infused to male guinea-pigs for 45 min in the presence and absence of tirofiban, a nonpeptidic blocker of the glycoprotein IIb/IIIa receptor (GPIIb/IIIa). Tissue factor and COX-2 expression were determined by Western blot. RESULTS: No changes in mean arterial pressure and heart rate were detected. ET-1-infused guinea-pigs showed a marked increase in the number of platelets expressing activated GPIIb/IIIa receptors (0.8+/-0.03% vs. 6.5+/-0.2%; P<0.05). Tirofiban (10 microg/Kg bw/min) blunted ex vivo platelet aggregation in response to ADP, although only partially reduced COX-2 and tissue factor expression in both the myocardium and leukocytes of ET-1-infused guinea-pigs. The myocardium of platelet-depleted guinea-pigs also showed a reduced COX-2 expression after ET-1 infusion (57+/-3% reduction; P<0.05). In vitro studies demonstrated that platelets (10(7) and 10(9) platelets/well) enhanced ET-1 (10(-7) mol/l)-induced COX-2 expression in heart slices. CONCLUSION: ET-1 stimulated in vivo the expression of the pro-inflammatory proteins COX-2 and tissue factor in the myocardium and in leukocytes by a mechanism GPIIb/IIIa platelet receptors.


Asunto(s)
Plaquetas/metabolismo , Endotelina-1/farmacología , Leucocitos Mononucleares/metabolismo , Miocardio/metabolismo , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/metabolismo , Animales , Células Cultivadas , Ciclooxigenasa 2 , Cobayas , Isoenzimas/análisis , Isoenzimas/metabolismo , Masculino , Recuento de Plaquetas , Complejo GPIIb-IIIa de Glicoproteína Plaquetaria/antagonistas & inhibidores , Prostaglandina-Endoperóxido Sintasas/análisis , Prostaglandina-Endoperóxido Sintasas/metabolismo , Estimulación Química , Tromboplastina/análisis , Tromboplastina/metabolismo , Tirofibán , Tirosina/análogos & derivados , Tirosina/farmacología
20.
Med Clin North Am ; 87(6): 1165-77, 2003 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-14680298

RESUMEN

A 20-year-old otherwise healthy woman on oral contraceptive pills presents with sudden-onset left leg swelling and pain extending from her calf to her groin. Pulmonary embolism symptoms are lacking. Venous duplex ultrasound reveals acute deep venous thrombosis (DVT) involving the distal external iliac, common femoral, superficial femoral, and popliteal veins. Her leg is markedly swollen, slightly cool to the touch, but has preserved pedal pulses. She is unable to ambulate secondary to pain. Thrombolytic therapy to eliminate the DVT is recommended.


Asunto(s)
Vena Femoral , Vena Ilíaca , Terapia Trombolítica , Trombosis de la Vena/tratamiento farmacológico , Adulto , Femenino , Humanos
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