Discovery of non-HLA antibodies associated with cardiac allograft rejection and development and validation of a non-HLA antigen multiplex panel: From bench to bedside.

We analyzed humoral immune responses to nonhuman leukocyte antigen (HLA) after cardiac transplantation to identify antibodies associated with allograft rejection. Protein microarray identified 366 non-HLA antibodies (>1.5 fold, P < .5) from a discovery cohort of HLA antibody-negative, endothelial cell crossmatch-positive sera obtained from 12 cardiac allograft recipients at the time of biopsy-proven rejection. From these, 19 plasma membrane proteins and 10 autoantigens identified from gene ontology analysis were combined with 48 proteins identified through literature search to generate a multiplex bead array. Longitudinal sera from a multicenter cohort of adult cardiac allograft recipients (samples: n = 477 no rejection; n = 69 rejection) identified 18 non-HLA antibodies associated with rejection (P < .1) including 4 newly identified non-HLA antigenic targets (DEXI, EMCN, LPHN1, and SSB). CART analysis showed 5/18 non-HLA antibodies distinguished rejection vs nonrejection. Antibodies to 4/18 non-HLA antigens synergize with HLA donor-specific antibodies and significantly increase the odds of rejection (P < .1). The non-HLA panel was validated using an independent adult cardiac transplant cohort (n = 21 no rejection; n = 42 rejection, >1R) with an area under the curve of 0.87 (P < .05) with 92.86% sensitivity and 66.67% specificity. We conclude that multiplex bead array assessment of non-HLA antibodies identifies cardiac transplant recipients at risk of rejection.

[Experience, prevalence, severity, treatment needs for dental caries and care index in Mexican adolescents and young adults]. / Experiencia, prevalencia, severidad necesidades de tratamiento para caries dental e índice de cuidados en adolescentes y adultos jócenes mexicanos.

OBJECTIVE: To determine the experience, prevalence and severity of dental caries as well as to establish the treatment needs and restorative care in adolescents and young adults. MATERIAL AND METHODS: This cross-sectional study included 638 subjects 16-25 years old candidates to enter to state public university of San Luis Potosí, México. For caries detection was used the DMFT index (sum of decayed teeth + missing teeth + filled teeth in the permanent dentition). With DMFT index data were calculated the experience, the prevalence and the severity of caries. Also are reported the significant caries index (SiC), the treatment needs index (TNI) and the care index (CI). Statistical analysis was performed using nonparametric tests. RESULTS: The mean DMFT index was 4.24 ± 3.85, prevalence 76.5% and severity of 52.3% for DMFT > 3 and 26.2% for DMFT > 6. The SiC index was 8.7. The TNI was 43.0% and 52.8% CI. No variation was observed (p > 0.05) on the experience, prevalence and severity of caries by age. The component "filled teeth" showed differences by age (p < 0.05). Women had higher caries experience and severity than men (p < 0.05), equally "decay teeth" and "filled teeth" (p < 0.05). CONCLUSIONS: We observed high levels of experience, prevalence and severity of dental caries in this sample of adolescents and young adults. We found almost 40% of untreated caries lesions. We found some differences by sex.

The reach of Spanish-language YouTube videos on physical examinations made by undergraduate medical students.

This study was conducted to evaluate the performance and reach of YouTube videos on physical examinations made by Spanish university students. We analyzed performance metrics for 4 videos on physical examinations in Spanish that were created by medical students at Miguel Hernández University (Elche, Spain) and are available on YouTube, on the following topics: the head and neck (7:30), the cardiovascular system (7:38), the respiratory system (13:54), and the abdomen (11:10). We used the Analytics application offered by the YouTube platform to analyze the reach of the videos from the upload date (February 17, 2015) to July 28, 2017 (2 years, 5 months, and 11 days). The total number of views, length of watch-time, and the mean view duration for the 4 videos were, respectively: 164,403 views (mean, 41,101 views; range, 12,389 to 94,573 views), 425,888 minutes (mean, 106,472 minutes; range, 37,889 to 172,840 minutes), and 2:56 minutes (range, 1:49 to 4:03 minutes). Mexico was the most frequent playback location, followed by Spain, Colombia, and Venezuela. Uruguay, Ecuador, Mexico, and Puerto Rico had the most views per 100,000 population. Spanish-language tutorials are an alternative tool for teaching physical examination skills to students whose first language is not English. The videos were especially popular in Uruguay, Ecuador, and Mexico.

Effect of nesiritide (B-type natriuretic peptide) and dobutamine on ventricular arrhythmias in the treatment of patients with acutely decompensated congestive heart failure: the PRECEDENT study.

BACKGROUND: Dobutamine is commonly used as a means of treating decompensated congestive heart failure (CHF). Although typically effective at improving short-term hemodynamics and symptomatology, the frequent occurrence of arrhythmias and tachycardia is undesirable. In this randomized, multicenter trial, we compared the safety and clinical effectiveness of the cardiac hormone nesiritide (human B-type natriuretic peptide) with dobutamine in hospitalized patients with decompensated CHF. METHODS: The study population consisted of 255 patients who were randomized to 1 of 2 doses of intravenous nesiritide (0.015 or 0.03 microg/kg/min) or dobutamine (> or =5 microg/kg/min) and stratified by means of an earlier history of ventricular tachycardia. Patients were also assessed with 24 hour Holter recordings immediately before and during study drug therapy and by means of signs and symptoms of CHF. RESULTS: Dobutamine significantly increased the mean (1) number of ventricular tachycardia events per 24 hours by 48 +/- 205 (P =.001), (2) repetitive ventricular beats per hour by 15 +/- 53 (P =.001), (3) premature ventricular beats per hour by 69 +/- 214 (P =.006), and (4) heart rate by 5.1 +/- 7.7 beats per minute (P <.001). These end points were significantly decreased or unchanged in the nesiritide groups. Nesiritide did not increase heart rate, despite a greater reduction of blood pressure. Both drugs were similarly effective means of improving signs and symptoms of CHF. CONCLUSIONS: Dobutamine is associated with substantial proarrhythmic and chronotropic effects in patients with decompensated CHF, whereas nesiritide actually reduces ventricular ectopy or has a neutral effect. Compared with dobutamine, nesiritide may be a safer, short-term treatment for patients with decompensated CHF.

[Exactness of transcutaneous sonography in the diagnosis of gastric wall lesions]. / Exactitud de la sonografía transcutánea en el diagnóstico de lesiones de pared gástrica.

OBJECTIVE: Our objective was to determine sensitivity, especificity and predictive values of transcutaneous sonography for detecting gastric wall lesions. MATERIALS AND METHODS: This prospective study was performed from March 1999 to April 2000 on 150 patients referred for transcutaneous sonography by the Endoscopic Service Unit. Sonographic examinations were performed using RT 4000 General Electric equipment with 5 Mhz transducer and replenishment of stomach with fluid. All scanning was done by the same sonographer, who was unaware of endoscopic, tomographic, or upper gastrointestinal series features. Results from sonography were compared with gastrointestinal tract endoscopy. Sensitivity, specificity, and predictive values were determined using contingency statistical procedure. Sonographic examination accuracy was calculated evaluating sensitivity and specificity confidence intervals (CI). Kappa index was calculated. Diagnostic accuracy differences observed between tumoral and non-tumoral lesions by sonography were evaluated by chi 2 probe. RESULTS: Sensitivity of 85% (95% CI, from 75.2 to 94.8%) and specificity of 90% (95% CI, from 86 to 93.9%) were obtained. Positive predictability was 78% and negative predictability was 94%. Diagnostic accuracy was 87%. Kappa index was 0.717. There were 35 no false-positive results (19 tumoral lesions and 16 non-tumoral lesions), seven false-negative results (one tumoral lesion and six non-tumoral lesions) and 10 false-positive results (two tumoral lesions and eight non-tumoral lesions). Only one of 20 tumoral lesions were diagnosed by ultrasound whereas from 22 non-tumoral lesions were not diagnosed 6 (chi 2 = 3.74, p > 0.05). CONCLUSION: Transcutaneous sonography is a rapid, low cost and non-invasive method that may be useful to establish clinic diagnosis and in the first steps of gastric wall lesions evaluation, it is valuable in assessment of diagnostic orientation for the referring clinic.

The role of echocardiography and other imaging modalities in patients with left ventricular assist devices.

Recent advances in the field of left ventricular device support have led to an increased use of left ventricular assist devices (LVADs) in patients with end stage heart disease. The primary imaging modality to monitor patients with LVADs has been echocardiography. The purpose of this review is to highlight the clinical role of echo and other noninvasive imaging modalities in the assessment of cardiac structure and function in patients with pulsatile and continuous flow LVADs. In addition, we discuss the role of imaging with emphasis on echo to detect LVAD dysfunction and device related complications.

Frecuencia y caractarísticas anatomoclínicas de cáncer de esófago: estudio multicéntrico de las Instituciones del Sector Salud, en la ciudad de Veracruz / Frequency and anatomo clinical characteristics of esophageal cancer: Multicentric study of Veracruz City, Mexico health care Institutions

Objetivo: conocer la frecuencia y características anatomoclínicas del cáncer del esófago en la ciudad de Veracruz.Tipo de estudio: observacional, retrospectivo. Material y método: revisión de los expedientes clínicos de los pacientes con diagnóstico de cáncer del esófago, detectados mediante procedimiento endoscópico, realizado en los servicios de gastroenterología de las Instituciones del Sector Salud de la ciudad de Veracruz (Hospital General de la Secretaría de Salud, Hospital de Especialidades del Centro Médico Nacional "Adolfo Ruiz Cortínes" del IMSS y del Hospital General del Instituto de Seguridad Social y Servicios para los trabajadores del Estado), en el periodo comprendido entre 1996 y 1999. Resultados: se detectaron 42 casos de cáncer del esófago en 5,083 endoscopias realizadas en los cuatro años, que corresponden a 0.83 casos por cada 100 endoscopias realizadas, con una frecuencia de 10.5 pacientes por año y equivalen a 1.49 casos por cada 100.000 habitantes. El grupo de edad con mayor frecuencia se encontró entre la sexta y octavas décadas y predominó en una relación de 4:1 el sexo masculino sobre el femenino. Los factores de riesgo identificados fueron: tabaquismo y alcoholismo e historia de neoplasia familiar en 75 por ciento de los casos y el tiempo que transcurrió entre el inicio de los síntomas y la fecha del diagnóstico fue de 14 a 16 meses. Las características clínicas predominantes fueron las correspondientes a obstrucción del esófago y el ataque al estado general y en 50 por ciento de los casos existían evidencias clínicas de invasión a otros órganos. El sitio de localización más frecuente del tumor fue el tercio inferior, seguido del tercio medio y la forma predominante fue la proliferante y polipoide. Correspondió a carcinoma epidermoide 50 por ciento y la otra mitad a adenocarcinoma, predominando el tipo bien diferenciado. Solamente en 9.52 por ciento fue factible la resección esofágica con ascenso gástrico y del total de pacientes que comprende el estudio sólo sobreviven cuatro, dos de ellos con actividad tumoral y dos sin actividad tumoral a los dos y tres años de haber sido intervenidos quirúrgicamente. Los resultados obtenidos son comparables con lo publicado en la literatura nacional y extranjera, llamando la atención que en nuestra serie, la mayoría de los pacientes se encontró en estadios III y IV al momento del diagnóstico, por lo que la terapéutica realizada fue ineficaz por lo avanzado de la enfermedad.

Ventajas de la Historia Clínica Informática / Adavantages of the computerized medical record

Si a veces el concepto de historia clínica no es comprendido y por lo tanto, utilizado adecuadamente, el de Historia Clínica Informática lo es muchos menos, tal vez porque las personas que lo utilizan tienen visiones muy diferentes, desde la más elemental a la más compleja. Este artículo trata de aclarar los conceptos que la componente o la rodean, contraponiéndola frecuentemente con su antecesora: la historia clínica que llamaremos “tradicional”, por no limitar su contenido llamándola simplemente “en papel” (AU)

This article seeks to explain the concepts which make up the Computerized Medical Record, contrasting it with its predecessor, the traditional medical record (AU)

Inducción anestésica bajo apoyo circulatorio mecánico / Anesthetic induction under mechanical circulatory assistance

Una paciente, portadora de una estenosis valvular aórtica por disfunción protésica, fue internada por un cuadro de insuficiencia cardíaca congestiva descompensada con escasa respuesta a drogas inotrópicas y diuréticas, decidiéndose su reoperación de emergencia. La inducción anestésica se llevó a cabo bajo apoyo circulatorio con bomba centrífuga, el esternón fue abierto bajo bypass total y luego, con apoyo inotrópico, fue destetada de la circulación extracorpórea transitoriamente. De esta manera fue posible recuperar la sangre heparinizada y disminuir el tiempo total de circulación extracorpórea (CEC). El objetivo de la presente comunicación es dar a conocer una estrategia posible para el manejo hemodinámico durante la inducción anestésica.

Cirugía coronaria sin by pass cardiopulmonar: efectos hemodinámicos (orígenes y terapéutica) / Off-pump coronary surgery: Hemodynamic effects (origin and therapeutic)

Los cambios hemodinámicos que ocurren durante la cirugía coronaria sin CEC están relacionados con: 1) los desplazamientos del corazón para abordar las diferentes arterias coronarias, 2) la utilización de sistemas de inmovilización del corazón para poder realizar anastomosis confiables y 3) los efectos de la isquemia regional sobre la contractilidad miocárdica. Del conocimiento de la fisiopatología de cada uno de estos tres eventos dependerá el tratamiento a emplear. Así, el primer objetivo terapéutico será atenuar los efectos del desplazamiento cardíaco, para lo cual se deberá adecuar la carga ventricular y racionalizar el uso de fármacos Alfa y Beta adrenérgicos. Por otro lado, en la cirugía coronaria sin CEC, el corazón que está latiendo en normotermia y realizando trabajo externo será sometido a isquemia regional. Por lo tanto, el segundo objetivo será mantener la presión de perfusión coronaria y proteger al miocardio. De esta manera, a pesar de los cambios en la hemodinamia intraoperatoria, será posible alcanzar la estabilidad circulatoria y prevenir eventos isquémicos.