Automated resolution of the spiral torsion spring inverse design problem.

Many mechanical applications take advantage of spiral torsion springs due to their robustness, compactness, and simplicity. Brand-new manufacturing methods allow to create spiral springs with unconventional geometries and materials that suit a wider range of uses demanding either linearity or nonlinearity. Designing a spiral torsion spring with a nonlinear desired torque curve may be a great challenge, due to their many degrees-of-freedom (length, width, thickness, arbor, and barrel diameters, etc.) and the complexity of the geometrical and mechanical requirements to ensure their manufacturability, system compatibility, operation safety and reliability; and the solution is never unique. This manuscript proposes and validates an innovative methodology for the resolution of this inverse design problem based on the application of a nonlinear restrained global optimization algorithm. This algorithm is adjusted to converge, out of the infinity of designs that match the desired torque curve and hold all the functional and manufacturing constraints, to a design solution that minimizes strip mass. The methodology is built on a formulation for the calculation of the torque curve of a generalized spiral spring, with or without coiling and with any along-the-length cross-section, already published by the authors.

Development of geriatric oncology in Latin America: A report from the Latin American Cooperative Oncology Group.

Population aging represents a critical issue for global cancer care, notably in low- and middle-income countries (LMIC). Latin America is a large region composed of 21 countries with notable diversity in both human development and access to quality healthcare. Thus, it is necessary to understand how care for older individuals is being delivered in such large and diverse regions of the world. This review describes the recent advances made in Mexico, Brazil, and Chile, focusing on the creation and implementation of educational, research, and clinical activities in geriatric oncology. These initiatives intend to change healthcare professionals' perceptions about the care for older adults and to improve the way older patients are being treated.

Influence of air pollutants on circulating inflammatory cells and microRNA expression in acute myocardial infarction.

Air pollutants increase the risk and mortality of myocardial infarction (MI). The aim of this study was to assess the inflammatory changes in circulating immune cells and microRNAs in MIs related to short-term exposure to air pollutants. We studied 192 patients with acute coronary syndromes and 57 controls with stable angina. For each patient, air pollution exposure in the 24-h before admission, was collected. All patients underwent systematic circulating inflammatory cell analyses. According to PM2.5 exposure, 31 patients were selected for microRNA analyses. STEMI patients exposed to PM2.5 showed a reduction of CD4+ regulatory T cells. Furthermore, in STEMI patients the exposure to PM2.5 was associated with an increase of miR-146a-5p and miR-423-3p. In STEMI and NSTEMI patients PM2.5 exposure was associated with an increase of miR-let-7f-5p. STEMI related to PM2.5 short-term exposure is associated with changes involving regulatory T cells, miR-146a-5p and miR-423-3p.

Surgical Repair of Huge Left Ventricular Pseudoaneurysm After Sutureless Repair of Free Wall Rupture.

Left ventricular pseudoaneurysm (LVPsA) is a rare complication after sutureless patch repair of left ventricular free wall rupture (LVFWR), with few cases reported in the literature so far. We present the case of a young patient who early developed a huge LVPsA and moderate mitral regurgitation after sutureless patch repair for LVFWR after undergoing a successful Dor procedure using the "triple empanada patch technique" to exclude the LVPsA, remodel the left ventricle, and address the moderate mitral regurgitation. Serial echocardiograms during follow-up are strongly recommended, even in patients with successful patch repair, to facilitate timely diagnosis and management.

Drug-eluting balloons in coronary interventions: the quiet revolution?

INTRODUCTION: Drug-eluting balloons (DEB) may be considered as a 'quiet revolution' in percutaneous coronary interventions. Early-generation DEB eluting paclitaxel proved to be very effective in animal models to reduce neointimal hyperplasia. Areas covered: Review of DEB efficacy in patients with coronary de novo lesions and in-stent restenosis (ISR). Expert opinion: Many randomized clinical trials and meta-analyses have demonstrated the value of DEB in patients with ISR. In this setting, DEB are safe and effective with clinical and angiographic results superior to plain balloon angioplasty and at least equivalent to first generation drug-eluting stents (DES). In selected 'de novo' lesions (bifurcation lesions, small vessels, diffuse disease, myocardial infarction) DEB represent an attractive alternative although additional evidence in these 'niche' indications is still required before a widespread clinical utilization can be recommended. Recently, new generation DEB have become available, offering interesting new possibilities (paclitaxel and also sirolimus) for coronary interventions. Further studies are required to compare the results of novel generation DEB with those of second-generation DES.

Optical Coherence Tomography Findings in Patients With Stent Thrombosis.

INTRODUCTION AND OBJECTIVES: Stent thrombosis (ST) is a rare but potentially serious complication. Optical coherence tomography (OCT) provides high-resolution images and additional information to angiography in the study of this event. METHODS: Prospective study of patients with ST undergoing reintervention with OCT imaging. RESULTS: The study included a total of 40 consecutive patients with ST. Mean age was 69 ± 13 years and 83% were male. Early ST (≤ 30 days) was observed in 16 patients and late ST (> 30 days) in 24 patients. Stent thrombosis occurred in 17 bare-metal stents and 23 drug-eluting stents. In 34 patients (85%), adequate OCT images were obtained at the time of the ST. The predominant mechanism in early ST was stent malapposition (39%). In late ST, high frequencies of uncovered (46%) and malapposed struts (17%) were observed, especially in patients with drug-eluting stents. Furthermore, the presence of neoatherosclerosis was very high (67%) in patients with late ST. After intervention, improvements were observed in malapposition length and the amount of residual thrombus. CONCLUSIONS: OCT allows identification of the underlying mechanisms potentially involved in ST. This imaging modality is helpful in guiding reintervention in these patients, which improves the area and length of malapposition, as well as the maximal residual thrombus area.

Mother-and-child catheter-facilitated optical coherence tomography: A novel approach to improve intracoronary imaging.

BACKGROUND: Our aim was to prospectively analyze the usefulness of mother-and-child catheter approach with the GuideLiner® (GL) catheter extension system to overcome some potential limitations associated with the use of optical coherence tomography (OCT). METHODS: We included consecutive patients referred to our institution for coronary angiogram in whom OCT image acquisition was obtained using GL. From February 2015 to May 2016, a total of 19 procedures (18 patients) were prospectively included. RESULTS: In more than two thirds of the procedures, the OCT catheter was unable to cross the coronary stenosis prior to the use of GL. The right coronary artery was the most frequently involved coronary vessel (63%). The main reason for using GL (47% of cases) was poor engagement of the coronary ostium and lack of support of the guiding catheter (47%). Eventually, in 18 out of 19 procedures, a good quality OCT image was obtained and, when indicated, successful percutaneous coronary intervention with stent implantation was performed. Of note, there were no serious complications related to the use of GL during OCT imaging. CONCLUSIONS: Optical coherence tomography through a catheter extension system is a useful technique able to overcome some of the limitations associated with this imaging technique ensuring adequate blood clearance and thus optimal image quality.

Tomografía de coherencia óptica de pacientes con trombosis del stent / Optical coherence tomography findings in patients with stent thrombosis

Introducción y objetivos: La trombosis del stent (TS) es una complicación infrecuente pero potencialmente grave. La tomografía de coherencia óptica (OCT) ofrece imágenes de alta resolución e información adicional a la angiografía en el estudio de esta enfermedad. Métodos: Estudio prospectivo en el que se incluyó a todos los pacientes con una TS a los que se realizó una OCT durante el procedimiento. Resultados: Se incluyó a un total de 40 pacientes con TS consecutivos, con una media de edad de 69 ± 13 años; el 83% eran varones. Las TS fueron precoces (≤ 30 días) en 16 pacientes y tardías (> 30 días) en 24. En 17 pacientes la TS se produjo en stents convencionales y en 23, en farmacoactivos. En 34 casos (85%) se realizó estudio con OCT en el momento de la TS. En las TS precoces, el mecanismo predominante (39%) fue la malaposición del stent. En las TS tardías se observaron frecuentemente (46%) struts no recubiertos y áreas de malaposición (17%), especialmente en pacientes con stents farmacoactivos. Además, la presencia de neoateroesclerosis fue muy elevada (67%) en los pacientes con TS tardía. Tras la intervención se observó una mejora en la longitud de la malaposición y la cantidad de trombo en el stent. Conclusiones: La OCT permite conocer los mecanismos subyacentes potencialmente implicados en la TS y guiar el intervencionismo en estos pacientes. La reintervención disminuye el área y la longitud de la malaposición, así como la cantidad de trombo residua (AU)

Introduction and objectives: Stent thrombosis (ST) is a rare but potentially serious complication. Optical coherence tomography (OCT) provides high-resolution images and additional information to angiography in the study of this event. Methods: Prospective study of patients with ST undergoing reintervention with OCT imaging. Results: The study included a total of 40 consecutive patients with ST. Mean age was 69 ± 13 years and 83% were male. Early ST (≤ 30 days) was observed in 16 patients and late ST (> 30 days) in 24 patients. Stent thrombosis occurred in 17 bare-metal stents and 23 drug-eluting stents. In 34 patients (85%), adequate OCT images were obtained at the time of the ST. The predominant mechanism in early ST was stent malapposition (39%). In late ST, high frequencies of uncovered (46%) and malapposed struts (17%) were observed, especially in patients with drug-eluting stents. Furthermore, the presence of neoatherosclerosis was very high (67%) in patients with late ST. After intervention, improvements were observed in malapposition length and the amount of residual thrombus. Conclusions: OCT allows identification of the underlying mechanisms potentially involved in ST. This imaging modality is helpful in guiding reintervention in these patients, which improves the area and length of malapposition, as well as the maximal residual thrombus area (AU)

Ginecomastía: aproximación clínica y terapeútica / Gynecomastia: clinical and therapeutic approach

La Ginecomastia es una condición frecuente especialmente en la pubertad y edad adulta, no obstante en ocasiones produce en el paciente un importante grado de ansiedad y discomfort social. Si bien la mayoría de las veces no representa un desafío clínico diagnóstico, puede ser la manifestación inicial de un gran numero de condiciones médicas de mayor importancia para el pronóstico del paciente. De capital importancia es el diagnóstico diferencial con el cáncer de mama masculino, que si bien es de presentación mas bien excepcional, puede ser resuelto con un tratamiento precoz. El presente articulo es una revisión de los aspectos más trascendentes a considerar en el enfrentamiento clínico y terapéutico de esta condición.