Cell culture: a promising environment for research on cardiology / Cultivos celulares: un entorno promisorio para la investigación en cardiología

Abstract At present, tissue engineering is transforming the area of cardiovascular regenerative medicine, which combines the principles and methods of materials engineering and biological sciences, interacting with biochemical and physicochemical factors, for the understanding of their structure-function relationship. Thus, the course of diseases is reoriented by implementing methods and procedures involved in the regeneration of organs and tissues by means of the interaction with biocompatible matrices, pre-treated organs or stem cell management, among others, thus recovering the functionality in the system affected by acquired pathologies, alterations or congenital defects. Consequently, these procedures are increasingly becoming one the most promising treatment alternative for patients who suffer from any type of functional deficit. Known that all these possibilities make cell cultures a promising study environment to be used in biomedical applications, especially in tissue engineering and regenerative medicine, this manuscript presents a general reviews of established cell lines or primary tissue lines and how cell cultures serve as a model before experimental work on laboratory animals and human subjects which makes it a valuable tool for broad models of study in the research on cardiology.

Resumen En la actualidad, la ingeniería de tejidos está transformando el área de la medicina regenerativa cardiovascular, combinando los principios y métodos de la ingeniería de materiales y las ciencias biológicas, interactuando entre factores bioquímicos y fisicoquímicos, para la comprensión de su relación estructura-función. Así, el curso de las enfermedades se viene a reorientar mediante la implementación de métodos y procedimientos implicados en la regeneración de órganos y tejidos a través de la interacción con matrices biocompatibles, órganos pretratados o manejo de células madre, entre otros, recuperando así la funcionalidad en el sistema afectado por enfermedades adquiridas y alteraciones o defectos congénitos. En consecuencia, estos procedimientos se están convirtiendo en una de las alternativas de tratamiento cada vez más prometedoras para los pacientes que sufren de algún tipo de alteración funcional. Considerando que todas estas posibilidades hacen de los cultivos celulares un entorno de estudio prometedor para ser utilizado en aplicaciones biomédicas, especialmente en ingeniería de tejidos y medicina regenerativa, este manuscrito presenta una revisión general de las líneas celulares establecidas o líneas de tejido primario y cómo los cultivos celulares sirven como modelo de evaluación antes del trabajo experimental en animales de laboratorio y sujetos humanos, lo cual los convierte en una herramienta valiosa para amplios modelos de estudio en la investigación en cardiología.

Fat-Free Mass Index, Visceral Fat Level, and Muscle Mass Percentage Better Explain Deviations From the Expected Value of Aortic Pressure and Structural and Functional Arterial Properties Than Body Fat Indexes.

Bioelectrical impedance analysis (BIA)-derived indexes [e.g., fat (FMI) and fat-free mass indexes (FFMI), visceral fat level (VFL)] are used to characterize obesity as a cardiovascular risk factor (CRF). The BIA-derived index that better predicts arterial variability is still discussed. Aims: To determine: (1) the association of classical [weight, height, body mass index (BMI), basal metabolic rate (BMR)] and BIA-derived indexes, with arterial properties deviations from expected values (arterial z-scores); (2) maximum arterial variations attributable to BIA-derived indexes; (3) whether the composition of total body, trunk and/or limbs is most closely associated with arterial variations. Methods: Hemodynamic, structural, and functional parameters of different histological types of arteries were assessed (n = 538, 7-85 years). Classical and BIA-derived indexes [fat mass and percentage, FMI, VFL, muscle mass percentage (PMM), FFMI, and percentage] were measured (mono- and multi-segmental devices). Arterial z-scores were obtained using age-related equations derived from individuals not-exposed to CRFs (n = 1,688). Results: First, regardless of the classical index considered, the associations with the arterial properties showed a specific hierarchy order: diameters and local stiffness > aortic and brachial blood pressure (BP) > regional stiffness. Second, all the associations of FMI and FFMI with z-scores were positive. Third, FFMI exceeded the association obtained with BMI and BMR, considering structural z-scores. In contrast, FMI did not exceed the association with z-scores achieved by BMI and BMR. Fourth, regardless of CRFs and classical indexes, arterial z-scores would be mainly explained by FFMI, VFL, and PMM. Fifth, regardless of the body-segment considered, the levels of association between FMI and z-scores did not exceed those found for classic and FFMI. Total fat mass and trunk indexes showed a greater strength of association with z-scores than the FMI of limbs. Sixth, compared to lower limb FFMI indexes, total and upper limbs FFMI showed higher levels of association with z-scores. Conclusions: FFMI (but not FMI) exceeded the strength of association seen between BMI or BMR and structural z-scores. Regardless of the body segment analyzed, the associations between FMI and z-scores did not exceed those found with classic and FFMI. Arterial z-scores could be independently explained by FFMI, VFL, and PMM.

Clinical trials in cardiac xenotransplantation: Are we ready to overcome barriers?

Heart allotransplantation has become one of the methods of choice in the treatment of severe heart failure. In the face of its difficulties, such as the unmet balance between organ supply and demand, the use of xenotransplantation (XTx) might be an attractive option shortly, even more with the ongoing progress achieved regarding the avoidance of hyperacute rejection and primary organ disfunction, maintenance of xenograft function and control of xenograft growth. To make possible this translational challenge, some points must be taken into account indeed, and they are the equipoise of human benefit and animal suffering, the risk of unknown infections, a well prepared informed consent, ethical and religious beliefs, and the role of cardiac XTx in a ventricular assistance device era.

Does the anthropometric profile influence infection morbidity after coronary artery bypass grafting?

BACKGROUND: Infection after cardiovascular surgery is multifactorial. We sought to determine whether the anthropometric profile influences the occurrence of infection after isolated coronary artery bypass grafting (CABG). METHODS: Between January 2011 and June 2016, 1777 consecutive adult patients were submitted to isolated coronary artery bypass grafting. Mean age was 61.7 ± 9.8 years and 1193 (67.1%) were males. Patients were divided into four groups according to the body mass index (BMI) classification: underweight (BMI < 18.5 kg/m2 ; N = 17, 0.9%), normal range (BMI: 18.5-24.99 kg/m2 ; N = 522, 29.4%), overweight (BMI: 25-29.99 kg/m2 ; N = 796, 44.8%), and obese (BMI > 30 kg/m2 ; N = 430, 24.2%). In-hospital outcomes were compared and independent predictors of infection were obtained through multiple Poisson regression with a robust variation. RESULTS: Independent predictors of any infection morbidity were female sex (relative ratio [RR], 1.47; p = .002), age > 60 years (RR, 1.85; p < .0001), cardiopulmonary bypass > 120 min (RR, 1.89; p = .0007), preoperative myocardial infarction < 30 days (RR, 1.37; p = .01), diabetes mellitus (RR, 1.59; p = .0003), ejection fraction < 48% (RR, 2.12; p < .0001), and blood transfusion (RR, 1.55; p = .0008). Among other variables, obesity, as well as diabetes mellitus, were independent predictors of superficial and deep sternal wound infection. CONCLUSIONS: Other factors rather than the anthropometric profile are more important in determining the occurrence of any infection after CABG. However, surgical site infection has occurred more frequently in obese patients. Appropriate patient selection, control of modifiable factors, and application of surgical bundles would minimize this important complication.

Diseño de un modelo predictivo de pesquisa cardiovascular utilizando árboles de decisión: propensión de pacientes a presentar diabetes tipo 2, hipertensión arterial o dislipidemia: estudio piloto, comuna de Quellón, Chiloé / Design of a predictive model of cardiovascular screening using decision trees: propensity of patients to present type 2 diabetes, arterial hypertension or dyslipidemia: pilot study commune of Quellón, Chiloé

Introducción : En la actualidad, la Minería de Datos es cada vez más popular en el campo de la salud porque existe una necesidad de eficiencia metodológica y analítica para detectar información desconocida y valiosa en datos de salud. Objetivo : Desarrollar un modelo predictivo utilizando técnicas de minería de datos, específicamente Arboles de Decisión, para pesquisar pacientes con propensión a desarrollar Diabetes Tipo II (DM II), Hipertensión Arterial (HTA) o Dislipidemia (DLP). Método : Se analizó el problema de los Factores de Riesgo Cardiovascular Mayores desde una perspectiva de procesos y se estudiaron las técnicas que permiten descubrir el conocimiento del fenómeno almacenado en las bases de datos de Examen de Medicina Preventiva del Adulto (EMPA) de la Población en Control Cardiovascular que presenta DM II, HTA o DLP Resultados : El Algoritmo C5, presenta un mayor poder predictivo, respecto de otros algoritmos de Árbol de Decisión. Se comprobó que las variables Edad y Circunferencia de Cintura fueron las de mayor poder de discriminación en el padecimiento de DM2, HTA o DLP. El algoritmo C5 alcanzó una precisión global de un 83,01% en la partición de prueba, luego en la misma partición el modelo logra discriminar un paciente con algunas de las patologías en el 85,25% de los casos, y uno que no presenta alguna de las patologías en un 80,27% de las oportunidades. Conclusión : La Minería de Datos y en este caso, específicamente los Modelos de Árboles de Decisión son una alternativa válida para la pesquisa cardiovascular temprana.

Introduction : Data Mining is increasingly popular in the health field because there is a need for an efficient analytical methodology to detect unknown and valuable information of health data. Objective : To develop a predictive model using data mining techniques, specifically Decision Trees, to investigate patients with a propensity to develop Type II Diabetes, Arterial Hypertension or Dyslipidemia. The data of adult patients presenting Type II diabetes, Hypertension or Dyslipidemia being followed in a preventive cardiovascular control program were analyzed with the aim of unveiling phenomena that could help develop the prediction of these risk factors. Results : With respect to other decision tree algorithms, Algorithm C 5, showed a greater predictive power. The variables age and waist circumference had the greatest power of discrimination for DM2, HTA or DLP. The C 5 algorithm reached a global precision of 83.01% in the test partition. Then, in the same partition the model managed to discriminate a patient with some of the risk factors in 85.25% of cases, and to rule out any of them in 80.27% of cases. Conclusion : Data Mining, specifically decisión tree models, is a valid alternative for early detection of cardiovascular of risk factors.

Length of Residence in the United States is Associated With a Higher Prevalence of Cardiometabolic Risk Factors in Immigrants: A Contemporary Analysis of the National Health Interview Survey.

BACKGROUND: Cardiometabolic risk (CMR) factors including hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia are high among United States ethnic minorities, and the immigrant population continues to burgeon. METHODS AND RESULTS: Hypothesizing that acculturation (length of residence) would be associated with a higher prevalence of CMR factors, the authors analyzed data on 54, 984 US immigrants in the 2010-2014 National Health Interview Surveys. The main predictor was length of residence. The outcomes were hypertension, overweight/obesity, diabetes mellitus, and hyperlipidemia. The authors used multivariable logistic regression to examine the association between length of US residence and these CMR factors.The mean (SE) age of the patients was 43 (0.12) years and half were women. Participants residing in the United States for ≥10 years were more likely to have health insurance than those with <10 years of residence (70% versus 54%, P<0.001). After adjusting for region of birth, poverty income ratio, age, and sex, immigrants residing in the United States for ≥10 years were more likely to be overweight/obese (odds ratio [OR], 1.19; 95% CI, 1.10-1.29), diabetic (OR, 1.43; 95% CI, 1.17-1.73), and hypertensive (OR, 1.18; 95% CI, 1.05-1.32) than those residing in the United States for <10 years. CONCLUSIONS: In an ethnically diverse sample of US immigrants, acculturation was associated with CMR factors. Culturally tailored public health strategies should be developed in US immigrant populations to reduce CMR.

El endotelio vascular / The vascular endothelium

La investigación sobre el endotelio vascular en los últimos 40 años ha provisto ideas para entender la enfermedad vascular. Este nuevo conocimiento ha encontrado su camino en la medicina clínica. En esta revisión nos ocupamos de ciertas áreas de la investigación en las que se ha obtenido avances significativos en la prevención y el tratamiento cardiovascular, así como algunas interrogantes que aún permanecen sin respuesta...

Over the last 40 years, research on the vascular endothelium has provided important clues for the understanding of vascular disease. This new knowledge is finding its way into clinical medicine. In this review we deal with some areas where significant advances in the prevention and treatment of cardiovascular research has been achieved and with some of the remaining questions...