Toxicity evaluation of novel imidacloprid nanoribbons, using somatic mutation and fitness indexes in Drosophila melanogaster.

Nanoribbons of imidacloprid, a systemic and chloronicotinyl insecticide, were successfully synthesized by laser-induced fragmentation/exfoliation of imidacloprid powders suspended in water, with widths ranging from 160 to 470 nm, lengths in the micron scale, and thickness of a few atoms layers. The aim of the present study was to examine the effects of acute and chronic exposure to imidacloprid (IMC) bulk and compare its effects with synthesized imidacloprid nanoribbons (IMCNR) on larval and adult viability, developmental time, olfactory capacity, longevity, productivity, and genotoxicity in Drosophila melanogaster. Larvae or adults were exposed at 0.01, 0.02, or 0.03 ppm to IMC or IMCNR. Results demonstrated that IMCNR produced a significant reduction in viability and olfactory ability. IMC did not significantly alter viability and olfactory ability. Similarly, marked differences on longevity were detected between treatment with IMC and IMCNR where the lifespan of males treated with IMC was significantly higher than control while IMCNR produced a reduction. As for productivity, developmental time, and genotoxicity, no marked differences were found between both forms of IMC.

Knockdown of Antisense Noncoding Mitochondrial RNA Reduces Tumorigenicity of Patient-Derived Clear Cell Renal Carcinoma Cells in an Orthotopic Xenograft Mouse Model.

Clear cell renal cell carcinoma (ccRCC) is the most prevalent form of renal cancer and its treatment is hindered by a resistance to targeted therapies, immunotherapies and combinations of both. We have reported that the knockdown of the antisense noncoding mitochondrial RNAs (ASncmtRNAs) with chemically modified antisense oligonucleotides induces proliferative arrest and apoptotic death in tumor cells from many human and mouse cancer types. These studies have been mostly performed in vitro and in vivo on commercially available cancer cell lines and have shown that in mouse models tumor growth is stunted by the treatment. The present work was performed on cells derived from primary and metastatic ccRCC tumors. We established primary cultures from primary and metastatic ccRCC tumors, which were subjected to knockdown of ASncmtRNAs in vitro and in vivo in an orthotopic xenograft model in NOD/SCID mice. We found that these primary ccRCC cells are affected in the same way as tumor cell lines and in the orthotopic model tumor growth was significantly reduced by the treatment. This study on patient-derived ccRCC tumor cells represents a model closer to actual patient ccRCC tumors and shows that knockdown of ASncmtRNAs poses a potential treatment option for these patients.

Biocompatibility Evaluation of TiO2, Fe3O4, and TiO2/Fe3O4 Nanomaterials: Insights into Potential Toxic Effects in Erythrocytes and HepG2 Cells.

Nanomaterials such as titanium dioxide and magnetite are increasingly used in several fields, such as water remediation and agriculture. However, this has raised environmental concerns due to potential exposure to organisms like humans. Nanomaterials can cause adverse interactions depending on physicochemical characteristics, like size, morphology, and composition, when interacting with living beings. To ensure safe use and prevent the risk of exposure to nanomaterials, their biocompatibility must be assessed. In vitro cell cultures are beneficial for assessing nanomaterial-cell interactions due to their easy handling. The present study evaluated the biocompatibility of TiO2, Fe3O4, and TiO2/Fe3O4 nanomaterials thermally treated at 350 °C and 450 °C in erythrocytes and HepG2 cells. According to the hemolysis experiments, non-thermally treated NMs are toxic (>5% hemolysis), but their thermally treated counterparts do not present toxicity (<2%). This behavior indicates that the toxicity derives from some precursor (solvent or surfactant) used in the synthesis of the nanomaterials. All the thermally treated nanomaterials did not show hemolytic activity under different conditions, such as low-light exposure or the absence of blood plasma proteins. In contrast, non-thermally treated nanomaterials showed a high hemolytic behavior, which was reduced after the purification (washing and thermal treatment) of nanomaterials, indicating the presence of surfactant residue used during synthesis. An MTS cell viability assay shows that calcined nanomaterials do not reduce cell viability (>11%) during 24 h of exposure. On the other hand, a lactate dehydrogenase leakage assay resulted in a higher variability, indicating that several nanomaterials did not cause an increase in cell death as compared to the control. However, a holotomographic microscopy analysis reveals a high accumulation of nanomaterials in the cell structure at a low concentration (10 µg mL-1), altering cell morphology, which could lead to cell membrane damage and cell viability reduction.

"My Body, My Rhythm, My Voice": a community dance pilot intervention engaging breast cancer survivors in physical activity in a middle-income country.

BACKGROUND: Interventions to promote physical activity among women breast cancer survivors (BCS) in low- to middle-income countries are limited. We assessed the acceptability and preliminary effectiveness of a theory-driven, group-based dance intervention for BCS delivered in Bogotá, Colombia. METHODS: We conducted a quasi-experimental study employing a mixed-methods approach to assess the 8-week, 3 times/week group dance intervention. The effect of the intervention on participants' physical activity levels (measured by accelerometry), motivation to engage in physical activity, and quality of life were evaluated using generalized estimating equation analysis. The qualitative method included semi-structured interviews thematically analyzed to evaluate program acceptability. RESULTS: Sixty-four BCS were allocated to the intervention (n = 31) or the control groups (n = 33). In the intervention arm, 84% attended ≥ 60% of sessions. We found increases on average minutes of moderate-to-vigorous physical activity per day (intervention: +8.99 vs control: -3.7 min), and in ratings of motivation (intervention change score = 0.45, vs. control change score= -0.05). BCS reported improvements in perceived behavioral capabilities to be active, captured through the interviews. CONCLUSIONS: The high attendance, behavioral changes, and successful delivery indicate the potential effectiveness, feasibility, and scalability of the intervention for BCS in Colombia. TRIAL REGISTRATION: ClinicalTrial.gov NCT05252780, registered on Dec 7th, 2021-retrospectively registered unique protocol ID: P20CA217199-9492018.

Medicago sativa L. Plant Response against Possible Eustressors (Fe, Ag, Cu)-TiO2: Evaluation of Physiological Parameters, Total Phenol Content, and Flavonoid Quantification.

The present study analyzed Medicago sativa L. crops irrigated by TiO2 in the anatase phase and TiO2 doped with Ag, Fe, and Cu ions at 0.1%w synthesized using the sol-gel method (SG) and the sol-gel method coupled with microwave (Mw-SG). The materials were added to the irrigation water at different concentrations (50, 100, and 500 ppm). Stress induction by nanomaterials was observed by measuring stem morphology, chlorophyll index, total phenols and flavonoids, and antioxidant activity through the DPPH (2,2-diphenyl-1-picrylhydrazy) radical inhibition assay. The nanomaterial treatments caused statistically significant reductions in parameters such as stem length, leaf size, and chlorophyll index and increases in total phenol content and DPPH inhibition percentage. However, the observed effects did not show clear evidence regarding the type of nanomaterial used, its synthesis methodology, or a concentration-dependent response. By generally grouping the results obtained to the type of dopant used and the synthesis method, the relationship between them was determined employing a two-way ANOVA. It was observed that the dopant factors, synthesis, and interaction were relevant for most treatments. Additionally, the addition of microwaves in the synthesis method resulted in the largest number of treatments with a significant increase in the total content of phenols and the % inhibition compared to the traditional sol-gel synthesis. In contrast, parameters such as stem size and chlorophyll index were affected under different treatments from both synthesis methods.

Tentorial dural arteriovenous fistula with perimedullary venous drainage-associated cervical myelopathy: illustrative case.

BACKGROUND: Tentorial dural arteriovenous fistulas (DAVFs) with perimedullary venous drainage causing cervical myelopathy are very uncommon conditions with an extremely aggressive behavior. When the characteristic radiological clues are missing, the unspecific clinical picture may cause delay and make the diagnosis challenging. OBSERVATIONS: Here the authors report a case of a 58-year-old man who developed progressive spastic tetraparesis and dyspnea with an extensive mild enhancing cervical cord lesion initially oriented as a neurosyphilis-associated transverse myelitis. Acute worsening after steroid administration redirected the diagnosis, and a tentorial Cognard type V DAVF was elicited. The microsurgical disconnection process is described, and previously documented cases in the literature are reviewed. LESSONS: If a DAVF is highly suspected, it is important to consider the possibility of its intracranial origin, and spinal as well as cerebral arteriography must be performed.

Green Synthesis via Eucalyptus globulus L. Extract of Ag-TiO2 Catalyst: Antimicrobial Activity Evaluation toward Water Disinfection Process.

The problem of water pollution by persistent substances and microorganisms requires solutions that materials such as silver-modified titanium dioxide can provide due to their excellent photocatalytic and antimicrobial properties. However, the synthesis methods conventionally used to obtain these materials involve toxic chemical reagents such as sodium borohydride (NaBH4). The search for alternative synthesis methods that use environmentally friendly substances, such as the biosynthesis method, was evaluated. Silver-titanium dioxide (Ag-TiO2) was synthesized by a Eucalyptus globulus L. extract as a reductive agent through sol-gel and microwave-assisted sol-gel processes. Four different solvents were tested to extract secondary metabolites to determine their roles in reducing silver nanoparticles. Titanium dioxide nanoparticles with sizes from 11 to 14 nm were obtained in the anatase phase, and no narrowing of the bandgap was observed (3.1-3.2 eV) for the Ag-TiO2 materials compared with the pure TiO2. Interestingly, the bacterial inhibition values were close to 100%, suggesting an effective antimicrobial mechanism related to the properties of silver. Finally, by the physicochemical characterization of the materials and their antimicrobial properties, it was possible to obtain a suitable biosynthesized Ag-TiO2 material as a green option for water disinfection that may be compared to the conventional methods.

Correlación de sincronía de la contracción del ventrículo izquierdo con función sisto-diastólica, masa y excentricidad en diversas afecciones cardíacas mediante un software comercial dedicado de SPECT gatillado / Gated Spect evaluation of ventricular systolic synchrony: correlation with ventricular mass and excentricity in different forms of cardiac disease

INTRODUCCIÓN: Actualmente, hay nuevas herramientas de software disponibles para medir la sincronía de la contracción intraventricular izquierda mediante SPECT de perfusión miocárdica. Esta técnica permite identificar anomalías de la conducción, apoyar la terapia de resincronización en insuficiencia cardíaca refractaria e incluso la detección precoz de isquemia. OBJETIVO: Conocer la correlación de la sincronía de contracción con otros parámetros de disfunción sisto-diastólica ventricular izquierda. MÉTODO: Estudiamos 135 pacientes remitidos para pesquisa o evaluación de enfermedad coronaria conocida mediante SPECT gatillado. La evaluación de la interpretación inicial con programas QPS/QGS® visual y cuantitativo se efectuó a 50 casos con defectos de perfusión transitoria de diversos tamaños (isquemia), 25 de tipo fijo o mixto (infarto) y 60 sin ellos (normal). Los volúmenes telesistólicos oscilaron entre 26 y 458 mL. Se excluyeron casos con arritmias, anomalías de conducción y artefactos (actividad o movimiento extracardiaco). Los SPECT se procesaron retrospectivamente utilizando el programa Emory Synctool®. Del histograma de sincronía de la contracción, el ancho de banda (BW) y la desviación estándar (SD) se correlacionaron con la fracción de eyección (FEVI), volúmenes y excentricidades sistólico / diastólico, masa ventricular izquierda, tasa máxima de llenado (PFR) y tiempo al máximo de llenado (TPFR). RESULTADOS: Los BW y SD del histograma de fase de contracción fueron mayores en el grupo con defectos fijos y mixtos en comparación con los con perfusión normal. Las correlaciones en reposo y post estrés (Spearman) entre SD y BW con FEVI, volúmenes, excentricidad y masa fueron significativas (p <0,0002) salvo TPFR que no fue significativa. CONCLUSIÓN: La sincronía de contracción intraventricular sistólica izquierda medida con SPECT se correlaciona excelentemente con los parámetros funcionales sistólicos y diastólicos, así como con masa y excentricidad en diversas condiciones y tamaños cardíacos.

INTRODUCTION: New software tools are available to measure left intraventricular contraction synchrony by myocardial perfusion SPECT. This technique allows identification of conduction abnormalities, support resynchronization therapy in refractory heart failure and even allows early detection of myocardial ischemia. OBJECTIVE: To determine the correlation of systolic synchrony with other parameters of left ventricular systolic-diastolic dysfunction. METHODS: We studied 135 patients referred for screening or known coronary artery disease evaluation by triggered SPECT. Evaluation of the initial interpretation with visual and quantitative QPS/QGS® programs was performed in 50 patients with transient perfusion defects of various sizes (ischemia), 25 of fixed or mixed type (infarction) and 60 without abnormalities. Telesystolic volumes ranged from 26 to 458 mL. Cases with arrhythmias, conduction abnormalities and artifacts (extracardiac activity or motion) were excluded. SPECT scans were retrospectively processed using the Emory Synctool® software. Histograms of systolic contraction synchrony bandwidth (BW) and standard deviation (SD) were correlated with ejection fraction (LVEF), systolic/diastolic volumes and eccentricities, left ventricular mass, peak filling rate (PFR) and time to maximum filling (TPFR). RESULTS: BW and SD of the contraction pase histogram were higher in the fixed and mixed defect group compared to studies showing normal perfusion. Spearman correlations at rest and poststress between SD and BW with LVEF, volumes, eccentricity and mass were all significant (p<0.0002) except for TPFR. CONCLUSION: Left systolic intraventricular contraction synchrony measured with SPECT presents an excellent correlation with systolic and diastolic functional parameters, as well as with mass and eccentricity in various cardiac conditions and ventricular dimensions.

Slump in Hospital Admissions for Stroke, a Fact of an Uncertain Nature That Requires Explanation.

(1) Background: The impact of the health crisis caused by coronavirus disease 2019 (COVID-19) has provoked collateral effects in the attention to pathologies with time-dependent treatments such as strokes. We compare the healthcare activity of two stroke units in the same periods of 2019 and 2020, with an emphasis on what happened during the state of alarm (SA). (2) Materials and methods. Hospitals in the region implemented contingency plans to contain the pandemic; in this planning, the stroke units were not limited in their operational capacity. The SA was declared on 15 March and remained in place for 10 weeks. For the analysis, the data were grouped by consecutive calendar weeks. (3) Results. When the SA was declared the number of calls to the emergency telephone went from 1225 to 3908 calls per week (318% increase). However, the activation of the stroke code went from 6.6 to 5.0 (p = 0.04) and the activity in both stroke units decreased. The largest drop in hospitalizations was for transient ischemic attacks (TIAs) with 35.7% less, 28 vs. 18, (p = 0.05). Reperfusion therapies fell by 37.5%; Poisson regression model 0.64; (95% confidence interval (CI), 0.43-0.95). The overall activity of the telestroke suffered a reduction of 28.9%. We also observed an increase in hospital mortality. (4) Conclusion. The excessive duration of the pandemic precludes any hope of resolving this public health crisis in the short or medium term. Further studies should be conducted to better understand the multifactorial nature of this dramatic decline in stroke admissions and its negative impact.

Targeting antisense mitochondrial noncoding RNAs induces bladder cancer cell death and inhibition of tumor growth through reduction of survival and invasion factors.

Knockdown of the antisense noncoding mitochondrial RNAs (ASncmtRNAs) induces apoptotic death of several human tumor cell lines, but not normal cells, supporting a selective therapy against different types of cancer. In this work, we evaluated the effects of knockdown of ASncmtRNAs on bladder cancer (BCa). We transfected the BCa cell lines UMUC-3, RT4 and T24 with the specific antisense oligonucleotide Andes-1537S, targeted to the human ASncmtRNAs. Knockdown induced a strong inhibition of cell proliferation and increase in cell death in all three cell lines. As observed in UMUC-3 cells, the treatment triggered apoptosis, evidenced by loss of mitochondrial membrane potential and Annexin V staining, along with activation of procaspase-3 and downregulation of the anti-apoptotic factors survivin and Bcl-xL. Treatment also inhibited cell invasion and spheroid formation together with inhibition of N-cadherin and MMP 11. In vivo treatment of subcutaneous xenograft UMUC-3 tumors in NOD/SCID mice with Andes-1537S induced inhibition of tumor growth as compared to saline control. Similarly, treatment of a high-grade bladder cancer PDX with Andes-1537S resulted in a strong inhibition of tumor growth. Our results suggest that ASncmtRNAs could be potent targets for bladder cancer as adjuvant therapy.

Improvement of the Anticancer Activity of Chlorambucil and Ibuprofen via Calix[4]arene Conjugates.

BACKGROUND: One of the possible ways of improving the activity and selectivity profile of anticancer agents is to design drug carrier systems employing nanomolecules. Calix[4]arene derivatives and chlorambucil and ibuprofen are important compounds that exhibit interesting anticancer properties. OBJECTIVE: The objective of this article is the synthesis of new calix[4]arene-derivative conjugates of chlorambucil or ibuprofen with potential anticancer activity. METHODS: Cytotoxicity assays were determined using the protein-binding dye sulforhodamine B (SRB) in microculture to measure cell growth as described [19, 20]. Conjugates of chlorambucil and resorcinarene-dendrimers were prepared in 2% DMSO and added into the culture medium immediately before use. Control cells were treated with 2% DMSO. RESULTS: Thus, calix[4]arene-derivative conjugates of chlorambucil or ibuprofen showed good stability of the chemical link between drug and spacer. Evaluation of the cytotoxicity of the calix[4]arene chlorambucil or ibuprofen conjugates employing a sulforhodamine B (SRB) assay in K-562 (human chronic myelogenous leukemia cells) and U-251 (human glioblastoma cells) demonstrated that the conjugate was more potent as an antiproliferative agent than free chlorambucil and ibuprofen. The conjugates did not show any activity against the COS-7 African green monkey kidney fibroblast cell line. CONCLUSION: In the paper, we report the synthesis and spectroscopic analyses of new calix[4]arene derivative conjugates of chlorambucil or ibuprofen. Cytotoxicity assays revealed that at 10 µM, the conjugates were very active against K-562 (human chronic myelogenous leukemia cells) and U- 251 (human glioblastoma cells) cancer cells' proliferation. In order to explain the molecular mechanisms involved in the anticancer activity of calix[4]arene chlorambucil or ibuprofen conjugates, our research will be continued.

Uso medicinal de cannabis: una revisión de la evidencia / Medicinal use of cannabis: a review of the evidence

Resumen Este estudio pretende reportar la evidencia actual sobre el uso medicinal de cannabis existente en la base de datos Scopus. Se llevó a cabo una revisión sistemática de las publicaciones científicas, entre el periodo 2013-2017, disponibles en Scopus sobre el uso medicinal de cannabis. Estados Unidos es el país con mayor cantidad de publicaciones, seguido de Canadá e Israel; existiendo un aumento progresivo y constante de la evidencia entre los años 2013 y 2017. Los contenidos de las publicaciones versan sobre efectos beneficiosos y adversos para la salud, consecuencias de la legislación del cannabis y su asociación con diversas variables. Existe una falta de estudios en uso medicinal de cannabis respecto a tratamientos y enfermedades, su estandarización, vías de administración y dosis, dando cuenta de la necesidad de un volumen mayor de investigaciones al respecto.

Abstract This study aims to report the current evidence on the medicinal use of cannabis in the Scopus database. A systematic review of the scientific publications was carried out, between the period 2013-2017, available in Scopus on the medicinal use of cannabis. The United States is the country with the most publications, followed by Canada and Israel; there is a progressive and constant increase in the evidence between 2013 and 2017. The contents of the publications are about beneficial and adverse effects on health, the consequences of cannabis legislation and its association with various variables. There is a lack of studies on the medicinal use of cannabis in relation to treatments and diseases, its standardization, administration routes and doses, giving account of the need for a greater volume of research in this regard.

Clinical Predictors of Hyperperfusion Syndrome Following Carotid Stenting: Results From a National Prospective Multicenter Study.

OBJECTIVES: The aim of the HISPANIAS (HyperperfusIon Syndrome Post-carotid ANgIoplasty And Stenting) study was to define CHS rates and develop a clinical predictive model for cerebral hyperperfusion syndrome (CHS) after carotid artery stenting (CAS). BACKGROUND: CHS is a severe complication following CAS. The presence of clinical manifestations is estimated on the basis of retrospective reviews and is still uncertain. METHODS: The HISPANIAS study was a national prospective multicenter study with 14 recruiting hospitals. CHS was classified as mild (headache only) and moderate-severe (seizure, impaired level of consciousness, or development of focal neurological signs). RESULTS: A total of 757 CAS procedures were performed. CHS occurred in 22 (2.9%) patients, in which 16 (2.1%) had moderate-severe CHS and 6 (0.8%) had mild CHS (only headache). The rate of hemorrhages was 0.7% and was associated with high mortality (20%). Pre-operative predictors of moderate-severe CHS in multivariate analysis were female sex (odds ratio [OR]: 3.24; 95% confidence interval [CI]: 1.11 to 9.47; p = 0.03), older patients (OR: 1.09; 95% CI: 1.01 to 1.17; p = 0.02), left carotid artery treated (OR: 4.13; 95% CI: 1.11 to 15.40; p = 0.03), and chronic renal failure (OR: 6.29; 95% CI: 1.75 to 22.57; p = 0.005). The area under the curve of this clinical and radiological model was 0.86 (95% CI: 0.81 to 0.92; p = 0.001). CONCLUSIONS: The rate of CHS in the HISPANIAS study was 2.9%, with moderate-severe CHS of 2.1%. CHS was independently associated with female sex, older age, history of chronic kidney disease, and a treated left carotid artery. Although further investigations are needed, the authors propose a model to identify high-risk patients and develop strategies to decrease CHS morbidity and mortality in the future.

In vitro activity of resorcinarene-chlorambucil conjugates for therapy in human chronic myelogenous leukemia cells.

A possible way of improving the activity and selectivity profile of antitumor agents is to design drug carrier systems employing soluble macromolecules. Thus, four resorcinarene-PAMAM-dendrimer conjugates of chlorambucil with different groups in the lower part of the macrocycle and different length dendritic arms showed a good stability of the chemical link between drug and spacer. Evaluation of the cytotoxicity of the resorcinarene-PAMAM-dendrimer-chlorambucil conjugate employing a sulforhodamine B (SRB) assay in K-562 (human chronic myelogenous leukemia cells) demonstrated that the conjugate was more potent as an antiproliferative agent than chlorambucil.

Caracterización del accidente por mordedura de serpiente atendidos en unidades de Salud, Zona 5, Ecuador / Characterization of snakebite accident, attended in Health Units, Zone 5, Ecuador

Introducción. El accidente por mordedura de serpiente ocasiona un problema importante en salud pública en el Ecuador, especialmente en la Zona 5-Salud. Objetivo.Determinar las características del envenenamiento accidental por mordedura de serpiente en pacientes atendidos en las unidades de salud de las provincias de la Zona 5-Salud, durante los meses de enero a julio del 2016. Material y métodos. Diseño no experimental, transversal, tipo descriptivo comparativo, realizándose revisión y análisis de fichas clínicas de 223 casos con accidentes por ofidios, atendidos en las unidades de salud de las provincias de la Coordinación Zonal 5 ­Salud, durante los meses de enero a julio del 2016. Resultados.Mayormente afectados fue el sexo masculino, entre 10 a 39 años, de los cantones rurales de Guayas y Los Ríos, con diagnóstico positivo del 77,13 %. Bothrops asperfue la especie que mayor número de accidentes provocó, con 55,61 % de la incidencia; los sitios de mordida frecuentes fueron los pies y manos, seguido de la extremidad inferior (pierna); y la mayoría de los pacientes presentó condición clínica leve. Conclusiones.Los accidentes por ofidios fueron más por laserpiente Bothrops asper, y el sitio de mordida frecuentes son los pies y manos, seguido de la extremidad inferior,siendo estos sitios que debe protegerse las personas, aunque su accidente mayormente sea de condición clínica leve.

Introduction. Accident caused by snake bite cause a major problem in public health in Ecuador, especially in Zone 5-Health. Objective.To determine the characteristics of accidental poisoning by snake bite in patients treated in the health units of the provinces of Zone 5-Health, during the months of January to July 2016. Material and methods. Non-experimental, transversal design, comparative descriptive type, review and analysis of clinical files of 223 cases with snake accidents, attended in the health units of the provinces of the Zonal Coordination 5 -Health, during the months of January to July 2016. Results.Mostly affected was the male sex, between 10 and 39 years old, from the rural cantons of Guayas and Los Ríos, with a positive diagnosis of 77,13%. Bothrops asper was the species that caused the greatest number of accidents, with 55,61% of the incidence; the frequent bite sites were the feet and hands, followed by the lower extremity (leg); and the majority of patients presented mild clinical condition. Conclusions.The snake accidents were more due to the snake Bothrops asper, and the frequent bite site is the feet and hands, followed by the lower extremity, these sites being that people should be protected, even if their accident is mostly of a mild clinical condition.

[Predictive value of dipyridamole myocardial perfusion tomography on survival]. / Estratificación de riesgo de muerte a mediano plazo de pacientes evaluados por enfermedad coronaria con SPECT de perfusión miocárdica bajo efecto de dipiridamol.

BACKGROUND: Dipyridamole (DIP) is the most commonly employed pharmacological stressor for myocardial perfusion tomography (SPECT) in patients unable to reach an adequate work load. AIM: To assess the predictive capacity of DIP SPECT on survival. MATERIAL AND METHODS: We included 985 adults aged 66 ±11 years (45% women) with rest and DIP-SPECT. The main indications for the procedure were coronary artery disease (CAD) screening in 66% and known CAD in 33%. Participants were followed up for a median of 65 months (interquartile range 54 to 86 months). During the follow up, 261 deaths were recorded and 98% had a specified cause in their death certificate. RESULTS: Myocardial SPECT was abnormal in 44% of participants. Transient ischemic defects were observed in 34%, fixed defects concordant with infarction in 27% and post-stress systolic dysfunction in 23%. Twenty five percent of deaths were attributable to cardiac or ischemic cause and 22% to cancer. In a bivariate analysis, the hazard ratio (HR) of death of any cause was lower in females and higher in the presence of CAD. The multivariate analysis showed that being older than 46 years increased the HR of death of any cause. In a bivariate analysis, the HR for cardiac death was higher when the myocardial SPECT showed ischemia, necrosis or left ventricular dilation. In the multivariate analysis, post-stress left ventricular systolic function was associated with a lower risk of cardiac death. CONCLUSIONS: An abnormal myocardial SPECT, perfusion abnormalities, left ventricular systolic function or dilation are independent predictors of cardiac death in these participants.

La intencionalidad de la acción en el proceso motivacional humano / The intentionality of action on the human motivational process

Resumen El presente escrito se propone analizar el papel de la intención como unidad de análisis que permite comprender y explicar el funcionamiento psíquico individual, lo cual se expresa a través del proceso conocido como condicionamiento intencional (Esteban-Guitart, 2013). Se propone que este funcionamiento psíquico individual de tipo intencional se sustenta sobre la formación de un sentido subjetivo acerca de la acción (González-Rey, 2010), y se hacen algunas hipótesis acerca del proceso que sigue su formación a través de las diversas fases del ciclo motivacional, de acuerdo con evidencia empírica proveniente de diversas fuentes. El aspecto diferencial de este escrito es que toma al modelo de Rubicón de la Acción (Heckhausen & Gollwitzer, 1987) como marco de análisis del proceso motivacional, para especificar los factores que, en cada fase del proceso, tanto en su etapa propiamente motivacional como en su etapa volitiva, subyacen a la formación de ese sentido subjetivo que da origen a la intención de actuar y mantiene a la persona en la ejecución de la acción hasta obtener el resultado esperado. Se concluye hipotéticamente que el sentido subjetivo de esas acciones se construye a lo largo de las fases del ciclo motivacional, condensando e integrando en sí mismo representaciones propias de un sentido de utilidad, de control, de valor, de coherencia, de realidad presente, y de tiempo futuro, en relación a una acción determinada.

Abstract The aim of this essay is to analyze the role of intention as a unit of analysis that allows for the understanding and explanation of individual psychic functioning, which is manifested by way of the process known as intentional conditioning (Esteban-Guitart, 2013). It is argued that this individual psychic functioning of an intentional type is sustained on the formation of a subjective sense about action (González-Rey, 2010), and some hypotheses are formulated about the process that follows its formation across the different phases of the motivational cycle, according to empirical evidence from different sources. The differential aspect in this essay is that it takes the Rubicon model of action (Heckhausen & Gollwitzer, 1987) as the framework of analysis of the motivational process in order to specify the factors that, in each phase of the process, both in the properly motivational stage and in the volitional stage, underlie the formation of such subjective sense giving rise to the intention to act and maintaining the individual in the performance of the action until the expected goal is achieved. It is concluded that the subjective sense of those actions is constructed throughout the phases of the motivational cycle, hence assimilating and integrating into itself representations that are proper to a sense of usefulness, control, value, coherence, current reality, and future time, regarding a particular action.

Efecto de la terapia de resincronización ventricular en los parámetros de disfunción endotelial y función sistólica izquierda en pacientes con insuficiencia cardíaca crónica y bloqueo completo de rama izquierda / Endothelial dysfunction, left ventricular function, and chronic heart failure with complete left bundle branch block: effect of resynchronization therapy

Resumen: Introducción: La insuficiencia cardíaca crónica (ICC) es una condición compleja asociada a inflamación sistémica y a disfunción endotelial (DE) cuya patogénesis no es bien comprendida. Objetivo: Evaluar una posible relación entre marcadores de DE periférica con la respuesta a terapia de resincronización ventricular (TRV). Método: 20 pacientes con ICC, QRS ≥120ms y fracción de eyección ventricular izquierda (FEVI) ≤35% se estudiaron pre y 6 meses post-TRV con: Minnesota Living with Heart Failure Questionnaire (MLHFQ); test de marcha (TM-6min); Ecocardiografía-2D y SPECT de perfusión gatillado en reposo; proteína C-reactiva ultra sensible (us-PCR); péptido natriurético cerebral (pro-BNP); células endoteliales circulantes (CEC); moléculas de adhesión soluble vascular (sVCAM) e intercelular (sICAM); interleukina-6 (IL-6) y Factor von Willebrand (FvW). Se clasificaron como respondedores o no a TRV según criterios preestablecidos. Resultados: Promedios basales: pro-BNP 5.290pg/ml; us-PCR 1,7ug/mL; MLHFQ 72; TM-6min 391 metros. Las CEC y sICAM estaban sobre límites normales. Post-TRV, el 50% fue respondedor: 11/20 mejoraron ≥1 clase NYHA y ≥10% del TM-6min; ML-HFQ disminuyó (p<0.0001); FEVI mejoró (p=0.003); volumen final sistólico disminuyó (p=0.008) y también pro-BNP (p=0.03). En los respondedores, las CEC disminuyeron, persistiendo elevadas, sobre lo normal. Existieron correlaciones entre cambios de pro-BNP con TM-6min y entre us-PCR con MLHFQ y FvW (p≤0.004 en todas). Conclusiones: En ICC existe evidencia de significativa DE, expresada por sICAM y CEC, biomarcador periférico sensible. Estas disminuyeron 6 meses post-TRV, persistiendo sobre el límite normal. Otros parámetros funcionales e inflamatorios se correlacionaron en el grupo total, sin diferencias entre grupos respondedores y no respondedores.

Abstract: Introduction: Chronic heart failure (CHF) is a complex condition associated with systemic inflammation and endothelial dysfunction (ED) whose pathogenesis is not well understood. Objective: to evaluate a possible relationship between peripheral ED markers and response to cardiac resynchronization therapy (CRT). Method: 20 patients with CHF, QRS ≥120ms and left ventricular ejection fraction (LVEF) ≤35% were studied before and 6 months post-CRT. Minnesota Living with Heart Failure Questionnaire (MLHFQ); walking test (6min-WT); 2D-echocardiography and gated perfusion SPECT at rest; ultra-sensitive C-reactive protein (us-CRP); brain natriuretic peptide (pro-BNP); circulating endothelial cells (CEC); vascular soluble adhesion (sVCAM) and intercellular adhesion molecules (sICAM); interleukin-6 (IL-6) and von Willebrand Factor (vWF) were measured in all subjects. They were classified as responders or not to CRT, according to pre-established criteria. Results: Basal means: pro-BNP 5,290 pg / ml; us-CRP 1.7 ug/mL; MLHFQ 72; 6min-WT 391 meters. The CEC and IL-6 were above normal limits. Post-CRT, 50% were responders: 11/20 improved ≥1 NYHA class and ≥10% increase in 6min-WT; MLHFQ decreased (p <0.0001); LVEF improved (p = 0.003); final systolic volume decreased (p = 0.008) and also pro-BNP (p= 0.03). In responders CEC decreased, persisting over normal limits. There were correlations between changes of pro-BNP with TM-6min and between us-PCR with MLHFQ and vWF (p≤0.004 in all). Conclusions: In CHF there is evidence of significant ED, expressed by sICAM and CEC, a sensitive peripheral biomarker that decreased 6 months post-CRT although persisting above normal limits. Other functional and inflammatory parameters were correlated in the total group, without differences between responders and non-responders.

Estratificación de riesgo de muerte a mediano plazo de pacientes evaluados por enfermedad coronaria con SPECT de perfusión miocárdica bajo efecto de dipiridamol / Predictive value of dipyridamole myocardial perfusion tomography on survival

Background: Dipyridamole (DIP) is the most commonly employed pharmacological stressor for myocardial perfusion tomography (SPECT) in patients unable to reach an adequate work load. Aim: To assess the predictive capacity of DIP SPECT on survival. Material and Methods: We included 985 adults aged 66 ±11 years (45% women) with rest and DIP-SPECT. The main indications for the procedure were coronary artery disease (CAD) screening in 66% and known CAD in 33%. Participants were followed up for a median of 65 months (interquartile range 54 to 86 months). During the follow up, 261 deaths were recorded and 98% had a specified cause in their death certificate. Results: Myocardial SPECT was abnormal in 44% of participants. Transient ischemic defects were observed in 34%, fixed defects concordant with infarction in 27% and post-stress systolic dysfunction in 23%. Twenty five percent of deaths were attributable to cardiac or ischemic cause and 22% to cancer. In a bivariate analysis, the hazard ratio (HR) of death of any cause was lower in females and higher in the presence of CAD. The multivariate analysis showed that being older than 46 years increased the HR of death of any cause. In a bivariate analysis, the HR for cardiac death was higher when the myocardial SPECT showed ischemia, necrosis or left ventricular dilation. In the multivariate analysis, post-stress left ventricular systolic function was associated with a lower risk of cardiac death. Conclusions: An abnormal myocardial SPECT, perfusion abnormalities, left ventricular systolic function or dilation are independent predictors of cardiac death in these participants.