Life expectancy after surgical aortic valve replacement for low-gradient aortic stenosis with preserved ejection fraction.

INTRODUCTION AND OBJECTIVES: Surgical aortic valve replacement (SAVR) can modify the natural history of severe aortic stenosis (SAS). However, compared with the general population, these patients have a loss of life expectancy. The life expectancy of patients who undergo SAVR due to low-gradient SAS with preserved left ventricular ejection fraction (LVEF) is unknown. METHODS: We included all patients between 50 and 65 years who underwent isolated SAVR in 27 Spanish centers during an 18-year period. We analyzed observed and expected survival at 18 years in patients with low-gradient SAS with preserved LVEF and all other types of SAS. We used propensity score matching to compare the life expectancy of patients with low-gradient SAS with preserved LVEF vs those with high-gradient SAS with preserved LVEF. RESULTS: We analyzed 5084 patients, of whom 413 had low-gradient SAS with preserved LVEF. For these patients, observed survival at 10, 15 and 18 years was 86.6% (95%CI, 85.3-87.8), 75% (95%CI, 72.7-77.2), and 63.5% (95%CI, 58.8-67.8). Expected survival at 10, 15 and 18 years was 90.2%, 82.1%, and 75.7%. In the matched sample, survival of patients with low-gradient SAS with preserved LVEF was similar to that of patients with high-gradient with preserved LVEF, log-rank test, P=.95; HR=1 (95%CI, 0.7-1.4; P=.95). CONCLUSIONS: There is a loss of life expectancy in patients with all types of SAS undergoing SAVR. This loss is higher in patients with left ventricular dysfunction and lower in patients with low-gradient or high-gradient aortic stenosis with preserved LVEF. The benefit of surgery is similar between these last 2 groups.

Life expectancy after aortic valve replacement in young patients.

INTRODUCTION AND OBJECTIVES: In young patients with severe aortic stenosis, it is unknown whether their life expectancy restored after aortic valve replacement (AVR) is unknown. METHODS: We analyzed all patients aged between 50 and 65 years who underwent isolated AVR in 27 Spanish centers during an 18-year period. We compared observed and expected survival at 15 years of follow-up. We repeated all analyses for patients without complications in the postoperative period. RESULTS: A total of 5084 patients were analyzed. For the overall sample, observed survival at 10 and 15 years was 85.3% (95%CI, 84.1%-86.4%) and 73.7% (95%CI, 71.6%-75.6%), respectively. Expected survival was 90.1% and 82.1%. Cumulative relative survival for 1, 5, 10 and 15 years of follow-up was 97.4% (95%CI, 96.9%-97.9%), 96.5% (95%CI, 95.7%-97.3%), 94.7% (95%CI, 93.3%-95.9%), and 89.8% (95%CI, 87.3%-92.1%). For patients without complications, cumulative relative survival for 1, 5, 10 and 15 years was 100.3% (95%CI, 99.8%-100.5%), 98.9% (95%CI 97.6% -99.9%), 97.3% (95%CI, 94.9%-99.4%), and 91.9% (95%CI, 86.5%-96.8%). CONCLUSIONS: Life expectancy in young patients who have severe aortic stenosis and undergo AVR is lower than that of the general population. Life expectancy of individuals without complications during the postoperative period is also reduced. Therefore, baseline characteristics are likely the main factors that explain the reduction in life expectancy.

Differences in life expectancy between men and women after aortic valve replacement.

OBJECTIVES: Some researchers have observed an increased number of deaths during the follow-up of young patients who undergo aortic valve replacement due to severe aortic stenosis, suggesting that this procedure does not restore their life expectancy. Our goal was to confirm these findings and explore sex-based differences. METHODS: All patients between 50 and 65 years of age who underwent isolated aortic valve replacement in 27 Spanish centres during an 18-year period were included. We compared observed and expected survival at 15 years of follow-up and estimated the cumulative incidence of death from a competing risks point of view. We stratified by sex and analysed if being a woman was an independent risk factor for death. RESULTS: For men, the observed survival at 10 and 15 years of follow-up was 85% [95% confidence interval (CI) 83.6%-86.4%] and 72.3% (95% CI 69.7%-74.7%), respectively whereas the expected survival was 88.1% and 78.8%. For women, the observed survival at 10 and 15 years was 85% (95% CI 82.8%-86.9%) and 73% (95% CI 69.1%-76.4%), whereas the expected survival was 94.6% and 89.4%. At 15 years of follow-up, the cumulative incidence of death due to the disease in men and women was 8.2% and 16.7%, respectively. In addition, being a woman was an independent risk factor for death (hazard ratio = 1.23 (95% CI 1.02-1.48; P = 0.03). CONCLUSIONS: After the aortic valve replacement, men and women do not have their life expectancy restored, but this loss is much higher in women than in men. In addition, being a woman is a risk factor for long-term death. Reasons for these findings are unknown and must be investigated.

Biogardens as constructed wetlands in tropical climate: A case study in the Central Pacific Coast of Costa Rica.

In Costa Rica, <10% of wastewater is treated before its discharge. This generates a significant impact on the environment, public health, and tourism industry, which is one of the country's main economic activities. Biogardens, subsurface flow artificial wetlands, are alternative systems for the treatment of wastewater. The present study evaluated the removal of organic matter and nutrients in a biogarden located at a hotel in the Central Pacific Coast of Costa Rica between 2012 and 2017. Pretreatment involved septic tanks and grease traps for sewage and gray water, respectively. The biogarden, which is composed of seven wetlands with an average area of 12 m2 and a depth of 0.7 m, contains river cobble as support material, gravel as bed, and Cyperus papyrus and Heliconia sp. plants. Removal of the biochemical oxygen demand (BOD), the chemical oxygen demand (COD), and the total suspended solids (TSS) on average were 80%, 66%, and 72%, respectively, thus producing an effluent in compliance with current national legislation. Furthermore, the biogarden did not emit noxious odors or display an excessive presence of mosquitoes. The results showed consistent and efficient removal of organic matter and nutrients from the wastewater throughout different seasons and pollutant loads, verifying that such systems can be used in decentralized locations (e.g., tourist areas) in tropical climates.

Mechanistic Investigation into DNA Modification by a RuII ,RhIII Bimetallic Complex.

Despite significant progress in the treatment of cancer, there remains an urgent need for more effective therapies that also have less impact on patient wellbeing. Photodynamic therapy employs targeted light activation of a photosensitizer in selected tissues, thereby reducing off-target toxicity. Our group previously reported a RuII ,RhIII bimetallic architecture that displays multifunctional covalent photomodification of DNA in the therapeutic window in an oxygen-independent manner, features that are essential for treating deep and hypoxic tumors. Herein, we explore the mechanism by which a new analogue, [(phen)2 Ru(dpp)Rh(phen)Cl2 ]3+ , or RuII -RhIII , interacts with DNA. We established that RuII -RhIII exhibits "light switch" behavior in the presence of DNA, undergoing strong electrostatic interactions that might involve groove binding. Furthermore, these noncovalent interactions play a major role in the covalent photobinding and photocleavage of DNA, which occur according to an oxygen-independent mechanism. Polymerase chain reaction (PCR) revealed that covalent modification of DNA by RuII -RhIII , especially photobinding, is critical to inhibiting amplification, thus suggesting that the complex could exert its toxic activity by interfering with DNA replication in cells. This new structural motif, with phenanthroline at all three terminal ligand positions, has a number of properties that are promising for the continued refinement of photodynamic-therapy strategies.

Resazurin Live Cell Assay: Setup and Fine-Tuning for Reliable Cytotoxicity Results.

In vitro cytotoxicity tests allow for fast and inexpensive screening of drug efficacy prior to in vivo studies. The resazurin assay (commercialized as Alamar Blue®) has been extensively utilized for this purpose in 2D and 3D cell cultures, and high-throughput screening. However, improper or lack of assay validation can generate unreliable results and limit reproducibility. Herein, we report a detailed protocol for the optimization of the resazurin assay to determine relevant analytical (limits of detection, quantification, and linear range) and biological (growth kinetics) parameters, and, thus, provide accurate cytotoxicity results. Fine-tuning of the resazurin assay will allow accurate and fast quantification of cytotoxicity for drug discovery. Unlike more complicated methods (e.g., mass spectrometry), this assay utilizes fluorescence spectroscopy and, thus, provides a less costly alternative to observe changes in the reductase proteome of the cells.

Exploring the activity of a polyazine bridged Ru(ii)-Pt(ii) supramolecule in F98 rat malignant glioma cells.

The mixed-metal supramolecular complex, [(Ph2phen)2Ru(dpp)PtCl2]2+, displays significant DNA modification, cell growth inhibition, and toxicity towards F98 malignant glioma cells following visible light irradiation. The design of this complex affords superior cellular uptake and antiproliferative activity compared to the classic chemotherapeutic agent, cisplatin.

A new class of Ru(II) polyazine agents with potential for photodynamic therapy.

Appending anthracene units to [(bpy)2Ru(dpp)](2+) results in Ru(II) agents that exhibit dynamic photoreactivity towards DNA and protein. [(Anthbpy)(bpy)Ru(dpp)](2+) and [(Anthbpy)2Ru(dpp)](2+) are the first metal-organic Ru(II) agent with dpp ligands shown to photomodify DNA in the presence or absence of oxygen, while also binding protein in an oxygen-dependent manner.

Histopatología de cirrosis y hepatocarcinoma por Virus B / Cirrhosis and hepatocarcinoma in HBV

Cirrosis por virus B: Se puede detectar en biopsia el antígeno de superficie con tinción de orceína (hepatocitos esmerilados) y por inmunohistoquímica (antígeno de superficie y anticore). Estadios de evolución: a) temprano o incipiente: nódulos no definidos, mucha fibrosis y alteración arquitectural; b) establecido: nódulos rodeados completamente de bandas fibroticas. estadio histológico: a) activo: necrosis e inflamación importante, colestasis; b) Inactivo: poca necrosis o inflamación, hepatocarcinoma: (tipos): trabecular, células claras, adenoide, sólido, escirroso. La immunohistoquimica ayuda a definir el tipo usando los antígenos hepatocelulares, antígeno carcinoembriónico, citoqueratinas, cromogranina y sinaptofisina.

HBV cirrosis: The surface antigen can be detected by biopsy, orcein tinctions (emery hepatocytes), and immunohistochemistry (surface antigen and anticore). Evolution Stages: a) Early or incipient (non-defined nodes, a lot of fibrosis and architectural alteration); b) established (nods completely surrounded by fibrotic bands). Histological Stages: a) active (main necrosis and inflammation; and cholestasis); b) inactive (little necrosisor inflammation). Types of Hepatocarcinomas: trabecular-clear cells- adenoid-solid-scirrhous. The immunohistochemistry helps to define the type using the hepatocellular antigens, carcinoembryonic antigen, cytokeratin, chromogranins and synapto-physins.

Lipomas submucosos de ileon terminal y de colon: informe de dos casos y revision de literatura / Terminal ileon and colon submucosal lipoma: report of two cases and review of the literature

Los lipomas submucosos de ileon terminal y colon ocupan el segundo lugar en frecuencia entre las neoplasias benignas del intestino. Clinicamente se manifiestan por sintomas que se atribuyen a otras enfermedades debido problamente a su baja frecuencia. La sintomatologia y signologia dependen del tamano del tumor y no necesariamente de su presencia en el tubo intestinal; asi entre mas grande sea, mayor la posibilidad de producir intususcepcion, obstruccion, sangrado, perforacion, peritonitis y abdomen agudo. Estos pacientes usualmente se catalogan como portadores de enfermedades inflamatorias e infeccionas del aparato gastrointestinal. Sin embargo, con mas acuciosidad clinica y con mejores estudios radiologicos o endoscopicos, se podrian diagnosticar preoperatoriamente. Se presentan en este trabajo dos casos de lipoma submucoso de ileon terminal y colon ascendente que produjeron intususcepcion, oclusion y en uno,perforacion y peritonitis. Al mismo tiempo, se hace una revision de la literatura sobre estas lesiones.