Pattern of care in radiotherapy at a University Hospital in Spain: the RENORT project

Purpose RENORT is a novel data mining application developed to extract relevant clinical data from oncology information systems (OIS; ARIA and Mosaiq) used in radiation oncology (RO). Methods/patients We used RENORT to extract demographic and clinical data from the OIS of all patients treated at the RO Department at the General Hospital of Valencia during the year 2019. Results A total of 1158 treatments were performed. The female/male ratio was 39.3%/60.7%, with a mean age of 66 years. The mean waiting time between the treatment decision/proposal to the first visit was 10.1 days. Mean duration of the treatment preparation process was 21 days. Most patients (90.4%) completed treatment within the prescribed time ± 7 days. The most common sites/treatment types were: metastatic/palliative treatments (n = 300; 25.9%), breast (209; 18.0%), genitourinary (195; 16.8%), digestive (116; 10.0%), thoracic (104; 9.0%), head and neck (62; 5.4%), and skin cancer (51; 4.4%). The distribution according to treatment intent was as follows: palliative (n = 266; 23.0%), adjuvant curative (335; 28.9%), radical without adjuvant treatment (229; 19.8%), radical with concomitant treatment (188; 16.2%), curative neoadjuvant (70; 6.0%), salvage radiotherapy (61; 5.3%); and reirradiation (9; 0.8%). The most common treatment techniques were IMRT/VMAT with IGRT (n = 468; 40.4%), 3D-CRT with IGRT (421; 36.4%), SBRT (127; 11.0%), 2DRT (57; 4.9%), and SFRT (56; 4.8%). A mean of 15.9 fractions were administered per treatment. Hypofractionated schemes were used in 100% of radical intent breast and prostate cancer treatments. Conclusions The RENORT application facilitates data retrieval from oncology information systems to allow for a comprehensive determination of the real role of radiotherapy in the treatment of cancer patients. This application is valuable to identify patterns of care and to assess treatment efficacy (AU)

Patterns of treatment failure in patients with prostate cancer treated with 76 80 radiotherapy to the prostate and seminal vesicles

Purpose To assess the pattern of treatment failure in patients with prostate cancer (PCa) treated with radiotherapy (76–80 Gy) ± hormone therapy (HT). We also evaluated the influence of treatment failure on survival outcomes. Methods Retrospective study of patients with PCa (n = 302) treated with radiotherapy (RT) ± HT at our centre between November 1999 and July 2007. The mean patient age was 70.2 years (range 51–87). Distribution by NCCN risk group was low (n = 80, 26.5%), intermediate (n = 86, 28.5%), high (n = 77, 25.5%), and very high (n = 49, 16.2%). Most patients (n = 273, 90.4%) received IMRT at a dose of 76–80 Gy. HT was administered in 237 patients (78.5%), in most cases (n = 167, 55.3%) for < 7 months Results Survival rates at 10 years were: overall survival (OS), 64.3%; biochemical disease-free survival, 83.9%; disease-free survival, 92.5%; and metastasis-free survival (MFS), 94.3%. Biochemical failure (BF) was observed in 55 cases (18.2%), 32 of whom subsequently developed clinical recurrence: metastasis (n = 17, 5.6%), local failure (n = 11, 3.6%), and regional failure (n = 4, 1.3%). The cause of death (n = 159) was intercurrent disease in 115 cases (72.3%), second cancer in 27 (17.0%), and PCa in 17 (10.7%). Biochemical failure-free survival ≤ 24 months was significantly associated with worse OS and MFS (p = 0.0001). Late genitourinary and gastrointestinal toxicity grade ≥ 3 (RTOG) was observed in 18 (6.0%) and 7 (2.3%) patients, respectively. Conclusions The main type of treatment failure after 76–80 Gy of radiotherapy ± HT is local or metastatic. In all cases, biochemical failure occurred prior to treatment failure. BF within 24 months of treatment completion was significantly associated with worse OS and MFS (AU)

Pattern of care in radiotherapy at a University Hospital in Spain: the RENORT project.

PURPOSE: RENORT is a novel data mining application developed to extract relevant clinical data from oncology information systems (OIS; ARIA and Mosaiq) used in radiation oncology (RO). METHODS/PATIENTS: We used RENORT to extract demographic and clinical data from the OIS of all patients treated at the RO Department at the General Hospital of Valencia during the year 2019. RESULTS: A total of 1158 treatments were performed. The female/male ratio was 39.3%/60.7%, with a mean age of 66 years. The mean waiting time between the treatment decision/proposal to the first visit was 10.1 days. Mean duration of the treatment preparation process was 21 days. Most patients (90.4%) completed treatment within the prescribed time ± 7 days. The most common sites/treatment types were: metastatic/palliative treatments (n = 300; 25.9%), breast (209; 18.0%), genitourinary (195; 16.8%), digestive (116; 10.0%), thoracic (104; 9.0%), head and neck (62; 5.4%), and skin cancer (51; 4.4%). The distribution according to treatment intent was as follows: palliative (n = 266; 23.0%), adjuvant curative (335; 28.9%), radical without adjuvant treatment (229; 19.8%), radical with concomitant treatment (188; 16.2%), curative neoadjuvant (70; 6.0%), salvage radiotherapy (61; 5.3%); and reirradiation (9; 0.8%). The most common treatment techniques were IMRT/VMAT with IGRT (n = 468; 40.4%), 3D-CRT with IGRT (421; 36.4%), SBRT (127; 11.0%), 2DRT (57; 4.9%), and SFRT (56; 4.8%). A mean of 15.9 fractions were administered per treatment. Hypofractionated schemes were used in 100% of radical intent breast and prostate cancer treatments. CONCLUSIONS: The RENORT application facilitates data retrieval from oncology information systems to allow for a comprehensive determination of the real role of radiotherapy in the treatment of cancer patients. This application is valuable to identify patterns of care and to assess treatment efficacy.

Patterns of treatment failure in patients with prostate cancer treated with 76-80 Gy radiotherapy to the prostate and seminal vesicles ± hormonotherapy.

PURPOSE: To assess the pattern of treatment failure in patients with prostate cancer (PCa) treated with radiotherapy (76-80 Gy) ± hormone therapy (HT). We also evaluated the influence of treatment failure on survival outcomes. METHODS: Retrospective study of patients with PCa (n = 302) treated with radiotherapy (RT) ± HT at our centre between November 1999 and July 2007. The mean patient age was 70.2 years (range 51-87). Distribution by NCCN risk group was low (n = 80, 26.5%), intermediate (n = 86, 28.5%), high (n = 77, 25.5%), and very high (n = 49, 16.2%). Most patients (n = 273, 90.4%) received IMRT at a dose of 76-80 Gy. HT was administered in 237 patients (78.5%), in most cases (n = 167, 55.3%) for < 7 months RESULTS: Survival rates at 10 years were: overall survival (OS), 64.3%; biochemical disease-free survival, 83.9%; disease-free survival, 92.5%; and metastasis-free survival (MFS), 94.3%. Biochemical failure (BF) was observed in 55 cases (18.2%), 32 of whom subsequently developed clinical recurrence: metastasis (n = 17, 5.6%), local failure (n = 11, 3.6%), and regional failure (n = 4, 1.3%). The cause of death (n = 159) was intercurrent disease in 115 cases (72.3%), second cancer in 27 (17.0%), and PCa in 17 (10.7%). Biochemical failure-free survival ≤ 24 months was significantly associated with worse OS and MFS (p = 0.0001). Late genitourinary and gastrointestinal toxicity grade ≥ 3 (RTOG) was observed in 18 (6.0%) and 7 (2.3%) patients, respectively. CONCLUSIONS: The main type of treatment failure after 76-80 Gy of radiotherapy ± HT is local or metastatic. In all cases, biochemical failure occurred prior to treatment failure. BF within 24 months of treatment completion was significantly associated with worse OS and MFS.

Genome Wide Meta-Analysis identifies common genetic signatures shared by heart function and Alzheimer's disease.

Echocardiography has become an indispensable tool for the study of heart performance, improving the monitoring of individuals with cardiac diseases. Diverse genetic factors associated with echocardiographic measures have been previously reported. The impact of several apoptotic genes in heart development identified in experimental models prompted us to assess their potential association with human cardiac function. This study aimed at investigating the possible association of variants of apoptotic genes with echocardiographic traits and to identify new genetic markers associated with cardiac function. Genome wide data from different studies were obtained from public repositories. After quality control and imputation, a meta-analysis of individual association study results was performed. Our results confirmed the role of caspases and other apoptosis related genes with cardiac phenotypes. Moreover, enrichment analysis showed an over-representation of genes, including some apoptotic regulators, associated with Alzheimer's disease. We further explored this unexpected observation which was confirmed by genetic correlation analyses. Our findings show the association of apoptotic gene variants with echocardiographic indicators of heart function and reveal a novel potential genetic link between echocardiographic measures in healthy populations and cognitive decline later on in life. These findings may have important implications for preventative strategies combating Alzheimer's disease.

Histone deacetylase inhibitors promote glioma cell death by G2 checkpoint abrogation leading to mitotic catastrophe.

Glioblastoma multiforme is resistant to conventional anti-tumoral treatments due to its infiltrative nature and capability of relapse; therefore, research efforts focus on characterizing gliomagenesis and identifying molecular targets useful on therapy. New therapeutic strategies are being tested in patients, such as Histone deacetylase inhibitors (HDACi) either alone or in combination with other therapies. Here two HDACi included in clinical trials have been tested, suberanilohydroxamic acid (SAHA) and valproic acid (VPA), to characterize their effects on glioma cell growth in vitro and to determine the molecular changes that promote cancer cell death. We found that both HDACi reduce glioma cell viability, proliferation and clonogenicity. They have multiple effects, such as inducing the production of reactive oxygen species (ROS) and activating the mitochondrial apoptotic pathway, nevertheless cell death is not prevented by the pan-caspase inhibitor Q-VD-OPh. Importantly, we found that HDACi alter cell cycle progression by decreasing the expression of G2 checkpoint kinases Wee1 and checkpoint kinase 1 (Chk1). In addition, HDACi reduce the expression of proteins involved in DNA repair (Rad51), mitotic spindle formation (TPX2) and chromosome segregation (Survivin) in glioma cells and in human glioblastoma multiforme primary cultures. Therefore, HDACi treatment causes glioma cell entry into mitosis before DNA damage could be repaired and to the formation of an aberrant mitotic spindle that results in glioma cell death through mitotic catastrophe-induced apoptosis.

Tuberculosis osteoarticular de muñeca. Artritis destructiva de muñeca secundaria a tuberculosis extrapulmonar / Osteoarticular tuberculosis with destructive wrist arthritis secondary to extrapulmonary tuberculosis

Paciente varón 69 años con antecedente de fractura de muñeca hace 50 años. Presenta dolor incapacitante refractario a analgésicos con destrucción articular de la muñeca en pruebas de imagen. Tras realizar artrodesis muñeca se confirma el diagnóstico de osteoartritis tuberculosa en examen histopatológico. Efectuamos una revisión de la bibliografía de esta inusual presentación de tuberculosis extrapulmonar, discutiendo acerca de la epidemiología, tratamiento y evolución (AU)

A case is presented of a 69 year old male patient with a history of wrist fracture from over 50 years ago with pain refractory to analgesics and with joint destruction of the wrist in conventional radiology. We have conducted a review of extrapulmonary tuberculous osteoarthritis discussing the diagnosis and treatment of this unusual presentation of the disease (AU)

[Osteoarticular tuberculosis with destructive wrist arthritis secondary to extrapulmonary tuberculosis]. / Tuberculosis osteoarticular de muñeca. Artritis destructiva de muñeca secundaria a tuberculosis extrapulmonar.

A case is presented of a 69 year old male patient with a history of wrist fracture from over 50 years ago with pain refractory to analgesics and with joint destruction of the wrist in conventional radiology. We have conducted a review of extrapulmonary tuberculous osteoarthritis discussing the diagnosis and treatment of this unusual presentation of the disease.

[NT-proBNP in chronic obstructive pulmonary disease patients]. / NT-proBNP en pacientes con enfermedad pulmonar obstructiva crónica.

BACKGROUND: Brain natriuretic peptide (BNP) is produced and released mainly from ventricles. It has several physiological actions. BNP has been shown to be useful for diagnosis and prognosis in heart failure. The aim of this study is to analyse NT-proBNP levels in chronic obstructive pulmonary disease (COPD) patients and to distinguish factors which could modify these levels. PATIENTS AND METHODS: A descriptive and prospective study was made. COPD patients admitted due to acute exacerbation of this disease at the Hospital Universitario Lozano Blesa (Zaragoza, Spain) were included from November 1st 2004 to May 1st 2007. We included 99 patients; they had not suffered heart failure and they did not present any exclusion criteria. Blood samples were taken to determine NT-proBNP concentrations. RESULTS: Mean age was 74 years and 79% of patients were men. Medium value of NT-proBNP was 1289 pg/ml. Mean body mass index (BMI) was 27.19. There were significant differences between NT-proBNP in patients with or without atrial fibrillation and depending on their age, but there were no differences between men and women nor between patients with or without renal insufficiency. CONCLUSION: COPD patients present high serum levels of NT-proBNP during acute exacerbations and these are modified with age and atrial fibrillation. NT-proBNP could be a prognostic factor identifying COPD patients at special risk, or with a worsening clinical evolution.

NT-proBNP en pacientes con enfermedad pulmonar obstructiva crónica / NT-proBNP in chronic obstructive pulmonary disease patients

Introducción. El péptido natriurético cerebral (BNP) esun péptido de producción fundamentalmente ventricular,con múltiples acciones fisiológicas, cuyo principaluso clínico es el diagnóstico y estratificación pronósticade la insuficiencia cardiaca. El presente trabajo tienepor objeto analizar las concentraciones de NT-proBNPen una población con enfermedad pulmonar obstructivacrónica (EPOC) y su correlación con algunos parámetrosque las modifican en condiciones normales.Material y métodos. Estudio descriptivo, prospectivo, enel que se incluyeron de forma consecutiva pacientes conEPOC ingresados en el servicio de Medicina Interna delH.C.U. “Lozano Blesa” de Zaragoza, del 1 de noviembre de2004 al 1 de mayo de 2007, por una reagudización de su enfermedad,sin insuficiencia cardiaca y sin criterios de exclusión.Se incluyeron 99 pacientes, a los que se les extrajosangre en las primeras 72 horas para analizar NT-proBNP.Resultados. La edad media fue de 74 años, el 79% fueronhombres. El valor medio del NT-proBNP fue de 1.289 pg/ml. El índice de masa corporal (IMC) medio fue de 27,19.Se encontraron diferencias estadísticamente significativasen las concentraciones de NT-proBNP en relacióncon la presencia o ausencia de fibrilación auricular yla edad, pero no hubo modificaciones con relación alsexo, IMC o la presencia de insuficiencia renal.Conclusiones. Los pacientes con EPOC presentan concentracioneselevadas de NT-proBNP durante las reagudizaciones,que se modifican en función de la edad y de lacoexistencia o no de fibrilación auricular. Ello podría tenerun valor pronóstico, constituyendo una herramienta deselección de los pacientes de riesgo o con peor evolución(AU)

Background. Brain natriuretic peptide (BNP) is producedand released mainly from ventricles. It has severalphysiological actions. BNP has been shown to be usefulfor diagnosis and prognosis in heart failure. The aimof this study is to analyse NT-proBNP levels in chronicobstructive pulmonary disease (COPD) patients and todistinguish factors which could modify these levels.Patients and methods. A descriptive and prospectivestudy was made. COPD patients admitted due to acuteexacerbation of this disease at the Hospital UniversitarioLozano Blesa (Zaragoza, Spain) were included fromNovember 1st 2004 to May 1st 2007. We included 99 patients;they had not suffered heart failure and they didnot present any exclusion criteria. Blood samples weretaken to determine NT-proBNP concentrations.Results. Mean age was 74 years and 79% of patientswere men. Medium value of NT-proBNP was 1289 pg/ml. Mean body mass index (BMI) was 27.19. There weresignificant differences between NT-proBNP in patientswith or without atrial fibrillation and depending ontheir age, but there were no differences between menand women nor between patients with or without renalinsufficiency.Conclusion. COPD patients present high serum levelsof NT-proBNP during acute exacerbations and theseare modified with age and atrial fibrillation. NT-proBNPcould be a prognostic factor identifying COPD patientsat special risk, or with a worsening clinical evolution(AU)

Polypyrimidine tract binding proteins (PTB) regulate the expression of apoptotic genes and susceptibility to caspase-dependent apoptosis in differentiating cardiomyocytes.

Cardiac morphologic abnormalities in mice deficient for key regulators of the caspase-dependent signaling underscored its role in heart development. However, the mechanisms regulating apoptotic gene expression in the developing heart are unknown. As polypyrimidine tract binding proteins (PTB) determine gene isoform expression during myoblast differentiation and contribute to Apaf-1 translation in cell lines, we investigated whether PTB regulate apoptotic gene expression in differentiating cardiomyocytes. Our results show that PTB are expressed in the embryonic heart and are silenced during development, coinciding with a reduction in the expression of apoptotic genes. Overexpression of PTB in postnatal cardiomyocytes, which express low levels of PTB and apoptotic genes, induced an increase in the amount of pro-apoptotic proteins without affecting abundance of their respective transcripts. Translation of the reporter gene Firefly Luciferase preceded by the 5'-untranslated region of Apaf-1 or Caspase-3 was enhanced by PTB in cardiomyocytes. PTB silencing in fibroblasts induced a decrease of apoptotic protein levels. PTB overexpression in cardiomyocytes induced caspase activity and caspase-dependent DNA fragmentation during ischemia, which is otherwise caspase-independent in differentiated cardiomyocytes. Our results show that PTB contribute to apoptotic gene expression and modulate the susceptibility to caspase activation in differentiating rat cardiomyocytes.

[Muscle weakness and tolerance of low doses of rocuronium in healthy awake volunteers breathing spontaneously]. / Debilidad muscular y tolerancia de dosis bajas de rocuronio en voluntarios sanos despiertos y con respiración espontánea.

OBJECTIVES: To study muscle weakness caused by low doses of rocuronium and rocuronium intolerance in healthy volunteers, with the general aim of producing brief skeletal-muscle relaxation that would have potential applications in clinical situations. PATIENTS AND METHODS: After receiving authorization from the clinical research ethics committee of our hospital, we set out to study the effects on subjective and objective muscle strength of injecting 3 doses of rocuronium (0.1 mg x kg(-1), 0.05 mg x kg(-2), and 0.075 mg x kg(-1)) in healthy volunteers, each dose on a different day. Objective muscle strength was measured using a hand dynamometer. We also recorded the development of expected adverse effects (diplopia, dysarthria, and dysphagia). RESULTS: Five volunteers (all authors) were studied. In the first subject, the dose of 0.1 mg x kg(-1) of rocuronium was unsatisfactory because it was too strong, causing extreme skeletal-muscle weakness and discomfort due to diplopia, dysarthria, and dysphagia. The dose of 0.05 mg x kg(-1) was well tolerated but caused no subjective feeling of weakness or any effect measurable on dynamometry. These doses were not administered to the other subjects. In the 4 remaining volunteers, the dose of 0.075 mg x kg(-1) caused a brief feeling of muscle weakness that was considered to be acceptable, though the findings were compromised by 2 technically defective baseline dynamometry readings. The volunteers also reported brief, mild discomfort, principally due to dysphagia. CONCLUSIONS: Doses of 0.075 mg x kg(-1) of rocuronium in healthy awake subjects breathing spontaneously are acceptably tolerated and cause brief muscle weakness that may be of use in situations that require skeletal muscle relaxation at specific moments.

Debilidad muscular y tolerancia de dosis bajas de rocuronio en voluntarios sanos despiertos y con respiración espontánea / Muscle weakness and tolerance of low doses of rocuronium in healthy awake volunteers breathing spontaneously

OBJETIVOS: Investigar en voluntarios sanos la debilidadmuscular producida por dosis bajas de rocuronio ysu tolerancia, con la idea general de producir una breverelajación muscular esquelética potencialmente aplicableen situaciones clínicas.PACIENTES Y MÉTODOS: Tras autorización del Comitéde Ética e Investigación Clínica de nuestro hospital, nospropusimos estudiar en voluntarios sanos los efectos detres dosis de rocuronio (0,1, 0,05 ó 0,075mg Kg-1), administradasen diferentes días, sobre la fuerza muscular anivel subjetivo y objetivo (medida con un dinamómetrode puño), y la aparición de efectos adversos previstos(diplopia, disartria, disfagia).RESULTADOS: Se incluyeron cinco voluntarios. En elprimer sujeto la dosis de 0,1 mg Kg-1 de rocuronio resultóinadecuada por exceso de efecto (debilidad extrema dela musculatura esquelética; experiencia desagradablepor diplopia, disartria y disfagia) y la dosis de 0,05 mgKg-1 fue bien tolerada, pero sin sensación de debilidad niefectos apreciables sobre la dinamometría. Estas dosdosis no se administraron al resto de sujetos. En losotros cuatro voluntarios, la dosis de 0,075 mg Kg-1 produjouna breve sensación de debilidad muscular consideradaaceptable (aunque los resultados estuvieroninterferidos por dos dinamometrías basales deficientestécnicamente), con leve y breve sensación desagradable(por disfagia principalmente).CONCLUSIONES: Dosis de rocuronio de 0,075 mg Kg-1en sujetos sanos conscientes y respiración espontáneason aceptablemente toleradas y producen un breve estadode debilidad muscular que podría ser de utilidad ensituaciones que precisen momentos puntuales de relajaciónmuscular esquelética(AU)

OBJETIVES: To study muscle weakness caused by lowdoses of rocuronium and rocuronium intolerance inhealthy volunteers, with the general aim of producingbrief skeletal-muscle relaxation that would havepotential applications in clinical situations.PATIENTS AND METHODS: After receiving authorizationfrom the clinical research ethics committee of ourhospital, we set out to study the effects on subjective andobjective muscle strength of injecting 3 doses ofrocuronium (0.1 mg.kg-1, 0.05 mg.kg-1, and 0.075 mg.kg-1)in healthy volunteers, each dose on a different day.Objective muscle strength was measured using a handdynamometer. We also recorded the development ofexpected adverse effects (diplopia, dysarthria, anddysphagia).RESULTS: Five volunteers (all authors) were studied.In the first subject, the dose of 0.1 mg.kg-1 of rocuroniumwas unsatisfactory because it was too strong, causingextreme skeletal-muscle weakness and discomfort due todiplopia, dysarthria, and dysphagia. The dose of 0.05mg.kg-1 was well tolerated but caused no subjectivefeeling of weakness or any effect measurable ondynamometry. These doses were not administered to theother subjects. In the 4 remaining volunteers, the dose of0.075 mg.kg-1 caused a brief feeling of muscle weaknessthat was considered to be acceptable, though thefindings were compromised by 2 technically defectivebaseline dynamometry readings. The volunteers alsoreported brief, mild discomfort, principally due todysphagia.CONCLUSIONS: Doses of 0.075 mg.kg-1 of rocuronium inhealthy awake subjects breathing spontaneously areacceptably tolerated and cause brief muscle weaknessthat may be of use in situations that require skeletalmuscle relaxation at specific moments(AU)

Colecistitis enfisematosa / Emphysematous cholecistitis

No disponible

[The postpericardiotomy syndrome following endovenous pacemaker insertion: case report and review]. / El síndrome postpericardiotomía tras la implantación de marcapasos: presentación de un caso y revisión.

We report a postpericardiotomy syndrome (PS) following the implantation of endovenous pacemaker in a 78-year-old woman. Ten more single cases were reported in the medical literature since 1975. The infrequent single reports and the high complication rate are in contrast with the 4,6% occurrence and the benign course of acute pericarditis following the insertion of endovenous pacemakers in 126 consecutive patients. This sort of PS is probably underdiagnosed and the cases reported represent the more severe clinical presentations. A higher suspicion index would improve the diagnosis and management.

El síndrome postpericardiotomía tras la implantación de marcapasos: presentación de un caso y revisión / The postpericardiotomy syndrome following endove-nous pacemaker insertion: case report and review

Presentamos un caso de síndrome postpericardiotomía tras la implantación de un marcapasos endovenoso (SPIV) en una mujer de 78 años y revisamos la experiencia publicada. Desde 1975 se han publicado en la literatura médica diez casos más de SPIV. La escasez de casos publicados y la alta tasa de complicaciones contrastan con la elevada prevalencia (4.6%) y el curso benigno de las pericarditis agudas tras la inserción de marcapasos endovenosos en una serie de 126 pacientes consecutivos. Esta clase de SPIV está probablemente infradiagnosticada y los casos publicados probablemente representan solo las formas clínicas más graves. Un alto índice de sospecha debería mejorar su diagnóstico y tratamiento

We report a postpericardiotomy syndrome (PS) following the implantation of endovenous pacemaker in a 78-year-old woman. Ten more single cases were reported in the medical literature since 1975. The infrequent single reports and the high complication rate are in contrast with the 4,6% occurrence and the benign course of acute pericarditis following the insertion of endovenous pacemakers in 126 consecutive patients. This sort of PS is probably underdiagnosed and the cases reported represent the more severe clinical presentations. A higher suspicion index would improve the diagnosis and management

Endocarditis infecciosa sobre cable de marcapasos / Infective endocarditis of pacemakers leads

No disponible

Lack of Apaf-1 expression confers resistance to cytochrome c-driven apoptosis in cardiomyocytes.

Apoptosis plays a role in cardiomyocyte death in several cardiovascular disorders. Here, we show that primary postnatal cardiomyocytes did not die upon activation of the intrinsic (cytochrome c-dependent) apoptotic pathway. Release of cytochrome c from mitochondria to the cytosol occurred, but did not activate the effector phase of apoptosis. Myocardial cells did not express apoptotic protease-activating factor-1 (Apaf-1), the allosteric activator of caspase-9 acting downstream of cytochrome c release. Forced expression of Apaf-1 restored the competence to complete the cytochrome c-induced apoptotic program and this effect was prevented by overexpression of Bcl-X(L). However, cardiomyocytes were able to enter the apoptotic program when it was initiated by activation of death receptors, as observed during serum deprivation and metabolic inhibition. Our results indicate that regulation of Apaf-1 expression may be a new regulatory mechanism developed in postmitotic cells in order to prevent irreversible commitment to die after release of cytochrome c.