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1.
JAMA ; 326(21): 2161-2171, 2021 Dec 07.
Article in English | MEDLINE | ID: mdl-34874419

ABSTRACT

IMPORTANCE: The effect of high-flow oxygen therapy vs conventional oxygen therapy has not been established in the setting of severe COVID-19. OBJECTIVE: To determine the effect of high-flow oxygen therapy through a nasal cannula compared with conventional oxygen therapy on need for endotracheal intubation and clinical recovery in severe COVID-19. DESIGN, SETTING, AND PARTICIPANTS: Randomized, open-label clinical trial conducted in emergency and intensive care units in 3 hospitals in Colombia. A total of 220 adults with respiratory distress and a ratio of partial pressure of arterial oxygen to fraction of inspired oxygen of less than 200 due to COVID-19 were randomized from August 2020 to January 2021, with last follow-up on February 10, 2021. INTERVENTIONS: Patients were randomly assigned to receive high-flow oxygen through a nasal cannula (n = 109) or conventional oxygen therapy (n = 111). MAIN OUTCOMES AND MEASURES: The co-primary outcomes were need for intubation and time to clinical recovery until day 28 as assessed by a 7-category ordinal scale (range, 1-7, with higher scores indicating a worse condition). Effects of treatments were calculated with a Cox proportional hazards model adjusted for hypoxemia severity, age, and comorbidities. RESULTS: Among 220 randomized patients, 199 were included in the analysis (median age, 60 years; n = 65 women [32.7%]). Intubation occurred in 34 (34.3%) randomized to high-flow oxygen therapy and in 51 (51.0%) randomized to conventional oxygen therapy (hazard ratio, 0.62; 95% CI, 0.39-0.96; P = .03). The median time to clinical recovery within 28 days was 11 (IQR, 9-14) days in patients randomized to high-flow oxygen therapy vs 14 (IQR, 11-19) days in those randomized to conventional oxygen therapy (hazard ratio, 1.39; 95% CI, 1.00-1.92; P = .047). Suspected bacterial pneumonia occurred in 13 patients (13.1%) randomized to high-flow oxygen and in 17 (17.0%) of those randomized to conventional oxygen therapy, while bacteremia was detected in 7 (7.1%) vs 11 (11.0%), respectively. CONCLUSIONS AND RELEVANCE: Among patients with severe COVID-19, use of high-flow oxygen through a nasal cannula significantly decreased need for mechanical ventilation support and time to clinical recovery compared with conventional low-flow oxygen therapy. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04609462.


Subject(s)
COVID-19/complications , Intubation, Intratracheal/statistics & numerical data , Oxygen Inhalation Therapy/methods , Oxygen/therapeutic use , Respiratory Insufficiency/therapy , Aged , Aged, 80 and over , COVID-19/therapy , Critical Illness/mortality , Critical Illness/therapy , Female , Humans , Intensive Care Units , Intubation, Intratracheal/adverse effects , Male , Middle Aged , Oxygen Inhalation Therapy/instrumentation , Respiration, Artificial , Respiratory Insufficiency/etiology , Respiratory Insufficiency/mortality , SARS-CoV-2 , Time Factors , Treatment Outcome
2.
Animals (Basel) ; 11(7)2021 Jul 06.
Article in English | MEDLINE | ID: mdl-34359148

ABSTRACT

Despite the mounting evidence supporting positive relationships between species abundance and habitat suitability, the capacity of ecological niche models (ENMs) to capture variations in population abundance remains largely unexplored. This study focuses on sympatric populations of hen harrier (Circus cyaneus) and Montagu's harrier (Circus pygargus), surveyed in 1997 and 2017 in an upland moor area in northwestern Spain. The ENMs performed very well for both species (with area under the ROC curve and true skill statistic values of up to 0.9 and 0.75). The presence of both species was mainly correlated with heathlands, although the normalized difference water index derived from Landsat images was the most important for hen harrier, indicating a greater preference of this species for wet heaths and peat bogs. The findings showed that ENM-derived habitat suitability was significantly correlated with the species abundance, thus reinforcing the use of ENMs as a proxy for species abundance. However, the temporal variation in species abundance was not significantly explained by changes in habitat suitability predicted by the ENMs, indicating the need for caution when using these types of models to infer changes in population abundance.

3.
J Biol Chem ; 297(3): 100999, 2021 09.
Article in English | MEDLINE | ID: mdl-34303704

ABSTRACT

High yields of RNA are routinely prepared following the two-step approach of high-yield in vitro transcription using T7 RNA polymerase followed by extensive purification using gel separation or chromatographic methods. We recently demonstrated that in high-yield transcription reactions, as RNA accumulates in solution, T7 RNA polymerase rebinds and extends the encoded RNA (using the RNA as a template), resulting in a product pool contaminated with longer-than-desired, (partially) double-stranded impurities. Current purification methods often fail to fully eliminate these impurities, which, if present in therapeutics, can stimulate the innate immune response with potentially fatal consequences. In this work, we introduce a novel in vitro transcription method that generates high yields of encoded RNA without double-stranded impurities, reducing the need for further purification. Transcription is carried out at high-salt conditions to eliminate RNA product rebinding, while promoter DNA and T7 RNA polymerase are cotethered in close proximity on magnetic beads to drive promoter binding and transcription initiation, resulting in an increase in overall yield and purity of only the encoded RNA. A more complete elimination of double-stranded RNA during synthesis will not only reduce overall production costs, but also should ultimately enable therapies and technologies that are currently being hampered by those impurities.


Subject(s)
DNA, Viral/genetics , DNA-Directed RNA Polymerases/metabolism , RNA/isolation & purification , Salts/chemistry , Transcription, Genetic , Viral Proteins/metabolism , Bacteriophage T7/genetics , DNA, Viral/metabolism , Promoter Regions, Genetic , RNA/biosynthesis
4.
Elife ; 102021 04 13.
Article in English | MEDLINE | ID: mdl-33847565

ABSTRACT

In Proteobacteria, integral outer membrane proteins (OMPs) are crucial for the maintenance of the envelope permeability barrier to some antibiotics and detergents. In Enterobacteria, envelope stress caused by unfolded OMPs activates the sigmaE (σE) transcriptional response. σE upregulates OMP biogenesis factors, including the ß-barrel assembly machinery (BAM) that catalyses OMP folding. Here we report that DolP (formerly YraP), a σE-upregulated and poorly understood outer membrane lipoprotein, is crucial for fitness in cells that undergo envelope stress. We demonstrate that DolP interacts with the BAM complex by associating with outer membrane-assembled BamA. We provide evidence that DolP is important for proper folding of BamA that overaccumulates in the outer membrane, thus supporting OMP biogenesis and envelope integrity. Notably, mid-cell recruitment of DolP had been linked to regulation of septal peptidoglycan remodelling by an unknown mechanism. We now reveal that, during envelope stress, DolP loses its association with the mid-cell, thereby suggesting a mechanistic link between envelope stress caused by impaired OMP biogenesis and the regulation of a late step of cell division.


Subject(s)
Bacterial Outer Membrane Proteins/genetics , Bacterial Outer Membrane/physiology , Escherichia coli Proteins/genetics , Escherichia coli/genetics , Lipoproteins/genetics , Bacterial Outer Membrane Proteins/metabolism , Escherichia coli/metabolism , Escherichia coli Proteins/metabolism , Genetic Fitness , Lipoproteins/metabolism , Protein Folding
5.
Nat Prod Res ; 35(5): 826-828, 2021 Mar.
Article in English | MEDLINE | ID: mdl-30990072

ABSTRACT

Secundiflorol G (SG) is an isoflavan isolated from the root bark of Aeschynomene fascicularis, a Mayan medicinal plant used to treat cancer-like symptoms. SG has been shown to have cytotoxic effects on cervical cancer cells (HeLa). Assays were done to identify the mechanisms of SG's cytotoxic effect.HeLa cells treated with SG exhibited early and late apoptosis, and caspase-9, -8 and -3 activities. It also induces generation of reactive oxygen species and disrupted mitochondrial membrane potential.SG isolated from A. fascicularis induces apoptosis through extrinsic and intrinsic pathways on HeLa cells. SG could be a candidate for in vivo studies and a promising natural compound in cervical cancer treatment.


Subject(s)
Apoptosis/drug effects , Benzopyrans/isolation & purification , Benzopyrans/pharmacology , Fabaceae/chemistry , Isoflavones/isolation & purification , Isoflavones/pharmacology , Plants, Medicinal/chemistry , Uterine Cervical Neoplasms/pathology , Antineoplastic Agents/pharmacology , Benzopyrans/chemistry , Caspases/metabolism , Cyclin-Dependent Kinase Inhibitor p21/metabolism , Enzyme Activation/drug effects , Female , HeLa Cells , Humans , Isoflavones/chemistry , Membrane Potential, Mitochondrial/drug effects , Plant Extracts/pharmacology , Reactive Oxygen Species/metabolism , Uterine Cervical Neoplasms/drug therapy , Uterine Cervical Neoplasms/enzymology , bcl-2-Associated X Protein/metabolism
6.
Ann Transl Med ; 8(12): 796, 2020 Jun.
Article in English | MEDLINE | ID: mdl-32647721

ABSTRACT

Septic shock involves a complex interaction between abnormal vasodilation, relative and/or absolute hypovolemia, myocardial dysfunction, and altered blood flow distribution to the tissues. Fluid administration, vasopressor support and inotropes, represent fundamental pieces of quantitative resuscitation protocols directed to assist the restoration of impaired tissue perfusion during septic shock. Indeed, current recommendations on sepsis management include the use of inotropes in the case of myocardial dysfunction, as suggested by a low cardiac output, increased filling pressures, or persisting signals of tissue hypoperfusion despite an adequate correction of intravascular volume and mean arterial pressure by fluid administration and vasopressor support. Evidence supporting the use of inotropes in sepsis and septic shock is mainly based on physiological studies. Most of them suggest a beneficial effect of inotropes on macro hemodynamics especially when sepsis coexists with myocardial dysfunction; others, however, have demonstrated variable results on regional splanchnic circulation, while others suggest favorable effects on microvascular distribution independently of its impact on cardiac output. Conversely, impact of inodilators on clinical outcomes in this context has been more controversial. Use of dobutamine has not been consistently related with more favorable clinical results, while systematic administration of levosimendan in sepsis do not prevent the development of multiorgan dysfunction, even in patients with evidence of myocardial dysfunction. Nevertheless, a recent metanalysis of clinical studies suggests that cardiovascular support regimens based on inodilators in sepsis and septic shock could provide some beneficial effect on mortality, while other one corroborated such effect on mortality specially in patients with proved lower cardiac output. Thus, using or not inotropes during sepsis and septic shock remains as controversy matter that deserves more research efforts.

7.
Ann Intensive Care ; 10(1): 41, 2020 Apr 16.
Article in English | MEDLINE | ID: mdl-32296976

ABSTRACT

BACKGROUND: Loss of vascular tone is a key pathophysiological feature of septic shock. Combination of gradual diastolic hypotension and tachycardia could reflect more serious vasodilatory conditions. We sought to evaluate the relationships between heart rate (HR) to diastolic arterial pressure (DAP) ratios and clinical outcomes during early phases of septic shock. METHODS: Diastolic shock index (DSI) was defined as the ratio between HR and DAP. DSI calculated just before starting vasopressors (Pre-VPs/DSI) in a preliminary cohort of 337 patients with septic shock (January 2015 to February 2017) and at vasopressor start (VPs/DSI) in 424 patients with septic shock included in a recent randomized controlled trial (ANDROMEDA-SHOCK; March 2017 to April 2018) was partitioned into five quantiles to estimate the relative risks (RR) of death with respect to the mean risk of each population (assumed to be 1). Matched HR and DAP subsamples were created to evaluate the effect of the individual components of the DSI on RRs. In addition, time-course of DSI and interaction between DSI and vasopressor dose (DSI*NE.dose) were compared between survivors and non-survivors from both populations, while ROC curves were used to identify variables predicting mortality. Finally, as exploratory observation, effect of early start of vasopressors was evaluated at each Pre-VPs/DSI quintile from the preliminary cohort. RESULTS: Risk of death progressively increased at gradual increments of Pre-VPs/DSI or VPs/DSI (One-way ANOVA, p < 0.001). Progressive DAP decrease or HR increase was associated with higher mortality risks only when DSI concomitantly increased. Areas under the ROC curve for Pre-VPs/DSI, SOFA and initial lactate were similar, while mean arterial pressure and systolic shock index showed poor performances to predict mortality. Time-course of DSI and DSI*NE.dose was significantly higher in non-survivors from both populations (repeated-measures ANOVA, p < 0.001). Very early start of vasopressors exhibited an apparent benefit at higher Pre-VPs/DSI quintile. CONCLUSIONS: DSI at pre-vasopressor and vasopressor start points might represent a very early identifier of patients at high risk of death. Isolated DAP or HR values do not clearly identify such risk. Usefulness of DSI to trigger or to direct therapeutic interventions in early resuscitation of septic shock need to be addressed in future studies.

8.
Ann Intensive Care ; 10(1): 35, 2020 Mar 24.
Article in English | MEDLINE | ID: mdl-32211957

ABSTRACT

BACKGROUND: Ventilation/perfusion inequalities impair gas exchange in acute respiratory distress syndrome (ARDS). Although increased dead-space ventilation (VD/VT) has been described in ARDS, its mechanism is not clearly understood. We sought to evaluate the relationships between dynamic variations in VD/VT and extra-pulmonary microcirculatory blood flow detected at sublingual mucosa hypothesizing that an altered microcirculation, which is a generalized phenomenon during severe inflammatory conditions, could influence ventilation/perfusion mismatching manifested by increases in VD/VT fraction during early stages of ARDS. METHODS: Forty-two consecutive patients with early moderate and severe ARDS were included. PEEP was set targeting the best respiratory-system compliance after a PEEP-decremental recruitment maneuver. After 60 min of stabilization, hemodynamics and respiratory mechanics were recorded and blood gases collected. VD/VT was calculated from the CO2 production ([Formula: see text]) and CO2 exhaled fraction ([Formula: see text]) measurements by volumetric capnography. Sublingual microcirculatory images were simultaneously acquired using a sidestream dark-field device for an ulterior blinded semi-quantitative analysis. All measurements were repeated 24 h after. RESULTS: Percentage of small vessels perfused (PPV) and microcirculatory flow index (MFI) were inverse and significantly related to VD/VT at baseline (Spearman's rho = - 0.76 and - 0.63, p < 0.001; R2 = 0.63, and 0.48, p < 0.001, respectively) and 24 h after (Spearman's rho = - 0.71, and - 0.65; p < 0.001; R2 = 0.66 and 0.60, p < 0.001, respectively). Other respiratory, macro-hemodynamic and oxygenation parameters did not correlate with VD/VT. Variations in PPV between baseline and 24 h were inverse and significantly related to simultaneous changes in VD/VT (Spearman's rho = - 0.66, p < 0.001; R2 = 0.67, p < 0.001). CONCLUSION: Increased heterogeneity of microcirculatory blood flow evaluated at sublingual mucosa seems to be related to increases in VD/VT, while respiratory mechanics and oxygenation parameters do not. Whether there is a cause-effect relationship between microcirculatory dysfunction and dead-space ventilation in ARDS should be addressed in future research.

9.
Crit Care ; 24(1): 52, 2020 02 14.
Article in English | MEDLINE | ID: mdl-32059682

ABSTRACT

BACKGROUND: Optimal timing for the start of vasopressors (VP) in septic shock has not been widely studied since it is assumed that fluids must be administered in advance. We sought to evaluate whether a very early start of VP, even without completing the initial fluid loading, might impact clinical outcomes in septic shock. METHODS: A total of 337 patients with sepsis requiring VP support for at least 6 h were initially selected from a prospectively collected database in a 90-bed mixed-ICU during a 24-month period. They were classified into very-early (VE-VPs) or delayed vasopressor start (D-VPs) categories according to whether norepinephrine was initiated or not within/before the next hour of the first resuscitative fluid load. Then, VE-VPs (n = 93) patients were 1:1 propensity matched to D-VPs (n = 93) based on age; source of admission (emergency room, general wards, intensive care unit); chronic and acute comorbidities; and lactate, heart rate, systolic, and diastolic pressure at vasopressor start. A risk-adjusted Cox proportional hazard model was fitted to assess the association between VE-VPs and day 28 mortality. Finally, a sensitivity analysis was performed also including those patients requiring VP support for less than 6 h. RESULTS: Patients subjected to VE-VPs received significantly less resuscitation fluids at vasopressor starting (0[0-510] vs. 1500[650-2300] mL, p < 0.001) and during the first 8 h of resuscitation (1100[500-1900] vs. 2600[1600-3800] mL, p < 0.001), with no significant increase in acute renal failure and/or renal replacement therapy requirements. VE-VPs was related with significant lower net fluid balances 8 and 24 h after VPs. VE-VPs was also associated with a significant reduction in the risk of death compared to D-VPs (HR 0.31, CI95% 0.17-0.57, p < 0.001) at day 28. Such association was maintained after including patients receiving vasopressors for < 6 h. CONCLUSION: A very early start of vasopressor support seems to be safe, might limit the amount of fluids to resuscitate septic shock, and could lead to better clinical outcomes.


Subject(s)
Fluid Therapy , Norepinephrine , Shock, Septic , Vasoconstrictor Agents , Acute Kidney Injury/complications , Aged , Female , Humans , Intensive Care Units , Male , Middle Aged , Norepinephrine/administration & dosage , Renal Replacement Therapy , Shock, Septic/drug therapy , Time Factors , Vasoconstrictor Agents/administration & dosage
10.
Phytochem Anal ; 31(2): 183-190, 2020 Mar.
Article in English | MEDLINE | ID: mdl-31343078

ABSTRACT

INTRODUCTION: (3S)-16,17-Didehydrofalcarinol (1) has been isolated from Tridax procumbens and has proved to have notorious bioactivity against Leishmania mexicana. In this study, hexane fractions obtained from the methanol extract of each plant part (roots, stems, leaves, flowers, and fruits) of T. procumbens collected monthly during a year were analysed in order to determine the quantity of 1 associated with biotic variables. OBJECTIVE: The aim of this study was to find the season of the year in which the bioactive metabolite 1 is at the highest concentration and to correlate it with temperature, length of day light, and rainfall. METHODS: Hexane fractions were obtained by liquid-liquid extraction and an accurate quantitation of 1 was performed using gas chromatography with a flame ionisation detector (GC-FID) employing pelargonic acid vanillyl amide (2) as internal standard. Partial validation was based on linearity and precision. RESULTS: Our results indicated that the total content of 1 has significant variation (P ≤ 0.05) during the different collecting months. The total content of the metabolite reached its highest level in the roots of the plant during June in the rainfall season (0.0358 ± 0.001 mg/g), and its lowest values in February and March during the drought season (0.0015 ± 0.000 and 0.0008 ± 0.000 mg/g, respectively). CONCLUSION: Our study provided evidence that the content of 1 in roots is strongly influenced by the variables of the harvesting season, also indicating that the biosynthesis of the active metabolite is enhanced during the warm and rainy months.


Subject(s)
Plant Extracts , Polyacetylene Polymer , Diynes , Fatty Alcohols , Seasons , Tissue Distribution
11.
J Environ Manage ; 241: 407-417, 2019 Jul 01.
Article in English | MEDLINE | ID: mdl-31030122

ABSTRACT

Urban adaptation to climate change is likely to emerge from the responses of residents, authorities, and infrastructure providers to the impact of flooding, water scarcity, and other climate-related hazards. These responses are, in part, modulated by political relationships under cultural norms that dominate the institutional and collective decisions of public and private actors. The legacy of these decisions, which are often associated with investment in hard and soft infrastructure, has lasting consequences that influence current and future vulnerabilities. Making those decisions visible, and tractable is, therefore, an urgent research and political challenge in vulnerability assessments. In this work, we present a modeling framework to explore scenarios of institutional decision-making and socio-political processes and the resultant effects on spatial patterns of vulnerability. The approach entails using multi-criteria decision analysis, agent-based models, and geographic information simulation. The approach allows for the exploration of uncertainties, spatial patterns, thresholds, and the sensitivities of vulnerability outcomes to different policy scenarios. Here, we present the operationalization of the framework through an intentionally simplified model example of the governance of water in Mexico City. We discuss results from this example as part of a larger effort to empirically implement the framework to explore sociohydrological risk patterns and trade-offs of vulnerability in real urban landscapes.


Subject(s)
Climate Change , Floods , Cities , Decision Making , Mexico
12.
PLoS One ; 14(3): e0213493, 2019.
Article in English | MEDLINE | ID: mdl-30917135

ABSTRACT

Looking for a biotechnical potential, aqueous extracts of leaves of 12 native species used in the Mayan traditional medicine of the coastal dune and mangrove of Yucatan (Mexico) were selected to evaluate their biological activities. Rhizophora mangle and Manilkara zapota showed the highest free radical scavenging activity (3.94 ± 0.19 and 6.42 ± 0.32 µg/mL, respectively), and the highest antihypertensive activity was obtained from Solanum donianum (0.38 µg/mL). The anti-hyperglycemic activity of these species was also tested; the highest activities were registered with R. mangle. The antimicrobial activity of Malvaviscus arboreus, S. donianum, M. zapota, and R. mangle at 10% (w/v) was positive against six human pathogenic bacteria and Bonellia macrocarpa against one pathogenic fungus. Solanum donianum, M. zapota, B. macrocarpa, and R. mangle were positive against two pathogenic plant fungi. These results show that the aqueous extracts of five native plants of the Yucatan coast have potential as antioxidants, ACE inhibitors, α-amylase and α-glucosidase inhibitors, and as antimicrobials, which make their exploration for utilization in the agricultural and pharmaceutical industries a possibility.


Subject(s)
Anti-Infective Agents , Antihypertensive Agents , Bacteria/growth & development , Fungi/growth & development , Hypoglycemic Agents , Plant Extracts , Plants, Medicinal/chemistry , Anti-Infective Agents/chemistry , Anti-Infective Agents/pharmacology , Antihypertensive Agents/chemistry , Antihypertensive Agents/pharmacology , Humans , Hypoglycemic Agents/chemistry , Hypoglycemic Agents/pharmacology , Plant Extracts/chemistry , Plant Extracts/pharmacology
13.
J Nat Med ; 73(3): 672-678, 2019 Jun.
Article in English | MEDLINE | ID: mdl-30778894

ABSTRACT

Neurological disorders are a public health problem worldwide for which there is currently no direct treatment of the cause of the disorder. The goal of this study was to investigate the potential in vitro neuroprotective property of plants used in Mayan traditional medicine. Plant ethanolic extracts were prepared and tested on models in which neuronal damage was induced by glutamate, i.e., a human neuroblastoma cell line (SH-SY5Y) and rat cortical neurons. HPLC profiles from active extracts were also obtained. A total of 51 plant species were identified in the literature as plant species used in Mayan traditional medicine for the treatment of symptoms suggestive of neurological disorders, and we studied 34 of these in our analysis. Six extracts had a neuroprotective effect on SH-SY5Y cells, with the most active extract being that from Schwenckia americana roots (half maximal effective concentration [EC50] 11.3 ± 2.9 µg/mL), and three extracts exhibited a neuroprotective effect in the rat neuron cortical model, with the most active extract being that from Elytraria imbricata aerial parts (EC50 6.8 ± 3.1 µg/mL). These results suggest that the active extracts from such plants have the potential to be a great resource. Future studies should be performed that are more extensive and which isolate the active constituents.


Subject(s)
Glutamic Acid/toxicity , Neuroprotective Agents/therapeutic use , Plant Extracts/chemistry , Plants, Medicinal/chemistry , Animals , Humans , Neuroprotective Agents/pharmacology , Rats , Rats, Wistar
15.
Eur J Trauma Emerg Surg ; 44(4): 527-533, 2018 Aug.
Article in English | MEDLINE | ID: mdl-29572730

ABSTRACT

Current literature shows the association of post-intubation hypotension and increased odds of mortality in critically ill non-trauma and trauma populations. However, there is a lack of research on potential interventions that can prevent or ameliorate the consequences of endotracheal intubation and thus improve the prognosis of trauma patients with post-intubation hypotension. This review paper hypothesizes that the deployment of REBOA among trauma patients with PIH, by its physiologic effects, will reduce the odds of mortality in this population. The objective of this paper is to review the current literature on REBOA and post-intubation hypotension, and, furthermore, to provide a rational hypothesis on the potential role of REBOA in severely injured patients with post-intubation hypotension.


Subject(s)
Aorta , Balloon Occlusion/methods , Hypotension/etiology , Hypotension/prevention & control , Intubation, Intratracheal/adverse effects , Shock, Hemorrhagic/etiology , Shock, Hemorrhagic/prevention & control , Wounds and Injuries/complications , Hemodynamics , Humans , Resuscitation , Survival Analysis
16.
Oxf Med Case Reports ; 2018(2): omx107, 2018 Feb.
Article in English | MEDLINE | ID: mdl-29507739

ABSTRACT

We present the case of a 72-year-old woman diagnosed with rheumatic fever at the age of 6. In 1972, she was diagnosed with mitral valve insufficiency and mitral valve stenosis, then in 1974, a decision was made to perform mitral valve replacement surgery with a 32-mm Braunwald-Cutter ball cage prosthesis. An echocardiogram performed in 2014 revealed normal biventricular systolic function, mechanical prosthesis in mitral position with maximum speed of 1.9 m/s, maximum gradient of 15 mmHg, mean gradient of 6 mmHg, severe tricuspid valve insufficiency, inferior vena cava measuring 15 mm with more than 50% collapse and pulmonary artery systolic pressure of 40 mmHg. We report the use of the 32-mm Braunwald-Cutter ball cage prosthesis with the longest longevity that remains functional after more than 43 years of implantation.

17.
J Nat Prod ; 80(11): 3038-3042, 2017 11 22.
Article in English | MEDLINE | ID: mdl-29120172

ABSTRACT

Three new lupane-type triterpenes, 3α,24-dihydroxylup-20(29)-en-28-oic acid (1), 3α,23-dihydroxy-30-oxolup-20(29)-en-28-oic acid (2), and 3α,23-O-isopropylidenyl-3α,23-dihydroxylup-20(29)-en-28-oic acid (3), together with eight known compounds (4-11) were isolated from a methanol extract of Phoradendron vernicosum aerial parts. The chemical structures of 1-3 were determined on the basis of spectroscopic data interpretation. The isolated compounds were tested against seven human cancer cell lines and two normal cell lines.


Subject(s)
Antineoplastic Agents, Phytogenic/isolation & purification , Phoradendron/chemistry , Plant Components, Aerial/chemistry , Triterpenes/isolation & purification , Antineoplastic Agents, Phytogenic/chemistry , Antineoplastic Agents, Phytogenic/pharmacology , Drug Screening Assays, Antitumor , HeLa Cells , Humans , KB Cells , MCF-7 Cells , Mexico , Molecular Structure , Nuclear Magnetic Resonance, Biomolecular , Plant Extracts/chemistry , Plant Leaves/chemistry , Triterpenes/chemistry , Triterpenes/pharmacology
18.
PLoS One ; 12(7): e0181769, 2017.
Article in English | MEDLINE | ID: mdl-28738072

ABSTRACT

Monitoring protected areas (PAs) is essential for systematic evaluation of their effectiveness in terms of habitat protection, preservation and representativeness. This study illustrates how the use of species distribution models that combine remote sensing data and information about biodiversity surrogates can contribute to develop a systematic protocol for monitoring PAs. In particular, we assessed the effectiveness of the Natura 2000 (N2000) network, for conserving and preserving the representativeness of seven raptor species in a highly-dynamic landscape in northwest Spain between 2001 and 2014. We also evaluated the cost-effectiveness of the N2000 network by using the total area under protection as a proxy for conservation costs. Overall, the N2000 network was found to poorly represent the habitats of the raptor species. Despite the low representativeness, this network showed a high degree of effectiveness due to increased overall habitat availability for generalist and forest specialist species between 2001 and 2014. Nevertheless, additional protected areas should be established in the near future to increase their representativeness, and thus ensure the protection of open-habitat specialist species and their priority habitats. In addition, proactive conservation measures in natural and semi-natural ecosystems (in particular, montane heathlands) will be essential for long-term protection of Montagu's harrier (species listed in the Annex I of the Bird Directive), and thus complying with the current European Environmental Legislation. This study sheds light on how the development and application of new protected area indices based on the combined use of freely-available satellite data and species distribution models may contribute substantially to the cost-efficiency of the PA monitoring systems, and to the 'Fitness Check' process of EU Nature Directives.


Subject(s)
Conservation of Natural Resources/methods , Raptors/physiology , Animals , Biodiversity , Ecosystem , Spain
20.
Nat Prod Commun ; 10(9): 1513-6, 2015 Sep.
Article in English | MEDLINE | ID: mdl-26594746

ABSTRACT

Serjania goniocarpa is a plant used in Mayan traditional medicine as a remedy for the treatment of cancer-like symptoms. Bio-guided fractionation of the methanol extract of the leaves led to the isolation of an α- and ß-amyrin mixture, palmitic acid, phytol and the new sesterterpene goniocarpic acid whose structure was elucidated by IR, GC-MS, and NMR spectroscopic analyses. Goniocarpic acid exhibited cytotoxic and antiproliferative activity against several cancer cell lines.


Subject(s)
Oleanolic Acid/analogs & derivatives , Sapindaceae/chemistry , Sesquiterpenes/chemistry , Sesquiterpenes/isolation & purification , Sesterterpenes/chemistry , Sesterterpenes/isolation & purification , Cell Line, Tumor , Humans , Medicine, Traditional , Molecular Structure , Oleanolic Acid/chemistry , Oleanolic Acid/isolation & purification , Plant Extracts/chemistry , Plant Leaves/chemistry
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