COVID-19 pandemic on coronary artery and cerebrovascular diseases in Southern Spain: interrupted time series analysis.

OBJECTIVE: Healthcare systems have been put under intense pressure by the COVID-19 pandemic, although some studies have shown a decline in hospital admissions for cardiovascular and cerebrovascular diseases during the first and second wave of the pandemic. In addition, studies analyzing gender and procedural differences are scarce. The present study aimed to determine the impact of the pandemic on hospital admissions for acute myocardial infarction (AMI) and cerebrovascular disease (CVD) in Andalusia (Spain) and analyzed differences by gender and by percutaneous coronary interventions performed. PATIENTS AND METHODS: An interrupted time series analysis of AMI and CVD hospital admissions in Andalusia (Spain) was carried out to measure the impact of the COVID-19 outbreak. AMI and CVD cases admitted daily in public hospitals of Andalusia between January 2018 and December 2020 were included. RESULTS: During the pandemic, significant reductions in AMI [-19%; 95% confidence interval (CI): (-29%, -9%), p<0.001] and CVD [-17%; 95% CI: (-26%, -9%); p<0.01] in daily hospital admissions were observed. Differences were also produced according to the diagnosis (ST-Elevation Myocardial Infarction, Non-ST-Elevation Myocardial Infarction, other AMI and stroke), with a greater reduction in females for AMI and in males for CVD. Although there were more percutaneous coronary interventions during the pandemic, no significant reductions were observed. CONCLUSIONS: A decline in AMI and CVD daily hospital admissions during the first and second wave of COVID-19 pandemic was noted. Gender differences were observed, but no clear impact was observed in percutaneous interventions.

Prediction of phosphenes occurrence in patients undergoing photon irradiation to ocular structures due to brain tumor.

BACKGROUND AND OBJECTIVE: Phosphenes are visual light phenomena that are experienced when there is no apparent light that stimulates the eye. In oncology, phosphenes are also present during radiation therapy for patients with tumors of the central nervous system, eyes, head and neck. Due to the discomfort of patients treated with irradiation to the head regions, research is conducted to determine whether the dose to the ocular structures is predictive for the occurrence of phosphenes. The objective was to demonstrate the relationship between the doses of the retina and vitreous humour with the appearance of phosphenes. MATERIAL AND METHOD: A descriptive study was carried out in a prospective cohort in 25 patients older than 18 years, with malignant tumours located at the level of the brain, both of primary and secondary origin, subjected to irradiation in 6 MV linear accelerators, during February 2020 to January 2021. As independent variables: Retinal dose and vitreous humour dose, and as dependent variables: Light flashes and stable light. Logistic regression analysis was used for prediction, using the SPSS statistical program (version 26.0). RESULT: A final date of 380 external radiotherapy treatments. The presence of any of the events in a prevalence of 58.7% of the total of fractions. The distribution for the presence of both events, flash of light and stable light, was 69.1%, 20.6% and 10.3% respectively. In the logistic regression analysis, for the light flare, only the dose factor in vitreous was significant (OR: 1.74, IC [1.059-2.419] p: 0.001). For stable light, the dose in the retina (OR: 1.73, IC [1.121-2.341] p: 0.005), and dose in the vitreous humor (OR: 1.82, IC [1.335-2.315] p: 0.003). CONCLUSIONS: There is a predictive relationship between the doses of irradiation of the retina and vitreous humour, for the generation of phosphenes. These results help radiotherapy centres take these anatomical structures into account to reduce the presence of phosphenes in patients. Likewise, it would help to reduce phosphenes, keeping the bunker area illuminated during the treatment.

Predicción de ocurrencia de fosfenos en pacientes sometidos a irradiación con fotones a estructuras oculares por tumor cerebral / Prediction of phosphenes occurrence in patients undergoing photon irradiation to ocular structures due to brain tumor

Antecedentes y objetivo Los fosfenos son fenómenos de luz visual que se experimentan cuando no hay luz aparente que estimule el ojo. En oncología, los fosfenos también están presentes durante la radioterapia para pacientes con tumores del sistema nervioso central, ojos, cabeza y cuello. Debido a la incomodidad de los pacientes tratados con irradiación en las regiones de la cabeza, se realiza investigación para determinar si la dosis en las estructuras oculares son predicción para la ocurrencia de fosfenos. El objetivo fue demostrar la relación entre las dosis de retina y humor vítreo con la aparición de fosfenos. Material y método Se realizó un estudio descriptivo, en una cohorte prospectiva en 25 pacientes mayores de 18 años, con tumores malignos localizados a nivel de encéfalo, tanto de origen primario como secundario, sometidos a irradiación en aceleradores lineales de 6MV, durante febrero 2020 a enero del 2021. Como variables independientes: dosis a retina y dosis a humor vítreo, y como variables dependientes: destellos de luz y luz estable. Para la predicción se utilizó el análisis de regresión logística, mediante el programa estadístico SPSS® versión 26.0. Resultado Una data final de 380 tratamientos de radioterapia externa. La presencia de cualquiera de los eventos en un predominio del 58,7% del total de fracciones. La distribución por la presencia de ambos eventos, destello de luz y luz estable, fue del 69,1, 20,6 y 10,3%, respectivamente. En el análisis de regresión logística, para el destello de luz, solo fue significativo el factor de dosis en vítreo (OR: 1,74; IC 95%: 1,059-2,419; p: 0,001). Para la luz estable, fueron significativos la dosis en retina (OR: 1,73; IC 95%: 1,121-2,341; p: 0,005) y dosis en humor vítreo (OR: 1,82; IC 95%: 1,335-2,315; p: 0,003). Conclusiones Existe una relación predictiva entre las dosis de irradiación de la retina y del humor vítreo, para la generación de fosfenos (AU)

Background and objective Phosphenes are visual light phenomena that are experienced when there is no apparent light that stimulates the eye. In oncology, phosphenes are also present during radiation therapy for patients with tumors of the central nervous system, eyes, head and neck. Due to the discomfort of patients treated with irradiation to the head regions, research is conducted to determine whether the dose to the ocular structures is predictive for the occurrence of phosphenes. The objective was to demonstrate the relationship between the doses of the retina and vitreous humor with the appearance of phosphenes. Material and method A descriptive study was carried out in a prospective cohort in 25 patients older than 18 years, with malignant tumors located at the level of the brain, both of primary and secondary origin, subjected to irradiation in 6MV linear accelerators, during February 2020 to January 2021. As independent variables: Retinal dose and vitreous humor dose, and as dependent variables: Light flashes and stable light. Logistic regression analysis was used for prediction, using the SPSS statistical program (version 26.0). Result A final date of 380 external radiotherapy treatments. The presence of any of the events in a prevalence of 58.7% of the total of fractions. The distribution for the presence of both events, flash of light and stable light, was 69.1%, 20.6% and 10.3% respectively. In the logistic regression analysis, for the light flare, only the dose factor in vitreous was significant (OR: 1.74; 95% CI: 1.059-2.419; p: 0.001). For stable light, the dose in the retina (OR: 1.73; 95% CI: 1.121-2.341; p: 0.005), and dose in the vitreous humor (OR: 1.82; 95% CI: 1.335-2.315; p: 0.003). Conclusions There is a predictive relationship between the doses of irradiation of the retina and vitreous humor, for the generation of phosphenes (AU)

Safety Aspects of Perinatal Ultrasound.

Ultrasound safety is of particular importance in fetal and neonatal scanning. Fetal tissues are vulnerable and often still developing, the scanning depth may be low, and potential biological effects have been insufficiently investigated. On the other hand, the clinical benefit may be considerable. The perinatal period is probably less vulnerable than the first and second trimesters of pregnancy, and ultrasound is often a safer alternative to other diagnostic imaging modalities. Here we present step-by-step procedures for obtaining clinically relevant images while maintaining ultrasound safety. We briefly discuss the current status of the field of ultrasound safety, with special attention to the safety of novel modalities, safety considerations when ultrasound is employed for research and education, and ultrasound of particularly vulnerable tissues, such as the neonatal lung. This CME is prepared by ECMUS, the safety committee of EFSUMB, with contributions from OB/GYN clinicians with a special interest in ultrasound safety.

Carcinoma adenoide quístico de cuello uterino: una rara entidad / Adenoid cystic carcinoma of uterine cervix: A rare entity

El carcinoma adenoide quístico es una enfermedad muy rara, representando menos del 1% de todos los carcinomas, con alto riesgo de recurrencia local y a distancia. Aunque no disponemos de una conducta terapéutica estándar hasta la fecha, sin embargo, se cuenta con reportes de ser radiosensible. Se presenta el caso de una mujer peruana de 76 años portadora de carcinoma adenoide quístico de cérvix estadio clínico i, manejada inicialmente con histerectomía radical con resultado patológico de carcinoma adenoide quístico asociado a carcinoma adenoide basal, que presentó recurrencia a distancia tempranamente.(AU)

Adenoid cystic carcinoma is a very rare pathology, representing less than 1% of all carcinomas, and has a high risk of local and distant recurrence. Although there is currently no standard management, there are reports of them being radiosensitive. The case is presented of a 76-year-old Peruvian woman with a clinical stage i cervical adenoid cystic carcinoma, specifically managed with radical hysterectomy with a histological result of an adenoid cystic carcinoma associated with basal adenoid carcinoma, presenting with an early distant recurrence.(AU)

EFSUMB Clinical Safety Statement for Diagnostic Ultrasound - (2019 revision).

This document is the updated 2019 revision of the EFSUMB Clinically Safety Statement. A Safety Statement has been published by EFSUMB annually since 1994 by the Safety Committee (ECMUS) of the federation. The text is deliberately brief and gives a concise overview of safety in the use of diagnostic ultrasound.

Hepatic insulin resistance both in prediabetic and diabetic patients determines postprandial lipoprotein metabolism: from the CORDIOPREV study.

BACKGROUND/AIMS: Previous evidences have shown the presence of a prolonged and exaggerated postprandial response in type 2 diabetes mellitus (T2DM) and its relation with an increase of cardiovascular risk. However, the response in prediabetes population has not been established. The objective was to analyze the degree of postprandial lipemia response in the CORDIOPREV clinical trial (NCT00924937) according to the diabetic status. METHODS: 1002 patients were submitted to an oral fat load test meal (OFTT) with 0.7 g fat/kg body weight [12 % saturated fatty acids (SFA), 10 % polyunsaturated fatty acids (PUFA), 43 % monounsaturated fatty acids (MUFA), 10 % protein and 25 % carbohydrates]. Serial blood test analyzing lipid fractions were drawn at 0, 1, 2, 3 and 4 h during postprandial state. Postprandial triglycerides (TG) concentration at any point >2.5 mmol/L (220 mg/dL) has been established as undesirable response. We explored the dynamic response in 57 non-diabetic, 364 prediabetic and 581 type 2 diabetic patients. Additionally, the postprandial response was evaluated according to basal insulin resistance subgroups in patients non-diabetic and diabetic without pharmacological treatment (N = 642). RESULTS: Prevalence of undesirable postprandial TG was 35 % in non-diabetic, 48 % in prediabetic and 59 % in diabetic subgroup, respectively (p < 0.001). Interestingly, prediabetic patients displayed higher plasma TG and large triacylglycerol-rich lipoproteins (TRLs-TG) postprandial response compared with those non-diabetic patients (p < 0.001 and p = 0.003 respectively). Moreover, the area under the curve (AUC) of TG and AUC of TRLs-TG was greater in the prediabetic group compared with non-diabetic patients (p < 0.001 and p < 0.005 respectively). Patients with liver insulin resistance (liver-IR) showed higher postprandial response of TG compared with those patients with muscle-IR or without any insulin-resistance respectively (p < 0.001). CONCLUSIONS: Our findings demonstrate that prediabetic patients show a lower phenotypic flexibility after external aggression, such as OFTT compared with nondiabetic patients. The postprandial response increases progressively according to non-diabetic, prediabetic and type 2 diabetic state and it is higher in patients with liver insulin-resistance. To identify this subgroup of patients is important to treat more intensively in order to avoid future cardiometabolic complications.

The effects of intermittent hypoxia training on hematological and aerobic performance in triathletes.

The aim of the present research was to analyze modifications on hematological and aerobic performance parameters after a 7-week intermittent hypoxia training (IHT) program. Eighteen male trained triathletes were divided in two groups: an intermittent hypoxia training group (IHTG: n: 9; 26.0 ± 6.7 years; 173.3 ± 5.9 cm; 66.4 ± 5.9 kg; VO2max: 59.5 ± 5.0 ml/kg/min) that conducted a normoxic training plus an IHT and a control group (CG: n: 9; 29.3 ± 6.8 years; 174.9 ± 4.6 cm; 59.7 ± 6.8 kg; VO2max: 58.9 ± 4.5 ml/kg/min) that performed only a normoxic training. Training process was standardized across the two groups. The IHT program consisted of two 60-min sessions per week at intensities over the anaerobic threshold and atmospheric conditions between 14.5 and 15% FiO2. Before and after the 7-week training, aerobic performance in an incremental running test and hematological parameters were analyzed. After this training program, the IHTG showed higher hemoglobin and erythrocytes (p < 0.05) values than in the CG. In terms of physiological and performance variables, between the two groups no changes were found. The addition of an IHT program to normoxic training caused an improvement in hematological parameters but aerobic performance and physiological variables compared to similar training under normoxic conditions did not increase.

Effect of 6 weeks of whole body vibration training on total and segmental body composition in healthy young adults.

The applied use of new technologies to enhance performance and improve health has been increasing. Initially, whole body vibration training (WBVT) was used as system to improve elite athlete performance. However, this is also used to improve body composition, especially there is a great attention on the effectiveness of WBVT to reduce fat and body weight, with a potential increase in muscle tissue. The aim of this study was to investigate the effects of a 6-week vibration-training program on total and segmental body composition in a group of physically healthy participants. The final study sample included 64 healthy young adults. Subjects were randomly allocated into the control group (CG: n = 26; 16 males and 10 females) and the experimental group (EGWBVT: n = 38; 19 males and 19 females). The program lasted six weeks with a frequency of three sessions per week and each session varied in intensity. There were not found statistically significant differences in any of the body composition variables analysed. This study suggests that a six-week vibration-training program with an increasing intensity (7.2 g-32.6 g) in healthy young adults that are not overweight did not alter total and segmental body composition.

Synthesis and biological evaluation as microtubule-active agents of several tetrahydrofuran and spiroacetal derivatives.

The stereoselective preparation of several molecules containing structural fragments of the tetrahydrofuran and spiroacetal type is described. Their degree of cytotoxicity and their interactions with tubulin have been investigated. It has been confirmed that the tetrahydrofuran derivatives are cytotoxic but, in contrast to previous reports, it has been found that the cytoxicity is not due to interactions with the microtubule network. Furthermore, and also in contrast to a previous report on closely related compounds, the spiroacetal derivatives do show interactions with tubulin, even though the precise mechanism and the binding site still remain to be established.

The postprandial inflammatory response after ingestion of heated oils in obese persons is reduced by the presence of phenol compounds.

SCOPE: Heating during the process of cooking alters the chemical properties of foods and may affect subsequent postprandial inflammation. We tested the effects of four meals rich in different oils subjected to heating on the postprandial inflammatory metabolism of peripheral blood mononuclear cells (PBMCs). METHODS AND RESULTS: Twenty obese participants received four breakfasts following a randomized crossover design, consisting of milk and muffins made with different oils (virgin olive oil (VOO), sunflower oil (SFO), and a mixture of seeds oil (SFO/canola oil) with added either dimethylpolysiloxane (SOD), or natural antioxidants from olive mill wastewater alperujo (phenols; SOP)), previously subjected to 20 heating cycles. Postprandial inflammatory status in PBMCs was assessed by the activation of nuclear NF-κB, the concentration in cytoplasm of the NF-κB inhibitor (IκB-α), the mRNA levels of NF-κB subunits and activators (p65, IKKß, and IKKα) and other inflammatory molecules (TNF-α, IL-1ß, IL-6, MIF, and JNK), and lipopolysaccharide (LPS) levels. VOO and SOP breakfasts reduced NF-κB activation, increased IκB-α, and decreased LPS plasma concentration. SFO increased IKKα, IKKß, p65, IL-1b, IL-6, MIF, and JNK mRNA levels, and plasma LPS. CONCLUSION: Oils rich in phenols, whether natural (VOO) or artificially added (SOP), reduce postprandial inflammation, compared with seed oil (sunflower).

A national programme for patient and staff dose monitoring in interventional cardiology.

A national programme on patient and staff dose evaluation in interventional cardiology made in cooperation with the haemodynamic section of the Spanish Society of Cardiology has recently been launched. Its aim is to propose a set of national diagnostic reference levels (DRLs) for patients as recommended by the International Commission on Radiological Protection and to initiate several optimisation actions to improve radiological protection of both patients and staff. Six hospitals have joined the programme and accepted to submit their data to a central database. First to be acquired were the quality control data of the X-ray systems and radiation doses of patients and professionals. The results from 9 X-ray systems, 1467 procedures and staff doses from 43 professionals were gathered. Provisional DRLs resulted in 44 Gy cm(2) for coronary angiography and 78 Gy cm(2) for interventions. The X-ray systems varied up to a factor of 5 for dose rates in reference conditions. Staff doses showed that 50 % of interventional cardiologists do not use their personal dosemeters correctly.

Possible binding site for paclitaxel at microtubule pores.

Taxanes and other microtubule-stabilizing agents comprise an important class of anticancer drugs. It is well known that taxanes act by binding to beta-tubulin on the lumenal side of microtubules. However, experimental evidence obtained in recent years led to the hypothesis of an external site on the microtubule wall to which taxanes and other microtubule-stabilizing agents could bind before being internalized to their lumenal site. In the present study, different computational techniques were combined to explore the possible existence of an exposed and easily accessible binding site for microtubule-stabilizing agents on the outside of microtubules. The results obtained indicate that the conformational rearrangement of the H6-H7 hoop of beta-tubulin can form a suitable pocket on the outer microtubule surface, and that paclitaxel can efficaciously interact with this newly-proposed binding site.

The interaction of microtubules with stabilizers characterized at biochemical and structural levels.

Since the discovery of paclitaxel and its peculiar mechanism of cytotoxicity, which has made it and its analogues widely used antitumour drugs, great effort has been made to understand the way they produce their effect in microtubules and to find other products that share this effect without the undesired side effects of low solubility and development of multidrug resistance by tumour cells. This chapter reviews the actual knowledge about the biochemical and structural mechanisms of microtubule stabilization by microtubule stabilizing agents, and illustrates the way paclitaxel and its biomimetics induce microtubule assembly, the thermodynamics of their binding, the way they reach their binding site and the conformation they have when bound.

An improved method of 90% pancreatectomy using a low dose of streptozotocin at the pancreaticoduodenal artery results in a rapid diabetic stage in dogs.

An improved method of inducing diabetes in dogs was developed. This method included 90% pancreatectomy, 2 mg/kg streptozotocin (STZ) perfused into pancreaticoduodenal artery, and the fixation suture of the duodenum to the costo-abdominal wall. Vasopressin injection administered to the animals before surgery reduced bleeding. All dogs used in this procedure survived and became diabetic. One month after the procedure the pancreatic islets were reduced in volume and the number compared with pancreas tissue obtained during the surgery. Acinar tissue remained with a normal histology, and exocrine function maintained the physiological parameters, except for a soft faecal consistency. We conclude that this procedure is effective in inducing experimental diabetes in dogs.

Movimiento versus ayudas técnicas en el anciano / Movement versus technique helps in the old man

No disponible

Dependencia en el anciano artrósico e intervención enfermera / Dependency in the arthrosic elderly and nursing intervention

La artrosis como enfermedad degenerativa osteoarticular incide de forma directa en la capacidad de independencia del individuo, sobre todo en el anciano. En este último se complejiza enormemente la respuesta ante la necesidad de desplazarse o de moverse condicionada, no ya solamente por factores orgánicos y fisiológicos, sino que, además, se intercalan aspectos de carácter psicológico, económico, social, cultural, etc. que convierten, no ya la necesidad sino incluso el placer del movimiento, en una verdadera tortura para el anciano amén de restar, considerablemente, su capacidad de independencia. Realizamos en el presente trabajo una valoración de dichos condicionantes en pacientes ancianos tributarios de tratamiento protésico en las articulaciones de la cadera y la rodilla, al tiempo que comprobamos la necesidad de implementar actuaciones enfermeras, en este tipo de pacientes, que rentabilicen mejor los recursos terapéuticos a través de una adecuada educación para la salud. (AU)

Activation of cell division protein FtsZ. Control of switch loop T3 conformation by the nucleotide gamma-phosphate.

The effect of bound nucleotide on the conformation of cell division protein FtsZ from Methanococcus jannaschii has been investigated using molecular dynamics and site-directed mutagenesis. The molecular dynamics indicate that the gamma-phosphate of GTP induces a conformational perturbation in loop T3 (Gly88-Gly99 segment), in a position structurally equivalent to switch II of Ha-ras-p21. In the simulated GTP-bound state, loop T3 is pulled by the gamma-phosphate into a more compact conformation than with GDP, related to that observed in the homologous proteins alpha- and beta-tubulin. The existence of a nucleotide-induced structural change in loop T3 has been confirmed by mutating Thr92 into Trp (T92W-W319Y FtsZ). This tryptophan (12 A away from gamma-phosphate) shows large differences in fluorescence emission, depending on which nucleotide is bound to FtsZ monomers. Loop T3 is located at a side of the contact interface between two FtsZ monomers in the current model of FtsZ filament. Such a structural change may bend the GDP filament upon hydrolysis by pushing against helix H8 of next monomer, thus, generating force on the membrane during cell division. A related curvature mechanism may operate in tubulin activation.