The homogeneous characterisation of Ariel host stars.

The Ariel mission will characterise the chemical and thermal properties of the atmospheres of about a thousand exoplanets transiting their host star(s). The observation of such a large sample of planets will allow to deepen our understanding of planetary and atmospheric formation at the early stages, providing a truly representative picture of the chemical nature of exoplanets, and relating this directly to the type and chemical environment of the host star. Hence, the accurate and precise determination of the host star fundamental properties is essential to Ariel for drawing a comprehensive picture of the underlying essence of these planetary systems. We present here a structured approach for the characterisation of Ariel stars that accounts for the concepts of homogeneity and coherence among a large set of stellar parameters. We present here the studies and benchmark analyses we have been performing to determine robust stellar fundamental parameters, elemental abundances, activity indices, and stellar ages. In particular, we present results for the homogeneous estimation of the activity indices S and log ( R HK ' ) , and preliminary results for elemental abundances of Na, Al, Mg, Si, C, N. In addition, we analyse the variation of a planetary spectrum, obtained with Ariel, as a function of the uncertainty on the stellar effective temperature. Finally, we present our observational campaign for precisely and homogeneously characterising all Ariel stars in order to perform a meaningful choice of final targets before the mission launch.

Implementación segura de la escisión total mesorrectal transanal (TaTME) en la práctica clínica / Safe implementation of total transanal mesorectal excision (TaTME) in clinical practice

Introducción: La escisión total del mesorrecto transanal (TaTME) es una técnica quirúrgica moderna que busca mejorar los resultados oncológicos sorteando dificultades anatómicas y propias del tumor en el cáncer de recto medio e inferior. La expansión de esta operación condujo a complicaciones propias que no se observaban con los procedimientos tradicionales puramente transabdominales. Es por esto que existen recomendaciones de expertos a seguir en el inicio de la práctica del TaTME. Objetivo: Mostrar resultados en la serie inicial de TaTME implementando estrategias de seguridad. Diseño: Análisis retrospectivo sobre una base de datos prospectiva. Métodos: Entre mayo de 2015 y junio de 2018 se seleccionaron pacientes con adenocarcinoma de recto medio o bajo con margen circunferencial de resección respetado sin enfermedad a distancia irresecable. Los pacientes fueron operados con la técnica TaTME por un mismo cirujano "en formación en TaTME" con experiencia y alto volumen de casos de cáncer de recto, habiendo realizado cursos homologados. En algunos de los casos se contó con la asistencia de un especialista internacional "proctor". Resultados: En el período estudiado se operaron 8 pacientes mediante TaTME. Edad media de 62 años (53-77). Siete recibieron Quimiorradioterapia preoperatoria (88%). Todas las piezas tuvieron un margen distal negativo, en 7 de 8 la resección del mesorrecto fue completa y en uno incompleta. El promedio de ganglios resecados fue de 12,5 (6-21). La mediana de tiempo operatorio fue de 351 minutos (255-480). La media de días de internación fue de 10.6 (4-19). Siete pacientes tuvieron complicaciones en el postoperatorio, 4 Clavien I y 3 II. Conclusiones: La aplicación de las estrategias de seguridad durante la implementación de una técnica nueva como el TaTME, ayudaría a la disminución de complicaciones intra y postoperatorias con buenos resultados desde el punto de vista oncológico. (AU)

Introduction: Transanal total mesorectal excision (TaTME) is a modern surgical technique that seeks the best oncological results avoiding anatomic and tumor-specific difficulties in middle and low rectal cancer. The spread of this operation led to complications that were not observed with traditional procedures in a purely transabdominal approach. That is why there are recommendations to follow when starting the TaTME practice. Objective: To show our initial results in TaTME operation implementing security strategies. Design: Retrospective analysis based on a prospective database. Methods: Between May 2015 and June 2018, patients with middle or low rectal adenocarcinoma, with respected circumferential margin in absence of distant unresectable disease were selected. Patients were operated with the TaTME technique by the same surgeon "trainee" with experience and high case volume of rectal cancer, who attended to different courses on the matter. In some of the cases, there was assistance of an international "proctor" specialist. Results: In the period of study, 8 patients underwent surgery through TaTME. Mean age was 62 years (53-77). Seven received preoperative chemoradiotherapy (88%). All the specimens had a negative distal margin, in 7 out of 8, resection of the mesorectum was complete whereas it was incomplete in one. The mean number of resected lymph nodes was 12.5 (6-21). The median operative time was 351 minutes (255-480). The mean time of hospital stay was 10.6 days (4-19). Seven patients had complications in the postoperative period, 4 Clavien I and 3 II. Conclusions: Application of safety strategies during the implementation of a new technique such as TaTME, would help to reduce intra and postoperative complications with good results from the oncological point of view. (AU)

Sol-gel coated ion sources for liquid chromatography-direct electron ionization mass spectrometry.

Advances in interfacing liquid chromatography and electron ionization mass spectrometry are presented. New ion source coatings synthesized by sol-gel technology were developed and tested as vaporization surfaces in terms of peak intensity, peak width and peak delay for the liquid chromatography-direct electron ionization mass spectrometry (Direct-EI) determination of environmental pollutants like polycyclic aromatic hydrocarbons and steroids. Silica-, titania-, and zirconia-based coatings were sprayed inside the stainless steel ion source and characterized in terms of thermal stability, film thickness and morphology. Negligible weight losses until 350-400 °C were observed for all the materials, with coating thicknesses in the 6 (±1)-11 (±2) µm range for optimal ionization process. The best performances in terms of both peak intensity and peak width were obtained by using the silica-based coating: the detection of the investigated compounds was feasible at low ng µl-1 levels with a good precision (RSD < 9% for polycyclic aromatic hydrocarbons and <11% for hormones).

Proenkephalin, Neutrophil Gelatinase-Associated Lipocalin, and Estimated Glomerular Filtration Rates in Patients With Sepsis.

BACKGROUND: Proenkephalin (PENK) has been suggested as a novel biomarker for kidney function. We investigated the diagnostic and prognostic utility of plasma PENK in comparison with neutrophil gelatinase-associated lipocalin (NGAL) and estimated glomerular filtration rates (eGFR) in septic patients. METHODS: A total of 167 septic patients were enrolled: 99 with sepsis, 37 with septic shock, and 31 with suspected sepsis. PENK and NGAL concentrations were measured and GFR was estimated by using the isotope dilution mass spectrometry traceable-Modification of Diet in Renal Disease (MDRD) Study and three Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations: CKD-EPI(Cr), CDK-EPI(CysC), and CKD-EPI(Cr-CysC). The PENK, NGAL, and eGFR results were compared according to sepsis severity, presence or absence of acute kidney injury (AKI), and clinical outcomes. RESULTS: The PENK, NGAL, and eGFR results were significantly associated with sepsis severity and differed significantly between patients with and without AKI only in the sepsis group (all P<0.05). PENK was superior to NGAL in predicting AKI (P=0.022) and renal replacement therapy (RRT) (P=0.0085). Regardless of the variable GFR category by the different eGFR equations, PENK showed constant and significant associations with all eGFR equations. Unlike NGAL, PENK was not influenced by inflammation and predicted the 30-day mortality. CONCLUSIONS: PENK is a highly sensitive and objective biomarker of AKI and RRT and is useful for prognosis prediction in septic patients. With its diagnostic robustness and predictive power for survival, PENK constitutes a promising biomarker in critical care settings including sepsis.

The use of discharge haemoglobin and NT-proBNP to improve short and long-term outcome prediction in patients with acute heart failure.

AIMS: To examine the prognostic value of admission (A) and discharge (D) haemoglobin (Hb) and its relationship with N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) in patients hospitalised for acute heart failure (AHF). The outcomes of interests were rehospitalisation or death after one, six or twelve months after discharge. METHODS: 317 hospitalised AHF patients (74.7±9.4 years) were enrolled in two academic centres in Belgrade and Rome. Laboratory analyses, including NT-proBNP were assessed at admission, and Hb also at discharge. Patients were divided into two groups according to the presence of anaemia. Follow-up contact was made by telephone. Statistical analyses were performed using SPSS software version 21.0. RESULTS: According to A and DHb levels (<120 g/l for women and <130 g/l for men), anaemia was present in 55% and 62% of patients, respectively ( P=0.497). Lower DHb was associated with the rehospitalisation risk after one (OR=0.96, P=0.004), six (OR=0.97, P<0.001) and 12 months (OR=0.97, P<0.001). For every g/l decrease of DHb, the risk of rehospitalisation after one year was increased by 3.3%. In the first six months, DHb contributed to increased risk of death (OR=0.97, P=0.005), but NT-proBNP showed greater power (OR=2.1, P<0.001). CONCLUSIONS: In AHF patients discharge anaemia is a strong predictor for short and long-term rehospitalisation, while NT-proBNP seems to be a better predictor for mortality. Discharge Hb and NT-proBNP should be assessed together in order to detect the patients with higher risk of future death and rehospitalisation.

Multicentre Italian analysis on cardiovascular diseases: impact of immigrants' referral to emergency department.

During the recent years, immigration in Italy has increased. There are few data on the health status of immigrants and there is a need to improve their healthcare. Cardiovascular disorders account for 7.6% of immigrants' diseases and cause 3.6% of the total deaths. Lack of healthcare services to general medicine support and prescriptions leads immigrants to contact the Emergency Department (ED) to receive medical assistance. Primary endpoints of this study were to assess the use of national healthcare system by immigrants and to determine the incidence of cardiovascular diseases, and the frequency and type of risk factors for cardiovascular diseases in these patients. A no-profit, observational, multicentre study was conducted from April to September 2012. We studied 642 foreign patients referring to the ED for various symptoms/signs. One hundred and fourteen patients referred for suspected cardiovascular disease and 105 had a confirmed final diagnosis of cardiovascular disease. The more represented ethnic origin was Caucasian (59%), whereas the most represented country was Romania (24%). The main symptom recorded at ED arrival was chest pain (37.1%). Final cardiovascular diagnoses were represented by: hypertensive crisis (28.5%), acute coronary syndrome (20%), acute heart failure (12.3%), atrial fibrillation (10.4%) and chest pain (10.4%). Past medical history of cardiovascular disease, hypertension, obesity and male sex showed independent significant predictive value for cardiovascular disease diagnosis.Our study provides support for the development of specific primary prevention of cardiovascular risk factors in immigrants with the important role of culturally competent education of individuals and families. Better outpatient management seems to be needed in order to limit the need for emergency room referral.

Usefulness of combining admission brain natriuretic peptide (BNP) plus hospital discharge bioelectrical impedance vector analysis (BIVA) in predicting 90 days cardiovascular mortality in patients with acute heart failure.

Heart failure is a disease characterized by high prevalence and mortality, and frequent rehospitalizations. The aim of this study is to investigate the prognostic power of combining brain natriuretic peptide (BNP) and congestion status detected by bioelectrical impedance vector analysis (BIVA) in acute heart failure patients. This is an observational, prospective, and a multicentre study. BNP assessment was measured upon hospital arrival, while BIVA analysis was obtained at the time of discharge. Cardiovascular deaths were evaluated at 90 days by a follow up phone call. 292 patients were enrolled. Compared to survivors, BNP was higher in the non-survivors group (mean value 838 vs 515 pg/ml, p < 0.001). At discharge, BIVA shows a statistically significant difference in hydration status between survivors and non-survivors [respectively, hydration index (HI) 85 vs 74, p < 0.001; reactance (Xc) 26.7 vs 37, p < 0.001; resistance (R) 445 vs 503, p < 0.01)]. Discharge BIVA shows a prognostic value in predicting cardiovascular death [HI: area under the curve (AUC) 0.715, 95% confidence interval (95% CI) 0.65-0.76; p < 0.004; Xc: AUC 0.712, 95% CI 0.655-0.76, p < 0.007; R: AUC 0.65, 95% CI 0.29-0.706, p < 0.0247]. The combination of BIVA with BNP gives a greater prognostic power for cardiovascular mortality [combined receiving operating characteristic (ROC): AUC 0.74; 95% CI 0.68-0.79; p < 0.001]. In acute heart failure patients, higher BNP levels upon hospital admission, and congestion detected by BIVA at discharge have a significant predictive value for 90 days cardiovascular mortality. The combined use of admission BNP and BIVA discharge seems to be a useful tool for increasing prognostic power in these patients.

Comparison Between Soluble ST2 and High-Sensitivity Troponin I in Predicting Short-Term Mortality for Patients Presenting to the Emergency Department With Chest Pain.

BACKGROUND: High-sensitivity cardiac troponin I (hs-cTnI) and the soluble isoform of suppression of tumorigenicity 2 (sST2) are useful prognostic biomarkers in acute coronary syndrome (ACS). The aim of this study was to test the short term prognostic value of sST2 compared with hs-cTnI in patients with chest pain. METHODS: Assays for hs-cTnI and sST2 were performed in 157 patients admitted to the Emergency Department (ED) for chest pain at arrival. In-hospital and 30-day follow-up mortalities were assessed. RESULTS: The incidence of ACS was 37%; 33 patients were diagnosed with ST elevation myocardial infarction (STEMI), and 25 were diagnosed with non-ST elevation myocardial infarction (NSTEMI). Compared with the no acute coronary syndrome (NO ACS) group, the median level of hs-cTnI was higher in ACS patients: 7.22 (5.24-14) pg/mL vs 68 (15.33-163.50) pg/mL (P<0.0001). In all patients, the sST2 level at arrival showed higher independent predictive power than hs-cTnI (odds ratio [OR] 20.13, P<0.0001 and OR 2.61, P<0.0008, respectively). sST2 at ED arrival showed a greater prognostic value for cardiovascular events in STEMI (area under the curve [AUC] 0.80, P<0.001) than NSTEMI patients (AUC 0.72, P<0.05). Overall, 51% of the STEMI patients with an sST2 value>35 ng/mL at ED arrival died during the 30-day follow-up. CONCLUSIONS: sST2 has a greater prognostic value for 30-day cardiac mortality after discharge in patients presenting to the ED for chest pain compared with hs-cTnI. In STEMI patients, an sST2 value >35 ng/mL at ED arrival showed the highest predictive power for short-term mortality.

IL-18 stimulates B-type natriuretic peptide synthesis by cardiomyocytes in vitro and its plasma levels correlate with B-type natriuretic peptide in non-overloaded acute heart failure patients.

BACKGROUND: An altered IL-18 pathway in heart failure (HF) has recently been described and this cytokine was shown to be of clinical and prognostic utility. Cardiomyocytes are a target of this cytokine which exerts inflammatory, hypertrophic, and profibrotic activities. B-type natriuretic peptide is a cardiac hormone produced in response to cardiac filling to regulate cardiovascular homeostasis. The aim of the study was to verify the ability of IL-18 to induce B-type natriuretic peptide synthesis in vitro and to analyse the relationship between these two molecules in plasma in vivo from acute HF patients. METHODS AND RESULTS: We demonstrated the ability of IL-18 to directly stimulate a murine cardiomyocyte cell line to express the B-type natriuretic peptide gene, synthesize the relative protein through a PI3K-AKT-dependent transduction, and induce a cell secretory phenotype with B-type natriuretic peptide release. A correlation between IL-18 and B-type natriuretic peptide plasma levels was found in non-overloaded acute HF patients, and in subgroups of acute HF patients with diabetes and coronary artery disease. Acute HF patients with renal failure had significantly higher IL-18 plasma levels than patients without. IL-18 plasma levels were correlated with C-reactive protein plasma levels. CONCLUSIONS: This study provides the first evidence of the ability of IL-18 to induce B-type natriuretic peptide synthesis in vitro and outlines the relationship between the two molecules in acute HF patients with an ongoing inflammatory status.

Prognostic value of decreased peripheral congestion detected by Bioelectrical Impedance Vector Analysis (BIVA) in patients hospitalized for acute heart failure: BIVA prognostic value in acute heart failure.

OBJECTIVES: The objective of this study was to investigate the prognostic role of quantitative reduction of congestion during hospitalization assessed by Bioelectrical Impedance Vector Analysis (BIVA) serial evaluations in patients admitted for acute heart failure (AHF). BACKGROUND: AHF is a frequent reason for patients to be admitted. Exacerbation of chronic heart failure is linked with a progressive worsening of the disease with increased incidence of death. Fluid overload is the main mechanism underlying acute decompensation in these patients. BIVA is a validated technique able to quantify fluid overload. METHODS: a prospective, multicentre, observational study in AHF and no AHF patients in three Emergency Departments centres in Italy. Clinical data and BIVA evaluations were performed at admission (t0) and discharge (tdis). A follow-up phone call was carried out at 90 days. RESULTS: Three hundred and thirty-six patients were enrolled (221 AHF and 115 no AHF patients). We found that clinical signs showed the most powerful prognostic relevance. In particular the presence of rales and lower limb oedema at tdis were linked with events relapse at 90 days. At t0, congestion detected by BIVA was observed only in the AHF group, and significantly decreased at tdis. An increase of resistance variation (dR/H) >11 Ω/m during hospitalization was associated with survival. BIVA showed significant results in predicting total events, both at t0 (area under the curve (AUC) 0.56, p<0.04) and at tdis (AUC 0.57, p<0.03). When combined with clinical signs, BIVA showed a very good predictive value for cardiovascular events at 90 days (AUC 0.97, p<0.0001). CONCLUSIONS: In AHF patients, an accurate physical examination evaluating the presence of rales and lower limbs oedema remains the cornerstone in the management of patients with AHF. A congestion reduction, obtained as a consequence of therapies and detected through BIVA analysis, with an increase of dR/H >11 Ω/m during hospitalization seems to be associated with increased 90 day survival in patients admitted for AHF.

Soluble ST2 Levels and Left Ventricular Structure and Function in Patients With Metabolic Syndrome.

BACKGROUND: A biomarker that is of great interest in relation to adverse cardiovascular events is soluble ST2 (sST2), a member of the interleukin family. Considering that metabolic syndrome (MetS) is accompanied by a proinflammatory state, we aimed to assess the relationship between sST2 and left ventricular (LV) structure and function in patients with MetS. METHODS: A multicentric, cross-sectional study was conducted on180 MetS subjects with normal LV ejection fraction as determined by echocardiography. LV hypertrophy (LVH) was defined as an LV mass index greater than the gender-specific upper limit of normal as determined by echocardiography. LV diastolic dysfunction (DD) was assessed by pulse-wave and tissue Doppler imaging. sST2 was measured by using a quantitative monoclonal ELISA assay. RESULTS: LV mass index (ß=0.337, P<0.001, linear regression) was independently associated with sST2 concentrations. Increased sST2 was associated with an increased likelihood of LVH [Exp (B)=2.20, P=0.048, logistic regression] and increased systolic blood pressure [Exp (B)=1.02, P=0.05, logistic regression]. Comparing mean sST2 concentrations (adjusted for age, body mass index, gender) between different LV remodeling patterns, we found the greatest sST2 level in the group with concentric hypertrophy. There were no differences in sST2 concentration between groups with and without LV DD. CONCLUSIONS: Increased sST2 concentration in patients with MetS was associated with a greater likelihood of exhibiting LVH. Our results suggest that inflammation could be one of the principal triggering mechanisms for LV remodeling in MetS.

Soluble Suppression of Tumorigenicity 2 and Echocardiography in Sepsis.

Soluble suppression of tumorigenicity 2 (sST2) has emerged as a biomarker of cardiac stretch or remodeling, and has demonstrated a role in acutely decompensated heart failure. However, its role in sepsis-induced cardiac dysfunction is still unknown. We explored whether sST2 serum concentration reflects either systolic or diastolic dysfunction as measured by Doppler echocardiography. In a total of 127 patients with sepsis, correlations between sST2 and blood pressure, left ventricular (LV) ejection fraction, LV diastolic filling (ratio of early transmitral flow velocity to early diastolic mitral annulus velocity), and resting pulmonary arterial pressure were evaluated. Correlations between sST2 and other sepsis biomarkers (high-sensitivity C-reactive protein [hs-CRP] and procalcitonin) were also examined. sST2 showed a moderate correlation with mean arterial pressure (r=-0.3499) but no correlation with LV ejection fraction, diastolic filling, or resting pulmonary hypertension. It showed moderate correlations with hs-CRP and procalcitonin (r=0.2608 and r=0.3829, respectively). sST2 might have a role as a biomarker of shock or inflammation, but it cannot reflect echocardiographic findings of LV ejection fraction or diastolic filling in sepsis.

Microextraction by packed sorbent (MEPS)-UHPLC-UV: A simple and efficient method for the determination of five benzodiazepines in an alcoholic beverage.

This article describes a nano-scale method for the determination and quantification of five benzodiazepines (BDZ) in an alcoholic grappa drink (chlordiazepoxide; lorazepam; diazepam; oxazepam; medazepam). BDZ are typically used in drug-facilitated crimes (DFC) for their accessibility and synergistic effects with alcohol. Specimens collected on the crime scene must be rapidly analyzed to prove the crime, though, in most cases, a very small amount is available. Off-line MEPS extraction of diluted grappa samples proved to be an efficient and reliable method for the recovery of the selected compounds. Requiring a very small amount of extraction solvents, MEPS is an environment-friendly technique. LC separation with UV detection was used as the analytical technique because it is simple, robust, relatively economic and easy-to-find in most laboratories. The method was validated in terms of precision, accuracy and recovery. Limits of detection and quantitation were in the range of 0.5-2ng/µL. Linearity (R(2)) spanned from 0.9994 and 1.0000. Intra- and inter-day repeatabilities were lower than 12% at any concentration. Recovery percentages of an equivalent-to-real sample at three different concentrations were between 70.7 and 74.1%.

Boosting the Detection Potential of Liquid Chromatography-Electron Ionization Mass Spectrometry Using a Ceramic Coated Ion Source.

Detection of target and non-target substances and their characterization in complex samples is a challenging task. Here we demonstrate that coating the electron ionization (EI) ion source of an LC-MS system with a sol-gel ceramic film can drastically improve the detection of high-molecular weight and high-boiling analytes. A new ion source coated with a ceramic material was developed and tested with a mixture of polycyclic aromatic hydrocarbons (PAH) with an increasing number of rings. Comparison of the results obtained with those for an uncoated stainless steel (SS) ion source shows a dramatic improvement in the MS signals, with a nearly 40-fold increase of the signal-to-noise ratio. We also demonstrate the ability of the new system to produce excellent chromatographic profiles for hard-to-detect hormones.

Diagnostic and Prognostic Utility of Procalcitonin in Patients Presenting to the Emergency Department with Dyspnea.

BACKGROUND: Among patients in the emergency department, dyspnea is a common complaint and can pose a diagnostic challenge. Biomarkers are used increasingly to improve diagnostic accuracy and aid with prognostication in dyspneic patients. The purpose of this study was to examine the clinical utility of serum procalcitonin (PCT) for the diagnosis of pneumonia in patients presenting to the emergency department with dyspnea. A secondary objective was to evaluate the prognostic value of PCT for death to 1 year. METHODS: This study pooled the patient populations of 2 prospective cohorts that previously enrolled patients presenting to 2 urban emergency departments with dyspnea. A total of 453 patients had serum samples available for biomarker analysis. Clinician certainty for the diagnosis of acutely decompensated heart failure was reviewed. Discrimination, calibration, and net reclassification improvement for the diagnosis of pneumonia as well as fatal outcomes were considered. The main outcome was accuracy of PCT for diagnostic categorization of pneumonia. The prognostic value of PCT for survival to 1 year was a secondary outcome. RESULTS: Pneumonia alone was diagnosed in 30 patients (6.6%), heart failure without pneumonia in 212 patients (47%), and both diagnoses in 30 patients (6.6%). Procalcitonin concentrations were higher in subjects with pneumonia (0.38 vs 0.06 ng/mL; P < .001). Area under the receiver operating characteristic curve for the diagnosis of pneumonia based on PCT was 0.84 (95% confidence interval [CI], 0.77-0.91; P < .001). Across all levels of clinician-based estimates of heart failure, PCT was sensitive and specific; notably, in patients judged with diagnostic uncertainty (n = 70), a PCT value of 0.10 ng/mL had the optimal balance of sensitivity and specificity (80% and 77%, respectively) for pneumonia. Adding PCT results to variables predictive of pneumonia resulted in a net reclassification improvement of 0.54 (95% CI, 0.24-0.83; P < .001) for both up- and down-reclassifying events. In adjusted analyses, elevated PCT was a predictor of 1-year mortality (hazard ratio 1.8; 95% CI, 1.4-2.3; P < .001) and was additive when elevated in conjunction with natriuretic peptides for this application. CONCLUSION: In emergency department patients with acute dyspnea, PCT is an accurate diagnostic marker for pneumonia and adds independent prognostic information for 1-year mortality.

Investigación multidisciplinar en el ámbito de urgencias / Multidisciplinary research in emergency medicine

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Soluble ST2 has a prognostic role in patients with suspected sepsis.

BACKGROUND: Soluble suppression of tumorigenicity 2 (sST2) has emerged as a novel biomarker for heart failure, and serum sST2 concentrations could be increased in inflammatory diseases. We explored whether sST2 is related to cardiac dysfunction/failure and has a prognostic role in patients with suspected sepsis. METHODS: In a total of 397 patients with suspected sepsis, sST2 concentrations were measured by using the Presage ST2 Assay (Critical Diagnostics, USA). sST2 concentrations were analyzed according to procalcitonin (PCT) concentrations, cardiovascular subscores of the sepsis-related organ failure assessment (SOFA) score, and clinical outcomes. RESULTS: sST2 concentrations were increased significantly according to the five groups of PCT concentrations and cardiovascular subscores of the SOFA score (P<0.000001 and P=0.036, respectively). In-hospital mortality was significantly higher among patients with sST2 concentrations above 35 ng/mL (P=0.0213) and among patients with increased concentrations of both sST2 and PCT (P=0.0028). CONCLUSIONS: sST2 seems to be related to both cardiac dysfunction/failure and severity in sepsis. Measurement of sST2 and PCT in combination would be useful for risk stratification and prognosis prediction in patients with suspected sepsis.

Tratamiento farmacológico en la insuficiencia cardiaca aguda / Drug therapy for acute heart failure

La insuficiencia cardiaca aguda es una de las causas de hospitalización más frecuentes y continúa conllevando dificultades para la elección del mejor tratamiento para mejorar la evolución clínica del paciente. Según lo indicado por las guías internacionales, en cuanto los pacientes con insuficiencia cardiaca aguda llegan al servicio de urgencias, el enfoque terapéutico habitual tiene como objetivo la mejoría de los signos y síntomas, corregir la sobrecarga de volumen y mejorar la hemodinámica cardiaca aumentando la perfusión de los órganos vitales. El tratamiento recomendado para tratar de manera inmediata la insuficiencia cardiaca aguda se caracteriza por el uso de diuréticos intravenosos, oxigenoterapia y vasodilatadores. Aunque estas medidas alivian los síntomas del paciente, no tienen una influencia favorable en la mortalidad a corto y largo plazo. Por consiguiente, hay una necesidad acuciante de nuevos fármacos para el tratamiento de la insuficiencia cardiaca aguda, lo que hace que la investigación en este campo aumente en todo el mundo (AU)

Acute heart failure is globally one of most frequent reasons for hospitalization and still represents a challenge for the choice of the best treatment to improve patient outcome. According to current international guidelines, as soon as patients with acute heart failure arrive at the emergency department, the common therapeutic approach aims to improve their signs and symptoms, correct volume overload, and ameliorate cardiac hemodynamics by increasing vital organ perfusion. Recommended treatment for the early management of acute heart failure is characterized by the use of intravenous diuretics, oxygen, and vasodilators. Although these measures ameliorate the patient's symptoms, they do not favorably impact on short- and long-term mortality. Consequently, there is a pressing need for novel agents in acute heart failure treatment with the result that research in this field is increasing worldwide (AU)