EpCAM y obstrucción microvascular en pacientes con un IAMCEST: estudio con resonancia magnética cardiaca / EpCAM and microvascular obstruction in patients with STEMI: a cardiac magnetic resonance study

Introducción y objetivos: La obstrucción microvascular (OMV) se asocia negativamente con la estructura cardiaca y el pronóstico de los pacientes tras un infarto agudo de miocardio con elevación del segmento ST (IAMCEST). El factor epithelial cell adhesion molecule (EpCAM), implicado en la cohesión de las células epiteliales, está poco estudiado en el contexto de la OMV. Por ello, el objetivo de este estudio es evaluar en una cohorte de pacientes con IAMCEST la asociación entre la concentración de EpCAM circulante con la extensión de la OMV, determinada por resonancia magnética cardiaca (RMC), y la función sistólica en fases crónicas. Métodos: Se incluyó prospectivamente a 106 pacientes con un primer IAMCEST tratados con angioplastia primaria percutánea. La concentración sérica de EpCAM se determinó 24h tras la reperfusión coronaria. Se estudió a todos los pacientes mediante RMC a la semana y a los 6 meses del IAMCEST. Se evaluó la correlación entre los valores de EpCAM circulante con la OMV, los índices de función sistólica y la fracción de eyección del ventrículo izquierdo. Resultados: La media de edad de la cohorte era 59±13 años y el 76% eran varones. Se dicotomizó a los pacientes según la mediana de EpCAM (4,48 pg/ml). Se observó que los pacientes que tenían valores más bajos de EpCAM presentaban una mayor extensión de la OMV (p=0,021) y un mayor tamaño de infarto (p=0,019) en los estudios de RMC realizados 1 semana después del evento cardiovascular. Respecto a las variables de presentación, la concentración de EpCAM se asoció significativamente con la presencia de OMV en análisis de regresión logística binaria univariable (OR=0,58; IC95%, 0,38-0,88; p=0,011) y multivariable (OR=0,55; IC95%, 0,35-0,87; p=0,010). A pesar de que la OMV tiende a resolverse espontáneamente en fases crónicas, unos valores más bajos de EpCAM se correlacionaron con una peor función sistólica (AU)

Introduction and objectives: Microvascular obstruction (MVO) is negatively associated with cardiac structure and worse prognosis after ST-segment elevation myocardial infarction (STEMI). Epithelial cell adhesion molecule (EpCAM), involved in epithelium adhesion, is an understudied area in the MVO setting. We aimed to determine whether EpCAM is associated with the appearance of cardiac magnetic resonance (CMR)-derived MVO and long-term systolic function in reperfused STEMI. Methods: We prospectively included 106 patients with a first STEMI treated with percutaneous coronary intervention, quantifying serum levels of EpCAM 24hours postreperfusion. All patients underwent CMR imaging 1 week and 6 months post-STEMI. The independent correlation of EpCAM with MVO, systolic volume indices, and left ventricular ejection fraction was evaluated. Results: The mean age of the sample was 59±13 years and 76% were male. Patients were dichotomized according to median EpCAM (4.48 pg/mL). At 1-week CMR, lower EpCAM was related to extensive MVO (P=.021) and larger infarct size (P=.019). At presentation, EpCAM values were significantly associated with the presence of MVO in univariate (OR, 0.58; 95%CI, 0.38-0.88; P=.011) and multivariate logistic regression models (OR, 0.55; 95%CI, 0.35-0.87; P=.010). Although MVO tends to resolve at chronic phases, decreased EpCAM was associated with worse systolic function: reduced left ventricular ejection fraction (P=.009) and higher left ventricular end-systolic volume (P=.043). Conclusions: EpCAM is associated with the occurrence of CMR-derived MVO at acute phases and long-term adverse ventricular remodeling post-STEMI

Use of linezolid in critically ill patients admitted to intensive care units.

All indications of linezolid (LZD) in Intensive Care Units (ICU) were included as cases in an observational, prospective and multicentre study. One hundred thirty-nine indications were analyzed. In most cases (92.7%), treatment for nosocomial infections was indicated. The most frequent infection was pneumonia (42.7%), followed by catheter-related bacteraemias (CRB). A total of 58.7% of the indications were empirical and in 45.7% of the cases the cultures confirmed infection by gram-positive cocci (GPC). In 43 cases (31.2%), the indication was made as a rescue measure (mainly due to clinical failure) in patients previously treated with glycopeptides. Of isolated GPC, 70.2% were methicillin-resistant. The cure rate of the population per intent-to-treat was 73.2%. Only one case of thrombocytopenia was recorded. Conclusions. LZD is used with a high degree of diagnostic safety. In the ICU, it is primarily indicated to treat pneumonias and CRB with good clinical and microbiological response. This antibiotic has acted as a good therapeutic resource against clinical failure in infections treated with glycopeptides.

Use of linezolid in critically ill patients admitted to Intensive Care Units / Uso del linezolid en pacientes enfermos admitidos en las Unidades de Cuidados Intensivos

All indications of linezolid (LZD) in Intensive Care Units (ICU) were included as cases in an observational, prospective and multicentre study. One hundred thirty-nine indications were analyzed. In most cases (92.7%), treatment for nosocomial infections was indicated. The most frequent infection was pneumonia (42.7%), followed by catheter-related bacteraemias (CRB). A total of 58.7% of the indications were empirical and in 45.7% of the cases the cultures confirmed infection by gram- positive cocci (GPC). In 43 cases (31.2%), the indication was made as a rescue measure (mainly due to clinical failure) in patients previously treated with glycopeptides. Of isolated GPC, 70.2% were methicillin-resistant. The cure rate of the population per intent-to-treat was 73.2%. Only one case of thrombocytopenia was recorded. Conclusions. LZD is used with a high degree of diagnostic safety. In the ICU, it is primarily indicated to treat pneumonias and CRB with good clinical and microbiological response. This antibiotic has acted as a good therapeutic resource against clinical failure in infections treated with glycopeptides (AU)

En un estudio observacional, prospectivo y multicéntrico, los casos incluidos fueron todas las indicaciones de linezolid en las Unidades de Cuidados Intensivos (UCI). Se analizaron 139 indicaciones. En la mayoría de los casos (92,7%), había indicación para un tratamiento de infecciones nosocomiales. La infección más frecuente fue la neumonía (42,7%), seguida de bacteriemias relacionadas con catéteres. Un total del 58,7% de las indicaciones fue empírico, mientras que, en el 45,7% de los casos, los cultivos confirmaron una infección por cocos grampositivos. En 43 casos (31,2%), la indicación se estableció como medida de rescate (principalmente por fracaso clínico) en pacientes tratados previamente con glucopéptidos. El 70,2% de los cocos grampositivos aislados fue meticilina resistente. La tasa de curación de la población de intención de tratar fue del 73,2%. Únicamente se registró un caso de trombocitopenia. Conclusiones. El uso de linezolid demostró un elevado grado de seguridad diagnóstica. Su indicación principal en la UCI es el tratamiento de neumonías y bacteriemias relacionados con catéteres obteniéndose una buena respuesta clínica y microbiológica. Este antibiótico ha actuado como un buen recurso terapéutico frente al fracaso clínico en las infecciones tratadas con glucopéptidos (AU)

Contactless ultrasonic device to measure surface acoustic wave velocities versus temperature.

A complete optical experimental setup for generating and detecting surface acoustic waves [Rayleigh waves (RWs)] in metals versus temperature up to the melting point is described. The RWs were excited by a pulsed Nd:YAG laser and detected by a high sensitivity subangstrom heterodyne interferometer. A special furnace was used to heat the sample using infrared radiation with a regulation of the sample temperature less than 0.1 K. First measurements on an aluminum alloy sample are presented to validate the setup.

Síndrome antifosfolipídico catastrófico y adenocarcinoma de páncreas / Catastrophic antiphospholipid syndrome and pancreatic cancer

No disponible

Calidad de vida en pacientes con diabetes mellitus controlados en Hospital Galvarino, Servicio de Salud Araucania Sur / Quality of life of patients with diabetes mellitus controlled at the Galvarino Hospital, Health Service of Araucania South

Diabetes mellitus is a chronic disease with an increasing prevalence and a raised life expectancy of patients.Since it is a disease presenting with multiple complications during its evolution special emphasis should be given to ever greather efforts for improving quality of life of the patients.A sample of 50 persons comprising 50 per cent of the diabetic population controlled by the Cardiovascular Programme of the Galvarino Hospital were studied, including a survey to assess their quality of life. Results showed that 100 per cent of the patients had one associated pathology, high blood pressure being the most frequent; 72 per cent were obese while a high percentage showed a deficient metabolic control. 71 per cent had a poorly compensated diabetes and 85 per cent presented high tensional figures at the time of assessment.A Cause of special concern is that none of the patients had a recent eye examination nor a fundoscopy.The above results show the ineffectiveness of the Cardiovascular Health Programme developed by the municipality of Galvarino as well as the absence of basic tools to carry out a proper assessment of diabetic patients.

Evaluation of viscoelastic constants of metallic materials by laser-ultrasonics at elevating temperature.

The main objective of this study is the determination of elastic moduli and viscosity coefficients of metals at elevating temperature up to melting point. More specifically, it involves the analysis of the propagation of acoustic waves generated and detected simultaneously by laser-ultrasonic for the measurement of longitudinal and shear velocities. This preliminary work primarily concerns Tin (Sn) metal known for its low melting point and attenuation coefficient.

Laser induced decohesion of coatings: probing by laser ultrasonics.

The aim of the present study is to investigate a conventional laser-ultrasonics technique for the determination of intrinsic properties of oxide coatings and their adhesion strength on a metallic substrate. The good agreement between experiments and computations in an epicenter configuration allows determining the longitudinal wave velocity as well as the Young's modulus of the oxide coatings versus the porosity. For a critical value of the laser energy, a breakdown at the coating-substrate interface is generated by the laser irradiation. The critical tensile stress field developed at the coating/substrate interface, which leads to the interfacial fracture, can be easily calculated. The value of the practical adhesion which is defined is found to be in accordance with those obtained by classic contact techniques (tensile adhesion test, indentation, bending test). Finally, this work demonstrates that this quantitative, contactless test fits well to simultaneously characterise the oxide coatings and evaluate the coating-substrate adhesion.

Effects of salinity, temperature and food level on the demographic characteristics of the seawater rotifer Synchaeta littoralis Rousselet.

A strain of the seawater species Synchaeta littoralis, isolated from a Spanish Mediterranean coastal salt marsh, was cultured in the laboratory and fed with the alga Tetraselmis sp. The effect of three salinities (25 per thousand, 30 per thousand and 35 per thousand), two temperatures (20 degrees C and 25 degrees C) and two food levels (75,000 and 150,000 cells ml(-1)) on demographic parameters was studied using a life table approach. Average lifespan (LS) ranged between 4.0 and 7.3 days, net reproductive rate (R(0)) between 4.2 and 9.1 offspring per female, and intrinsic growth rate (r) between 0.50 and 0.95 day(-1). Salinity and temperature had a significant negative effect (***p<0.001) on both average lifespan (LS) and net reproductive rate (R(0)). Nevertheless, S. littoralis grew adequately at 35 per thousand (average value of r=0.67 day(-1)). Intrinsic growth rate also increased with temperature due to the lower value of the generation time (ranged between 2.3 and 3.8 days in all assays). Food level only had a significant negative effect (***p<0.001) on R(0). The experiments designed allowed us to know the basic demographic parameters of S. littoralis.

Isolation and characterization of Vibrio parahaemolyticus causing infection in Iberian toothcarp Aphanius iberus.

High mortality among laboratory cultured Iberian toothcarp Aphanius iberus occurred in February 1997 in Valencia (Spain). The main signs of the disease were external haemorrhage and tail rot. Bacteria isolated from internal organs of infected fish were biochemically homogeneous and identified as Vibrio parahaemolyticus. The bacteria were haemolytic against erythrocytes from eel Anguilla anguilla, amberjack Seriola dumerili, toothcarp A. iberus and humans, and were Kanagawa-phenomenon-negative. Infectivity tests showed that the virulence for A. iberus was dependent on salinity. Finally, all strains were virulent for amberjack and eel.

[Plasma exchange in dermatology: apropos of a case of dermatomyositis]. / Recambio plasmático en dermatología: a propósito de un caso de dermatomiositis.

We present a 45 years old male with dermatomyositis refractory to eight months of standard treatment who responded to plasma exchange. The efficacy of the procedure is estimated from clinical follow-up (increase in strength) and serum creatine-kinase activity (decrease from 3,380 to 44 u/ml.) after five sessions of plasma exchange. The therapeutic indications for PE are reviewed in dermatological diseases with emphasis on cases where the response to steroids or cytotoxic drugs is inadequate.