Controlling A x Mn[Fe(CN)6] charge transfer pathways through tilt-engineering for enhanced metal-to-metal interactions.

The induction of structural distortion in a controlled manner through tilt engineering has emerged as a potent method to finely tune the physical characteristics of Prussian blue analogues. Notably, this distortion can be chemically induced by filling their pores with cations that can interact with the cyanide ligands. With this objective in mind, we optimized the synthetic protocol to produce the stimuli-responsive Prussian blue analogue A x Mn[Fe(CN)6] with A = K+, Rb+, and Cs+, to tune its stimuli-responsive behavior by exchanging the cation inside pores. Our crystallographic analyses reveal that the smaller the cation, the more pronounced the structural distortion, with a notable 20-degree Fe-CN tilting when filling the cavities with K+, 10 degrees with Rb+, and 2 degrees with Cs+. Moreover, this controlled distortion offers a means to switch on/off its stimuli-responsive behavior, while modifying its magnetic response. Thereby empowering the manipulation of the PBA's physical properties through cationic exchange.

Unlocking room-temperature bistable spin transition at the nanoscale: the synthesis of core@shell [Fe(NH2trz)3(NO3)2]@SiO2 nanoparticles.

In this work, we address the synthesis of stable spin-crossover nanoparticles capable of undergoing a hysteretic spin transition at room temperature. For this purpose, we use the reverse-micelle protocol to prepare naked [Fe(NH2trz)3](NO3)2 and core@shell [Fe(NH2trz)3](NO3)2@SiO2 nanoparticles. Through meticulous adjustment of synthetic parameters, we achieved nanoparticle sizes ranging from approximately 40 nm to 60 nm. Our findings highlight that [Fe(NH2trz)3](NO3)2 presents a modest thermal hysteresis of 7 K, which decreases by downsizing. Conversely, silica-coated nanoparticles with sizes of ca. 60 and 40 nm demonstrate a remarkable hysteretic response of approximately 30 K, switching their spin state around room temperature. Moreover, the presence of a SiO2 shell substantially enhances the nanoparticles' stability against oxidation. In this context, the larger 60 nm [Fe(NH2trz)3](NO3)2@SiO2 hybrid remains stable in water for up to two hours, enabling the observation of an unreported water-induced spin transition after 30 min. Therefore, this work also introduces an intriguing avenue for inducing spin transitions through solvent exchange, underscoring the versatility and potential of these nanoparticles.

El sistema TriClip para la reparación transcatéter de la válvula tricúspide. Estudio multicéntrico español / The TriClip system for edge-to-edge transcatheter tricuspid valve repair. A Spanish multicenter study

Introducción y objetivos En pacientes con insuficiencia tricuspídea (IT), la reparación transcatéter de la válvula tricúspide (RTVT) mediante el uso de dispositivos «borde a borde» ha experimentado un creciente uso en todo el mundo. Recientemente se ha puesto a disposición un sistema dedicado de RTVT borde a borde. El presente artículo describe la experiencia inicial con este sistema en España. Métodos Estudio multicéntrico prospectivo que incluyen los centros aceptados para el uso del novedoso sistema. Entre junio de 2020 y marzo de 2021 se incluyó a todos los pacientes sometidos a una RTVT con el sistema TriClip en España. El criterio de valoración principal fue la consecución de una reducción de la IT de al menos 1 grado al alta hospitalaria. Resultados Se incluyó a un total de 34 pacientes. La mayoría de ellos refería antecedentes de fibrilación auricular (91%). El objetivo primario se alcanzó en todos los pacientes. La mayoría requirieron uno (47%) o dos clips (44%), con un claro predominio del dispositivo XT (87%) sobre NT (13%). La localización del primer clip fue principalmente anteroseptal (> 90%). Solo un paciente presentó un desprendimiento parcial que pudo ser estabilizado con clips adicionales en el mismo procedimiento. Al alta, la gravedad de la IT fue de grado 2 en el 91% de los pacientes. A los 3 meses, no se detectó ninguna muerte. Al seguimiento, el 88% de los pacientes se encontraban en clase funcional New York Heart Association 2 y el 80% presentaban IT grado 2 residual. Conclusiones La RTVT borde a borde pareció ser eficaz y segura con una reducción sostenida de la IT a los 3 meses. Serán necesarios más estudios para confirmar estos resultados (AU)

Introduction and objectives In patients with tricuspid regurgitation (TR), edge-to-edge transcatheter tricuspid valve repair (TTVR) is the strategy with the highest penetration worldwide. A dedicated edge-to-edge TTVR system has recently become available in Europe. The present study describes the initial experience with the system in Spain. Methods This multicenter study collected individual data from the centers accepted for the use of the novel system within an initial limited release. Between June 2020 and March 2021, all patients undergoing an edge-to-edge TTVR using the TriClip system in Spain were included in the study. The primary endpoint was the achievement of a TR reduction of at least 1 grade at discharge. Results We included 34 patients. Most of them reported a previous history of atrial fibrillation (91%) and only 1 had a pacemaker lead. The primary endpoint (TR reduction of at least 1 grade at discharge) was met in all patients. Most of the patients required 1 (47%) or 2 clips (44%) with a clear predominance of XT (87%) over NT (13%). The location of the first clip was anteroseptal in >90% of the patients. Only 1 patient had a partial detachment, which was stabilized with additional clips in the same procedure. At discharge, TR severity was≤2 in 91% of patients. At 3 months, mortality was nil. Overall, 88% of patients were in New York Heart Association functional class≤2 and 80% had residual TR≤2. Conclusions Edge-to-edge TTVR seemed to be effective and safe with a sustained TR reduction at 3 months. Further studies will be needed to confirm our findings (AU)

Dispositivos de modificación de placa en oclusiones coronarias crónicas totales: estudio PLACCTON / Plaque modification in calcified chronic total occlusions: the PLACCTON study

Introducción y objetivos: La calcificación grave está presente en más del 50% de las oclusiones coronarias crónicas totales (OCT) tratadas mediante intervención percutánea. Nuestro objetivo fue describir el uso contemporáneo de los dispositivos de modificación de placa (DMP) en este contexto. Métodos: Los pacientes se incluyeron en el Registro Ibérico de OCT de forma prospectiva y consecutiva (32 centros de España y Portugal), de 2015 a 2020. Se compararon en función del uso o no de DMP. Resultados: Se incluyó a 2.235 pacientes, en 1.900 de los cuales se logró cruzar con éxito la lesión con guía. Se utilizó al menos un DMP en un 7% (134 pacientes) y más de uno en 24 pacientes (1%). Los DMP seleccionados fueron: aterectomía rotacional (35,1%), litotricia (5,2%), láser (11,2%), balones de corte (27,6%), balones OPN (2,9%) o combinaciones de más de uno (18%). Se utilizaron DMP en pacientes más ancianos, con mayor riesgo cardiovascular y puntuaciones Syntax y J-CTO más elevados. Esta mayor complejidad se asoció con procedimientos más prolongados, pero similar longitud total de stent (52 frente a 57mm; p=0,105). Cuando la guía cruzó con éxito la oclusión, la tasa de éxito final del procedimiento fue del 87,2%, pero se incrementó al 96,3% cuando se utilizaron DMP (p=0,001). Por el contrario, los DMP no se asociaron con mayor tasa de complicaciones en el procedimiento (3,7 frente a 3,2%; p=0,615). Pese al peor perfil de riesgo basal, a los 2 años de seguimiento no hubo diferencias en la tasa de supervivencia (94,3% DPM frente a no-DMP: 94,3% no-DPM, respectivamente, p=0,967). Conclusiones: Cuando la guía cruzó con éxito una OCT, la tasa de uso de los DMP fue del 7% y se asoció a una tasa de éxito final del procedimiento significativamente mayor. Los resultados a medio plazo fueron comparables cuando se precisaron DMP pese a su mayor riesgo basal, lo que sugiere que un mayor uso adecuado de estas técnicas en este contexto (AU)

Introduction and objectives: Severe calcification is present in> 50% of coronary chronic total occlusions (CTOs) undergoing percutaneous intervention. We aimed to describe the contemporary use and outcomes of plaque modification devices (PMDs) in this context. Methods: Patients were included in the prospective, consecutive Iberian CTO registry (32 centers in Spain and Portugal), from 2015 to 2020. Comparison was performed according to the use of PMDs. Results: Among 2235 patients, wire crossing was achieved in 1900 patients and PMDs were used in 134 patients (7%), requiring more than 1 PMD in 24 patients (1%). The selected PMDs were rotational atherectomy (35.1%), lithotripsy (5.2%), laser (11.2%), cutting/scoring balloons (27.6%), OPN balloons (2.9%), or a combination of PMDs (18%). PMDs were used in older patients, with greater cardiovascular burden, and higher Syntax and J-CTO scores. This greater complexity was associated with longer procedural time but similar total stent length (52 vs 57mm; P=.105). If the wire crossed, the procedural success rate was 87.2% but increased to 96.3% when PMDs were used (P=.001). Conversely, PMDs were not associated with a higher rate of procedural complications (3.7 vs 3.2%; P=.615). Despite the worse baseline profile, at 2 years of follow-up there were no differences in the survival rate (PMDs: 94.3% vs no-PMDs: 94.3%, respectively; P=.967). Conclusions: Following successful wire crossing in CTOs, PMDs were used in 7% of the lesions with an increased success rate. Mid-term outcomes were comparable despite their worse baseline profile, suggesting that broader use of PMDs in this setting might have potential technical and prognostic benefits (AU)

Autosomal recessive agammaglobulinemia due to defect in µ heavy chain caused by a novel mutation in the IGHM gene.

Agammaglobulinemia is a primary immunodeficiency disorder characterized by profoundly low or absent serum antibodies and low or absent circulating B cells. The most common form is X-linked agammaglobulinemia (XLA) caused by mutations in BTK gene. The remaining cases, clinically similar to XLA, are autosomal recessive agammaglobulinemia (ARA). Nearly 30% of ARA cases present mutations in the µ heavy constant region gene IGHM. Here, we present a 7-month-old patient, born from non-consanguineous parents, who is affected by ARA due to defect in the µ heavy chain. The genetic study showed that the patient is compound heterozygous for an IGHM gene deletion and the novel nonsense mutation X57331.1:g.275C>A (p.Tyr43*) (ClinVar Accession Number: SCV000537868.1). This finding allows for an adequate genetic counseling to the family and also broadens the spectrum of already described point mutations at this locus. The IGHM gene is very complex and it is likely that yet unidentified mutations appear in other patients.

Brecha de género en los cuidados médicos en las redes de atención al infarto agudo de miocardio con elevación del segmento ST: hallazgos de la red catalana Codi Infart / Gender gap in medical care in ST segment elevation myocardial infarction networks: Findings from the Catalan network Codi Infart

OBJETIVO: Evaluar el impacto del género sobre el pronóstico y el manejo en una red regional de atención al infarto agudo de miocardio con elevación del segmento ST. DISEÑO: Estudio observacional sobre una base de pacientes consecutivos recogida prospectivamente. Ámbito: Red catalana de atención al infarto agudo de miocardio con elevación del segmento ST. PACIENTES: Pacientes atendidos entre enero de 2010 y diciembre de 2011. INTERVENCIONES: Angioplastia primaria, fibrinólisis o manejo conservador. Variables de interés: Se compararon, según el género, intervalos de tiempo, proporción y tipo de reperfusión, mortalidad global y complicaciones intrahospitalarias y mortalidad global a 30 días y un año. RESULTADOS: De 5.831 pacientes atendidos, 4.380 tenían diagnóstico de infarto agudo de miocardio con elevación del segmento ST, siendo 961 (21,9%) de ellos mujeres. Estas tenían mayor edad (69,8±13,4 frente a 60,6±12,8 años, p < 0,001), mayor prevalencia de diabetes (27,1 frente a 18,1%, p < 0,001), Killip>I (24,9 frente a 17,3%, p < 0,001) y ausencia de reperfusión (8,8 frente a 5,2%, p < 0,001) que los hombres. Además, las mujeres presentaban mayores retrasos en la atención (primer contacto médico-balón: 132 frente a 122min, p < 0,001; inicio de síntomas-balón: 236 frente a 210min, p < 0,001), más complicaciones intrahospitalarias (20,6 frente a 17,4%, p = 0,031) y mortalidad intrahospitalaria, a 30 días y un año (4,8 frente a 2,6%, p = 0,001; 9,1 frente a 4,5%, p < 0,001; 14,0 frente a 8,3%, p < 0,001). Sin embargo, tras el análisis multivariado no hubo diferencias en mortalidad a 30 días y un año. CONCLUSIONES: A pesar del peor perfil de riesgo y el peor tratamiento recibido, las mujeres presentaron similares resultados a 30 días y un año que sus homólogos masculinos atendidos por una red de atención al infarto

OBJECTIVE: To assess the impact of gender upon the prognosis and medical care in a regional acute ST-elevation myocardial infarction management network. DESIGN: An observational study was made of consecutive patients entered in a prospective database. Scope: The Catalan acute ST-elevation myocardial infarction management network. PATIENTS: Patients treated between January 2010 and December 2011. INTERVENTIONS: Primary angioplasty, thrombolysis or conservative management. Variables of interest: Time intervals, proportion and type of reperfusion, overall mortality, and in-hospital complication and overall mortality at 30 days and one year were compared in relation to gender. RESULTS: Of the 5,831 patients attended by the myocardial infarction network, 4,380 had a diagnosis of acute ST-elevation myocardial infarction, and 961 (21.9%) were women. Women were older (69.8±13.4 vs. 60.6±12.8 years; P<.001), had a higher prevalence of diabetes (27.1 vs. 18.1%, P<.001), Killip class>I (24.9 vs. 17.3%; P<.001) and no reperfusion (8.8 vs. 5.2%; P<.001) versus men. In addition, women had greater delays in medical care (first medical contact-to-balloon: 132 vs. 122min; P<.001, and symptoms onset-to-balloon: 236 vs. 210min; P<.001). Women presented higher percentages of overall in-hospital complications (20.6 vs. 17.4%; P=.031), in-hospital mortality (4.8 vs. 2.6%; P=.001), 30-day mortality (9.1 vs. 4.5%; P<.001) and one-year mortality (14.0 vs. 8.3%; P<.001) versus men. Nevertheless, after multivariate adjustment, no gender differences in 30-day and one-year mortality were observed. CONCLUSIONS: Despite a higher risk profile and poorer medical management, women present similar 30-day and one-year outcomes as their male counterparts in the context of the myocardial infarction management network

Gender gap in medical care in ST segment elevation myocardial infarction networks: Findings from the Catalan network Codi Infart. / Brecha de género en los cuidados médicos en las redes de atención al infarto agudo de miocardio con elevación del segmento ST: hallazgos de la red catalana Codi Infart.

OBJECTIVE: To assess the impact of gender upon the prognosis and medical care in a regional acute ST-elevation myocardial infarction management network. DESIGN: An observational study was made of consecutive patients entered in a prospective database. SCOPE: The Catalan acute ST-elevation myocardial infarction management network. PATIENTS: Patients treated between January 2010 and December 2011. INTERVENTIONS: Primary angioplasty, thrombolysis or conservative management. VARIABLES OF INTEREST: Time intervals, proportion and type of reperfusion, overall mortality, and in-hospital complication and overall mortality at 30 days and one year were compared in relation to gender. RESULTS: Of the 5,831 patients attended by the myocardial infarction network, 4,380 had a diagnosis of acute ST-elevation myocardial infarction, and 961 (21.9%) were women. Women were older (69.8±13.4 vs. 60.6±12.8 years; P<.001), had a higher prevalence of diabetes (27.1 vs. 18.1%, P<.001), Killip class>I (24.9 vs. 17.3%; P<.001) and no reperfusion (8.8 vs. 5.2%; P<.001) versus men. In addition, women had greater delays in medical care (first medical contact-to-balloon: 132 vs. 122min; P<.001, and symptoms onset-to-balloon: 236 vs. 210min; P<.001). Women presented higher percentages of overall in-hospital complications (20.6 vs. 17.4%; P=.031), in-hospital mortality (4.8 vs. 2.6%; P=.001), 30-day mortality (9.1 vs. 4.5%; P<.001) and one-year mortality (14.0 vs. 8.3%; P<.001) versus men. Nevertheless, after multivariate adjustment, no gender differences in 30-day and one-year mortality were observed. CONCLUSIONS: Despite a higher risk profile and poorer medical management, women present similar 30-day and one-year outcomes as their male counterparts in the context of the myocardial infarction management network.