Complete revascularization with PCI in STEMI patients with multivessel disease, when is the appropriate time? / Revascularización completa mediante ICP en pacientes con STEMI y enfermedad coronaria multivaso, ¿cuál es el momento adecuado?

Abstract Objective: The purpose was to compare the outcomes of patients with ST-elevation myocardial infarction and multivessel coronary artery disease undergoing one-time multivessel revascularization (OTMVR) versus in-hospital staged complete revascularization with percutaneous coronary intervention. Methods: This was a single-center, retrospective, observational, and cohort study, including data from January 2013 to April 2019. A total of 634 patients were included in the study. Comparisons were made between patients who underwent in-hospital staged complete revascularization versus OTMVR. The primary endpoint was all-cause in-hospital mortality, secondary endpoints included cardiovascular complications, all-cause new hospitalization, and mortality evaluated at 30 days and 1 year. In addition, we constructed a logistic regression model for determining the risk factors that predicted mortality. Results: Of the 634 patients, 328 were treated with staged revascularization and 306 with OTMVR. About 76.7% were men, with a mean age of 63.3 years. Less complex coronary lesions and a higher proportion of the left anterior descending artery as the culprit vessel were found in the OTMVR group. Compared with staged revascularization, the primary and secondary endpoints occurred less frequently with OTMVR strategy. Conclusions: OTMVR did not generate more complications and demonstrate better clinical outcomes than in-hospital staged revascularization.

Resumen Objetivo: El propósito fue comparar resultados de pacientes con infarto agudo de miocardio con elevación del segmento ST y enfermedad coronaria multivaso sometidos a revascularización completa de un solo momento frente a revascularización completa por etapas mediante intervención coronaria percutánea. Métodos: Estudio cohorte observacional, retrospectivo, unicéntrico, con datos de enero de 2013 a abril de 2019, incluyendo 634 pacientes. Se compararon resultados entre pacientes sometidos a revascularización completa por etapas frente a revascularización completa en un solo momento. El objetivo primario fue valorar mortalidad intrahospitalaria por cualquier causa y como objetivos secundarios se evaluaron a 30 días y 1 año las complicaciones cardiovasculares, hospitalizaciones y mortalidad. Se construyó un modelo de regresión logística para determinar los factores de riesgo que predijeron mortalidad. Resultados: De 634 pacientes, 328 fueron tratados con revascularización por etapas y 306 con revascularización en una intervención. El 76.7% fueron hombres, con una media de edad de 63.3 años. En el grupo de revascularización de un solo tiempo se encontraron lesiones coronarias menos complejas y una mayor proporción de la arteria descendente anterior como vaso culpable. Comparado con el grupo de revascularización por etapas, los objetivos primarios y secundarios ocurrieron con menos frecuencia en el grupo de revascularización en un solo tiempo. Conclusiones: Comparada con la revascularización intrahospitalaria por etapas, la revascularización en una intervención lleva a mejores desenlaces clínicos sin generar más complicaciones.

Complete revascularization with PCI in STEMI patients with multivessel disease, when is the appropriate time? / Revascularización completa mediante ICP en pacientes con STEMI y enfermedad coronaria multivaso, ¿cuál es el momento adecuado?

Objective: The purpose was to compare the outcomes of patients with ST-elevation myocardial infarction and multivessel coronary artery disease undergoing one-time multivessel revascularization (OTMVR) versus in-hospital staged complete revascularization with percutaneous coronary intervention. Methods: This was a single-center, retrospective, observational, and cohort study, including data from January 2013 to April 2019. A total of 634 patients were included in the study. Comparisons were made between patients who underwent in-hospital staged complete revascularization versus OTMVR. The primary endpoint was all-cause in-hospital mortality, secondary endpoints included cardiovascular complications, all-cause new hospitalization, and mortality evaluated at 30 days and 1 year. In addition, we constructed a logistic regression model for determining the risk factors that predicted mortality. Results: Of the 634 patients, 328 were treated with staged revascularization and 306 with OTMVR. About 76.7% were men, with a mean age of 63.3 years. Less complex coronary lesions and a higher proportion of the left anterior descending artery as the culprit vessel were found in the OTMVR group. Compared with staged revascularization, the primary and secondary endpoints occurred less frequently with OTMVR strategy. Conclusions: OTMVR did not generate more complications and demonstrate better clinical outcomes than in-hospital staged revascularization.

Objetivo: El propósito fue comparar resultados de pacientes con infarto agudo de miocardio con elevación del segmento ST y enfermedad coronaria multivaso sometidos a revascularización completa de un solo momento frente a revascularización completa por etapas mediante intervención coronaria percutánea. Métodos: Estudio cohorte observacional, retrospectivo, unicéntrico, con datos de enero de 2013 a abril de 2019, incluyendo 634 pacientes. Se compararon resultados entre pacientes sometidos a revascularización completa por etapas frente a revascularización completa en un solo momento. El objetivo primario fue valorar mortalidad intrahospitalaria por cualquier causa y como objetivos secundarios se evaluaron a 30 días y 1 año las complicaciones cardiovasculares, hospitalizaciones y mortalidad. Se construyó un modelo de regresión logística para determinar los factores de riesgo que predijeron mortalidad. Resultados: De 634 pacientes, 328 fueron tratados con revascularización por etapas y 306 con revascularización en una intervención. El 76.7% fueron hombres, con una media de edad de 63.3 años. En el grupo de revascularización de un solo tiempo se encontraron lesiones coronarias menos complejas y una mayor proporción de la arteria descendente anterior como vaso culpable. Comparado con el grupo de revascularización por etapas, los objetivos primarios y secundarios ocurrieron con menos frecuencia en el grupo de revascularización en un solo tiempo. Conclusiones: Comparada con la revascularización intrahospitalaria por etapas, la revascularización en una intervención lleva a mejores desenlaces clínicos sin generar más complicaciones.

Linguistic Competence in Early Childhood Education as a Predictor of Verbal Naming Speed.

BACKGROUND: This study determined the predictive value of linguistic competence in children in Early Childhood Education for verbal naming speed. METHOD: The participants were 86 pupils in the second Early Childhood Education cycle. They were evaluated with WPPSI-IV Wechsler Preschool & Primary Scale of Intelligence (Verbal Comprehension, VC) and Vocabulary Acquisition, VA; Childish Vocabulary Test (Vavel) and the Rapid and Automatic Naming Test. RESULTS: Children who had high scores in the Verbal Comprehension Index and Vocabulary Acquisition spent less time doing the verbal naming task. Linguistic competence predicted verbal naming speed, with Vavel having the strongest correlation. CONCLUSIONS: Linguistic competence of children in Early Childhood Education allows us to predict their aptitude for verbal naming. Lexical-semantic knowledge was linguistic competence dimension with the highest predictive value for the Verbal Naming Task. Automatic Naming and Verbal Comprehension depend on the same cerebral area, Wernicke's area.

An Adversarial Risk Analysis Framework for Cybersecurity.

Risk analysis is an essential methodology for cybersecurity as it allows organizations to deal with cyber threats potentially affecting them, prioritize the defense of their assets, and decide what security controls should be implemented. Many risk analysis methods are present in cybersecurity models, compliance frameworks, and international standards. However, most of them employ risk matrices, which suffer shortcomings that may lead to suboptimal resource allocations. We propose a comprehensive framework for cybersecurity risk analysis, covering the presence of both intentional and nonintentional threats and the use of insurance as part of the security portfolio. A simplified case study illustrates the proposed framework, serving as template for more complex problems.

Linguistic Competence in Early Childhood Education as a Predictor of Verbal Naming Speed / La Competencia Lingüística en Educación Infantil Como Predictor de la Velocidad de Denominación Verbal

Background: This study determined the predictive value of linguistic competence in children in Early Childhood Education for verbal naming speed. Method: The participants were 86 pupils in the second Early Childhood Education cycle. They were evaluated with WPPSI-IV Wechsler Preschool & Primary Scale of Intelligence (Verbal Comprehension, VC) and Vocabulary Acquisition, VA; Childish Vocabulary Test (Vavel) and the Rapid and Automatic Naming Test. Results: Children who had high scores in the Verbal Comprehension Index and Vocabulary Acquisition spent less time doing the verbal naming task. Linguistic competence predicted verbal naming speed, with Vavel having the strongest correlation. Conclusions: Linguistic competence of children in Early Childhood Education allows us to predict their aptitude for verbal naming. Lexical-semantic knowledge was linguistic competence dimension with the highest predictive value for the Verbal Naming Task. Automatic Naming and Verbal Comprehension depend on the same cerebral area, Wernicke’s area. (AU)

Antecedentes: el presente estudio determinó el valor predictivo de la competencia lingüística de niños/as de Educación Infantil en la velocidad de denominación verbal. Método: participaron 86 alumnos de segundo ciclo de Educación Infantil, quienes fueron evaluados con los Índices de Comprensión Verbal (ICV) y Adquisición de Vocabulario (AV) de WPPSI-IV; Vavel Infantil y el Test de Denominación Verbal (TDV). Resultados: alumnos/as que obtuvieron una puntuación elevada en el ICV y en AV precisaron de menos tiempo en el TDV. La competencia lingüística predijo la velocidad de denominación, siendo Vavel Infantil la tarea que obtuvo una mayor correlación. Conclusiones: la competencia lingüística de niños/as de Educación Infantil permite predecir su aptitud para denominación verbal. El conocimiento léxico-semántico fue la dimensión de competencia lingüística con mayor valor predictivo para el TDV. Las tareas propuestas dependen de la misma base anatómica. Las tareas de denominación y comprensión léxica están ligadas al lóbulo temporal y, más concretamente, al área de Wernicke. (AU)

Estudio cualitativo de la opinión de los estudiantes del Grado de Medicina sobre su rotación en atención primaria / Qualitative research of the opinion of Medical Degree students on their rotation in primary care

OBJETIVO: Conocer la opinión de los estudiantes de medicina que han realizado su rotación por el centro de salud en los últimos años, mediante el análisis de su opinión reflejada en la memoria de la estancia práctica que elaboran al final de su rotación en tercer y sexto curso. SUJETOS Y MÉTODOS: Se realizó un análisis documental de la opinión expresada por los estudiantes de medicina en la memoria de estancia práctica. Se analizaron un total de 15 memorias de estudiantes del Grado de Medicina de la Universidad Complutense de Madrid que han rotado por dos consultas de un centro de salud desde el año 2011 hasta 2019. RESULTADOS: Se han identificado seis categorías en las que se pueden agrupar las opiniones de los estudiantes de medicina sobre su rotación práctica en atención primaria: utilidad de la rotación para su formación, existencia de ideas preconcebidas sobre medicina de familia, grado de satisfacción de la rotación, duración de la rotación, aspectos positivos y negativos de la atención primaria y la medicina de familia, y relación con el tutor. CONCLUSIONES: La opinión del estudiante del grado de medicina sobre sus rotaciones en atención primaria es muy positiva sobre la utilidad y satisfacción con las rotaciones a pesar de su corta duración y la existencia de ideas preconcebidas negativas sobre la medicina de familia y la atención primaria. La rotación ha servido para conocer los aspectos conceptuales de la atención primaria y los valores de la medicina de familia

AIM: To know the opinion of medical students who have performed their rotation by the health center in recent years by analyzing their opinion reflected in the report of the practical stay they perform at the end of their rotation in third and sixth grades. SUBJECTS AND METHODS: A documentary analysis of the opinion expressed by medical students in the practical stay report was carried out. A total of 15 reports of Universidad Complutense de Madrid Medical Degree students who have rotated by two health primary care centers from 2011 to 2019. RESULTS: Six categories have been identified in which medical students' opinions on their practical rotation in primary care can be grouped: usefulness of rotation for their training; the existence of preconceived ideas on family medicine; the degree of rotation satisfaction; duration of rotation; positive and negative aspects of primary care and family medicine; and relationship with the tutor. CONCLUSION: The medical grade student's opinion of his or her rotations in primary care is very positive about the usefulness and satisfaction with rotations despite their short duration and the existence of negative preconceived ideas about the medicine of family and primary care. Rotation has served to understand the conceptual aspects of primary care and the values of family medicine

Ambulatory High-dose Methotrexate Administration in Pediatric Osteosarcoma Patients at a Single Institution in Argentina.

BACKGROUND: The purpose of this study was to evaluate the feasibility and safety of ambulatory high-dose methotrexate (HDMTX) administration with oral hydration, alkalinization, and leucovorin rescue. HDMTX (12 g/m) was given intravenously over 4 hours after urine alkalinization. Families and patients were instructed to continue ambulatory oral hydration and alkalinization to monitor urine pH and to adjust bicarbonate according to our institution's treatment algorithm. Clinical status and MTX levels were controlled every 24 hours, and oral leucovorin dose was adjusted accordingly. RESULTS: From April 2007 to December 2010, 150 of 447 courses of HDMTX (31.4%) were given on an outpatient basis, and 91.2% were successfully completed. The main causes of failure were poor oral tolerance (n=6) and fever (n=4). Most patients (81%) had MTX levels of <10 µmol/L 24 hours post-HDMTX; only in 1 course the levels were >50 µmol/L (50.96 µmol/L). Neutropenia grade III/IV was observed in 18.3% of the courses, grade III/IV leukopenia in 2.7%, and grade III/IV thrombocytopenia and anemia in 4.7%. Around 39% were associated with grade III/IV hepatic toxicity (asymptomatic hypertransaminasemia), grade III-IV gastrointestinal toxicity (vomiting and diarrhea) (5%), grade III-IV mucositis (4%), and none of the patients developed renal toxicity. CONCLUSIONS: Ambulatory HDMTX administration is feasible and safe in a population with poor resources in a developing country.

Peripheral insulin resistance in ILK-depleted mice by reduction of GLUT4 expression.

The development of insulin resistance is characterized by the impairment of glucose uptake mediated by glucose transporter 4 (GLUT4). Extracellular matrix changes are induced when the metabolic dysregulation is sustained. The present work was devoted to analyze the possible link between the extracellular-to-intracellular mediator integrin-linked kinase (ILK) and the peripheral tissue modification that leads to glucose homeostasis impairment. Mice with general depletion of ILK in adulthood (cKD-ILK) maintained in a chow diet exhibited increased glycemia and insulinemia concurrently with a reduction of the expression and membrane presence of GLUT4 in the insulin-sensitive peripheral tissues compared with their wild-type littermates (WT). Tolerance tests and insulin sensitivity indexes confirmed the insulin resistance in cKD-ILK, suggesting a similar stage to prediabetes in humans. Under randomly fed conditions, no differences between cKD-ILK and WT were observed in the expression of insulin receptor (IR-B) and its substrate IRS-1 expressions. The IR-B isoform phosphorylated at tyrosines 1150/1151 was increased, but the AKT phosphorylation in serine 473 was reduced in cKD-ILK tissues. Similarly, ILK-blocked myotubes reduced their GLUT4 promoter activity and GLUT4 expression levels. On the other hand, the glucose uptake capacity in response to exogenous insulin was impaired when ILK was blocked in vivo and in vitro, although IR/IRS/AKT phosphorylation states were increased but not different between groups. We conclude that ILK depletion modifies the transcription of GLUT4, which results in reduced peripheral insulin sensitivity and glucose uptake, suggesting ILK as a molecular target and a prognostic biomarker of insulin resistance.

Monocyte CD49e and 110-120 kDa fibronectin fragments: HIV prognostic indicators independent of viral load and CD4 T-cell counts.

OBJECTIVE: To investigate the prognostic impact of chronic inflammation associated with HIV infections. Previously, we had observed that proteases, released in the course of HIV infections, cause 110-120 kDa fibronectin fragments (FNf) to appear in the blood of many patients. In vitro, at concentrations within the range found in patients' plasma, FNf stimulate monocytes to release proteolytic enzymes that remove CD49e from the cell surface and produce cytokines that suppress proliferation of activated T cells when stimulated by agents that crosslink their antigen receptors. DESIGN: A long-term observational study of patients whose plasma FNf and monocyte CD49e had been measured at 90-day intervals for 1.4 + or - 0.5 years. METHODS: Plasma FNf was measured by a quantitative western blot assay and monocyte CD49e expression by flow cytometry. Patients were monitored clinically for up to 5 years after enrollment. RESULTS: All-cause mortality was significantly higher in patients who had at least 5 microg/ml FNf in more than 50% of plasma samples and/or persistent depletion of monocyte CD49e. Persistence of FNf and depletion of monocyte CD49e were not associated with changes in viral load or CD4 T-cell counts. CONCLUSION: Persistently reduced expression of blood monocyte CD49e and/or the persistent presence of FNf in plasma are adverse prognostic markers in HIV-infected patients.

Monocyte activation by circulating fibronectin fragments in HIV-1-infected patients.

To identify signals that can alter leukocyte function in patients receiving highly active antiretroviral therapy (HAART), we analyzed single blood samples from 74 HIV-1-infected patients and additional blood was collected at 90-day intervals from 51 HIV-1-infected patients over a 516 +/- 172 (mean +/- SD) day interval. Despite the absence of circulating immune complexes and normalization of phagocytic function, compared with controls, the fraction of patients' monocytes expressing CD49e and CD62L was decreased and expression of CD11b and CD86 increased. Plasma from 63% of patients but none from normal controls contained 110-120 kDa fibronectin fragments (FNf). Presence of FNf did not reflect poor adherence to therapy. Addition of FNf to normal donor blood in vitro replicated changes in monocyte CD49e, CD62L, CD11b, and CD86 seen in vivo. FNf also induced monocytes to release a serine proteinase, nominally identified as proteinase-3, that hydrolyzed cell surface CD49e. alpha(1)-Antitrypsin blocked FNf-induced shedding of CD49e in a dose-dependent manner. Plasma with a normal frequency of CD49e(+) monocytes contained antiproteases that partially blocked FNf-induced monocyte CD49e shedding, whereas plasma from patients with a low frequency of CD49e(+) monocytes did not block this effect of FNf. Electrophoretic analyses of plasma from the latter group of patients suggested that a significant fraction of their alpha(1)-antitrypsin was tied up in high molecular mass complexes. These results suggest that monocyte behavior in HIV-1-infected patients may be influenced by FNf and the ratio of protease and antiproteases in the cells' microenvironment.