Rationale and design of the artificial intelligence scalable solution for acute myocardial infarction (ASSIST) study.

BACKGROUND: Acute coronary syndrome (ACS), specifically ST-segment elevation myocardial infarction is a major cause of morbidity and mortality throughout Europe. Diagnosis in the acute setting is mainly based on clinical symptoms and physician's interpretation of an electrocardiogram (ECG), which may be subject to errors. ST-segment elevation is the leading criteria to activate urgent reperfusion therapy, but a clear ST-elevation pattern might not be present in patients with coronary occlusion and ST-segment elevation might be seen in patients with normal coronary arteries. METHODS: The ASSIST project is a retrospective observational study aiming to improve the ECG-assisted assessment of ACS patients in the acute setting by incorporating an artificial intelligence platform, Willem™ to analyze 12­lead ECGs. Our aim is to improve diagnostic accuracy and reduce treatment delays. ECG and clinical data collected during this study will enable the optimization and validation of Willem™. A retrospective multicenter study will collect ECG, clinical, and coronary angiography data from 10,309 patients. The primary outcome is the performance of this tool in the correct identification of acute myocardial infarction with coronary artery occlusion. Model performance will be evaluated internally with patients recruited in this retrospective study while external validation will be performed in a second stage. CONCLUSION: ASSIST will provide key data to optimize Willem™ platform to detect myocardial infarction based on ECG-assessment alone. Our hypothesis is that such a diagnostic approach may reduce time delays, enhance diagnostic accuracy, and improve clinical outcomes.

UCP1-dependent brown adipose activation accelerates cardiac metabolic remodeling and reduces initial hypertrophic and fibrotic responses to pathological stress.

Brown adipose tissue (BAT) is correlated to cardiovascular health in rodents and humans, but the physiological role of BAT in the initial cardiac remodeling at the onset of stress is unknown. Activation of BAT via 48 h cold (16°C) in mice following transverse aortic constriction (TAC) reduced cardiac gene expression for LCFA uptake and oxidation in male mice and accelerated the onset of cardiac metabolic remodeling, with an early isoform shift of carnitine palmitoyltransferase 1 (CPT1) toward increased CPT1a, reduced entry of long chain fatty acid (LCFA) into oxidative metabolism (0.59 ± 0.02 vs. 0.72 ± 0.02 in RT TAC hearts, p < .05) and increased carbohydrate oxidation with altered glucose transporter content. BAT activation with TAC reduced early hypertrophic expression of ß-MHC by 61% versus RT-TAC and reduced pro-fibrotic TGF-ß1 and COL3α1 expression. While cardiac natriuretic peptide expression was yet to increase at only 3 days TAC, Nppa and Nppb expression were elevated in Cold TAC versus RT TAC hearts 2.7- and 2.4-fold, respectively. Eliminating BAT thermogenic activation with UCP1 KO mice eliminated differences between Cold TAC and RT TAC hearts, confirming effects of BAT activation rather than autonomous cardiac responses to cold. Female responses to BAT activation were blunted, with limited UCP1 changes with cold, partly due to already activated BAT in females at RT compared to thermoneutrality. These data reveal a previously unknown physiological mechanism of UCP1-dependent BAT activation in attenuating early cardiac hypertrophic and profibrotic signaling and accelerating remodeled metabolic activity in the heart at the onset of cardiac stress.

Incidencia, predictores e impacto pronóstico de una clase funcional disminuida inmediatamente después de un implante percutáneo de válvula aórtica / Incidence, predictors, and prognostic significance of impaired functional status early after transcatheter aortic valve replacement

Introducción y objetivos: Existen pocos datos acerca del impacto pronóstico de una clase funcional NYHA III-IV después del implante percutáneo de válvula aórtica (TAVI). El objetivo del estudio fue determinar la incidencia, los predictores y las implicaciones pronósticas de una clase NYHA III-IV al mes del TAVI.MétodosEstudio multicéntrico que incluyó a 3.462 pacientes sometidos a TAVI que recibieron dispositivos de nueva generación. Se compararon pacientes en clase funcional NYHA I-II frente a pacientes en clase NYHA III-IV al mes de seguimiento. Los predictores de clase NYHA III-IV a un mes se identificaron mediante regresión logística multivariante. La supervivencia se evaluó con el método de Kaplan-Meier y los factores asociados a peor pronóstico se identificaron mediante la regresión de Cox.ResultadosLa edad media de la población de estudio era de 80,3±7,3 años, con el 47% de mujeres y un valor mediano en la escala de la Society of Thoracic Surgeons del 3,8% [IQR, 2,5-5,8]). Un total de 208 pacientes (6%) presentaron NYHA III-IV al mes del TAVI. Los predictores de NYHA III-IV al mes fueron: NYHA basal III-IV (OR=1,76; IC95%, 1,08-2,89; p=0,02), enfermedad pulmonar obstructiva crónica (OR=1,80; IC95%, 1,13-2,83; p=0,01) e insuficiencia mitral severa post-TAVI (OR=2,00; IC95%, 1,21-3,31; p<0,01). Los pacientes en NYHA III-IV al mes del TAVI tenían un mayor riesgo de muerte (HR=3,68; IC95%, 2,39-5,70; p<0,01) y hospitalización por insuficiencia cardiaca (HR=6,00; IC95%, 3,76-9,60; p<0,01) durante el año que siguió al TAVI. (AU)

Introduction and objectives: There are scarce data on the factors associated with impaired functional status after transcatheter aortic valve replacement (TAVR) and its clinical impact. This study aimed to determine the incidence, predictors, and prognostic implications of impaired functional class (NYHA class III-IV) following TAVR.MethodsThis multicenter study included 3462 transarterial TAVR patients receiving newer generation devices. The patients were compared according to their NYHA class at 1 month of follow-up (NYHA I-II vs NYHA III-IV). A multivariate logistic regression was performed to identify the predictors of 30-day NYHA class III-IV. Patient survival was compared with the Kaplan-Meier method and factors associated with decreased survival were identified with Cox regression analysis.ResultsThe mean age of the study population was 80.3±7.3 years, with 47% of women, and a median Society of Thoracic Surgeons score of 3.8% [IQR, 2.5-5.8]. A total of 208 patients (6%) were in NYHA class III-IV 1 month after TAVR. Predictors of 30-day NYHA class III-IV were baseline NYHA class III-IV (OR, 1.76; 95%CI, 1.08-2.89; P=.02), chronic pulmonary obstructive disease (OR, 1.80; 95%CI, 1.13-2.83; P=.01), and post-TAVR severe mitral regurgitation (OR, 2.00; 95%CI, 1.21-3.31; P<.01). Patients in NYHA class III-IV 1 month after TAVR were at higher risk of death (HR, 3.68; 95%CI, 2.39-5.70; P<.01) and heart failure-related hospitalization (HR, 6.00; 95%CI, 3.76-9.60; P<.01) at 1-year follow-up. (AU)

Chronic exercise improves hepatic acylcarnitine handling.

Exercise mediates tissue metabolic function through direct and indirect adaptations to acylcarnitine (AC) metabolism, but the exact mechanisms are unclear. We found that circulating medium-chain acylcarnitines (AC) (C12-C16) are lower in active/endurance trained human subjects compared to sedentary controls, and this is correlated with elevated cardiorespiratory fitness and reduced adiposity. In mice, exercise reduced serum AC and increased liver AC, and this was accompanied by a marked increase in expression of genes involved in hepatic AC metabolism and mitochondrial ß-oxidation. Primary hepatocytes from high-fat fed, exercise trained mice had increased basal respiration compared to hepatocytes from high-fat fed sedentary mice, which may be attributed to increased Ca2+ cycling and lipid uptake into mitochondria. The addition of specific medium- and long-chain AC to sedentary hepatocytes increased mitochondrial respiration, mirroring the exercise phenotype. These data indicate that AC redistribution is an exercise-induced mechanism to improve hepatic function and metabolism.

Transplantation of committed pre-adipocytes from brown adipose tissue improves whole-body glucose homeostasis.

Obesity and its co-morbidities including type 2 diabetes are increasing at epidemic rates in the U.S. and worldwide. Brown adipose tissue (BAT) is a potential therapeutic to combat obesity and type 2 diabetes. Increasing BAT mass by transplantation improves metabolic health in rodents, but its clinical translation remains a challenge. Here, we investigated if transplantation of 2-4 million differentiated brown pre-adipocytes from mouse BAT stromal fraction (SVF) or human pluripotent stem cells (hPSCs) could improve metabolic health. Transplantation of differentiated brown pre-adipocytes, termed "committed pre-adipocytes" from BAT SVF from mice or derived from hPSCs improves glucose homeostasis and insulin sensitivity in recipient mice under conditions of diet-induced obesity, and this improvement is mediated through the collaborative actions of the liver transcriptome, tissue AKT signaling, and FGF21. These data demonstrate that transplantation of a small number of brown adipocytes has significant long-term translational and therapeutic potential to improve glucose metabolism.

Contributions of mouse genetic strain background to age-related phenotypes in physically active HET3 mice.

We assessed aging hallmarks in skin, muscle, and adipose in the genetically diverse HET3 mouse, and generated a broad dataset comparing these to individual animal diagnostic SNPs from the 4 founding inbred strains of the HET3 line. For middle- and old-aged HET3 mice, we provided running wheel exercise to ensure our observations were not purely representative of sedentary animals, but age-related phenotypes were not improved with running wheel activity. Adipose tissue fibrosis, peripheral neuropathy, and loss of neuromuscular junction integrity were consistent phenotypes in older-aged HET3 mice regardless of physical activity, but aspects of these phenotypes were moderated by the SNP% contributions of the founding strains for the HET3 line. Taken together, the genetic contribution of founder strain SNPs moderated age-related phenotypes in skin and muscle innervation and were dependent on biological sex and chronological age. However, there was not a single founder strain (BALB/cJ, C57BL/6J, C3H/HeJ, DBA/2J) that appeared to drive more protection or disease-risk across aging in this mouse line, but genetic diversity in general was more protective.

Implementación de un cribado de fragilidad desde atención primaria en el Área Sanitaria de Ferrol / Implementation of a frailty screening from primary care in the Health Area of Ferro

Objetivos: Conocer la prevalencia de fragilidad entre los sujetos de 70 o más años que acuden a la consulta de enfermería de atención primaria, así como conocer las variables asociadas a la presencia de fragilidad. Metodología: Estudio observacional transversal en el que, tras un muestreo por conveniencia, se utilizó la Short Physical Performance Battery para realizar un cribado de fragilidad a 114 pacientes. Se utilizó una regresión logística multivariante para conocer las variables asociadas a la fragilidad. Resultados: Un 35,4% de los sujetos estudiados se catalogaron como frágiles tras la realización de las pruebas de función física. Las variables asociadas en el análisis multivariado a la fragilidad fueron la edad, el entorno de residencia, el riesgo de caídas, la toma de anticoagulantes orales y el tratamiento con insulina lenta. Conclusiones: Este estudio ha evidenciado las altas prevalencias existentes de fragilidad, poniendo de relieve la importancia de este tipo de cribados y la pertinencia de que la enfermería de atención primaria contribuya a su detección y manejo.(AU)

Objectives: To know the prevalence of frailty among subjects aged 70 or over who attend the primary care nursing consultation, as well as to know the variables associated with the presence of frailty. Methodology: Cross-sectional observational study in which, after convenience sampling, the Short Physical Performance Battery was used to screen 114 patients for frailty. Multivariate logistic regression was used to determine the variables associated with frailty. Results: 35.4% of the subjects studied were classified as frail after performing the physical function tests. The variables associated with frailty in the multivariate analysis were age, residence environment, risk of falls, taking oral anticoagulants, and slow insulin treatment. Conclusions: This study has evidenced the high existing prevalence of frailty, highlighting the importance of this type of screening and the relevance of primary care nursing contributing to its detection and management.(AU)

In Vivo and In Silico Studies of the Hepatoprotective Activity of Tert-Butylhydroquinone.

Tert-butylhydroquinone (TBHQ) is a synthetic food antioxidant with biological activities, but little is known about its pharmacological benefits in liver disease. Therefore, this work aimed to evaluate TBHQ during acute liver damage induced by CCl4 (24 h) or BDL (48 h) in Wistar rats. It was found that pretreatment with TBHQ prevents 50% of mortality induced by a lethal dose of CCl4 (4 g/kg, i.p.), and 80% of BDL+TBHQ rats survived, while only 50% of the BDL group survived. Serum markers of liver damage and macroscopic and microscopic (H&E staining) observations suggest that TBHQ protects from both hepatocellular necrosis caused by the sublethal dose of CCl4 (1.6 g/kg, i.p.), as well as necrosis/ductal proliferation caused by BDL. Additionally, online databases identified 49 potential protein targets for TBHQ. Finally, a biological target candidate (Keap1) was evaluated in a proof-of-concept in silico molecular docking assay, resulting in an interaction energy of -5.5491 kcal/mol, which was higher than RA839 and lower than monoethyl fumarate (compounds known to bind to Keap1). These findings suggest that TBHQ increases the survival of animals subjected to CCl4 intoxication or BDL, presumably by reducing hepatocellular damage, probably due to the interaction of TBHQ with Keap1.

Detección molecular de Rickettsia massiliae y Anaplasma platys en garrapatas Rhipicephalus sanguineus y caninos domésticos del municipio de Bahía Blanca (Argentina) / Molecular detection of Rickettsia massiliae and Anaplasma platys infecting Rhipicephalus sanguineus ticks and dogs, Bahía Blanca (Argentina)

Background: Rickettsioses, ehrlichioses and anaplasmoses are caused by Gram negative obligate intracellular bacteria and transmitted mainly by arthropods. Aim: To detect and perform the molecular characterization of these pathogens in ticks and domestic dogs in Bahia Blanca City (Buenos Aires, Argentina). Methods: Fifty six blood samples from dogs and 82 ticks (75 Rhipicephalus sanguineus and 7 Amblyomma tigrinum) were studied. The samples were analyzed by PCR for Rickettsia (intergenic space 23S-5S rRNA), Ehrlichia/Anaplasma (16S rRNA), and Anaplasma platys (16S rRNA). Results: 12% of R. sanguineus resulted positive for Rickettsia, identified by sequencing as Rickettsia massiliae; and 37.5% of the canine blood samples analyzed were positive for A. platys. Molecular characterization was also performed by amplification of the fragment of the citrate synthase gene (gltA) (Rickettsia genus) and the groESL gene (A. platys). Phylogenetic trees were constructed using the neighbor-joining method. These trees revealed that sequences obtained are similar to those from other geographical regions. Conclusion: The results indicate the presence of R. massiliae in R. sanguineus ticks for the second time in an urban area of South America and A. platys infection in dogs, being the southernmost region of Argentina where it has been notified.

Introducción: Las rickettsiosis, ehrlichiosis y anaplasmosis son causadas por bacterias gramnegativas, intracelulares obligadas y transmitidas principalmente por artrópodos. Objetivo: Detectar y caracterizar molecularmente estos patógenos en garrapatas y caninos domésticos del municipio de Bahía Blanca (provincia de Buenos Aires, Argentina). Material y Métodos: Se estudiaron 56 muestras sanguíneas de caninos, 75 garrapatas Rhipicephalus sanguineus y 7 Amblyomma tigrinum. Las muestras fueron analizadas por RPC para Rickettsia (espacio intergénico 23S-5S ARNr), Ehrlichia y Anaplasma (16S ARNr), y Anaplasma platys (16S ARNr). Resultados: Se detectó positividad a Rickettsia en 12% de R. sanguineus, identificándose por secuenciación a Rickettsia massiliae. Las muestras sanguíneas de los caninos resultaron en 37,5% positivas a A. platys. También se caracterizaron molecularmente por la amplificación del fragmento del gen citrato sintasa (gltA) (género Rickettsia) y del gen groESL (A. platys). Se construyeron árboles filogenéticos utilizando el método del vecino más cercano (neighbor-joining) revelando que las secuencias obtenidas son similares a las de otras regiones geográficas. Conclusión: Los resultados indican la presencia de R. massiliae en garrapatas R. sanguineus en una segunda zona urbana de Sudamérica y la infección por A. platys en caninos, siendo la región más austral de Argentina donde ha sido notificada.

Utilidad de la escala Obesity surgery mortality risk score en la predicción de complicaciones tras cirugía bariátrica por vía laparoscópica / Obesity surgery mortality risk score for the prediction of complications after laparoscopic bariatric surgery

INTRODUCCIÓN: La morbimortalidad tras la cirugía bariátrica varía según las características de los pacientes y las comorbilidades asociadas. El objetivo de este estudio fue evaluar la posible utilidad de la escalaObesity sugery mortality risk score (OS-MRS) para prever el riesgo de complicaciones postoperatorias tras cirugía bariátrica. MÉTODOS: Estudio retrospectivo de una serie prospectiva de pacientes intervenidos de cirugía bariátrica a los que se aplicó antes de la operación la escala OS-MRS. Se clasificaron las complicaciones postoperatorias siguiendo la propuesta de Dindo-Clavien. Se analizó la relación entre las categorías de la escala OS-MRS: A) bajo riesgo; B) riesgo intermedio y C) riesgo elevado, y la presencia de complicaciones. RESULTADOS: Entre mayo del 2008 y junio del 2012 se incluyó a 198 pacientes (85 [42,9%] a los que se realizó un bypass gástrico y 113 [57,1%] con una gastrectomía vertical). Utilizando la escala OS-MRS, 124 pacientes se clasificaron como clase A (62,6%), 70 como clase B (35,4%) y 4 como clase C (2%). La tasa de morbilidad global fue del 12,6% (25 pacientes). Se demostró una asociación significativa entre la escala OS-MRS y la tasa de complicaciones (7,3, 20 y 50%, respectivamente; p = 0,004). El bypass gástrico se asociaba a mayor número de complicaciones que la gastrectomía vertical (p = 0,007). En el análisis multivariado, la escala OS-MRS y la técnica quirúrgica fueron los únicos factores con valor predictivo. CONCLUSIONES: La escala OS-MRS es una herramienta útil para predecir el riesgo de complicaciones y puede orientar a la hora de escoger el tipo de cirugía bariátrica

INTRODUCTION: Morbimortality after bariatric surgery varies according to patient characteristics and associated comorbidities. The aim of this study was to evaluate the usefulness of the obesity surgery mortality risk score scale (OS-MRS) to predict the risk of postoperative complications after bariatric surgery. METHODS: A retrospective study was performed on a prospective series of patients undergoing bariatric surgery in which the OS-MRS scale was applied preoperatively. Postoperative complications were classified as proposed by Dindo-Clavien. We analysed the relationship between the categories of OS-MRS scale: (A) low risk, (B) intermediate risk, and (C) high risk and the presence of complications. RESULTS: Between May 2008 and June 2012, 198 patients were included (85 [42.9%] after gastric bypass and 113 [57.1%] after sleeve gastrectomy). Using the OS-MRS scale, 124 patients were classified as class A (62.6%), 70 as class B (35.4%) and 4 as class C (2%). The overall morbidity rate was 12.6% (25 patients). A significant association between OS-MRS scale and rate of complications (7.3, 20 and 50%, respectively, P=.004) was demonstrated. The gastric bypass was associated with a higher complication rate than sleeve gastrectomy (P=.007). In multivariate analysis, OS-MRS scale and surgical technique were the only significant predictive factors. CONCLUSIONS: The OS-MRS scale is a useful tool to predict the risk of complications and can be used as a guide when choosing the type of bariatric surgery