Invasive Phenoprofiling of Acute-Myocardial-Infarction-Related Cardiogenic Shock.

BACKGROUND: Studies had previously identified three cardiogenic shock (CS) phenotypes (cardiac-only, cardiorenal, and cardiometabolic). Therefore, we aimed to understand better the hemodynamic profiles of these phenotypes in acute myocardial infarction-CS (AMI-CS) using pulmonary artery catheter (PAC) data to better understand the AMI-CS heterogeneity. METHODS: We analyzed the PAC data of 309 patients with AMI-CS. The patients were classified by SCAI shock stage, congestion profile, and phenotype. In addition, 24 h hemodynamic PAC data were obtained. RESULTS: We identified three AMI-CS phenotypes: cardiac-only (43.7%), cardiorenal (32.0%), and cardiometabolic (24.3%). The cardiometabolic phenotype had the highest mortality rate (70.7%), followed by the cardiorenal (52.5%) and cardiac-only (33.3%) phenotypes, with significant differences (p < 0.001). Right atrial pressure (p = 0.001) and pulmonary capillary wedge pressure (p = 0.01) were higher in the cardiometabolic and cardiorenal phenotypes. Cardiac output, index, power, power index, and cardiac power index normalized by right atrial pressure and left-ventricular stroke work index were lower in the cardiorenal and cardiometabolic than in the cardiac-only phenotypes. We found a hazard ratio (HR) of 2.1 for the cardiorenal and 3.3 for cardiometabolic versus the cardiac-only phenotypes (p < 0.001). Also, multi-organ failure, acute kidney injury, and ventricular tachycardia/fibrillation had a significant HR. Multivariate analysis revealed that CS phenotypes retained significance (p < 0.001) when adjusted for the Society for Cardiovascular Angiography & Interventions score (p = 0.011) and ∆congestion (p = 0.028). These scores independently predicted mortality. CONCLUSIONS: Accurate patient prognosis and treatment strategies are crucial, and phenotyping in AMI-CS can aid in this effort. PAC profiling can provide valuable prognostic information and help design new trials involving AMI-CS.

Serie de casos de trasplante hepático ortotópico del Hospital "Dr. Rafael Ángel Calderón Guardia" / Case series of liver transplantation in "Dr. Rafael Ángel Calderón Guardia Hospital"

Resumen Objetivo: Analizar los resultados y evolución del programa de trasplante hepático del Hospital "Dr. Rafael Ángel Calderón Guardia", así como las complicaciones más frecuentes y características de las hepatopatías que llevaron a trasplante hepático. Métodos: Esta es una investigación retrospectiva que involucra la revisión de expedientes clínicos de los pacientes que recibieron un trasplante de hígado entre los años 2009 y 2018 en el Hospital "Dr. Rafael Ángel Calderón Guardia" en San José, Costa Rica. Se consideraron las siguientes variables categóricas o discontinuas: edad, sexo, nacionalidad, lugar de procedencia, manifestaciones de la hepatopatía, motivo del trasplante, curso clínico postrasplante, comorbilidades, medicamentos empleados, complicaciones, resultados relevantes de exámenes de gabinete y biopsias. Los cálculos estadísticos se llevaron a cabo con paquetes estadísticos STATA, empleando como umbral de significancia estadística un valor de p menor de 0,05. Resultados: La muestra estuvo compuesta de un total de 45 cirugías de trasplante hepático y 44 pacientes que requirieron trasplante de hígado entre abril de 2009 y agosto de 2018, provenientes principalmente de la provincia de San José. El promedio de edad al momento del trasplante para la muestra total fue de 51 años. La hepatopatía que más frecuentemente llevó a trasplante fue la cirrosis etílica, seguida por esteatohepatitis no alcohólica y cirrosis criptogénica. Las complicaciones de la hepatopatía documentadas previo al trasplante: várices esofágicas, sangrado digestivo alto y síndrome hepatorenal. De los pacientes incluidos en el estudio fallecieron 10 en total, lo cual equivale a 22.7%. Conclusiones: La mortalidad observada en los casos de trasplante hepático analizados fue de 22,7%, la mayoría de los casos fueron llevados a trasplante por hepatopatía relacionada con cirrosis etílica, esteatohepatitis y cirrosis criptogénica.

Abstract Objective. To analyze the outcomes, most frequent complications and characteristics of the patients enrolled in the Liver Transplant Program from the Hospital "Dr. Rafael Ángel Calderón Guardia". Methods: This is a retrospective investigation that involves the revision of clinical records from the patients that received a liver transplant between the years 2009 and 2018 in the Hospital "Dr. Rafael Ángel Calderón Guardia". The following variables were considered: age, gender, nationality, city of residence, manifestations of the liver disease, reason for the liver transplant, clinical outcomes after transplant, comorbidities, medication received, important laboratory results and biopsies. The data analysis was performed with STATA, using a statistic significance threshold of a p < 0.05. Results: The sample was composed of a total of 45 liver transplant surgeries and 44 patients who received a liver transplant between the years 2009 and 2018. The patients mostly came from the city of San José. The average age at the time of the surgery was 51 years. The most common liver disease that led to transplant was alcoholic cirrhosis, followed by NASH and cryptogenic cirrhosis. The most common complications of the liver disease documented prior to transplant where esophageal varices, gastrointestinal bleeding and hepatic-renal syndrome. 10 of the patients included in the study died, which corresponds to 22.7% of the sample. Conclusions: The mortality observed in the liver transplant cases analyzed was 22.7%, most of the cases were taken to transplantation due to liver disease related to alcoholic cirrhosis, steatohepatitis and cryptogenic cirrhosis.

FT-NIR spectroscopy and RP-HPLC combined with multivariate analysis reveals differences in plant cell suspension cultures of Thevetia peruviana treated with salicylic acid and methyl jasmonate.

Plant cell suspension culture of T. peruviana is a feasible biotechnological platform for the production of secondary metabolites with anti-proliferative/cytotoxic activity, as phenolic compounds (PC); however, different in in vitro growth conditions may affect the production, demanding strategies to increase the metabolite biosynthesis, as well as the development of sensitive and rapid analytical methods for metabolite monitoring. The Fourier transform near-infrared (FT-NIR) spectroscopy and Reversed-phase high-performance liquid chromatography (RP-HPLC) combined with Multivariate analysis (MVA) were used to detect significant differences in the PC production in cultures treated with two elicitors. The results suggest that the FT-NIR-MVA is useful for discriminating samples according to the treatment, showed significant influence of the PC signal. RP-HPLC-MVA showed that the elicitor effect occurs at 72 h post-elicitation. Detection of dihydroquercetin (maximum concentration = 12.59 mg/L), a flavonoid with anti-cancer properties, is highlighted. Future studies will be aimed at scaling this culture to increase the productivity of dihydroquercetin.

Phytochemical Screening of Callus and Cell Suspensions Cultures of Thevetia peruviana

Abstract Thevetia peruviana is an ornamental shrub grown-up in many tropical region of the world. This plant produces secondary metabolites with biological properties of interest for the pharmaceutical industry. The objective was to determine the secondary metabolites profile of callus and cell suspension cultures of T. peruviana and compare them with those from explant (fruit pulp). Extracts in 50% aqueous ethanol and ethyl acetate were prepared. The phytochemical analysis was performed using standard chemical tests and thin layer chromatography. In addition, total phenolic and flavonoids compounds (TPC and TFC), total cardiac glycosides (TCG) and total antioxidant activity (TAA) was determined during the cell suspension growth. Phenolic chemical profile was also analyzed by high performance liquid chromatography (HPLC). Common metabolites (alkaloids, amino acids, antioxidants, cardiac glycosides, leucoanthocyanidins, flavonoids, phenols, sugars and triterpenes) were detected in all samples. The maximum production of extracellular TCG, TPC, TFC and TAA in cells suspensions were at 6-12 days; in contrast, intracellular content was relatively constant during the exponential grown phase (0 to 12-days). HPLC analysis detected one compound with retention time at 11.6 min; this compound was tentatively identified as dihydroquercetin, a flavonoid with anti-cancer properties. These results provide evidence on the utility of the in vitro cell cultures of T. peruviana for valuable pharmaceutical compounds production.

Vesículas extracelulares como predictores tempranos de diabetes gestacional / Extracellular vesicle concentration in maternal plasma as an early marker of gestational diabetes

Background During pregnancy, there is an increase in the amount of extracellular vesicles, especially placental exosomes, in maternal plasma. Aim To isolate and characterize extracellular vesicles from blood during the three trimesters of pregnancy and to evaluate their capacity to identify patients at risk of developing gestational diabetes. Material and Methods A case-control study was conducted in a cohort of 50 pregnant women with plasma samples taken in each trimester. Six women who developed gestational diabetes were paired with three healthy controls per case (a total of 19). Clinical characteristics were recorded at first prenatal appointment, and blood samples were obtained during the first, second and third trimesters. Extracellular vesicles were isolated from plasma by the commercial kit, ExoQuick™. Nanoparticle tracking analysis, was used to characterize the obtained extracellular vesicles. Results The total concentration of extracellular particles isolated from maternal plasma increased along with gestational age. The size of the extracellular vesicles obtained in the first trimester of pregnancy was very similar between groups (144 ± 37 nm for controls and 143 ± 34 nm for patients with gestational diabetes mellitus). Moreover, the concentration of extracellular vesicles collected in the first trimester, was significantly higher in patients who developed gestational diabetes mellitus later in pregnancy compared to normoglycemic pregnant women (7.94 x 10 8 and 5.15 x 10 8 , p = 0.03). Conclusions Our results provide an insight into the potential capacity of first trimester plasma extracellular vesicles as early biomarkers for the prediction of gestational diabetes mellitus.

Doble ruptura miocárdica como complicación mecánica de un infarto agudo / Double myocardial rupture as a mechanical complication of an acute infarction

Resumen Las complicaciones del infarto agudo de miocardio se clasifican en mecánicas, eléctricas, isquémicas, tromboembólicas e inflamatorias; entre las complicaciones mecánicas destaca la ruptura de la pared libre del ventrículo izquierdo, músculos papilares y del septum ventricular, con incidencia menor de 1%, que ha descendido con la introducción de la intervención coronaria percutánea como principal estrategia de reperfusión. Se comunica el caso de una paciente de 64 años de edad, que acudió a urgencias por un cuadro de dolor torácico agudo compatible con síndrome coronario agudo con elevación del segmento ST (SICACEST) y durante su evolución tuvo deterioro clínico, se identificó una doble ruptura miocárdica. Se plantea el abordaje del caso y se revisa la bibliografía, porque una doble ruptura miocárdica corresponde solo a 0.3% de los casos reportados.

Abstract The complications of acute myocardial infarction are classified in mechanical, electrical, ischemic, embolic and inflammatory. The main mechanical complications are free wall rupture, papillary muscle and ventricular septal rupture. Its incidence is less than 1% and has decreased with the introduction of percutaneous coronary intervention as the main reperfusion strategy. This article presents a clinical case of a 64-year-old female that arrived to emergency room with thoracic pain, due to an acute coronary syndrome: ST-elevation myocardial infarction (STEMI); with a clinical deterioration presenting a double myocardial rupture. Clinical approach and bibliographic review are reported, the incidence estimation of this disorder is only 0.3% of the reported clinical cases.

[Extracellular vesicle concentration in maternal plasma as an early marker of gestational diabetes]. / Vesículas extracelulares como predictores tempranos de diabetes gestacional.

Background During pregnancy, there is an increase in the amount of extracellular vesicles, especially placental exosomes, in maternal plasma. Aim To isolate and characterize extracellular vesicles from blood during the three trimesters of pregnancy and to evaluate their capacity to identify patients at risk of developing gestational diabetes. Material and Methods A case-control study was conducted in a cohort of 50 pregnant women with plasma samples taken in each trimester. Six women who developed gestational diabetes were paired with three healthy controls per case (a total of 19). Clinical characteristics were recorded at first prenatal appointment, and blood samples were obtained during the first, second and third trimesters. Extracellular vesicles were isolated from plasma by the commercial kit, ExoQuick™. Nanoparticle tracking analysis, was used to characterize the obtained extracellular vesicles. Results The total concentration of extracellular particles isolated from maternal plasma increased along with gestational age. The size of the extracellular vesicles obtained in the first trimester of pregnancy was very similar between groups (144 ± 37 nm for controls and 143 ± 34 nm for patients with gestational diabetes mellitus). Moreover, the concentration of extracellular vesicles collected in the first trimester, was significantly higher in patients who developed gestational diabetes mellitus later in pregnancy compared to normoglycemic pregnant women (7.94 x 10 8 and 5.15 x 10 8 , p = 0.03). Conclusions Our results provide an insight into the potential capacity of first trimester plasma extracellular vesicles as early biomarkers for the prediction of gestational diabetes mellitus.

Efecto cardiometabólico de los inhibidores del cotransportador sodio glucosa tipo 2 (SGLT2) / Cardiometabolic effect of inhibitors of sodium glucose cotransporter type 2 (SGLT2)

Resumen: El advenimiento de nuevos fármacos para el tratamiento de los distintos componentes del síndrome metabólico, que por su farmacocinética y farmacodinamia tengan un efecto pleiotrópico, ha tomado auge. Hace poco los inhibidores del cotransportador sodio glucosa tipo 2 (SGLT2) prescritos para el tratamiento de la diabetes mellitus 2 han demostrado tener un efecto protector cardiorrenal. Éstos actúan en el segmento S1 del túbulo proximal disminuyendo la filtración de glucosa e incrementando su excreción urinaria; con efecto glucosúrico y natriurético. Este último es el principal mecanismo de protección cardiovascular. Modelos experimentales y estudios, entre los que destacan el estudio EMPAREG y el programa CANVAS, han demostrado que los inhibidores de SGLT2 permiten disminuir la progresión de la miocardiopatía hipertrófica, fibrosis, remodelamiento, disfunción sistólica e insuficiencia cardiaca, por su efecto en la precarga y poscarga. Los resultados de estos estudios reconocen a este grupo de fármacos (específicamente a la empagliflozina y canagliflozina) como tratamiento de protección cardiovascular en pacientes con diabetes mellitus 2, recomendados actualmente por la FDA, ACC/AHA, la Sociedad Europea de Cardiología y recientemente por la Asociación Americana de Diabetes (ADA) en su reciente publicación de 2018.

Abstract: There is an increase in the use of new drugs for the treatment of the different elements that integrate the metabolic syndrome; that, by their pharmacokinetics and pharmacodynamics have a pleiotropic effect. Recently, the inhibitors of sodium glucose cotransporter type 2 (SGLT2) used for the treatment of diabetes mellitus type 2 have demonstrated a cardio-renal protector effect. They function at the S1 segment of the proximal tube, lowering the filtration of glucose and enhancing its excretion; resulting in a glycosuric and natriuretic effect. This is the main mechanism of cardiovascular protection. Experimental essays and different studies, such as the EMAREG study and the CANVAS program, have established that the inhibitors of SGLT2 reduce the progression of hypertrophic cardiomyopathy, fibrosis, cardiac remodeling, systolic dysfunction and heart failure. The results of these studies recognize this group of drugs (empaglifozine and canaglifozine) as a valid treatment for cardiovascular protection in patients with diabetes mellitus type 2, and which is recommended by the FDA, the ACC/AHA, the European Society of Cardiology and the American Diabetes Association (ADA) in its last publication in 2018.

Effect of salicylic acid and methyl jasmonate in the production of phenolic compounds in plant cell suspension cultures of Thevetia peruviana.

The objective was to enhance the production of the phenolic compounds in plant cell suspension cultures of T. peruviana at shake flask scale. The effects of salicylic acid (SA), methyl-jasmonate (MeJA) and the combination of both (SA/MeJA) were studied. Elicitor concentration, elicitation time and harvest time of cells were optimized. Phenolic compound content (PCC), flavonoid content (FC) and antioxidant activity (AA) were determined by the folin-ciocalteu method, flavonoid-aluminum complexation method and the ABTS assay, respectively. Differences between intracellular metabolite profiles due to the mentioned treatments were analyzed by Thin-layer chromatography and High-performance liquid chromatography. Highest PCC, FC and AA were obtained under the following treatments: 3 µM MeJA > 3 µM MeJA/300 µM SA > 300 µM SA > control, when elicited on the 4th day and harvested 96-h post-elicitation. It was demonstrated that exposure to 3 µM MeJA increase 1.49-fold of PCC, 1.66-fold of AA and 2.55-fold of FC compared to the control culture.

Enfermedad de Castleman multicéntrica en una paciente postrasplantada de médula ósea / Multicentric Castleman's disease in a patient post-transplanted of bone marrow

Resumen La enfermedad de Castleman es un grupo heterogéneo de trastornos linfoproliferativos con dos formas de manifestación: variedad unicéntrica y multicéntrica. En términos histológicos se caracteriza por ganglios linfáticos con hiperplasia del centro germinal y aumento en la vascularidad. Se comunica el caso de una paciente de 70 años de edad con antecedente de trasplante autólogo de células troncales y progenitoras hematopoyéticas, que acudió a consulta por padecer astenia, pérdida de peso, dolor abdominal y disnea de evolución progresiva; a la que se le encontró un tumor retroperitoneal y derrame pleural derecho. Se plantea el abordaje del caso y se revisa la bibliografía, ya que se estima la incidencia en 21-25 casos por un millón de habitantes, sólo 14% de los casos reportados con manifestación retroperitoneal.

Abstract Castleman's disease is a heterogeneous group of lymphoproliferative disorders (LPD'S), which has two types of presentation, unicentric (UCD) and multicentric (MCD) variety. Histologically it is characterized by lymph nodes with hyperplasia of germinal centers and increased vascularity. This article reports the clinical case of a 70-year-old female with previous autologous haematopoietic stem cell transplant. She arrived with asthenia, weight loss, abdominal pain and progressive dyspnea. A retroperitoneal tumor and right pleural effusion were found. Clinical approach and bibliographic review are reported, the incidence estimation for this disorder is 21-25 cases per million population, and only 14% of reported cases had a retroperitoneal presentation.

CARDIAC GLYCOSIDES, PHENOLIC COMPOUNDS AND ANTIOXIDANT ACTIVITY FROM PLANT CELL SUSPENSION CULTURES OF Thevetia peruviana / PRODUCCIÓN DE GLÍCOSIDOS CARDIOTÓNICOS, COMPUESTOS FENÓLICOS Y ACTIVIDAD ANTIOXIDANTE EN CULTIVOS DE CÉLULAS VEGETALES EN SUSPENSIÓN DE Thevetia peruviana

Cell suspension cultures of Thevetia peruviana were established under dark for 19 days to investigate kinetic behavior related to biomass, substrate, cardiac glycoside, polyphenols, reactive oxygen species and anti-oxidant activity. The results showed high biomass production (18.80gDW/L) as well as sucrose consumption in 7 days. Preferential glucose over fructose consumption was observed. Intracellular production of cardiac glycosides reached 2.58mg DE/gDW at day 19. Highest extracellular production was reached between day 2 and 7 (6.19mg DE/L). Highest extracellular phenolic content was 80.61 ± 5.16mg GAE/L at day 7. Intracellular phenolic content increased to 2.76 ± 0.14mg GAE/gFW at day 7 and remained constant until day 19. ROS production at day 7 could be related to sucrose and glucose total consumption. Pearson Product-Moment Correlation Coefficient (ρ) showed that the phenolic compounds in cell suspension cultures of T. peruviana were responsible for the observed anti-oxidant activity. All together, these results give the first steps in metabolic behavior in cell suspension cultures of T. peruviana.

Se establecieron cultivos en suspensión de la especie vegetal Thevetia peruviana en oscuridad, durante 19 días, para estudiar el comportamiento cinético de producción de biomasa, consumo de sustrato, producción de glicósidos cardiotónicos, polifenoles, especies reactivas de oxígeno y actividad antioxidante. Los resultados mostraron una alta producción de biomasa (18,80g PS/L), al igual que consumo total de sacarosa, a los 7 días de cultivo. Se observó un consumo preferencial de glucosa sobre fructosa durante todo el cultivo. La producción de glicósidos cardiotónicos intracelulares alcanzó valores de 2,58mg ED/g PS, al día 19. La mayor producción extracelular (6,19mg ED/L), se alcanzó entre los días 2 y 7. El mayor contenido de compuestos fenólicos extracelular fue de 80,61 ± 5,16mg GAE/L, en el día 7. El contenido de compuestos fenólicos intracelulares incrementó a 2,76 ± 0,14mg AGE/gPF, al día 7 y se mantuvo constante, hasta el día 19. La producción de EROs, al día 7, puede estar relacionada con el consumo total de sacarosa y glucosa. El coeficiente de correlación producto-momento de Pearson (ρ) indicó que los compuestos fenólicos en cultivos celulares en suspensión de T. peruviana eran los responsables de la actividad antioxidante observada. En conjunto, estos resultados brindan las primeras bases relacionadas al comportamiento metabólico de cultivos celulares en suspensión, de T. peruviana.

First principle-based models in plant suspension cell cultures: a review.

In this work, the development and application of published models for describing the behavior of plant cell cultures is reviewed. The structure of each type of model is analyzed and the new tendencies for the modeling of biotechnological processes that can be applied in plant cell cultures are presented. This review is a tool for clarifying the main features that characterize each type of model in the field of plant cell cultures and can be used as a support on the selection of the more suitable model type, taking into account the purpose of specific research.