Manejo integral de los factores de riesgo en enfermedad arterial periférica. Consenso de expertos / Comprehensive management of risk factors in peripheral vascular disease. Expert consensus

Antecedentes y objetivo: Actualmente existe cierta divergencia entre las principales guías de práctica clínica sobre el manejo de los factores de riesgo de la enfermedad arterial periférica (EAP). El objetivo de este proyecto es conocer el manejo de los factores de riesgo de la EAP en la práctica clínica y alcanzar un consenso multidisciplinar sobre las estrategias que se tienen que seguir para optimizar su identificación, tratamiento y seguimiento. Metodología: Consenso multidisciplinar mediante metodología Delphi. Resultados: En la consulta participaron 130 profesionales con amplia experiencia en EAP. Los resultados sugieren que para optimizar el control de los factores de riesgo, los esfuerzos deben dirigirse a: 1) promover la involucramiento y concienciación de todas las especialidades en la identificación y el cribado de la enfermedad; 2) garantizar la posibilidad de realizar el índice tobillo-brazo (ITB) en todas las especialidades implicadas; 3) fomentar estrategias de deshabituación del tabaquismo mediante el uso de fármacos, programas o derivaciones a unidades especializadas; 4) promover el seguimiento de una alimentación adecuada basada en la dieta mediterránea y la prescripción de ejercicio diario; 5) concienciar sobre la importancia de alcanzar unos valores de colesterol unido a lipoproteínas de baja densidad (cLDL) inferiores a 70 mg/Dl, especialmente en pacientes sintomáticos, pero también en asintomáticos (< 55 mg/dL tras la publicación de la guía de la European Society of Cardiology y la European Atherosclerosis Society [ESC/EAS]); 6) recomendar el uso de antiagregantes plaquetarios en pacientes asintomáticos con diabetes mellitus (DM) y/o ITB patológico; y 7) protocolizar la reevaluación del ITB anualmente en pacientes de alto riesgo. Conclusión: Las 22 estrategias consensuadas en el presente documento pretenden ayudar a los profesionales a optimizar el manejo multidisciplinar de los factores de riesgo de la EAP (AU)

Introduction: There is currently a degree of divergence among the main clinical practice guidelines on the management of risk factors for peripheral arterial disease (PAD). This project aims to gain understanding of the management of PAD risk factors in clinical practice and to reach a multidisciplinary consensus on the strategies to be followed in order to optimize its identification, treatment, and follow-up. Methodology: A multidisciplinary consensus following the Delphi methodology. Results: Professionals (n = 130) with extensive experience in PAD participated in this consultation. The results suggest that in order to optimize the control of risk factors, efforts should be aimed at: (1) promoting the involvement and awareness of all specialists in the identification of and screening for the disease; (2) guaranteeing the possibility of evaluating the ankle-brachial index (ABI) in all the medical specialties involved; (3) promoting strategies for patients to quit smoking through the use of drugs, programs, or referrals to specialized units; (4) promoting an appropriate Mediterranean-based diet and the prescription of daily exercise; (5) raising awareness of the importance of ensuring LDL cholesterol values below 70 mg/dL, especially in symptomatic but also in asymptomatic patients (< 55 mg/dL following the publication of the ESC/EAS guide); (6) recommending the use of antiplatelet therapy in asymptomatic patients with diabetes mellitus (DM) and/or a pathological ABI; and (7) protocolizing the annual evaluation of ABI in high-risk patients. Conclusion:This document presents the 22 agreed-upon strategies which are intended to help professionals optimize multidisciplinary management of PAD risk factors (AU)

Comprehensive management of risk factors in peripheral vascular disease. Expert consensus.

INTRODUCTION: There is currently a degree of divergence among the main clinical practice guidelines on the management of risk factors for peripheral arterial disease (PAD). This project aims to gain understanding of the management of PAD risk factors in clinical practice and to reach a multidisciplinary consensus on the strategies to be followed in order to optimize its identification, treatment, and follow-up. METHODOLOGY: A multidisciplinary consensus following the Delphi methodology. RESULTS: Professionals (n = 130) with extensive experience in PAD participated in this consultation. The results suggest that in order to optimize the control of risk factors, efforts should be aimed at: (1) promoting the involvement and awareness of all specialists in the identification of and screening for the disease; (2) guaranteeing the possibility of evaluating the ankle-brachial index (ABI) in all the medical specialties involved; (3) promoting strategies for patients to quit smoking through the use of drugs, programs, or referrals to specialized units; (4) promoting an appropriate Mediterranean-based diet and the prescription of daily exercise; (5) raising awareness of the importance of ensuring LDL cholesterol values below 70 mg/dL, especially in symptomatic but also in asymptomatic patients (<55 mg/dL following the publication of the ESC/EAS guide); (6) recommending the use of antiplatelet therapy in asymptomatic patients with diabetes mellitus (DM) and/or a pathological ABI; and (7) protocolizing the annual evaluation of ABI in high-risk patients. CONCLUSION: This document presents the 22 agreed-upon strategies which are intended to help professionals optimize multidisciplinary management of PAD risk factors.

Composition-driven Cu-speciation and reducibility in Cu-CHA zeolite catalysts: a multivariate XAS/FTIR approach to complexity.

The small pore Cu-CHA zeolite is attracting increasing attention as a versatile platform to design novel single-site catalysts for deNO x applications and for the direct conversion of methane to methanol. Understanding at the atomic scale how the catalyst composition influences the Cu-species formed during thermal activation is a key step to unveil the relevant composition-activity relationships. Herein, we explore by in situ XAS the impact of Cu-CHA catalyst composition on temperature-dependent Cu-speciation and reducibility. Advanced multivariate analysis of in situ XANES in combination with DFT-assisted simulation of XANES spectra and multi-component EXAFS fits as well as in situ FTIR spectroscopy of adsorbed N2 allow us to obtain unprecedented quantitative structural information on the complex dynamics during the speciation of Cu-sites inside the framework of the CHA zeolite.

Conversion of methanol to hydrocarbons over zeolite ZSM-23 (MTT): exceptional effects of particle size on catalyst lifetime.

A variety of synthetic procedures have been used to obtain zeolite ZSM-23 (MTT) catalysts with crystallite sizes ranging from the micrometer to nanometer scale. When the acidic zeolite is used as a catalyst for the methanol to hydrocarbon (MTH) reaction, the catalytic lifetime is dramatically influenced by the crystallite shape and size.

Revisiting the nature of Cu sites in the activated Cu-SSZ-13 catalyst for SCR reaction.

Cu-SSZ-13 is a highly active NH3-SCR catalyst for the abatement of harmful nitrogen oxides (NO x , x = 1, 2) from the exhausts of lean-burn engines. The study of Cu-speciation occurring upon thermal dehydration is a key step for the understanding of the enhanced catalytic properties of this material and for identifying the SCR active sites and their redox capability. Herein, we combined FTIR, X-ray absorption (XAS) and emission (XES) spectroscopies with DFT computational analysis to elucidate the nature and location of the most abundant Cu sites in the activated catalyst. Different Cu species have been found to be dominant as a function of the dehydration temperature and conditions. Data analysis revealed that the dehydration process of Cu cations is essentially completed at 250 °C, with the formation of dehydrated [CuOH]+ species hosted in close proximity to 1-Al sites in both d6r and 8r units of the SSZ-13 matrix. These species persist at higher temperatures only if a certain amount of O2 is present in the gas feed, while under inert conditions they undergo virtually total "self-reduction" as a consequence of an OH extra-ligand loss, resulting in bi-coordinated bare Cu+ cations. Synchrotron characterization supported by computational analysis allowed an unprecedented quantitative refinement of the local environment and structural parameters of these Cu(ii) and Cu(i) species.

Sistema de acreditación en atención primaria (SaAP) (II): retos de la formación continuada / Accreditation system in primary care (SaSP) (II): challenges of ongoing training

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Nefropatía hipertensiva / Hypertensive nephropathy

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