Microplastics in stomach contents of juvenile Patagonian blennies (Eleginops maclovinus).

Microplastics are one of the major environmental issues that need to be addressed because they are starting to impact food chains and are also affecting human populations. The size, colour, form, and abundance of microplastics in young blennies of the species Eleginops maclovinus were examined in the current study. While the stomach contents of 70 % of the studied individuals contained microplastics, 95 % of them included fibres. Individual size and the largest particle size that can be eaten, which ranges between 0.09 and 1.5 mm present no statistical correlation. The quantity of particles taken in by each individual does not change with size. The most present microfibers colours were blue and red. Sampled fibres were analysed with FT-IR and no natural fibres were detected, proving the synthetic origin of the detected particles. These findings suggest that protected coastlines create conditions that favour the encounter of microplastics increasing local wildlife exposure to microplastics, raising the danger of their ingestion with potential physiological, ecological, economical and human health consequences.

Tratamiento de la angina refractaria con electroestimulación medular / Therapy refractory angina with spinal cord electric stimulation

La electroestimulación medular (EEM) es una de las técnicas alternativas para el tratamiento de la angina refractaria. Consiste en la colocación, mediante una punción transdérmica, de un electrodo tetrapolar en el espacio epidural junto al cordón posterior de la médula espinal, a nivel de T1-T2; este electrodo se conecta mediante tunelización subdérmica de un cable conectado a una batería generadora de impulsos eléctricos que se implante subcutáneamente en la pared abdominal. El régimen de estimulación no es continuo (24 horas al día) sino intermitente (una hora tres veces al día y siempre que se presente una crisis anginosa). Si se siguen unos criterios de inclusión y exclusión estrictos la EEM es altamente efectiva (mejorando notablemente la calidad de vida de estos pacientes) a la par que segura, pues reduce notablemente la morbilidad ( menos ingresos por eventos cardíacos) sin aumentar la mortalidad esperada en este tipo de pacientes. (AU)

[Practice Guidelines of the Spanish Society of Cardiology for the management of cardiac disease in pregnancy]. / Guías de práctica clínica de la Sociedad Española de Cardiología en la gestante con cardiopatía.

Maternal adaptation to pregnancy includes reproductive hormone interaction plasma, volume changes with an increase in total body water, vascular alterations with a decrease in systemic resistance and modifications associated with hypercoagulability. These explain, in part, the appearance of signs and symptoms, even in a normal pregnant woman, that are difficult to distinguish from those occurring in heart disease and why some cardiac abnormalities are not well tolerated during pregnancy. Cardiovascular abnormalities are considered the first non-obstetric cause of morbidity and mortality during pregnancy. Rheumatic and congenital heart diseases are currently the most frequent cardiopathy found in women of childbearing age, followed by hypertension, coronary artery disease and arrhythmia. Although pregnancy is well tolerated by most women with heart disease, there are some cardiovascular abnormalities which place the mother and the infant at extremely high risk: patients with congestive heart failure and severe cardiac dysfunction, pulmonary hypertension, cyanotic congenital heart disease, Marfan's syndrome, severe obstructive lesions of the left side of the heart, patients with prosthetic cardiac valves and antecedents of peripartum cardiomyopathy should be encouraged to avoid pregnancy and the interruption of pregnancy may be advisable in cases with great risk of disability or death. The most severe cardiopathies significantly increase the risk of fetal loss and the presence of a congenital cardiac abnormality in either parent increases the risk of congenital cardiac disease in the fetus. Medical care must be initiated early, prior to conception and women with cardiopathy should be informed of the possible risks of pregnancy to both the mother and fetus.

[Refractory angina treated by spinal cord stimulation. The results of a long-term follow-up]. / Tratamiento de la angina refractaria con electroestimulación medular. Resultados del seguimiento a largo plazo.

INTRODUCTION AND OBJECTIVES: The quality of life in patients with refractory angina has been shown to improve dramatically with spinal cord stimulation because of its beneficial results. The aim of this study was to assess the long-term morbimortality of this technique of spinal cord stimulation in the long term. PATIENTS AND METHODS: 41 patients with refractory angina and treated with spinal cord stimulation were included. Median follow-up was 31.0 [12.0-42.5] months, and total follow-up was 1,236 months. RESULTS: Annual number of admissions per patient year were dramatically reduced after spinal cord stimulation (2.31 vs. 0.28). Patients that died during follow-up had a 3-fold increase rate of admissions than patients that survived (0.37 vs. 0.19). However, patients that died during follow-up also had a lower admission rate after spinal cord stimulation (2.03 vs. 0.37). Overall mortality was 9.7%/year; cardiac mortality was 7.7%/year. Both figures are not different from those of other groups of patients with similar anatomical characteristics of coronary artery disease severity without spinal cord stimulation. Complications of this treatment were minimal (we only observed an early post implantation infection and a battery extrusion, without any complications with electrodes). The outcome was similar in patients with subacute unstable refractory angina or stable angina. CONCLUSIONS: Spinal cord stimulation can be considered a safe and effective alternative treatment of refractory angina. Long-term morbidity is low, and mortality is not higher than the expected in this group of patients.

[Is prophylaxis needed? Is it really effective? Risk of endocarditis after heart surgery]. / Se debe realizar profilaxis? Es realmente efectiva? Riesgo de endocarditis tras cirugía cardíaca.

Infective endocarditis still has an important morbidity and mortality in the acute phase and also in the following years. Because of this, the development and use of preventive strategies have been an important target in developed countries. Until we have some prospective studies their use will be only intuitive and based on the following criteria: endocarditis frequently follows a bacteremia; some diagnostic or therapeutic procedures cause bacteremia; the germs are habitually predictable in each procedure and are sensitive to specific antibiotics; patients with some cardiac or major structural defects have a higher risk of endocarditis. For these reasons, a rational treatment is to give the specific antibiotic against the microorganism prophylactically before it enters the bloodstream during the procedure. Although available data are inconclusive and sometimes even contradictory, most authors recommend the indication of prophylactic measures whose efficacy depends on three basic points: a) identification of patients with a high risk of endocarditis, especially those with a prosthetic cardiac valve; b) knowledge of procedures that need chemoprophylaxis, especially dental and oral procedures, and c) selection of the best prophylactic policy in each specific case. In summary, it is necessary to know to "whom", "when" and "how" to apply prophylactic measures. There are some special situations that must be considered carefully: patients treated with anticoagulant drugs or with a cardiac pacemaker or with an implanted defibrillator, patients with renal insufficiency and an arteriovenous fistulae, and some patients needing open heart surgery, or those who have already had open heart surgery. In conclusion, the prevention of bacterial endocarditis using antibiotics is currently practiced in clinical settings, especially in some specific groups of patients. It is necessary to recommend this treatment in high risk patients (i.e. in those with prosthetic cardiac valves) before a high risk procedure (i.e. dental procedures known to induce gingival or dental bleeding, including professional cleaning) and in medium risk patients, the indication must always be based on an individual analysis according to American Heart Association guidelines.

Adsorption to aluminum hydroxide promotes the activity of IL-12 as an adjuvant for antibody as well as type 1 cytokine responses to HIV-1 gp120.

A series of protocols were tested to examine the adjuvant effects of IL-12 on humoral and type 1 cytokine responses elicited in mice by recombinant gp120 envelope protein from HIV-1. This Ag fails to induce detectable Ab responses when administered s.c. alone, but stimulates low Ab levels when combined with aluminum hydroxide (alum). Moreover, when i.p. injected rIL-12 was included in the immunization, no increase in Ab production was observed. Importantly, optimal gp120 Ab responses were achieved by immunizing mice s.c. with gp120 and rIL-12 simultaneously coadsorbed to alum. These animals displayed a highly polarized, type 1 cytokine profile, with the emergence of anti-gp120 Ig belonging to the IgG2 and IgG3 isotypes. In addition, a major increase occurred in Ab of the IgG1 subclass. The superior adjuvant activity of alum-adsorbed IL-12 compared with that of the free cytokine correlated with the prolonged detection of IFN-gamma in the sera of animals immunized using the former procedure. In related experiments, in vitro neutralization of IL-12 was shown to inhibit IFN-gamma production by spleen cells from mice immunized with gp120 plus alum, but not by splenocytes from mice primed in the presence of IL-12, suggesting that the latter protocol induces a stable type 1 phenotype. These studies demonstrate that presentation of IL-12 on alum enhances its immunomodulatory effects and establish a protocol for the use of the cytokine as an adjuvant for simultaneously promoting both humoral Ab and type 1 cytokine responses.

[Principles and rules of the use of nitrates]. / Principes et règles d'utilisation des dérivés nitrés.

Nitrates, which have been used for more than a century, are the second oldest drug (after digitalis alkaloids) in the cardiological pharmacological arsenal. However, several facets of their mode of use still remain controversial. Their vasodilator and arteriolodilator action (especially in coronary vessels) and their platelet aggregation inhibitory effect make them useful drugs, particularly in all clinical forms of ischaemic heart disease (unstable or stable angina and acute myocardial infarction), for the prevention or treatment of ischaemic episodes (silent or not) and also in heart failure where nitrates are useful not only as symptomatic treatment (alone or associated with diuretics), but also in view of their positive effect on survival (associated with hydralazine: V-Heft I trial). At the present time, nitrates can be administered via the sublingual, oral, intravenous of transdermal routes in the form of nitroglycerin and isosorbide dinitrate or mononitrate (short-acting and sustained-effect forms). Their rare contraindications concern patients suffering from severe hypotension (< 70 mmHg), severe anaemia, glaucoma or intracranial hypertension. The most serious adverse effects are pulsatile headache (which usually disappear after several days), postural hypotension (possibly causing fainting), facial erythema, vertigo, palpitations or nausea and vomiting. Most of these adverse effects can be controlled by dosage adaptation and it is rarely necessary to stop treatment. However, the major problem raised by the use of nitrates concerns the development of a tolerance. The pathophysiology of this multifactorial phenomenon is still unclear. The protagonist role played by loss of SH groups or activation of humoral feedback mechanisms, with an increase of circulating catecholamine levels, activation of the R-A-A system and increased plasma volume, has been postulated. This complication can be avoided by prescribing intermittent treatment, with a drug-free interval of 10-12 hours per day. A single dose of a sustained-release preparation (60 mg of isosorbide dinitrate or 40 to 60 mg of isosorbide mononitrate), or 2 or 3 doses of a short-acting preparation (20-40 mg of isosorbide mononitrate) can be prescribed via the oral route. When the transdermal route is used, the patch should be left in place for 12 hours. Treatment should be started at low doses, which are then gradually increased. The free period is usually at night, which can be covered, when necessary, by other antiischaemic drugs (for example, beta-blockers and/or calcium channel blockers), already usually used in combination with nitrates. This interruption is not accompanied by a rebound phenomenon. It must be remembered that nitrates potentiate the action of other vasodilators and calcium channel blockers and that, in some patients, intravenous nitroglycerin reduces the anticoagulant effect of heparin, while indomethacin can inhibit their vasodilator effect. Nitrates are therefore in very good health despite their advanced age and, when used correctly, they continue to be very useful in the pharmacological treatment of cardiovascular diseases.

Vaccine protection by a triple deletion mutant of simian immunodeficiency virus.

Twelve rhesus monkeys were vaccinated with SIVmac316 delta nef (lacking nef sequences), and 12 were vaccinated with SIVmac239 delta3 (lacking nef, vpr, and upstream sequences in U3). SIVmac316 and SIVmac239 differ by only eight amino acids in the envelope; these changes render SIVmac316 highly competent for replication in macrophages. Seventeen of the animals developed persistent infections with the vaccine viruses. Seven of the 24 vaccinated animals, however, developed infections that were apparently transient in nature. Six of these seven yielded virus from peripheral blood when tested at weeks 2 and/or 3, three of the seven had transient antibody responses, but none of the seven had persisting antibody responses. The 24 monkeys were challenged in groups of four with 10 rhesus monkey infectious doses of wild-type, pathogenic SIVmac251 at weeks 8, 20, and 79 following receipt of vaccine. None of the seven with apparently transient infections with vaccine virus were protected upon subsequent challenge. Analysis of cell-associated viral loads, CD4+ cell counts, and viral gene sequences present in peripheral blood in the remainder of the monkeys following challenge allowed a number of conclusions. (i) There was a trend toward increased protection with length of time of vaccination. (ii) Solid vaccine protection was achieved by 79 weeks with the highly attenuated SIV239 delta3. (iii) Solid long-term protection was achieved in at least two animals in the absence of complete sterilizing immunity. (iv) Genetic backbone appeared to influence protective capacity; animals vaccinated with SIV239 delta3 were better protected than animals receiving SIV316 delta nef. This better protection correlated with increased levels of the replicating vaccine strain. (v) The titer of virus-neutralizing activity in serum on the day of challenge correlated with protection when measured against a primary stock of SIVmac251 but not when measured against a laboratory-passaged stock. The level of binding antibodies to whole virus by enzyme-linked immunosorbent assay also correlated with protection.

[Diagnostic methods in angina pectoris. The Angina Pectoris Study Group of the Ischemic Cardiopathy Section and Coronary Units of the Spanish Society of Cardiology]. / Métodos diagnósticos en la angina de pecho. Grupo de Estudio de Angina de Pecho de la Sección de Cardioplatía Isquémica y Unidades Coronarias de la Sociedad Espanola de Cardilogía.

Diagnosis and risk stratification in angina pectoris is supported on clinical evaluation, rest electrocardiogram, exercise stress test and coronary angiography. Use and timing application of that diagnostic methods depend on coronary artery disease prevalence and on clinical situation. This review describe diagnostic and prognostic value of the tests in angina pectoris.

Coronary artery spasm and acute myocardial infarction in naproxen-associated anaphylactic reaction.

We present the case of a 43-year-old man who suffered an acute myocardial infarction after oral administration of 250 mg of naproxen, prescribed as antiinflammatory-analgesic agent after tooth extraction. Both intradermal skin test and human basophil degranulation test were positive to naproxen. These findings suggest a naproxen-associated anaphylactic reaction with concomitant coronary artery spasm and posteroinferior infarction, a clinical event previously not reported with the use of this drug.

[Successful fibrinolytic treatment in a patient with acute mitral prosthetic thrombosis]. / Tratamiento fibrinolítico resolutivo en un paciente con trombosis protésica mitral aguda.

A case is described of a 50 year-old man with an acute prosthetic dysfunction due to valve thrombosis and cardiogenic shock, on a prosthesis in the mitral position (Bjork-Shiley). The patient was promptly treated with a streptokinase in two infusions 1.5 x 10(6) UI over 180 and 90 minutes, respectively. Early clinical, fluoroscopy and echocardiography improvement was observed. The authors comment the present role of the thrombolytic therapy in front of surgery of prosthetic valve thrombosis.

Non-invasive preoperative assessment of chronic valvular heart disease by Doppler ultrasound.

Between February 1986 and June 1987, 306 consecutive patients were included in a programme of non-invasive preoperative assessment of valvular heart disease using M-mode and cross-sectional echocardiography and Doppler ultrasound. In 285 cases (93%), echocardiography provided all the necessary preoperative information. Coronary angiography was performed in 74 patients because of angina and in 55 because of their age. Invasive investigation was needed in 21 cases because of discrepancies between clinical data and echo-Doppler results. The results were definitely misleading in six patients, mainly due to erroneous assessment of valvular regurgitation. One hundred and ninety one patients underwent valve surgery (179 evaluated exclusively by echocardiography, 79 with coronary angiography as the sole invasive procedure). No discrepancies were observed between echo-Doppler diagnosis and macroscopic evaluation of valvular heart disease at surgery. Operative mortality (3.6%) was not significantly different from that observed during the preceeding period when preoperative catheterisation was performed (3.3%). It is concluded that echo-Doppler techniques are perfectly satisfactory for the preoperative assessment of patients with valvular heart disease. Cardiac catheterisation is only infrequently required, although coronary angiography remains mandatory in a selected group of these patients.

Adaptation of skeletal muscle to increased contractile activity. Expression nuclear genes encoding mitochondrial proteins.

An increase in mitochondrial biogenesis in mammalian cells requires a coordinated increase in the expression of a number of nuclear genes that encode mitochondrial proteins. To examine the regulatory mechanisms involved, we used specific anti-sense RNA probes to estimate the cellular concentrations of mRNA transcripts of two such nuclear genes in rabbit tibialis anterior muscles subjected in vivo to 10-21 days of indirect electrical stimulation. The unstimulated contralateral muscle in the same animals provided a base line for comparison. Change in expression of mitochondrial proteins was assessed in terms of the enzymatic capacity of citrate synthase and cytochrome oxidase, which increased 2.1-fold after 10 days and 5.5- and 4.1-fold, respectively, after 21 days of stimulation. As a proportion of total cellular RNA, messenger RNA encoding subunit beta of F1-ATPase increased 2.2-fold over control levels after 10 days and 2.3-fold after 21 days; mRNA encoding subunit VIC of cytochrome oxidase increased 1.3-fold and 1.9-fold over control levels after stimulation for 10 and 21 days, respectively. These changes were not attributable to nonspecific effects of stimulation on all mRNA transcripts, since aldolase A mRNA decreased to 26% of control levels after 21 days of stimulation. Furthermore, mRNA transcripts from these nuclear genes encoding mitochondrial proteins did not increase to the same extent as mRNA transcripts of mitochondrial genes such as cytochrome b, which increased 5.9-fold after 21 days of stimulation. We conclude that the increase in mitochondrial biogenesis induced by electrical stimulation of skeletal muscle is supported by pretranslational regulation of expression of nuclear genes encoding mitochondrial proteins. There are, however, indications that translational or post-translational regulatory events may also be involved.

Holter ECG study of the electrocardiographic phenomena in Prinzmetal angina attacks with emphasis on the study of ventricular arrhythmias.

The ECG phenomena in 20 outpatients (121 episodes) suffering from variant angina with transient ST segment elevation greater than 1.5 mm. (Prinzmetal angina) were studied by Holter monitoring. The most important changes in the ECG morphology were: a) increased height of the R wave in all cases, b) the S wave decreased or disappeared, c) the ST segment elevation varied from 1.5 to 38 mm, d) the TQ interval was ascending in 78 episodes, e) there was a double alternance of ST-TQ in 20 episodes and f) the first modification of the ECG was an increase of the T wave height. Arrhythmias were seen in 19 patients (44 episodes). The most frequent were premature ventricular contractions. The prevalence and importance of the ventricular arrhythmias were statistically related to the duration of the episodes (p less than 0.005), the degree of the ST segment elevation (p less than 0.005), the presence of ST-TQ alternance (p less than 0.005) and the presence of increased R wave greater than 25% (p less than 0.025).