Transcatheter or Surgical Aortic Valve Replacement in Patients With Severe Aortic Stenosis and Small Aortic Annulus: A Randomized Clinical Trial.

BACKGROUND: The optimal treatment in patients with severe aortic stenosis and small aortic annulus (SAA) remains to be determined. This study aimed to compare the hemodynamic and clinical outcomes between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with a SAA. METHODS: This prospective multicenter international randomized trial was performed in 15 university hospitals. Participants were 151 patients with severe aortic stenosis and SAA (mean diameter <23 mm) randomized (1:1) to TAVR (n=77) versus SAVR (n=74). The primary outcome was impaired valve hemodynamics (ie, severe prosthesis patient mismatch or moderate-severe aortic regurgitation) at 60 days as evaluated by Doppler echocardiography and analyzed in a central echocardiography core laboratory. Clinical events were secondary outcomes. RESULTS: The mean age of the participants was 75.5±5.1 years, with 140 (93%) women, a median Society of Thoracic Surgeons predicted risk of mortality of 2.50% (interquartile range, 1.67%-3.28%), and a median annulus diameter of 21.1 mm (interquartile range, 20.4-22.0 mm). There were no differences between groups in the rate of severe prosthesis patient mismatch (TAVR, 4 [5.6%]; SAVR, 7 [10.3%]; P=0.30) and moderate-severe aortic regurgitation (none in both groups). No differences were found between groups in mortality rate (TAVR, 1 [1.3%]; SAVR, 1 [1.4%]; P=1.00) and stroke (TAVR, 0; SAVR, 2 [2.7%]; P=0.24) at 30 days. After a median follow-up of 2 (interquartile range, 1-4) years, there were no differences between groups in mortality rate (TAVR, 7 [9.1%]; SAVR, 6 [8.1%]; P=0.89), stroke (TAVR, 3 [3.9%]; SAVR, 3 [4.1%]; P=0.95), and cardiac hospitalization (TAVR, 15 [19.5%]; SAVR, 15 [20.3%]; P=0.80). CONCLUSIONS: In patients with severe aortic stenosis and SAA (women in the majority), there was no evidence of superiority of contemporary TAVR versus SAVR in valve hemodynamic results. After a median follow-up of 2 years, there were no differences in clinical outcomes between groups. These findings suggest that the 2 therapies represent a valid alternative for treating patients with severe aortic stenosis and SAA, and treatment selection should likely be individualized according to baseline characteristics, additional anatomical risk factors, and patient preference. However, the results of this study should be interpreted with caution because of the limited sample size leading to an underpowered study, and need to be confirmed in future larger studies. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03383445.

Successful perioperative management of a primary pulmonary arterial angiosarcoma: case report

Abstract Introduction: Primary pleomorphic pulmonary angiosarcomas are extremely rare tumors which could be easily mistaken for pulmonary emboli. Background and findings: We describe the successful perioperative management of a patient with a pulmonary arterial mass which turned out to be a primary pulmonary angiosarcoma. The severe pulmonary hypertension was a particular challenge compounded with the site and adhesions of the tumor, and pulmonary hemorrhage. The procedure was successfully performed with strict hemodynamic control ensuring stable systemic and pulmonary arterial pressures using perioperative transesophageal echocardiography to continuously monitor cardiac function, along with other standard cardiac surgical monitors including depth of anesthesia monitoring. Conclusion: Tight hemodynamic control, ensuring stable pulmonary arterial pressures using perioperative echocardiography, and thorough preparation with measures to reduce and prevent increase in pulmonary arterial pressure along with close communication within the multidisciplinary team are essential for successful management of patients with this pathology.

Pneumolysin as a target for new therapies against pneumococcal infections: A systematic review.

BACKGROUND: This systematic review evaluates pneumolysin (PLY) as a target for new treatments against pneumococcal infections. Pneumolysin is one of the main virulence factors produced by all types of pneumococci. This toxin (53 kDa) is a highly conserved protein that binds to cholesterol in eukaryotic cells, forming pores that lead to cell destruction. METHODS: The databases consulted were MEDLINE, Web of Science, and Scopus. Articles were independently screened by title, abstract, and full text by two researchers, and using consensus to resolve any disagreements that occurred. Articles in other languages different from English, patents, cases report, notes, chapter books and reviews were excluded. Searches were restricted to the years 2000 to 2021. Methodological quality was evaluated using OHAT framework. RESULTS: Forty-one articles describing the effects of different molecules that inhibit PLY were reviewed. Briefly, the inhibitory molecules found were classified into three main groups: those exerting a direct effect by binding and/or blocking PLY, those acting indirectly by preventing its effects on host cells, and those whose mechanisms are unknown. Although many molecules are proposed as toxin blockers, only some of them, such as antibiotics, peptides, sterols, and statins, have the probability of being implemented as clinical treatment. In contrast, for other molecules, there are limited studies that demonstrate efficacy in animal models with sufficient reliability. DISCUSSION: Most of the studies reviewed has a good level of confidence. However, one of the limitations of this systematic review is the lack of homogeneity of the studies, what prevented to carry out a statistical comparison of the results or meta-analysis. CONCLUSION: A panel of molecules blocking PLY activity are associated with the improvement of the inflammatory process triggered by the pneumococcal infection. Some molecules have already been used in humans for other purposes, so they could be safe for use in patients with pneumococcal infections. These patients might benefit from a second line treatment during the initial stages of the infection preventing acute respiratory distress syndrome and invasive pneumococcal diseases. Additional research using the presented set of compounds might further improve the clinical management of these patients.

Review: Presence, distribution and current pesticides used in Spanish agricultural practices.

To guarantee an adequate food supply for the world's growing population, intensive agriculture is necessary to ensure efficient food production. The use of pesticides helps maintain maximum productivity in intensive agriculture by minimizing crop losses due to pests. However, pesticide contamination of surface waters constitutes a major problem as they are resistant to degradation and soluble enough to be transported in water. In recent years, all groups of pesticides defined by the World Health Organization have increased their use and, therefore, their prevalence in the different environmental compartments that can have harmful effects. Despite this effort, there is no rigorous monitoring program that quantifies and controls the toxic effects of each pesticide. However, multiple scientific studies have been published by specialized research groups in which this information is disseminated. Therefore, any attempt to systematize this information is relevant. This review offers a current overview of the presence and distribution of the most widely-used pesticides (insecticides, herbicides, and fungicides) by crop type and an evaluation of the relationships between their uses and environmental implications in Spain. The data demonstrated that there are correlations between the presence of specific pesticides used in the main crops and their presence in the environmental compartments. We have found preliminary data pointing to existing associations between specific pesticides used in the main crops and their presence in environmental compartments within different geographical areas of Spain; this should be the subject of further investigation.

Fast 1H-NMR Species Differentiation Method for Camellia Seed Oils Applied to Spanish Ornamentals Plants. Comparison with Traditional Gas Chromatography.

Camellia genus (Theaceae) is comprised of world famous ornamental flowering plants. C. japonica L. and C. sasanqua Thunb are the most cultivated species due to their good adaptation. The commercial interest in this plant linked to its seed oil increased in the last few years due to its health attributes, which significantly depend on different aspects such as species and environmental conditions. Therefore, it is essential to develop fast and reliable methods to distinguish between different varieties and ensure the quality of Camellia seed oils. The present work explores the study of Camellia seed oils by species and location. Two standardized gas chromatography methods were applied and compared with that of data obtained from proton nuclear magnetic resonance spectroscopy (1H-NMR) for fatty acids profiling. The principal component analysis indicated that the proposed 1H-NMR methodology can be quickly and reliably applied to separate specific Camellia species, which could be extended to other species in future works.

Successful perioperative management of a primary pulmonary arterial angiosarcoma: case report.

INTRODUCTION: Primary pleomorphic pulmonary angiosarcomas are extremely rare tumors which could be easily mistaken for pulmonary emboli. BACKGROUND AND FINDINGS: We describe the successful perioperative management of a patient with a pulmonary arterial mass which turned out to be a primary pulmonary angiosarcoma. The severe pulmonary hypertension was a particular challenge compounded with the site and adhesions of the tumor, and pulmonary hemorrhage. The procedure was successfully performed with strict hemodynamic control ensuring stable systemic and pulmonary arterial pressures using perioperative transesophageal echocardiography to continuously monitor cardiac function, along with other standard cardiac surgical monitors including depth of anesthesia monitoring. CONCLUSION: Tight hemodynamic control, ensuring stable pulmonary arterial pressures using perioperative echocardiography, and thorough preparation with measures to reduce and prevent increase in pulmonary arterial pressure along with close communication within the multi-disciplinary team are essential for successful management of patients with this pathology.

Descripción del posicionamiento de una copa monobloque no cementada en el posoperatorio inmediato / Description of uncemented monobloc cup positioning in the immediate postoperative period

Introducción El posicionamiento adecuado de la copa acetabular en el reemplazo total de cadera (RTC) puede mejorar la función, reducir el desgaste, el pinzamiento y la luxación. La posición de la copa se describe como la relación espacial entre el centro de rotación de la cadera y la pelvis. El objetivo de este estudio es describir el posicionamiento de una copa monobloque no cementada en el posoperatorio inmediato de los pacientes a quienes se les realizo un RTC primario. Materiales y Métodos Estudio observacional descriptivo, los pacientes fueron operados por 4 cirujanos especialistas en cirugía de reemplazo articular de cadera en 8 clínicas, los procedimientos se realizaron entre octubre de 2015 a agosto de 2018, las medidas radiológicas fueron la inclinación, anteversión, lateralización, porcentaje de descubrimiento y espacio detrás de la copa acetabular. Resultados Los mayores porcentajes son para las copas acetabulares con inclinación de 36 a 48 grados, anteversión de 5 a 15 grados, lateralización de -2 a +2mm, porcentaje de descubrimiento del 0% y espacio detrás de la copa de 0 a 3mm. Discusión Diferentes autores han identificado zonas seguras de implantación las cuales concuerdan con los resultados de nuestro estudio. El posicionamiento adecuado de la copa acetabular monobloque no cementada se pudo lograr con una correcta indicación del implante, un abordaje quirúrgico que permitió una ubicación tridimensional idónea y un acetábulo sin alteraciones anatómicas a nivel periférico.

Background Appropriate positioning of the acetabular cup in total hip arthroplasty (THA) can improve hip function, reduce wear, impingement and dislocation. The position of the cup is described as the spatial relationship between the centre of rotation of the hip and the pelvis. The aim of this study is to describe the positioning of the uncemented monoblock cup in the immediate postoperative period in patients who underwent a primary THA. Methods Descriptive observational study. The patients were operated by 4 joints arthroplasty surgeons in 8 different hospitals, from October 2015 to August 2018. The radiological measurements were taken from the AP Pelvis Xrays of the immediate postoperative. The inclination, anteversion, lateralization, percentage of cup uncovered and the space behind the acetabular cup. Results 82.05% of the cups were in the range of inclination from 36 to 48 degrees; 85.71% had an anteversion between 5 to 15 degrees, 76.56% presented a lateralization of -2 to +2mm, 94.51% of the patients didnt have a uncover cup, and 92.67% of the cups had a space behind the cup from 0 to 3mm. Discussion In our study the highest percentage of cups were implanted with parameters agree to the safety areas reported by various authors. Adequate positioning of the uncemented monoblock acetabular cup can be achieved with a proper indication, a surgical approach that allows an ideal three-dimensional location and an acetabulum with a good peripheral rim that provides the required press-fit.

Diminishing Cognitive Capacities in an Ever Hotter World: Evidence From an Applicable Power-Law Description.

OBJECTIVE: Modeling and evaluating a series of power law descriptions for boundary conditions of undiminished cognitive capacities under thermal stress. BACKGROUND: Thermal stress degrades cognition, but precisely which components are affected, and to what degree, has yet to be fully determined. With increasing global temperatures, this need is becoming urgent. Power-law distributions have proven their utility in describing differing natural mechanisms, including certain orders of human performance, but never as a rationalization of stress-altered states of attention. METHOD: From a survey of extant empirical data, absolute thresholds for thermal tolerance for varying forms of cognition were identified. These thresholds were then modeled using a rational power-law description. The implications of the veracity of that description were then identified and analyzed. RESULTS: Cognitive performance thresholds under thermal stress are advanced as power-law relationships, t = f(T) = c[(T - Tref)/Tref]-α. Coherent scaling parameters for diverse cognitive functionalities are specified that are consistent with increases in deep (core) body temperature. Therefore, scale invariance provides a "universal constant," viz, 20% detriment in mental performance per 10% increase in T deviation, from a comfortable reference temperature Tref. CONCLUSION: We know the thermal range within which humans can survive is quite narrow. The presented power-law descriptions imply that if making correct decisions is critical for our future existence, then our functional thermal limits could be much more restricted than previously thought. APPLICATION: We provide our present findings, such that others can both assess and mitigate the effects of adverse thermal loads on cognition, in whatever human scenario they occur.

Thermal effects on cognition: a new quantitative synthesis.

There is little doubt that increases in thermal load beyond the thermo-neutral state prove progressively stressful to all living organisms. Increasing temperatures across the globe represent in some locales, and especially for outdoors workers, a significant source of such chronic load increase. However, increases in thermal load affect cognition as well as physical work activities. Such human cognition has perennially been viewed as the primary conduit through which to solve many of the iatrogenic challenges we now face. Yet, thermal stress degrades the power to think. Here, we advance and refine the isothermal description of such cognitive decrements, founded upon a synthesis of extant empirical evidence. We report a series of mathematical functions which describe task-specific patterns of performance deterioration, linking such degrees of decrement to the time/temperature conditions in which they occur. Further, we provide a simple, free software tool to support such calculations so that adverse thermal loads can be monitored, assessed and (where possible) mitigated to preserve healthy cognitive functioning.

Guía de práctica clínica (GPC): guía de actuación en AnafiLAXIA 2016 / Clinical practice guide (CPG): guide to action in AnafiLAXIA 2016

Esta nueva versión de GALAXIA está dirigida a todos los profesionales sanitarios, en todos los niveles de asistencia, para proporcionar recomendaciones en el manejo de la anafilaxia. La anafilaxia es la reacción alérgica más grave que puede ocurrir, e incluso puede llegar a poner en peligro la vida del paciente. Todos los profesionales sanitarios deberían ser capaces de reconocerla y actuar de forma rápida y adecuada. Se incluyen recomendaciones para pacientes adultos y pediátricos, se comentan situaciones especiales, y se consideran situaciones en el ambiente sanitario y fuera de el.

Síndrome de Munchausen por poderes: análisis e implicaciones / Powered syndrome of Münchausen: implications and analysis

Aunque todavía se considera infrecuente, la sospecha de casos de Munchausen por poderes ha aumentado significativamente. Uno de los padres, generalmente la madre, induce o refiere síntomas físicos en el niño, inventando la correspondiente historia de la que se van a derivar exploraciones y tratamientos innecesarios en base a recabar atención para ella. El cuidador puede perpetrar el maltrato del Munchausen por poderes través de una combinación de exageración, invento o inducción. Normalmente, las víctimas son niños menores de seis años. Resulta crítico identificar las situaciones abusivas cuanto antes. El primer paso para identificar cualquier caso de abuso infantil consiste en una vigilancia y educación adecuadas. Hay dos métodos que pueden proporcionar una evidencia indiscutible: coger al perpetrador «in fraganti» y la vigilancia a través de una vídeo-cámara. Si se piensa que existe una amenaza inmediata para la vida del niño, se pueden iniciar las medidas de custodia. Estas intervenciones pueden ser el eslabón crítico en la supervivencia de estos niños

While still considered to be a rare condition, cases of MSBP are suspected with greater frequency. A parent, usually the mother, induces o reports physical symptoms in a child and fabricates a corresponding history that results in unnecessary evaluation and treatment in order to draw attention to herself. A caretaker may perpetrate MSBP maltreatment through one or a combination of exaggeration, fabrication or inducing. The victim is, usually, a children under six years. Identifying abusive situations as early as possible is critical. The first step in identify any case of child abuse is being aware and educated about it Two methods can provide indisputable evidence: catching the perpetrator in the act and video camera surveillance. Ifthe child's life is thought to be in immediate danger, protective custody may need to be initiated. These interventions may be the critical link in the survival of these children