OSMAC Approach and Cocultivation for the Induction of Secondary Metabolism of the Fungus Pleotrichocladium opacum.

The application of an OSMAC (One Strain-Many Compounds) approach on the fungus Pleotrichocladium opacum, isolated from a soil sample collected on the coast of Asturias (Spain), using different culture media, chemical elicitors, and cocultivation techniques resulted in the isolation and identification of nine new compounds (8, 9, 12, 15-18, 20, 21), along with 15 known ones (1-7, 10, 11, 14, 19, 22-25). Compounds 1-9 were detected in fungal extracts from JSA liquid fermentation, compounds 10-12 were isolated from a solid rice medium, whereas compounds 14 and 15 were isolated from a solid wheat medium. Addition of 5-azacytidine to the solid rice medium caused the accumulation of compounds 16-18, whereas adding N-acetyl-d-glucosamine triggered the production of two additional metabolites, 19 and 20. Finally, cocultivation of the fungus Pleotrichocladium opacum with Echinocatena sp. in a solid PDA medium led to the production of five additional natural products, 21-25. The structures of the new compounds were elucidated by HRESIMS and 1D and 2D NMR as well as by comparison with literature data. DP4+ and mix-J-DP4 computational methods were applied to determine the relative configurations of the novel compounds, and in some cases, the absolute configurations were assigned by a comparison of the optical rotations with those of related natural products.

Induction of New Aromatic Polyketides from the Marine Actinobacterium Streptomyces griseorubiginosus through an OSMAC Approach.

Using the OSMAC (One Strain Many Compounds) approach, the actinobacterium Streptomyces griseorubiginosus, derived from an unidentified cnidarian collected from a reef near Pointe de Bellevue in Réunion Island (France), was subjected to cultivation under diverse conditions. This endeavour yielded the isolation of a repertoire of 23 secondary metabolites (1-23), wherein five compounds were unprecedented as natural products (19-23). Specifically, compounds 19 and 20 showcased novel anthrone backbones, while compound 23 displayed a distinctive tetralone structure. Additionally, compounds 21 and 22 presented an unusual naphtho [2,3-c]furan-4(9H)-one chromophore. Interestingly, the detection of all these novel compounds (19-23) was exclusively achieved when the bacterium was cultured in FA-1 liquid medium supplemented with the epigenetic modifier γ-butyrolactone. The elucidation of the structural features of the newfound compounds was accomplished through a combination of HRESIMS, 1D and 2D NMR spectroscopy, as well as QM-NMR (Quantum Mechanical-Nuclear Magnetic Resonance) methods and by comparison with existing literature. Moreover, the determination of the relative configuration of compound 23 was facilitated by employing the mix-J-DP4 computational approach.

IAM por trombosis de aneurisma del seno de Valsalva / Thrombosis of a Valsalva sinus aneurysm causing AMI

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Drug-eluting vs. conventional balloon for side branch dilation in coronary bifurcations treated by provisional T stenting.

OBJECTIVE: The origin of the side branch (SB) is the most common site for restenosis in coronary bifurcations. The end-point is to compare the results of SB dilation with drug-eluting balloon (DEB group) versus conventional balloon (BAL group) in bifurcations treated with provisional T stenting. METHODS AND RESULTS: Each group included 50 patients. In DEB, the origin of SB was dilated with a Sequent(®) Please balloon. In both groups, a Taxus Liberté(®) stent was implanted in the main vessel, with kissing balloon postdilation. If the outcome for the SB was suboptimal, a Taxus stent was implanted in BAL and a bare stent in DEB group. An angiographic follow-up and IVUS were scheduled for 12 months later. Adverse events (MACE) were 24% in BAL versus 11% in DEB (P = 0.11), with greater revascularization (TLR) in the BAL group (22% vs. 12%, P = 0.16). At angiographic follow-up, there was a lower percentage of SB restenosis in the DEB group (20% vs. 7%, P = 0.08), with less late loss (0.40 mm vs. 0.09 mm, P = 0.01). CONCLUSION: Side branch dilation with a drug-eluting balloon resulted in better angiographic outcomes than with a conventional balloon, with less late loss and restenosis at the 12-month follow-up.

Isquemia, ¿sustrato o desencadenante? / Ischemia: substrate or trigger?

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Comparison of paclitaxel-eluting stents (Taxus) and everolimus-eluting stents (Xience) in left main coronary artery disease with 3 years follow-up (from the ESTROFA-LM registry).

Evidence regarding therapy with drug-eluting stents in the left main coronary artery (LM) is based mostly on trials performed with first-generation drug-eluting stents. The aim of this study was to evaluate long-term clinical outcomes after treatment for unprotected LM disease with paclitaxel-eluting stents (PES) and everolimus-eluting stents (EES). The ESTROFA-LM is a multicenter retrospective registry including consecutive patients with unprotected LM disease treated with PES or EES. A total of 770 patients have been included at 21 centers, 415 with treated PES and 355 with EES. Treatment with 2 stents was more frequent with PES (17% vs 10.4%, p = 0.007), whereas intravascular ultrasound was more frequently used with EES (35.2% vs 26%, p = 0.006). The 3-year death and infarction survival rates were 86.1% for PES and 87.3% for EES (p = 0.50) and for death, infarction, and target lesion revascularization were 83.6% versus 82% (p = 0.60), respectively. Definite or probable thrombosis was 1.6% for PES and 1.4% for EES (p = 0.80). The use of 2 stents, age, diabetes, and acute coronary syndromes were independent predictors of mortality. In the subgroup of distal lesions, the use of intravascular ultrasound was an independent predictor of better outcome. Comparison of propensity score-matched groups did not yield differences between the 2 stents. In conclusion, the results of this multicenter registry show comparable safety and efficacy at 3 years for PES and EES in the treatment of LM disease. The use of bifurcation stenting techniques in distal lesions was a relevant independent predictor for events. The use of intravascular ultrasound appears to have a positive impact on patients treated for LM distal disease.

Comparison of zotarolimus- versus everolimus-eluting stents in the treatment of coronary bifurcation lesions.

OBJECTIVES: To compare zotarolimus-eluting stent (Endeavor Sprint®; ZES-S) and the everolimus-eluting stent (Xience V®; EES) in the treatment of coronary bifurcation lesions. BACKGROUND: Both these stents have demonstrated good outcomes in the treatment of coronary lesions. However, the outcomes with respect to treatment of bifurcation lesions have yet to be conclusively demonstrated. METHODS: In this single centered, nonrandomized, open label study, we treated, between August 2006 and December 2008, 110 bifurcations with ZES-S and, in a second stage of the study, 129 bifurcations with EES. The primary end point was to compare the rate of major adverse cardiac events (MACE) (death, myocardial infarction, and new target lesion revascularization) in-hospital and at 12 months of follow-up. Provisional T stenting was the strategy used in the majority of cases. Angiographic follow-up was performed only in patients who presented signs or symptoms suggestive of angina or ischemia. RESULTS: There were no significant differences in in-hospital MACE between the groups (ZES-S: 8.1%; EES: 6.2%; P = 0.5). At 12 months, the ZES-S group had significantly more MACE than the EES group (23.1% vs. 4.5%; P < 0.001) and an elevated index of new revascularization of the bifurcation (17.5% vs. 3.2%; P < 0.001). There were no significant differences in mortality (four patients in ZES-S vs. one in EES; P = 0.14). CONCLUSION: The treatment of coronary bifurcation lesions using everolimus-eluting stents results in better outcomes at 12 months of follow-up than zotarolimus-eluting stents.

Analgesia controlada por el paciente (PCA) en cirugía cardiotorácica. Experiencia de 13 años de la Fundación Cardiovascular del Oriente Colombiano / Patient-controlled analgesia (PCA) in cardiothoracic surgery

Este estudio relata la experiencia en el manejo del dolor agudo posterior a cirugía cardiotorácia de la Clínica de Dolor de la Fundación Cardiovascular del Oriente Colombiano, específicamente en el uso de bombas para analgesia controlada por el paciente (PCA). En él se muestra como la variabilidad en las dosis requeridas de analgésicos opioides tipo morfina es extremadamente grande y difícil de predecir, por lo que se necesita un método de administración oportuno, eficaz y flexible para lograr el adecuado control del dolor postoperatorio. Así mismo, demuestra como la utilización de bombas de PCA proporciona una buena calidad de analgesia con una incidencia mínima de efectos adversos o secundarios y sin reportar ningún efecto adverso grave tal como depresión respiratoria

Tratamiento quirúrgico de la estenosis esofágica por reflujo / Surgical treatment of the reflux esophageal stenosis

Se presentan los resultados de las operaciones de 70 pacientes con estenosis esofágica benigna por reflujo gastroesofágico. El tratamiento quirúrgico se dividió en cuatro categorías: a) Procedimientos reconstructivos (64.2 por ciento) b) procedimientos resectivos (17.2 por cinto) c) Procedimientos derivativos (14.2 por ciento) d) Procedimientos alternos (4.2 por ciento). La morbilidad perioperatoria fue de 4.2 por ciento y la mortalidad de 1.4 por ciento. La evaluación postoperatoria se hizo a 12.6 meses en promedio y 7/70 pacientes tuvieron que reintervenirse por persistencia del reflujo y la estenosis. Consideramos que el paciente con estenosis esofágica por reflujo debe estudiarse cuidadosamente. Es deseable rehabilitar el esófago hasta donde sea posible y dejar los procedimientos resectivos como último recursos. El seguimiento postoperatorio necesariamente debe hacerse a largo plazo.

Evalución nutricional preoperatoria como indicador de pronóstico en cirugía mayor electiva: resultados preliminares / Preoperative nutritional assessment as prognostic indicator in elective major surgery: preliminary results

Se realizó un estudio prospectivo con la finalidad de determinar la utilidad de la evaluación nutricional preoperatoria como índice pronóstico en cirugía mayor electiva. Utilizamos los siguientes parámetros: Porciento del peso corporal ideal y del peso corporal habitual, perímetro mesobraquial, pliegue cutáneo a nivel del tríceps, área muscular del brazo, albúmina sérica, transferrina sérica, cuenta de linfocitos periféricos totales y pruebas cutáneas de sensibilidad a antígenos comunes. Se estudiaron con 25 pacientes en quienes se realizó cirugía del aparato digestivo, con morbilidad del 20% y mortalidad del 16%. Los parámetros con significancia estadística como índice pronóstico fueron: El porciento del peso corporal habitual (p <.05), la albúmina sérica (p <.03) y las pruebas cutáneas de sensibilidad (p <.005). Nuestros resultados preliminares coinciden con los publicados en la literatura mundial

Neoplasias del aparato digestivo. Revision de 70,055 casos de material quirurgico y necropsias. / Digestive system neoplasms.Review of 70,055 cases of surgical specimens and necropsies

El cancer del aparato digestivo es una causa frecuente de mortalidad, sin embargo su prevalencia en nuestro medio se desconece. En este trabajo se informan los resultados obtenidos en un analisis retrospectivo de 70,055 estudios histopatologicos; 61,533 correspondieron a material quirurgico-biopsia o pieza operatoria - de cinco anos (1975-1980), de ellos 673 (1.09%) presentaban proceso neoplasico maligno del aparato digestivo; los restantes 8, 522 correspondieron o protocolos de necropsia de 20 anos (1960-1980) en los que 352 (4.13%) presentaban igual patologia.Tanto en piezas operatorias como en necropsias la variedad histologica mas frecuente fue el carcinoma 82.6% y 92.8% respectivamente, seguida del linfoma. Por lo que hace a la localizacion del proceso los resultados varian igualmente segun el material motivo de estudio; en piezas operatorias los carcinomas mas frecuentes fueron: estomago (37.95%), vesicula y vias biliares (24.29%), colon (19.25%); mientras que al estudiar el material de necropsias la frecuencia fue: vesiculas y vias biliares (35.47%) pancreas (22.62%) y estomago (18.45%).Se senalan aspectos epidemiologicos, clinicos y terapeuticos de las neoplasias mas frecuentes informadas en esta revision

Colangitis aguda supurada. / Acute suppurative cholangitis

Se analizo retrospectivamente la experiencia del Hospital de Especialidades del Centro Medico La Raza con veinticuatro pacientes con colangitis obstructiva supurada aguda tratados de Abril de 1979 a Agosto de 1981. El 84% de los casos tenia etiologia benigna; embargo, la morbilidad fue de 38% y, aunque la mortalidad de toda la serie fue de 8%, en los casos con septicemia fue de 29%. Se encontro que el caracter supurativo de la colangitis no necesariamente se anuncia con un cuadro clinico tipico, que la presencia de pus en la via biliar y la diseminacion de la infeccion dependen del tiempo de evolucion y que si bien el tratamiento medico preoperatorio mejora el pronostico, cuando las condiciones clinicas del enfermo permiten instituirlo, el tratamiento definitivo es el drenaje del coledoco y no debe soslayarse mas alla del lapso indispensable para hacer el diagnostico de la enfermeda

Tratamiento quirurgico de la hernia hiatal: analisis de tres anos. / Surgical treatment of hiatal hernia: analysis of 3 years

La hernia hiatal es un padecimiento frecuente, con manifestaciones clinicas variables; generalmente su tratamiento es medico-dietetico, pero cuando este fracasa o aparecen complicaciones el tratamiento debe ser quirurgico. En un lapso de tres anos se atendieron 92 enfermos con hernia hiatal, a quienes se les efectuaron 97 intervenciones quirurgicas. En 74 pacientes la hernia fue por deslizamiento, en seis paraesofagico, en tres mixta y en nueve enfermos se establecio el diagnostico de esofago de Barret. La via de abordaje fue abdominal en 80, toracica en 14 y toraco-abdominal en tres, los procedimientos quirurgicos realizados fueron: cierre de pilares 84, funduplastia posterior 62, funduplastia completa 29, dilataciones transoperatorias 19, gastrostomia seis, plastia tipo Belsey tres, anastomosis esofago gastrica dos y parche de Thal uno.Los resultados fueron buenos en 80 enfermos, regulares en ocho y malos en cuatro que fallecieron, dos por complicaciones quirurgicas inmediatas y dos por complicaciones cardiovasculares. Concluimos que el tratamiento quirurgico oportuno, antes de que aparezcan complicaciones, eligiendo la tecnica mas adecuada de acuerdo con las condiciones particulares de cada enfermo, mejora el pronostico, en cambio la mayor edad, obesidad, recidiva y estenosis, favorecen la aparicion de complicaciones