Assessment of Risk for Ventricular Tachycardia based on Extensive Electrophysiology Simulations.

Patients that have suffered a myocardial infarction are at high risk of developing ventricular tachycardia. Patient stratification is often determined by characterization of the underlying myocardial substrate by cardiac imaging methods. In this study, we show that computer modeling of cardiac electrophysiology based on personalized fast 3D simulations can help to assess patient risk to arrhythmia. We perform a large simulation study on 21 patient digital twins and reproduce successfully the clinical outcomes. In addition, we provide the sites which are prone to sustain ventricular tachycardias, i.e, onset sites around the scar region, and validate if they colocalize with exit sites from slow conduction channels.Clinical relevance- Fast electrophysiological simulations can provide advanced patient stratification indices and predict arrhythmic susceptibility to suffer from ventricular tachycardia in patients that have suffered a myocardial infarction.

Long-term toxicity assessment of soils in a recovered area affected by a mining spill.

Residual pollution in the Guadiamar Green Corridor still remains after Aználcollar mine spill in 1998. The polluted areas are identified by the absence of vegetation, soil acidic pH and high concentrations of As, Pb, Zn and Cu. Soil toxicity was assessed by lettuce root elongation and induced soil respiration bioassays. In bare soils, total As and Pb concentrations and water-extractable levels for As, Zn and Cu exceeded the toxicity guidelines. Pollutants responsible for toxicity were different depending on the tested organism, with arsenic being most toxic for lettuce and the metal mixture to soil respiration. Soil properties, such as pH or organic carbon content, are key factors to control metal availability and toxicity in the area. According to our results, there is a risk of pollution to living organisms and the soil quality criteria established in the area should be revised to reduce the risk of toxicity.

Long-term contamination in a recovered area affected by a mining spill.

Soil pollution from the spill of Aznalcóllar mine (S Spain) was monitored by analysing polluted soils in 1998, 1999, and 2004. Following the methodology used in previous studies, in 2013 we conducted a new sampling and analysis of the soils affected by the spill and the data were compared with those of 2004. The results confirm that the pH tended to rise and concentration of pollutants tended to diminish over time. In 2013, the total concentration of pollutants was within the normal range for uncontaminated soils and close to the background concentration of the soils prior to the spill; while the soluble concentration of pollutants was clearly below the toxic level. These results indicate that remediation measures implemented have been effective. However, the removal of tailings (first remediation measure applied) was deficient and in many places the tailings were mixed with the soil. The high concentration of sulphides and metal(loid)s in the tailings gave rise to spots with very acidic and highly polluted soils devoid of vegetation. In 2013, fifteen years after the spill, these spots of bare soils remain a major source of pollution from which pollutants are scattered through the solid and liquid phases of runoff water, requiring action to immobilize pollutants and encourage the restoration of vegetation on these soils. In this type of pollution in a Mediterranean environment, the complete removal of tailings is more important than the speed at which they are removed.

[Evaluation of needle exchange program at Pereiro de Aguiar prison (Ourense, Spain): ten years of experience]. / Evaluación del Programa de Intercambio de Jeringuillas en el Centro Penitenciario de Pereiro de Aguiar (Ourense): diez años de experiencia.

OBJECTIVES: To evaluate the effectiveness of NEPs in prison to reduce the prevalence of infections associated with intravenous drug use and to know more about acceptance of the program by inmates and staff. MATERIAL AND METHODS: cross-sectional observational study at baseline, 6 and 12 months and 10 years of program development. Interviews were conducted with program users, as well as random sample surveys of officials at the various cuts, and a random sample of inmates from the centre after10 years. Activity indicators of the program were recorded continuously, and the prevalence of HIV, HBV and HCV at baseline and after 10 years was evaluated. For the statistical analysis, the chi-square test was used with the Yates correction when necessary. RESULTS: In ten years we have supplied a total of 15,962 syringes to 429 users, (average 20.2 users/month), and 11,327 (70.9%) were returned. The prevalence of HIV infection decreased from 21% in 1999 to 8.5% in 2009, HCV prevalence from 40% to 26.1% (p <0.01), finding no significant differences in the prevalence of HBsAg +. Most of the inmates and civil servants believe that the program did not increase intravenous drug use and improves hygienic living conditions in prison. CONCLUSIONS: After ten years of development of the NEP, there was a significant decrease in the prevalence of HIV and HCV in the prison population at the centre, and the program is accepted as beneficial by most of the inmates and staff participating in the survey.

Evaluación del Programa de Intercambio de Jeringuillas en el Centro Penitenciario de Pereiro de Aguiar (Ourense): diez años de experiencia / Evaluation of needle exchange program at Pereiro de Aguiar prison (Ourense, Spain): ten years of experience

Objetivos: Evaluar la eficacia de un programa de intercambio de jeringuillas (PIJ) en una prisión para reducir la prevalencia de infecciones asociadas al uso de drogas intravenosas, y conocer la aceptación del programa por internos y funcionarios del centro penitenciario. Material y métodos: Estudio observacional con cortes transversales al inicio, 6 y 12 meses y 10 años de desarrollo del programa. Se realizaron entrevistas a los usuarios del programa y encuestas a muestras accidentales de funcionarios en los distintos cortes, y a una muestra aleatoria de internos a los 10 años. Se registraron diariamente los indicadores de actividad del programa, y se valoró la prevalencia de infección por VIH, hepatitis B y C al inicio y a los 10 años. Para el análisis estadístico utilizamos la prueba ji-cuadrado con la corrección de Yates en caso necesario. Resultados: Durante estos diez años se suministraron 15.962 jeringuillas a 429 usuarios (media de 20,2 usuarios/mes), recuperándose 11.327 (70,9%). La prevalencia de infección por VIH pasó del 21% en 1999 al 8,5% en 2009, la de VHC del 40% al 26,1% (p<0,01). La mayoría de internos y funcionarios consideran que el programa no incrementa el consumo de drogas intravenosas y que mejora las condiciones higiénicas de vida en la prisión. Conclusiones: Tras diez años de PIJ, se observa un significativo descenso en la prevalencia de infección por VIH y por VHC en la población reclusa del centro, y el programa es aceptado como beneficioso por la mayoría de los internos y funcionarios encuestados(AU)

Objectives: To evaluate the effectiveness of NEPs in prison to reduce the prevalence of infections associated with intravenous drug use and to know more about acceptance of the program by inmates and staff. Material and methods: cross-sectional observational study at baseline, 6 and 12 months and 10 years of program development. Interviews were conducted with program users, as well as random sample surveys of officials at the various cuts, and a random sample of inmates from the centre after10 years. Activity indicators of the program were recorded continuously, and the prevalence of HIV, HBV and HCV at baseline and after 10 years was evaluated. For the statistical analysis, the chi-square test was used with the Yates correction when necessary. Results: In ten years we have supplied a total of 15,962 syringes to 429 users, (average 20.2 users/month), and 11,327 (70.9%) were returned. The prevalence of HIV infection decreased from 21% in 1999 to 8.5% in 2009, HCV prevalence from 40% to 26.1% (p <0.01), finding no significant differences in the prevalence of HBsAg +. Most of the inmates and civil servants believe that the program did not increase intravenous drug use and improves hygienic living conditions in prison. Conclusions: After ten years of development of the NEP, there was a significant decrease in the prevalence of HIV and HCV in the prison population at the centre, and the program is accepted as beneficial by most of the inmates and staff participating in the survey(AU)

Elimination of water pathogens with solar radiation using an automated sequential batch CPC reactor.

Solar disinfection (SODIS) of water is a well-known, effective treatment process which is practiced at household level in many developing countries. However, this process is limited by the small volume treated and there is no indication of treatment efficacy for the user. Low cost glass tube reactors, together with compound parabolic collector (CPC) technology, have been shown to significantly increase the efficiency of solar disinfection. However, these reactors still require user input to control each batch SODIS process and there is no feedback that the process is complete. Automatic operation of the batch SODIS process, controlled by UVA-radiation sensors, can provide information on the status of the process, can ensure the required UVA dose to achieve complete disinfection is received and reduces user work-load through automatic sequential batch processing. In this work, an enhanced CPC photo-reactor with a concentration factor of 1.89 was developed. The apparatus was automated to achieve exposure to a pre-determined UVA dose. Treated water was automatically dispensed into a reservoir tank. The reactor was tested using Escherichia coli as a model pathogen in natural well water. A 6-log inactivation of E. coli was achieved following exposure to the minimum uninterrupted lethal UVA dose. The enhanced reactor decreased the exposure time required to achieve the lethal UVA dose, in comparison to a CPC system with a concentration factor of 1.0. Doubling the lethal UVA dose prevented the need for a period of post-exposure dark inactivation and reduced the overall treatment time. Using this reactor, SODIS can be automatically carried out at an affordable cost, with reduced exposure time and minimal user input.

Use of modified Sandwich-graft technique to preserve hypogastric artery in EVAR treatment of complex aortic aneurysm anatomy.

AIM: Since the introduction of the first endoprosthetic devices, continuous development in techniques and implants has occurred, such as the introduction of a stent graft with branches designed to preserve antegrade flow in the hypogastric artery, a stent-graft designed to treat extreme neck angulation and iliac tortuosity, as well as "Sandwich" and "Chimney" techniques used to maintain perfusion in branch vessels originating in the region to be treated. This paper describes how the Sandwich-Graft technique was adapted, as described by Lobato et al., employing the Aorfix™ system (Lombard Medical) and the Viabahn™ (W.L.Gore) to preserve hypogastric flow in cases with extreme neck angulation and iliac tortuosity. METHODS: The study included four patients treated from April 2010 until November 2010 with the modified Sandwich technique. All patients eligible for this approach were considered unfit for open repair and were not suitable for an iliac branch graft (Z-BIS Zenith™ Cook Medical). RESULTS: A bifurcated endograft was implanted with specific, in-situ, branching to the target hypogastric artery and achieved clinical and technical success, in all the patients. After a 11-month follow-up in two cases and a six-month follow-up in the other two, clinical results were successful. All patients were endoleak-free, had patent hypogastric branches and had shrinking or stable aneurysms. CONCLUSION: The initial experience shows that the Sandwich technique with the Aorfix™ stent-graft demonstrated to be effective in endovascular repair of abdominal aortic aneurysms in patients with aortoiliac anatomy hostile to preserving hypogastric artery patency. This graft allows a broader group of patients to be treated with endovascular repair without potential complications of hypogastric artery occlusion; however, further studies are needed to evaluate long-term results in larger numbers of patients.

[Retinal autofluorescence imaging in patients with pseudoxanthoma elasticum]. / Imágenes funduscópicas con autofluorescencia en pacientes con pseudoxantoma elástico.

PURPOSE: To evaluate the autofluorescence findings in patients diagnosed with pseudoxanthoma elasticum. MATERIAL AND METHODS: A prospective study was conducted on 18 eyes of 9 patients who had ocular pathology andfollowed up in the pseudoxanthoma elasticum (PSX) unit of our hospital. We evaluated the best corrected visual acuity (BCVA), colour and autofluorescence photography (AF), and fluorescein angiography (FA) in patients with choroidal neovascularitation. RESULTS: Of the 9 patients, 7 were women and 2 were men. The mean age was 40 +/- 14 years. The BCVA ranged from 1 to 0.01 (Mean 0.65 +/- 0.4). All patients showed PSX injuries. Angioid streaks (AS) 18 (100%), peau d'orange 16 (87.5%) and pigmented fibrotic plates 5 (31,5%). We observed different hypoautofluorescence patterns (RPE atrophy), of which 2 of them were AS patterns (irregular lines with hyperautofluorescence speckled in its interior and edges, or bands with lobulated lesions inside and hyperautofluorescence at the edges), and finally widespread areas of hypoautofluorescence, larger than observed by ophthalmoscope. CONCLUSIONS: Autofluorescence in patients with PSX is an easy method to evaluate the initial level of ophthalmoscopic involvement and its subsequent progression. The extensive changes in the retinal pigment epithelium (RPE) suggests the important role of this in the physiopathology of the disease.

Imágenes funduscópicas con autofluorescencia en pacientes con pseudoxantoma elástico / Retinal autofluorescence imaging in patients with pseudoxanthoma elasticum

PropósitoEvaluar las lesiones funduscópicas con autofluorescencia en pacientes diagnosticados de pseudoxantoma elástico (PSX).Material y métodoSe realizó un estudio prospectivo de 9 pacientes (18 ojos), en seguimiento por la unidad de PSX de nuestro hospital, que presentaban dolencia ocular. Evaluamos mejor agudeza visual corregida (MAVC), fotografía en color y con autofluorescencia (FA), así como angiografía fluoresceínica (AFG) en los casos que presentaban neovascularización coroidea (NVC).ResultadosDe los 9 pacientes, 7 eran mujeres y 2 hombres. Edad media de 40,5 +/- 14, MAVC desde la 1 a 0,01 (media=0,65 +/- 0,4). Todos los pacientes (18 ojos) presentaban lesiones del PSX: estrías angioides (EA) en 18 (100%), fondo en «piel de naranja» en 16 (87,5%) y placas fibrogliales pigmentadas en 5 ojos (31,5%). Observamos diferentes patrones de hipoautofluorescencias (atrofia de epitelio pigmentario), dos que se corresponderían a EA (líneas anfractuosas con moteado hiperautofluorescente en su seno y bordes, o bien bandas con lesiones lobuladas en su seno e hiperautofluorescencia en sus bordes) y por último grandes placas hipoautofluorescentes, de mayor tamaño que las observadas funduscópicamente.ConclusionesLa autofluorescencia en los pacientes con PSX es un método fácil para valorar el grado de afectación funduscópica inicial y su posterior evolución. La gran afectación del epitelio pigmentario retiniano (EPR), que hemos observado, nos sugiere el importante papel que juega este, en la fisiopatología de esta enfermedad(AU)

PurposeTo evaluate the autofluorescence findings in patients diagnosed with pseudoxanthoma elasticum.Material and methodsA prospective study was conducted on 18 eyes of 9 patients who had ocular pathology andfollowed up in the pseudoxanthoma elasticum (PSX) unit of our hospital. We evaluated the best corrected visual acuity (BCVA), colour and autofluorescence photography (AF), and fluorescein angiography (FA) in patients with choroidal neovascularitation.ResultsOf the 9 patients, 7 were women and 2 were men. The mean age was 40 +/- 14 years. The BCVA ranged from 1 to 0.01 (Mean 0.65 +/- 0.4).All patients showed PSX injuries. Angioid streaks (AS) 18 (100%), peau d‘orange 16 (87.5%) and pigmented fibrotic plates 5 (31,5%). We observed different hypoautofluorescence patterns (RPE atrophy), of which 2 of them were AS patterns (irregular lines with hyperautofluorescence speckled in its interior and edges, or bands with lobulated lesions inside and hyperautofluorescence at the edges), and finally widespread areas of hypoautofluorescence, larger than observed by ophthalmoscope.ConclusionsAutofluorescence in patients with PSX is an easy method to evaluate the initial level of ophthalmoscopic involvement and its subsequent progression. The extensive changes in the retinal pigment epithelium (RPE) suggests the important role of this in the physiopathology of the disease(AU)

Hybrid approach to AAA: bilateral "banana" technique to preserve hypogastric artery in complex anatomy aorto-biiliac aneurysm.

UNLABELLED: The surgical approach for hypogastric preservation in aorto-iliac aneurysm (AAA) open repair (OR) has been described and performed with different techniques but all of them represent a higher mortality and potencial complications to the procedure; this is even more critical in bilateral disease. Since the introduction of the first endograft, a continuous development has occurred, such as the stent graft with specific branch designed for preserving antegrade flow in the hypogastric artery. On highly angulated and tortuous iliac anatomies, the use of Sandwich-Graft technique, as described by Armando Lobato, represents a valid alternative to iliac branch. The hybrid approach could be a good treatment option in young patients with AAA affecting hypogastric arteries. PATIENTS AND METHODS: We present the technical description and a case report of bilateral "banana" technique perfor- med with flexible covered stent (Viabahn(®) WL Gore) to preserve both hypogastric arteries combined with open repair in a 52 years old patient. Technical report and Results: A bilateral retrograde endograft was implanted from both external ilac arteries to hypo- gastric artery excluding bilateral common iliac aneurysms followed by an open repair to the AAA (aneurismectomy + aorto bifemoral by-pass) with good inmediate and short-midterm follow up (12 months) CONCLUSIONS: This hybrid technique could be a good approach to hypogastric preservation in low risk and young patients reducing potencial complications of hypogastric artery oclusion.

Solar disinfection of fungal spores in water aided by low concentrations of hydrogen peroxide.

Our previous contribution showed that Fusarium solani spores are inactivated by low amounts of hydrogen peroxide (lower than 50 mg L(-1)) together with solar irradiation in bottles. The purpose of the current study was to evaluate the effectiveness of solar H(2)O(2)/UV-Vis in distilled water and simulated municipal wastewater treatment plant effluent (SE) contaminated with chlamydospores of Fusarium equiseti in a 60 L solar CPC photo-reactor under solar irradiation. This study showed that F. equiseti chlamydospores in distilled and simulated municipal wastewater effluent were inactivated with 10 mg L(-1) of H(2)O(2) in a 60 L CPC photoreactor. F. equiseti chlamysdospore concentration decreased from 325 (±70) CFU mL(-1) to below the detection limit (DL=2 CFU mL(-1)) within five hours of solar exposure in a solar bottle reactor and from 180 (±53) CFU mL(-1) to below the detection limit in distilled water within two hours of solar irradiation in the solar CPC reactor. These results demonstrate that the use of low concentrations of hydrogen peroxide and CPC systems may be a good alternative for disinfection of resistant microorganisms in water.

Búsqueda de neoplasia oculta asociada a trombosis venosa profunda idiopática / Screening of hidden neoplasm in idiophatic deep venous thrombosis

Introducción. La dificultad de cualquier programa de detección de patología oculta estriba en encontrar una prueba diagnóstica sensible, específica, inocua y barata. Objetivo. Evaluar la eficacia diagnóstica de un protocolo diagnóstico (concreto) de cáncer oculto en pacientes ingresados por trombosis venosa profunda (TVP) idiopática. Pacientes y métodos. Estudio prospectivo sobre 209 pacientes consecutivos, con edad igual o menor a 80 años, diagnosticados de TVP idiopática mediante técnicas de imagen, entre enero 1995 y diciembre 1999. La distribución por sexos fue: 128 varones y 81 mujeres. Realizamos una búsqueda de neoplasia oculta ampliando el protocolo básico (historia clínica y pruebas diagnósticas básicas) mediante ecografía abdominopélvica y marcadores biológicos tumorales. El seguimiento clínico (repitiendo pruebas diagnósticas si era necesario) se llevó a cabo a los 3, 6, 12 y 24 meses (media: 21,2 meses), se produjeron 11 pérdidas de seguimiento (5,6 por ciento). Resultados. Se encontraron 14 neoplasias ocultas (6,7 por ciento). Seis presentaban algún síntoma o signo clínico de sospecha. El primer signo de alarma fue: ecografía en 6 casos, marcadores tumorales positivos en 6 ( 3 prostáticos, 2 CEA, Ca 195 y uno Ca 19,9, Ca 125) y radiografía de tórax en 2. Ocho de 14 (57,14 por ciento) con enfermedad metastásica al diagnóstico. Falsos positivos: 3 ecografías y 12 marcadores tumorales sin tumor en investigación posterior o seguimiento. En el seguimiento, solo un tumor no fue detectado inicialmente. Conclusiones. El porcentaje de tumores detectados (6,7 por ciento) y de tumores en estadio temprano (43,8 por ciento) justifica el protocolo diagnóstico establecido de cáncer oculto. La sensibilidad del protocolo diagnóstico fue del 93,33 por ciento (14/15). Casuísticas más amplias podrían acotar la sistemática futura en la investigación de tumores ocultos asociados a TVP idiopática (AU)

Variación genética y enfermedad aterosclerótica periférica: estudio preliminar / Genetic variability and peripheral atherosclerotic disease: a preliminary study

Objetivo. Definir la asociación entre variaciones de genes específicos y enfermedad aterosclerótica periférica en pacientes jóvenes. Pacientes y métodos. Estudio prospectivo observacional. Tres grupos: 50 pacientes menores de 50 años con enfermedad aterosclerótica periférica objetivada mediante exploración física, índices tobillo/brazo y ecografía Doppler; grupo control de 240 voluntarios sanos, y grupo control de 181 pacientes coronarios (ambos menores de 50 años, con exploración vascular periférica normal). Análisis genético de polimorfismos de los genes de la enzima convertidora de angiotensina, receptores tipo I y II de la angiotensina, angiotensinógeno, óxido nítrico-sintetasa y metilentetrahidrofolato-reductasa; se comparan sus frecuencias en los pacientes con enfermedad aterosclerótica periférica en conjunto y por sectores (extremidades inferiores; extremidades inferiores + aorta; extremidades inferiores + aorta + carótidas) respecto a los grupos control. Resultados. No se aprecian diferencias estadísticamente significativas entre controles sanos y enfermos periféricos. Por sectores se observa diferencia en el gen del angiotensinógeno (sector extremidades inferiores + aorta + carótidas mayor presencia del genotipo TT: 66,6 por ciento frente a 33,3 por ciento; p= 0,06). Con la comparación de la afectación periférica y coronaria se observan diferencias estadísticamente significativas en el polimorfismo del gen de la enzima convertidora de la angiotensina, global (DD 50 por ciento en coronario frente a 28 por ciento en periférico; p= 0,0063 OR 2,54; 95 por ciento IC= 1,28-5,00) y por sectores (ID 85,7 por ciento en extremidades inferiores + aorta y 87,5 por ciento en extremidades inferiores + aorta + carótida frente a 14,3 y 12,5 por ciento, respectivamente, en coronarios; p< 0,01). Conclusiones. Se trata de un estudio preliminar con un número reducido de pacientes. Sugerimos que el sector de aparición de enfermedad aterosclerótica (coronario o arterial periférico en sus diversas localizaciones) podría estar predeterminado genéticamente (AU)