Comparison of the Use of Desflurane vs. Propofol in Aortic Valve Replacement Surgery: Differences in Nephroprotection: An Explorative and Hypothesis-Generating Study.

Introduction: The cardioprotective effect of halogenated drugs in cardiac surgery has been the subject of several studies. However, there is scarcity of data on their potential nephroprotective effects. Aortic valve replacement and coronary revascularization are the most frequent cardiac surgery procedures. The objective of this explorative study was to examine the effect of desflurane vs. propofol on renal function, when administered in aortic valve replacement surgery, including the extracorporeal circulation period. Method: A quasi-experimental prospective study was performed in 60 patients, who were allocated to receive either desflurane or propofol intraoperatively during aortic valve replacement surgery. As a hypnotic, group 1 received propofol, whereas group 2 received desflurane. Markers of renal function and level of cardiac preservation were determined based on biochemical parameters (troponin I, NTProBNP). Results: In the propofol group, there were significant variations between postoperative values of urinary NGAL and creatinine and baseline values. In contrast, no variations were found in the desflurane group in terms of hemodynamic parameters and myocardial damage. Conclusions: The use of propofol vs. desflurane during aortic valve replacement surgery is associated with a decrease in renal function.

Heart Failure after Cardiac Surgery: The Role of Halogenated Agents, Myocardial Conditioning and Oxidative Stress.

Heart disease requires a surgical approach sometimes. Cardiac-surgery patients develop heart failure associated with ischemia induced during extracorporeal circulation. This complication could be decreased with anesthetic drugs. The cardioprotective effects of halogenated agents are based on pre- and postconditioning (sevoflurane, desflurane, or isoflurane) compared to intravenous hypnotics (propofol). We tried to put light on the shadows walking through the line of the halogenated anesthetic drugs' effects in several enzymatic routes and oxidative stress, waiting for the final results of the ACDHUVV-16 clinical trial regarding the genetic modulation of this kind of drugs.

Risk factors associated with tongue lesions: a propensity score-matched case-control study

Background: to analyse the potential risk factors of tongue lesions, comparing the results with a control group. Material and Methods: An observational, case-control study was designed. The study included a case group comprising 336 patients with tongue lesions and 336 sex and age-matched controls. We recorded tobacco/alcohol habits, presence of dentures, allergies, medical conditions, and medications. Statistical analysis was performed via logistic regression models to estimate the odds ratio (OR) adjusted for gender, age, tobacco, and alcohol using propensity score-matching analysis (PSM). Results: According to the final PSM model, patients with tongue lesions were more likely to suffer from allergies (OR 2.13; 1.27-3.66) or medical conditions (OR 2.14; 1.19-3.85), and more likely to take medication (OR 1.99; 1.11-3.57). Elderly individuals were more prone to hairy tongue (OR 3.82; 1.53-10.47). Smoking was associated with coated tongue (OR 2.05; 1.12-3.63), hairy tongue (OR 3.77; 1.52-9.22) and median rhomboid glossitis (OR 40.49; 5.84-860.43). Allergic individuals were more likely to exhibit sublingual varices (OR 1.73; 1.02-2.88). Medical conditions increased the chances of having coated tongue (OR 2.44; 1.36-4.64) or crenated tongue (OR 2.70; 1.42-5.30). Arterial hypertension was associated with median rhomboid glossitis (OR 5.85; 1.08-34.18). Individuals on medication showed a higher risk of fissured tongue (OR 1.87; 1.20-2.94) and varices (OR 2.42; 1.58-3.80). Agents acting on the alimentary tract and metabolism increased the probability of fissured tongue (OR 2.31; 1.42-3.79). Conclusions: As far as we are aware, this is the first study on lingual pathology to include a PSM analysis. The results suggest that a history of allergies, the presence of medical conditions, and the use of medication are associated with increased probability of tongue lesions. The analysis of diseases and medications by subgroups requires studies matched by habits with larger sample sizes, in order to corroborate our observations.(AU)

Identification of miRNAs as Biomarkers of Cardiac Protection in Non-Genetically Modified Primary Human Cardiomyocytes Exposed to Halogenated Hypnotics in an In Vitro Model of Transfection and Ischemia/Reperfusion: A New Model in Translational Anesthesia.

BACKGROUND: Many clinical studies have identified some circulating micro-RNAs (miRNAs) as potential biomarkers with regard to the cardioprotective effects of halogenated agents administered perioperatively during myocardial conditioning procedures. However, there is a major methodological difficulty in identifying these potential miRNA targets in cardiac cells. METHODS: We developed an in vitro protocol to analyze the differential expression of target miRNAs at the intracellular level in non-genetically modified primary human cardiomyocytes (HCMs) through their exposure to different hypnotic compounds (i.e., halogenated versus non-halogenated). For this purpose, we performed a validated in vitro model of "ischemia and reperfusion" with the transfection of specific miRNA mimics (MIMICs) designed to simulate naturally occurring mature miRNAs as a functional study. Afterwards, next-generation sequencing (NGS) was used to identify and quantify miRNAs and elucidate their function. The differences in miRNA expression between HCMs exposed to different hypnotic drugs, along with the prediction of functional miRNA targets, were assessed using a meticulous in-house bioinformatics pipeline in order to derive diagnostic biomarkers and possible therapeutic targets. CONCLUSION: In brief, this methodological procedure was designed to investigate whether the cardioprotective effects of halogenated agents are a phenomenon mediated by either the activation or the suppression of miRNAs targeted by halogenated anesthetics.

Mesityl(amidinato)tetrylenes as ligands in iridium(i) and iridium(iii) complexes: silicon versus germanium and simple κ1-coordination versus cyclometallation.

Reactions of the mesityl(amidinato)tetrylenes E(tBu2bzam)Mes (tBu2bzam = N,N'-bis(tert-butyl)benzamidinate; Mes = mesityl; E = Ge (1Ge), Si (1Si)) with the iridium precursors [Ir2(µ-Cl)2(η4-cod)2] (cod = 1,5-cyclooctadiene) and [Ir2Cl2(µ-Cl)2(η5-Cp*)2] (Cp* = 1,2,3,4,5-pentamethylcyclopentadienyl) at room temperature led to simple coordination of the tetrylene in the case of the germylenes ([IrCl(η4-cod){κ1Ge-Ge(tBu2bzam)Mes}] (2Ge) and [IrCl2(η5-Cp*){κ1Ge-Ge(tBu2bzam)Mes}] (3Ge), respectively, but to cyclometallated products in the case of the silylenes ([IrHCl(η4-cod){κ2C,Si-Si(tBu2bzam)CH2C6H2Me2}] (4Si) and [IrCl(η5-Cp*){κ2C,Si-Si(tBu2bzam)CH2C6H2Me2}] (5Si), respectively. While the cyclometallation of the germylene ligand of the iridium(i) complex 2Ge could not be achieved by heating this complex in toluene at 90 °C, a similar treatment of the iridium(iii) complex 3Ge led to [IrCl(η5-Cp*){κ2C,Ge-Ge(tBu2bzam)CH2C6H2Me2}] (5Ge), which is the germanium analogue of 5Si. DFT calculations have shown that the mononuclear κ1E-tetrylene iridium(i) complexes [IrCl(η4-cod){κ1E-E(tBu2bzam)Mes}] (E = Si, Ge; isolated only for E = Ge, 2Ge) should not participate as intermediates in the synthesis of the cyclometallated iridium(iii) derivatives [IrHCl(η4-cod){κ2C,E-E(tBu2bzam)(CH2C6H2Me2)}] (E = Ge, Si; isolated only for E = Si, 4Si).

Two Types of σ-Allenyl Complexes from Reactions of Silylenes and Germylenes with Chromium Fischer Alkynyl(alkoxy)carbenes.

The reactivity of amidinatotetrylenes of the type E(tBu2 bzm)R1 (E=Si, Ge; tBu2 bzm=N,N'-bis(tertbutyl)benzamidinate; R1 =alkyl or aryl) with the chromium Fischer alkynylcarbene complexes [Cr{C(OEt)C2 R2 }(CO)5 ] (R2 =Ph; ferrocenyl, Fc) has been studied. At room temperature, two different reaction pathways have been identified: (a) attack of the amidinatotetrylene to the alkynyl C2 atom (γ-attack), which leads to σ-allenyl complexes in which the original Ccarbene atom maintains its attachment to the Cr(CO)5 and OEt groups (compounds 3 E - R 1 - R 2 ), and (b) attack of the amidinatotetrylene to the Ccarbene atom (α-attack), which ends in σ-allenyl complexes in which the original Ccarbene atom is not attached to the metal atom and has been inserted into an E-N bond of the amidinatotetrylene forming an E-C-N-C-N five-membered ring (compounds 4 E - R 1 - R 2 ). It has been found that compounds 3 E - R 1 - R 2 are thermodynamically less stable than their corresponding 4 E - R 1 - R 2 isomers and that some of the former (E=Ge; R1 =CH2 SiMe3 ) can be transformed into the latter upon heating. At high temperatures (>70 °C) the reactions involving bulky amidinatotetrylenes (R1 =Mes, tBu) end in the carbene-substitution products [Cr{E(tBu2 bzm)R1 }(CO)5 ].

Association between geographic tongue and psoriasis: A systematic review and meta-analyses.

Geographic tongue (GT) has been described as a predictor of psoriasis. The objective of this study was to analyse the prevalence of GT in psoriatic and non-psoriatic patients. For this purpose, we conducted a systematic review and meta-analysis. A literature search was performed on PubMed, Embase, Web of Science and the Cochrane Database of Systematic Reviews. The search and selection process was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria. Only case-control studies were selected, and the prevalence of GT in both groups was compared. Eleven articles met the inclusion criteria, and the frequency of GT was statistically associated with psoriasis in ten studies. The pooled odds ratio (OR) was 3.53 (95% confidence interval [CI] 2.56-4.86). There were no significant differences between the presence of GT and the clinical form. However, the Psoriasis Area and Severity Index (PASI) score was statistically higher in patients affected by GT in three of four studies. Psoriatic patients with GT also exhibited less improvement in the PASI score after treatment. One study found an association between GT and a negative impact on patients' quality of life. Nevertheless, age, gender, toxic habits, psoriasis onset and duration of the disease were not clearly associated. The results support the concept of GT as a manifestation of psoriasis. Future research should focus on the repercussions of GT in psoriatic patients, due to the negative consequences on severity and treatment response.

Reversible Carbene Insertion into a Ge-N Bond and Insights into CO and Carbene Substitution Reactions Involving Amidinatogermylenes and Fischer Carbene Complexes.

The formation of the five-membered-ring germylene complexes [M(CO)5 {Ge(tBu2 bzamC(OEt)Me)tBu}] (3M ; M=Cr, W), which occurs readily at room temperature from the germylene Ge(tBu2 bzam)tBu (1tBu ) and Fischer carbenes [M(CO)5 {C(OEt)Me}] (2M ; M=Cr, W), has been found to be reversible. Upon heating at 60 °C, complexes 3M undergo epimerization to an equilibrium mixture of 3M and 3'M . At that temperature, the chromium epimers (but not the tungsten ones) release CO to end in the mixed germylene-Fischer carbene complexes [Cr(CO)4 {C(OEt)Me}{Ge(tBu2 bzam)tBu}] (cis-4Cr and trans-4Cr ). The latter decompose at 120 °C to [Cr(CO)5 {Ge(tBu2 bzam)tBu}] (6Cr ). Because the formation of cis-4Cr and trans-4Cr from 3Cr or 3'Cr requires the presence of free 1tBu and 2Cr in the reaction solutions, the reactions of 1tBu with 2M to give 3M (and 3'M at 60 °C) should be reversible. This proposal has been proven by germylene-exchange crossover reactions in which free 1tBu and [M(CO)5 {Ge(tBu2 bzamC(OEt)Me)CH2 SiMe3 }] (5'M ; M=Cr, W) were formed when complexes 3M were treated at room temperature with the germylene Ge(tBu2 bzam)CH2 SiMe3 (1tmsm ). A clear differential behavior between N-heterocyclic carbenes (NHCs) and amidinatogermylenes (1tBu and 1tmsm ) in their reactivity against group 6 metal Fischer carbene complexes is demonstrated. The higher electron-donor capacity of amidinatogermylenes with respect to NHCs and the bias of the former to get involved in ring expansion processes are responsible for this differential behavior.

Unexpected Zwitterionic Allenyls from Silylenes and a Fischer Alkynylcarbene: A Remarkable Silylene-Promoted Rearrangement.

The silylenes Si(tBu2 bzam)R (tBu2 bzam=N,N'-bis(tertbutyl)benzamidinate; R=mesityl, CH2 SiMe3 ) attack the Ccarbene atom of the Fischer alkynyl(ethoxy)carbene complex [W(CO)5 {C(OEt)C2 Ph}] to give, after a striking rearrangement, zwitterionic σ-allenyl complexes in which the original carbene C atom forms part of the allene C3 fragment and also of a Si-C-N-C-N five-membered ring after insertion into a Si-N bond of the original amidinatosilylene. These remarkable allenyl products, which contain two stereogenic groups, are selectively formed as single diastereomers.

Tratamiento del liquen plano oral. Revisión sistemática y protocolo de actuación / Treatment of oral lichen planus. Systematic review and therapeutic guide

En la presente revisión sistemática se analizaron 55 artículos estructurados sobre la eficacia terapéutica frente al dolor y a los signos clínicos del liquen plano oral (LPO). La búsqueda bibliográfica se elaboró siguiendo los criterios del sistema PRISMA, seleccionando los ensayos realizados mediante alguno de los siguientes diseños metodológicos: entre fármaco (principio activo) vs. mismo fármaco en diferente excipiente o concentración, fármaco vs. diferente principio activo, fármaco vs. fitoterapia y fármaco vs. tratamiento con fototerapia. Basándonos en los resultados se propone un algoritmo que sirva de guía para establecer el tratamiento del LPO en sus formas clínicas atrófica y erosiva. Se destaca el empleo del propionato de clobetasol al 0,025-0,05% de aplicación tópica como primera alternativa terapéutica. En segundo lugar, el tacrolimús al 0,1% y pimecrolimús al 1% también formulado para su pauta tópica. Y, finalmente, se aborda el empleo de corticosteroide sistémico y la aplicación de láser de diodo (AU)

In this systematic review, 55 structured articles on the therapeutic efficacy against pain and clinical signs of oral lichen planus (OLP) were analysed. The literature search was developed according to the criteria of the PRISMA system, selecting the tests performed using one of the following methodological designs: drug (active ingredient) vs. drug in different excipient or concentration, drug vs. different active principle, drug vs. phytotherapy and drug vs. treatment with phototherapy. Based on the results, an algorithm is proposed to guide the treatment of OLP in its atrophic and erosive clinical forms. The use of clobetasol propionate at 0.025-0.05% of topical application as the first therapeutic alternative is highlighted. Secondly, 0.1% tacrolimus and 1% pimecrolimus also formulated for its topical regimen. And finally, we address the use of systemic corticosteroids and the application of diode lasers (AU)

Facile cyclometallation of a mesitylsilylene: synthesis and preliminary catalytic activity of iridium(iii) and iridium(v) iridasilacyclopentenes.

Reactions of the mesityl-amidinato-silylene Si(tBu2bzam)Mes (1; tBu2bzam = N,N'-bis(tert-butyl)benzamidinato; Mes = mesityl) with three different iridium precursors led, at room temperature, to two iridium(iii) and one iridium(v) complexes featuring one (IrIII) or two (IrV) cyclometallated silylene ligands. The iridium(iii) complexes are active catalyst precursors for H/D exchange and dehydrogenative borylation of arene C-H bonds.

Treatment of oral lichen planus. Systematic review and therapeutic guide. / Tratamiento del liquen plano oral. Revisión sistemática y protocolo de actuación.

In this systematic review, 55 structured articles on the therapeutic efficacy against pain and clinical signs of oral lichen planus (OLP) were analysed. The literature search was developed according to the criteria of the PRISMA system, selecting the tests performed using one of the following methodological designs: drug (active ingredient) vs. drug in different excipient or concentration, drug vs. different active principle, drug vs. phytotherapy and drug vs. treatment with phototherapy. Based on the results, an algorithm is proposed to guide the treatment of OLP in its atrophic and erosive clinical forms. The use of clobetasol propionate at 0.025-0.05% of topical application as the first therapeutic alternative is highlighted. Secondly, 0.1% tacrolimus and 1% pimecrolimus also formulated for its topical regimen. And finally, we address the use of systemic corticosteroids and the application of diode lasers.