Resultados de la ablación con catéter con mínimo o nulo empleo de fluoroscopia en pacientes pediátricos con taquiarritmias supraventriculares / Results of catheter ablation with zero or near zero fluoroscopy in pediatric patients with supraventricular tachyarrhythmias

Introducción y objetivos: La exposición a radiación ionizante en los procedimientos de ablación conlleva riesgos para la salud, sobre todo en pacientes pediátricos. Nuestro objetivo es comparar la seguridad y la eficacia de la ablación guiada por un sistema de navegación intracardiaca no fluoroscópica (SNINF) con las de la ablación guiada exclusivamente por fluoroscopia en pacientes pediátricos. Métodos: Se analizaron los resultados de la ablación con catéter en pacientes pediátricos con vías accesorias de riesgo o taquicardias supraventriculares remitidos a nuestro centro en un periodo de 6 años. Se compararon los procedimientos guiados solo por fluoroscopia (grupo A) y los guiados por SNINF (grupo B). Resultados: Se analizaron 120 procedimientos de ablación en 110 pacientes (edad, 11±3,2 años; el 70% varones), 62 procedimientos en el grupo A y 58 en el grupo B. No se encontraron diferencias significativas entre ambos grupos en éxito del procedimiento (el 95% del grupo A y el 93,5% del grupo B; p=0,53), complicaciones (el 1,7 frente al 1,6%; p=0,23) y recurrencia (el 7,3 frente al 6,9%; p=0,61). Sin embargo, el tiempo de fluoroscopia (mediana, 1,1 frente a 12 min; p<0,0005) y el tiempo de ablación (mediana, 96,5 frente a 133,5 s; p=0,03) fueron menores en el grupo B. La presencia de cardiopatía se comportó como un predictor independiente de recurrencia (p=0,03). Conclusiones: El SNINF para guiar los procedimientos de ablación en pacientes pediátricos reduce el tiempo de exposición a la radiación ionizante. Su empleo generalizado en las ablaciones pediátricas podría reducir el riesgo atribuido a la radiación (AU)

Introduction and objectives: Ionizing radiation exposure in catheter ablation procedures carries health risks, especially in pediatric patients. Our aim was to compare the safety and efficacy of catheter ablation guided by a nonfluoroscopic intracardiac navigation system (NFINS) with those of an exclusively fluoroscopy-guided approach in pediatric patients. Methods: We analyzed catheter ablation results in pediatric patients with high-risk accessory pathways or supraventricular tachycardia referred to our center during a 6-year period. We compared fluoroscopy-guided procedures (group A) with NFINS guided procedures (group B). Results: We analyzed 120 catheter ablation procedures in 110 pediatric patients (11±3.2 years, 70% male); there were 62 procedures in group A and 58 in group B. We found no significant differences between the 2 groups in procedure success (95% group A vs 93.5% group B; P=.53), complications (1.7% vs 1.6%; P=.23), or recurrences (7.3% vs 6.9%; P = .61). However, fluoroscopy time (median 1.1minutes vs 12minutes; P <.0005) and ablation time (median 96.5seconds vs 133.5seconds; P=.03) were lower in group B. The presence of structural heart disease was independently associated with recurrence (P=.03). Conclusions: The use of NFINS to guide catheter ablation procedures in pediatric patients reduces radiation exposure time. Its widespread use in pediatric ablations could decrease the risk of ionizing radiation (AU)

Phlebosclerotic colitis in a non-Asian patient: a case report.

BACKGROUND: Phlebosclerotic colitis is a rare condition with a high mortality. It has been seen almost exclusively in Asian patients who are ≥ 60 years old, with a slight male predominance. Although it predominantly affects the right colon and seems to be related in some cases to using natural herbal medicines, neither its etiology nor its pathogenesis are known. CASE PRESENTATION: We present an extremely rare case of a 62-year-old Spanish white man patient of non-Asian ethnicity with no history of using natural medications, who was diagnosed with phlebosclerotic colitis of submucosal veins. CONCLUSION: To date, this is the only case reported in Spain, and only the second reported for Europe, in the literature. Due to the nonspecific symptoms and insidious radiological findings of this disease (both in early and mild stages) as well as exclusive submucosal involvement presented here, it is necessary that the treating physician has a high level of suspicion for its diagnosis.

Perioperatorio de cirugía plástica reconstructiva y quemados en Medicina Intensiva / Perioperative in Intensive Medicine of reconstructive surgery and burned patients

Los pacientes quemados pueden necesitar ingresos prolongados en el Servicio de Medicina Intensiva, tanto para la atención inicial como para el tratamiento pre y postoperatorio de las múltiples cirugías que precisan. La reanimación inicial del paciente quemado crítico requiere una adecuada monitorización para calcular la fluidoterapia necesaria para reponer las pérdidas y asegurar la perfusión tisular, pero sin excesos que aumenten el edema intersticial. Además, la monitorización puede evaluar la respuesta inflamatoria sistémica, que puede llevar a shock y a disfunciones orgánicas. Tras esta fase inicial nos encontraremos con un paciente crítico que requiere múltiples reintervenciones en situaciones no óptimas, por lo que necesitará cuidados especiales durante un largo periodo. Además, el Servicio de Medicina Intensiva ofrece la atención postoperatoria específica para la cirugía reconstructiva y el trasplante de tejidos compuestos (miembro superior y cara), en los que el éxito depende de un riguroso control mediante la monitorización y el tratamiento adecuados

Burned patients may need prolonged admissions in the Intensive Care Service, both for initial care and for the pre and postoperative treatment of the multiple surgeries they require. The initial resuscitation of critically burned patients requires adequate monitoring to calculate the fluid therapy necessary to replenish the losses and ensure tissue perfusion, but without excesses that increase interstitial edema. In addition, monitoring can evaluate the systemic inflammatory response that can lead to shock and organic dysfunctions. After this initial phase we will find a critical patient who requires multiple reinterventions in non-optimal situations, so he will need special care over a long period of time. In addition, the Intensive Care Service offers specific postoperative care for reconstructive surgery and the transplantation of composite tissues (upper limb and face) in which its success depends on a rigorous control through adequate monitoring and treatment

Perioperative in Intensive Medicine of reconstructive surgery and burned patients. / Perioperatorio de cirugía plástica reconstructiva y quemados en Medicina Intensiva.

Burned patients may need prolonged admissions in the Intensive Care Service, both for initial care and for the pre and postoperative treatment of the multiple surgeries they require. The initial resuscitation of critically burned patients requires adequate monitoring to calculate the fluid therapy necessary to replenish the losses and ensure tissue perfusion, but without excesses that increase interstitial edema. In addition, monitoring can evaluate the systemic inflammatory response that can lead to shock and organic dysfunctions. After this initial phase we will find a critical patient who requires multiple reinterventions in non-optimal situations, so he will need special care over a long period of time. In addition, the Intensive Care Service offers specific postoperative care for reconstructive surgery and the transplantation of composite tissues (upper limb and face) in which its success depends on a rigorous control through adequate monitoring and treatment.

Improvements in the conception rate, milk composition and embryo quality of rabbit does after dietary enrichment with n-3 polyunsaturated fatty acids.

This work attempts to confirm the effect of an enriched diet with n-3 polyunsaturated fatty acids (PUFA) trying to mitigate the reproductive performances issues such as low conception rate of primiparous rabbits. A total of 127 does were fed ad libitum throughout their two first cycles with two diets with different fat sources: mixed fat in the control and salmon oil in the enriched one, with 3.19 g/100 g (n=63 does) and 28.77 g/100 g (n=64 does) of n-3 of the total fatty acid, respectively. Feed intake was similar between groups (P>0.05). Plasma progesterone concentration was higher in the enriched females than in control ones at 7 (30.9±2.18 v. 23.9±2.30 ng/ml, respectively; P=0.029) and 14 (38.7±2.18 v. 28.2±2.30 ng/ml, respectively; P=0.001) days of first gestation. Considering both cycles, reproductive parameters of mothers (fertility, duration of gestation and prolificacy) and litter parameters (weight at parturition and weaning, mortality and average daily gain (ADG) of kits during lactation) were similar in both groups. However, individual measurements of neonates of enriched group improved 5.87%, 7.10% and 18.01% (P0.05), but embryo apoptosis rate was higher in control group than in enriched one (31.1±4.56% v. 17.1±3.87%, respectively; P<0.05). In conclusion, dietary PUFA enrichment from the rearing and throughout two productive cycles improved plasma progesterone during pregnancy, fertility, milk fatty acid profile and neonates development of primiparous supporting the beneficial effect of n-3 PUFA supplementation in rabbit does.

Desensibilización al ácido acetilsalicílico en pacientes con cardiopatía isquémica: ahorro de costes / Aspirin desensitization in patients with coronary artery disease: Cost savings

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A diet supplemented with n-3 polyunsaturated fatty acids influences the metabomscic and endocrine response of rabbit does and their offspring.

The aim of the present study was to evaluate the productive, endocrine, and metabomscic responses as well as oxidative stress of rabbit does and their offspring when fed a diet supplemented with -3 PUFA during their first productive cycle. To this aim, a total of 105 rabbit does were fed ad mscibitum from d 60 to 172 of age 2 isoenergetic and isoproteic diets differing in fatty acid composition. The control diet ( = 52 does) contained 45.9 g/kg of -3 of the total fatty acids and the enriched diet ( = 53 does) contained 149.2 g/kg of -3 of the total fatty acids. Both experimental groups had similar feed intake during rearing, pregnancy, and lactation. The enrichment of diet had no effect on ultrasonographic assessment of does on d 9 and 16 of pregnancy, with an embryonic vesicle number and fetus and placenta size similar between groups ( > 0.05). Even though there were no major effects ( > 0.05) on fertimscity, duration of gestation, and number born amscive and stillborn kits at parturition, mscive kits from enriched does were longer (71.6 ± 2.42 vs. 79.5 ± 2.13 mm; < 0.05) and tended to be heavier (42.5 ± 3.94 vs. 50.8 ± 3.47 g; = 0.07) than those from control does ( < 0.05). The 2 groups had similar milk production and mortamscity values during lactation; consequently, there were no differences between diets in ADG, mscitter weight, and number of weaned kits ( > 0.05). In enriched does, higher plasma leptin and estradiol concentrations than in control does ( < 0.05) were observed. In addition, enriched females also had lower total and high-density mscipoprotein cholesterol (HDL-c) than control females during lactation ( < 0.05). Regarding offspring, the enrichment of diet with PUFA caused a hypermscipidemic status (greater values of plasma triglycerides, total cholesterol, and HDL-c; < 0.05) at 1 d postpartum (dpp), compared with the control group, that disappeared at 32 dpp. Supplemented does before parturition and their offspring at 1 dpp had greater oxidative stress than those in the control group. In conclusion, an increase of -3 PUFA concentration in the diet of rabbit does and, consequently, of their offspring during a productive cycle alters their mscipid profile and the indicators of oxidative stress, without major endocrine modifications or improvements in the productive variables.

Prevalence of Abdominal Aortic Aneurysm in Men Aged 65-74 Years in a Metropolitan Area in North-East Spain.

BACKGROUND: A declining prevalence of AAA and a shift in the distribution towards the older population have been observed during the last decade in Europe. The aim was to estimate the current screening prevalence of AAA in men aged 65-74 years in a metropolitan area in north-east Spain and to identify associated risk factors. METHODS: A cross sectional prevalence study in men registered in L'Hospitalet Primary Healthcare Services (Barcelona, Spain) was performed. There were 619 randomly selected subjects (expected prevalence of aneurysm, 5%; accuracy of estimation, ±2%; loss to follow up, 30%). Exclusion criteria were life expectancy <1 year, limited quality of life, previous diagnosis of AAA, prior aorto-femoral surgery, and non-Caucasian. The following were measured: internal diameter of the infrarenal abdominal aorta using ultrasound, cardiovascular risk factors, personal (heart disease, stroke, peripheral vascular disease) and family history (AAA), physical examination, and blood tests. We estimated the prevalence and 95% confidence interval of AAA, and used logistic regression analysis to identify risk factors for AAA. RESULTS: Among the 651 individuals included in the analysis the prevalence of aneurysm was 2.30% (95% CI, 1.30-3.77%). In the regression analysis, AAA was associated with smoking (0-10, 11-20, or >20 cigarettes/day), diagnosis of myocardial infarction, and being taller than the median (165 cm). CONCLUSIONS: The current screening prevalence of AAA among men aged 65-74 years in a metropolitan area in north-east Spain is similar to that in northern Europe. Smoking, myocardial infarction, and height were associated with the presence of AAA.

Successful desensitization to irinotecan after severe hypersensitivity reaction

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Revisión sistemática del efecto del propranolol sobre el hipermetabolismo del quemado / Systematic review of the effect of propanolol on hypermetabilism in burn injuries

Antecedentes El uso de propranolol se ha propuesto para atenuar la respuesta hipermetabólica del paciente quemado. Objetivos Revisar los estudios publicados hasta diciembre de 2013 que analizan los efectos del propranolol en el paciente quemado. Métodos Se aplicaron los términos «burns», «thermal injury», «betablocker» y «propranolol», con los filtros «human» y «English» y «Spanish» en el buscador Pubmed. Se identificaron 42 artículos de los que 15 eran ensayos clínicos aleatorizados. Se resumen los resultados principales de estos artículos. Resultados principales El propranolol ajustado para lograr una frecuencia cardiaca un 20% menor a la basal (4-6mg/kg/día por vía enteral) disminuye la termogénesis suprafisiológica, el trabajo cardiaco, el gasto energético en reposo y la lipólisis periférica. Aumenta la eficiencia de la síntesis proteica muscular y disminuye la acreción de masa central. La mayor parte de estudios han sido realizados en niños. Conclusiones El propranolol atenúa la respuesta hipermetabólica del paciente quemado pediátrico. Son necesarios más estudios sobre su efecto en la población adulta (AU)

Background The use of propranolol has been proposed to reduce the hypermetabolic response of patients with burn injuries. Objectives To review the studies published up to December 2013 on the effects of propranolol in burn patients. Methods A PubMed search was conducted using the terms «burns», «thermal injury», «beta-blocker» and «propranolol», with the filters «human» and «English» and «Spanish». A total of 42 citations were retrieved, 15 of which were randomized clinical trials. The main results are summarized. Main results Propranolol at doses adjusted to decrease the heart rate by 20% of the baseline value (4-6mg/kg/day p.o.) reduces supraphysiological thermogenesis, cardiac work, resting energy expenditure and peripheral lipolysis. It likewise increases the efficiency of muscular protein synthesis and reduces central mass accretion. Most studies have been conducted in pediatric burn patients. Conclusions Propranolol reduces the hypermetabolic response in pediatric burn patients. More studies on its effects in adult burn patients are needed (AU)

Isoflavones and their effects on the onset of puberty in male Wistar rats.

This study was performed to determine how two of the most important isoflavones, genistein and daidzein, affect the gonadal axis in male prepuberal rats. One hundred and seventy-five prepuberal male Wistar rats were allocated into seven groups: one control group and six experimental groups that were orally administered a high or low dose of genistein, daidzein or a mixture of both. Testosterone determination was assayed by EIA. The testes and body weights were measured, and the histology of the epididymis with the sperm content and epididymal sperm count were evaluated. In the control group, we observed an increase in the serum testosterone levels (>2.5 ng ml(-1) ) at the third week (52 days), which corresponded to the onset of puberty in these rats. The same increase in serum testosterone levels was observed at the fourth week in rats that received low doses of isoflavones; therefore, we concluded that the onset of puberty was delayed. At high doses, there was no significant increase in testosterone levels, which could be related to the fact that these male rats did not reach puberty. These findings were supported by the results obtained from the analysis of the epididymal content as well as the testes/body weight ratio.

Systematic review of the effect of propanolol on hypermetabolism in burn injuries.

BACKGROUND: The use of propranolol has been proposed to reduce the hypermetabolic response of patients with burn injuries. OBJECTIVES: To review the studies published up to December 2013 on the effects of propranolol in burn patients. METHODS: A PubMed search was conducted using the terms "burns", "thermal injury", "beta-blocker" and "propranolol", with the filters "human" and "English" and "Spanish". A total of 42 citations were retrieved, 15 of which were randomized clinical trials. The main results are summarized. MAIN RESULTS: Propranolol at doses adjusted to decrease the heart rate by 20% of the baseline value (4­6 mg/kg/day p.o.) reduces supraphysiological thermogenesis, cardiac work, resting energy expenditure and peripheral lipolysis. It likewise increases the efficiency of muscular protein synthesis and reduces central mass accretion. Most studies have been conducted in pediatric burn patients. CONCLUSIONS: Propranolol reduces the hypermetabolic response in pediatric burn patients. More studies on its effects in adult burn patients are needed.

Induction of ovulation in rabbits by adding Lecirelin to the seminal dose: in vitro and in vivo effects of different excipients.

This study evaluates the effect of Lecirelin (Dalmarelin(®), Fatro, Italy) diluted in different excipients (benzilic alcohol, benzoic acid and paraben) added to a seminal dose on LH concentrations, progesterone concentrations and ovarian status in rabbits. The in vitro effect on spermatozoa was also tested. A total of 100 multiparous female rabbits were divided into 5 groups, which at the moment of AI, received 0.2 mL (5 µg/dose) intramuscular (im) inoculation of Lecirelin (control) or the same Lecirelin dose administered intravaginally (iv) with the seminal dose alone (Lecirelin group) or with benzilic alcohol (Lecirelin BA group), benzoic acid (Lecirelin BAc group) or parabens (Lecirelin PA group) as an excipient. After 7 days, 10 rabbits per group were euthanized to analyze their ovarian status. In the control group, a high LH peak was detected 30 min post AI, while in the iv groups a slight increase in LH occurred after 120 min. The ovulation and fertility rate was similar in control and Lecirelin groups, while the lowest fertility rate was detected in the Lecirelin BA group. In a second experiment, the semen samples collected from male rabbits were diluted in TALP (control) or mixed with the 5 µg of Lecirelin solutions used in the first experiment. The highest percentage of capacitated sperm (68.3%) was recorded in the Lecirelin PA. The lowest percentages were observed in the Lecirelin BA and BAc groups. In conclusion, the iv administration of Lecirelin represents an alternative method for simplifying rabbit insemination procedures.

The effects of isoflavones on androgens and glucocorticoids during puberty on male Wistar rats.

Isoflavones are the most common phytoestrogens found in human diets. However, it is still not clear whether isoflavones have effects on the reproductive and the endocrine systems under normal dietary intake and overdose. The aim of this study was to determine how the most important isoflavones, genistein and daidzein, affect androgen and glucorticoid levels on male prepuberal rats. A hundred and seventy-five 30-day-old male Wistar rats were dosed orally by stomach tube every day for 35 days, with saline solution, low and high doses of genistein, daidzein and a mixture of both. Serum samples were analysed by an enzyme immunoassay for hormone determinations. In control group, there was a peak of testosterone (T) and dihydrotestosterone levels associated to the onset of puberty, at the third week. However, in low-dose groups, the same peak was found at the fourth week (p < 0.05), indicating a delay in the onset of puberty in these groups. Moreover, high doses groups serum androgen levels were significantly lower (p < 0.05) than the control group from the first week until fifth week. This fact was supported by a epididymal histological analysis that indicate in low doses there were several content of spermatozoa at fourth week and in high doses there were few content of spermatozoa. Besides, corticosterone levels followed the same pattern of androgens in all groups. We can conclude that oral administration of isoflavones in male rats decreased the secretion of androgens and glucocorticoids causing a delay in the onset of puberty and may cause physiological and developmental problems.

Reproductive long-term effects, endocrine response and fatty acid profile of rabbit does fed diets supplemented with n-3 fatty acids.

The effect of a diet enriched with polyunsaturated n-3 fatty acids (PUFA) on endocrine, reproductive, and productive responses of rabbit females and the litters has been studied. Nulliparous does (n=125) were fed ad libitum from rearing to second weaning two diets supplemented with different fat sources: 7.5g/kg lard for the control diet (group C; n=63) or 15g/kg of a commercial supplement containing a 50% ether extract and 35% of total fatty acids (FAs) as PUFA n-3 (Group P; n=62). Dietary treatments did not affect apparent digestibility coefficients of nutrients, or reproductive variables of does including milk production, mortality and average daily gain of kits over two lactations. However, on Day 5 and 7 post-induction of ovulation, progesterone of Group P tended to increase to a greater extent than in does of Group C. Total PUFAs, n-6 and n-3 and eicosapentanoic (EPA) contents were greater in adipose tissues of does in Group P than in Group C. Docosapentaenoic acid (DPA), EPA, and docosahexaenoic acid (DHA) concentrations were greater in peri-ovarian than in scapular fat with abdominal fat being intermediate in concentration. In PUFA supplemented does, kit mortality at the second parturition tended to be less than in control does. Also, kits born to does of the PUFA-supplemented group weighed more and were of greater length than from does of control group. In conclusion, effectiveness of dietary intervention on reproductive and performance response is greater in the second parity, which suggests an accumulative long-term beneficial effect of n-3 FA supplementation in reproductive rabbit does.

Phase recovery by using optical fiber dispersion.

We propose a simple and fast procedure to retrieve the phase profile of arbitrary light pulses. It combines a first experimental stage, followed by a one-step numerical stage. To this end, it is necessary to perform a Fresnel transform, which is obtained just by propagating the light pulses through an optical fiber. We experimentally test this proposal recovering the phase profile in the light pulses provided by a passively mode-locked laser. The proposal is then compared with a temporal variation of the Gerchberg-Saxton recursive algorithm, which is specially modified for this purpose.

All-fiber processing of terahertz-bandwidth signals based on cascaded tapered fibers.

Tapered single-mode fibers are employed to perform dynamic pulse shaping in a bandwidth of several terahertz. The transfer function of cascaded biconical tapers is controlled by introducing a phase shift into one of them through mechanical stretching. It is a simple and low-cost technique with potential to process signals with bandwidths as large as those allocated by standard optical fiber while introducing little degradation. Femtosecond pulses are shaped to prove the concept.