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1.
J Cardiovasc Pharmacol Ther ; : 1074248420922793, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32356454

RESUMO

BACKGROUND: Circulating microRNAs (miRNAs) may play a pathogenic role in acute coronary syndromes (ACS). It is not yet known if miRNAs dysregulated in ACS are modulated by colchicine. We profiled miRNAs in plasma samples simultaneously collected from the aorta, coronary sinus, and right atrium in patients with ACS. METHODS: A total of 396 of 754 miRNAs were detected by TaqMan real-time polymerase chain reaction from EDTA-plasma in a discovery cohort of 15 patients (n = 3 controls, n = 6 ACS standard therapy, n = 6 ACS standard therapy plus colchicine). Fifty-one significantly different miRNAs were then measured in a verification cohort of 92 patients (n = 13 controls, n = 40 ACS standard therapy, n = 39 ACS standard therapy plus colchicine). Samples were simultaneously obtained from the coronary sinus, aortic root, and right atrium. RESULTS: Circulating levels of 30 of 51 measured miRNAs were higher in ACS standard therapy patients compared to controls. In patients with ACS, levels of 12 miRNAs (miR-17, -106b-3p, -191, -106a, -146a, -130a, -223, -484, -889, -425-3p, -629, -142-5p) were lower with colchicine treatment. Levels of 7 of these 12 miRNA were higher in ACS standard therapy patients compared to controls and returned to levels seen in control individuals after colchicine treatment. Three miRNAs suppressed by colchicine (miR-146a, miR-17, miR-130a) were identified as regulators of inflammatory pathways. MicroRNAs were comparable across sampling sites with select differences in the transcoronary gradient of 4 miRNA. CONCLUSION: The levels of specific miRNAs elevated in ACS returned to levels similar to control individuals following colchicine. These miRNAs may mediate ACS (via inflammatory pathways) or increase post-ACS risk, and could be potentially used as biomarkers of treatment efficacy.

2.
Lancet Respir Med ; 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32422180

RESUMO

Global health care is experiencing an unprecedented surge in the number of critically ill patients who require mechanical ventilation due to the COVID-19 pandemic. The requirement for relatively long periods of ventilation in those who survive means that many are considered for tracheostomy to free patients from ventilatory support and maximise scarce resources. COVID-19 provides unique challenges for tracheostomy care: health-care workers need to safely undertake tracheostomy procedures and manage patients afterwards, minimising risks of nosocomial transmission and compromises in the quality of care. Conflicting recommendations exist about case selection, the timing and performance of tracheostomy, and the subsequent management of patients. In response, we convened an international working group of individuals with relevant expertise in tracheostomy. We did a literature and internet search for reports of research pertaining to tracheostomy during the COVID-19 pandemic, supplemented by sources comprising statements and guidance on tracheostomy care. By synthesising early experiences from countries that have managed a surge in patient numbers, emerging virological data, and international, multidisciplinary expert opinion, we aim to provide consensus guidelines and recommendations on the conduct and management of tracheostomy during the COVID-19 pandemic.

3.
Arch Bronconeumol ; 2020 Mar 30.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32336563

RESUMO

Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials.

4.
Med Intensiva ; 2020 Mar 30.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32312600

RESUMO

Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials.

5.
Sci Rep ; 10(1): 3487, 2020 Feb 26.
Artigo em Inglês | MEDLINE | ID: mdl-32103053

RESUMO

The bronze bug, Thaumastocoris peregrinus, an Australian native insect, has become a nearly worldwide invasive pest in the last 16 years and has been causing significant damage to eucalypts (Myrtaceae), including Eucalyptus spp. and Corymbia spp. Its rapid expansion leads to new questions about pathways and routes that T. peregrinus used to invade other continents and countries. We used mtDNA to characterize specimens of T. peregrinus collected from 10 countries where this species has become established, including six recently invaded countries: Chile, Israel, Mexico, Paraguay, Portugal, and the United States of America. We then combined our mtDNA data with previous data available from South Africa, Australia, and Europe to construct a world mtDNA network of haplotypes. Haplotype A was the most common present in all specimens of sites sampled in the New World, Europe, and Israel, however from Australia second more frequently. Haplotype D was the most common one from native populations in Australia. Haplotype A differs from the two major haplotypes found in South Africa (D and G), confirming that at least two independent invasions occurred, one from Australia to South Africa, and the other one from Australia to South America (A). In conclusion, Haplotype A has an invasion success over many countries in the World. Additionally, analyzing data from our work and previous reports, it is possible to suggest some invasive routes of T. peregrinus to predict such events and support preventive control measures.

6.
N Biotechnol ; 55: 58-64, 2020 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-31593776

RESUMO

The effectiveness of physical, chemical and biological barriers to the diffusion of genetically modified microorganisms (GMMs) to prevent their release into the environment is currently under scrutiny worldwide because of the associated potential ecological impacts. An industrial discharge of a non-sterilized fermentation broth containing GMM biomass into a conventional municipal wastewater treatment plant would deliver the GMMs into the activated sludge system process (ASSP). The present work aimed to model and evaluate the containment capability of a small ASSP (part of a 20,000 people equivalent municipal plant) in the event of receiving GMM biomass from a medium-small biotechnological plant dedicated to the production of polyhydroxyalkanoates (3000 t/year of biopolymer). An actual GMM (Pseudomonas putida KTOY06) was injected into a bench-scale ASSP (ASSPLab) in a quantity proportional to the relative dimensions of the plants mentioned. The experimental and model results indicated that the ASSP of the target municipal treatment plant would not be capable of holding back such a sudden input of GMM; 6 h after the discharge, 11-15 % of injected GMM cells were released through the clarified stream of the ASSPLab, with the rest being gradually released over time. Since the GMM employed did not exhibit any growth in the ASSPLab, its concentration in the clarified water stream would not represent a substantial risk of release into the environment if appropriate tertiary treatments were integrated. This study confirmed the necessity of a thorough risk assessment of biotechnological processes prior to their implementation.

7.
Med. intensiva (Madr., Ed. impr.) ; 44: 1-30, 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-186897

RESUMO

La enfermedad por coronavirus 2019 (COVID-19) es una infección del tracto respiratorio causada por un nuevo coronavirus emergente, que se reconoció por primera vez en Wuhan, China, en diciembre de 2019. Actualmente, la Organización Mundial de la Salud (OMS) ha definido la infección como pandemia y existe una situación de emergencia sanitaria y social para el manejo de esta nueva infección. Mientras que la mayoría de las personas con COVID-19 desarrollan solo una enfermedad leve o no complicada, aproximadamente el 14% desarrolla una enfermedad grave que requiere hospitalización y oxígeno, y el 5% puede requerir ingreso en una Unidad de Cuidados Intensivos (1). En casos severos, COVID-19 puede complicarse por el síndrome de dificultad respiratoria aguda (SDRA), sepsis y shock séptico y fracaso multiorgánico. Este documento de consenso se ha preparado sobre directrices basadas en evidencia desarrolladas por un panel multidisciplinario de profesionales médicos de cuatro sociedades científicas españolas (Sociedad Española de Medicina Intensiva y Unidades Coronarias [SEMICYUC], Sociedad Española de Neumología y Cirugía Torácica [SEPAR], Sociedad Española de Urgencias y Emergencias [SEMES], Sociedad Española de Anestesiología, Reanimación y Terapéutica delDolor [SEDAR]) con experiencia en el manejo clínico de pacientes con COVID-19 y otras infecciones virales, incluido el SARS, así como en sepsis y SDRA. El documento proporciona recomendaciones clínicas para el soporte respiratorio no invasivo (ventilación no invasiva, oxigenoterapia de alto flujo con cánula nasal) en cualquier paciente con presentación sospechada o confirmada de COVID-19 con insuficiencia respiratoria aguda. Esta guía de consenso debe servir como base para una atención optimizada y garantizar la mejor posibilidad de supervivencia, así como permitir una comparación fiable de las futuras intervenciones terapéuticas de investigación que formen parte de futuros estudios observacionales o de ensayos clínicos. Palabras clave: Ventilación mecánica no invasiva, terapia nasal de alto flujo, procedimientos generadores de aerosoles, control de infección. Esta guía de consenso debe servir como base para una atención optimizada y garantizar la mejor posibilidad de supervivencia, así como permitir una comparación fiable de las futuras intervenciones terapéuticas de investigación que formen parte de futuros estudios observacionales o de ensayos clínicos


Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus , that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit (1). In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials


Assuntos
Humanos , Adulto , Síndrome Respiratória Aguda Grave/terapia , Ventilação não Invasiva/métodos , Insuficiência Respiratória/terapia , Betacoronavirus , Insuficiência Respiratória/etiologia , Síndrome Respiratória Aguda Grave/complicações , Doenças Transmissíveis Emergentes , Oxigenoterapia , Administração Intranasal , Ventilação não Invasiva/instrumentação , Pandemias , Sociedades Médicas/normas , Espanha
8.
Rev. Asoc. Argent. Ortop. Traumatol ; 84(4): 361-371, dic. 2019. []
Artigo em Espanhol | LILACS | ID: biblio-1057061

RESUMO

Objetivo: Comparar dos series de pacientes sometidos a ligamentoplastia con tendones isquiotibiales autólogos mediante las dos técnicas quirúrgicas preferentes: monotúnel transtibial y bitúnel anatómica, utilizando idénticas fijaciones óseas, y establecer conclusiones funcionales. Materiales y Métodos: Estudio retrospectivo de dos series de 30 pacientes, con un seguimiento superior a un año, sometidos a ligamentoplastia del ligamento cruzado anterior con tendones isquiotibiales mediante técnicas monotúnel transtibial y bitúnel con tunelización retrógrada, utilizando fijación elástica cortical en fémur y fijación tibial mediante tornillo retrógrado. Se los evaluó con la escala del IKDC, y las pruebas de Lachman, de resalte (pivot-shift) y del salto monopodal, valorando la reincorporación a la actividad previa habitual y deportiva, y examen radiológico de la evolución de los túneles óseos. Resultados: La técnica bitúnel anatómica logra resultados significativamente mejores (p <0,05) en la evaluación subjetiva de la escala del IKDC, en las pruebas de resalte, del salto y en la recuperación de la actividad deportiva previa a la lesión, sin diferencias en la prueba de Lachman. No hubo casos de osteólisis en los túneles óseos, en ninguna de las dos series. Conclusiones: La técnica de ligamentoplastia bitúnel anatómica es mejor valorada y más eficaz que la técnica monotúnel transtibial, fundamentalmente en pacientes con actividad deportiva exigente, ya que en aquellos sin actividades de impacto, los resultados son satisfactorios de igual forma. Con el atornillado retrógrado tibial no hubo osteólisis significativa en el túnel tibial. Nivel de Evidencia: III


Objective: To compare two series of patients who underwent anterior cruciate ligament reconstruction using hamstring tendon autografts, identical bone fixations, and one of the two standard surgical approaches: transtibial single-tunnel and anatomical double-tunnel technique. To draw conclusions regarding functional outcomes. Materials and Methods: This was a retrospective study consisting in two series of 30 patients, followed up for more than a year, who had undergone an anterior cruciate ligament reconstruction with hamstring tendon graft placement using the transtibial single-tunnel or the anatomical double-tunnel technique. The latter employed retrograde tunneling, as well as an adjustable cortical fixation for the femur and a retrograde screw fixation for the tibia. Patients were assessed using the International Knee Documentation Committee (IKDC) Questionnaire, the Lachman Test, the Lateral Pivot-Shift Test and the Single Leg Hop Test with the aim of determining if they were ready to return to their previous daily and sports activities. Radiological examination of the bone tunnels was also performed to assess progress. Results: The anatomical double-tunnel technique yields significantly (p <0.05) better results on the IKDC Questionnaire, the Lateral Pivot- Shift Test and the Hop Test and allows patients to resume sports activities in a shorter time. The Lachman Test showed similar results with both techniques. There were no cases of tunnel osteolysis in either of the two series. Conclusions: The anatomical double-tunnel ligament reconstruction technique was better rated by patients and more efficient than the transtibial single-tunnel technique, especially in patients who engage in demanding sports activities. In patients who do not practice high-impact activities, results were equally satisfactory. The tibial retrograde screw fixation did not result in significant tunnel osteolysis. Level of Evidence: III


Assuntos
Adulto , Ligamento Cruzado Anterior/cirurgia , Procedimentos Ortopédicos , Reconstrução do Ligamento Cruzado Anterior , Parafusos Ósseos , Estudos Retrospectivos , Seguimentos , Resultado do Tratamento
9.
Nutrients ; 11(9)2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31500172

RESUMO

A healthy dietary pattern and high quality nutrient intake reduce atherosclerotic cardiovascular disease risk. Red wine grape pomace (RWGP)-a rich natural source of dietary fiber and antioxidants-appears to be a potential functional food ingredient. The impact of a dietary supplementation with RWGP flour was evaluated in atherogenic diet-fed SR-B1 KO/ApoER61h/h mice, a model of lethal ischemic heart disease. SR-B1 KO/ApoER61h/h mice were fed with atherogenic (high fat, cholesterol, and cholic acid, HFC) diet supplemented with: (a) 20% chow (HFC-Control), (b) 20% RWGP flour (HFC-RWGP), or (c) 10% chow/10% oat fiber (HFC-Fiber); and survival time was evaluated. In addition, SR-B1 KO/ApoER61h/h mice were fed for 7 or 14 days with HFC-Control or HFC-RWGP diets and plasma lipid levels, inflammation, oxidative damage, and antioxidant activity were measured. Atherosclerosis and myocardial damage were assessed by histology and magnetic resonance imaging, respectively. Supplementation with RWGP reduced premature death, changed TNF-α and IL-10 levels, and increased plasma antioxidant activity. Moreover, decreased atheromatous aortic and brachiocephalic plaque sizes and attenuated myocardial infarction and dysfunction were also observed. These results suggest that RWGP flour intake may be used as a non-pharmacological therapeutic approach, contributing to decreased progression of atherosclerosis, reduced coronary heart disease, and improved cardiovascular outcomes.


Assuntos
Antioxidantes/administração & dosagem , Aorta/metabolismo , Doenças da Aorta/prevenção & controle , Aterosclerose/prevenção & controle , Suplementos Nutricionais , Frutas/química , Isquemia Miocárdica/prevenção & controle , Miocárdio/metabolismo , Estresse Oxidativo , Extratos Vegetais/administração & dosagem , Vitis/química , Ração Animal , Animais , Antioxidantes/isolamento & purificação , Antioxidantes/metabolismo , Aorta/patologia , Doenças da Aorta/sangue , Doenças da Aorta/genética , Doenças da Aorta/patologia , Aterosclerose/sangue , Aterosclerose/genética , Aterosclerose/patologia , Biomarcadores/sangue , Dieta Aterogênica , Modelos Animais de Doenças , Feminino , Mediadores da Inflamação/sangue , Interleucina-10/sangue , Lipídeos/sangue , Masculino , Camundongos Knockout para ApoE , Isquemia Miocárdica/sangue , Isquemia Miocárdica/genética , Isquemia Miocárdica/patologia , Miocárdio/patologia , Extratos Vegetais/sangue , Extratos Vegetais/isolamento & purificação , Placa Aterosclerótica , Receptores Depuradores Classe B/deficiência , Receptores Depuradores Classe B/genética , Fator de Necrose Tumoral alfa/sangue
10.
Clin Ther ; 41(10): 2172-2181, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31409556

RESUMO

PURPOSE: Existing literature reports that colchicine inhibits inflammasome activation and downstream inflammatory cytokine production and stabilizes coronary plaque. However, colchicine's effect on chemokines, which orchestrate multiple atheroinflammatory pathways, is unknown. METHODS: Patients with acute coronary syndrome (ACS) were randomly assigned to colchicine (1.5 mg PO) (n = 12; mean age, 65.2 years) or no treatment (n = 13; mean age, 62.2 years). Blood samples were collected during cardiac catheterization within 24 hours of colchicine administration from the coronary sinus, aortic root, and right atrium. Patients with colchicine-naive stable angina (SAP) (n = 13; mean age, 66.8 years) were additionally sampled. Serum chemokine levels were analyzed with ELISA. In parallel, monocytes from healthy donors were isolated and subjected to colchicine treatment. FINDINGS: Transcoronary (TC) levels of chemokine ligand 2 (CCL2) and C-X3-C motif chemokine ligand 1 (CX3CL1) were significantly elevated in patients with ACS versus patients with SAP (P < 0.01). TC chemokine ligand 5 (CCL5) levels were not significantly (P = 0.084) elevated in patients with ACS versus patients with SAP. Colchicine treatment markedly reduced TC levels of CCL2, CCL5, and CX3CL1 in patients with ACS (P < 0.05). In vitro colchicine suppressed CCL2 gene expression in stimulated monocytes (P < 0.05). Colchicine treatment reduced the intracellular concentration of all 3 chemokines (P < 0.01) and impaired monocyte chemotaxis (P < 0.05). IMPLICATIONS: Here, we report for the first time that short-term colchicine therapy significantly reduces the local production of coronary chemokines, in part by attenuating production of these mediators by monocytes. These data provide further evidence of colchicine's beneficial role in patients with ACS.

11.
iScience ; 12: 41-52, 2019 Feb 22.
Artigo em Inglês | MEDLINE | ID: mdl-30665196

RESUMO

Circulating tumor necrosis factor (TNF)-related apoptosis-inducing ligand (TRAIL) levels are reduced in patients with cardiovascular disease, and TRAIL gene deletion in mice exacerbates atherosclerosis and inflammation. How TRAIL protects against atherosclerosis and why levels are reduced in disease is unknown. Here, multiple strategies were used to identify the protective source of TRAIL and its mechanism(s) of action. Samples from patients with coronary artery disease and bone-marrow transplantation experiments in mice lacking TRAIL revealed monocytes/macrophages as the main protective source. Accordingly, deletion of TRAIL caused a more inflammatory macrophage with reduced migration, displaying impaired reverse cholesterol efflux and efferocytosis. Furthermore, interleukin (IL)-18, commonly increased in plasma of patients with cardiovascular disease, negatively regulated TRAIL transcription and gene expression, revealing an IL-18-TRAIL axis. These findings demonstrate that TRAIL is protective of atherosclerosis by modulating monocyte/macrophage phenotype and function. Manipulating TRAIL levels in these cells highlights a different therapeutic avenue in the treatment of cardiovascular disease.

12.
Sci Total Environ ; 656: 550-557, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30529959

RESUMO

Dune belts are crucial for the recharge of coastal aquifers. In spite of their hydrological relevance for the maintenance of precious natural wetland and wildlife environments and a range of other ecosystem services, only limited knowledge of soil water dynamics in dune belts is currently available. This study presents soil water balance components measured during one hydrological year using a high precision meteo-lysimeter with lower boundary control installed in a coastal dune belt under a dry subhumid climate in southern Spain close to the Atlantic Ocean. The site is equipped with a cylindrical lysimeter of 1 m2 surface and 1.50 m height (METER Group, Inc. USA) and a weighing resolution of 10 g, 2 SC650 soil moisture sensors (Campbell Scientific, Logan, UT) and 1 automatic meteorological station. The lower boundary condition at the bottom of the lysimeter is controlled at 1.4 m depth by a bidirectional peristaltic pump to maintain field conditions. Results show a recharge rate of 64% of the precipitation measured by the lysimeter. Diurnal oscillations of the measured upper boundary flow during days without rainfall represented vapor adsorption and real evaporation rates ranging between 0.3 and 0.4 mm/day and 0.4 and 0.6 mm/day, respectively throughout the whole year summing up an annual vapor adsorption of 77 mm. The measured precipitation of the lysimeter exceeded pluviometer data by 13% as a result of vapor adsorption. The presented results provide a precise balance of soil water components in a coastal dune belt including the relevant contribution of vapor flow.

13.
Clin Ther ; 41(1): 11-20, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30185392

RESUMO

PURPOSE: Because inflammation is a key process implicated in the pathogenesis of atherosclerosis at all stages, including plaque formation, progression, instability, and rupture, and because colchicine has unique anti-inflammatory properties, this review article summarizes the pathophysiologic mechanisms underpinning inflammation in atherosclerosis and acute coronary syndrome (ACS), outlines anti-inflammatory therapeutic approaches that have been tested thus far, and evaluates the evidence supporting the potential role of colchicine in improving outcomes and reducing cardiovascular morbidity and mortality in patients after ACS. METHODS: PubMed was searched for publications on colchicine and ACSs and atherosclerosis, and www.clinicaltrials.org was searched for completed and ongoing trials of colchicine use in ACSs. FINDINGS: Despite contemporary optimal medical therapy, patients remain at a high risk of future events after an ACS because of residual inflammation at culprit and nonculprit sites. Several attempts have been made to address this with targeted anti-inflammatory therapies, but until the recent promising results of canakinumab (an anti-interleukin-1ß monoclonal antibody), most have failed to find any prognostic benefit in large clinical trials with hard end points. The pathogenic role of neutrophils and monocytes in atheroinflammation is well established, and a fundamental component in this process is the activation of the NOD-like receptor protein 3 inflammasome, a cytosolic multiprotein complex that, when activated by a stress signal such as cholesterol crystals, drives caspase-1-dependent release of 2 key proinflammatory cytokines, which are predictive of future adverse cardiovascular events: interleukin-1ß and interleukin-18. Colchicine is a widely available, inexpensive, and well-tolerated medication that, among several anti-inflammatory mechanisms of action, inhibits activation of the NOD-like receptor protein 3 inflammasome complex. A seminal trial has found the beneficial properties of colchicine in reducing adverse cardiovascular events in the stable coronary artery disease population. IMPLICATIONS: Despite promising results in small prospective observational and randomized trials, there is a need for more evidence evaluating the role of colchicine as a secondary preventive agent after ACSs.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Aterosclerose/tratamento farmacológico , Colchicina/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Doença da Artéria Coronariana/tratamento farmacológico , Citocinas/metabolismo , Humanos , Inflamação/tratamento farmacológico , Monócitos/metabolismo
14.
Rev. chil. cardiol ; 37(3): 176-182, dic. 2018. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-977999

RESUMO

Resumen: Introducción Las fallas de los puentes venosos pueden llegar casi al 50% a 10 años y la angioplastía percutánea es el tratamiento de elección. Estos pacientes constituyen un grupo de muy alto riesgo cardiovascular con tasas de mortalidad cercanas al 30% en el mediano plazo. Objetivo Caracterizar a la población sometida a angioplastia de puentes coronarios (APC) y comparar su mortalidad con un grupo pareado de pacientes intervenidos con Infarto agudo al miocardio con elevación del segmento ST (IAMCEST). Métodos Estudio retrospectivo de tipo Caso-Control que incluyó a pacientes con APC entre los años 2010-2016 comparados con igual número de controles con IAMCEST pareados por edad y sexo. Se analizaron características clínicas del procedimiento y mortalidad, tanto global como de causa cardiaca usando T Student, Chi2 y curvas de Kaplan Meier. Resultados Se identificaron 63 pacientes sometidos a APC (total 76 procedimientos). Los puentes más comúnmente intervenidos fueron a la arteria circunfleja 48,7%. Hubo 18 (28,5%) pacientes fallecidos en el grupo APC y 6 (9,5%) pacientes en el grupo con IAM-CEST, lo que resultó en un exceso de mortalidad global en pacientes con APC (HR 3,02; IC 95% 1,11 - 8,22, p=0,02). Esta diferencia se debió a una mayor mortalidad de causa no cardiaca en el grupo APC (12,7% (n=8) vs 3,2% (n= 2) [p=0,04]). Conclusión Los pacientes sometidos a APC presentan una mortalidad 3 veces mayor que aquellos pacientes con IAMCEST, principalmente derivada de una mayor mortalidad no cardíaca.


Abstract: Background Failure rates of saphenous vein grafts can reach almost 50% at 10 years and percutaneous angioplasty is the treatment of choice. This is a group with a very high cardiovascular risk, with mid-term mortality rates close to 30%. Aim To describe the population undergoing coronary bypass angioplasty (CBA) and compare their mortality with an age and gender matched group of patients with acute myocardial infarction with ST segment elevation (STEMI) Methods This was a retrospective case-control study including patients with CBA between 2010-2016. This group was compared with the same number of controls with STEMI matched by age and sex. Clinical characteristics, procedure variables and overall mortality as well as cardiac mortality were analyzed using Student's T test, Chi squared test and Kaplan Meier curves (significance set at p <0.05). Results: We identified 63 patients undergoing CBA (76 procedures). The most commonly intervened bypasses were to the circumflex artery (48.7%). There were 18 (28.5%) patients who died in the CBA group and 6 (9.5%) patients in the STEMI group, which resulted in an excess of global mortality risk in patients with CBA (HR 3.02, 95% CI 1.11 - 8.22, p = 0.02). This difference was driven by a higher non-cardiac mortality in the CBA group (12.7% (n = 8) vs 3.2% (n = 2) [p = 0.04]) Conclusion Patients undergoing CBA have a mortality rate more than three times that of the STEMI patients, mainly due to a higher non-cardiac mortality.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Angioplastia Coronária com Balão/mortalidade , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Veia Safena , Estudos de Casos e Controles , Análise de Sobrevida , Ponte de Artéria Coronária/mortalidade , Estudos Retrospectivos , Causas de Morte , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia
15.
World J Cardiol ; 10(10): 187-190, 2018 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-30386495

RESUMO

We report three cases of Takotsubo syndrome (TS) with atypical myocardial involvement. All three cases were triggered by physical or mental stress, resulting in transient myocardial compromise. However, the clinical presentation, localization and extent of myocardial damage varied in each case, ranging from low-risk acute chest pain to cardiogenic shock with low ejection fraction and dynamic obstruction of the left ventricular outflow tract. These cases outline the range of possible presentations of this rare entity and illustrate atypical forms of TS.

16.
J Environ Qual ; 47(5): 1293-1297, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30272789

RESUMO

After rainfall or irrigation begins, surface-applied chemicals and manure-borne microorganisms typically enter the soil with infiltration until the soil saturates, after which time the chemicals and microbes are exported from the field in the overland flow. This process is viewed as a reason for the dependence of chemical export on the time between rainfall start and runoff initiation that has been documented for agricultural chemicals. The objective of this work was to observe and quantify such dependence for released from solid farmyard dairy manure in field conditions. Experiments were performed for 6 yr and consisted of manure application followed by an immediate simulated rainfall event and a second event 1 wk later. The nonlinearity of the release seen in laboratory and plot studies did not manifest itself in the field. The number of exported cells in runoff was proportional to rainfall depth after runoff initiation in each trial. The proportionality coefficient, termed export rate, demonstrated a strong dependence on the runoff delay time that could be approximated with the exponential decrease. The export rate decreased by one order of magnitude when the rainfall depth at runoff initiation increased from 18 to 42 mm. The same dependence could approximate data from the simulated rainfall event 1 wk after the manure application, assuming that the initial content in manure after 1 wk of weathering was 10% of the initial content. Overall, accounting for the dependence of manure-borne export on the runoff delay time should improve the accuracy of export predictions related to the assessment of agricultural practices on microbial water quality.


Assuntos
Monitoramento Ambiental , Escherichia coli/crescimento & desenvolvimento , Microbiologia do Solo , Microbiologia da Água , Agricultura , Fertilizantes , Esterco , Chuva , Movimentos da Água
17.
Can J Cardiol ; 34(10): 1370.e1-1370.e3, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30205990

RESUMO

A 68-year-old man with previous coronary artery bypass surgery presented with acute onset chest pain. After ruling out an acute coronary syndrome, a computed tomography scan demonstrated a giant aneurysm (10 cm × 8 cm) of the right coronary artery saphenous vein graft (SVG) with signs of rupture into the mediastinum. An Amplatzer Vascular Plug II was successfully deployed at the proximal anastomosis of the SVG, achieving complete exclusion. At 6-month follow-up the patient remained asymptomatic and a computed tomography scan confirmed adequate position of the device. Amplatzer Vascular Plug II is a reasonable alternative for SVG aneurysm closure, providing the vein graft supplies nonviable myocardium.


Assuntos
Síndrome Coronariana Aguda/cirurgia , Aneurisma Roto/cirurgia , Cateterismo Cardíaco/métodos , Aneurisma Coronário/terapia , Ponte de Artéria Coronária/efeitos adversos , Embolização Terapêutica/métodos , Veia Safena/transplante , Síndrome Coronariana Aguda/diagnóstico , Idoso , Aneurisma Roto/terapia , Aneurisma Coronário/diagnóstico , Aneurisma Coronário/etiologia , Angiografia Coronária , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias , Reoperação , Fatores de Tempo , Tomografia Computadorizada por Raios X
18.
Rev Med Chil ; 146(1): 68-77, 2018 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-29806680

RESUMO

Recently, we have witnessed major improvements in cancer treatment. Early diagnosis and development of new therapies have reduced cancer-related mortality. However, these new therapies, along with greater patient survival, are associated with an increase in untoward effects, particularly in the cardiovascular system. Although cardiotoxicity induced by oncologic treatments affects predominantly the myocardium, it can also involve other structures of the cardiovascular system, becoming one of the main causes of morbidity and mortality in those who survive cancer. The main objective of cardio-oncology is to achieve the maximum benefits of oncologic treatments while minimizing their deleterious cardiovascular effects. It harbors the stratification of patients at risk of cardiotoxicity, the implementation of diagnostic tools (imaging techniques and biomarkers) for early diagnosis, preventive strategies and early treatment options for the complications. Herein, we discuss the basic knowledge for the implementation of cardio-oncology units and their role in the management of cancer patients, the diagnostic tools available to detect cardiotoxicity and the present therapeutic options.


Assuntos
Antineoplásicos/efeitos adversos , Cardiotoxicidade/etiologia , Cardiotoxicidade/prevenção & controle , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Radioterapia/efeitos adversos , Antineoplásicos/classificação , Biomarcadores , Humanos , Neoplasias/complicações , Neoplasias/tratamento farmacológico , Desenvolvimento de Programas , Fatores de Risco
19.
MethodsX ; 5: 184-203, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29755950

RESUMO

Data assimilation is becoming a promising technique in hydrologic modelling to update not only model states but also to infer model parameters, specifically to infer soil hydraulic properties in Richard-equation-based soil water models. The Ensemble Kalman Filter method is one of the most widely employed method among the different data assimilation alternatives. In this study the complete Matlab© code used to study soil data assimilation efficiency under different soil and climatic conditions is shown. The code shows the method how data assimilation through EnKF was implemented. Richards equation was solved by the used of Hydrus-1D software which was run from Matlab. •MATLAB routines are released to be used/modified without restrictions for other researchers•Data assimilation Ensemble Kalman Filter method code.•Soil water Richard equation flow solved by Hydrus-1D.

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