Prevalence of a large panel of systemic autoantibodies in the Bavarian adult population.

Objective: Autoimmune diseases commonly feature the presence of specific humoral autoantibodies. However, the prevalence of a large panel of systemic autoantibodies has never been assessed in the general population. We, therefore, described the prevalence of about 50 humoral systemic autoantibodies in a sample of the general Bavarian adult population. Methods: Non-fasting venous serum samples from 331 participants were analyzed for 7 autoantibody screening tests (nuclear, cytoplasmic, and mitotic ANA, ANCA, cANCA and pANCA, anti-ENA autoantibodies) and 44 different monospecific humoral non-organ specific/systemic autoantibodies using indirect immunofluorescence tests, ELISAs, and line blots. In order to assess associations between sex, age, BMI, education level, smoking status and the presence of systemic autoantibodies, logistic regression analyses were conducted. Results: At least one screening test was positive in 29.9% of the participants, and 42.3% of the participants were seropositive for at least one monospecific autoantibody. The most frequently found monospecific autoantibodies were rheumatoid factor (35.6%), ß2-glycoprotein 1 IgM (4.8%), and cardiolipin IgG (1.8%). Only few associations between sex, age, BMI, education, smoking status and autoantibody frequencies were observed. Conclusion: Systemic autoantibodies are common in the general Bavarian population, and largely independent of sex, age, BMI, education, or smoking status. The study results may give orientation to clinicians about the occurrence of autoantibodies in the population, not (yet) associated with clinical symptoms.

Quantifying the effect of cerebral atrophy on head injury risk in elderly individuals: Insights from computational biomechanics and experimental analysis of bridging veins.

The objective of this study was to quantitatively investigate the relationship between cerebral atrophy and the risk of injury in elderly individuals. To achieve this, a sophisticated computational biomechanics approach utilizing finite element analysis was employed to simulate the mechanical behavior of the brain and skull under various conditions. In addition, particular emphasis was placed on understanding the role of cerebral bridging veins (BVs) and their mechanical properties at different ages in the occurrence of head injuries. Head models representing healthy brains and five atrophy models were developed based on imaging data. After validation, the models underwent the identical impact loading conditions to enable the simulation of brain damage. The resulting outcomes of the models with brain atrophy were then compared to the results obtained from the healthy model, allowing for a comparative analysis. Simulations showed increased relative displacement with worsening brain atrophy, particularly in the frontal and occipital regions. Compared to the healthy brain model, relative displacement increased by 2.36 %-9.21 % in the atrophy models, indicating an elevated risk of injury. In severe brain atrophy (FEM 6), the strain reached 83.59 % in local model simulations, leading to damage and rupture of cerebral BVs in both young and elderly individuals. Mechanical tests on cerebral BVs demonstrated a negative correlation between age and ultimate force, stress, and strain, suggesting increased susceptibility to damage with age. An observed sharp decline of approximately 50 % in ultimate stress and 35 % in ultimate strain was noted as age increased. We implemented a 50 % reduction in the intensity of head impact forces; nevertheless, vascular damage continues to manifest in the elderly population. To establish a truly safe zone, it is imperative to further decrease the intensity of the impact. This investigation represents a significant step forward in our understanding of the complex interplay between cerebral atrophy, the mechanical properties of BVs at different age, and the risk of head injury in the elderly. Through continued research in this field, we can strive to improve the quality of care, enhance prevention strategies, and ultimately enhance the well-being and safety of the elderly population.

Thermo-Mechanical Characterization of 4D-Printed Biodegradable Shape-Memory Scaffolds Using Four-Axis 3D-Printing System.

This study was conducted on different models of biodegradable SMP (shape-memory polymer) scaffolds. A comparison was conducted utilizing a basic FDM (fused deposition modeling)/MEX (material extrusion) printer with a standard printing technique and a novel, modified, four-axis printing method with a PLA (poly lactic acid) polymer as the printing material. This way of making the 4D-printed BVS (biodegradable vascular stent) made it possible to achieve high-quality surfaces due to the difference in printing directions and improved mechanical properties-tensile testing showed a doubling in the elongation at break when using the four-axis-printed specimen compared to the regular printing, of 8.15 mm and 3.92 mm, respectfully. Furthermore, the supports created using this method exhibited a significant level of shape recovery following thermomechanical programming. In order to test the shape-memory effect, after the thermomechanical programming, two approaches were applied: one approach was to heat up the specimen after unloading it inside temperature chamber, and the other was to heat it in a warm bath. Both approaches led to an average recovery of the original height of 99.7%, while the in-chamber recovery time was longer (120 s) than the warm-bath recovery (~3 s) due to the more direct specimen heating in the latter case. This shows that 4D printing using the newly proposed four-axis printing is an effective, promising technique that can be used in the future to make biodegradable structures from SMP.

Safety and Efficacy of Everolimus-Eluting Bioresorbable Vascular Scaffold Versus Second-Generation Drug-Eluting Stents in Real-World Practice.

BACKGROUND: The risk of device thrombosis and device-oriented clinical outcomes with bioresorbable vascular scaffold (BVS) was reported to be significantly higher than with contemporary drug-eluting stents (DESs). However, optimal device implantation may improve clinical outcomes in patients receiving BVS. The current study evaluated mid-term safety and efficacy of Absorb BVS with meticulous device optimization under intravascular imaging guidance. METHODS: The SMART-REWARD and PERSPECTIVE-PCI registries in Korea prospectively enrolled 390 patients with BVS and 675 patients with DES, respectively. The primary endpoint was target vessel failure (TVF) at 2 years and the secondary major endpoint was patient-oriented composite outcome (POCO) at 2 years. RESULTS: Patient-level pooled analysis evaluated 1,003 patients (377 patients with BVS and 626 patients with DES). Mean scaffold diameter per lesion was 3.24 ± 0.30 mm in BVS group. Most BVSs were implanted with pre-dilatation (90.9%), intravascular imaging guidance (74.9%), and post-dilatation (73.1%) at proximal to mid segment (81.9%) in target vessel. Patients treated with BVS showed comparable risks of 2-year TVF (2.9% vs. 3.7%, adjusted hazard ratio [HR], 1.283, 95% confidence interval [CI], 0.487-3.378, P = 0.615) and 2-year POCO (4.5% vs. 5.9%, adjusted HR, 1.413, 95% CI, 0.663-3.012, P = 0.370) than those with DES. The rate of 2-year definite or probable device thrombosis (0.3% vs. 0.5%, P = 0.424) was also similar. The sensitivity analyses consistently showed comparable risk of TVF and POCO between the 2 groups. CONCLUSION: With meticulous device optimization under imaging guidance and avoidance of implantation in small vessels, BVS showed comparable risks of 2-year TVF and device thrombosis with DES. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02601404, NCT04265443.

Third-Generation Sirolimus-Eluting Bioresorbable Tyrocore Scaffold Implantation in Patients with ST-Segment Elevation Myocardial Infarction: Baseline and 6-Month OCT and Clinical Outcomes-a FANTOM STEMI Pilot Study.

PURPOSE: The aim of this study was to evaluate the safety and efficacy of the Fantom BRS 6 months after implantation using the optical coherence tomography (OCT) imaging. METHODS: Twenty STEMI patients treated with a sirolimus-eluting Fantom BRS were enrolled into a prospective, single-arm, serial observational study. The scaffold sizing, positioning and optimisation were guided by OCT imaging. The primary endpoint was device-orientated composite endpoints (DOCE), comprised of cardiac death, target-vessel-related myocardial infarction and target lesion failure. To evaluate the device performance at the scaffold level, we performed a quantitative coronary angiography (QCA) and OCT imaging at 6 months. RESULTS: The primary endpoint did not occur in any patient within the 6-month follow-up. There were no major adverse cardiac events (MACEs) or DOCEs, no cases of scaffold thrombosis, target lesion revascularization and no deaths. In QCA, we observed a decrease in the minimum and mean lumen diameter in the in-scaffold region and in the proximal and distal peri-scaffold region. Similarly, the minimum lumen area and reference vessel diameter had decreased in both QCA and OCT. The OCT imaging showed improvement in the expansion index and malposition rate. CONCLUSION: A serial 6-month OCT imaging after implantation of a third-generation Tyrocore-based bioresorbable coronary scaffold indicated good coverage of the struts with excellent healing of the scaffold, low neointima growth and no signs of neoatherosclerosis.

An investigation of cerebral bridging veins rupture due to head trauma.

Subdural hematoma (SDH) is common abnormality that is caused by the rupture of cerebral bridge veins (BVs). It occurs in more than 30% of severe head injuries. The purpose of this research was to develop a numerical model to examine the effects of brain atrophy and age on the rupture of bridging veins in subdural hematoma. Three types of models were developed to simulate subdural hematoma, namely global solid, global FSI, and local solid models. In the next step, a head impact with the head injury criterion (HIC) value of 744 was applied as a loading condition to global models. For the global solid models, we measured the relative displacement between the skull and brain. We extracted the pressure distribution from the global FSI models. The data were used as boundary conditions on the local models to evaluate the damage to the cerebral bridge veins precisely The results showed that the relative displacement was greater in the atrophied model compared to the healthy one (2.64 and 2.20 mm, respectively). In addition, the pressure value was higher in atrophied models. In the healthy local model, the maximum strain on BVs was around 1.38, while in the atrophied model, it was 2.77. The head impact, which had a HIC value of 744, did not cause serious injury to a human with a healthy brain, but it caused severe damage to an atrophied brain. The degeneration of the brain and intracranial space changes are two important factors for the movement of the brain and its vulnerability to impact.

Relationship between dental occlusion and brain activity: A narrative review.

Objectives: Occlusal function stimulates different areas of the cerebral cortex. The purpose of this narrative review was to identify the relationship between occlusion and brain activity so as to provide theoretical support to enable future studies on the subject. Study selection data and sources: Relevant case-control studies, clinical trials, and systematic reviews available in English were retrieved from the following databases: MEDLINE, PubMed, ScienceDirect, Wiley Online Library, and Biblioteca Virtual en Salud (BVS). Of the 53 articles obtained, 12 were included. Conclusion: The sensorimotor cortex is affected by changes in occlusion. It is speculated that occlusion could play an important role in the development of diseases, from anxiety and stress to Alzheimer's disease and senile dementia. Further investigations into the interactions between occlusion and brain function are needed to elucidate the parts of the brain that are affected when occlusion is disturbed and to determine whether brain function is altered. Clinical significance: Dentists must consider that alterations in the occlusal pattern during mastication can lead to changes in the activation of different brain regions related to memory, learning, anticipatory pain, and anxiety. This suggests that mastication maintains the integrity of certain brain areas and that it may be a key factor in the onset of neurodegenerative diseases.

Conflito com a lei e sexismo: percepções de adolescentes de Sergipe (Brasil) / Conflicto con la ley y sexismo: percepciones de adolescentes de Sergipe (Brasil) / Conflict with the law and sexism: perceptions of adolescents in Sergipe (Brazil)

Resumo O objetivo deste estudo é investigar como adolescentes do gênero feminino, em privação de liberdade, percebem a situação de conflito com a lei e o sexismo. Participaram quatro adolescentes que cumpriam medida socioeducativa de privação de liberdade em Sergipe (Brasil). Foram realizadas entrevistas semiestruturadas, interpretadas por meio da análise temática de conteúdo. Emergiram duas categorias: «Diferenças de gênero no ato infracional: a transgressão como característica masculina¼ e «Diferenças de gênero na medida socio-educativa: a obediência como característica feminina¼, indicando o impacto do gênero na percepção dessas adolescentes. Em conjunto, os resultados evidenciam que atentar ao recorte de gênero e às relações entre conflito com a lei e o sexismo são aspectos fundamentais para alcançar o ideário da legislação brasileira, o atendimento às especificidades das adolescentes numa proteção integral e igualitária.

Resumen El objetivo de este estudio es investigar cómo adolescentes, privadas de libertad, perciben la situación de conflicto con la ley y el sexismo. Participaron cuatro adolescentes que cumplían medida so-cioeducativa de privación de libertad en Sergipe (Brasil). Se realizaron entrevistas semiestructuradas, interpretadas mediante análisis de contenido temático. Surgieron dos categorías: «diferencias de género en la infracción: la transgresión como característica masculina¼ y «diferencias de género en la medida socioeducativa: la obediencia como característica femenina¼, indicando el impacto del género en la percepción de estas adolescentes. En conjunto, los resultados muestran que la atención al género y la relación entre conflicto con la ley y sexismo son aspectos fundamentales para lograr los ideales de la legislación brasileña, que es respetar las especificidades de las adolescentes en una protección integral e igualitaria.

Abstract This study aims to research how female adolescents who are deprived of their liberty perceive the relationship between their conflict with the law and sexism. The participants were four adolescents who were detained in a correctional facility in Sergipe (Brazil). Semi-structured interviews were conducted and these were interpreted using thematic content analysis. Two categories emerged: «Gender differences in infractions: transgression as a male characteristic¼ and «Gender differences in so-cioeducational scenarios: obedience as a female characteristic¼, highlighting the impact of gender on the perceptions of these adolescents. The results obtained through this research indicate that concentrating gender and the relationship between conflict with the law and sexism are fundamental aspects for achieving ideal legislation that respects the specific situations experienced by adolescents and provides them with integrated and equal protection.

Bone morphogenetic protein-4 system expression in human coronary artery endothelial and smooth muscle cells under dynamic flow: effect of medicated bioresorbable vascular scaffolds at low and normal shear stress.

Endothelial and smooth muscle cell dysfunction is an early event at the onset of atherosclerosis, a heterogeneous and multifactorial pathology of the vascular wall. Bone morphogenetic protein (BMP)-4, a mechanosensitive autocrine cytokine, and BMPR-1a, BMPR-1b, BMPR-2 specific receptors play a key role in atherosclerotic plaque formation and vascular calcification and BMP4 is regarded as a biomarker of endothelial cell activation. The study aimed to examine the BMP4 system expression by Real-Time PCR in Human Coronary Artery Endothelial (HCAECs) and Smooth Muscle Cells (HCASMCs) under different flow rates determining low or physiological shear stress in the presence/absence of medicated Bioresorbable Vascular Scaffold (BVS). The HCAEC and HCASMC were subjected to 1-10-20 dyne/cm2 shear stress in a laminar flow bioreactor system, with/without BVS+ Everolimus (600 nM). In HCAECs without BVS the BMP4 expression was similar at 1, 20 dyne/cm2 decreasing at 10 dyne/cm2, while adding BVS+ Everolimus, it decreased both at 1, 10 compared to 20 dyne/cm2. In HCASMCs without BVS + Everolimus, the BMP4 system mRNA expression was significantly reduced at 1, 10 dyne/cm2 compared to 20 dyne/cm2, while in the presence of BVS+ Everolimus, higher BMP4 mRNA levels were observed at 10 compared to 1, 20 dyne/cm2. In HCAECs and HCASMCs BMPRs were expressed in all experimental conditions except for BMPR-1a at 1 dyne/cm2 in HCAEC. Significant correlations were found between BMP4 and BMPRs. The more negligible on BMP4 expression due to low shear stress in HCAEC compared to HCASMC and its reduction in the presence of BVS+ Everolimus at low shear stress highlighted the protection of BMP4-mediated against endothelial dysfunction and neoatherogenesis.

A Sporulation-Specific sRNA Bvs196 Contributing to the Developing Spore in Bacillus velezensis.

Many putative sRNAs have been characterized using bioinformatic analysis and high-throughput sequencing in Gram-positive Bacillus strains, but there are only a few functional studies on the sRNAs involved in the spore formation developmental process. In particular, there is no sRNA confirmed experimentally to regulate the late stages of sporulation. Bvs196 is an sRNA with a length of 294 nucleotides that is abundantly expressed in the stationary phase of several media and independently transcribed in Bacillus velezensis strain PEBA20, as validated by RNA-seq and Northern blot,. It is also confirmed, by qRT-PCR, that Bvs196 is transcribed abundantly throughout the intermediate and late stages of sporulation. Using the gfpmut3a gene transcriptional reporter demonstrates that Bvs196 is expressed specifically in the forespore during sporulation and controlled by σF and σG (mainly by σG). This was observed by fluorescence microscopy and multi-function microplate reader. Further evolutionary conservation analysis found that Bvs196 is widely present in Bacillus with a strongly conserved and stable secondary structure. Resistance phenotypic assays of spores formed from the Bvs196 deletion mutant, the overexpressed Bvs196 mutant, and the wild-type strain revealed that the absence of Bvs196 led to reduced heat and UV resistance and enhanced formaldehyde resistance. We determined, by MST analysis, that Bvs196 can directly interact with spo0A and sspN-tlp mRNAs in vitro, and that short incomplete complementary paired bases affect the binding affinity of Bvs196 to target mRNAs. Our results suggest that Bvs196 is a novel sporulation-specific sRNA of B. velezensis, 294 nt in length, independently transcribed under the control of σF and σG in the forespore during sporulation, and that it affects spore resistance, and is able to directly interact with spo0A and sspN-tlp mRNAs. The remarkable conservation and impressive expression level of Bvs196 imply that it acts as an important conservative regulator, presumably by interacting with many other unknown targets in the forespore, and therefore contributing to spore properties. This work provides new clues for further understanding of the spore formation regulatory network.

Tungsten disulfide nanotubes enhance flow-induced crystallization and radio-opacity of polylactide without adversely affecting in vitro toxicity.

Treatment of vascular disease, from peripheral ischemia to coronary heart disease (CHD), is poised for transformation with the introduction of transient implants designed to "scaffold" regeneration of blood vessels and ultimately leave nothing behind. Improved materials could expand the use of these devices. Here, we examine one of the leading polymers for bioresorbable scaffolds (BRS), polylactide (PLA), as the matrix of nanocomposites with tungsten disulfide (WS2) nanotubes (WSNT), which may provide mechanical reinforcement and enhance radio-opacity. We evaluate in vitro cytotoxicity using vascular cells, flow-induced crystallization and radio-opacity of PLA-WSNT nanocomposites at low WSNT concentration. A small amount of WSNT (0.1 wt%) can effectively promote oriented crystallization of PLA without compromising molecular weight. And radio-opacity improves significantly: as little as 0.5 to 1 wt% WSNT doubles the radio-opacity of PLA-WSNT relative to PLA at 17 keV. The results suggest that a single component, WSNT, has the potential to increase the strength of BRS to enable thinner devices and increase radio-opacity to improve intraoperative visualization. The in vitro toxicity results indicate that PLA-WSNT nanocomposites are worthy of investigation in vivo. Although substantial further preclinical studies are needed, PLA-WSNT nanocomposites may provide a complement of material properties that may improve BRS and expand the range of lesions that can be treated using transient implants. STATEMENT OF SIGNIFICANCE: Bioresorbable Scaffolds (BRSs) support regeneration of arteries without permanent mechanical constraint. Poly-L-lactide (PLLA) is the structural material of the first approved BRS for coronary heart disease (ABSORB BVS), withdrawn due to adverse events in years 1-3. Here, we examine tungsten disulfide (WS2) nanotubes (WSNT) in PLA to address two contributors to early complications: (1) reinforce PLLA (enable thinner BRS), and (2) increase radiopacity (provide intraoperative visibility). For BRS, it is significant that WSNT disperse, remain dispersed, reduce friction and improve mechanical properties without additional chemicals or surface modifications. Like WS2 nanospheres, bare WSNT and PLA-WSNT nanocomposites show low cytotoxicity in vitro. PLA-WSNT show enhanced flow-induced crystallization relative to PLA, motivating future study of the processing behavior and strength of these materials.

Five-year angiographic, OCT and clinical outcomes of a randomized comparison of everolimus and biolimus-eluting coronary stents with everolimus-eluting bioresorbable vascular scaffolds.

AIMS: To compare 5-year angiographic, optical coherence tomography (OCT), and clinical outcomes between patients treated with bioresorbable vascular scaffolds (BVS) and drug-eluting stents (DES). METHODS: The EverBio-2 trial (Comparison of Everolimus- and Biolimus-Eluting Coronary Stents with Everolimus-Eluting Bioresorbable Vascular Scaffold) was a single-center, assessor-blinded, randomized controlled trial in which 240 patients were randomly allocated (1:1:1) to BVS, everolimus-eluting (EES) or biolimus-eluting (BES) DES. Clinical follow-up was scheduled up to 5 years. All patients, alive and who did not have repeat revascularization of the target lesion during follow-up were asked to return for angiographic follow-up at 5 years. RESULTS: Five-year angiographic follow-up was completed in 122 patients (51%) and OCT analysis was performed in 86 (36%) patients. In-stent late lumen loss was similar in both groups with 0.50 ± 0.38 mm in BVS versus 0.58 ± 0.36 mm in EES/BES, p = 0.20. Clinical follow-up was complete in 232 patients (97%) at 5 years. The rate of the device-oriented endpoint was 22% in the BVS and 18% in the EES/BES group (p = 0.49). The patient-oriented composite endpoint occurred in 40% of BVS- and 43% of EES/BES-treated patients (p = 0.72) at 5 years. No acute coronary syndrome due to stent thrombosis was detected after 2 years. Complete BVS strut resorption was observed at 5 years in the OCT subgroup. CONCLUSION: Five-year clinical outcomes were similar between BVS and DES patients as well as angiographic outcomes in a selected subgroup. However, a definitive conclusion cannot be drawn because the EverBio-2 trial was not powered for clinical and angiographic endpoints at 5 years of follow-up.

Calidad de vida en demencia Alzheimer: un nuevo desafío / Quality of life in Alzheimer's dementia: a new challenge

Resumen El progresivo envejecimiento de la población mundial se encuentra directamente asociado al aumento de las patologías neurodegenerativas. Dentro de estas, la Enfermedad de Alzheimer es el tipo de demencia de mayor prevalencia a nivel mundial y se asocia a un mayor deterioro de la calidad de vida, no solo en los pacientes, sino que también en sus cuidadores y entorno familiar. Frente a este escenario, durante los últimos años ha adquirido especial importancia el evaluar la calidad de vida en pacientes con demencia Alzheimer, siendo un aspecto de creciente interés en el ámbito clínico y de la salud pública al ser considerado como un indicador en la medición de la efectividad de los distintos tipos de intervenciones, farmacológicas y no farmacológicas, sobre la enfermedad y su evolución. El conocer el concepto calidad de vida por parte de los equipos de salud y la evaluación clínica de esta en pacientes con demencia Alzheimer se ha vuelto un pilar fundamental tanto en el manejo, como en el uso de la información para la toma de decisiones en relación a políticas públicas relacionadas a pacientes con demencia. En este trabajo se abordará la temática desde tres ámbitos, la importancia de la enfermedad de Alzheimer, la calidad de vida a lo largo de los años, y como ésta puede ser utilizada en el manejo de patologías neurodegenerativas como la demencia.

The progressive aging of the world population is directly associated with the increase in neurodegenerative pathologies. Among these, Alzheimer's disease is the most prevalent type of dementia worldwide which is associated with a greater deterioration in the quality of life, not only in patients but also in their caregivers and family environment. In this context, during the last years has become important to evaluate the quality of life in patients with Alzheimer's dementia to be an area of growing interest in clinical and public health because it is considered as an indicator in effectiveness measurement of the different types of interventions, pharmacological and non-pharmacological, on the disease and its evolution. Heath teams know the concept of quality of life and its clinical evaluation in patients with Alzheimer's dementia and it has become fundamental support for both management and the use of information for decision-making in the field of public policies related to patients with dementia. In this viewpoint the theme will be addressed from three areas, the importance of Alzheimer's disease, quality of life throughout history, and how it can be used in the management of neurodegenerative diseases such as dementia.

Necrólisis epidérmica tóxica en una adolescente diagnosticada de trastorno bipolar II y tratada con lamotrigina / Toxic epidermal necrolysis in an adolescent with Bipolar Disorder II and treated with Lamotrigine

Resumen La necrólisis epidérmica tóxica es una enfermedad cutánea severa, la mayoría de las veces desencadenada como reacción adversa a medicamentos, con alta morbilidad y mortalidad. La lamotrigina, junto a otros medicamentos estabilizadores del ánimo, constituye la causa medicamentosa más frecuente de esta complicación, consistente en necrosis y esfacelo de la epidermis y mucosas en más del 30 % de la superficie corporal, con la consecuente pérdida de líquidos y electrolitos, respuesta inflamatoria sistémica, susceptibilidad a infecciones y hasta sepsis, además de posibles secuelas ominosas. En la actualidad, el diagnóstico de trastorno bipolar se hace con mayor frecuencia, incluyendo al grupo etario de niños y adolescentes, pero tal proceso diagnóstico se caracteriza por dificultades y controversias en mayor cuantía que otros diagnósticos psiquiátricos. Ello obliga a una meticulosa elucubración diagnóstica y selección farmacológica, con pleno conocimiento de las moléculas del arsenal medicamentoso para, en caso de prescripción de lamotrigina, establecer una escrupulosa psicoeducación al paciente y sus familiares además de un seguimiento estricto y cercano. A propósito del caso de una adolescente diagnosticada de trastorno bipolar II, que recibió lamotrigina durante un episodio depresivo pero con un esquema posológico inadecuado, y desarrolló necrólisis epidérmica tóxica, revisamos y comentamos la literatura correspondiente. Concluimos en que es preciso extremar las precauciones al decidir el uso de lamotrigina para minimizar el riesgo de este severo efecto adverso.

Toxic epidermal necrolysis is a severe skin disease, most often triggered as an adverse drug reaction, with high morbidity and mortality. Lamotrigine, together with other mood stabilizer drugs, constitutes the most frequent drug that causes this complication, which consists of necrosis and detachment of the epidermis and mucosa in more than 30% of the body surface, with the consequent loss of water and electrolytes, systemic inflammatory response, susceptibility to infections and even sepsis, in addition to other possible ominous sequelae. Currently, the diagnosis of bipolar disorder is made more frequently, including the age group of children and adolescents, but such a diagnostic process is characterized by difficulties and controversies to a greater extent than other psychiatric diagnoses. This requires meticulous diagnostic process and pharmacological selection, with full knowledge of the molecules in the drug arsenal so, in case of lamotrigine prescription, it should be established scrupulous psychoeducation to the patient and their family members, as well as strict and close follow-up. A propos of the case of an adolescent girl diagnosed with bipolar II disorder, who received lamotrigine during a depressive episode but with an inappropriate posology, and developed toxic epidermal necrolysis, we reviewed and commented on the corresponding literature. We conclude that extreme caution is necessary when deciding the use of lamotrigine to minimize the risk of this severe adverse effect.

Conocimiento de la anticoncepción de emergencia en mujeres adolescentes de enseñanza media de la comuna de Hualqui, Chile / Emergency contraception knowledge in female adolescent secondary education students from Hualqui commune, Chile

INTRODUCCIÓN Dado que el conocimiento sobre la anticoncepción de emergencia puede ser de gran utilidad en la promoción de la salud sexual y salud reproductiva, especialmente en los adolescentes, la deficiencia del mismo podría disminuir su prescripción y uso. OBJETIVO Describir el conocimiento sobre los métodos anticonceptivos de emergencia de un grupo de mujeres adolescentes estudiantes de enseñanza media de la comuna de Hualqui, Chile. MATERIAL Y MÉTODO Se realizó un estudio descriptivo de corte transversal. Se encuestó a 115 mujeres adolescentes estudiantes de primer a cuarto año de enseñanza media del liceo San Juan Bautista de Hualqui, Octava Región de Chile. Se exploraron antecedentes generales de salud sexual y salud reproductiva, y conocimientos sobre la anticoncepción de emergencia, su uso y formas de adquisición. RESULTADOS La edad promedio fue de 16,1 años. El 39% de las estudiantes eran sexualmente activas, y en promedio iniciaron su vida sexual a los 15,3 años y tuvieron 2,1 parejas sexuales. El método anticonceptivo que más utilizaban fue el anticonceptivo hormonal inyectable (31,1%), seguido de la anticoncepción oral combinada (20,0%). Con respecto a la anticoncepción de emergencia, el 80,9% declaró saber de su entrega liberada, mientras que el 11,1% declaró haberlos usado alguna vez. El 91,3% de las encuestadas consideró necesario tener mayor información. CONCLUSIÓN Las adolescentes participantes del estudio mostraron algún grado de conocimiento respecto a la anticoncepción de emergencia, pese a no utilizarla habitualmente. No obstante, la mayoría expresó la necesidad de tener mayor acceso a información relacionada al tema.

BACKGROUND Given that knowledge about emergency contraception can be very useful in promoting sexual health and reproductive health, especially in adolescents, its deficiency could decrease its prescription and use. AIM To describe the knowledge about emergency contraceptive methods of a group of female adolescent secondary education students from the Hualqui commune, Chile. METHOD A descriptive cross-sectional study was carried out. 115 adolescent women students from first to fourth year of high school at San Juan Bautista high school in Hualqui, Eighth Region of Chile, were surveyed. General sexual health and reproductive health backgrounds, and knowledge of emergency contraception, its use, and forms of acquisition were explored. RESULTS The average age was 16,1 years. 39% of the students were sexually active, and on average started their sex life at 15,3 years and had 2,1 sexual partners. The most widely used contraceptive method was injectable hormonal contraception (31,1%), followed by combined oral contraception (20,0%). Regarding the emergency contraception, 80,9% stated that they knew of their free delivery, while 11,1% stated that they had ever used them. 91,3% of respondents considered it necessary to have more information. CONCLUSIONS The adolescents participating in the study showed some degree of knowledge regarding emergency contraception, despite not using it regularly. However, the majority expressed the need for greater access to information related to the topic.

Treatment of In-Stent Restenosis Using Excimer Laser Coronary Atherectomy and Bioresorbable Vascular Scaffold Guided by Optical Coherence Tomography.

The rate of in-stent restenosis (ISR) has become increasingly prevalent with the exponential growth in stent implantation due to an aging population and a higher life expectancy, in addition to the high rates of obesity and diabetes. In this prospective, single operator, all-comer study, we sought to analyze the performance of ELCA followed by bioresorbable vascular scaffold (BVS) placement in patients undergoing percutaneous coronary intervention (PCI) for ISR. A total of 13 patients had ISR treated with a combination of ELCA and BVS, with 9 patients having matched OCT pre, post ELCA and post BVS. Mean age was 65 ± 11.22 and 83% of the patients were male. Hypertension and dyslipidemia were present in 100% of the patients and smoking and diabetes in 50%. After the procedure, we did not detect residual stenosis over 10% in any patient, resulting in a technical success of 100%. No patients had MACE during their hospital stay or within the next six months, resulting in a procedure success of 100%. The mean lumen area increased 0.35 mm2 from pre procedure to post ELCA and 3.58 mm2 from post ELCA to post BVS. The final difference, from pre procedure to post BVS, was a 3.93 mm2 lumen area gain. The mean lumen diameter increased 0.11 mm from baseline to ELCA, 0.95 mm from post laser to BVS implantation and 1.06 mm from pre procedure to post BVS. The NIH area reduced 0.48 mm2 from pre to post ELCA, 1.13mm2 from post ELCA to BVS implantation and 1.61 mm2 from baseline to post BVS implantation. We conclude that ELCA is a safe and feasible debulking method to approach ISR, with high rates of post-procedural BVS success, within six months follow-up.

Transcatheter-Delivered Expandable Bioresorbable Polymeric Graft With Stenting Capacity Induces Vascular Regeneration.

As the next step in the translation of vascular tissue engineering, this study uniquely combines transcatheter delivery and in situ tissue regeneration using a novel bioresorbable electrospun polymer graft that can be implanted minimally invasively. Once delivered inside a small-diameter vessel, the electrospun microstructure supports the vessel wall, facilitates cellular infiltration, and guides organized tissue formation.

Biocompatibility analysis of PLA based candidate materials for cardiovascular stents in a rat subcutaneous implant model.

Modification of Polylactic acid (PLA), a biopolymer, is a strategy still to be fully explored for the next generation of bioresorbable vascular stent (BVS) biomaterials. With this focus, inclusions upto 5% of Polycaprolactone (PCL) and Magnesium in PLA were tested in the rat subcutaneous model and their cellular and tissue interactions characterized, specifically with respect to inflammatory response, angiogenesis and capsularization. The cytokines IL6, TNF Alpha and IL-1Beta were estimated in the peri-implant tissue, all of which showed a non-significant difference between the non-implanted animals and those containing PLA by 8 weeks, speaking to the benign nature of PLA as an implant biomaterial. Both modified materials, had increased macrophage counts and cytokine levels, except IL6 at 8 weeks. Vascularization only at 8 weeks in PLA PCL containing tissue was significantly higher than pure PLA, which may be more carefully controlled along with the material hydrophobicity for possible efforts towards therapeutic angiogenesis. Capsule thickness, measured by staining with both Hematoxylin & Eosin and Masson's Trichome did not show any differences between materials, including PLA.

Triple molybdates K3-xNa1+xM4(MoO4)6 (M = Ni, Mg, Co) and K3+xLi1-xMg4(MoO4)6 isotypic with II-Na3Fe2(AsO4)3 and yurmarinite: synthesis, potassium disorder, crystal chemistry and ionic conductivity.

The triple molybdates K3-xNa1+xM4(MoO4)6 (M = Ni, Mg, Co) and K3+xLi1-xMg4(MoO4)6 were found upon studying the corresponding ternary molybdate systems, and their structures, thermal stability and electrical conductiviplusmnty were investigated. The compounds crystallize in the space group R3c and are isostructural with the sodium-ion conductor II-Na3Fe2(AsO4)3 and yurmarinite, Na7(Fe3+, Mg, Cu)4(AsO4)6; their basic structural units are flat polyhedral clusters of the central M1O6 octahedron sharing edges with three surrounding M2O6 octahedra, which combine with single NaO6 octahedra and bridging MoO4 tetrahedra to form open three-dimensional (3D) frameworks where the cavities are partially occupied by disordered potassium (sodium) ions. The split alkali-ion positions in K3-xNa1+xM4(MoO4)6 (M = Ni, Mg, Co) give their structural formulae as [(K,Na)0.5□0.5)]6(Na)[M1][M2]3(MoO4)6, whereas the lithium-containing compound (K0.5□0.5)6(Mg0.89K0.11)(Li0.89Mg0.11)Mg3(MoO4)6 shows an unexpected (Mg, K) isomorphism, which is similar to (Mn, K) and (Co, K) substitutions in isostructural K3+xLi1-xM4(MoO4)6 (M = Mn, Co). The crystal chemistry of the title compounds and related arsenates, phosphates and molybdates was considered, and the connections of the cationic distributions with potential 3D ionic conductivity were shown by means of calculating the bond valence sum (BVS) maps for the Na+, Li+ and K+ ions. Electrical conductivity measurements gave relatively low values for the triple molybdates [σ = 4.8 × 10-6 S cm-1 at 390°C for K3NaCo4(MoO4)6 and 5 × 10-7 S cm-1 at 400°C for K3LiMg4(MoO4)6] compared with II-Na3Fe2(AsO4)3 (σ = 8.3 × 10-4 S cm-1 at 300°C). This may be explained by a low concentration of sodium or lithium ions and the blocking of their transport by large potassium ions.

Scaffold underexpansion and late lumen loss after bioresorbable scaffold implantation: Insights from ABSORB JAPAN trial.

BACKGROUND: Device underexpansion is associated with late adverse outcomes after bioresorbable vascular scaffold (BVS) implantation. This study, representing official IVUS results of the ABSORB Japan trial, aimed to characterize IVUS findings, focusing specifically on acute device expansion, and to investigate its impact on late lumen loss (LLL) with Absorb-BVS compared with cobalt-chromium everolimus-eluting stents (CoCr-EES). METHODS: ABSORB Japan enrolled 148 patients (2:1 randomization) in the IVUS cohort. Serial IVUS was prescheduled at post-procedure and 3 years. Acute device expansion was evaluated with respect to the degree and uniformity of the implanted device. RESULTS: Overall, Absorb-BVS showed smaller and more nonuniform device expansion at post-procedure, compared with CoCr-EES, which was particularly prominent in small-vessel lesions. In serial analysis, Absorb-BVS showed unique associations of smaller device expansion (r = 0.40, p = 0.001) and more nonuniformity (r = 0.29, p = 0.007) at post-procedure with greater LLL at 3 years, primarily attributable to greater negative remodeling (r = 0.39, p = 0.006). In contrast, acute device expansion showed no relation with subsequent lumen change in CoCr-EES. In Absorb-BVS, ischemic-driven target lesion or vessel revascularization (ID-TLR or ID-TVR) at 3 years occurred more frequently in small- versus large-vessel lesions (12.5% vs. 0%, p = 0.04 for ID-TLR and 15.6% vs. 2.3%, p = 0.08 for ID-TVR). Conversely, Absorb BVS had no target lesion nor vessel failure, even in small-vessel lesions, when adequate device expansion was achieved at post-procedure. CONCLUSIONS: Unlike CoCr-EES, underexpansion was associated with greater negative remodeling and LLL in Absorb-BVS. This may in part account for the poorer outcomes of Absorb-BVS than CoCr-EES when under-expanded.