Study of the Time-Temperature-Dependent behaviour of PVB: application to laminated glass elements

The mechanical behavior of laminated glass elements is governed by material properties of the interlayer, the Polyvinyl Butiral (PVB) being the most used interlayer material in these elements. PVB is a viscoelastic material whose mechanical properties (Young’s modulus, shear modulus, etc.) depend mainly on the load application time and the temperature. Thus an adequate mechanical characterization of the PVB must be performed in order to predict the response of laminated glass elements with a good accuracy In this work, PVB specimens were subjected to static relaxation tests and to dynamic experimental tests (frequency domain) at different temperatures from -〖15〗^o C to 〖50〗^o C using a DMTA equipment. Then the curves at different temperatures were related using the William-Landel-Ferry (WLF) Time-Temperature Superposition (TTS) model to obtain the mastercurve of both the time and frequency domain Young’s moduli of the PVB. Finally, a viscoelastic Prony based model was fitted to the experimental data and used, afterwards, to simulate numerically the static and dynamic behaviour of different laminated glass elements at different temperatures. The numerical simulations were compared with the static and dynamic experimental results achieving a good accuracy in both the static deflections and the natural frequencies. With respect to the damping, the discrepancies are less than 22%

Ecocardiografía en la valoración de un fibroelastoma papilar múltiple

Fibroelastoma is the second most common primary benign cardiac tumor. It can be multiple; the aortic valve is the most frequently affected location and the most important complication is systemic embolism. We present the case of a 67-year-old woman who attended the emergency room due to heart failure. In the study, the echocardiogram showed a nodular small mass in the left coronary leaflet of the aortic valve suggestive of fibroelastoma. The transesophageal echocardiogram confirmed the finding and found a second mass in the non-coronary leaflet, for which to the final diagnosis of multiple papillary fibroelastoma.El fibroelastoma es el segundo tumor benigno cardiaco primario más frecuente. Puede ser múltiple, la válvula aórtica es la localización más frecuentemente más afectada y la complicación más importante es el embolismo sistémico. Presentamos el caso de una mujer de 67 años que acudió a Urgencias por insuficiencia cardiaca. En el estudio se realizó un ecocardiograma en el que se apreció una imagen nodular en el velo coronariano izquierdo de la válvula aórtica sugestiva de fibroelastoma, El ecocardiograma transesofágico confirmó el hallazgo y encontró una segunda masa en el velo no coronariano, por lo que se llegó al diagnóstico final de fibroelastoma papilar múltiple

Effects of sevoflurane postconditioning on cell death, inflammation and TLR expression in human endothelial cells exposed to LPS

Background: Sevoflurane is an anesthetic agent which also participates in protective mechanisms in sepsis, likely due to anti-inflammatory properties. A key tissue in sepsis is the endothelium, which expresses TLR2 and TLR4 receptors, known regulators of inflammatory mechanisms and potential therapeutic targets for this pathology. In this context, we explored the effect of sevoflurane postconditioning in an in vitro sepsis model. Methods: Primary cultures of human umbilical vein endothelial cells were used for two different experiments. In the first set, cultures were placed in an airtight incubation chamber and exposed to different concentrations of sevoflurane (0,1,3 or 7% vol,) for 1 hour. In the second set, lipopolysaccharide from Escherichia coli 0111:B4 (1 μg/mL) was added to culture medium for 3 hours and cells were subsequently exposed to sevoflurane (0,1,3 or 7% vol,) for 1 hour as explained before. In both cases, cell viability was measured by MTT and Trypan blue assays, TLR2 and TLR4 expression were analyzed by flow cytometry, and TNFα and IL-6 levels were quantified in cell culture media by an immunoassay immediately after exposure, at 6 and 24 hours. Results: Exposure to 3% sevoflurane decreased TLR2 at 24 hours and TLR4 at 6 and 24 hours (both p<0.05), whereas exposure to 7% decreased TLR4 expression at 6 hours (p<0.05). Both 3 and 7% sevoflurane decreased TNF-α and IL-6 levels at 24 hours (both p<0.05). In LPS-stimulated cultures, exposure to 3% sevoflurane was cytoprotective at 6 and 24 hours (p<0.05) compared with control, and decreased TLR2 and TLR4 expression at 24 hours (p<0.05); whereas 7% decreased TLR4 expression at 24 hours (p<0.05). Both 3% and 7% sevoflurane decreased TNF-α and IL-6 levels at 24 hours (both p<0.05). Conclusions: Postconditioning with the halogenated anesthetic agent sevoflurane after LPS stimulation shows a cytoprotective effect in an in vitro model, decreasing cell death and reducing TLR2 and TLR4 expression as well as levels of the inflammatory mediators TNF-α and IL-6 in human endothelial cells

Safety of statins when response is carefully monitored: a study of 336 heart recipients

[Abstract] Background. Statins are used as first-line drugs against hypercholesterolemia after heart transplantation. Randomized clinical trials have shown that they reduce cholesterol levels, and the incidence of rejection and coronary vasculopathy. Adverse effects have been related to the use of certain statins, high statin dosages, comorbidities, and coadministration with cyclosporine. However, estimation of the risk of adverse effects for a given patient is difficult. The aims of this study were to determine the incidence of various kinds of adverse effect of statins; to evaluate certain potential risk factors; and to assess the efficacy of early response to signs of adverse effects. Methods. Between April 1991 and December 2003, we retrospectively evaluated 336 heart transplant patients (including 55 women) with regard to the occurrence of possible adverse effects of statins (rhabdomyolysis, myalgia, hepatotoxicity, high CK without muscle symptoms, and others). Resolution on reduction of dosage or discontinuance and/or change of statin were deemed to constitute confirmation of cause. Relations were sought between adverse effects and age, sex, immunosuppressive therapy, kidney failure, body mass index (BMI), arterial hypertension, and diabetes mellitus. Results. Possible adverse events of statins were suffered by 60 patients, all of them men. The causal role of statins was confirmed in 41 (12.2% of all 336): hepatotoxicity was suffered by 13, high CK without muscle ache or weakness by 18, rhabdomyolysis by 5, myalgia by 3, and other effects by 2. The incidence of confirmed statin-related complications was higher among patients with BMI >29 kg/m2 than among those with lower BMI (P = .055). None of the patients with confirmed statin-related complications needed dialysis, none died, and permanent suspension of statin treatment was only necessary in 13 cases (3.9% of the 336). Conclusions. Some 10% to 20% of HT patients appear to suffer adverse side effects of initial statin therapy. However, early detection of such effects through diligent clinical and analytical monitoring allows the therapy to be modified in time to minimize the appearance of severe complications. In only a minority of cases permanent suspension of statin therapy is necessary

Hypotension, acidosis and vasodilation syndrome after heart transplant: incidence, risk factors, and prognosis

[Abstract] Background. HAV syndrome, the combination of hypotension, acidosis and vasodilation (HAV), is a serious postoperative complication after heart transplantation (HT). Its etiology and prognosis are poorly understood. Aim. To determine the incidence and prognosis of post-HT HAV syndrome and examine possible risk factors. Methods. Retrospective examination of the records of 85 consecutive patients who underwent HT between December 1999 and June 2002 sought the HAV criteria: systolic BP <85 mm Hg plus HCO3 <19 mEq/l whole excluding cardiogenic, hypovolemic and septic shock. Donor variables included sex, age, weight, height, cause of death, time in ICU, and ischemic time; while recipient variables, sex, age, weight, height, etiology of cardiopathy, previous cardiopulmonary bypass surgery, preoperative amiodarone, β-blockers, catecholamines, mechanical ventilation or intra aortic balloon pump (IABP), RVP, time on waiting list, pump time, reoperations, polytransfusion, preoperative creatinine, GOT, GPT and GGT, induction with OKT3 or anti-CD25, bypass-to-HAV time, duration of catecholamine treatment, and 1 month survival after HT. Results. The 11 HAV cases (13%) appeared between 1 and 72 h after HT (75% in the first hour). Catecholamines were used for 1 to 6 days; control was achieved within 48 h in 58% of cases. Two HAV patients (18%) died within the first month versus six non-HAV patients (8.1%) (P = .275). Only polytransfusion showed more than a borderline value to predict HAV syndrome. Conclusions. HAV syndrome has an incidence of 13% and a mortality of 18% within 1 month post-HT. The only likely risk factor is polytransfusion

Efecto de un programa de formación en atención primaria sobre la optimización del tratamiento con bloqueadores beta en pacientes ancianos con insuficiencia cardiaca

[Abstract] Introduction and objectives. Underuse of beta-blockers may contribute to elevated mortality in chronic heart failure. The aim of this study was to determine whether a specific interventional training program for primary care physicians would help optimize the use of beta-blockers in elderly chronic heart failure patients. Methods. This randomized comparative study included 627 patients aged 70 years or more who were discharged consecutively from 53 Spanish hospitals with a principal diagnosis of chronic heart failure. In total, 292 health-care centers in the catchment areas of these hospitals were randomly assigned to two groups: one group of 146 centers carried out an interventional training program on beta-blocker use for primary care physicians belonging to the centers assigned to training, and 146 centers served as a control group. The main outcome variable was the percentage of patients who were receiving a beta-blocker at the maximum or maximum tolerated dose 3 months after hospital discharge. Results. The patients’ mean age was 78±5 years and 42% were women. There was no difference between the groups in demographic characteristics, clinical care, or treatment at discharge. The percentage of patients who received beta-blockers at the maximum tolerated dose 3 months after discharge was greater in the training group (49% vs. 38%; P=.014). Being treated in the training group was an independent predictor of receiving a beta-blocker at the MTD (odds ratio=2.46; 95% confidence interval, 1.29-4.69; P<.001). Conclusions. Implementation of an interventional training program on beta-blocker treatment for primary care physicians improved the use of these medications in elderly chronic heart failure patients.[Resumen] Introducción y objetivos. La infrautilización de bloqueadores beta puede influir en la elevada mortalidad de la insuficiencia cardiaca. El objetivo de nuestro estudio es evaluar si un programa específico de intervención sobre médicos de atención primaria permite optimizar el uso de bloqueadores beta en pacientes ancianos con insuficiencia cardiaca. Métodos. Se diseñó un estudio aleatorizado y comparativo en el que se incluyó a 627 pacientes de 70 o más años, dados de alta de forma consecutiva con el diagnóstico principal de insuficiencia cardiaca en 53 hospitales españoles. Se realizó una asignación aleatoria de los 292 centros de salud de las áreas de esos hospitales a dos grupos (formación, 146 centros, y control, 146 centros), para impartir un programa de intervención y formación sobre bloqueadores beta a los médicos pertenecientes a los centros del grupo formación. La variable principal fue el porcentaje de pacientes que recibían la dosis máxima o máxima tolerada de bloqueadores beta a los 3 meses del alta. Resultados. La edad de los pacientes era de 78 ± 5 años; el 42% eran mujeres. No hubo diferencias entre ambos grupos en sus características demográficas, clínicas o en el tratamiento al alta. El porcentaje de pacientes que recibían la dosis máxima tolerada de bloqueadores beta a los 3 meses del alta fue mayor en el grupo formación (el 49 frente al 38%; p = 0,014); pertenecer al grupo formación fue predictor independiente de recibir la dosis máxima tolerada de bloqueadores beta (odds ratio = 2,46; intervalo de confianza del 95%, 1,29-4,69; p < 0,001). Conclusiones. Un programa de formación sobre bloqueadores beta en atención primaria mejora su uso en pacientes ancianos con insuficiencia cardiaca

Impact of CD68/(CD3+CD20) Ratio at the Invasive Front of Primary Tumors on Distant Metastasis Development in Breast Cancer

Tumors are infiltrated by macrophages, T and B-lymphocytes, which may favor tumor development by promoting angiogenesis, growth and invasion. The aim of this study was to investigate the clinical relevance of the relative amount of macrophages (CD68⁺), T-cells (CD3⁺ and B-cells (CD20⁺) at the invasive front of breast carcinomas, and the expression of matrix metalloproteases (MMPs) and their inhibitors (TIMPs) either at the invasive front or at the tumor center. We performed an immunohistochemical study counting CD3, CD20 and CD68 positive cells at the invasive front, in 102 breast carcinomas. Also, tissue sections were stained with MMP-2, -9, -11, -14 and TIMP-2 antibodies, and immunoreactivity location, percentage of reactive area and intensity were determined at the invasive front and at the tumor center. The results showed that an increased CD68 count and CD68/(CD3+CD20) ratio were directly associated with both MMP-11 and TIMP-2 expression by mononuclear inflammatory cells at the tumor center (p = 0.041 and p = 0.025 for CD68 count and p = 0.001 and p = 0.045 for ratio, respectively for MMP-11 and TIMP-2). In addition, a high CD68/(CD3+CD20) ratio (>0.05) was directly associated with a higher probability of shortened relapse-free survival. Multivariate analysis revealed that CD68/(CD3+CD20) ratio was an independent factor associated with distant relapse-free survival (RR: 2.54, CI: (1.23-5.24), p<0.01). Therefore, CD68/(CD3+CD20) ratio at the invasive front could be used as an important prognostic marker

Psycho-emotional disorders as incoming risk factors for myocardial infarction with non-obstructive coronary arteries

  Background: There is an emerging field underlying the myocardial infarction (MI) with non-obstruc­tive coronary arteries (MINOCA). The aim of this study was to evaluate the impact of psycho-emotional disorders and social habits in MINOCA patients. Methods: The study included 95 consecutive patients diagnosed of MINOCA and 178 patients with MI and obstructive lesions. MINOCA patients were included when they fulfilled the three main criteria: accomplishment of the Third Universal Definition of Myocardial Infarction, absence of obstructive coronary arteries and no clinically overt specific cause for the acute presentation. Results: MINOCA patients had a higher frequency of previous psychiatric illnesses than the obstructive coronary arteries group (29.7% vs. 12.9%, p = 0.001). MINOCA patients recognized emotional stress in 75.7% of the cases, while only 32.1% of the obstructive related group did (p &lt; 0.001). The relation­ship remained after excluding takotsubo syndrome from the analysis (26 cases, 27.4%): psychiatric diseases (27.9% vs. 12.9%, p &lt; 0.01) and recognition of emotional stress (70.8% vs. 32.1%, p &lt; 0.001). Social habits which could act as stress modulating showed no significant relation with MINOCA. Conclusions: Psycho-emotional disorders are related to MINOCA and they could act as risk fac­tor. This relationship is maintained after excluding takotsubo from the analysis. (Cardiol J 2018; 25, 1: 24–31

Novedades para la flora de la Región de Murcia, III

New records for the Murcian flora are shown to the scientific community: Athamanta vayredana, Bupleurum ranunculoides, Epilobium angustifolium, Kleinia anteuphorbium, Ononis spinosa subsp. antiquorum, Orobanche schultzii, Platanthera algeriensis, Senna artemisioides, Valerianella multidentata and Valerianella microcarpa.Se ponen en conocimiento de la comunidad científica nuevas referencias corológicas para la flora vascular de la Región de Murcia: Athamanta vayredana, Bupleurum ranunculoides, Epilobium angustifolium, Kleinia anteuphorbium, Ononis spinosa subsp. antiquorum, Orobanche schultzii, Platanthera algeriensis, Senna artemisioides, Valerianella multidentata y Valerianella microcarpa

Diferencias en el pronóstico de la insuficiencia cardiaca con función sistólica conservada o deprimida en pacientes mayores de 70 años que toman bloqueadores beta

[Abstract] Introduction and objectives. Most studies have shown that prognosis of heart failure with preserved systolic function is as poor as that of heart failure with depressed systolic function, although these results may be biased by the fact that these types of heart failure have different characteristics (age, comorbidity, treatment), which can influence prognosis. Our aim was to determine whether short-term morbidity and mortality differed in these 2 subgroups of heart failure patients when they were comparable in terms of age, associated comorbidity, and therapy. Methods. We analyzed 2 groups of patients aged >70 years who were candidates to receive beta blockers (preserved systolic function, 245; depressed systolic function, 374), consecutively discharged from 53 participating Spanish hospitals with a diagnosis of heart failure, and compared cardiovascular morbidity and mortality 3 months after discharge. Results. Mean age was similar (77.5 ± 4.8 vs 78.2 ± 5.5 years). Left ventricular ejection fraction was 56.2% ± 8.1% vs 33% ± 6.9% (P<.001). The combined event rate (death, hospitalization for heart failure, acute coronary syndrome, or stroke) at 3 months after discharge was lower in patients with heart failure and preserved systolic function (13.4% vs 20.6%; P=.026). Depressed systolic function was an independent predictor of greater incidence of events (odds ratio=1.732; P=.048). Conclusions. In patients of similar age and receiving similar treatment, short-term prognosis is better in patients with heart failure and preserved systolic function than in those with depressed systolic function.[Resumen] Introducción y objetivos. La mayoría de los trabajos han puesto de manifiesto que el pronóstico de la insuficiencia cardiaca con función sistólica conservada es tan malo como el de la insuficiencia cardiaca con función sistólica deprimida, aunque estos resultados pueden estar sesgados debido a que estos dos tipos de insuficiencia cardiaca tienen características distintas (edad, comorbilidades, tratamiento) que pueden influir en el pronóstico. Nuestro objetivo es evaluar si la morbimortalidad a corto plazo es distinta en estos dos subgrupos de insuficiencia cardiaca, con pacientes homogéneos en cuanto a edad, comorbilidad y tratamiento recibido. Métodos. Analizamos dos grupos de pacientes mayores de 70 años y que pudieran recibir bloqueadores beta, dados de alta consecutivamente tras un ingreso por insuficiencia cardiaca en 53 hospitales españoles (función sistólica deprimida, 245; función sistólica conservada, 374), y se comparó la morbimortalidad cardiovascular a los 3 meses del alta. Resultados. Las medias de edad fueron similares (77,5 ± 4,8 frente a 78,2 ± 5,5 años). La fracción de eyección ventricular izquierda fue de 56,2 ± 8,1% frente a 33 ± 6,9% (p < 0,001). La incidencia del evento combinado (muerte, ingreso por insuficiencia cardiaca, síndrome coronario agudo o ictus) a los 3 meses del alta fue menor en los pacientes con insuficiencia cardiaca y función sistólica conservada (el 13,4 frente al 20,6%; p = 0,026). Tener la función sistólica deprimida fue predictor independiente de mayor incidencia de eventos (odds ratio = 1,732; p = 0,048). Conclusiones. En pacientes de edad similar que reciben el mismo tratamiento, el pronóstico a corto plazo es mejor en los pacientes con insuficiencia cardiaca y función sistólica conservada que en aquellos con función sistólica deprimida