Las guías de práctica clínica de manejo de la dislipemia. Una visión transatlántica.Clinical Practice Guidelines for the Management of Dyslipidemia. Transatlantic Perspectives

Situación de la dislipemia en España. Las guías de práctica clínica (GPC) se han convertido en un instru- mento fundamental en nuestra actividad asistencial. La revisión deta- llada de la evidencia científica disponible permite la elaboración de documentos de recomendaciones diagnósticas y terapéuticas avala- dos por las principales instituciones científicas. A pesar de que habi- tualmente están basadas en los mismos estudios y, por lo tanto, se redactan a partir de los mismos resultados, pueden existir diferentes interpretaciones y distintos enfoques, como ha sucedido reciente- mente en las principales GPC que abordan el manejo de las dislipe- mias. En el año 2011 la Sociedad Europea de Cardiología (ESC) y la European Atherosclerosis Society (EAS) publicaron la Guía ESC/EAS para el manejo de las dislipemias1, con unas recomendaciones que se mantienen vigentes y la mayoría de las sociedades científicas de nuestro entorno respaldan. A finales de 2013, el American College of Cardiology (ACC) y la American Heart Association (AHA) hicieron pública su guía sobre el tratamiento del colesterol sanguíneo para reducir el riesgo cardiovascular aterosclerótico en adultos2. Aunque persiguen la misma finalidad, que es la reducción del riesgo cardio- vascular mediante el tratamiento de la dislipemia, lo hacen con una orientación completamente distinta que ha generado un gran debate en el último año y ha hecho correr ríos de tinta, no solo en la literatura médica, sino también en la prensa generalista. En este número de REVISTA ESPAÑOLA DE CARDIOLOGÍA SUPLEMENTOS se revisarán detalladamente ambas GPC, sus fortalezas y sus debilidades. Como sucede la mayoría de las veces, habrá aspectos positivos en una y otra, y no necesariamente debemos elegir entre las dos, sino que tenemos la oportunidad de conocer la visión de las sociedades impli- cadas y hacer un análisis constructivo de sus recomendaciones. En lo que sí hay un acuerdo total en las GPC del manejo de dislipemia es que el tratamiento debe basarse, además de en medidas de estilo de vida, en la utilización de estatinas como fármacos hipolipemiantes de elección cuando esté indicado, en prevención primaria según el nivel de riesgo y siempre en prevención secundaria, salvo contraindicación. Se ha demostrado rotundamente la eficacia de las estatinas en la disminución del colesterol plasmático, con una reducción proporcional de la morbimortalidad cardiovascular. Las estatinas, por su mecanismo de acción, no solo reducen el colesterol plasmático, sino que también poseen otros efectos extrali- pídicos; estas acciones pleotrópicas se están estudiando en diferentes escenarios, tanto clínicos como experimentales, con la finalidad de establecer posibles beneficios de las estatinas más allá de su capacidad hipolipemiante. Este aspecto, así como la utilización de las estatinas en el síndrome coronario agudo y el manejo de la dislipemia de pacientes con cardiopatía isquémica, diabéticos y otros grupos de riesgo, también se abordará en esta monografía. A lo largo de los seis artículos que la componen, expertos en el manejo de la enfermedad cardiovascular en nuestro país ofrecen una puesta al día sobre el manejo de la dislipemia

Tiempos de vuelo de fotones más allá del marco de la relatividad especial

En el presente trabajo de fin de grado se pretende estudiar dos modificaciones a la relatividadespecial propuestas en la literatura como posibles caminos hacia una teoría de la gravedad cuántica.Se presentarán estas dos vías y sus principales características y consecuencias: la Violación de Invariancia Lorentz (LIV) y la Relatividad Especial Deformada (DSR) cuyos efectossolo tendrían importancia a una escala muy alta de energías. Fenomenológicamente, se cree que laúnica consecuencia observable compartida por ambos contextos es la diferencia en los tiempos devuelo de fotones de distinta energía emitidos a la vez por la misma fuente. Por todo ello el objetivofinal es comparar la posible fenomenología en estos escenarios para un universo en expansión.<br /

Identification, biochemical composition and phycobiliproteins production of Chroococcidiopsis sp. from arid environment

Molecular and microscopic studies were performed to identify Chroococcidiopsis sp., an endolithic cyanobacterium, isolated from gypsum rocks of Atacama Desert (Chile). It was adapted to grow in mineral liquid medium, with 9 mM nitrate, bubbled with CO2-enriched air (2.5 % v/v), and continuously illuminated with a white light of 70 μmol photons m–2 s–1. The obtained biomass (productivity of 0.21 g L–1 d–1) had a C/N ratio of 6.67, and it contained carbohydrates (45.40 % of dry weight), proteins (36.72 %), lipids (5.60 %) nucleic acids (3.90 %) and ashes (8.28 %). The lipid fraction was particularly rich in palmitic (29.86 % of total fatty acids), linoleic (18.20 %), palmitoleic (12.75 %), linolenic (10.92 %), stearic (9.64 %) and capric acid (6.29 %). Chroococcidiopsis sp. accumulated phycobiliproteins in a light-dependent process and produced 204 mg g–1, under incident light of 10 μmol photons·m–2·s–1, with a relative abundance of 40.9 % for phycocyanin, 23.3 % for phycoerythrin, and 35.8 % for allophycocyanin. The biomass from this cyanobacterium can be a good source of these pigments, especially APC (maximum of 95 mg g dw−1), which are of interest for pharmacological, cosmetic, and food industries.Ministerio de Ciencia, Innovación y Universidades PGC2018–094076-B-I0

Two cases of accidental dislocation of the silicone sleeve of an extrusion cannula into the vitreous cavity

Background: fluid-air exchange during vitreoretinal surgery is often used as a tool for subretinal fluid endodrainage. Soft-tipped flexible extrusion cannulas are commonly used to aspirate the posterior subretinal fluid. Methods: this is an observational two-case series describing two patients who underwent 20-G pars plana vitrectomy complicated by the accidental fall of the silicone sleeve of a soft-tipped extrusion cannula into the vitreous cavity. In the first case, the cannula had inadvertently been subjected to sterilization process. Results: while withdrawing the soft-tipped extrusion cannula from the eye, following internal drainage of transvitreal and subretinal fluid, the loose silicone sleeve probably got entangled at the inner lip of the sclerotomy and finally fell on the retinal surface. In both cases, the silicone sleeve was held and removed with an intraocular forceps. Conclusions: this rare complication has been reported in the literature only once previously. Sterilization of disposable subretinal fluid cannulas is not advisable because of the risk of dislocation of the silicone sleeve into the eye. Besides this, it is important to check the integrity of the silicone sleeve before and after surgery

Targeted gene sequencing, bone health, and body composition in Cornelia de Lange Syndrome

The aim of this study was to evaluate bone health and body composition by dual-energy X-ray absorptiometry (DXA) in individuals with Cornelia de Lange Syndrome (CdLS). Overall, nine individuals with CdLS (five females, all Caucasian, aged 5-38 years) were assessed. Total body less head (TBLH) and lumbar spine (LS) scans were performed, and bone serum biomarkers were determined. Molecular analyses were carried out and clinical scores and skeletal features were assessed. Based on deep sequencing of a custom target gene panel, it was discovered that eight of the nine CdLS patients had potentially causative genetic variants in NIPBL. Fat and lean mass indices (FMI and LMI) were 3.4-11.1 and 8.4-17.0 kgm2, respectively. For TBLH areal bone mineral density (aBMD), after adjusting for height for age Z-score of children and adolescents, two individuals (an adolescent and an adult) had low BMD (aBMD Z-scores less than -2.0 SD). Calcium, phosphorus, 25-OH-vitamin D, parathyroid hormone, and alkaline phosphatase levels were 2.08-2.49 nmolL, 2.10-3.75 nmolL, 39.94-78.37 nmolL, 23.4-80.3 pgmL, and 43-203 IUL, respectively. Individuals with CdLS might have normal adiposity and low levels of lean mass measured with DXA. Bone health in this population seems to be less of a concern during childhood and adolescence. However, they might be at risk for impaired bone health due to low aBMD in adulthood

Fatty acid profile, secondary compounds and antioxidant activities in the fresh forage, hay and silage of sainfoin (Onobrychis viciifolia) and sulla (Hedysarum coronarium)

BACKGROUND Sainfoin (Onobrychis viciifolia) and sulla (Hedysarum coronarium) are forage legumes usually preserved to optimise their utilization as feedstuffs. However, the method of preservation modifies the chemical composition differently in both legume species. Secondary compounds (such as proanthocyanidins, fatty acids, carotenoids and tocopherols) present in forages affect the quality of animal products. Therefore, the effect of preservation on the contents of secondary compounds should be studied. For that, samples of sainfoin and sulla were directly freeze-dried (fresh), dried at ambient temperature (hay), and vacuum-packaged for 82 days (silage). RESULTS In both legumes, the total FA and C18:3 n-3 contents decreased and C16:0 increased with preservation (P < 0.001), with a greater effect for the hays than for the silages. For both legumes, the lutein, neoxanthin and violaxanthin contents decreased to a greater extent in the silages than in the hays (P < 0.001). Both hays exhibited the lowest β-carotene concentrations (P < 0.001). The α-tocopherol contents decreased in hays but not in silages when compared to the fresh forages of both legumes (P < 0.001). The antioxidant activities were lower in the silages than in the hays and fresh forages (P < 0.001), and were very strongly related with the contents of polyphenols and proanthocyanidins (P < 0.001). CONCLUSIONS Haymaking affected the FA, carotenoid and α-tocopherol contents to a greater extent but had a lesser effect on the antioxidant activities than silage-making, which were very strongly related to their contents of polyphenols and proanthocyanidins.Publishe

Type 1 diabetic mellitus patientswith increased atherosclerosisriskdisplay decreased CDKN2A/2B/2BAS gene expression in leukocytes

Background: Type 1 diabetes mellitus (T1DM) patients display increased risk of cardiovascular disease (CVD) and are characterized by a diminished regulatory T (Treg) cell content or function. Previous studies have shown an association between decreased CDKN2A/2B/2BAS gene expression and enhanced CVD. In the present study the potential relationship between CDKN2A/2B/2BAS gene expression, immune cell dysfunction and increased cardiovascular risk in T1DM patients was explored. Methods: A cross-sectional study was performed in 90 subjects divided into controls and T1DM patients. Circulating leukocyte subpopulations analysis by flow cytometry, expression studies on peripheral blood mononuclear cell by qPCR and western blot and correlation studies were performed in both groups of subjects. Results: Analysis indicated that, consistent with the described T cell dysfunction, T1DM subjects showed decreased circulating CD4+CD25+CD127- Treg cells. In addition, T1DM subjects had lower mRNA levels of the transcription factors FOXP3 and RORC and lower levels of IL2 and IL6 which are involved in Treg and Th17 cell differentiation, respectively. T1DM patients also exhibited decreased mRNA levels of CDKN2A (variant 1 p16Ink4a), CDKN2A (p14Arf, variant 4), CDKN2B (p15Ink4b) and CDKN2BAS compared with controls. Notably, T1DM patients had augmented pro-atherogenic CD14++CD16+-monocytes, which predict cardiovascular acute events and enhanced common carotid intima-media thickness (CC-IMT). Conclusions: Decreased expression of CDKN2A/2B/2BAS in leukocytes associates with increased CC-IMT atherosclerosis surrogate marker and proatherogenic CD14++CD16+ monocytes in T1DM patients. These results suggest a potential role of CDKN2A/2B/2BAS genes in CVD risk in T1DM

Comparative evaluation of community interventions for the immigrant population of Latin American origin at risk for Chagas disease in the city of Barcelona

Introduction: Chagas disease presents bio-psycho-social and cultural determinants for infected patients, their family members, close friends, and society. For this reason, diagnosis and treatment require an active approach and an integral focus, so that we can prevent the disease from creating stigma and exclusion, as is actively promoting access to diagnosis, medical attention and social integration. Methodology: The study was conducted in the Metropolitan Area of Barcelona (Catalonia, Spain) from 2004 to 2017. After an increased detection rates of CHD in our region, the process of construction of community strategies started (2004-2013). Different community interventions with informational, educational, and communication components were designed, developed, implemented, and evaluated. The results of the evaluation helped to determine which intervention should be prioritized: 1) workshop; 2) community event; 3) in situ screening. Afterwards, those strategies were implemented (2014-2017). Results: Each of the three strategies resulted in a different level of coverage, or number of people reached. Thein situscreening interventions reached the highest coverage (956 persons, 58.98%). Clear differences exist (p-value<0.001) between the three strategies regarding the percentage of screenings and diagnoses carried out. The largest number was in thein situscreening intervention, with a total of 830 persons screened despite the greatest number of diagnoses was among the workshop participants (33 persons, 20.75% of those screened). The prevalence of infection found is similar among the three strategies, ranging from 16.63% to 22.32% of the screened patients (p-value= 0.325). Conclusions: The results of the study show that community interventions seem to be necessary to improve access to diagnosis and treatment of CHD in the area of Barcelona. They also show which strategy is the most appropriate based on the detected needs of the community, the proposed objectives of the intervention, and the given socio-temporal context

Novel Immune Features of the Systemic Inflammation Associated with Primary Hypercholesterolemia: Changes in Cytokine/Chemokine Profile, Increased Platelet and Leukocyte Activation

Primary hypercholesterolemia (PH) is associated with a low grade systemic inflammation that is likely the main driver of premature atherosclerosis. Accordingly, we characterized the immune cell behaviour in PH and its potential consequences. Whole blood from 22 PH patients and 21 age-matched controls was analysed by flow cytometry to determine the percentage of leukocyte immunophenotypes, activation, and platelet-leukocyte aggregates. Plasma markers were determined by Enzyme-Linked ImmunoSorbent Assay (ELISA). The adhesion of platelet-leukocyte aggregates to tumor necrosis factor-α (TNFα)-stimulated arterial endothelium was investigated using the dynamic model of the parallel-plate flow chamber. PH patients presented greater percentage of Mon 3 monocytes, Th2 and Th17 lymphocytes, activated platelets, and leukocytes than controls. The higher percentages of circulating platelet-neutrophil, monocyte and lymphocyte aggregates in patients caused increased platelet-leukocyte adhesion to dysfunctional arterial endothelium. Circulating CXCL8, CCL2, CX3CL1, and IL-6 levels positively correlated with key lipid features of PH, whereas negative correlations were found for IL-4 and IL-10. We provide the first evidence that increased platelet and leukocyte activation leads to elevated platelet-leukocyte aggregates in PH and augmented arterial leukocyte adhesiveness, a key event in atherogenesis. Accordingly, modulation of immune system behavior might be a powerful target in the control of further cardiovascular disease in PH