On Bogovski\u{\i} and regularized Poincar\'e integral operators for de Rham complexes on Lipschitz domains

We study integral operators related to a regularized version of the classical Poincar\'e path integral and the adjoint class generalizing Bogovski\u{\i}'s integral operator, acting on differential forms in $R^n$. We prove that these operators are pseudodifferential operators of order -1. The Poincar\'e-type operators map polynomials to polynomials and can have applications in finite element analysis. For a domain starlike with respect to a ball, the special support properties of the operators imply regularity for the de Rham complex without boundary conditions (using Poincar\'e-type operators) and with full Dirichlet boundary conditions (using Bogovski\u{\i}-type operators). For bounded Lipschitz domains, the same regularity results hold, and in addition we show that the cohomology spaces can always be represented by $C^\infty$ functions.Comment: 23 page

Adaptive FE-BE Coupling for Strongly Nonlinear Transmission Problems with Coulomb Friction

We analyze an adaptive finite element/boundary element procedure for scalar elastoplastic interface problems involving friction, where a nonlinear uniformly monotone operator such as the p-Laplacian is coupled to the linear Laplace equation on the exterior domain. The problem is reduced to a boundary/domain variational inequality, a discretized saddle point formulation of which is then solved using the Uzawa algorithm and adaptive mesh refinements based on a gradient recovery scheme. The Galerkin approximations are shown to converge to the unique solution of the variational problem in a suitable product of L^p- and L^2-Sobolev spaces.Comment: 27 pages, 3 figure

Mediat. Inflamm.

There is increasing evidence that proteasomes have a biological role in the extracellular alveolar space, but inflammation could change their composition. We tested whether immunoproteasome protein-containing subpopulations are present in the alveolar space of patients with lung inflammation evoking the acute respiratory distress syndrome (ARDS). Bronchoalveolar lavage (BAL) supernatants and cell pellet lysate from ARDS patients (n = 28) and healthy subjects (n = 10) were analyzed for the presence of immunoproteasome proteins (LMP2 and LMP7) and proteasome subtypes by western blot, chromatographic purification, and 2D-dimensional gelelectrophoresis. In all ARDS patients but not in healthy subjects LMP7 and LMP2 were observed in BAL supernatants. Proteasomes purified from pooled ARDS BAL supernatant showed an altered enzyme activity ratio. Chromatography revealed a distinct pattern with 7 proteasome subtype peaks in BAL supernatant of ARDS patients that differed from healthy subjects. Total proteasome concentration in BAL supernatant was increased in ARDS (971 ng/mL perpendicular to 1116 versus 59 perpendicular to 25; P < 0.001), and all fluorogenic substrates were hydrolyzed, albeit to a lesser extent, with inhibition by epoxomicin (P = 0.0001). Thus, we identified for the first time immunoproteasome proteins and a distinct proteasomal subtype pattern in the alveolar space of ARDS patients, presumably in response to inflammation

Schrödinger operators with δ and δ′-potentials supported on hypersurfaces

Self-adjoint Schrödinger operators with δ and δ′-potentials supported on a smooth compact hypersurface are defined explicitly via boundary conditions. The spectral properties of these operators are investigated, regularity results on the functions in their domains are obtained, and analogues of the Birman–Schwinger principle and a variant of Krein’s formula are shown. Furthermore, Schatten–von Neumann type estimates for the differences of the powers of the resolvents of the Schrödinger operators with δ and δ′-potentials, and the Schrödinger operator without a singular interaction are proved. An immediate consequence of these estimates is the existence and completeness of the wave operators of the corresponding scattering systems, as well as the unitary equivalence of the absolutely continuous parts of the singularly perturbed and unperturbed Schrödinger operators. In the proofs of our main theorems we make use of abstract methods from extension theory of symmetric operators, some algebraic considerations and results on elliptic regularity

Impacto del pretratamiento con inhibidores P2Y12 en pacientes con síndromes coronarios agudos sin elevación del ST. Análisis de dos registros multicéntricos

Objectives. To evaluate the rate of use of antiplatelet pretreatment in patients with non-ST elevated acute coronary syndrome (NSTEACS) and its association with adverse events in two Argentine registries. Materials and methods. We retrospectively analyzed two Argentine acute coronary syndrome (ACS) registries from 2017 and 2022. We explored the incidence of pretreatment and the drug used. We evaluated the relationship between this strategy and a composite clinical outcome of in-hospital events: death + myocardial infarction + stent thrombosis + post-MI angina + transient ischemic event/cerebrovascular event, and with bleeding events (BARC 2 or higher). Subsequently, we performed a multivariate analysis by logistic regression with other clinical variables. Results. A total of 1297 patients were included; 75.6% were men, 25.6% diabetics, 27.1% smokers, 70.3% hypertensive, and 23.1% had a previous ACS. The mean age was 55.3 years. The mean GRACE score was 113.5, and the CRUSADE was 23.8. 44% of the patients received pretreatment, the majority with clopidogrel (93.5%). Pretreatment was significantly associated with a higher incidence of the composite clinical outcome (10.1% vs. 6.9%) (OR 1,56; IC 95%: 1,06-2,3; p=0,02). Bleeding events were numerically more frequent with pretreatment (8.7% vs. 5.9%) (OR 1,51; IC95%: 0,99 -2,3; p=0,054). In the multivariate analysis, pretreatment was no longer associated with a higher incidence of ischemic outcomes (OR 1,4; IC95%: 0,89-2,3; p=0,13). Conclusion. Pretreatment was used in almost half of the patients, mainly with clopidogrel, and did not show a reduction in ischemic events in patients with NSTACS.Objetivos. Evaluar la tasa de uso de pretratamiento antiagregante en pacientes con síndrome coronario agudo sin elevación del segmento ST (SCASEST) y su asociación con eventos adversos en dos registros argentinos. Materiales y métodos. Se analizaron retrospectivamente dos registros argentinos de síndromes coronarios agudos (SCA) de 2017 y 2022. Se exploró la incidencia de pretratamiento y el fármaco utilizado y se evaluó la relación entre esta estrategia y un resultado clínico compuesto de eventos intrahospitalarios: muerte + infarto de miocardio + trombosis del stent + angina postinfarto + accidente isquémico transitorio/accidente cerebro vascular más los eventos hemorrágicos (BARC 2 o superior). Posteriormente, se realizó un análisis multivariado por regresión logística con otras variables clínicas. Resultados. Se incluyeron 1297 pacientes. El 75,6% eran hombres, 25,6% diabéticos, 27,1% fumadores, 70,3% hipertensos y 23,1% tenían un SCA previo. La edad media era de 55,3 años. La puntuación GRACE media fue de 113,5 y la CRUSADE de 23,8. El 44% de los pacientes recibieron pretratamiento, la mayoría con clopidogrel (93,5%). El pretratamiento se asoció significativamente con una mayor incidencia del resultado clínico compuesto (10,1% vs. 6,9%) (OR 1,56; IC 95%: 1,06-2,3; p=0,02). Los eventos hemorrágicos fueron numéricamente más frecuentes con el pretratamiento (8,7% frente a 5,9%) (OR 1,51; 0,99-2,3; p=0,054). En el análisis multivariado el pretratamiento ya no se asoció con una mayor incidencia de desenlaces isquémicos (OR 1,4; 0,89-2,3; p=0,13) ni hemorrágicos. Conclusiones. El pretratamiento se utilizó en casi la mitad de los pacientes, principalmente con clopidogrel, y no mostró una reducción de eventos isquémicos en pacientes con SCASEST de la vida real

Impacto del equipo multidisciplinario “ECMO Team” en el pronóstico de pacientes sometidos a membrana de oxigenación extracorpórea venoarterial por choque cardiogénico o paro cardiorrespiratorio refractario

Objectives. Veno-arterial Extracorporeal membrane oxygenation (VA ECMO) is a salvage intervention in patients with cardiogenic shock (CS), and cardiac arrest  (CA) refractory to standard therapies. The design of ECMO Teams has achieved the standardization of processes, although its impact on survival and prognosis is unknown. Objective: We aimed to analyze whether the creation of an ECMO Team has modified the prognosis of patients undergoing VA ECMO for refractory CS or CA. Materials and methods. We conducted a single-center retrospective cohort study. Patients with refractory CS or CA who underwent VA ECMO were divided in two consecutive periods: from 2014 to April 2019 (pre-ECMO T) and from May 2019 to December 2022 (Post ECMO T). The main outcomes were survival on ECMO, in-hospital survival, complications, and annual ECMO volume. Results. Eighty-three patients were included (36 pre-ECMO T and 47 post-ECMO T). The mean age was 53 +/-13 years. The most common reason for  device indication was different:  postcardiotomy shock (47.2%) pre-ECMO T and refractory cardiogenic shock (29.7%) post-ECMO T. The rate of extracorporeal  cardiopulmonary resuscitation was 14.5%.  The median duration of VA ECMO was longer after ECMO team implementation: 8 days (IQR 5-12.5) vs. five days (IQR 2-9, p=0.04). Global in-hospital survival was 45.8% (38.9% pre-ECMO T vs. 51.1% post-ECMO T; p=0.37),  and the survival rate from VA ECMO was 60.2% (55.6% pre-ECMO T vs 63.8% post-ECMO T; p= 0.50). The volume of VA ECMO implantation was significantly higher in the post-ECMO team period (13.2  +/3.5 per year vs. 6.5 +/-3.5 per year, p: 0.02). The rate of complications was similar in both groups. Conclusions. After the implementation of an ECMO team, there was no statistical difference in the survival rate of patients treated with VA ECMO. However, a significant increase in the number of patients supported per year was observed after the implementation of this multidisciplinary team. Post-ECMO T, the most common reason for device indication was cardiogenic shock, with longer run times and a higher rate of extracorporeal cardiopulmonary resuscitation.Introducción. La oxigenación por membrana extracorpórea venoarterial (ECMO VA) es una intervención de rescate utilizada en choque cardiogénico (CC) o paro cardiorrespiratorio (PCR) refractario. La creación de equipos multidisciplinarios ECMO Teams (ECMO T), ha permitido la estandarización de procesos, aunque se desconoce su impacto en  sobrevida y pronóstico. Objetivo: El propósito es analizar si la creación del ECMO Team ha modificado el pronóstico de los pacientes sometidos a ECMO VA por CC o PCR refractario. Materiales y métodos. Estudio observacional, unicéntrico, retrospectivo, que comparó los resultados del implante de ECMO VA por CC o PCR refractario en dos períodos consecutivos: entre 2014 y abril de 2019 (pre-ECMO T), y entre mayo de 2019 y diciembre de 2022 (pos-ECMO T). Como puntos finales, se evaluó la sobrevida intrahospitalaria y en ECMO, complicaciones, y volumen de ECMO anual. Resultados. Se analizaron 83 pacientes (36 pre-ECMO T, y 47 pos-ECMO T), con edad de 53 +/-13 años. La causa más frecuente de asistencia fue: poscardiotomía pre-ECMO T (47,2%) y CC refractario pos-ECMO T (29,7%). En el 14,5% se realizó ECMO en PCR. La mediana de asistencia fue mayor pos-ECMO T (8 días, RIC 5-12,5 vs. 5 días, RIC 2-9 pre-ECMO T; p:0,04). La supervivencia al alta fue del 45,8% (38,9% pre-ECMO T vs. 51,1% pos-ECMO T;p:0,37) y en ECMO VA del 60,2% (55,6% pre-ECMO T y 63,8% pos-ECMO T; p:0,50). El volumen de ECMO VA fue significativamente mayor pos-ECMO T (13,2+/3,5 por año vs. 6,5+/-3,5 por año, p: 0,02). La tasa de complicaciones fue similar en ambos períodos. Conclusiones.Luego de la implementación del ECMO Team no se observó una diferencia significativa en la sobrevida en pacientes asistidoscon ECMO VA. Sin embargo, luego de su creación se evidenció un aumento significativo del volumen de pacientes asistidos por año. Pos-ECMO T se asistió mayor número de pacientes por choque cardiogénico, en PCR y con más días de asistencia