Carretera d'Inca a Lluc

[cat] En aquest article es tractarà l'obra de la carretera d'Inca a Lluc, per Eusebi Estada. Veurem els detalls del seu projecte i el sistema previst per a la seva execució, donat que es tracta d'una carretera complexa. També comprovarem l'estat actual de la via, i, farem referència a la seva importància per a la societat, tant en l'època de la seva construcció com actualmen

Paper del sistema GAS6-TAM en el remodelat ventricular post infart agut de miocardi

[cat][eng

Invasive pulmonary aspergillosis in heart transplant recipients: Is mortality decreasing

Introduction: Infection remains a major complication among heart transplant (HT) recipients, causing approximately 20% of deaths in the first year after transplantation. In this population, Aspergillus spp. can have various clinical presentations including invasive pulmonary aspergillosis (IPA), with high mortality (53-78%). Objectives: To establish the characteristics of IPA infection in HT recipients and their outcomes in our center. Methods: Among 328 HTs performed in our center between 1998 and 2016, we identified five cases of IPA. Patient medical records were examined and clinical variables were extracted. Results: All cases were male, and mean age was 62 years. The most common indication for HT was non-ischemic dilated cardiomyopathy. Productive cough was reported as the main symptom. The radiological assessment was based on chest X-ray and chest computed tomography. The most commonly reported radiographic abnormality was multiple nodular opacities in both techniques. Bronchoscopy was performed in all patients and Aspergillus fumigatus was isolated in four cases on bronchoalveolar lavage culture. Treatment included amphotericin in four patients, subsequently changed to voriconazole in three, and posaconazole in one patient, with total treatment lasting an average of 12 months. Neutropenia was found in only one patient, renal failure was observed in two patients, and concurrent cytomegalovirus infection in three patients. All patients were alive after a mean follow-up of 18 months. Conclusions: IPA is a potentially lethal complication after HT. Early diagnosis and prompt initiation of aggressive treatment are the cornerstone of better survival

Serum AXL levels are increased in patients with heart failure during acute myocardial infarction

Trabajo presentado en el Acute Cardiovascular Care, celebrado en Lisboa, Portugal, del 15 al 17 de octubre de 2016[Background] The GAS6-AXL system plays a role in tissue repair through modulation of fibroblast and macrophage function. We previously showed that AXL is increased in late stages of human heart failure and provides prognostic information, but little is known on AXL expression in STsegment elevation myocardial infarction (STEMI).[Purpose] To determine plasma levels of soluble AXL (sAXL), a tyrosine kinase receptor belonging to TAM family acutely and at 6 months following STEMI, and to study its association with heart failure. Methods: Blood samples were drawn at day 3 and 6 months in 27 STEMI patients (60±8 years, 78 % men, 44 % anterior infarction), and in 23 healthy controls matched for age and cardiovascular risk factors. Soluble serum AXL levels were measured using an ELISA technique. The occurrence of heart failure during admission was registered using Killip classification.[Results] STEMI patients had increased levels of sAXL at day 3 (90±39 ng/ml) and at 6 months follow-up (105±65 ng/ml) when compared to controls (68±17 ng/ml, p1 (n=7) showed higher sAXL levels than the remaining (n=20) both at 3 days (120±51 vs 80±29 ng/ml, p<0.05) and 6 months (161±105 vs 85058 ng/ml, p<0.05, figure 1B).[Conclusion] Patients with STEMI who develop heart failure have higher levels of sAXL acutely and specially at mid-term follow-up. These preliminary results suggest a potential role of AXL in post-STEMI remodelling and development of heart failure that needs to be confirmed in larger studies.Peer Reviewe

Efficacy of two interventions on the discontinuation of benzodiazepines in long-term users: 36-month follow-up of a cluster randomised trial in primary care

[eng] Background Primary care interventions that promote cessation of benzodiazepine (BZD) use in long-term users are effective at 1 year, but their efficacy at 3 years is uncertain. Aim To assess the 3-year efficacy of two primary care interventions delivered by GPs on cessation of BZD use in long-term users. Design and setting Multicentre, three-arm, cluster randomised, controlled trial, with random allocation at the GP level. Method Seventy-five GPs and 532 patients were randomly allocated to three groups: usual care (control), structured intervention with stepped-dose reduction and follow-up visits (SIF), or structured intervention with written stepped-dose reduction (SIW). The primary outcome was BZD use at 36 months. Results At 36 months, 66/168 patients (39.2%) in the SIW group, 79/191 patients (41.3%) in the SIF group, and 45/173 patients (26.0%) in the control group had discontinued BZD use. The relative risks (RR) adjusted by cluster were 1.51 (95% CI = 1.10 to 2.05; P = 0.009) in the SIW group and 1.59 (95% CI = 1.15 to 2.19; P = 0.005) in the SIF group. A total of 131/188 patients (69.7%) who successfully discontinued BZD use at 12 months remained abstinent at 36 months. The groups showed no significant differences in anxiety, depression, or sleep dissatisfaction at 36 months. Conclusion The interventions were effective on cessation of BZD use; most patients who discontinued at 12 months remained abstinent at 3 years. Discontinuation of BZD use did not have a significant effect on anxiety, depression, or sleep quality

Serum levels of Growth Arrest-Specific 6 protein and soluble AXL in patients with ST-segment elevation myocardial infarction

Background: Serum soluble AXL (sAXL) and its ligand, Growth Arrest-Specific 6 protein (GAS6), intervene in tissue repair processes. AXL is increased in end-stage heart failure, but the role of GAS6 and sAXL in ST-segment elevation myocardial infarction (STEMI) is unknown. Objectives: To study the association of sAXL and GAS6 acutely and six months following STEMI with heart failure and left ventricular remodelling. Methods: GAS6 and sAXL were measured by enzyme-linked immunosorbent assay at one day, seven days and six months in 227 STEMI patients and 20 controls. Contrast-enhanced magnetic resonance was performed during admission and at six months to measure infarct size and left ventricular function. Results: GAS6, but not sAXL, levels during admission were significantly lower in STEMI than in controls. AXL increased progressively over time (p1) had higher values of sAXL at day 1 (48.9±11.9 vs. 44.0±10.7 ng/ml; p<0.05) and at six months (63.3±15.4 vs. 55.9±13.7 ng/ml; p<0.05). GAS6 levels were not different among subjects with heart failure or left ventricular remodelling. By multivariate analysis including infarct size, Killip class and sAXL at seven days, only the last two were independent predictors of left ventricular remodelling (odds ratio 2.24 (95% confidence interval: 1.08-4.63) and odds ratio 1.04 (95% confidence interval: 1.00-1.08) respectively). Conclusion: sAXL levels increased following STEMI. Patients with heart failure and left ventricular remodelling have higher sAXL levels acutely and at six month follow-up. These findings suggest a potential role of the GAS6-AXL system in the pathophysiology of left ventricular remodelling following STEMI

Relación entre el volumen extracelular en el miocardio remoto y el remodelado ventricular en el síndrome coronario agudo con elevación del segmento st

Trabajo presentado en el SEC 2018: Congreso de las Enfermedades Cardiovasculares, celebrado en Sevilla, del 25 al 27 de octubre de 2018Previamente hemos demostrado un aumento progresivo de AXL circulante (sAXL) post-IAMCEST, un receptor transmembrana relacionado con la regulación inflamatoria. Niveles más altos se asocian a insuficiencia cardiaca y son un predictor independiente de remodelado ventricular adverso. Métodos: Para determinar si la contribución de sAXL en el remodelado se produce por un aumento de la fibrosis en el miocardio remoto, se determinó el volumen extracelular (VEC) mediante resonancia cardiaca en la fase aguda y a los 6 meses post-IAMCEST en una población de 33 individuos. Se determinaron los niveles de sAXL a las 24h, 7 días y 6 meses mediante ELISA. Resultados: Los valores de VEC en el miocardio remoto se incrementaron en la mayoría de pacientes a los 6 meses del infarto (23,92 ± 2,99% basal frente a 25,59 ± 2,67% a los 6 meses, p 28,5% en el seguimiento tenían mayores niveles de sAXL en el primer día (53,6 ± 17,9 ng/ml frente a 39,9 ± 14,1 ng/ml; p 0,029). VEC basal VEC seguimiento r p r p iVTDVI inicial 0,361 0,028 0,288 0,043 iVTSVI inicial 0,280 0,093 0,311 0,028 iVTDVI 6m 0,213 0,226 0,356 0,010 iVTSVI 6m 0,265 0,130 0,368 0,008 BNP admisión 0,323 0,051 0,317 0,023 Conclusiones: sAXL ejerce su modulación sobre el remodelado adverso posinfarto a través del aumento de la fibrosis en el miocardio remoto, de manera independiente a otros mediadores neurohormonales como en BNP.Peer reviewe