Revascularización percutánea en el tratamiento de la cardiopatía isquémica crónica estable: aspectos asistenciales, técnicos y de seguridad

Al nostre estudi avaluem l' estratègia de revascularització percutània com a tractament de la cardiopatia isquèmica crònica i estable al nostre medi. Estudiem els predictors independents per a la prolongació de l'ingrés després de la realització de l'intervencionisme coronari percutani. Amb això es dibuixen els criteris d'exclusió d'un programa d'angioplàstia ambulatòria. També s'identifiquen els pacients amb un major risc per a reingressar al mes i al cap de tres mesos post procediment. Finalment s'analitza la mortalitat a l'any. Els predictors independents per la prolongació de l'ingrés són: realitzar el procediment via femoral, que a la nostra població selecciona pacients amb procediments més complexos, els pacients de més edat, la hipertensió arterial, la insuficiència renal crònica, la malaltia vascular perifèrica i el tractament del tronc coronari esquerra. L'accés femoral i realitzar intervencionisme per insuficiència cardíaca o miocardiopatia dilatada, varen augmentar de forma significativa el risc de reingrés al mes. Els factors que es relacionen de manera significativa amb la mortalitat a l'any per totes les causes, varen ser el reingrés al mes, l'intervencionisme per insuficiència cardíaca, la no utilització de stent farmacoactiu i tractar un vas diferent de la coronària dreta.En nuestro estudio evaluamos la estrategia de la revascularización percutánea como tratamiento de la cardiopatía isquémica crónica y estable en nuestro medio. Estudiamos los predictores independientes para la prolongación del ingreso tras realización de intervencionismo coronario percutáneo. Con ello se dibujan los criterios de exclusión de un programa de angioplastia ambulatoria. También se identifican los pacientes de mayor riesgo para reingresar al mes y tres meses postprocedimiento. Finalmente se analiza la mortalidad al año. Los predictores independientes para la prolongación del ingreso son: realizar el procedimiento por vía femoral, que en nuestra población selecciona pacientes con procedimientos más complejos, los pacientes más añosos, la hipertensión arterial, la insuficiencia renal crónica, la enfermedad vascular periférica y el tratamiento de tronco coronario izquierdo. El acceso femoral y realizar intervencionismo por insuficiencia cardiaca o miocardiopatía dilatada, aumentaron de manera significativa el riesgo de reingreso al mes. Los factores que se relacionaron de manera significativa con la mortalidad al año por todas las causas fueron el reingreso al mes, el intervencionismo por insuficiencia cardiaca, la no utilización de stent farmacoactivo y el tratar un vaso diferente a la coronaria derecha.Our study evaluates percutaneous revascularization strategy as a treatment for chronic stable cardiac ischemic disease in our environment. We study independent predictors for prolonging hospitalization after percutaneous coronary revascularization. These predictors are used in the design of exclusion criteria for a same day discharge angioplasty program. We also identify the profile of patients who have a higher risk for readmission at one month and at three months. Finally, we analyse mortality after one year follow up. The independent predictors for prolonging hospitalization were femoral approach (this approach is used for more complex procedures in our sample), older people, hypertension, chronic renal failure, peripheral vascular disease and percutaneous treatment of left main coronary artery. Femoral approach and percutaneous revascularization for the treatment of heart failure or dilated cardiomyopathy were significant factors for one-month readmission. Significant factors related to one-year overall mortality were one-month readmission, percutaneous coronary intervention in heart failure context, non-use of drug eluting stent and the treatment of a different vessel than right coronary artery

Usefulness of the Hybrid RFR-FFR Approach: Results of a Prospective and Multicenter Analysis of Diagnostic Agreement between RFR and FFR—The RECOPA (REsting Full-Cycle Ratio Comparation versus Fractional Flow Reserve (A Prospective Validation)) Study

Cardiologia; Estudi fisiològic; EspanyaCardiología; Estudio fisiológico; EspañaCardiology; Physiological study; SpainBackground. The resting full‐cycle ratio (RFR) is a novel resting index which in contrast to the gold standard (fractional flow reserve (FFR)) does not require maximum hyperemia induction. The objectives of this study were to evaluate the agreement between RFR and FFR with the currently recommended thresholds and to design a hybrid RFR-FFR ischemia detection strategy, allowing a reduction of coronary vasodilator use. Materials and Methods. Patients subjected to invasive physiological study in 9 Spanish centers were prospectively recruited between April 2019 and March 2020. Sensitivity and specificity studies were made to assess diagnostic accuracy between the recommended levels of RFR ≤0.89 and FFR ≤0.80 (primary objective) and to determine the RFR “grey zone” in order to define a hybrid strategy with FFR affording 95% global agreement compared with FFR alone (secondary objective). Results. A total of 380 lesions were evaluated in 311 patients. Significant correlation was observed (R2 = 0.81; ) between the two techniques, with 79% agreement between RFR ≤ 0.89 and FFR ≤ 0.80 (positive predictive value, 68%, and negative predictive value, 80%). The hybrid RFR-FFR strategy, administering only adenosine in the “grey zone” (RFR: 0.86 to 0.92), exhibited an agreement of over 95% with FFR, with high predictive values (positive predictive value, 91%, and negative predictive value, 92%), reducing the need for vasodilators by 58%. Conclusions. Dichotomous agreement between RFR and FFR with the recommended thresholds is significant but limited. The adoption of a hybrid RFR-FFR strategy affords very high agreement, with minimization of vasodilator use

Correlation vs. exchange competition drive the singlet-triplet excited-state inversion in non-alternant hydrocarbons

In this work, we focus on the understanding of the driving force behind the S1 - T1 excited-state energy inversion (which would thus violate the Hund’s rule, situating the S1 state lower in energy than the T1 state) of two non-benzenoid non-alternant hydrocarbons, composed of odd-membered rings. The molecules considered here have identical chemical composition but different atomic configuration in space. The delicate interplay between structural and electronic factors that might induce the inversion and its energy extension, only by few meV, are systematically investigated here by state-of-the-art calculations. Qualitative and quantitative accurate predictions are obtained employing post-HF methods, thanks to the balanced and careful inclusion of electron correlation effects. The obtained results might guide and rationalize new searches of molecules violating Hund’s rule, concomitantly advising the importance of key contributions from the theoretical method of choice.The work in Alicante is supported by project PID2019-106114GB-I00 (“Ministerio de Ciencia e Innovación”). M.E.S.-S. acknowledges the funding by the United Kingdom Research and Innovation (U.K.R.I.) under the U.K. government’s Horizon Europe funding guarantee (grant number EP/X020908/1). Y.O. acknowledges the funding by the “Fonds de la Recherche Scientifique-FNRS” under Grant n. F.4534.21 (MIS-IMAGINE). G.R. acknowledges a grant from the “Fonds pour la formation a la Recherche dans l’Industrie et dans l’Agriculture” (F.R.I.A.) of the F.R.S.-F.N.R.S. Computational resources were also provided by the “Consortium des Équipements de Calcul Intensif” (C´ECI), funded by the “Fonds de la Recherche Scientifiques de Belgique” (F.R.S.-F.N.R.S.) under Grant No. 2.5020.11. D.C. acknowledges funding by projects PID2019-109555GB-I00 and RED2018-102815-T (“Ministerio de Ciencia e Innovación”) and from project No. PIBA19-0004 (“Eusko Jaularitza”)

Clinical follow-up of long nontapered sirolimus-eluting coronary stent in real-world patients with de novo lesions. The Billar registry

Introduction and objectives: Coronary lesions with stent overlapping are associated with higher neointimal proliferation that leads to more restenosis. Furthermore, the tapering of coronary arteries is a major challenge when treating long coronary lesions. This study attempted to assess the safety and clinical level of performance of long nontapered sirolimus-eluting coronary stent systems (> 36 mm) to treat long and diffused de novo coronary lesions in real-world scenarios. Methods: This was a prospective, non-randomized, multicentre study that included 696 consecutive patients treated with the long nontapered BioMime sirolimus-eluting coronary stent system in long and diffused de novo coronary lesions. The safety endpoint was major adverse cardiovascular events defined as a composite of cardiac death, myocardial infarction, clinically driven target lesion revascularization, stent thrombosis, and major bleeding at the 12-month follow-up. Results: Of a total of 696 patients, 38.79% were diabetic. The mean age of all the patients was 64.6 +/- 14 years, and 80% were males. The indication for revascularization was acute coronary syndrome in 63.1%. A total of 899 lesions were identified out of which 742 were successfully treated with long BioMime stents (37 mm, 40 mm, 44 mm, and 48 mm). The cumulative incidence of major adverse cardiovascular events was 8.1% at the 12-month follow-up including cardiac death (2.09%), myocardial infarction (1.34%), and total stent thrombosis (0.5%). Conclusions: This study confirms the safety and good performance of long nontapered BioMime coronary stents to treat de novo coronary stenosis. Therefore, it can be considered a safe and effective treatment for long and diffused de novo coronary lesions in the routine clinical practice

The role of topology in organic molecules: origin and comparison of the radical character in linear and cyclic oligoacenes and related oligomers

We discuss the nature of electron-correlation effects in carbon nanorings and nanobelts using an analysis tool known as fractional occupation number weighted electron density (ρFOD) and the RAS-SF method, revealing for the first time significant differences in static correlation effects depending on how the rings (i.e. chemical units) are fused and/or connected until closing the loop. We choose to study in detail linear and cyclic oligoacene molecules of increasing size, and relate the emerging differences with the difficulties for the synthesis of the latter due to their radicaloid character. We finally explore how minor structural modifications of the cyclic forms can alter these results, showing the potential use of these systems as molecular templates for the growth of well-shaped carbon nanotubes as well as the usefulness of theoretical tools for molecular design.A. J. P. J. and J. C. S. G acknowledge the “Ministerio de Economa y Competitividad” of Spain and the “European Regional Development Fund” through the project CTQ2014-55073-P, and E. S. F. M. through the project FIS2015-64222-C2-2-P. D. C. is thankful to Eusko Jaurlaritza and the Spanish Government MINECO/FEDER (projects IT588-13 and CTQ2016-80955). M. E. S.-S. acknowledges CONACyT-México for a PhD fellowship (ref. 591700)

From cyclic nanorings to single-walled carbon nanotubes: disclosing the evolution of their electronic structure with the help of theoretical methods

We systematically investigate the relationships between structural and electronic effects of finite size zigzag or armchair carbon nanotubes of various diameters and lengths, starting from a molecular template of varying shape and diameter, i.e. cyclic oligoacene or oligophenacene molecules, and disclosing how adding layers and/or end-caps (i.e. hemifullerenes) can modify their (poly)radicaloid nature. We mostly used tight-binding and finite-temperature density-based methods, the former providing a simple but intuitive picture about their electronic structure, and the latter dealing effectively with strong correlation effects by relying on a fractional occupation number weighted electron density (ρFOD), with additional RAS-SF calculations backing up the latter results. We also explore how minor structural modifications of nanotube end-caps might influence the results, showing that topology, together with the chemical nature of the systems, is pivotal for the understanding of the electronic properties of these and other related systems.A. J. P. J. and J. C. S. G acknowledge the project CTQ2014-55073-P from the Spanish Government (MINECO/FEDER) and the project AICO/2018/175 from the Regional Government (GVA/FSE). J. F. R. acknowledges the projects MAT2016-78625 from the Spanish Government (MINECO/FEDER) and projects No. PTDC/FIS-NAN/4662/2014 and No. PTDC/FIS-NAN/3668/2014 from the Portuguese Government (Fundaçao para a Ciencia e Tecnologia). D. C. is thankful to projects IT588-13 (Eusko Jaurlaritza) and CTQ2016-80955 from the Spanish Government (MINECO/FEDER). M. E. S.-S. acknowledges CONACyT-México for a PhD fellowship (ref. 591700). R. O. C. acknowledges “Generalitat Valenciana” and “Fondo Social Europeo” for a PhD fellowship (ACIF/2018/198)

Ajustando RFR por Preditores de Discordância, “The Adjusted RFR”: Uma Metodologia Alternativa para Melhorar a Capacidade Diagnóstica de Índices Coronarianos

Background: Cutoff thresholds for the "resting full-cycle ratio" (RFR) oscillate in different series, suggesting that population characteristics may influence them. Likewise, predictors of discordance between the RFR and fractional flow reserve (FFR) have been documented. The RECOPA Study showed that diagnostic capacity is reduced in the RFR "grey zone", requiring the performance of FFR to rule out or confirm ischemia. Objectives: To determine predictors of discordance, integrate the information they provide in a clinical-physiological index, the "Adjusted RFR", and compare its agreement with the FFR. Methods: Using data from the RECOPA Study, predictors of discordance with respect to FFR were determined in the RFR "grey zone" (0.86 to 0.92) to construct an index ("Adjusted RFR") that would weigh RFR together with predictors of discordance and evaluate its agreement with FFR. Results: A total of 156 lesions were evaluated in 141 patients. Predictors of discordance were: chronic kidney disease, previous ischemic heart disease, lesions not involving the anterior descending artery, and acute coronary syndrome. Though limited, the "Adjusted RFR" improved the diagnostic capacity compared to the RFR in the "grey zone" (AUC-RFR = 0.651 versus AUC-"Adjusted RFR" = 0.749), also showing an improvement in all diagnostic indices when optimal cutoff thresholds were established (sensitivity: 59% to 68%; specificity: 62% to 75%; diagnostic accuracy: 60% to 71%; positive likelihood ratio: 1.51 to 2.34; negative likelihood ratio: 0.64 to 0.37). Conclusions: Adjusting the RFR by integrating the information provided by predictors of discordance to obtain the "Adjusted RFR" improved the diagnostic capacity in our population. Further studies are required to evaluate whether clinical-physiological indices improve the diagnostic capacity of RFR or other coronary indices.Fundamento: Os limiares de corte para a “relação do ciclo completo de repouso” (RFR) oscilam em diferentes séries, sugerindo que as características da população podem influenciá-los. Da mesma forma, foram documentados preditores de discordância entre a RFR e a reserva de fluxo fracionado (FFR). O Estudo RECOPA, mostrou que a capacidade diagnóstica está reduzida na “zona cinzenta” da RFR, tornando necessária a realização de FFR para descartar ou confirmar isquemia. Objetivos: Determinar os preditores de discordância, integrar as informações que eles fornecem em um índice clínico-fisiológico: a “RFR Ajustada”, e comparar sua concordância com o FFR. Métodos: Usando dados do Estudo RECOPA, os preditores de discordância em relação à FFR foram determinados na “zona cinzenta” da RFR (0,86 a 0,92) para construir um índice (“RFR Ajustada”) que pesaria a RFR juntamente com os preditores de discordância e avaliar sua concordância com a FFR. Resultados: Foram avaliadas 156 lesões em 141 pacientes. Os preditores de discordância foram: doença renal crônica, cardiopatia isquêmica prévia, lesões não envolvendo a artéria descendente anterior esquerda e síndrome coronariana aguda. Embora limitada, a “RFR Ajustada” melhorou a capacidade diagnóstica em comparação com a RFR na “zona cinzenta” (AUC-RFR = 0,651 versus AUC-“RFR Ajustada” = 0,749), mostrando também uma melhora em todos os índices diagnósticos quando foram estabelecidos limiares de corte otimizados (sensibilidade: 59% a 68%; especificidade: 62% a 75%; acurácia diagnóstica: 60% a 71%; razão de verossimilhança positiva: 1,51 a 2,34; razão de verossimilhança negativa: 0,64 a 0,37). Conclusões: Ajustar a RFR integrando as informações fornecidas pelos preditores de discordância para obter a “RFR Ajustada” melhorou a capacidade diagnóstica em nossa população. Mais estudos são necessários para avaliar se os índices clínico-fisiológicos melhoram a capacidade diagnóstica da RFR ou de outros índices coronarianos

La magia de tus pensamientos : poesías & cuentos

Recopilación de poesías y cuentos realizados por aprendices del SENA de los programas de Mantenimiento de Motores Diesel, Técnico en Sistemas, Automatización Industrial, Electricidad Industrial, Diseño e Integración de Automatismos Mecatrónicos, Mantenimiento de Equipo Biomédico, Animación 3D, Manejo Ambiental, Diseño e integración de Automatismos Mecatrónicos y Mantenimiento mecatrónico automotriz, entre 2015 y 2017.Poesías 2018 -- Dándome tu vida / Brayan Orlando Jaimes Chaparro -- Tierra infinita / Christian Ricardo Caballero Villamizar -- Lamento a la tierra / Jeferson Alexis Montoya Moreno -- Conciencia por favor / Daniel Rincón -- Salvar un hogar llamado tierra / William Gamboa Arguello -- Planeta tierra / Iván Arley jurado -- Salvemos nuestro planeta / Jonathan David Silva -- Tierra bella / Martin Santiago -- Mi planeta / Fabián Moreno -- Generando conciencia / José Alberto Lizarazo -- Añoranza / Javier Casanova -- Sin tierra… / Gustavo Andrés Rodríguez Mendoza -- Planeta vivo y limpio / Yesid Serrano -- Palabras del destino / Osneider David Hernández Otalvaro -- Planeta tierra / Luis Fernando Isidro -- Medio ambiente / Yorgin David Hernández -- Prevenir / Brayan Mauricio Sanmiguel Luengas -- Nada será cómo antes / Jaime Andres Rodriguez Parrado -- Yo…Sol / Jonathan Bautista -- Lamento / Héctor Mauricio Parra Cuesta -- Nuestro hogar / Juan José Amaya -- Te agradecemos / Edwin Andrés Navarro Rozo, Anderson Cardozo Villamizar -- HErmoso milagro / Jhonatan Jaimes Solano -- El creador / Ana Rosa Hernández Santana -- Cuentos 2015 -- Juventud en la zona azul / Jeniffer Solano Ardila -- Los Ucayali y los Cubeo / Oscar Ivan Rueda Quintero -- Vientos de armonía / Ever Edinson Monsalve Salcedo -- El nacimiento de una nueva era / Carlos Leonardo Ardila Alvarado -- Luz de sueños / Hugo Andrés Álvarez -- Sol de medio día / Claudia Ramírez Guarín -- Cuentos 2016 -- Mucha verraquera mano / Héctor Josué Amado Sandoval -- El viaje de irse y nunca volver / Dayana Marcela Fuentes Duran -- “Santander es hermosa” / Kelly Tatiana Pabón Blanco -- Los valores del SENA / Ana Rosa Hernandez Santana -- La fuerza del espiritu y el deseo de cambiar / Pablo Andrés Capera Rodríguez -- SENA, paz y reconciliación / Adrián Benítez R., Rubén Darío Martínez -- Cuentos 2017 -- Cartas a un pasado / Angelita Delgado Pérez -- ¿Por qué así? ¿por qué tan blanco? ¿por qué no de otra manera? / Cristian Felipe Vargas Buenahora -- El gato pacho pacho, el gato más pacho de todos los pachos / Edwin Matajira García -- Freeland “el paraíso perdido” / Dámaso Antonio Morales Palacin -- Un mundo al revés / Fabio Eduardo Contreras Piñeresna91 página