Riesgo al suspender el antiagregante en el perioperatorio: Ensayo clínico

La aspirina ha venido usándose durante décadas como prevención secundaria del infarto de miocardio o del ictus en pacientes con cardiopatía isquémica o enfermedad cerebrovascular conocida. El tratamiento antiagregante se asocia a una reducción del riesgo de infarto de miocardio no fatal de un 33%, de un 25% la reducción del ictus no fatal y un 17% sería la reducción de otros eventos vasculares. Estos pacientes, al igual que otros sin patología vascular previa, pueden verse sometidos a intervenciones quirúrgicas. Dichas prácticas están asociadas a un riesgo de desarrollar una complicación cardiovascular perioperatoria, aunque no se trate de cirugía cardíaca. Estas complicaciones incluyen muerte por PCR, infarto de miocardio no fatal y otros síndromes coronarios agudos. Además, el infarto de miocardio perioperatorio se asocia a una mortalidad intrahospitalaria del 15-25%. Datos recientes sobre el riesgo de interrumpir el tratamiento antiagregante en pacientes con stents coronarios han destacado el papel de la aspirina en el periodo periopeatorio. Sin embargo, es llamativa la falta de estudios prospectivos y randomizados en la literatura científica acerca de esta cuestión

Perioperative management and early complications after intestinal resection with ileocolonic anastomosis in Crohn’s disease: analysis from the PRACTICROHN study

This study is aimed at describing the prevalence of and risk factors associated with early post-operative complications after Crohn’s disease-related intestinal resection. Methods: This was a retrospective analysis of data from the PRACTICROHN cohort. Adult Crohn’s disease patients who underwent ileocolonic resection with ileocolonic anastomosis between January 2007 and December 2010 were included. The complications evaluated included death, ileus, anastomotic leak, abscess, wound infection, catheter-related infection, digestive bleeding and other extra-abdominal infections that occurred in the 30 days after surgery.Results: A total of 364 patients (median age at surgery 38 years and 50% men) were included. Indication for surgery was: stricturing disease (46.4%), penetrating disease (31.3%), penetrating and stricturing disease (14.0%) or resistance to medical treatment (5.8%). Early complications were recorded in 100 (27.5%) patients, with wound infection, intra-abdominal abscess and anastomotic leakage being the most frequent complications. Median hospitalization duration was 16 days for patients with complications vs. 9 days without complications (P<0.001). Complications were more common among patients with penetrating disease (36/114, 31.6%) and those refractory to treatment (9/21, 42.9%) compared with stricturing disease (45/169, 26.6%) or stricturingþpenetrating disease (6/51, 11.8%) (P¼0.040). The rate of complications was higher among patients with diagnosis made at the time of surgery (15/31, 48.4%) compared with the rest (85/331, 25.7%) (P¼0.013). Medication received at the time of surgery did not affect the rate of complications. Conclusions: Almost a quarter of patients developed early complications after intestinal resection. Penetrating disease and urgent surgery were associated with an increased risk of complicationsThis study was supported by Merck Sharp and Dohme, Spai

Results of a Phase 2b Trial With GB001, a Prostaglandin D2 Receptor 2 Antagonist, in Moderate to Severe Eosinophilic Asthma

Asthma; Asthma worsening; Eosinophilic asthmaAsma; Empitjorament de l'asma; Asma eosinofílicaAsma; Empeoramiento del asma; Asma eosinofílicaBackground Prostaglandin D2 receptor 2 (DP2) antagonists inhibit prostaglandin D2-induced effects, including recruitment and activation of cells driving asthma pathogenesis. However, challenges identifying target population and end points persist. Research Question What is the effect of the DP2 antagonist GB001 on asthma worsening in patients with moderate to severe eosinophilic asthma? Study Design and Methods In this phase IIb, randomized, double-blind, placebo-controlled, dose-ranging, parallel-group, multicenter study, GB001 or placebo was added to standard-of-care treatment in patients with moderate to severe asthma with a blood eosinophil count ≥ 250 cells/μL. Patients aged ≥ 18 years to < 75 years received one of four once-daily treatments (GB001 20 mg, 40 mg, or 60 mg or placebo). The primary end point was the proportion of patients who experienced asthma worsening by 24 weeks. Efficacy analyses were performed for the intention-to-treat population and safety analyses for patients who received at least one dose of study treatment. Results A total of 480 patients were treated. The ORs for asthma worsening for GB001 20 mg, 40 mg, and 60 mg vs placebo were 0.674 (95% CI, 0.398-1.142), 0.677 (95% CI, 0.399-1.149), and 0.651 (95% CI, 0.385-1.100), respectively. Analysis according to baseline blood eosinophil levels and/or fractional exhaled nitric oxide did not show greater treatment effects with higher values. Elevated liver aminotransferase levels and adverse events leading to discontinuation were more frequent for GB001 60 mg than with placebo, GB001 20 mg, and GB001 40 mg. Interpretation Although GB001 did not significantly reduce the odds of asthma worsening, reductions favoring GB001 were observed. Treatment effects were consistent regardless of high/low type 2 phenotype. The overall safety profile was acceptable, although GB001 60 mg was associated with risk of liver injury.This work was supported by GB001, Inc., a wholly owned subsidiary of Gossamer Bio, Inc

Prospection and identification of grapevine varieties cultivated in north Portugal and northwest Spain

A broad prospection of grapevine plants was carried out in northwest Spain and north of Portugal during the period from 2002 to 2009. It included zones located in Galicia as well as in the provinces of León, Zamora and Salamanca in Spain and the region delimited by the right side of the Douro river and the spanish border in Portugal. A total of 669 accessions were sampled, studied and identified, both by using the six microsatellite loci included in the OIV descriptors list, plus ampelographic characters. As a result of the study a total of 53 different grapevine varieties were identified. Most of them correspond to minor varieties that are present in the zone. In many cases the same variety was detected in both countries, although denominated with different names that are synonymous. The molecular markers that were analyzed are those included in the OIV 801 to 806 descriptors, and correspond to the following loci: VVS2, VVMD5, VVMD7, VVMD27, ssrVrZAG62 and ssrVrZAG79. Allele sizes of the studied varieties are recorded. Relationships among these varieties seem to be possible. Recommended priority names for the studied varieties both in Spain and in Portugal are listed, in order to avoid misidentifications and reduce the incidence of homonymies.

Escala de Encuentro de Beneficio para pacientes cardiacos

Resumen:El encuentro de beneficio, que se define como la percepción de cambios positivos por parte del individuo como resultado de su enfrentamiento a un suceso vital adverso, ha sido asociado con bienestar emocional y mejor salud. El objetivo del presente estudio fue analizar las propiedades psicométricas de la Benefit Finding Scale (BFS; Antoni et al., 2001) en una muestra de pacientes que acababan de sufrir un primer episodio cardiaco (n=153). Los resultados mostraron que en la escala se pueden distinguir tres dimensiones que recogen aspectos relacionados con el crecimiento personal, la importancia de la familia y la aceptación de las situaciones, aunque también es posible emplearla como una escala unidimensional. Tanto la escala total como las tres subescalas mostraron alta consistencia interna y estabilidad temporal relativa, así como adecuada validez de criterio. Se concluye que puede ser empleada con total garantía y se discute la idoneidad de realizar análisis confirmatorios.Abstract: Benefit Finding Scale for cardiac patients. Benefit finding, which is defined as the perception of positive changes by the individual because of his confrontation with an adverse life event, has been associated with emotional well-being and better health. The main objective of this study was to analyze the psychometric properties of the Benefit Finding Scale (BFS; Antoni et al., 2001) in a sample of patients who had just suffered a fi rst cardiac event (n = 153). The results showed that in this scale three dimensions can be distinguished which collect aspects of personal growth, the importance of family and acceptance of situations, although it can also be used as a one-dimensional scale. Both the total scale and the three subscales showed high internal consistency and relative temporal stability, and adequate criterion validity. It is concluded that it can be used with full warranty and the suitability of confi rmatory analyses is discussed

Tachyphylaxis to β2-agonists in Spanish asthmatic patients could be modulated by β2-adrenoceptor gene polymorphisms

Producción CientíficaThe study of determinants of asthma is a subject of much interest currently, especially the pharmacogenetic aspects of asthma management. Genetic polymorphisms affecting amino-acids at positions 16 and 27 within β2-adrenoceptor (β2AR) gene have been implicated in the asthma phenotypes and influence on the variability observed in response to use of bronchodilator agents used in the treatment of asthma. Whether these polymorphisms alter the bronchoprotection response to -agonist treatment in Spanish asthmatic population is unknown. The aim of this study was to investigate whether genetic polymorphisms within β2AR gene modulate the clinical outcomes of the individual response to β2-agonist therapy and the development of desensitization in Spanish asthmatic patients.Fondo de Investigación Sanitaria y Ministerio de Sanidad, Consumo y Bienestar Social (FIS00648 and 02/3068)Junta de Castilla y León (VA032/04

Early habituation of maize (Zea mays) suspension-cultured cells to 2,6- diclorobenzonitrile is associated with the enhancement of antioxidant status

30 p.The cellulose biosynthesis inhibitor 2,6-diclorobenzonitrile (DCB) has been widely used to gain insights into cell wall composition and architecture. Studies of changes occurring during incipient habituation to DCB can provide information on early cell mechanisms leading to cope with DCB-induced stress. In this context, maize cultured cells with a reduced amount of cellulose were obtained by stepwise habituation to low DCB concentrations. The results reported here attempt to elucidate the putative role of an antioxidant strategy during incipient habituation. The short-term exposure to DCB of non-habituated maize cultured cells induced a substantial increase in oxidative damage. Concomitantly, short-term treated cells presented an increase in class III peroxidase and glutathione S-transferase activities and total glutathione content. Maize cells habituated to 0.3 – 1 μM DCB (incipient habituation) were characterised by a reduction in the relative cell growth rate, an enhancement of ascorbate peroxidase and class III peroxidase activities, and a net increment in total glutathione content. Moreover, these cell lines showed increased levels of glutathione S-transferase activity. Changes in antioxidant/detoxifying status enabled 0.3 and 0.5 μM DCB-habituated cells to control lipid peroxidation levels, but this was not the case of maize cells habituated to 1 μM DCB, which despite showing an increased antioxidant capacity were not capable of reducing the oxidative damage to control levels. The results reported here confirm that exposure and incipient habituation of maize cells to DCB are associated with an enhancement in antioxidant/detoxifying activities which could play a role in incipient DCB habituation of maize cultured cellsS

Quinclorac-habituation of bean (Phaseolus vulgaris) cultured cells is related to an increase in their antioxidant capacity

7 p.The habituation of bean cells to quinclorac did not rely on cell wall modifications, contrary to what it was previously observed for the well-known cellulose biosynthesis inhibitors dichlobenil or isoxaben. The aim of the present study was to investigate whether or not the bean cells habituation to quinclorac is related to an enhancement of antioxidant activities involved in the scavenging capacity of reactive oxygen species. Treating non-habituated bean calluses with 10 μM quinclorac reduced the relative growth rate and induced a two-fold increase in lipid peroxidation. However, the exposition of quinclorac-habituated cells to a concentration of quinclorac up to 30 μM neither affected their growth rate nor increased their lipid peroxidation levels. Quinclorac-habituated calluses had significantly higher constitutive levels of three antioxidant activities (class-III peroxidase, glutathione reductase, and superoxide dismutase) than those observed in non-habituated calluses, and the treatment of habituated calluses with 30 μM quinclorac significantly increased the level of class III-peroxidase and superoxide dismutase. The results reported here indicate that the process of habituation to quinclorac in bean callus-cultured cells is related, at least partially, to the development of a stable antioxidant capacity that enables them to cope with the oxidative stress caused by quinclorac. Class-III peroxidase and superoxide dismutase activities could play a major role in the quinclorac-habituation. Changes in the antioxidant status of bean cells were stable, since the increase in the antioxidant activities were maintained in quinclorac-dehabituated cellsS

Plan de marketing de turismo gastronómico en Lima para Chile y Ecuador

El turismo en el Perú muestra un notorio crecimiento, el cual se evidencia en las alentadoras cifras para los siguientes años, así como en muchas oportunidades a futuro. En tal contexto, en este trabajo se presenta un Plan de Marketing que, al ser llevado a cabo por el Estado peruano a través de PROMPERÚ, mostrará las bondades de la cocina nacional a turistas chilenos y ecuatorianos. Con ello se logrará que el turismo gastronómico limeño crezca. Así pues, este crecimiento ayudará a que el país cumpla con los objetivos trazados por el Ministerio de Comercio Exterior y Turismo (Mincetur) respecto al número de turistas por recibir (5’000,000 para el 2021). Los ciudadanos chilenos y ecuatorianos representan el 58.9% de turistas recibidos en el Perú en los últimos años. En esa línea, la propuesta presentada buscará potenciarlos y, a su vez, atraer a otros nuevos. Además, con el auge gastronómico se logrará expandir el espectro de comunicación de la gastronomía peruana, y promover la innovación y la adopción de nuevas tendencias en los turistas de estos países. De esta forma, el plan de marketing contribuirá a que el Perú mantenga el primer lugar en el mundo como destino culinario según el World Travel Awards. Asimismo, contribuirá a que Lima se mantenga como la ciudad más visitada de América Latina. Por su parte, la comunicación de la marca gastronómica buscará posicionar al país como “Perú, destino gastronómico y de mayor variedad culinaria en el mundo”. Al ejecutar el plan presentado, se logrará: (a) que la gastronomía se ubique en el segundo motivo para visitar el Perú para los turistas chilenos y ecuatorianos según el estudio del Perfil del Turista de Mincetur (PROMPERÚ, 2015c) en el 2021; (b) incrementar el número de turistas chilenos y ecuatorianos que vienen a disfrutar de la gastronomía al país de 4% a 8% para el 2021, según el estudio del Perfil del Turista de Mincetur; finalmente, (c) acreditar a 300 restaurantes peruanos que cumplan con la estandarización de la propuesta para el 2021. La propuesta se basará en la estandarización de restaurantes y en la venta de paquetes para la realización de turismo gastronómico a través del portal de PROMPERÚ, al cual podrán acceder los turistas directamente o a través de sus agencias de viaje. Estos productos vienen acompañados de estrategias de promoción, canales, personas y procesos. La ejecución del plan significará una inversión de US$1’171,484 para el primer año y un crecimiento del 5por la venta de paquetes turísticos gastronómicos. Se ha comprobado que esta propuesta es económicamente rentable debido a que, al traer los valores futuros al presente (utilizando 14siendo positivo cuando se estudia un escenario negativo, donde se proyectaría no llegar al 8de turistas que vienen al Perú para disfrutar la gastronomía, sino solo al 7in the positive numbers predicted for tourism for next years. In that context, this project presents a Marketing Plan that will show the greatness of national Peruvian cuisine to tourists from Chile and Ecuador, when implemented by Peruvian State (PROMPERÚ). This plan would also help the country to achieve the goal set by the Minister of Tourism (Mincetur): to receive 5’000,000 tourists by 2021. Tourists from Chile and Ecuador represent 58.9 percent of tourism Peru received in the past years. This project will aim to potentiate them and, at the same time, attract new tourists. This marketing plan will contribute to maintain Peru on the first place as a culinary destiny, according to the World Travel Awards. Also, it will contribute to maintain Lima as the most visited city in Latin America. The communication strategy will seek to position Peru as a “National destiny with the most culinary variety in the world”. When Peruvian Government executes this plan, it will accomplish: (a) that gastronomy becomes the second motive for visiting Peru for tourists from Chile and Ecuador by 2021, according to the “Tourist Profile” developed by Mincetur; (b) to increase the percentage of tourists from Chile and Ecuador that come to Peru because of its gastronomy from 4 percent to 8 percent by 2021, according to the “Tourist Profile” developed by Mincetur; and (c) to certificate 300 Peruvian restaurants that meet high-quality standards by 2021. The proposal will focus on the standardization of restaurants and the sale of gastronomy tourism packages offered through PROMPERÚ web page, that tourists access to directly or through their travel agencies. These products will have promotion, channel, persons and process strategies, which will be described in the correspondent chapter. Execution of this plan will need an investment of US$ 1’71,484, for the first year, and an annual growth of 5 percent. This investment will be recovered with the taxes received from the sale of the packages. If the proposal is rentable (using VNA), when bringing value to the present, using 14 percent as a discount rate2. This result remains positive in a negative scenario, where the number of gastronomic tourists that come to Peru does not reach 8 percent, but only 7 percent.Tesi

A Metabolomics Signature Linked To Liver Fibrosis In The Serum Of Transplanted Hepatitis C Patients

Liver fibrosis must be evaluated in patients with hepatitis C virus (HCV) after liver transplantation because its severity affects their prognosis and the recurrence of HCV. Since invasive biopsy is still the gold standard to identify patients at risk of graft loss from rapid fibrosis progression, it becomes crucial the development of new accurate, non-invasive methods that allow repetitive examination of the patients. Therefore, we have developed a non-invasive, accurate model to distinguish those patients with different liver fibrosis stages. Two hundred and three patients with HCV were histologically classified (METAVIR) into five categories of fibrosis one year after liver transplantation. In this cross-sectional study, patients at fibrosis stages F0-F1 (n = 134) were categorised as "slow fibrosers" and F2-F4 (n = 69) as "rapid fibrosers". Chloroform/methanol serum extracts were analysed by reverse ultra-high performance liquid chromatography coupled to mass spectrometry. A diagnostic model was built through linear discriminant analyses. An algorithm consisting of two sphingomyelins and two phosphatidylcholines accurately classifies rapid and slow fibrosers after transplantation. The proposed model yielded an AUROC of 0.92, 71% sensitivity, 85% specificity, and 84% accuracy. Moreover, specific bile acids and sphingomyelins increased notably along with liver fibrosis severity, differentiating between rapid and slow fibrosers