Are pleiotropic effects of statins real?

The clinical benefits of statins are strongly related to their low density lipoprotein-cholesterol (LDL-C) lowering properties. However, because mevalonic acid (MVA), the product of 3-hydroxy-3-methyl-3-glutaryl coenzyme A (HMG-CoA) reductase reaction, is the precursor not only of cholesterol but also of nonsteroidal isoprenoid compounds, the inhibition of HMG-CoA reductase may result in pleiotropic effects, independent of their hypocholesterolemic properties. The discrimination between the pleiotropic from LDL-C lowering effects may potentially be more evident during the early phase of treatment since plasma MVA levels drop up to 70% within 1–2 hours while a reduction of LDL-C, detectable after 24 hours, became significant after 6–7 days. Therefore, the deprivation of circulating MVA-derived isoprenoids in the early phase of treatment could be the main mechanism responsible for the atheroprotective effect of statins. This early window of protection in the absence of LDL-C lowering suggests that the anti-inflammatory and the pleiotropic properties of statins may have clinical importance. Therefore, acute coronary syndromes could represent a clinical condition for addressing the early benefits of statins therapy, ie, within 24 h of the event, independent of LDL-C lowering

Repensar el futuro de los territorios rurales. Cinco perspectivas de abordaje

[EN] In recent years, the debate on rural territories has gained visibility in the media, in the political arena, and at different levels of administration. From the Urban Planning Research Group of the Universitat Politècnica de Catalunya, we have been contributing to this debate with research that addresses issues related to the morphological analysis of settlements and territories in rural contexts. Throughout these investigations, we have focused on the analysis of problems linked to the imbalance in the distribution of population and activities in the territory and in rural depopulation, with the aim of evaluating the relevance and potential of so many areas, as well as the possibilities of reversing situations and processes of a certain complexity. This article shows some of the perspectives from which we have been reflecting on these territories. These works have in common their trans-scalar approach, the use of new technologies for analysis, the link between research applied to teaching, the implementation of research by design, and the collaboration between university departments and different administrations.[ES] En los últimos años, el debate sobre los territorios rurales ha ganado visibilidad en los medios de comunicación, en el ámbito político y en diferentes niveles de la administración. Desde el Grupo de Investigación en Urbanismo de la Universitat Politècnica de Catalunya, venimos contribuyendo a este debate con investigaciones que abordan temas vinculados al análisis morfológico de poblaciones y territorios en contextos rurales. A lo largode estas investigaciones hemos puesto el foco en el análisis de problemáticas vinculadas al desequilibrio en la distribución de las personas y actividades en el territorio y en la despoblación rural, con el objetivo de evaluar la relevancia y el potencial de tantos ámbitos, así como las posibilidades de revertir situaciones y procesos de cierta complejidad. El presente artículo quiere mostrar algunas de las perspectivas desde las que venimos reflexionando sobre estos territorios. Estos trabajos tienen en común su abordaje transescalar, la utilización de nuevas tecnologías para el análisis, la vinculación entre la investigación aplicada a la docencia, la implementación del research by design y la colaboración entre departamentos universitarios y diferentes administraciones.Agradecemos su soporte al Ministerio de Ciencia e Innovación (proyecto PCI2020-120716-2, financiado por MCIN/AEI/10.13039/501100011033/ y la Unión Europea “NextGenerationEU”/PRTR), al Instituto Cartográfico y Geológico de Catalunya, a la Diputación de Barcelona, a los Ayuntamientos de Guimerà, Vallcebre, Alp y Les Planes d’Hostoles, al Consell Comarcal de la Cerdanya y del Berguedà, y a la Associació pel Desenvolupament Rural de la Catalunya Central, así como la Càtedra en Innovació en Habitatge de la Conselleria d’Habitatge, Obres Públiques i Vertebració del Territori de la Generalitat Valenciana.Cortellaro, S.; Franquesa Sanchez, J.; Moreno Sanz, J.; Pesoa, M.; Sabaté Bel, J. (2022). Rethinking the future of rural territories. Five perspectives of approach. VLC arquitectura. Research Journal. 9(2):275-300. https://doi.org/10.4995/vlc.2022.177602753009

Dynamic changes and prognostic value of pulmonary congestion by lung ultrasound in acute and chronic heart failure: a systematic review

Aims: Pulmonary congestion is an important finding in patients with heart failure (HF) that can be quantified by lung ultrasound (LUS). We conducted a systematic review to describe dynamic changes in LUS findings of pulmonary congestion (B-lines) in HF and to examine the prognostic utility of B-lines in HF. Methods and results: We searched online databases for studies conducted in patients with chronic or acute HF that used LUS to assess dynamic changes or the prognostic value of pulmonary congestion. We included studies in adult populations, published in English, and conducted in ≥25 patients. Of 1327 identified studies, 13 (25–290 patients) met the inclusion criteria: six reported on dynamic changes in LUS findings (438 patients) and seven on the prognostic value of B-lines in HF (953 patients). In acute HF, B-line number changed within as few as 3 h of HF treatment. In acute HF, ≥15 B-lines on 28-zone LUS at discharge identified patients at a more than five-fold risk for HF readmission or death. Similarly, in ambulatory patients with chronic HF, ≥3 B-lines on five- or eight-zone LUS marked those at a nearly four-fold risk for 6-month HF hospitalization or death. Conclusions: Lung ultrasound findings change rapidly in response to HF therapy. This technique may represent a useful and non-invasive method to track dynamic changes in pulmonary congestion. Furthermore, residual congestion at the time of discharge in acute HF or in ambulatory patients with chronic HF may identify those at high risk for adverse events