Un mètode més precís per al diagnòstic de la dissecció aòrtica

La dissecció aòrtica és una malaltia vascular en què s'esquinça la paret de l'aorta i que té una elevada mortalitat. Determinar les variables que caracteritzen la dissecció (localització, extensió, dimensions...) condiciona el tractament dels pacients i la seva evolució per la qual cosa és important disposar d'unes bones eines de diagnòstic. Els mètodes tradicionals presenten tots la mateixa precisió però s'usen diferencialment en funció de la fase de la malaltia o del que es vulgui observar. Recentment, s'ha desenvolupat l'ecocardiografia transesofàgica tridimensional que permet obtenir una major precisió anatòmica en les 3 dimensions de l'espai. El paper d'aquesta tècnica en aquesta malaltia no havia estat validat. Investigadors de l'Hospital Universitari Vall d'Hebron n'han comparat els resultats amb els mètodes tradicionals.La disección aórtica es una enfermedad vascular en la que se rasga la pared de la aorta y que tiene una elevada mortalidad. Determinar las variables que caracterizan la disección (localización, extensión, dimensiones ...) condiciona el tratamiento de los pacientes y su evolución por lo que es importante disponer de unas buenas herramientas de diagnóstico. Los métodos tradicionales presentan todos la misma precisión pero se usan diferencialmente en función de la fase de la enfermedad o lo que se quiera observar. Recientemente, se ha desarrollado la ecocardiografía transesofágica tridimensional que permite obtener una mayor precisión anatómica en las 3 dimensiones del espacio, cuyo papel en esta enfermedad no había sido validado. Investigadores del Hospital Universitario Vall d'Hebron han comparado sus resultados con los de los métodos tradicionales

Actualización en válvula aórtica bicúspide y complicaciones asociadas

Bicuspid aortic valve (BAV) is the most common congenital heart disease affecting 1-2% of the population. It affects more frequently males than females with a ratio of 3:1. Despite the fact that it has been historically considered a relatively benign disease, 35% of individuals with BAV will develop complications throughout life such as valve dysfunction, aortic aneurysm or aortic dissection. In spite of the relevance of this disease many aspects are not still clarified. The aim of this article is to show an updated version of the basic aspects of this pathology with emphasis on the latest developments related to the diagnosis, evolution and associated complications from a cardiac imaging viewpoint.La válvula aórtica bicúspide (VAB) es la cardiopatía congénita más frecuente y afecta a un 1-2% de la población. Afecta de forma más habitual a varones que a mujeres, con una relación 3:1. A pesar de haberse considerado históricamente una patología de carácter relativamente benigno, un 35% de los individuos con VAB desarrollará a lo largo de la vida complicaciones derivadas como disfunción valvular, endocarditis, aneurisma aórtico o disección aórtica. A pesar de la relevancia de esta patología quedan aún muchos aspectos por dilucidar. El objetivo de este artículo es mostrar una revisión actualizada de los aspectos básicos de esta patología haciendo hincapié en las últimas novedades relacionadas con su diagnóstico, evolución y complicaciones asociadas desde el punto de vista de la imagen cardíaca

Resistencias LGBT en universidades de Chiapas, México: más allá de la víctima pasiva

This paper aims to expose and analyze how LGBT students in three public universities in Chiapas, Mexico, are carrying out forms of resistance in response to manifestations of violence and discrimination. The research was based on a qualitative methodology and analyzed through a grounded-theory strategy. We found that LGBT students are not passive victims of discrimination, but rather resist in various ways, making the university a space in dispute over heteropatriarchal norms.El presente artículo tiene el objetivo de exponer y analizar las formas de resistencia de estudiantes LGBT en tres universidades públicas de Chiapas, México, frente a manifestaciones diversas de violencia y discriminación. La investigación se desarrolló con base en una metodología cualitativa, y la información se analizó por medio de la estrategia de la teoría fundamentada. Entre los resultados encontramos que las y los estudiantes LGBT no son víctimas pasivas de la discriminación, sino que se resisten de formas variadas, lo que hace de la universidad un espacio de disputa frente al dictado heteropatriarcal

Nuevo instituto de educación superior tecnológico público en Huaycán

El tema se encuentra inserto dentro del campo de la arquitectura en la educación superior tecnológica que sirva de estímulo para la correcta actividad educativa en jóvenes y docentes. Este proyecto consiste en la planificación en conjunto con el Instituto Superior Tecnológico Publico de Huaycán y proponer una nueva visión de la arquitectura de sí misma llegando a desarrollarlo a nivel de proyecto, cumpliendo con todo lo estipulado según normas del RNE y del MINEDU. Preliminarmente se ha considerado la demolición total del Instituto Superior Tecnológico Público de Huaycán para su respectiva planificación desde cero, debido a que según lo visto en campo carece de una total planificación a futuro, una mala infraestructura académica y el deterioro de los sistemas estructurales, lo cual genera peligro en alumnos, profesores y personal administrativo

Interdisciplinary expert consensus on management of type B intramural haematoma and penetrating aortic ulcer

An expert panel on the treatment of type B intramural haematoma (IMH) and penetrating atherosclerotic ulcer (PAU) consisting of cardiologists, cardiothoracic surgeons, vascular surgeons and interventional radiologists reviewed the literature to develop treatment algorithms using a consensus method. Data from 46 studies considered relevant were retrieved for a total of 1386 patients consisting of 925 with IMH, and 461 with PAU. The weighted mean 30-day mortality from IMH was 3.9%, 3-year aortic event-related mortality with medical treatment 5.4%, open surgery 23.2% and endovascular therapy 7.1%. In patients with PAU early and 3-year aortic event-mortality rates with open surgery were 15.9 and 25.0%, respectively, and with TEVAR were 7.2 and 10.4%, respectively. According to panel consensus statements, haemodynamic instability, persistent pain, signs of impending rupture and progressive periaortic haemorrhage in two successive imaging studies require immediate surgical or endovascular treatment. In the absence of these complications, medical treatment is warranted, with imaging control at 7 days, 3 and 6 months and annually thereafter. In the chronic phase, aortic diameter >55 mm or a yearly increase ≥5 mm should be considered indications for open surgery or thoracic endovascular treatment, with the latter being preferred. In complicated type B aortic PAU and IMH, endovascular repair is the best treatment option in the presence of suitable anatom

Specific Targeting of Human Inflamed Endothelium and In Situ Vascular Tissue Transfection by the Use of Ultrasound Contrast Agents

ObjectivesWe used human umbilical cord segments as an ex vivo model to investigate the possible clinical diagnostic and therapeutic applications of microbubbles (MBs).BackgroundMicrobubbles are commonly used in clinical practice as ultrasound contrast agents. Several studies have addressed the in vivo applications of MBs for specific targeting of vascular dysfunction or sonoporation in animal models, but to date no human tissue model has been established.MethodsPrimary venular endothelial cell monolayers were targeted with MBs conjugated to an antibody against a highly expressed endothelial marker (tetraspanin CD9), and binding was assessed under increasing flow rates (0.5 to 5 dynes/cm2). Furthermore, CD9-coupled MB endothelial targeting was measured under flow conditions by contrast-enhanced ultrasound analysis in an ex vivo human macrovascular model (umbilical cord vein), and the same tissue model was used for the detection of inflamed vasculature with anti-intercellular adhesion molecule (ICAM)-1–coated MBs. Finally, plasmids encoding fluorescent proteins were sonoporated into umbilical cord vessels.ResultsSpecific endothelial targeting in the in vitro and ex vivo models described previously was achieved by the use of MBs covered with an anti-CD9. Furthermore, we managed to induce inflammation in umbilical cord veins and detect it with real-time echography imaging using anti–ICAM-1–coupled MBs. Moreover, expression and correct localization of green fluorescent protein and green fluorescent protein-tagged ICAM-1 were assessed in this human ex vivo model without causing vascular damage.ConclusionsIn the absence of clinical trials to test the benefits and possible applications of ultrasound contrast agents for molecular imaging and therapy, we have developed a novel ex vivo human model using umbilical cords that is valid for the detection of inflammation and for exogenous expression of proteins by sonoporation

Fluid–structure interaction simulations outperform computational fluid dynamics in the description of thoracic aorta haemodynamics and in the differentiation of progressive dilation in Marfan syndrome patients

Abnormal fluid dynamics at the ascending aorta may be at the origin of aortic aneurysms. This study was aimed at comparing the performance of computational fluid dynamics (CFD) and fluid–structure interaction (FSI) simulations against four-dimensional (4D) flow magnetic resonance imaging (MRI) data; and to assess the capacity of advanced fluid dynamics markers to stratify aneurysm progression risk. Eight Marfan syndrome (MFS) patients, four with stable and four with dilating aneurysms of the proximal aorta, and four healthy controls were studied. FSI and CFD simulations were performed with MRI-derived geometry, inlet velocity field and Young's modulus. Flow displacement, jet angle and maximum velocity evaluated from FSI and CFD simulations were compared to 4D flow MRI data. A dimensionless parameter, the shear stress ratio (SSR), was evaluated from FSI and CFD simulations and assessed as potential correlate of aneurysm progression. FSI simulations successfully matched MRI data regarding descending to ascending aorta flow rates (R2 = 0.92) and pulse wave velocity (R2 = 0.99). Compared to CFD, FSI simulations showed significantly lower percentage errors in ascending and descending aorta in flow displacement (−46% ascending, −41% descending), jet angle (−28% ascending, −50% descending) and maximum velocity (−37% ascending, −34% descending) with respect to 4D flow MRI. FSI- but not CFD-derived SSR differentiated between stable and dilating MFS patients. Fluid dynamic simulations of the thoracic aorta require fluid–solid interaction to properly reproduce complex haemodynamics. FSI- but not CFD-derived SSR could help stratifying MFS patients.This study was funded by Ministerio de Economía y Competitividad (grant no. RTC-2016-5152-1), Fundació la Marató de TV3 (grant no. 20151330), FP7 People: Marie-Curie Actions (grant no. 267128), Instituto de Salud Carlos III (grant nos PI14/0106 and PI17/00381) and ‘la Caixa’ Foundation. M.V. was funded by CompBioMed2, grant agreement ID: 823712, funded under: H2020-EU.1.4.1.3; and SILICOFCM, grant agreement ID: 777204, funded under: H2020-EU.3.1.5.Peer ReviewedPostprint (published version

Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography

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