Relationship Between the Plasma Concentration of C-Reactive Protein and Severity of Peripheral Arterial Disease

Objective To determine whether the increase in plasma levels of C-Reactive Protein (CRP), a non-specific reactant in the acute-phase of systemic inflammation, is associated with clinical severity of peripheral arterial disease (PAD). Methods and Results This is a cross-sectional study at a referral hospital center of institutional practice in Madrid, Spain. A stratified random sampling was done over a population of 3370 patients with symptomatic PAD from the outpatient vascular laboratory database in 2007 in the order of their clinical severity: the first group of patients with mild chronological clinical severity who did not require surgical revascularization, the second group consisted of patients with moderate clinical severity who had only undergone only one surgical revascularization procedure and the third group consisted of patients who were severely affected and had undergone two or more surgical revascularization procedures of the lower extremities in different areas or needed late re-interventions. The Neyman affixation was used to calculate the sample size with a fixed relative error of 0.1. A homogeneity analysis between groups and a unifactorial analysis of comparison of medians for CRP was done. The groups were homogeneous for age, smoking status, Arterial Hypertension HTA, diabetes mellitus, dyslipemia, homocysteinemia and specific markers of inflammation. In the unifactorial analysis of multiple comparisons of medians according to Scheffe, it was observed that the median values of CRP plasma levels were increased in association with higher clinical severity of PAD (3.81 mg/L [2.14-5.48] vs. 8.33 [4.38-9.19] vs. 12.83 [9.5-14.16]; p < 0.05) as a unique factor of tested ones. Conclusion Plasma levels of CRP are associated with not only the presence of atherosclerosis but also with its chronological clinical severity

Enhanced Vascular Endothelial Growth Factor Gene Expression in Ischaemic Skin of Critical Limb Ischaemia Patients

Objectives. To perform a quantitative analysis of the vascular endothelial growth factor (VEGF) gene transcription in the skin of ischemic legs and provide information for VEGF in the pathogenesis in critical limb ischemia (CLI). Methods. Skin biopsies were obtained from 40 patients with CLI. Control samples came from 44 patients with chronic venous disease. VEGF gene expression was analysed using quantitative polymerase chain reaction. Results. Patients with CLI had higher skin VEGF expression than control group (RQ: 1.3 ± 0.1 versus 1, P = 0.04). Conclusions. We found an association between ischemic skin and an elevated VEGF expression in legs from patients with CLI. These data support that the mechanism for VEGF upregulation in hypoxia conditions is intact and acts appropriately in the ischaemic limbs from patients with CLI

A prospective randomized controlled study with intermittent mechanical compression of the calf in patients with claudication

ObjectivesThe study tested the feasibility of using a new portable mechanical compression device for the treatment of claudication. The device applies intermittent non-pneumatic mechanical compression (IMC) to the calf. It was hypothesized that it can offer a low-cost convinient option for patients and achieve good compliance and improved clinical outcomes.MethodsThirty patients were enrolled in a randomized controlled single blind study. Fourteen patients were assigned to active IMC. Sixteen control patients continued with medical treatment alone. Outcomes were recorded at baseline, after one month, three months, and six months. The study examined changes in exercise tolerance using Initial Claudiacation Distance (ICD) and Absolute Claudiaction Distance (ACD) as well as ankle-brachial index at rest (ABI-r) and post-exercise (ABI-pe). All patients had stable claudication due to peripheral arterial disease (PAD) and were already under best medical treatment (BMT). To be eligible for inclusion, patients had to be between the ages of 50 and 75 years, had to have stable claudication with an absolute claudication distance >40 meters but <300 meters on a standardized treadmill stress test (3.8 km/h at a 10% grade), have a resting ABI in the affected limb <0.8 with a drop of at least 0.15 following exercise, in whom surgical intervention was not expected for at least three months. Fourteen patients were assigned to active IMC consisting of compressions 65 mm Hg in amplitude, applied for three 3-second compressions/minute, two hours/day for three months. Sixteen control patients continued with BMT alone.ResultsOne month after treatment, ICD increased by 66% (P = .001), ACD increased by 51.75% (P = .005), and ABI-pe increased by 42% (P = .01). Treatment effects were maintained or further improved after three months. ABI-r did not increase at any time. Compliance exceeded 80%. Three months following cessation of therapy, claudication distances and ABI-pe did not decrease significantly.ConclusionsWe concluded that the use of IMC of the calf for three months increased claudication distances and led to objective improvements in ABI-pe. Intermittent mechanical compression may be a useful approach to patients with continued claudication despite standard medical treatment

Investigación e intervención en educación en prisiones: nuevos conocimientos y propuestas curriculares en la universidad

La ponencia de cuenta de los resultados alcanzados, las contribuciones a la educación, las estrategias de divulgación llevadas a cabo y la puntualización de algunas observaciones a partir de una investigación vinculada a un proyecto de intervención del Programa Universitario en la Cárcel cuyo propósito fue retroalimentar su desenvolvimiento. Además de la devolución a los estudiantes presos que participan en el programa y al Área Educación del Servicio Penitenciario, la principal contribución se centra al interior de la universidad en tanto visibiliza un sector de la realidad educativa poco conocido dentro de la universidad. Junto a la propuesta de intervención educativa del PUC que inició un camino en tal sentido, los resultados del proyecto promovieron la apertura de espacios curriculares optativos para estudiantes de Ciencias de la Educación e interdisciplinarios que abarcaron a estudiantes de otras carrera.http://hdl.handle.net/2445/47904Fil: Acin, Alicia Beatriz. Universidad Nacional de Córdoba. Facultad de Filosofía y Humanidades. Centro de Investigaciones (CIFFyH); Argentina.Fil: Correa, Ana María. Universidad Nacional de Córdoba. Facultad de Filosofía y Humanidades. Centro de Investigaciones (CIFFyH); Argentina.Fil: Mercado, Patricia. Universidad Nacional de Córdoba. Facultad de Filosofía y Humanidades. Centro de Investigaciones (CIFFyH); Argentina.Fil: Gelmi, Eda. Universidad Nacional de Córdoba. Facultad de Filosofía y Humanidades. Centro de Investigaciones (CIFFyH); Argentina.Fil: Barrios, Luciana. Universidad Nacional de Córdoba. Facultad de Filosofía y Humanidades. Centro de Investigaciones (CIFFyH); Argentina.Fil: Abril, Francisco. Universidad Nacional de Córdoba. Facultad de Filosofía y Humanidades. Centro de Investigaciones (CIFFyH); Argentina.Fil: Rodríguez, María Julia. Universidad Nacional de Córdoba. Facultad de Filosofía y Humanidades. Centro de Investigaciones (CIFFyH); Argentina.Fil: Ferrer, Cecilia. Universidad Nacional de Córdoba. Facultad de Filosofía y Humanidades. Centro de Investigaciones (CIFFyH); Argentina.Educación General (incluye capacitación, pedagogía y didáctica

Treatment of thromboangiitis obliterans (Buerger's disease) with bosentan

<p>Abstract</p> <p>Background</p> <p>This study assessed the effectiveness and safety of bosentan when administered to thromboangiitis obliterans (Buerger's disease) patients.</p> <p>Methods</p> <p>A clinical pilot study was designed in which patients with ulcer and/or pain at rest were treated with bosentan p.o. at a dose of 62.5 mg twice daily during the first month, which was thereafter up-titrated to 125 mg twice daily. The study endpoints were clinical improvement rate, major or minor amputation rate, haemodynamic changes, changes in endothelial function and angiographic changes.</p> <p>Results</p> <p>Seven out of 12 patients were male (58%). Median age was 39 years (range 29-49). The median follow-up was 20 months (range 11-40). All patients were smokers. With bosentan treatment, new ischaemic lesions were observed in only one patient. Overall, clinical improvement was observed in 12 of the 13 extremities (92%). Only two out of 13 extremities underwent amputation (one major and one minor) after bosentan treatment. After being assessed by digital arteriography with subtraction or angio-magnetic resonance imaging, an increase of distal flow was observed in 10 out of the 12 patients. All patients experienced a statistically significant improvement in their BAFMD values (mean: 1.8 at baseline; 6.6 at the end of the treatment; 12.7 three months after the end of the treatment; p < 0.01).</p> <p>Conclusion</p> <p>Bosentan treatment may result in an improvement of clinical, angiographic and endothelial function outcomes. Bosentan should be investigated further in the management of TAO patients. Larger studies are required to confirm these results.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: <a href="http://www.clinicaltrials.gov/ct2/show/NCT01447550">NCT01447550</a></p

VIII Encuentro de Docentes e Investigadores en Historia del Diseño, la Arquitectura y la Ciudad

Acta de congresoLa conmemoración de los cien años de la Reforma Universitaria de 1918 se presentó como una ocasión propicia para debatir el rol de la historia, la teoría y la crítica en la formación y en la práctica profesional de diseñadores, arquitectos y urbanistas. En ese marco el VIII Encuentro de Docentes e Investigadores en Historia del Diseño, la Arquitectura y la Ciudad constituyó un espacio de intercambio y reflexión cuya realización ha sido posible gracias a la colaboración entre Facultades de Arquitectura, Urbanismo y Diseño de la Universidad Nacional y la Facultad de Arquitectura de la Universidad Católica de Córdoba, contando además con la activa participación de mayoría de las Facultades, Centros e Institutos de Historia de la Arquitectura del país y la región. Orientado en su convocatoria tanto a docentes como a estudiantes de Arquitectura y Diseño Industrial de todos los niveles de la FAUD-UNC promovió el debate de ideas a partir de experiencias concretas en instancias tales como mesas temáticas de carácter interdisciplinario, que adoptaron la modalidad de presentación de ponencias, entre otras actividades. En el ámbito de VIII Encuentro, desarrollado en la sede Ciudad Universitaria de Córdoba, se desplegaron numerosas posiciones sobre la enseñanza, la investigación y la formación en historia, teoría y crítica del diseño, la arquitectura y la ciudad; sumándose el aporte realizado a través de sus respectivas conferencias de Ana Clarisa Agüero, Bibiana Cicutti, Fernando Aliata y Alberto Petrina. El conjunto de ponencias que se publican en este Repositorio de la UNC son el resultado de dos intensas jornadas de exposiciones, cuyos contenidos han posibilitado actualizar viejos dilemas y promover nuevos debates. El evento recibió el apoyo de las autoridades de la FAUD-UNC, en especial de la Secretaría de Investigación y de la Biblioteca de nuestra casa, como así también de la Facultad de Arquitectura de la UCC; va para todos ellos un especial agradecimiento

Treatment of Buerger disease (thromboangiitis obliterans) with bosentan: a case report

Buerger disease (thromboangiitis obliterans) is a non-atherosclerotic segmental inflammatory disease strongly associated with tobacco use, and it affects small and medium-sized blood vessels in the upper and lower extremities. The only known treatment for this disease is complete discontinuation of tobacco use. This report describes the case history of a woman with Buerger disease treated with the oral dual endothelin receptor antagonist bosentan. It is believed that this is the first description in the literature of this use for bosentan

Rationale and Design of Randomized Clinical Trial for the Assessment of Macitentan Efficiency as Coadjuvant Treatment to Open and Endovascular Revascularization in Critical Limb Ischemia

Introduction Critical limb ischemia (CLI) is defined by ischemic rest pain, tissue loss, or both, secondary to arterial insufficiency, and its prevalence is increasing mainly as a result of the worldwide high prevalence of diabetes. Currently, there are no available conclusive data on the efficacy of any coadjuvant therapy after revascularization procedure benefiting amputation and patency rates. Macitentan is an orally active dual endothelin (ET) receptor antagonist that may contribute to reduce the amputation rate and improve revascularization patency in CLI. Methods/Design REVASC is a proposed pilot, open-label, controlled, randomized, single-center clinical double-blind trial to be conducted in Spain on a study population of European patients with CLI, which will compare the clinical outcomes and cost-effectiveness of macitentan coadjuvant treatment after limb revascularization with the standard antiplatelet treatment strategy for severe limb ischemia. Patients are randomized 1:1 to receive macitentan or placebo for 12 weeks. The primary clinical end point will be amputation-free survival rate at 12 months, defined as the time to major (above the ankle) amputation for the index (trial) limb or death from any cause, whichever comes first. Secondary outcomes include overall survival, quality of life, in-hospital mortality and morbidity, repeat interventions, healing of tissue loss, and hemodynamic changes following revascularization. Sample size is estimated as 120 patients. The economic analysis will consist of two components: a “within-study” analysis, which will be based on study end points; and a “model-based” analysis, which will extrapolate and compare costs and effects likely to accrue beyond the study follow-up period. Discussion The REVASC trial is designed to be pragmatic and represents current practice of the real-world population management after limb revascularization for CLI due to atherosclerosis. Current evidence does not support any coadjuvant treatment. A new pathway of treatment may be opened with the use of ET receptor antagonists in these patients