Procesos de decisión en la antiagregación (V): Riesgo hemorrágico

Una vez valorada la indicación del tratamiento antiagregante y el riesgo tromboembólico en anteriores entradas, este último, bajo niveles de evidencia III o IV, debemos conocer y valorar el riesgo hemorrágico del procedimiento al que será sometido el paciente si decidimos no suspender los antiplaquetarios con el fin de llegar al último punto del proceso de decisión con todos los argumentos necesarios para, desde un punto de vista multidisciplinario, individualizando e informando adecuadamente al paciente, consensuar la decisión de retirar o continuar la terapia antiagregante

Evaluación de una intervención mediante sofrología para disminuir la ansiedad en las gestantes con un feto con retraso de crecimiento

Objetivo: comparar el grado de ansiedad de un grupo de mujeres con un feto con retraso de crecimiento intrauterino (RCIU) visitadas exclusivamente por especialistas en medicina maternofetal en relación a otras mujeres que, además, también fueron visitadas por una matrona formada en técnicas de relajación y detectar los sentimientos prevalentes cuando se informa del diagnóstico. Material y método: estudio multimétodo: cuantitativo (diseño cuasi-experimental) y cualitativo (fenomenológico). Las participantes fueron gestantes con feto con RCIU, mayores de edad, sin trastornos psiquiátricos ni dificultad idiomática. En el grupo control, se incluyeron mujeres que siguieron el control de la gestación de alto riesgo. Las mujeres del grupo experimental además del control estándar, tuvieron tres visitas con la matrona en la que se explicaron técnicas de control de la ansiedad. Ambos grupos realizaron el mismo test para evaluar la ansiedad (test STAI), al inicio y al final de su participación. Finalmente, se realizaron entrevistas semiestructuradas a las mujeres del grupo experimental. Resultados y conclusiones: las mujeres que tuvieron contacto con la matrona, además de los cuidados técnicos, obtuvieron puntuaciones más bajas en la escala STAI (menor grado de ansiedad) que aquellas que sólo recibieron cuidados por especialistas en Medicina Maternofetal. Las entrevistas pusieron de manifiesto sentimientos: las categorías que emergieron del análisis fueron: a) sentimientos en relación a ellas mismas, b) sentimientos en relación al personal o al hospital y c) sentimientos de afrontamiento. En suma, ofrecer técnicas de relajación a aquellas madres con un embarazo de riesgo (feto RCIU) mejora su grado de ansiedad

Influence of operational parameters on photocatalytic amitrole degradation using nickel organic xerogel under UV irradiation

The objectives of this study were to analyze the influence of different operational variables and to determine the time course of total organic carbon (TOC) and medium toxicity during amitrole (AMT) photodegradation in the presence of Ni xerogel (X-Ni) as photocatalyst. A further study objective was to analyze the influence of the type of water on the photodegradation process. Results show that the degradation rate is directly proportional to the initial X-Ni concentration up to a maximum of 250 mg/L with a slight decrease thereafter, indicating progressive photon absorption saturation of the catalyst for a given incident radiation flow. At concentrations close to 250 mg/L X-Ni, the AMT photodegradation rate is not affected by further increases in X-Ni concentration. In addition, AMT photolysis is highly pH-dependent and is generally favored at pH values at which AMT is in its ionic form. The increase observed in AMT degradation rate under alkaline conditions can be attributed to the higher generation of radicals. The presence of chloride reduces the AMT degradation rate, because Cl− anions behave as h+ and radical scavengers. The degradation rate is also decreased by addition to the medium of organic matter, which acts as a filter. The behavior of TOC removal kinetics during AMT degradation in the presence of X-Ni is similar to that observed for AMT degradation kinetics. Finally, we highlight that photocatalysis is more effective in ultrapure water than in wastewater or tap water. In all systems, the optimal catalyst concentration is 250 mg/L. The medium toxicity increases with longer treatment time, indicating the formation of by-products that are smaller than AMT and can more readily penetrate the cell.Financial support provided by the Ministerio de Ciencia e Innovación (Spain) and FEDER (Projects CTQ-2011-29035-C02-01 and CTQ-2011-29035- C02-02), and by the University of Jaén (Project UJA 2015/06/01)

APP-derived peptides reflect neurodegeneration in frontotemporal dementia

Altres ajuts: The Catalan frontotemporal initiative (CATFI) is funded by the Health Department of the Government of Catalonia (grant PERIS SLT002/16/00408 to Alberto Lleó and Raquel Sánchez-Valle). This work was also supported by research grants from the CIBERNED Program (Program 1, Alzheimer Disease to Alberto Lleó and SIGNAL study, file://www.signalstudy.es), partly funded by Fondo Europeo de Desarrollo Regional (FEDER), Unión Europea, "Una manera de hacer Europa." This work has also been supported by a "Marató TV3" grant (20141210 to Juan Fortea, 044412 to Rafael Blesa, 20143710 to Ricard Rojas-García and 20143810 to Raquel Sánchez-Valle) and Fundación BBVA (grant to A. Lleó) and a grant from the Fundació Bancaria La Caixa to Rafael Blesa. Ignacio Illán-Gala and Sergi Borrego-Écija are supported by the Rio Hortega grant from "Acción estratégica en Salud 2013-2016" and the European Social Fund. Ignacio Illán-Gala is supported by the Global Brain Health Institute (Atlantic Fellow for Equity in Brain Health). We acknowledge all the participants in this study and all the collaborators of the SPIN cohort. We also acknowledge Soraya Torres and Laia Muñoz for technical assistance. We thank EUROIMMUN for providing Aβ1-38 and Aβ1-40 ELISA assays for this study.Objective: We aimed to investigate the relationship between cerebrospinal fluid levels (CSF) of amyloid precursor protein (APP)-derived peptides related to the amyloidogenic pathway, cortical thickness, neuropsychological performance, and cortical gene expression profiles in frontotemporal lobar degeneration (FTLD)-related syndromes, Alzheimer's disease (AD), and healthy controls. Methods: We included 214 participants with CSF available recruited at two centers: 93 with FTLD-related syndromes, 57 patients with AD, and 64 healthy controls. CSF levels of amyloid β (Aβ)1-42, Aβ1-40, Aβ1-38, and soluble β fragment of APP (sAPPβ) were centrally analyzed. We compared CSF levels of APP-derived peptides between groups and, we studied the correlation between CSF biomarkers, cortical thickness, and domain-specific cognitive composites in each group. Then, we explored the relationship between cortical thickness, CSF levels of APP-derived peptides, and regional gene expression profile using a brain-wide regional gene expression data in combination with gene set enrichment analysis. Results: The CSF levels of Aβ1-40, Aβ1-38, and sAPPβ were lower in the FTLD-related syndromes group than in the AD and healthy controls group. CSF levels of all APP-derived peptides showed a positive correlation with cortical thickness and the executive cognitive composite in the FTLD-related syndromes group but not in the healthy control or AD groups. In the cortical regions where we observed a significant association between cortical thickness and CSF levels of APP-derived peptides, we found a reduced expression of genes related to synaptic function. Interpretation: APP-derived peptides in CSF may reflect FTLD-related neurodegeneration. This observation has important implications as Aβ1-42 levels are considered an indirect biomarker of cerebral amyloidosis

Activated prothrombin complex concentrate to treat bleeding events in acquired hemophilia A: BAHAS study

[Objective] Activated prothrombin complex concentrate (aPCC) is a bypassing agent indicated to treat bleeds in patients with acquired hemophilia A (AHA). Nevertheless, its efficacy and safety in the real-world setting have not often been addressed.[Methods] We report the experience of Spanish reference centers for coagulation disorders and from acquired hemophilia Spanish Registry (AHASR) from August 2012 to February 2021. Follow-up period of 30 days after aPCC withdrawal.[Results] Thirty patients with a median age of 70 years old, suffering from 51 bleeds treated with aPCC were finally evaluated. As first-line treatment, aPCC stopped bleeding in 13 of 14 (92.9%) cases. aPCC as the second line after recombinant factor VIIa failure, stopped bleeding in all cases. In 17 patients, aPCC was used far from initial bleed control as prophylaxis of rebleeding with 94% effectiveness. No thromboembolic episodes were communicated. One patient developed hypofibrinogenemia, which did not prevent aPCC from halting bleeding. No other serious adverse events possibly or probably associated with aPCC were reported.[Conclusions] This data support aPCC as hemostatic treatment in AHA with high effectiveness and excellent safety profile in acute bleeds and as extended use to prevent rebleedings, even in aging people with high cardiovascular risk.Shire IIR-ES-002899.Peer reviewe

Embedded Software of the KM3NeT Central Logic Board

The KM3NeT Collaboration is building and operating two deep sea neutrino telescopes at the bottom of the Mediterranean Sea. The telescopes consist of latices of photomultiplier tubes housed in pressure-resistant glass spheres, called digital optical modules and arranged in vertical detection units. The two main scientific goals are the determination of the neutrino mass ordering and the discovery and observation of high-energy neutrino sources in the Universe. Neutrinos are detected via the Cherenkov light, which is induced by charged particles originated in neutrino interactions. The photomultiplier tubes convert the Cherenkov light into electrical signals that are acquired and timestamped by the acquisition electronics. Each optical module houses the acquisition electronics for collecting and timestamping the photomultiplier signals with one nanosecond accuracy. Once finished, the two telescopes will have installed more than six thousand optical acquisition nodes, completing one of the more complex networks in the world in terms of operation and synchronization. The embedded software running in the acquisition nodes has been designed to provide a framework that will operate with different hardware versions and functionalities. The hardware will not be accessible once in operation, which complicates the embedded software architecture. The embedded software provides a set of tools to facilitate remote manageability of the deployed hardware, including safe reconfiguration of the firmware. This paper presents the architecture and the techniques, methods and implementation of the embedded software running in the acquisition nodes of the KM3NeT neutrino telescopes

Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study

Despite current guidelines, intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of intraperitoneal collections, but were associated with prolonged hospital stay and increased risk of surgical-site infections.Background Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien-Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P < 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P < 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Pathogenic Huntingtin Repeat Expansions in Patients with Frontotemporal Dementia and Amyotrophic Lateral Sclerosis.

We examined the role of repeat expansions in the pathogenesis of frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS) by analyzing whole-genome sequence data from 2,442 FTD/ALS patients, 2,599 Lewy body dementia (LBD) patients, and 3,158 neurologically healthy subjects. Pathogenic expansions (range, 40-64 CAG repeats) in the huntingtin (HTT) gene were found in three (0.12%) patients diagnosed with pure FTD/ALS syndromes but were not present in the LBD or healthy cohorts. We replicated our findings in an independent collection of 3,674 FTD/ALS patients. Postmortem evaluations of two patients revealed the classical TDP-43 pathology of FTD/ALS, as well as huntingtin-positive, ubiquitin-positive aggregates in the frontal cortex. The neostriatal atrophy that pathologically defines Huntington's disease was absent in both cases. Our findings reveal an etiological relationship between HTT repeat expansions and FTD/ALS syndromes and indicate that genetic screening of FTD/ALS patients for HTT repeat expansions should be considered