Propensity score matched comparison of transcatheter aortic valve implantation versus conventional surgery in intermediate and low risk aortic stenosis patients: A hint of real-world

Background: Recently, the use of transcatheter aortic valve implantation (TAVI) in inter­mediate-low risk patients has been evaluated in the PARTNER II randomized trial. However, in the last years, this therapy has been employed in this scenario with underreported results, as compared to surgical aortic valve replacement (SAVR). Methods: We enrolled 362 consecutive patients with severe symptomatic aortic stenosis and intermediate-low surgical risk (logEuroSCORE < 20%), treated in our center with TAVI (103 patients) or single SAVR (259 patients) between 2009 and 2014. Patients were matched according to age, gender, logEuroSCORE, and use of bioprosthesis. Results: Mean age of the patients was 73 ± 10.4 years, and 40.3% were women. LogEuroSCORE and Society Thoracic Surgeons score were 7.0 ± 4.4% and 4.2 ± 2.5%, respectively, with mean left ventricular ejection fraction of 52 ± 9%. There were no differences regarding other comorbidities. The length-of-hospitalization was 11 ± 5 days after TAVI vs. 17 ± 9 days after SAVR (p = 0.003). After matched comparison, no differences in terms of in-hospital mortality (5.7% after TAVI vs. 2.9% after SAVR, p = 0.687) and 1-year mortality (11.4% vs. 7.1%, p = 0.381) were found. The combined endpoint of stroke and mortality at 1-year was also similar between both groups (15.7% in TAVI patients vs. 14.4% after SAVR, p = 0.136). Multivariate analysis determined that aortic regurgitation (AR) was an independent predictor of mortality (OR = 3.623, 95% CI: 1.267–10.358, p = 0.016). Although the rate of AR was higher after TAVI, none of the patients treated with the newest generation devices (10.7%) presented more than a mild degree of AR. Conclusions: TAVI is feasible and shows comparable results to surgery in terms of early, 1-year mortality, as well as cerebrovascular events in patients with severe aortic stenosis and intermediate-low operative risk. Better transvalvular gradients, yet higher rates of AR were found, however, newer devices presented comparable rate of AR.

In search of sustainable livestock management in the Dry Chaco: effect of different shrub-removal practices on vegetation

Increasing shrub density hinders cattle raising in central Argentina rangelands. While roller- chopping and hand-cutting are used to remove shrubs and make land accessible for cattle grazing, studies on the effects of these practices on ecosystem composition, structure and functioning are scarce. We assessed the impact of shrub removal on (a) vegetation cover, composition, species richness and diversity and (b) green biomass and seasonal phenological dynamics. We used a randomised design with three treatments (degraded rangeland; roller-chopping and hand-cutting) with four replicates, and compared the treatments with the least disturbed woodland (conserved woodland). Cenchrus ciliaris L. was sown following removal treatments and grass cover increased significantly (45% roller-chopping and 84% hand-cutting vs 27% degraded rangeland, and 13% conserved woodland), and tree cover decreased (3% roller-chopping and 2% hand-cutting vs 16% degraded rangeland, and 23% conserved woodland). Shrub cover reached 45% under roller- chopping, similar to the degraded rangeland treatment (46% degraded rangeland, 60% conserved woodland), but in hand-cutting reached only 3% cover. Hand-cutting reduced species richness and vegetation diversity, whereas roller-chopping had no effect. Shrub-removal treatments decreased normalised difference vegetation index (NDVI; proxy of green biomass) and modified ecosystem phenology. Under both shrub treatments, the maximum, minimum and integral NDVI (area under the NDVI curve) were significantly lower than those of the degraded rangeland treatment. The results suggest that shrub-removal practices increase forage for livestock, but reduce functional diversity and compromise the return to less disturbed states (woodland), where tree populations are maintained.EEA La RiojaFil: Guzman, Luis Miguel. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria La Rioja; ArgentinaFil: Villagra, Pablo Eugenio. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales (IANIGLA); ArgentinaFil: Villagra, Pablo Eugenio. Universidad Nacional de Cuyo. Instituto Argentino de Nivología, Glaciología y Ciencias Ambientales (IANIGLA); ArgentinaFil: Quiroga, Raul Emiliano. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Catamarca; ArgentinaFil: Pereyra, Diego Ivan. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria La Rioja; ArgentinaFil: Pelliza, Ernesto Martin. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria La Rioja; ArgentinaFil: Ricarte, Ramon Armando. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria La Rioja; ArgentinaFil: Blanco, Lisandro Javier. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria La Rioja; Argentin

Cost-utility of cognitive behavioral therapy versus U.S. Food and Drug Administration recommended drugs and usual care in the treatment of patients with fibromyalgia: an economic evaluation alongside a 6-month randomized controlled trial

Introduction:- Cognitive behavioral therapy (CBT) and U.S. Food and Drug Administration (FDA)-recommended pharmacologic treatments (RPTs; pregabalin, duloxetine, and milnacipran) are effective treatment options for fibromyalgia (FM) syndrome and are currently recommended by clinical guidelines. We compared the cost-utility from the healthcare and societal perspectives of CBT versus RPT (combination of pregabalin + duloxetine) and usual care (TAU) groups in the treatment of FM. Methods:- The economic evaluation was conducted alongside a 6-month, multicenter, randomized, blinded, parallel group, controlled trial. In total, 168 FM patients from 41 general practices in Zaragoza (Spain) were randomized to CBT (n = 57), RPT (n = 56), or TAU (n = 55). The main outcome measures were Quality-Adjusted Life Years (QALYs, assessed by using the EuroQoL-5D questionnaire) and improvements in health-related quality of life (HRQoL, assessed by using EuroQoL-5D visual analogue scale, EQ-VAS). The costs of healthcare use were estimated from patient self-reports (Client Service Receipt Inventory). Cost-utility was assessed by using the net-benefit approach and cost-effectiveness acceptability curves (CEACs). Results:- On average, the total costs per patient in the CBT group (1,847€) were significantly lower than those in patients receiving RPT (3,664€) or TAU (3,124€). Patients receiving CBT reported a higher quality of life (QALYs and EQ-VAS scores); the differences between groups were significant only for EQ-VAS. From a complete case-analysis approach (base case), the point estimates of the cost-effectiveness ratios resulted in dominance for the CBT group in all of the comparisons performed, by using both QALYs and EQ-VAS as outcomes. These findings were confirmed by bootstrap analyses, net-benefit curves, and CEACs. Two additional sensitivity analyses (intention-to-treat analysis and per-protocol analysis) indicated that the results were robust. The comparison of RPT with TAU yielded no clear preference for either treatment when using QALYs, although RPT was determined to be more cost-effective than TAU when evaluating EQ-VAS. Conclusions:- Because of lower costs, CBT is the most cost-effective treatment for adult FM patients. Implementation in routine medical care would require policymakers to develop more-widespread public access to trained and experienced therapists in group-based forms of CBT. Trial registration:- Current Controlled Trials ISRCTN10804772. Registered 29 September 2008

Intrapericardial delivery of APA-microcapsules as promising stem cell therapy carriers in an experimental acute myocardial infarction model

The administration of cardiosphere-derived cells (CDCs) after acute myocardial infarction (AMI) is very promising. CDC encapsulation in alginate-poly-l-lysine-alginate (APA) could increase cell survival and adherence. The intrapericardial (IP) approach potentially achieves high concentrations of the therapeutic agent in the infarcted area. We aimed to evaluate IP therapy using a saline vehicle as a control (CON), a dose of 30 × 106 CDCs (CDCs) or APA microcapsules containing 30 × 106 CDCs (APA-CDCs) at 72 h in a porcine AMI model. Magnetic resonance imaging (MRI) was used to determine the left ventricular ejection fraction (LVEF), infarct size (IS), and indexed end diastolic and systolic volumes (EDVi; ESVi) pre- and 10 weeks post-injection. Programmed electrical stimulation (PES) was performed to test arrhythmia inducibility before euthanasia. Histopathological analysis was carried out afterwards. The IP infusion was successful in all animals. At 10 weeks, MRI revealed significantly higher LVEF in the APA-CDC group compared with CON. No significant differences were observed among groups in IS, EDVi, ESVi, PES and histopathological analyses. In conclusion, the IP injection of CDCs (microencapsulated or not) was feasible and safe 72 h post-AMI in the porcine model. Moreover, CDCs APA encapsulation could have a beneficial effect on cardiac function, reflected by a higher LVEF at 10 weeks.Peer ReviewedPostprint (published version

Cohort profile: the Hortega Study for the evaluation of non-traditional risk factors of cardiometabolic and other chronic diseases in a general population from Spain.

PURPOSE: The Hortega Study is a prospective study, which investigates novel determinants of selected chronic conditions with an emphasis on cardiovascular health in a representative sample of a general population from Spain. PARTICIPANTS: In 1997, a mailed survey was sent to a random selection of public health system beneficiaries assigned to the University Hospital Rio Hortega's catchment area in Valladolid (Spain) (n=11 423, phase I), followed by a pilot examination in 1999-2000 of 495 phase I participants (phase II). In 2001-2003, the examination of 1502 individuals constituted the Hortega Study baseline examination visit (phase III, mean age 48.7 years, 49% men, 17% with obesity, 27% current smokers). Follow-up of phase III participants (also termed Hortega Follow-up Study) was obtained as of 30 November 2015 through review of health records (9.5% of participants without follow-up information). FINDINGS TO DATE: The Hortega Study integrates baseline information of traditional and non-traditional factors (metabolomic including lipidomic and oxidative stress metabolites, genetic variants and environmental factors, such as metals), with 14 years of follow-up for the assessment of mortality and incidence of chronic diseases. Preliminary analysis of time to event data shows that well-known cardiovascular risk factors are associated with cardiovascular incidence rates, which add robustness to our cohort. FUTURE PLANS: In 2020, we will review updated health and mortality records of this ongoing cohort for a 5-year follow-up extension. We will also re-examine elder survivors to evaluate specific aspects of ageing and conduct geolocation to study additional environmental exposures. Stored biological specimens are available for analysis of new biomarkers. The Hortega Study will, thus, enable the identification of novel factors based on time to event data, potentially contributing to the prevention and control of chronic diseases in ageing populations

Association of acid phosphatase locus 1*C allele with the risk of cardiovascular events in rheumatoid arthritis patients

Introduction: Acid phosphatase locus 1 (ACP1) encodes a low molecular weight phosphotyrosine phosphatase implicated in a number of different biological functions in the cell. The aim of this study was to determine the contribution of ACP1 polymorphisms to susceptibility to rheumatoid arthritis (RA), as well as the potential contribution of these polymorphisms to the increased risk of cardiovascular disease (CV) observed in RA patients. Methods: A set of 1,603 Spanish RA patients and 1,877 healthy controls were included in the study. Information related to the presence/absence of CV events was obtained from 1,284 of these participants. All individuals were genotyped for four ACP1 single-nucleotide polymorphisms (SNPs), rs10167992, rs11553742, rs7576247, and rs3828329, using a predesigned TaqMan SNP genotyping assay. Classical ACP1 alleles (*A, *B and *C) were imputed with SNP data. Results: No association between ACP1 gene polymorphisms and susceptibility to RA was observed. However, when RA patients were stratified according to the presence or absence of CV events, an association between rs11553742*T and CV events was found (P = 0.012, odds ratio (OR) = 2.62 (1.24 to 5.53)). Likewise, the ACP1*C allele showed evidence of association with CV events in patients with RA (P = 0.024, OR = 2.43). Conclusions: Our data show that the ACP1*C allele influences the risk of CV events in patients with R

Cost-effectiveness of active monitoring versus antidepressants for major depression in primary health care: a 12-month non-randomized controlled trial (INFAP study)

Background Clinical practice guidelines for the treatment of major depressive disorder (MDD) recommend antidepressants for patients with moderate-severe depression and active monitoring for patients with mild-moderate symptoms. The feasibility and efficiency of active monitoring has not been proven conclusively. The aim of this study is to evaluate the cost-effectiveness of active monitoring in comparison to antidepressants for primary care patients with mild-moderate MDD. Methods/Design This is a 12-month follow-up multicenter observational prospective controlled trial. Patients are enrolled in 12 primary care centers in Barcelona (Spain). Eligible patients are adults (≥18 years-old) with a new episode of MDD that sign a written consent to participate. This is a naturalistic study in which general practitioners (GPs) use their professional judgment to allocate patients into active monitoring or antidepressants groups. GPs treat the patients following their clinical criteria. At baseline, GPs complete a questionnaire (sociodemographic/job characteristics, training, attitude towards depression, interest on mental health and participation in communication groups). Patients’ measurements take place at baseline and after six and 12 months. Main outcome measures include severity of depression (PHQ-9), health-related quality of life (EuroQol-5D) and use of healthcare and social care services (Client Service Receipt Inventory). Secondary outcomes include diagnosis of MDD according to DSM-IV diagnostic criteria (SCID-I), disability (WHO-DAS), anxiety (BAI), comorbidities, medication side-effects and beliefs about medicines (BMQ). The analysis will be done according to the intention to treat analysis. Missing data will be imputed using multiple imputation by chained equations. To minimize the bias resulting from the lack of randomization, a propensity score will be used. Incremental effects and costs between groups will be modelled in each of the imputed databases using multivariate generalized linear models and then combined as per Rubin’s rules. Propensity scores will be used to adjust the models. Incremental cost-effectiveness ratios will be calculated by dividing the difference in costs between groups by the difference in effects. To deal with the uncertainty, resampling techniques with bootstrapping will be used and cost-effectiveness planes and cost-effectiveness acceptability curves will be constructed. A series of sensitivity analyses will be performed. Discussion Given the high burden and costs generated by depressive disorder, it is important that general practitioners treat major depression efficiently. Recent evidence has suggested that antidepressants have low benefits for patients with mild to moderate major depression. For such cases of depression, active monitoring exists as a treatment option, but it is not without difficulties for implementation and its effectiveness and efficiency have not been demonstrated conclusively. The results of the study will provide information on which is the most efficient approach to treat patients with mild to moderate major depression in primary care

Aplicaciones de machine learning para el uso sustentable de recursos naturales

Se propone una investigación para predecir la ocurrencia de incendios forestales basada en el entrenamiento de Modelos de Machine Learning. Se utiliza para el entrenamiento de los modelos, datos de registros históricos provistos por las propias Asociaciones de Bomberos Voluntarios, datos del Servicio Meteorológico Nacional (SMN) e imágenes satelitales provistas por la NASA. Se propone extender la solución para abarcar el monitoreo de áreas en riesgo, mediante dispositivos de IoT en puntos fijos o móviles, y equipados con sensores y cámaras. El procesamiento de las imágenes se propone realizar mediante algoritmos de reconocimiento de imágenes para enviar alertas de posibles focos de incendios.Red de Universidades con Carreras en Informátic

Red nacional de monitoreo de pastizales naturales de Argentina: productividad forrajera de la vegetación extrapampeana

Las regiones extrapampeanas sostienen una porción relevante de la producción ganadera de Argentina (bovinos, caprinos, ovinos y camélidos), sustentada principalmente por el aporte forrajero de la vegetación nativa. En este contexto, es fundamental generar herramientas que permitan un manejo forrajero sustentable de estos ambientes. Para ello, el INTA implementó en 2006 una red nacional de sitios de monitoreo forrajero de la vegetación nativa. En este trabajo se analizó la productividad forrajera de 179 sitios extrapampeanos involucrados en la red (productividad anual promedio de entre 3 a 6 años). Se detectaron asimetrías regionales en cuanto a la disponibilidad de sitios monitoreados y a la longitud de las series de datos de productividad forrajera. Las regiones mejor representadas fueron el distrito ñandubay del Espinal, las estepas patagónicas, el extremo occidental de la provincia fitogeográfica chaqueña y la Puna catamarqueña. Contrariamente, el distrito oriental de la provincia fitogeográfica chaqueña, la porción central del Monte y la provincia Paranaense fueron detectadas como regiones de vacancia. En 101 de los 179 sitios de la red, la productividad forrajera herbácea (PFH) fue inferior a 1.000 kg ha-1 año-1. Lo mismo ocurrió con la productividad forrajera leñosa (PFL) en los 85 sitios evaluados. Los mayores valores de PFH se reportaron en mallines de Patagonia, vegas de la Puna, el distrito de ñandubay en el Espinal y en comunidades vegetales ribereñas de Entre Ríos. Mientras que la PFH de humedales aumentó significativamente con el incremento de la temperatura media anual (TMA), la PFH de sitios no correspondientes a humedales aumentó con la precipitación media anual (PMA). Finalmente, se observó qué sitios históricamente sobrepastoreados presentaron valores de PFH muy inferiores a sitios sometidos a pastoreo más conservativo. Los resultados de este trabajo aportan información relevante para la planificación forrajera de la ganadería a escala regional, y también pueden ser utilizados como insumo para la calibración de modelos de estimación de la productividad forrajera basados en el uso de sensores remotos.In Argentina, a significant portion of livestock production (cows, goats, sheeps and camelids) is sustained by the extra-pampean region, mainly supported by the forage contribution of native plant communities. In this context, it is essential to generate tools that allow a sustainable forage management of these environments. During 2006, INTA implemented a national network for monitoring forage productivity of native plant communities. We analyzed the forage productivity of 179 extra-pampean sites involved in the network. We detected regional asymmetries in relation to the number of monitored sites and the length of forage productivity datasets. The best-represented regions were the “ñandubay” district of the Espinal phytogeographical province, the Patagonian steppes, the western end of the Chaco province, and the Puna in Catamarca. Herbaceous forage productivity (HFP) was less than 1,000 kg ha-1 year-1 in 101 of the 179 sites, and the same was true for woody forage productivity (WFP) in the analyzed 85 sites. The highest HFP values were reported in wetlands of Patagonia (“mallines”) and Puna (“vegas”), the “ñandubay” district of the Espinal and riparian communities of Entre Ríos. While the HFP in the wetlands increased significantly with the increase of mean annual temperature (MAT), the HFP of non-wetland sites increased with mean annual rainfall (MAP). Finally, we observed that overgrazed sites had HFP values lower than those sites subject to conservative grazing. These results could be relevant for planning livestock production at regional scale, as well as an input for forage productivity models based on remote sensing.EEA La RiojaFil: Blanco, Lisandro Javier. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria La Rioja; ArgentinaFil: Durante, Martin. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Concepción del Uruguay; ArgentinaFil: Ferrante, Daniela. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Santa Cruz; ArgentinaFil: Quiroga, Raul Emiliano. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Catamarca; ArgentinaFil: Demaria, Manuel Rodolfo. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria San Luis; ArgentinaFil: Di Bella, Carlos Marcelo. Instituto Nacional de Tecnología Agropecuaria (INTA). Instituto de Clima y Agua; Argentin

Impact of human-associated Escherichia coli clonal groups in Antarctic pinnipeds: presence of ST73, ST95, ST141 and ST131

There is growing concern about the spreading of human microorganisms in relatively untouched ecosystems such as the Antarctic region. For this reason, three pinniped species (Leptonychotes weddellii, Mirounga leonina and Arctocephalus gazella) from the west coast of the Antartic Peninsula were analysed for the presence of Escherichia spp. with the recovery of 158 E. coli and three E. albertii isolates. From those, 23 harboured different eae variants (α1, β1, β2, ε1, θ1, κ, ο), including a bfpA-positive isolate (O49:H10-A-ST206, eae-k) classified as typical enteropathogenic E. coli. Noteworthy, 62 of the 158 E. coli isolates (39.2%) exhibited the ExPEC status and 27 (17.1%) belonged to sequence types (ST) frequently occurring among urinary/bacteremia ExPEC clones: ST12, ST73, ST95, ST131 and ST141. We found similarities >85% within the PFGE-macrorrestriction profiles of pinniped and human clinic O2:H6-B2-ST141 and O16:H5/O25b:H4-B2-ST131 isolates. The in silico analysis of ST131 Cplx genomes from the three pinnipeds (five O25:H4-ST131/PST43-fimH22-virotype D; one O16:H5-ST131/PST506-fimH41; one O25:H4-ST6252/PST9-fimH22-virotype D1) identified IncF and IncI1 plasmids and revealed high core-genome similarities between pinniped and human isolates (H22 and H41 subclones). This is the first study to demonstrate the worrisome presence of human-associated E. coli clonal groups, including ST131, in Antarctic pinnipeds.The sampling was funded by the Spanish Ministry of Science and Innovation (CGL-2005-25073-E/ANT and CTM2008-00570) and the Sea World & Bush Gardens Conservation Fund. Work at USC-LREC was supported by projects AGL2013-47852-R from the Ministerio de Economía y Competitividad (MINECO, Spain) and Fondo Europeo de Desarrollo Regional (FEDER); AGL2016-79343-R from the Agencia Estatal de Investigación (AEI, Spain) and FEDER; PI16/01477 from Plan Estatal de I + D + I 2013-2016, Instituto de Salud Carlos III (ISCIII), Subdirección General de Evaluación y Fomento de la Investigación, and FEDER; CN2012/303 and ED431C 2017/57 from the Consellería de Cultura, Educación e Ordenación Universitaria, (Xunta de Galicia) and FEDER. We would like to thank the military personnel at the Spanish Antarctic Base “Gabriel de Castilla” for their help and assistance and the Marine Technology Unit (CSIC), the Spanish Navy’s Oceanographic Research Ship “Las Palmas” and the Unidad de Tecnología Marítima (UTM, CSIC) for logistics and transport. We also express our gratitude to J. Castro-Urda, F.T. García-Moreno, C. Rengifo-Herrera, S. Rojo-Montejo, I. Ferre, V. Navarro, M. Gómez-Bautista, T. Alvaro-Alvarez and J. Coello-Pérez for their invaluable help in the sample collection. A. Mora acknowledges the Ministerio de Educación, Cultura y Deporte (Spain) for the mobility grant for teachers and researchers from the Programa Estatal de Promoción del Talento y su Empleabilidad, Plan Estatal de Investigación Científica y Técnica y de Innovación 2013–2016.S