Outcomes and factors associated with mortality in patients with atrial fibrillation and heart failure: FARAONIC study

Background: Heart failure (HF) and atrial fibrillation (AF) are common and coexistent conditions. Hypothesis: To investigate the adverse events and mortality risk factors in patients with AF and HF treated with rivaroxaban in Spain. Methods: Multicenter, prospective and observational study with a follow-up of 2 years, that included adults, with a diagnosis of nonvalvular AF and chronic HF, anticoagulated with rivaroxaban at least 4 months before being enrolled. Results: A total of 672 patients from 71 Spanish centers were recruited, of whom 658 (97.9%) were included in the safety analysis and 552 (82.1%) in the per protocol analysis. At baseline, the mean age was 73.7 +/- 10.9 years, 65.9% were male, 51.3% had HF with preserved ejection fraction and 58.7% were on New York Heart Association functional class II. CHA2DS2-VASc was 4.1 +/- 1.5. During the follow-up, 11.6% of patients died and around one-quarter of patients were hospitalized or visited the emergency department, being HF worsening/progression the main cause (51.1%), with a 2.9% of thromboembolic events and 2.0% of acute coronary syndromes. Major bleeding occurred in 3.1% of patients, with 0.5% experiencing intracranial bleeding but no fatalities. Compliance with HF treatment was associated with a lower risk of death (hazard ratio: 0.092; 95% confidence interval: 0.03-0.31). Conclusions: Among patients with HF and AF anticoagulated with rivaroxaban, incidences of thromboembolic or hemorrhagic complications were low. The most important factor for improving survival was compliance with HF drugs, what strengths the need for early treatment with HF disease-modifying therapy and anticoagulation

Estratègies d’aula inversa basades en eines web 2.0 per a la millora del procés d’aprenentatge de l’estudiant

Projecte: 2018PID-UB/029Es presenta com a informe final la difusió portada a terme en el marc del projecte d’innovació docent “Estratègies d’aula inversa basades en eines web 2.0 per a la millora del procés d’aprenentatge de l’estudiant” (2018PID-UB/029). El projecte se centra en el desenvolupament i implementació de noves metodologies docents fonamentades en estratègies d’aula inversa basades en eines web 2.0 que potenciïn l’ús i l’aplicació de les TIC en la nostra activitat docent per garantir el correcte seguiment de l’avaluació continuada de l’estudiant i de l’assoliment de les competències de l’assignatura, fomentar la motivació i participació a classe de l’estudiant, a més de facilitar-ne una retroacció activa, àgil i constant, en definitiva, millorar-ne el seu procés d’aprenentatg

Impact of heart failure on the clinical profile and outcomes in patients with atrial fibrillation treated with rivaroxaban. Data from the EMIR study

Background: The aim of this study was to analyze the impact of the presence of heart failure (HF) on the clinical profile and outcomes in patients with atrial fibrillation (AF) anticoagulated with rivaroxaban. Methods: Observational and non-interventional study that included AF adults recruited from 79 Spanish centers, anticoagulated with rivaroxaban ≥ 6 months before inclusion. Data were analyzed according to baseline HF status. Results: Out of 1,433 patients, 326 (22.7%) had HF at baseline. Compared to patients without HF, HF patients were older (75.3 ± 9.9 vs. 73.8 ± 9.6 years; p = 0.01), had more diabetes (36.5% vs. 24.3%; p < 0.01), coronary artery disease (28.2% vs. 12.9%; p < 0.01), renal insufficiency (31.7% vs. 22.6%; p = 0.01), higher CHA2DS2-VASc (4.5 ± 1.6 vs. 3.2 ± 1.4; p < 0.01) and HAS-BLED (1.8 ± 1.1 vs. 1.5 ± 1.0; p < 0.01). After a median follow-up of 2.5 years, among HF patients, annual rates of stroke/systemic embolism/transient ischemic attack, MACE-non-fatal myocardial infarction, revascularization and cardiovascular death-, cardiovascular death, and major bleeding were 1.2%, 3.0%, 2.0%, and 1.4%, respectively. Compared to those patients without HF, HF patients had greater annual rates of MACE (3.0% vs. 0.5%; p < 0.01) and cardiovascular death (2.0% vs. 0.2%; p < 0.01), without significant differences regarding other outcomes, including thromboembolic or bleeding events. Previous HF was an independent predictor of MACE (odds ratio 3.4; 95% confidence interval 1.6-7.3; p = 0.002) but not for thromboembolic events or major bleeding. Conclusions: Among AF patients anticoagulated with rivaroxaban, HF patients had a worse clinical profile and a higher MACE risk and cardiovascular mortality. HF was independently associated with the development of MACE, but not with thromboembolic events or major bleeding

Bariatric surgery: evidence-based practical recommendations

[Resumen] La obesidad mórbida es, habitualmente, refractaria a los tratamientos convencionales, por lo que la modificación de hábitos dietéticos y de actividad física y/o el uso de fármacos consiguen pérdidas de peso parciales con habitual recuperación posterior. La cirugía bariátrica constituye una opción terapéutica para los casos de obesidad con elevado índice de masa corporal (IMC) asociada a comorbilidades, con buenos resultados a corto y largo plazo. El Grupo de Trabajo sobre Obesidad de la Sociedad Española de Endocrinología y Nutrición (GOSEEN) ha elaborado un documento con recomendaciones prácticas basadas en la evidencia para el tratamiento quirúrgico de la obesidad. La revisión se estructura en 3 partes. En la primera se definen los conceptos de obesidad y comorbilidades asociadas, los tratamientos médicos y sus resultados, las indicaciones y contraindicaciones para el tratamiento quirúrgico con los criterios de selección de los pacientes, el manejo pre y perioperatorio y la valoración de grupos especiales, como adolescentes y personas de edad avanzada. En la segunda parte se describen las distintas técnicas quirúrgicas, las vías de acceso y los resultados comparativos, las complicaciones tanto a corto como a largo plazo, la repercusión de la pérdida ponderal sobre las comorbilidades y los criterios para evaluar la efectividad de la cirugía. En la tercera parte se desarrolla el seguimiento postoperatorio, el control dietético en fases tempranas y más tardías tras la cirugía, y el calendario de control médico y analítico con la suplementación de los distintos macro y micronutrientes en función de la técnica quirúrgica empleada. Se incluye un apartado final sobre gestación y cirugía bariátrica, así como tablas y gráficos complementarios al texto desarrollado. La cirugía bariátrica sigue siendo un tratamiento discutido para la obesidad, pero los resultados en la corrección del exceso ponderal con mejoría en las patologías asociadas y en la calidad de vida confirman que puede ser el tratamiento de elección en pacientes seleccionados, con la técnica quirúrgica apropiada y con un correcto control pre y postoperatorio.[Abstract] Morbid obesity is usually refractory to conventional treatments. Consequently, weight that is lost by modifying diet and exercise and/or the use of drugs is usually later regained. Bariatric surgery constitutes a therapeutic option in obese patients with a high body mass index associated with comorbidities and achieves good results in both the short and the long term. The Obesity Working Group of the Spanish Society of Endocrinology and Nutrition has produced a document with practical, evidencebased recommendations for the surgical treatment of obesity. The review is structured in three parts. The first part defines the concepts of obesity and associated comorbidities, medical treatments, their results, and the indications and contraindications for surgical treatment, as well as the criteria for patient selection, pre- and perisurgical management, and assessment of special groups such as adolescents and the elderly. The second part discusses the different surgical techniques, approaches and comparative results, short- and long-term complications, the repercussions of weight loss on comorbidities, and the criteria for assessing the effectiveness of surgery. The third part discusses postsurgical follow-up, dietary control in the early and subsequent stages after surgery and the schedule for medical and laboratory follow-up, together with the different macro- and micronutrient supplements that should be used depending on the surgical technique employed. A final section is included on pregnancy and bariatric surgery, as well as tables and figures that complement the text. Although bariatric surgery continues to be a questionable treatment for obesity, the results correcting excess weight, with improvements in associated comorbidities and in quality of life, confirm that this option could be the treatment of choice in selected patients when the appropriate surgical technique and correct preand postoperative follow-up are employed

La vida en España en la època romana

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The structure of the dorsal lateral geniculate nucleus in the mouse. A Golgi and electron microscopic study

Two types of neurons have been distinguished in Golgi and electron microscopic preparations of the dorsal lateral geniculate nucleus of young mice. In addition to a thalamo striate relay cell (TSR neuron) with brush like dendritic arbors and a thick, unbranched axon, a small to medium size cell (PA neuron) of oval or spindle shaped body and few, long and seldom branched dendrites is frequently identified in the Golgi preparations. This second type of cell may exhibit none, one or several sparsely branched axon like processes which terminate in the vicinity of the cell body. The dendrites of the PA neurons show characteristically large, spheroidal processes (p) 1-3μ in diameter issuing forth singly, in clusters or as a 'string of beads' from delicate, often long, pedicles attached to the dendritic shafts. Profiles comparable to these processes and in apparent continuity with PA dendrites have been identified with the electron microscope and show synaptic vesicles and a system of sacs of smooth E.R. The portions of the dendrites from which these vesicle containing processes issue also show clusters of vesicles, ribosomes and an orderly array of microtubules. Golgi impregnated axons are followed from the optic tract and seen terminating as irregular enlargements (2-6μ) on proximal dendrites of relay cells and on distal dendrites of the PA neuron. The intimate contact of the terminal branches of an optic collateral with a distal PA dendrite is carefully illustrated. Small calibered axons are likewise traced from the internal medullary lamina and seen to end by means of end knobs on distal dendrites of both types of neurons. Electron microscopic observations substantiate the Golgi images and reveal 3 different types (I, II, III) of endings in the geniculate neuropil. The large type I endings correspond to the retinal afferents which generally make asymmetric synaptic contact with type II profiles and/or with clusters of microspines on the TSR dendrites. Type II, thought to be the spheroidal dendritic appendages of the PA neurons, form symmetrical synaptic contacts with profiles of its own kind or more commonly with dendrites of the TSR neuron. The type III ending, probably cortical in origin, establishes asymmetrical synaptic contacts with small dendritic profiles. Only profiles of types I and II endings, together with those of other dendritic profiles, form part of the nest like junctions known as the synaptic glomeruli. The significance of the unusual polarization of the geniculate interneurons is discussed.Peer Reviewe

Emporion

Na parte sup. da capa consta: IV Congreso Internacional de Arqueologí

Inflammation in Diabetic Encephalopathy is Prevented by C-Peptide

Encephalopathy is an increasingly recognized complication of type 1 diabetes. The underlying mechanisms are not well understood, although insulin deficiency has been implicated. The spontaneously diabetic BB/Wor-rat develops neuro-behavioral deficits and neuronal cell death in hippocampus and frontal cortex, which can be prevented by insulinomimetic C-peptide. Here we examined whether contributing factors such as activation of innate immune mediators are responsive to C-peptide replacement. Seven-month diabetic BB/Wor-rats and those treated with full C-peptide replacement were compared to age-matched control rats. Hippocampi of diabetic rats showed upregulation of RAGE and NF-κB, the former being localized to proliferating astrocytes. These changes were associated with increased expression of TNF-α, IL-1β, IL-2 and IL-6 in hippocampi of diabetic rats. Full C-peptide replacement, which did not induce hyperglycemia, resulted in significant prevention of upregulation of RAGE expression, activation of NF-κB and activation of pro-inflammatory factors. In conclusion, impaired insulin activity is associated with upregulation of RAGE and pro-inflammatory factors, and these are likely to contribute to previously described oxidative and apoptotic neuronal cell death. Replacement of insulinomimetic C-peptide significantly prevents this cascade of events

Prehistoria

O tradutor do volume II é Luis PericotContén: Vol. I. La edad de la piedra, 1928 (179 p., [5] f. de il.) -- Vol. II. La edad del bronce, 1929 (153 p., X f. de lám.) -- Vol. III. La edad de hierro, 1931 (184 p., XVI p. de lám.