Peroxisome proliferator-activated receptor β/δ activation inhibits hypertrophy in neonatal rat cardiomyocytes

Objective: Peroxisome proliferator-activated receptor β/δ (PPARβ/δ) is the predominant PPAR subtype in cardiac cells and plays a prominent role in the regulation of cardiac lipid metabolism. However, the role of PPARβ/δ activators in cardiac hypertrophy is not yet known. Methods and Results: In cultured neonatal rat cardiomyocytes, the selective PPARβ/δ activator L-165041 (10 μmol/L) inhibited phenylephrine (PE)-induced protein synthesis ([3H]leucine uptake), induction of the fetal-type gene atrial natriuretic factor (ANF) and cardiac myocyte size. Induction of cardiac hypertrophy by PE stimulation also led to a reduction in the transcript levels of both muscle-type carnitine palmitoyltransferase (50%, P<0.05) and pyruvatedehydrogenase kinase 4 (30%, P<0.05), and these changes were reversed in the presence of the PPARβ/δ agonist L-165041. Stimulation of neonatal rat cardiomyocytes with PE and embryonic rat heart-derived H9c2 cells with lipopolysaccharide (LPS) enhanced the expression of the nuclear factor (NF)-κB-target gene monocyte chemoattractant protein 1 (MCP-1). The induction of MCP-1 was reduced in the presence of L-165041, suggesting that this compound prevented NF-κB activation. Electrophoretic mobility shift assay (EMSA) revealed that L-165041 significantly decreased LPS-stimulated NF-κB binding activity in H9c2 myotubes. Finally, coimmunoprecipitation studies showed that L-165041 strongly enhanced the physical interaction between PPARβ/δ and the p65 subunit of NF-κB, suggesting that increased association between these two proteins is the mechanism responsible for antagonizing NF-κB activation by PPARβ/δ activators. Conclusion: These results suggest that PPARβ/δ activation inhibits PE-induced cardiac hypertrophy and LPS-induced NF-κB activatio

Estudio sobre las posibilidades de aplicación de la fotocatálisis heterogénea a los procesos de remoción de fenoles en medio acuoso

RESUMEN: Los fenoles son compuestos orgánicos recalcitrantes y de toxicidad considerable, los cuales se encuentran generalmente en aguas residuales de industrias petroquímicas, papeleras, de producción de pesticidas y herbicidas, entre otras. Convencionalmente estos compuestos son tratados por: adsorción, electroquímica, biodegradación o incineración, sin lograr una remoción óptima, por lo que se hace necesario el estudio de técnicas más eficientes. La fotocatálisis heterogénea es una de ellas, la cual se basa en una reacción catalítica que involucra la absorción de luz por parte de un semiconductor, con el fin de degradar los contaminantes orgánicos a dióxido de carbono, agua y ácidos minerales, inocuos para el medio ambiente. Actualmente los estudios buscan valores óptimos para los diferentes parámetros que afectan el proceso fotocatalítico. Estos son: pH, temperatura, intensidad de radiación, diseño del reactor, naturaleza y concentración del contaminante, aditivos y la cinética de reacción, la cual juega un papel muy importante en la aplicación real del proceso. La tendencia de la fotocatálisis está enfocada al desarrollo de prototipos útiles en la industria, principalmente en tratamientos de descontaminación de aire, agua o suelos, y en aplicaciones de autolimpieza de superficies.ABSTRACT: Phenols are recalcitrant and quite-toxic organic compounds, which are generally in wastewaters from some industries, such as petrochemical, paper mills, chemical industries of production of pesticides and herbicides, among others. Conventionally these compounds are treated with some treatment, such as electrochemistry, biodegradation or incineration, in which ones it is not achieved an optimal removal of phenols. Due to this becomes necessary the study of more efficient techniques. Heterogeneous Photocatalysis belongs one to them, which one is based on a catalytic reaction that involves the absorption of light on a semiconductor, with the purpose of degrading the organic pollutants to dioxide of carbon, water and mineral acids, these ones innocuous for the environment. At the moment, studies look for to optimize the values for the different parameters that affect the photocatalytic process. These are: pH, temperature, radiation intensity, reactor design, nature and concentration of the pollutant, preservatives, and kinetics of the reaction. This last one plays a very important role in the real application of the process. The tendency of the photocatalysis is focused to the development of useful prototypes in the industry, mainly in decontamination treatments of air, water, or soils, and in self-cleaning surface application

Evaluation of Nutritional Practices in the Critical Care Patient (The ENPIC Study): Does Nutrition Really Affect ICU Mortality?

Background & aims: The importance of artificial nutritional therapy is underrecognized, typically being considered an adjunctive rather than a primary therapy. We aimed to evaluate the influence of nutritional therapy on mortality in critically ill patients. Methods: This multicenter prospective observational study included adult patients needing artificial nutritional therapy for >48 h if they stayed in one of 38 participating intensive care units for >= 72 h between April and July 2018. Demographic data, comorbidities, diagnoses, nutritional status and therapy (type and details for <= 14 days), and outcomes were registered in a database. Confounders such as disease severity, patient type (e.g., medical, surgical or trauma), and type and duration of nutritional therapy were also included in a multivariate analysis, and hazard ratios (HRs) and 95% confidence intervals (95% CIs) were reported. Results: We included 639 patients among whom 448 (70.1%) and 191 (29.9%) received enteral and parenteral nutrition, respectively. Mortality was 25.6%, with non-survivors having the following char-acteristics: older age; more comorbidities; higher Sequential Organ Failure Assessment (SOFA) scores (6.6 +/- 3.3 vs 8.4 +/- 3.7; P < 0.001); greater nutritional risk (Nutrition Risk in the Critically Ill [NUTRIC] score: 3.8 +/- 2.1 vs 5.2 +/- 1.7; P < 0.001); more vasopressor requirements (70.4% vs 83.5%; P=0.001); and more renal replacement therapy (12.2% vs 23.2%; P=0.001). Multivariate analysis showed that older age (HR: 1.023; 95% CI: 1.008-1.038; P=0.003), higher SOFA score (HR: 1.096; 95% CI: 1.036-1.160; P=0.001), higher NUTRIC score (HR: 1.136; 95% CI: 1.025-1.259; P=0.015), requiring parenteral nutrition after starting enteral nutrition (HR: 2.368; 95% CI: 1.168-4.798; P=0.017), and a higher mean Kcal/Kg/day intake (HR: 1.057; 95% CI: 1.015-1.101; P=0.008) were associated with mortality. By contrast, a higher mean protein intake protected against mortality (HR: 0.507; 95% CI: 0.263-0.977; P=0.042). Conclusions: Old age, higher organ failure scores, and greater nutritional risk appear to be associated with higher mortality. Patients who need parenteral nutrition after starting enteral nutrition may represent a high-risk subgroup for mortality due to illness severity and problems receiving appropriate nutritional therapy. Mean calorie and protein delivery also appeared to influence outcomes. (C) 2021 The Author(s). Published by Elsevier Ltd on behalf of European Society for Clinical Nutrition and Metabolism

Factores asociados a la brecha de recursos humanos y estrategias de cierre de brechas en el Complejo Hospitalario PNP Luis N. S?enz

La nueva infraestructura del Complejo Hospitalario PNP Luis N. S?enz generar? un incremento de brecha de Recursos Humanos en Salud (RHUS), que ha llevado a plantear diferentes estrategias de cierre de brechas y an?lisis de requerimientos de profesionales en salud. Esta tesis tiene como objetivos identificar la brecha de RHUS, identificar y analizar los factores asociados a la brecha y plantear estrategias con miras a cerrar la brecha; mediante la recopilaci?n de experiencias regionales y globales, recolecci?n de datos de las diferentes ?reas y un instrumento que consisti? en una entrevista a 14 jefes de diferentes ?reas. Esta investigaci?n determin? que, con la apertura de los nuevos ambientes, la brecha de m?dicos ascender? a 382. La Divisi?n de Cirug?a es la m?s comprometida, con una brecha de 113 m?dicos. Los factores econ?micos (80%), repercuten tanto en la baja captaci?n, como en la deserci?n del personal. Asimismo, la principal fuente de dotaci?n de RHUS es el residentado m?dico (66.7%) y el principal atractivo es la estabilidad laboral (73.3%). Finalmente, recomienda implementar estrategias para lograr atraer y retener al personal, principalmente con un aumento del salario e incentivos econ?micos, as? como, aumentar las vacantes para la asimilaci?n de profesionales y t?cnicos

Machine learning enables noninvasive prediction of atrial fibrillation driver location and acute pulmonary vein ablation success using the 12-lead ECG

Background: Atrial fibrillation (AF) is the most common supraventricular arrhythmia, characterized by disorganized atrial electrical activity, maintained by localized arrhythmogenic atrial drivers. Pulmonary vein isolation (PVI) allows to exclude PV-related drivers. However, PVI is less effective in patients with additional extra-PV arrhythmogenic drivers. Objectives: To discriminate whether AF drivers are located near the PVs vs extra-PV regions using the noninvasive 12-lead electrocardiogram (ECG) in a computational and clinical framework, and to computationally predict the acute success of PVI in these cohorts of data. Methods: AF drivers were induced in 2 computerized atrial models and combined with 8 torso models, resulting in 1128 12-lead ECGs (80 ECGs with AF drivers located in the PVs and 1048 in extra-PV areas). A total of 103 features were extracted from the signals. Binary decision tree classifier was trained on the simulated data and evaluated using hold-out cross-validation. The PVs were subsequently isolated in the models to assess PVI success. Finally, the classifier was tested on a clinical dataset (46 patients: 23 PV-dependent AF and 23 with additional extra-PV sources). Results: The classifier yielded 82.6% specificity and 73.9% sensitivity for detecting PV drivers on the clinical data. Consistency analysis on the 46 patients resulted in 93.5% results match. Applying PVI on the simulated AF cases terminated AF in 100% of the cases in the PV class. Conclusion: Machine learning–based classification of 12-lead-ECG allows discrimination between patients with PV drivers vs those with extra-PV drivers of AF. The novel algorithm may aid to identify patients with high acute success rates to PVI

Inhibition of Cardiac Hypertrophy by Triflusal (4-Trifluoromethyl Derivative of Salicylate) and Its Active Metabolite

ABSTRACT The nuclear factor (NF)-B signaling pathway is an important intracellular mediator of cardiac hypertrophy. The aim of the present study was to determine whether triflusal (2-acetoxy-4-trifluoromethylbenzoic acid), a salicylate derivative used as antiplatelet agent, and its active metabolite 2-hydroxy-4-trifluoromethylbenzoic acid (HTB) inhibit cardiac hypertrophy in vitro and in vivo by blocking the NF-B signaling pathway. In cultured neonatal rat cardiomyocytes, HTB (300 M, a concentration reached in clinical use) inhibited phenylephrine (PE)-induced protein synthesis ([ 3 H]leucine uptake), induction of the fetal-type gene atrial natriuretic factor (ANF), and sarcomeric disorganization. Assessment of the effects of triflusal in pressure overload-induced cardiac hypertrophy by aortic banding resulted in a significant reduction in the ratio of heart weight to body weight and in a reduction of the mRNA levels of the cardiac hypertrophy markers ANF and ␣-actinin compared with untreated banded rats. Electrophoretic mobility shift assay revealed an increase in the NF-B binding activity in cardiac nuclear extracts of banded rats that was prevented by triflusal treatment. It is noteworthy that banded rats treated with oral triflusal, compared with untreated rats, showed enhanced protein levels of IB␣, which forms a cytoplasmic inactive complex with the p65-p50 heterodimeric complex. Finally, HTB increased phospho-IB␣ levels in neonatal cardiomyocytes and inhibited proteosome activity, suggesting that this drug prevented proteosome-mediated degradation of IB␣. These results indicate that triflusal, a drug with a well characterized pharmacological and safety profile currently used as antiplatelet, inhibits cardiomyocyte growth by interfering with the NF-B signaling pathway through a post-transcriptional mechanism involving reduced-proteosome degradation of IB␣. Cardiac hypertrophy is a response of the heart to a wide range of extrinsic stimuli, such as arterial hypertension, valvular heart disease, myocardial infarction, and cardiomyopathy. Although this process is initially compensatory for an increase workload, its prolongation frequently results in congestive heart failure, arrhythmia, and sudden deat

Changes in the Viral Distribution Pattern after the Appearance of the Novel Influenza A H1N1 (pH1N1) Virus in Influenza-Like Illness Patients in Peru

Background: We describe the temporal variation in viral agents detected in influenza like illness (ILI) patients before and after the appearance of the ongoing pandemic influenza A (H1N1) (pH1N1) in Peru between 4-January and 13-July 2009. Methods: At the health centers, one oropharyngeal swab was obtained for viral isolation. From epidemiological week (EW) 1 to 18, at the US Naval Medical Research Center Detachment (NMRCD) in Lima, the specimens were inoculated into four cell lines for virus isolation. In addition, from EW 19 to 28, the specimens were also analyzed by real time-polymerase-chainreaction (rRT-PCR). Results: We enrolled 2,872 patients: 1,422 cases before the appearance of the pH1N1 virus, and 1,450 during the pandemic. Non-pH1N1 influenza A virus was the predominant viral strain circulating in Peru through (EW) 18, representing 57.8% of the confirmed cases; however, this predominance shifted to pH1N1 (51.5%) from EW 19–28. During this study period, most of pH1N1 cases were diagnosed in the capital city (Lima) followed by other cities including Cusco and Trujillo. In contrast, novel influenza cases were essentially absent in the tropical rain forest (jungle) cities during our study period. The city of Iquitos (Jungle) had the highest number of influenza B cases and only one pH1N1 case. Conclusions: The viral distribution in Peru changed upon the introduction of the pH1N1 virus compared to previous months. Although influenza A viruses continue to be the predominant viral pathogen, the pH1N1 virus predominated over the other influenza A viruses