Association between Stable Coronary Artery Disease and In Vivo Thrombin Generation

Background. Thrombin has been implicated as a key molecule in atherosclerotic progression. Clinical evidence shows that thrombin generation is enhanced in atherosclerosis, but its role as a risk factor for coronary atherosclerotic burden has not been proven in coronary artery disease (CAD) stable patients. Objectives. To evaluate the association between TAT levels and homocysteine levels and the presence of coronary artery disease diagnosed by coronary angiography in patients with stable CAD. Methods and Results. We included 95 stable patients admitted to the Haemodynamics Department, including 63 patients with significant CAD and 32 patients without. We measured the thrombin-antithrombin complex (TAT) and homocysteine concentrations in all the patients. The CAD patients exhibited higher concentrations of TAT (40.76 g/L versus 20.81 g/L, = 0.002) and homocysteine (11.36 mol/L versus 8.81 mol/L, < 0.01) compared to the patients without significant CAD. Specifically, in patients with CAD+ the level of TAT level was associated with the severity of CAD being 36.17 ± 24.48 g/L in the patients with bivascular obstruction and 42.77 ± 31.81 g/L in trivascular coronary obstruction, = 0.002. Conclusions. The level of in vivo thrombin generation, quantified as TAT complexes, is associated with the presence and severity of CAD assessed by coronary angiography in stable CAD patients

Association between Stable Coronary Artery Disease and In Vivo Thrombin Generation

Background. Thrombin has been implicated as a key molecule in atherosclerotic progression. Clinical evidence shows that thrombin generation is enhanced in atherosclerosis, but its role as a risk factor for coronary atherosclerotic burden has not been proven in coronary artery disease (CAD) stable patients. Objectives. To evaluate the association between TAT levels and homocysteine levels and the presence of coronary artery disease diagnosed by coronary angiography in patients with stable CAD. Methods and Results. We included 95 stable patients admitted to the Haemodynamics Department, including 63 patients with significant CAD and 32 patients without. We measured the thrombin-antithrombin complex (TAT) and homocysteine concentrations in all the patients. The CAD patients exhibited higher concentrations of TAT (40.76 μg/L versus 20.81 μg/L, p=0.002) and homocysteine (11.36 μmol/L versus 8.81 μmol/L, p<0.01) compared to the patients without significant CAD. Specifically, in patients with CAD+ the level of TAT level was associated with the severity of CAD being 36.17 ± 24.48 μg/L in the patients with bivascular obstruction and 42.77 ± 31.81 μg/L in trivascular coronary obstruction, p=0.002. Conclusions. The level of in vivo thrombin generation, quantified as TAT complexes, is associated with the presence and severity of CAD assessed by coronary angiography in stable CAD patients

Acceptance of living liver donation among medical students: A multicenter stratified study from Spain

AIM: To analyze the attitude of Spanish medical students toward living liver donation (LLD) and to establish which factors have an influence on this attitude. METHODS: STUDY TYPE: A sociological, interdisciplinary, multicenter and observational study. STUDY POPULATION: Medical students enrolled in Spain (n = 34000) in the university academic year 2010-2011. SAMPLE SIZE: A sample of 9598 students stratified by geographical area and academic year. Instrument used to measure attitude: A validated questionnaire (PCID-DVH RIOS) was self-administered and completed anonymously. Data collection procedure: Randomly selected medical schools. The questionnaire was applied to each academic year at compulsory sessions. STATISTICAL ANALYSIS: Student´s t test, ?(2) test and logistic regression analysis. RESULTS: The completion rate was 95.7% (n = 9275). 89% (n = 8258) were in favor of related LLD, and 32% (n = 2937) supported unrelated LLD. The following variables were associated with having a more favorable attitude: (1) age (P = 0.008); (2) sex (P < 0.001); (3) academic year (P < 0.001); (4) geographical area (P = 0.013); (5) believing in the possibility of needing a transplant oneself in the future (P < 0.001); (6) attitude toward deceased donation (P < 0.001); (7) attitude toward living kidney donation (P < 0.001); (8) acceptance of a donated liver segment from a family member if one were needed (P < 0.001); (9) having discussed the subject with one's family (P < 0.001) and friends (P < 0.001); (10) a partner's opinion about the subject (P < 0.001); (11) carrying out activities of an altruistic nature; and (12) fear of the possible mutilation of the body after donation (P < 0.001). CONCLUSION: Spanish medical students have a favorable attitude toward LLD

Three-dimensional transesophageal echocardiography of the atrial septal defects

Transesophageal echocardiography has advantages over transthoracic technique in defining morphology of atrial structures. Even though real time three-dimensional echocardiographic imaging is a reality, the off-line reconstruction technique usually allows to obtain higher spatial resolution images. The purpose of this study was to explore the accuracy of off-line three-dimensional transesophageal echocardiography in a spectrum of atrial septal defects by comparing them with representative anatomic specimens

El grupu neandertal de la Cueva d' El Sidrón (Borines, Piloña)

El artículo está en la lengua asturianaPeer reviewe

Heart failure in COVID-19 patients: prevalence, incidence and prognostic implications

Aims: Data on the impact of COVID-19 in chronic heart failure (CHF) patients and its potential to trigger acute heart failure (AHF) are lacking. The aim of this work was to study characteristics, cardiovascular outcomes and mortality in patients with confirmed COVID-19 infection and a prior diagnosis of heart failure (HF). Further aims included the identification of predictors and prognostic implications for AHF decompensation during hospital admission and the determination of a potential correlation between the withdrawal of HF guideline-directed medical therapy (GDMT) and worse outcomes during hospitalization. Methods and results: Data for a total of 3080 consecutive patients with confirmed COVID-19 infection and follow-up of at least 30 days were analysed. Patients with a previous history of CHF (n = 152, 4.9%) were more prone to the development of AHF (11.2% vs. 2.1%; P < 0.001) and had higher levels of N-terminal pro brain natriuretic peptide. In addition, patients with previous CHF had higher mortality rates (48.7% vs. 19.0%; P < 0.001). In contrast, 77 patients (2.5%) were diagnosed with AHF, which in the vast majority of cases (77.9%) developed in patients without a history of HF. Arrhythmias during hospital admission and CHF were the main predictors of AHF. Patients developing AHF had significantly higher mortality (46.8% vs. 19.7%; P < 0.001). Finally, the withdrawal of beta-blockers, mineralocorticoid receptor antagonists and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was associated with a significant increase in in-hospital mortality. Conclusions: Patients with COVID-19 have a significant incidence of AHF, which is associated with very high mortality rates. Moreover, patients with a history of CHF are prone to developing acute decompensation after a COVID-19 diagnosis. The withdrawal of GDMT was associated with higher mortalit

Investigación y conceptualización del diseño

Departamento de Procesos y Técnicas de Realización, Área de investigación Nuevas Tecnologías.El propósito de este libro es despertar y transmitir el interés, por la investigación y conceptualización del diseño. Los artículos que se presentan en este libro, muestran la intención de los editores de abrir la publicación a la discusión académica novedosa, e inteligente, en una experiencia interdisciplinaria. Así, el tema principal del primer capítulo es el diseño incluyente donde la responsabilidad del diseñador radica en comprender las necesidades y experiencias de los usuarios y asegurarse que sus diseños sean inclusivos desde el principio. El siguiente capítulo ahonda sobre la transformación de la pedagogía del diseño; El tercer artículo nos presenta una serie de formatos muy útiles para reflexionar ante las carencias o excesos de cada una de las partes que conforman un proyecto de investigación; en el cuarto capítulo se presenta al diseño como instrumento de influencia en la mejora de la calidad de vida de las y los ciudadanos; la publicación continúa con el trabajo donde se ubica la metodología de la investigación participativa como una metodología de investigación aplicada principalmente en los ámbitos de las ciencias sociales; el libro continúa con La metodología en el campo de la representación en el proceso de enseñanza aprendizaje del diseño. Caso de estudio taller de proyectos arquitectónicos, el cual se enfoca a la arquitectura pero éste en el ámbito de la enseñanza; la siguiente lectura aborda el tema del uso del diseño centrado en el usuario el cual parte de comprender y responder a las necesidades de los usuarios a través de la investigación, diseño orientado a objetivos, pruebas y enfoque en la accesibilidad; para continuar, en el penúltimo artículo se hace un análisis detallado sobre el desarrollo del conocimiento y el método científico y cómo impulsó la necesidad de llevar a cabo investigación formal dentro del diseño y su desarrollo; para cerrar Carlos Córdoba Cely y Yadira Alatriste Martínez nos presentan El taller y el laboratorio como estrategia de autonomía creativa. Nos hablan de la larga tradición en la academia que se remonta a la primera escuela de diseño.Directoras de la publicación: Adriana Acero Gutiérrez; Beatriz Irene Mejía Modesto; coordinadores: Lorenzo Miguel Ángel Herrera Batista; Marco Antonio Marín Álvarez; Yadira Alatriste Martínez; Adriana Acero Gutiérrez; Beatriz Irene Mejía Modest

Early- versus late-onset systemic sclerosis. Differences in clinical presentation and outcome in 1037 patients

Peak age at onset of systemic sclerosis (SSc) is between 20 and 50 years, although SSc is also described in both young and elderly patients. We conducted the present study to determine if age at disease onset modulates the clinical characteristics and outcome of SSc patients. The Spanish Scleroderma Study Group recruited 1037 patients with a mean follow-up of 5.2 ± 6.8 years. Based on the mean ± 1 standard deviation (SD) of age at disease onset (45 ± 15 yr) of the whole series, patients were classified into 3 groups: age ≤ 30 years (early onset), age between 31 and 59 years (standard onset), and age ≥ 60 years (late onset). We compared initial and cumulative manifestations, immunologic features, and death rates. The early-onset group included 195 patients; standard-onset group, 651; and late-onset, 191 patients. The early-onset group had a higher prevalence of esophageal involvement (72% in early-onset compared with 67% in standard-onset and 56% in late-onset; p = 0.004), and myositis (11%, 7.2%, and 2.9%, respectively; p = 0.009), but a lower prevalence of centromere antibodies (33%, 46%, and 47%, respectively; p = 0.007). In contrast, late-onset SSc was characterized by a lower prevalence of digital ulcers (54%, 41%, and 34%, respectively; p < 0.001) but higher rates of heart conduction system abnormalities (9%, 13%, and 21%, respectively; p = 0.004). Pulmonary hypertension was found in 25% of elderly patients and in 12% of the youngest patients (p = 0.010). After correction for the population effects of age and sex, standardized mortality ratio was shown to be higher in younger patients. The results of the present study confirm that age at disease onset is associated with differences in clinical presentation and outcome in SSc patients

Manual de Tutoría y Orientación Educativa

Material destinado a los tutores y tutoras de los niveles de primaria y secundaria. En este material, se presenta el marco conceptual que sustenta la tutoría y orientación educativa, así como un conjunto de sesiones de tutoría sobre temáticas relacionadas con el bienestar y desarrollo de los y las estudiantes. Estas sesiones buscan ser un punto de partida para que cada tutor y tutora diseñe e implemente otras, que respondan a las particularidades de sus estudiantes, su contexto sociocultural y su etapa de desarrollo

Caminos contables : problemas y metodologías para el desarrollo de la investigación

RESUMEN: Caminos contables” es una hermosa metáfora para ilustrar que el proceso de generar y transmitir nuevos conocimientos es una forma de caminar, una manera de pensar y hacer, un estilo para moverse, con brújula en mano, por una densa cartografía de “eje problemáticos” en la búsqueda de respuestas propias. Esta forma de pensar la investigación, más allá de ser una tarea rígida, ejercida por enigmáticos profesores y tratada no pocas veces con exagerada pomposidad intelectual, es una vía que permite no sólo estimular el interés por resolver problemas, sino asegurar resultados ciertos, verificables, de alta calidad técnica y pertinencia académica. El texto tiene como propósito fundamental, de un lado darle continuidad a los estados del arte que se construyeron en las líneas de investigación del Grupo de Investigaciones y Consultorías en Ciencias Contables –GICCO, que quedaron plasmados en libro Huellas y Devenir Contable: Construyendo las rutas del Pensamiento Contable publicado en 2012 en el marco de los 50 años del Programa de Contaduría Pública de la Universidad de Antioquia; y por otro lado, desarrollar una aproximación a los problemas de investigación y las alternativas metodológicas para abordarlo desde los ejes problémicos y las líneas de investigación del Departamento de Ciencias Contables