Apolipoproteína e y enfermedad cardiovascular

La apolipoproteína E es una glicoproteína polimórfica que interactúa con los receptores de lipoproteínas (LRP-Receptor Related Protein) o receptores ApoE y los receptores de lipopro­teínas de baja densidad (receptores LDL). Cuando las lipoproteínas se unen al receptor comienza la captación y degradación de lípidos por parte de la célula, lo que permite la utilización del colesterol contenido en las lipoproteínas, produciéndose una autorregulación intracelular.La tres isoformas de mayor importancia de ApoE se denominan Apo E2, E3 y E4 y son producto de tres alelos ε2, ε3, ε4 de un gen único. Este factor está relacionado con la cantidad de lipo­pro­teínas que contienen ApoE para receptores E/B. El menor contenido de lipoproteínas con ApoE puede aumentar la actividad del receptor LDL y consecuentemente, bajar la concentración de LDL en circulación. De otra parte, las partículas con Apo E3 o Apo E4, causan disminución de la regulación de receptores LDL y producen elevación del LDL plasmático. Muchos estudios en poblaciones humanas han demostrado la relación entre este polimorfismo de apoE y la variación en los niveles plasmáticos de lípidos y de lipoproteínas y el riesgo de desarrollar enfermedad cardiovascular.La enfermedad cardiovascular es el resultado de la interacción de diferentes factores entre los que se encuentra el factor genético y específica­mente el polimorfismo de la ApoE. La presencia del alelo ε4 de la ApoE puede explicar, en parte, la mayor frecuencia de enfermedad cardio­vascular en quienes lo portan

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Apolipoprotein E and cardiovascular disease

Apolipoprotein E is a polymorphic glycoprotein who interacts with the lipoprotein receptors (LRP-Receptor Related Protein) and the receptors for low density lipoproteins of (LDL receptors). When lipoproteins bring up the receptors begins lipids captation and degradation which allows cholesterol utilization, taking place an intracellular auto regulation. The three isoforms of greater importance: Apo E2, E3 and E4 are product of three alleles e2, e3, e4 of one only gene. This factor is related with the amount of lipoproteins that contains ApoE for E/B receptors. A low concentration of lipoproteins with ApoE can increase the activity of LDL receptors and consequently downward the circulating LDL. In the other hand particles with Apo E3 or Apo E4, can cause a downward regulation of LDL and in this way produces a LDL plasma elevation. Many studies in human populations have concluded that this polymorphism of apoE and the plasma variation of lipoproteins are associated with cardiovascular risk. Cardiovascular disease is the result of different interaction between factors which are genetic factor specially ApoE polymorphism e4 allelic of ApoE can explain, in some degree, the greater frequency of cardiovascular disease in those who carries it

Respuesta de los sistemas planta-fitófago-parasitoide a condiciones microambientales en hábitats naturales y urbanos

Uno de los mayores desafíos de la ecología será predecir las posibles consecuencias del cambio climático sobre los organismos biológicos y proponer medidas que las suavicen. Es de esperar que los cambios climáticos provoquen la extinción de especies sensibles, a través de la disminución de su éxito reproductivo, la reducción de la cantidad y accesibilidad a hábitats adecuados, y también indirectamente por la eliminación de los recursos esenciales para su supervivencia. En un contexto de cambio climático global, el objetivo general de este proyecto es comprender los efectos de las condiciones microambientales sobre sistemas planta-herbívoro-parasitoide, en ambientes naturales y urbanos. Para ello estudiaremos las relaciones entre plantas, minadores de hojas y sus parasitoides considerando las diversas condiciones microambientales en donde el sistema se desarrolla. En ambientes nativos se prevé el estudio de dichos sistemas en tres ubicaciones del bosque (interior, bordes con orientación norte y bordes con orientación sur), analizando la identidad y abundancia de las especies, y los niveles de herbivoría y parasitismo. También se realizarán experimentos de laboratorio para analizar los niveles de herbivoría que sufran hojas obtenidas en cada una de las ubicaciones, a fin de conocer si poseen diferencias que puedan ser detectadas por los insectos, y se analizarán también posibles diferencias en la dureza de las hojas y su contenido de nitrógeno y carbono. En ambientes urbanos se estudiará la ocurrencia y grado de herbivoría de un minador de hojas asociado al “jacarandá”, árbol común en veredas de la ciudad de Córdoba, asi como la incidencia de sus parasitoides. Se relacionarán las variables biológicas con variables ambientales a nivel de sitio, tales como temperatura, tráfico vehicular, distancia al centro geográfico e “índice verde”, tomado a partir de imágenes satelitales. Los datos obtenidos a partir de los muestreos de campo en ambientes nativos serán analizados mediante modelos lineales generalizados que contemplen la dependencia de los microhábitats por localidad. Las variables obtenidas en experimentos en laboratorio serán analizadas mediante ANOVA con medidas repetidas o Test de Kruskall-Wallis. Los datos provenientes de ambientes urbanos serán analizados mediante regresiones logísticas para determinar la probabilidad de ocurrencia del minador, asi como los niveles de herbivoría y parasitismo en los diversos árboles estudiados. Se incluirán en el modelo todas las variables de urbanización anteriormente mencionadas así como la densidad de árboles en el sitio

Optimization of RAS/BRAF Mutational Analysis Confirms Improvement in Patient Selection for Clinical Benefit to Anti-EGFR Treatment in Metastatic Colorectal Cancer.

In metastatic colorectal cancer (mCRC), recent studies have shown the importance to accurately quantify low-abundance mutations of the RAS pathway because anti-EGFR therapy may depend on certain mutation thresholds. We aimed to evaluate the added predictive value of an extended RAS panel testing using two commercial assays and a highly sensitive and quantitative digital PCR (dPCR). Tumor samples from 583 mCRC patients treated with anti-EGFR- (n = 255) or bevacizumab- (n = 328) based therapies from several clinical trials and retrospective series from the TTD/RTICC Spanish network were analyzed by cobas, therascreen, and dPCR. We evaluated concordance between techniques using the Cohen kappa index. Response rate, progression-free survival (PFS), and overall survival (OS) were correlated to the mutational status and the mutant allele fraction (MAF). Concordance between techniques was high when analyzing RAS and BRAF (Cohen kappa index around 0.75). We observed an inverse correlation between MAF and response in the anti-EGFR cohort (

Make EU trade with Brazil sustainable

Brazil, home to one of the planet's last great forests, is currently in trade negotiations with its second largest trading partner, the European Union (EU). We urge the EU to seize this critical opportunity to ensure that Brazil protects human rights and the environment

New insights into the genetic etiology of Alzheimer’s disease and related dementias

Characterization of the genetic landscape of Alzheimer’s disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/‘proxy’ AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele