Deterioro cognitivo, cirugía cardíaca y circulación extracorpórea

El deterioro cognitivo postoperatorio junto con otras alteraciones neurológicas suponen unas de las complicaciones más frecuentes tras la cirugía cardíaca. Para evaluar los efectos cognitivos de esta cirugía, hemos realizado este estudio donde se evalúan diferentes dominios neurocognitivos mediante una batería de test incluyendo la evaluación preoperatoria y un seguimiento hasta un año posterior, convertiéndose en el primer estudio de estas características en población española

Deterioro cognitivo postquirúrgico en pacientes con enfermedad coronaria y/o valvulopatía aórtica

Se muestra la presencia de deterioro cognitivo postquirúrgico en pacientes con enfermedad coronaria y/o valvulopatía aórticaUniversidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Vericiguat, nuevo pilar en el tratamiento de la insuficiencia cardiaca con fracción de eyección reducida

Heart failure with reduced ejection fraction (HFrEF) is associated with high morbidity and mortality, conditioned by multiple hospitalizations. Vericiguat has currently beenshown to be effective and safe in patients with a recent decompensation. We present a series of three cases using vericiguat in different clinical scenarios: an elderly patient with dilated cardiomyopathy of ischemic origin, a patient with alcoholic cardiomyopathy and polyvalvular heart disease, and a young patient with idiopathic cardiomyopathy. In the 3 cases vericiguat was effective and safe. This medication has been tested and monitored in other studies and we consider it plays an important role in the therapeutic armamentarium of this population, although it is necessary to accumulate more clinical experience.La insuficiencia cardiaca con fracción de eyección reducida (ICFEr) se asocia con una elevada morbimortalidad, condicionada por múltiples hospitalizaciones. Actualmente vericiguat ha mostrado ser eficaz y seguro en pacientes con una descompensación reciente. Presentamos una serie de tres casos clínicos usando vericiguat en diferentes perfiles clínicos: paciente de edad avanzada con miocardiopatía dilatada de origen isquémico, paciente con miocardiopatía de origen enólico y enfermedad polivalvular y paciente joven con miocardiopatía de origen idiopático. En los 3 casos el vericiguat mostró resultados eficaces y seguros. Este fármaco ha sido monitorizado en otros estudios y creemos que constituye un arma terapéutica importante para pacientes con ICFEr, aunque es necesario acumular mayor experiencia clínica

Repair of complete bilateral cleft lip with severely protruding premaxilla performing a premaxillary setback and vomerine ostectomy in one stage surgery

Background: The authors present a technique for selected cases of CBCL. The primary repair of the CBCL with a severely protruding premaxilla in one stage surgery is very difficult, essentially because a good muscular apposition is difficult, forcing synchronously to do a premaxillary setback to facilitate subsequent bilateral lip repair and, thus, achieving satisfactory results. We achieve this by a reductive ostectomy on the vomero- premaxillary suture. Material and Methods: 4 patients with CBCL and severely protruding premaxilla underwent premaxillary setback by vomerine ostectomy at the same time of lip repair in the past 24 months. The extent of premaxillary setback varied between 9 and 16 mm. The required amount of bone was removed anterior to the vomero-premaxillary suture. The authors did an additional simultaneous gingivoperiosteoplasty in all patients, achieving an enough stability of the premaxilla in its new position, to be able to close the alveolar gap bilaterally. The authors have examined the position of premaxilla and dental arch between 6 and 24 months. We did not do the primary nose correction, because this increased the risk of impairment of the already compromised vascularity of the philtrum and premaxilla. Results : The follow-up period ranged between 6 and 24 months. None of the patients had any major complication. During follow-up, the premaxilla was minimally mobile. We achieved a good lip repair in all cases: adequate muscle repair, symmetry of the lip, prolabium and Cupid’s bow, as well as good scars. Conclusions : To our knowledge, there are few reports of one stage surgery with vomerine ostectomy to repair CBCL with severely protruding premaxilla. Doing this vomerine ostectomy, we don’t know how it will affect the subsequent growth of the premaxila and restrict the natural maxillary growth. Applying this alternative treatment for children with CBCL and protruded premaxilla without any preoperative orthopedic, we can successfully perform, in a single-stage surgery, a good primary lip repair at our center. Further confirmations of this surgery with follow up and anthropometric studies of these patients during childhood and adolescence are require

Relationship between quadriceps femoris echotexture biomarkers and muscle strength and physical function in older adults with heart failure with preserved ejection fraction

Background: Muscle wasting is pronounced in patients with heart failure with preserved ejection fraction (HFpEF). The quadriceps femoris echotexture biomarkers assessed by ultrasound (US) have not been studied in these patients. Objective: To describe echotexture biomarkers assessed by the US and to assess their relationship with sex, age, body mass index (BMI), self-reported outcomes, muscle strength and physical function in older adults with HFpEF. Methods: A cross-sectional study was conducted. Patients 70 years and older with HFpEF were included. The sex, age, BMI, and self-reported outcomes were collected. The US assessed muscle and subcutaneous fat tissue contrast, correlation, energy, homogeneity, and entropy at rest and maximal voluntary isometrical contraction (MVIC). The six-minute walk test (6MWT), the short physical performance battery (SPPB), the timed up and go test (TUG), the usual pace gait speed test (UGS), and the fast pace gait speed test (FGS) were used to assess physical function. The five-repetitions sit-to-stand test (5-STS) was performed to assess muscle strength. Bivariant Pearson correlations and subsequent multivariate linear regression analyses were conducted. Results: Seventy-two older adults with HFpEF [81.06 years, 29.13 BMI, and 55.60% females] were recruited. In women, relaxed and MVIC muscle energy and entropy explained 35.40% of the TUG variance; relaxed muscle entropy and MVIC muscle energy shared 24.00% of the UGS variance; relaxed and MVIC muscle entropy, MVIC muscle contrast and MVIC muscle energy explained 32.60% of the FGS variance, adjusted all the models by age and BMI.Funding for open access charge: Universidad de málaga /CBU

Mala adherencia terapéutica en un paciente de edad avanzada, deterioro cognitivo y polimedicado con diabetes mellitus tipo 2

A 84-years-old woman with long-duration type 2 diabetes, severe cognitive impairment, frailty and polypharmacy came with episodes of dizziness and palpitations that improved after eating, but occasionally causing secondary falls. Frequently, the caretaker did not give her the antidiabetic medication, suspecting drug-induced hypoglycemia. After antidiabetic treatment optimization, the hypoglycemias were avoided and the therapeutic adherence was safely improved.Mujer de 84 años con diabetes mellitus tipo 2 de larga duración, deterioro cognitivo severo, fragilidad y polimedicación que consultaba por presentar episodios de mareos y palpitaciones que mejoraban con la ingesta de alimentos, pero provocando algunas veces caídas traumáticas secundarias. La cuidadora frecuentemente no le daba la medicación por sospecha de hipoglucemias asociadas al tratamiento antidiabético. Tras la optimización del tratamiento antidiabético, se consiguieron evitar las hipoglucemias y mejorar de forma segura la adherencia terapéutica.

Open Innovation for Sustainability or Not: Literature Reviews of Global Research Trends

The demand for innovative approaches applied to productive sectors is a reality present in the circular economy and open innovation is a relatively new concept that has revolutionized the literature about innovation management. Since the concept appeared in 2003, many articles have focused on its development and application. Although some studies have connected open innovation with sustainability, the relevance of this current on the global literature about open innovation is still unidentified. In this context, this paper tries to cover this gap with a bibliometric analysis focused on the evolution of the open innovation paradigm and the relevance of sustainability in this field of research. A sample of 3087 papers published between 2003 and 2019 in the Scopus database was obtained. The analysis revealed the main topics and the most prolific journals, authors, institutions, and countries, in terms of productivity, citations, and h-indexes. Besides of these contributions, keywords analysis reveals that, in recent years, sustainability and ecosystems are decisive variables in open innovation research

Biomarkers and the quadriceps femoris muscle architecture assessed by ultrasound in older adults with heart failure with preserved ejection fraction: a cross-sectional study

Background: Sarcopenia is an important comorbidity in patients with heart failure with preserved ejection fraction (HFpEF). The ultrasound (US) assessment has all the advantages of being used in primary care to assess muscle quantity and quality. Some biomarkers could be indicative of muscle mass loss. Aims: To describe the quantitative and qualitative characteristics of the quadriceps femoris assessed by US in older adults with HFpEF and to assess the relationship of the blood and urinary biomarkers, the polypharmacy and comorbidities with US outcomes in older adults with HFpEF. Methods: A cross-sectional study was conducted. 76 older adults with HFpEF were included. The quadriceps femoris muscle thickness (MT, cm), the subcutaneous fat tissue thickness (FT, cm), the muscle echo intensity (MEI) and the subcutaneous fat tissue echo intensity (FEI) were assessed by US in a non-contraction (non-con) and contraction (con) situations. Polypharmacy, comorbidities, blood and urine biomarkers were also collected. Results: The carbohydrate antigen 125 (CA-125), the folic acid and the urine creatinine shared the 86.6% variance in the non-con MT, adjusted by age, sex and body mass index (BMI). The folic acid shared the 38.5% of the variance in the con MT, adjusted by age, sex and BMI. The glycosylated haemoglobin explained the 39.6% variance in the non-con MEI, adjusted by age, sex and BMI. The chlorine (Cl−) explained the 40.2% of the variance in the non-con FT, adjusted by age, sex and BMI. The polypharmacy and the folic acid explained the 37.9% of variance in the non-con FEI, while the polypharmacy and the thyrotropin (TSH) shared the 44.4% of variance in the con FEI, both adjusted by age, sex and BMI. No comorbidities, polypharmacy, or blood and urinary biomarkers could explain the con MEI and the con FT variance. Conclusions: (...)Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. Funding for open access charge: Universidad de Málaga / CBUA. This work was supported by the Spanish Foundation of Internal Medicine, through the call “PROF. DR. MIGUEL VILARDELL 2019 research project”. Grant number: FEMI-PB-PI-MV-2019

Deterioro cognitivo posquirúrgico a largo plaza tras cirugía cardiaca

Objetivos: Evaluar de forma longitudinal el Deterioro Cognitivo Postquirúrgico (DCP) a largo plazo en pacientes tras cirugía cardíaca, analizar el perfil cognitivo obtenido e identificar los factores de riesgo involucrados. Material y Métodos: Estudio prospectivo de 70 pacientes sometidos a cirugía cardíaca (36 con……..). Se recogieron los datos sociodemográficos y clínicos y se realizó evaluación longitudinal neuropsicológica (pre y postquirúrgica a los 1, 6 y 12 meses) para caracterizar el DCP (Proyecto Neuronorma). Se evaluaron las funciones ejecutivas (Test del Trazo, Test de Stroop), memoria (Test de Recuerdo libre y selectivamente facilitado), fluidez verbal (Semántica y Fonológica) y función visuoespacial (Orientación de Líneas. Se valoró también depresión y ansiedad (escalas de Hamilton). Resultados: Se comprobó la presencia de DCP en los dos grupos de pacientes (p>0.05-p>0.001, mayor en el grupo con CEC), que fue máximo a los 6 meses de la intervención, pero aún significativo a los 12 meses. El deterioro cognitivo se asoció con variables intraoperatorias (baja saturación de oxígeno intraoperatoria y tiempo de bypass cardiopulmonar prolongado) y con factores de riesgo cardiovasculares (tabaquismo, insuficiencia cardíaca, hipertrofia ventricular izquierda, diabetes mellitus, enfermedad coronaria de 3 vasos y arteriopatía periférica) como factores predictivos. Conclusión: Los resultados indican la prevalencia del deterioro cognitivo postquirúrgico (DCP) al año de la intervención en ambos grupos, siendo mayor en el grupo con CEC. El DCP se caracteriza por un deterioro multidominio significativo en atención, funciones ejecutivas y fluencia verbal. Se describen los factores intraoperatorios y cardiovasculares significativos en el DCP, planteando la necesidad de establecer protocolos para su detección así como su prevención.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Expression of sterol regulatory element-binding proteins in epicardial adipose tissue in patients with coronary artery disease and diabetes mellitus: preliminary study

[Abstract] Objectives: Sterol regulatory element-binding proteins (SREBP) genes are crucial in lipid biosynthesis and cardiovascular homeostasis. Their expression in epicardial adipose tissue (EAT) and their influence in the development of coronary artery disease (CAD) and type-2 diabetes mellitus remain to be determined. The aim of our study was to evaluate the expression of SREBP genes in EAT in patients with CAD according to diabetes status and its association with clinical and biochemical data. Methods: SREBP-1 and SREBP-2 mRNA expression levels were measured in EAT from 49 patients with CAD (26 with diabetes) and 23 controls without CAD or diabetes. Results: Both SREBPs mRNA expression were significantly higher in patients with CAD and diabetes (p<0.001) and were identified as independent cardiovascular risk factor for coronary artery disease in patients with type-2 diabetes (SREBP-1: OR 1.7, 95%CI 1.1-2.5, p=0.02; SREBP-2: OR 1.6, 95%CI 1.2-3, p=0.02) and were independently associated with the presence of multivessel CAD, left main and anterior descending artery stenosis, and higher total and LDL cholesterol levels, and lower HDL cholesterol levels, in patients with CAD and diabetes. Conclusions: SREBP genes are expressed in EAT and were higher in CAD patients with diabetes than those patients without CAD or diabetes. SREBP expression was associated as cardiovascular risk factor for the severity of CAD and the poor lipid control. In this preliminary study we suggest the importance of EAT in the lipid metabolism and cardiovascular homeostasis for coronary atherosclerosis of patients with diabetes and highlight a future novel therapeutic target.Instituto de Salud Carlos III; PI13/02542Instituto de Salud Carlos III; PI11/01661Red de Investigación Cardiovascular; RD12/0042/003