Antiagregación y anticoagulación en síndromes coronarios agudos: niveles de evidencia

Management of acute coronary syndromes (ACS) has moved rapidly in parallel with our understanding of the pathophysiological basis of the disease. In the eighties, the demonstration of the pivotal role of coronary thrombosis in the etiology of a ACS led to administration of aspirin and unfractionated heparin. In recent years, new medical and invasive therapies have been developed: anti-platelets (thienopyridines and glycoprotein Ilb/IlIa inhibitors), antithrombins (low molecularweight heparins) and most recently, factor Xa inhibitors (pentasaccharides). As new treatments are rapidly added, clinicians are constantly challenged to incorporate new information and guidelines into their practices in a timely fashion

Tratamiento del síndrome antifosfolípido

The antiphospholipid syndrome (APS) is a disorder of recurrent thrombosis and/or pregnancy loss associated with the presence of antiphospholipid antibodies and persistently positive lupus anticoagulant, anticardiolipin or anti beta2-glycoprotein1. Oral anticoagulants are the best available and most effective treatment for the secondary prevention of recurrent venous or arterial thrombosis. Patients with APS are treated with long-term therapy to prolong the INR to 2.0-3.0. Low-molecular-weight heparin in combination with low-aspirin dose is a reasonable strategy to avoid pregnancy loss in women with this syndrome

Diagnóstico y tratamiento de la trombosis venosa profunda

Deep-vein thrombosis (DVT) is a common condition that can lead to complications such as postphlebitic syndrome, pulmonary embolism and death. Currently, an algorithm strategy combining pretest probability, D-dimer testing and compression ultrasonography imaging allows for safe and convenient estimation of suspected lower-limb thrombosis. The mainstay of treatment is anticoagulation therapy. The use of low-molecular-weight heparin or pentasaccharide (fondaparinux) allows for outpatient management of most patients with DVT. The duration of anticoagulation depends on whether the primary event was idiopathic or secondary to a transient risk factor. Interventions such as thrombolysis and placement of inferior vena cava filter are reserved for special situations

Ionized gas kinematics of galaxies in the CALIFA survey I: Velocity fields, kinematic parameters of the dominant component, and presence of kinematically distinct gaseous systems

This work provides an overall characterization of the kinematic behavior of the ionized gas of the galaxies included in the Calar Alto Legacy Integral field Area (CALIFA), offering kinematic clues to potential users of this survey for including kinematical criteria for specific studies. From the first 200 galaxies observed by CALIFA, we present the 2D kinematic view of the 177 galaxies satisfying a gas detection threshold. After removing the stellar contribution, we used the cross-correlation technique to obtain the radial velocity of the dominant gaseous component. The main kinematic parameters were directly derived from the radial velocities with no assumptions on the internal motions. Evidence of the presence of several gaseous components with different kinematics were detected by using [OIII] profiles. Most objects in the sample show regular velocity fields, although the ionized-gas kinematics are rarely consistent with simple coplanar circular motions. 35% of the objects present evidence of a displacement between the photometric and kinematic centers larger than the original spaxel radii. Only 17% of the objects in the sample exhibit kinematic lopsidedness when comparing receding and approaching sides of the velocity fields, but most of them are interacting galaxies exhibiting nuclear activity. Early-type galaxies in the sample present clear photometric-kinematic misaligments. There is evidence of asymmetries in the emission line profiles suggesting the presence of kinematically distinct gaseous components at different distances from the nucleus. This work constitutes the first determination of the ionized gas kinematics of the galaxies observed in the CALIFA survey. The derived velocity fields, the reported kinematic peculiarities and the identification of the presence of several gaseous components might be used as additional criteria for selecting galaxies for specific studies.Comment: 38 pages, 16 figures, 4 tables. Paper accepted for publication in A&

Identification of soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) as a possible biomarker of subclinical atherosclerosis

OBJECTIVES: Assessment of vascular risk in asymptomatic patients and the response to medical therapy is a major challenge for prevention of cardiovascular events. Our aim was to identify proteins differentially released by healthy versus atherosclerotic arterial walls, which could be found in plasma and serve as markers of atherosclerosis. METHODS AND RESULTS: We have analyzed supernatants obtained from cultured human carotid plaques and healthy arteries by surface-enhanced laser-desorption/ionization time-of-flight mass spectrometry ProteinChip System. Surface-enhanced laser-desorption/ionization analysis unveiled an 18.4-kDa peak released in lower amount by carotid plaques than normal endarteries. This protein was identified as soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK). To confirm that sTWEAK was the protein of interest, Western blot and enzyme-linked immunosorbent assay were performed. Both techniques confirmed that sTWEAK levels were decreased in carotid plaque supernatants. Subsequent measurement of sTWEAK in plasma showed a reduced concentration in subjects with carotid stenosis (N=30) compared with healthy subjects matched by sex and age (N=28) (P<0.001). Furthermore, in a test population of 106 asymptomatic subjects, we showed that sTWEAK concentrations negatively correlated with the carotid intima-media thickness (r=-0.4; P<0.001), an index of subclinical atherosclerosis. CONCLUSIONS: These results suggest that sTWEAK could be a potential biomarker of atherosclerosis

Supernovae in isolated galaxies, in pairs and in groups of galaxies

In order to investigate the influence of the environment on the supernova (SN) production we have performed a statistical investigation of the SNe discovered in isolated galaxies, in pairs and in groups of galaxies. 22 SNe in 18 isolated galaxies, 48 SNe in 40 galaxies members of 37 pairs and 211 SNe in 170 galaxies members of 116 groups have been selected and studied. We found that the radial distributions of core-collapse SNe in galaxies located in different environments are similar, and consistent with that reported by Bartunov, Makarova & Tsvetkov (1992). SNe discovered in pairs do not privilege a particular direction with respect to the companion galaxy. Also the azimuthal distributions inside the hosts members of galaxy groups are consistent with being isotropics. The fact that SNe are more frequent in the brighter components of the pairs and groups is expected from the dependence of the SN rates on the galaxy luminosity. There is an indication that the SN rate is higher in galaxy pairs compared with that in groups. This can be related to the enhanced star formation rate in strongly interacting systems. It is concluded that, with the possible exception of strongly interacting system, the parent galaxy environment has no direct influence on the SN productionComment: 10 pages, accepted for publication to MNRA

Stellar Population gradients in galaxy discs from the CALIFA survey

While studies of gas-phase metallicity gradients in disc galaxies are common, very little has been done in the acquisition of stellar abundance gradients in the same regions. We present here a comparative study of the stellar metallicity and age distributions in a sample of 62 nearly face-on, spiral galaxies with and without bars, using data from the CALIFA survey. We measure the slopes of the gradients and study their relation with other properties of the galaxies. We find that the mean stellar age and metallicity gradients in the disc are shallow and negative. Furthermore, when normalized to the effective radius of the disc, the slope of the stellar population gradients does not correlate with the mass or with the morphological type of the galaxies. Contrary to this, the values of both age and metallicity at $\sim$2.5 scale-lengths correlate with the central velocity dispersion in a similar manner to the central values of the bulges, although bulges show, on average, older ages and higher metallicities than the discs. One of the goals of the present paper is to test the theoretical prediction that non-linear coupling between the bar and the spiral arms is an efficient mechanism for producing radial migrations across significant distances within discs. The process of radial migration should flatten the stellar metallicity gradient with time and, therefore, we would expect flatter stellar metallicity gradients in barred galaxies. However, we do not find any difference in the metallicity or age gradients in galaxies with without bars. We discuss possible scenarios that can lead to this absence of difference.Comment: 24 pages, 17 figures, accepted for publication in A&