Fenotipos de válvula aórtica bicúspide y dilatación de aorta ascendente : estudio mediante cardiorresonancia

El objetivo del estudio ha sido caracterizar mediante cardiorresonancia los fenotipos de válvula aórtica bicúspide (VAB) y su asociación con patrones de dilatación de aorta ascendente (AA). En este estudio la VAB fenotipo 1 (fusión velo coronario derecho -izquierdo) es la más prevalente y se asocia a coartación aórtica, insuficiencia aórtica moderada-severa y dilatación de raiz aórtica. El fenotipo 2 de VAB (fusión velo coronario derecho- no coronario) se asocia a dilatación de porción tubular aórtica. La edad predice dilatación de AA en pacientes con VAB y la estenosis aórtica moderada-severa es un factor protector contra dicha dilatación.L'objectiu de l'estudi ha estat caracteritzar mitjançant ressonància magnètica nuclear cardíaca els fenotips de vàlvula aòrtica bicúspide (VAB) i la seva associació amb patrons de dilatació d'aorta ascendent (AA). En aquest estudi la VAB fenotip 1 (fusió valva coronàrica dreta -esquerra) és la més prevalent i s'associa a coartació aòrtica, insuficiència aòrtica moderada- greu i dilatació d'arrel aòrtica. El fenotip 2 de VAB (fusió valva coronàrica dreta- no coronàrica) s'associa a dilatació de porció tubular aòrtica. L'edat prediu dilatació de AA en pacients amb VAB i l'estenosi aòrtica moderada- greu és un factor protector contra aquesta dilatació

Treatment With Diflunisal in Domino Liver Transplant Recipients With Acquired Amyloid Neuropathy

Objectives: To analyze the efficacy and tolerability of diflunisal for the treatment of acquired amyloid neuropathy in domino liver transplant recipients.Methods: We performed a retrospective longitudinal study of prospectively collected data for all domino liver transplant recipients with acquired amyloid neuropathy who received diflunisal at our hospital. Neurological deterioration was defined as an score increase of >= 2 points from baseline on the Neurological Impairment Scale/Neurological Impairment Scale-Lower Limbs.Results: Twelve patients who had received compassionate use treatment with diflunisal were identified, of whom seven had follow-up data for >= 12 months. Five patients (71.4%) presented with neurological deterioration on the Neurological Impairment Scale after 12 months (p = 0.0382). The main adverse effects were cardiovascular and renal, leading to diflunisal being stopped in five patients and the dose being reduced in two patients.Conclusion: Our study suggests that most domino liver transplant recipients with acquired amyloid neuropathy will develop neurological deterioration by 12 months of treatment with diflunisal. This therapy was also associated with a high incidence of adverse effects and low treatment retention. The low efficacy and low tolerability of diflunisal treatment encourage the search for new therapeutic options

Evaluación de la equidad del servicio de transporte público: El caso de Palma de Mallorca

The practice of sustainable transport planning must take into account the level of territorial and social equity of service. The equity analysis requires a deep understanding of the service and the territorial and social characteristics where it is implanted. We propose a simplified method to analyze the equity of the public bus system that has been used in the city of Palma de Mallorca. The bus service level was calculated from the spatial analysis of the offer and was contrasted with the population and with a multidimensional index of social need for public transportation leading to horizontal and vertical equity respectively. Next the overall equity of the service was tested with the support of the Lorenz curve and Gini coefficient. Finally, a sensitivity analysis of bus routes depending on the role they play in the equity of the service was performed.La planificación sostenible del transporte público requiere la consideración de la equidad territorial y social. El análisis de la equidad precisa de un profundo conocimiento del servicio así como de las características territoriales y sociales dónde se implanta. En este artículo se propone un método simplificado para el análisis de la equidad del sistema de autobuses públicos, aplicado a la ciudad de Palma. El nivel de servicio se calcula a partir del análisis territorial de la oferta, y se contrasta con la población existente y con un índice multidimensional de necesidad social de transporte público, dando lugar a la equidad horizontal y vertical, respectivamente. Posteriormente, se verifica la equidad global del servicio con el apoyo de la curva de Lorenz y del coeficiente GINI. Finalmente, se realiza un análisis de sensibilidad a través de la frecuencia de las rutas de autobús en relación a la equidad social del servicio

Los sistemas de bicicleta pública y la movilidad urbana sostenible. Un análisis en la ciudad de Palma (Mallorca, Islas Baleares)

El artículo analiza los sistemas de bicicleta pública como instrumento de incentivación de los desplazamientos en bicicleta en el marco de las políticas de movilidad sostenible. Se centra en su implantación en la ciudad de Palma y se valoran tres componentes: la evolución del reparto modal en la ciudad desde su instalación en 2011 y su relación con el tráfico ciclista; la cobertura territorial del sistema y su funcionamiento; y, por último, las características, el perfil y las motivaciones de los usuarios. Del análisis se deduce una baja aceptación del sistema, a pesar del incremento más que notable del número de ciclistas en la ciudad

Allogenic adipose-derived stem cell therapy overcomes ischemia-induced microvessel rarefaction in the myocardium : systems biology study

Altres ajuts: This work was supported by the Spanish Cardiovascular Network of Cell Therapy (Red TerCel RD16/0011/018) and Ciber CV(CB16/11/00411) from the Instituto Salud Carlos III (to LB). Additional funding was received from Plan Nacional de Salud (PNS SAF2016-76819-R to LB, 2015-71653-R to GV) from the Spanish Ministry of Science and Innovation and FEDER funds; from Instituto de Salud Carlos III (CPII13/00012 to GA); and support from a grant from the Muy Ilustrísima Administración from the Hospital de la Santa Creu I Sant Pau (to MG). The authors thank Fundacion Jesus Serra, Barcelona for continuous support.Myocardial microvascular loss after myocardial infarction (MI) remains a therapeutic challenge. Autologous stem cell therapy was considered as an alternative; however, it has shown modest benefits due to the impairing effects of cardiovascular risk factors on stem cells. Allogenic adipose-derived stem cells (ASCs) may overcome such limitations, and because of their low immunogenicity and paracrine potential may be good candidates for cell therapy. In the present study we investigated the effects of allogenic ASCs and their released products on cardiac rarefaction post MI. Pig subcutaneous adipose tissue ASCs were isolated, expanded and GFP-labeled. ASC angiogenic function was assessed by the in-vivo chick chorioallantoic membrane (CAM) model. Pigs underwent MI induction and 7 days after were randomized to receive: allogenic ASCs (intracoronary infusion); conditioned media (CM; intravenous infusion); ASCs + CM; or PBS/placebo (control). Cardiac damage and function were monitored by 3-T cardiac magnetic resonance imaging upon infusion (baseline CMR) and 1 and 3 weeks thereafter. We assessed in the myocardium: microvessel density; angiogenic markers (CD105, CD31, TF, VEGFR2, VEGFR1, vWF, eNOS, CD62); collagen deposition; and reparative fibrosis (TGFβ/TβRII/collagen). Differential proteomics of ASCs and CM was performed to characterize the ASC protein signature. CAM indicated a significant ASC proangiogenic capacity. In pigs after MI, only PBS/placebo animals displayed an impaired cardiac function 3 weeks after infusion (p < 0.05 vs baseline). Administration of ASCs + CM significantly enhanced neovessel formation and favored cardiac repair post MI (p < 0.05 vs the other groups). Molecular markers of angiogenesis were significantly upregulated both at transcriptional and protein levels (p < 0.05). The in-silico bioinformatics analysis of the ASC and CM proteome (interactome) indicated activation of a coordinated protein network involved in the formation of microvessels and the resolution of rarefaction. Coadministration of allogenic ASCs and their CM synergistically contribute to the neovascularization of the infarcted myocardium through a coordinated upregulation of the proangiogenic protein interactome. The online version of this article (doi:10.1186/s13287-017-0509-2) contains supplementary material, which is available to authorized users

Colangiopancreatoscopia. Protocolo de trabajo. Recomendaciones de la SEED

La visión endoscópica directa de los ductos biliares y pancreáticos ha constituido un paso más en el recorrido de la endoscopia digestiva. Ha permitido identificar lesiones que previamente lo eran por medios indirectos. La obtención de biopsias dirigidas ha permitido caracterizar mejor las lesiones. La aplicación de fuentes de energía a través del colangiopancreatoscopio está posibilitando la fragmentación y extracción de litiasis refractarias mediante los medios endoscópicos tradicionales. En este documento, se pretende definir el flujo de trabajo aconsejado por la Sociedad Española de Endoscopia Digestiva (SEED) durante el uso de un colangiopancreatoscopio flexible de un solo uso (SpyGlass®, Boston Scientific). Sus dos versiones digitales, SpyScope DS y DS II, han incorporado mejoras tecnológicas. Este protocolo de trabajo ofrece una revisión llevada a cabo por un grupo de expertos de la SEED que ahonda en aspectos prácticos de la técnica endoscópica. Para la realización de una colangiopancreatoscopia flexible (CPF) a través de un duodenoscopio se requiere la participación multidisciplinar coordinada en las diferentes fases de la técnica de endoscopista, enfermería, anestesiólogo y técnico de radiología

Everolimus plus minimized tacrolimus on kidney function in liver transplantation: REDUCE, a prospective, randomized controlled study

Background and aim: reduction in calcineurin inhibitor levels is considered crucial to decrease the incidence of kidney dysfunction in liver transplant (LT) recipients. The aim of this study was to evaluate the safety and impact of everolimus plus reduced tacrolimus (EVR + rTAC) vs. mycophenolate mofetil plus tacrolimus (MMF + TAC) on kidney function in LT recipients from Spain. Methods: the REDUCE study was a 52-week, multicenter, randomized, controlled, open-label, phase 3b study in de novo LT recipients. Eligible patients were randomized (1:1) 28 days post-transplantation to receive EVR + rTAC (TAC levels <_ 5 ng/mL) or to continue with MMF + TAC (TAC levels = 6-10 ng/mL). Mean estimated glomerular filtration rate (eGFR), clinical benefit in renal function, and safety were evaluated. Results: in the EVR + rTAC group (n = 105), eGFR increased from randomization to week 52 (82.2 [28.5] mL/min/1.73 m2 to 86.1 [27.9] mL/min/1.73 m2) whereas it decreased in the MMF + TAC (n = 106) group (88.4 [34.3] mL/min/1.73 m2 to 83.2 [25.2] mL/min/1.73 m2), with significant (p < 0.05) differences in eGFR throughout the study. However, both groups had a similar clinical benefit regarding renal function (improvement in 18.6 % vs. 19.1 %, and stabilization in 81.4 % vs. 80.9 % of patients in the EVR + rTAC vs. MMF + TAC groups, respectively). There were no significant differences in the incidence of acute rejection (5.7 % vs. 3.8 %), deaths (5.7 % vs. 2.8 %), and serious adverse events (51.9 % vs. 44.0 %) between the 2 groups. Conclusion: EVR + rTAC allows a safe reduction in tacrolimus exposure in de novo liver transplant recipients, with a significant improvement in eGFR but without significant differences in renal clinical benefit 1 year after liver transplantation

Palynological and chemical volatile components of tipically autumnal honeys of the western Mediterranean

[EN] Twenty-five samples of autumnal honeys from the western Mediterranean (Mallorca and Eivissa, Balearic Islands) were examined for pollen content (qualitative and quantitative melissopalynological analysis), moisture, electrical conductivity, colour, sensorial qualities and volatile components. Quantitative analysis showed that the honey contained Maurizio's Class II: 64%, Class III: 28%, Class IV: 4% and Class V: 4%. Fifty-four pollen types, with an average number of 16.68 per sample, were identified, belonging to 29 botanical families. Only two taxa (Ceratonia siliqua and Erica multiflora) were found in all samples. Seventeen samples were unifloral (68%) - ten (40%) of C. siliqua, six (24%) of E. multiflora and one (4%) of Hedera helix. All honeys have a low honeydew index (<?0.09%), while the values for electrical conductivity and water content were high. The major honey volatile components are: cis- and trans-linalool oxides (64.2%) and hotrienol (10.4%) for the carob (C. siliqua) and trans-linalool oxide (13.4%), p-menthane-1,8-diol (11.1%), safranal (9.7%), limonene (5,4%), -pinene (3.7%) and oxoisophorone (3.4%) for the winter heather (E. multiflora).The authors would like to extend their gratitude to the Mallorca Rural 'Leader plus' programme and the beekeepers of Mallorca and Eivissa for their support and friendly collaboration. The authors also thank an anonymous reviewer for useful comments and suggestions on an earlier version of the manuscript.Boi, M.; Llorens Molina, JA.; Cortés, L.; Lladó, G.; Llorens, L. (2013). Palynological and chemical volatile components of tipically autumnal honeys of the western Mediterranean. Grana. 52(2):93-105. doi:10.1080/00173134.2012.744774S93105522Andrade, P. B., Amaral, M. T., Isabel, P., Carvalho, J. C. M. F., Seabra, R. M., & Proença da Cunha, A. (1999). 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Endoscopic treatment (endoscopic balloon dilation/self-expandable metal stent) vs surgical resection for the treatment of de novo stenosis in Crohn's disease (ENDOCIR study): an open-label, multicentre, randomized trial.

Background: Stenosis is one of the most common complications in patients with Crohn's disease (CD). Endoscopic balloon dilation (EBD) is the treatment of choice for a short stenosis adjacent to the anastomosis from previous surgery. Self-expandable metal stents (SEMS) may be a suitable treatment option for longer stenoses. To date, however, there is no scientific evidence as to whether endoscopic (EBD/SEMS) or surgical treatment is the best approach for de novo or primary stenoses that are less than 10 cm in length. Methods/design: Exploratory study as "proof-of-concept", multicentre, open-label, randomized trial of the treatment of de novo stenosis in the CD; endoscopic treatment (EBD/SEMS) vs surgical resection (SR). The type of endoscopic treatment will initially be with EDB; if a therapeutic failure occurs, then a SEMS will be placed. We estimate 2 years of recruitment and 1 year of follow-up for the assessment of quality of life, costs, complications, and clinical recurrence. After the end of the study, patients will be followed up for 3 years to re-evaluate the variables over the long term. Forty patients with de novo stenosis in CD will be recruited from 15 hospitals in Spain and will be randomly assigned to the endoscopic or surgical treatment groups. The primary aim will be the evaluation of the patient quality of life at 1 year follow-up (% of patients with an increase of 30 points in the 32-item Inflammatory Bowel Disease Questionnaire (IBDQ-32). The secondary aim will be evaluation of the clinical recurrence rate, complications, and costs of both treatments at 1-year follow-up. Discussion: The ENDOCIR trial has been designed to determine whether an endoscopic or surgical approach is therapeutically superior in the treatment of de novo stenosis in CD