Beneficio del ecocardiograma intracardiaco en pacientes sometidos a la ablación de las venas pulmonares por fibrilación auricular

Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, leída el 17/12/2015La cateterización transeptal a través de la punción del septo interauricular es un procedimiento fundamental para el tratamiento de ciertas arritmias, como la Fibrilación Auricular y otras patologías cardiacas. Para ello es preciso atravesar el septo interauricular en la región de la fosa oval (FO), usualmente utilizando una aguja conocida como aguja “de Brockenbrough”. Para la localización de la FO se utilizan referencias anatómicas identificables bajo visión radioscópica. El avance y la mejora en el tratamiento de ciertas patologías cardiacas que requieren la punción del septo, han convertido a la punción transeptal (PT) en un procedimiento cada vez más frecuente en los laboratorios de electrofisiología y hemodinámica, extendiéndose esta técnica a casos cada vez más complejos. Esto a su vez supone un incremento de la posibilidad de enfrentarnos a una anatomía cardiaca menos predecible por marcas anatómicas fluoroscópicas y, por tanto, un incremento del riesgo de sufrir complicaciones. Algunas de estas complicaciones ocurren como consecuencia de referencias anatómicas insuficientes o variaciones interindividuales de la anatomía cardiaca que pueden suponer atravesar el septo interauricular por zonas erróneas, con incremento del riesgo de perforación y taponamiento cardiaco. Hoy en día disponemos de una técnica de imagen, la ecocardiografía intracardiaca (EIC), que proporciona una excelente información anatómica y en tiempo real. Desde la aurícula derecha nos permite visualizar las cuatro cavidades cardiacas además de otras estructuras extracardiacas. Se trata de una técnica de imagen que podría facilitar la PT, disminuir el riesgo de complicaciones y además acortar su curva de aprendizaje...Transseptal catheterization through the atrial septal puncture is fundamental to treat certain arrhythmias, such as atrial fibrillation (AF) and other cardiac pathologies. This requires crossing the atrial septum in the region of the oval fossa (OF), usually using a needle called "Brockenbrough". Locating the OF an identifiable anatomical landmarks is done using fluoroscopy. The progress in the treatment of certain cardiac pathologies requires puncturing the septum. Transseptal puncture (TP) in an increasingly frequent in electrophysiology and hemodynamic laboratories procedures, extending this technique to cases that are more complex. This in turn means an increase of the possibility of facing a less predictable fluoroscopic cardiac anatomy and anatomical landmarks; therefore, an increases risk of complications. Some of these complications occur as a result of insufficient anatomical landmarks or interindividual variations of cardiac anatomy, which my result in crossing the atrial septum into the wrong areas, and increase the risk of perforation and cardiac tamponade. Today, we have an imaging technique intracardiac echocardiography (ICE), which provides excellent anatomic information in real time. From the right atrium, it allows us to visualize the four heart chambers as well as other extracardiac structures. This is an imaging technique that could facilitate the TP, by reducing the risk of complications and also shortening the learning curve. Additionally, using ICE would potentially reduce the risk of puncture, as well as providing security in complex cases such as failed punctures due to complex anatomy, presence of prosthetic material, or congenital heart disease patients on anticoagulantes...Fac. de MedicinaTRUEunpu

Beneficio del ecocardiograma intracardiaco en pacientes sometidos a la ablación de las venas pulmonares por fibrilación auricular

La cateterización transeptal a través de la punción del septo interauricular es un procedimiento fundamental para el tratamiento de ciertas arritmias, como la Fibrilación Auricular y otras patologías cardiacas. Para ello es preciso atravesar el septo interauricular en la región de la fosa oval (FO), usualmente utilizando una aguja conocida como aguja “de Brockenbrough”. Para la localización de la FO se utilizan referencias anatómicas identificables bajo visión radioscópica. El avance y la mejora en el tratamiento de ciertas patologías cardiacas que requieren la punción del septo, han convertido a la punción transeptal (PT) en un procedimiento cada vez más frecuente en los laboratorios de electrofisiología y hemodinámica, extendiéndose esta técnica a casos cada vez más complejos. Esto a su vez supone un incremento de la posibilidad de enfrentarnos a una anatomía cardiaca menos predecible por marcas anatómicas fluoroscópicas y, por tanto, un incremento del riesgo de sufrir complicaciones. Algunas de estas complicaciones ocurren como consecuencia de referencias anatómicas insuficientes o variaciones interindividuales de la anatomía cardiaca que pueden suponer atravesar el septo interauricular por zonas erróneas, con incremento del riesgo de perforación y taponamiento cardiaco. Hoy en día disponemos de una técnica de imagen, la ecocardiografía intracardiaca (EIC), que proporciona una excelente información anatómica y en tiempo real. Desde la aurícula derecha nos permite visualizar las cuatro cavidades cardiacas además de otras estructuras extracardiacas. Se trata de una técnica de imagen que podría facilitar la PT, disminuir el riesgo de complicaciones y además acortar su curva de aprendizaje..

Article Evaluating Topological Conflict in Centipede Phylogeny Using Transcriptomic Data Sets

Abstract Relationships between the five extant orders of centipedes have been considered solved based on morphology. Phylogenies based on samples of up to a few dozen genes have largely been congruent with the morphological tree apart from an alternative placement of one order, the relictual Craterostigmomorpha, consisting of two species in Tasmania and New Zealand. To address this incongruence, novel transcriptomic data were generated to sample all five orders of centipedes and also used as a test case for studying gene-tree incongruence. Maximum likelihood and Bayesian mixture model analyses of a data set composed of 1,934 orthologs with 45% missing data, as well as the 389 orthologs in the least saturated, stationary quartile, retrieve strong support for a sister-group relationship between Craterostigmomorpha and all other pleurostigmophoran centipedes, of which the latter group is newly named Amalpighiata. The Amalpighiata hypothesis, which shows little gene-tree incongruence and is robust to the influence of among-taxon compositional heterogeneity, implies convergent evolution in several morphological and behavioral characters traditionally used in centipede phylogenetics, such as maternal brood care, but accords with patterns of first appearances in the fossil record

Global maps of soil temperature

Research in global change ecology relies heavily on global climatic grids derived from estimates of air temperature in open areas at around 2 m above the ground. These climatic grids do not reflect conditions below vegetation canopies and near the ground surface, where critical ecosystem functions occur and most terrestrial species reside. Here, we provide global maps of soil temperature and bioclimatic variables at a 1-km2 resolution for 0–5 and 5–15 cm soil depth. These maps were created by calculating the difference (i.e. offset) between in situ soil temperature measurements, based on time series from over 1200 1-km2 pixels (summarized from 8519 unique temperature sensors) across all the world\u27s major terrestrial biomes, and coarse-grained air temperature estimates from ERA5-Land (an atmospheric reanalysis by the European Centre for Medium-Range Weather Forecasts). We show that mean annual soil temperature differs markedly from the corresponding gridded air temperature, by up to 10°C (mean = 3.0 ± 2.1°C), with substantial variation across biomes and seasons. Over the year, soils in cold and/or dry biomes are substantially warmer (+3.6 ± 2.3°C) than gridded air temperature, whereas soils in warm and humid environments are on average slightly cooler (−0.7 ± 2.3°C). The observed substantial and biome-specific offsets emphasize that the projected impacts of climate and climate change on near-surface biodiversity and ecosystem functioning are inaccurately assessed when air rather than soil temperature is used, especially in cold environments. The global soil-related bioclimatic variables provided here are an important step forward for any application in ecology and related disciplines. Nevertheless, we highlight the need to fill remaining geographic gaps by collecting more in situ measurements of microclimate conditions to further enhance the spatiotemporal resolution of global soil temperature products for ecological applications

Evaluating Topological Conflict in Centipede Phylogeny Using Transcriptomic Data Sets

14 páginas, 2 tablas, 6 figuras.Relationships between the five extant orders of centipedes have been considered solved based on morphology. Phylogenies based on samples of up to a few dozen genes have largely been congruent with the morphological tree apart from an alternative placement of one order, the relictual Craterostigmomorpha, consisting of two species in Tasmania and New Zealand. To address this incongruence, novel transcriptomic data were generated to sample all five orders of centipedes and also used as a test case for studying gene-tree incongruence. Maximum likelihood and Bayesian mixture model analyses of a data set composed of 1,934 orthologs with 45% missing data, as well as the 389 orthologs in the least saturated, stationary quartile, retrieve strong support for a sister-group relationship between Craterostigmomorpha and all other pleurostigmophoran centipedes, of which the latter group is newly named Amalpighiata. The Amalpighiata hypothesis, which shows little gene-tree incongruence and is robust to the influence of among-taxon compositional heterogeneity, implies convergent evolution in several morphological and behavioral characters traditionally used in centipede phylogenetics, such as maternal brood care, but accords with patterns of first appearances in the fossil record.This work was supported by internal funds from the Museum of Comparative Zoology and by a postdoctoral fellowship from the Fundación Ramón Areces to R.F.Peer reviewe

Sex-Specific Ventricular Arrhythmias and Mortality in Cardiac Resynchronization Therapy Recipients

OBJECTIVES The study goal was to examine whether there are sex-related differences in the incidence of ventricular arrhythmias and mortality in CRT-defibrillator (CRT-D) recipients. BACKGROUND Few studies have evaluated sex-related benefits of cardiac resynchronization therapy (CRT). Moreover, data on sex-related differences in the occurrence of ventricular tachyarrhythmias in this population are limited. METHODS A multicenter retrospective study was conducted in 460 patients (355 male subjects and 105 female sub- jects) from the UMBRELLA (Incidence of Arrhythmia in Spanish Population With a Medtronic Implantable Cardiac Defi- brillator Implant) national registry. Patients were followed up through remote monitoring after the first implantation of a CRT-D during a median follow-up of 2.2 1.0 years. Sex differences were analyzed in terms of ventricular arrhythmia– treated incidence and death during the follow-up period, with a particular focus on primary prevention patients. RESULTS Baseline New York Heart Association functional class was worse in women compared with that in men (67.0% of women in New York Heart Association functional class III vs. 49.7% of men; p ¼ 0.003), whereas women had less ischemic cardiac disease (20.8% vs. 41.7%; p < 0.001). Female sex was an independent predictor of ventricular ar- rhythmias (hazard ratio: 0.40; 95% confidence interval: 0.19 to 0.86; p ¼ 0.020), as well as left ventricular ejection fraction and nonischemic cardiomyopathy. Mortality in women was one-half that of men, although events were scarce and without significant differences (2.9% vs. 5.6%; p ¼ 0.25). CONCLUSIONS Women with left bundle branch block and implanted CRT have a lower rate of ventricular tachyarrhythmias than men. All-cause mortality in patients is, at least, similar between female and male subjects.Medicin

El derecho a los derechos : infancias y adolescencias en Cuba

«El derecho a los derechos. Infancias y adolescencias en Cuba», constituye un título atractivo y seductor, en el que se ofrece al lector una mirada crítica a retos, problemáticas y cuestiones teórico-prácticas en la protección integral de los niños, niñas y adolescentes. Profesionalidad, originalidad, impronta y opinión personal de cada uno de los autores signaron la concepción del libro. De igual forma, un lenguaje apropiado que se sustrae de tecnicismos barrocos y excesivos para facilitar la lectura. Es una obra pensada desde la academia para impactar la realidad social. (...) engrosa los estudios sobre infancia y adolescencia existentes, es expresión de un saber especializado, tanto a nivel de la investigación científica como de la práctica y la gestión institucional estatal y de la sociedad civil. No busca ser meta, punto de llegada, al contrario, es una propuesta que invita permanentemente al debate, la discusión teórica, la reflexión, al examen de las formas de hacer y al pensamiento crítico. Dr. Yuri Pérez Martíne