Miocarditis aguda: diagnóstico mediante resonancia magnética cardiaca

Cardiomyopathies are a common cause of morbidity and mortality. Myocarditis, which is included among specific cardiomyopathies, frequently presents non-specific clinical manifestations and thus may be difficult to diagnose, or even be misdiagnosed. Traditionally employed diagnostic techniques, including endomyocardial biopsy, have been shown to be of limited value. Following its overall implantation in clinical practice, cardiac magnetic resonance imaging (MRI) is nowadays widely considered to be the best non-invasive diagnostic tool available for diagnosing myocarditi

Coronariografía por tomografía computarizada de doble fuente

La tomografía computarizada multicorte (TCMC) permite estudiar las arterias coronarias de forma no invasiva. A pesar de la elevada resolución espacial y temporal de los equipos de sesenta y cuatro cortes (TCMC- 64) esta técnica no se encuentra exenta de limitaciones. La tomografía computarizada de doble fuente (TCDF) permite estudiar las arterias coronarias con gran calidad diagnóstica en todos los sujetos independien- temente de su frecuencia cardiaca sin necesidad, por tanto, de emplear betabloqueantes. En este trabajo se describen los estudios por TCDF de tres pacientes con elevada frecuencia cardiaca y gran variabilidad del ritmo. Se demuestra la utilidad de esta técnica para obtener estudios de excelente calidad diagnóstica en casos en que la coronariografía por TCMC-64 convencional presenta limitaciones. INGLÉS: Multidetector computed tomography (MDCT) has been demonstrated to be a very useful technique to non-invasively study coronary arteries. Despite the high spatial and temporal resolution of 64-slice MDCT scanners, this technique has several limitations. Dual-source computed tomography (DSCT) allows to study coronary arteries with excellent diagnostic quality in all subjects independent of the heart rate, thus avoiding the use of beta-blockers. In this article DSCT studies from three subjects with elevated heart rate and irregular heart rhythm are described. Usefulness of this technique to obtain studies of excellent quality in cases in which conventional 64-row-MDCT might present limitations is emphasized

Valoración global del corazón en el paciente con transplante cardiaco mediante tomografía computarizada de doble fuente

In routine clinical practice surveillance of heart transplant recipients is usually performed using echocardiography and conventional coronary angiography. The latter permits diagnosis and follow-up of coronary allograft vasculopathy. However, this procedure is invasive and is not free of complications. Conventional multislice computed tomography (MSCT) has been shown to be a useful non-invasive tool for ruling out coronary artery disease and evaluating cardiac function. However, due to its limited temporal resolution betablocker administration is required, and its usefulness in certain patient populations with restricted response to this medication, such as heart transplant recipients, may therefore be limited. Dual-source CT (DSCT) allows evaluation of the coronary arteries in all individuals independent of their heart rate. In the case presented here, we demonstrate that DSCT may be useful for evaluating cardiac function and ruling out coronary allograft vasculopathy in heart transplant recipients

Dual-source CT for visualization of the coronary arteries in heart transplant patients with high heart rates

OBJECTIVE. The purpose of this study was to evaluate the quality of dual-source CT images of the coronary arteries in heart transplant recipients with high heart rates. SUBJECTS AND METHODS. Contrast-enhanced dual-source CT coronary angiography was performed on 23 heart transplant recipients (20 men, three women; mean age, 61.1 ± 12.8 years). Data sets were reconstructed in 5% steps from 30% to 80% of the R-R interval. Two blinded independent readers using a 5-point scale (0, not evaluative; 4, excellent quality) assessed the quality of images of coronary segments. RESULTS. The mean heart rate during scanning was 89.2 ± 10.4 beats/min. Interobserver agreement on the quality of images of the whole coronary tree was a kappa value of 0.78 and for selection of the optimal reconstruction interval was a kappa value of 0.82. The optimal reconstruction interval was systole in 17 (74%) of the 23 of heart transplant recipients. At the best reconstruction interval, diagnostic image quality (score ≥ 2) was obtained in 92.1% (303 of 329) of the coronary artery segments. The mean image quality score for the whole coronary tree was 3.1 ± 1.01. No significant correlation between mean heart rate (ρ = 0.31) or heart rate variability (ρ = 0.23) and overall image quality score was observed (p = not significant). CONCLUSION. Dual-source CT acquisition yields coronary angiograms of diagnostic quality in heart transplant recipients. Mean heart rate and heart rate variability during scanning do not have a negative effect on the overall quality of images of the coronary arteries

Downregulation of G protein-coupled receptor kinase 2 levels enhances cardiac insulin sensitivity and switches on cardioprotective gene expression patterns

G protein-coupled receptor kinase 2 (GRK2) has recently emerged as a negative modulator of insulin signalling. GRK2 downregulation improves insulin sensitivity and prevents systemic insulin resistance (IR). Cardiac GRK2 levels are increased in 5 human heart failure, while genetically inhibiting GRK2 leads to cardioprotection in mice. However, the molecular basis underlying the 6 deleterious effects of GRK2 up-regulation and the beneficial effects of its inhibition in the heart are not fully understood. Therefore, 7 we have explored the interconnections among a systemic IR status, GRK2 dosage and cardiac insulin sensitivity in adult (9 month-old) animals. GRK2+/- mice display enhanced cardiac insulin sensitivity and mild heart hypertrophy with preserved systolic function. Cardiac gene expression is reprogrammed in these animals, with increased expression of genes related to physiological hypertrophy, while the expression of genes related to pathological hypertrophy or to diabetes/obesity co-morbidities is repressed. Notably, we find that cardiac GRK2 levels increase in situations where IR develops, such as in ob/ob mice or after high fat diet feeding. Our data suggest that GRK2 downregulation/inhibition can help maintain cardiac function in the face of co-morbidities such as IR, diabetes or obesity by sustaining insulin sensitivity and promoting a gene expression reprogramming that confers cardioprotection.Grants from Ministerio de Educación y Ciencia (SAF2011-23800), Fundación para la Investigación Médica Aplicada (FIMA) and UTE project CIMA, The Cardiovascular Network of Ministerio Sanidad y Consumo-Instituto Carlos III (RD06-0014/0037 and RD12/0042/0012), Comunidad de Madrid (S2010/BMD-2332) and EFSD-Novo Nordisk to F.M and UAM Grupo Santander to C.M and Wood-Whelan Research Fellowship from IUBMB to E.L. We also acknowledge institutional support from Fundación Ramón Arece

La relación entre política comercial y política de competencia en el sistema comercial mundial

En esta comunicación presentaremos algunos aspectos de las interrelaciones entre política comercial y política de competencia en la forma en que se están presentando en los foros multilaterales. Damos por supuesto que partimos de descripciones y definiciones de ambas. Por razones de simetría hemos dividido esta relación en dos grandes etapas tomando como línea de distinción la Conferencia de la OMC de 1999, la ya famosa Conferencia de Seattle, que provocó una reacción importante de los movimientos antiglobalización. Creemos que dicha conferencia es más conocida por ese hecho que por sus actividade

Early lung cancer detection using spiral computed tomography and positron emission tomography

RATIONALE: Lung cancer screening using computed tomography (CT) is effective in detecting lung cancer in early stages. Concerns regarding false-positive rates and unnecessary invasive procedures have been raised. OBJECTIVE: To study the efficiency of a lung cancer protocol using spiral CT and F-18-fluorodeoxyglucose positron emission tomography (FDG-PET). METHODS: High-risk individuals underwent screening with annual spiral CTs. Follow-up CTs were done for noncalcified nodules of 5 mm or greater, and FDG-PET was done for nodules 10 mm or larger or smaller (> 7 mm), growing nodules. RESULTS: A total of 911 individuals completed a baseline CT study and 424 had at least one annual follow-up study. Of the former, 14% had noncalcified nodules of 5 mm or larger, and 3.6% had nodules of 10 mm or larger. Eleven non-small cell lung cancers (NSCLC) and one small cell lung cancer (SCLC) were diagnosed in the baseline study (prevalence rate, 1.32%), and two NSCLCs in the annual study (incidence rate, 0.47%). All NSCLCs (92% of prevalence cancers) were diagnosed in stage I (12 stage IA, 1 stage IB). FDG-PET was helpful for the correct diagnosis in 19 of 25 indeterminate nodules. The sensitivity, specificity, positive predictive value, and negative predictive value of FDG-PET for the diagnosis of malignancy were 69, 91, 90, and 71%, respectively. However, the sensitivity and negative predictive value of the screening algorithm, which included a 3-month follow-up CT for nodules with a negative FDG-PET, was 100%. CONCLUSION: A protocol for early lung cancer detection using spiral CT and FDG-PET is useful and may minimize unnecessary invasive procedures for benign lesions

How to increase technology transfers to developing countries: a synthesis of the evidence

The existing United Nations Framework Convention on Climate Change (UNFCCC) has failed to deliver the rate of low-carbon technology transfer (TT) required to curb GHG emissions in developing countries. This failure has exposed the limitations of universalism and renewed interest in bilateral approaches to TT. Gaps are identified in the UNFCCC approach to climate change TT: missing links between international institutions and the national enabling environments that encourage private investment; a non-differentiated approach for (developing) country and technology characteristics; and a lack of clear measurements of the volume and effectiveness of TTs. Evidence from econometric literature and business experience on climate change TT is reviewed, so as to address the identified pitfalls of the UNFCCC process. Strengths and weaknesses of different methodological approaches are highlighted. International policy recommendations are offered aimed at improving the level of emission reductions achieved through TT

Mapa de anomalía de Bouguer del Pirineo Suroccidental

Las relaciones geométricas y cinemáticas entre las unidades de basamento de los Pirineos Suroccidentales, específicamente entre la terminación de la Zona Axial y el afloramiento de los Macizos Vascos, son desconocidas y potencialmente muy complejas (Oliva-Urcia, 2018). La gravimetría se ha aplicado con éxito en otras regiones pirenaicas para resolver la geometría de las unidades de cobertera y basamento debido al contraste de densidad existente en las rocas involucradas. Con el objetivo de resolver dichas relaciones y sus implicaciones en la comprensión 4D de esta parte de la cadena, hemos llevado a cabo un exhaustivo programa de adquisición de datos gravimétricos (2018-2020) entre los valles de Salazar (al oeste) y del Aragón Subordán (hacia el este) en el marco del proyecto 3DGeoEU (GeoERA-H2020). Más de 1500 nuevas estaciones (varias de ellas en alta montaña) junto con > 1700 puntos de la base de datos SITOPO, ¿ 1200 de campañas mineras, y > 500 de anteriores proyectos del IGME hacen un total de > 5000 estaciones gravimétricas armonizadas. Además, se han recopilado > 500 datos de densidad de bases de datos o muestreados en el campo. En este trabajo presentaremos los mapas de anomalías Bouguer y de anomalía residual obtenidos, junto con una revisión de las principales estructuras cartográficas en la zona