Remodelado inverso del ventrículo izquierdo a largo plazo en miocardiopatía dilatada

Introducción: El remodelado inverso del VI se observa con frecuencia durante el seguimiento de pacientes con miocardiopatía dilatada (MCD) a pesar de lo cual este fenómeno ha sido pobremente descrito. Nuestro objetivo es determinar la incidencia actual de remodelado inverso, su pronóstico así como los factores que se relacionan con la recuperación de la fracción de eyección del ventrículo izquierdo (FEVI). Métodos: Análisis retrospectivo de una cohorte de 387 pacientes ambulatorios consecutivos. Se analizaron variables clínicas, electrocardiográficas, terapéuticas y obtenidas por técnicas de imagen. La FEVI se midió semicuantitativamente clasificándose en 4 niveles (severa, moderada, levemente deprimida y conservada). Se consideró que hubo remodelado inverso del VI cuando se produjo una mejoría de la FEVI de al menos un nivel. Resultados: Edad media de 64,5±12,1 años, sexo femenino 25,6%. El seguimiento medio fue de 50,4±28,4 meses. El remodelado inverso sostenido del VI ocurrió en el 57,6% de los pacientes. Los factores que identificaron de manera independientes a los pacientes con remodelado inverso fueron el GF de la NYHA al final del seguimiento (HR 0,38; IC 95% 0,27-0,54: p< 0,001), el número de vasos con enfermedad severa (HR 0,69; IC 95% 0,55-0,86; p=0,001), el grado de insuficiencia mitral (IMI) al final del seguimiento (HR 0,42; IC 95% 0,30-0,58; p<0,001) y el tiempo transcurrido hasta el primer evento -incluyendo muerte, trasplante cardiaco o ingreso por ICC- (HR 1,02; IC 95% 1,01-1,03; p<0,001). El remodelado inverso se relacionó estrechamente con el pronóstico: la recuperación de la función sistólica hasta alcanzar una FEVI final ligeramente deprimida o normal (HR 0,31; IC 95% 0,17-0,56; p<0,001) así como un menor tiempo para alcanzar dicha recuperación (HR 1,01; IC 95% 1,01-1,02; p=0,017) formaron parte del mejor modelo para identificar a los pacientes que no presentaron eventos durante el seguimiento, independientemente del GF de la NYHA final (HR 2,78; IC 95% 1,92-4,01; p<0,001), de la dislipemia (HR 1,82; IC 95% 1,09-3,06; p=0,023), de la insuficiencia renal crónica (HR 2,73; IC 95% 1,61-4,62; p<0,001) y de la presencia de hipertensión pulmonar significativa (HR 2,47; IC 95% 1,30-4,69; p=0,006). Conclusiones: Más de la mitad de los pacientes experimentaron remodelado inverso del VI durante el seguimiento, siendo el pronóstico de este grupo significativamente mejor. La presencia de un mejor GF al final, un menor número de arterias con enfermedad severa, una IMI de menor cuantía al final del seguimiento y un mayor tiempo libre de eventos fueron predictores independientes de remodelado inverso. El remodelado inverso del VI así como un menor tiempo para conseguirlo fueron factores independientes a la hora de identificar a los pacientes con un mejor pronóstico

Providing choice increases children's vegetable intake

This work has been partially supported by the pre-doctoral fellowship of Junta de Andalucía, grant HUM-02763 (Junta de Andalucía, Spain) and PSI2011-23702; PSI2012-31641 (MINECO, Spain).One hundred and fifty children between 4 and 6 years old were studied to examine the effect of providing them with a choice of vegetables on their vegetable consumption. Offering vegetable choice was expected to increase the children’s vegetable intake due to increased personal autonomy. The option for the children to choose the vegetables to ingest was varied across three different conditions. Within the discrete choice condition (DCC), children could choose the target vegetable at the beginning of the meal; within the continued discrete choice plus variety condition (CDCP), children were exposed to a variety of vegetables (zucchini and green beans), so that they could choose the target vegetable whenever they made a bite during the whole meal. Within the no-choice condition (NCC), children were alternately exposed to only one kind of vegetable, so that no choice possibility was provided. The choice conditions (CDCP and DCC) were associated with higher vegetable intake, in comparison to the no-choice control condition (NCC). No significant differences were found between the DCC and the CDCP regarding participants’ total vegetable intake. These results demonstrate the enhancing effect of providing choice to increase vegetable intake in young children. A higher degree of personal control and consequent level of intrinsic motivation is hypothesized to underlie the effect of choice availability.Junta de Andalucía, grant HUM-02763PSI2011-23702; PSI2012-31641 (MINECO, Spain

¿Qué tengo que saber para medir bien el ventrículo derecho por ecocardiograma?

Right ventricle echocardiographic evaluation is technically complex, affecting sometimes its quality in standard studies. This review article focuses on how to properly measure and interpretate the most commonly use echocardiographic parameters, taking into account its particularities, indications and limitations in our daily clinical practice.La dificultad técnica de la valoración del ventrículo derecho por medio de la imagen y, especialmente por ecocardiografía, hace que su evaluación quede relegada a un segundo plano en numerosas ocasiones. Este artículo de revisión se centra de forma específica en las particularidades del estudio del ventrículo derecho por ecocardiografía, sus indicaciones y limitaciones, así como el modo de interpretación de los principales parámetros empleados en la práctica clínica diaria

CD45 expression discriminates waves of embryonic megakaryocytes in the mouse

Embryonic megakaryopoiesis starts in the yolk sac on gestational day 7.5 as part of the primitive wave of hematopoiesis, and it continues in the fetal liver when this organ is colonized by hematopoietic progenitors between day 9.5 and 10.5, as the definitive hematopoiesis wave. We characterized the precise phenotype of embryo megakaryocytes in the liver at gestational day 11.5, identifying them as CD41++CD45-CD9++CD61+MPL+CD42c+ tetraploid cells that express megakaryocyte-specific transcripts and display differential traits when compared to those present in the yolk sac at the same age. In contrast to megakaryocytes from adult bone marrow, embryo megakaryocytes are CD45- until day 13.5 of gestation, as are both the megakaryocyte progenitors and megakaryocyte/erythroid-committed progenitors. At gestational day 11.5, liver and yolk sac also contain CD41+CD45+ and CD41+CD45- cells. These populations, and that of CD41++CD45-CD42c+ cells, isolated from liver, differentiate in culture into CD41++CD45-CD42c+ proplatelet-bearing megakaryocytes. Also present at this time are CD41-CD45++CD11b+ cells, which produce low numbers of CD41++CD45-CD42c+ megakaryocytes in vitro, as do fetal liver cells expressing the macrophage-specific Csf receptor-1 (Csf1r/CD115) from MaFIA transgenic mice, which give rise poorly to CD41++CD45-CD42c+ embryo megakaryocytes both in vivo and in vitro In contrast, around 30% of adult megakaryocytes (CD41++CD45++CD9++CD42c+) from C57BL/6 and MaFIA mice express CD115. We propose that differential pathways operating in the mouse embryo liver at gestational day 11.5 beget CD41++CD45-CD42c+ embryo megakaryocytes that can be produced from CD41+CD45- or from CD41+CD45+ cells, at difference from those from bone marrow.This work was supported by grants from the Ministerio de Ciencia e Innovacion (MICINN SAF2009-12596) and from the Ministerio de Economia y Competitividad (MINECO SAF2012-33916 and SAF2015-70880-R MINECO/FEDER). NS was the recipient of a fellowship from the Centro de Biologia Molecular Severo Ochoa (CBMSO) and IC received a fellowship from the MICINN. The CBMSO receives institutional funding from Fundacion Ramon Areces. The CNIC is supported by the MEIC and the Pro CNIC Foundation, and is a Severo Ochoa Center of Excellence (MEIC award SEV-2015-0505).S

Proyectiles en ventrículo derecho. ¿Sin puerta de entrada?

The presence of intracardiac foreign bodies and their treatment are still a controversial issue given the variety of locations, the different clinical manifestations and the prognostic implications. The number of published cases in which there is no direct entrance site of the foreign body to the cardiac cavities, diagnosing or assuming theirembolization, is much more limited. We present the case of an adult male with cervical firearm wound, and two foreign bodies in the right ventricle without a direct entry door.La presencia de cuerpos extraños intracardiacos y su tratamiento suponen todavía un tema controvertido dada la variedad de localizaciones en las que se puede presentar y las diferentes manifestaciones clínicas e implicaciones pronósticas de cada una de ellas. El número de casos publicados en los que no existe puerta de entrada directa del cuerpo a las cavidades cardiacas, diagnosticando o asumiendo su embolización a distancia, es mucho más reducido. Presentamos el caso de un varón adulto con herida cervical por arma de fuego y dos cuerpos extraños alojados en ventrículo derecho sin puerta de entrada directa

Biogeofilter with hydrothermal treated stevensite clay and laccase enzymes for retention and degradation of tetracycline

The concentration of antibiotics in surface water is an issue of high concern. The present study aims to manufacture and evaluate a biogeofilter, with stevensite clay and enzymes immobilized on it, for the adsorption and degradation of tetracycline-based antibiotics. To retain the small particle aggregates of the clay in the filter, a hydrothermal treatment was applied to the stevensite, prior to compaction in pellets and its insertion into a cylindric cell, mixed with sand. The structure of the pellets avoids the loss of the clay material during the fluid transport through the porous medium. Several temperature treatments were applied to the pellets, but the treatment at 300 °C was revealed as the best option. Laccase enzymes were immobilized on the stevensite surface. Reactive transport experiments of tetracycline solutions were performed through the transport cells. The biogeofilter has a relevant adsorption capacity with a significant degradation factor. By modelling with STANMOD software, the hydrodynamic characteristics of the transport were determined and, therefore, the behaviour of a large-scale filter and transports of low tetracycline concentrations could be predicted. The results obtained are promising for irrigation systems at medium scale, as well as for the perspective of wastewater treatment plants at large scaleThis work was supported by the Spanish State Research Agency (Project PDC2021-120744-I00). Adrien Saphy’s stay in Madrid was funded by an Erasmus gran

La influencia de las TICs en la rentabilidad, productividad y calidad de los servicios del sector hotelero andaluz

El objetivo del presente trabajo es determinar el grado de influencia de un conjunto de aspectos relacionados con las Tecnologías de la Información y de las Comunicaciones sobre la productividad, rentabilidad y calidad de los servicios ofrecidos por el sector hotelero andaluz. Para ello, se ha recogido información, a través de una encuesta a directivos, de una muestra de hoteles seleccionada de forma que se asegure la representatividad de los diferentes tipos de establecimientos. Como resultado de ello, se pone de manifiesto, entre otras cuestiones, que los aspectos analizados influyen de forma importante en todos los establecimientos, excepto en el conjunto de hoteles de una o dos estrellas, hostales y pensiones y hoteles-apartamentos de menos de tres llaves, en los que los directivos parecen ser conscientes de la existencia de un desfase entre las necesidades reales de informatización de los procesos y el grado de implantación actual de éstos.Consejería de Turismo, Comercio y Deporte de la Junta de Andalucí

Control of occult hepatitis B virus infection

Background: The diagnosis of hepatitis B virus (HBV) infection requires HBV DNA testing and serologic testing for detection of the surface antigen (HBsAg) and the hepatitis B core antibody (anti-HBc). There is a population of patients with occult HBV infection (OBI), which is not detected by HBsAg or HBV DNA quantification in blood, despite the presence of active replication in the liver.Scope: This document provides a definition of OBI and describes the diagnostic techniques currently used. It also addresses the detection of patients with risk factors and the need for screening for OBI in these patients.Summary:Correct diagnosis of OBI prevents HBV reactivation and transmission. Diagnosis of OBI is based on the detection of HBV DNA in patients with undetectable HBsAg in blood.Perspectives: A high number of patients with OBI may remain undiagnosed; therefore, screening for OBI in patients with factor risks is essential. For a correct diagnosis of OBI, it is necessary that new markers such as ultrasensitive HBsAg are incorporated, and a more comprehensive marker study is performed by including markers such as cccDNA

Statistical Evaluation of Metaproteomics and 16S rRNA Amplicon Sequencing Techniques for Study of Gut Microbiota Establishment in Infants with Cystic Fibrosis

Newborn screening for cystic fibrosis (CF) can identify affected but asymptomatic infants. The selection of omic technique for gut microbiota study is crucial due to both the small amount of feces available and the low microorganism load. Our aims were to compare the agreement between 16S rRNA amplicon sequencing and metaproteomics by a robust statistical analysis, including both presence and abundance of taxa, to describe the sequential establishment of the gut microbiota during the first year of life in a small size sample (8 infants and 28 fecal samples). The taxonomic assignations by the two techniques were similar, whereas certain discrepancies were observed in the abundance detection, mostly the lower predicted relative abundance of Bifidobacterium and the higher predicted relative abundance of certain Firmicutes and Proteobacteria by amplicon sequencing. During the first months of life, the CF gut microbiota is characterized by a significant enrichment of Ruminococcus gnavus, the expression of certain virulent bacterial traits, and the detection of human inflammation-related proteins. Metaproteomics provides information on composition and functionality, as well as data on host-microbiome interactions. Its strength is the identification and quantification of Actinobacteria and certain classes of Firmicutes, but alpha diversity indices are not comparable to those of amplicon sequencing. Both techniques detected an aberrant microbiota in our small cohort of infants with CF during their first year of life, dominated by the enrichment of R. gnavus within a human inflammatory environment. IMPORTANCE In recent years, some techniques have been incorporated for the study of microbial ecosystems, being 16S rRNA gene sequencing being the most widely used. Metaproteomics provides the advantage of identifying the interaction between microorganisms and human cells, but the available databases are less extensive as well as imprecise. Few studies compare the statistical differences between the two techniques to define the composition of an ecosystem. Our work shows that the two methods are comparable in terms of microorganism identification but provide different results in alpha diversity analysis. On the other hand, we have studied newborns with cystic fibrosis, for whom we have described the establishment of an intestinal ecosystem marked by the inflammatory response of the host and the enrichment of Ruminococcus gnavus