Observación de oportunidad de un Giro argelino al sur de Cabo de Palos (Mediterráneo sudoccidental)

Large anticyclonic eddies can detach from the Algerian Current, forming open-sea Algerian Eddies. These mesoscale structures have been intensively studied by means of sea surface temperature and altimetry data, and using numerical models. However, few studies describe an in situ sampling of their whole vertical structure. Furthermore, the area extending from Cape La Nao (western edge of the Balearic Channels) to the Almería-Orán Front has received very little attention, and it could be considered that there is a gap in our present oceanographic knowledge of this part of the western Mediterranean. An Algerian Eddy lasting for several months was detected in December 2021 to the south of Cape Palos. In order to analyse this eddy, an opportunity sampling was designed taking advantage of the periodic monitoring campaign RADMED 0222. This sampling revealed that the eddy had a baroclinic character, affecting the whole water column. These results suggest that this eddy was generated at the Algerian Current, finally affecting an area close to the eastern Spanish coast. The presence of these structures in this region of the western Mediterranean could alter the southward progression of the Northern Current and even the presence and structure of the Almería-Orán Front.Giros anticiclónicos de gran tamaño pueden desprenderse de la Corriente Argelina, llegando a formar giros en mar abierto. Estas estructuras de mesoescala han sido estudiadas intensamente mediante datos de temperatura superficial del mar, datos de altimetría, y modelos numéricos. Sin embargo, hay pocos trabajos que describan mediante medidas in situ la estructura vertical de estos giros. Al margen de esta circunstancia, la zona que se extiende desde el Cabo La Nao (en el extremo occidental de los Canales Baleares) hasta el Frente Almería-Orán, ha recibido poca atención, pudiéndose considerar que existe una laguna en nuestro conocimiento sobre la oceanografía de esta zona. Un giro anticiclónico fue detectado en diciembre de 2021 al sur de Cabo de Palos, pudiéndose observar durante varios meses. Para analizar este giro se diseñó un muestreo de oportunidad, aprovechando la campaña rutinaria RADMED0222. Este muestreo mostró la estructura baroclina del giro, la cual afectaba a toda su extensión vertical. Los resultados obtenidos también sugieren que el giro se formó en la Corriente Argelina, afectando finalmente a una zona próxima a la costa española. La presencia de este tipo de estructuras en esta región del Mediterráneo Occidental podría afectar a la progresión hacia el sur de la Corriente Septentrional, e incluso a la presencia y estructura del Frente Almería-Orán

Observations in the Spanish Mediterranean Waters: A Review and Update of Results of 30-Year Monitoring

The Instituto Español de Oceanografía (IEO, Spanish Institute of Oceanography) has maintained different monitoring programs in the Spanish Mediterranean waters (Western Mediterranean) since 1992. All these monitoring programs were unified in 2007 under the current program RADMED (series temporales de datos oceanográficos en el Mediterráneo), which is devoted to the in situ multidisciplinary sampling of the water column of coastal and open-sea waters by means of periodic oceanographic campaigns. These campaigns, together with a network of tide-gauges, are part of the IEO Observing system (IEOOS). In some cases, the temperature and salinity time series collected in the frame of these monitoring programs are now more than 30 years long, whereas sea level time series date to the beginning of the 1940s. This information has been complemented with international databases and has been analyzed in numerous works by the Grupo mediterráneo de Cambio Climático (GCC; Mediterranean Climate Change Group) for more than 20 years. These works have been devoted to the detection and quantification of the changes that climate change is producing on the physical, chemical, and biological properties of the Spanish Mediterranean waters. In this work, we review the results obtained by the GCC since 2005 in relation to the changes in the physical properties of the sea: water column temperature, salinity, and density, heat content, mixed layer depth, and sea level. Time series and results are updated from the last works, and the reliability of the existing time series for the detection of climatologies and long-term trends are analyzed. Furthermore, the different sources of uncertainty in the estimation of linear trends are considered in the present work. Besides this review and update of the results obtained from the data collected in the frame of the IEOOS, we conduct a review of the existing monitoring capabilities from other institutions in the Spanish Mediterranean waters and a review of results dealing with climate change in the Spanish Mediterranean obtained by such institutions. In particular, we include a review of the results obtained by SOCIB (Servicio de Observación y Predicción Costero de las Islas Baleares; Balearic Islands costal observing and forecasting system) in relation to the study of marine heat waves and the warming of the sea surface, and the results corresponding to the intense warming of the Catalan continental shelf at L’Estartit oceanographic station. All these results evidence that the surface Spanish Mediterranean waters are warming up at a rate higher than that affecting the global ocean (>2 °C/100 years). This warming and a salinity increase are also observed along the whole water column. Marine heat waves are increasing their intensity, frequency, and duration since 1982, and coastal sea level is increasing at a rate of 2.5 mm/yr. The salinity increase seems to have compensated for the warming, at least at surface and intermediate waters where no significant trends have been detected for the density. This could also be the reason for the lack of significant trends in the evolution of the mixed layer depth. All these results highlight the importance of monitoring the water column and the necessity of maintaining in situ sampling programs, which are essential for the study of changes that are occurring throughout the Spanish Mediterranean waters

Expression of CD20 after viral reactivation renders HIV-reservoir cells susceptible to Rituximab

The identification of exclusive markers to target HIV-reservoir cells will represent a significant advance in the search for therapies to cure HIV. Here, we identify the B lymphocyte antigen CD20 as a marker for HIV-infected cells in vitro and in vivo. The CD20 molecule is dimly expressed in a subpopulation of CD4-positive (CD4) T lymphocytes from blood, with high levels of cell activation and heterogeneous memory phenotypes. In lymph node samples from infected patients, CD20 is present in productively HIV-infected cells, and ex vivo viral infection selectively upregulates the expression of CD20 during early infection. In samples from patients on antiretroviral therapy (ART) this subpopulation is significantly enriched in HIV transcripts, and the anti-CD20 monoclonal antibody Rituximab induces cell killing, which reduces the pool of HIV-expressing cells when combined with latency reversal agents. We provide a tool for targeting this active HIV-reservoir after viral reactivation in patients while on ART

Experiencia multicéntrica con prótesis valvular aórtica transcatéter de segunda generación reposicionable y recuperable

Introduction and objectives: The Lotus Valve device (Boston Scientific) is a second-generation fully-retrievable and repositionable transcatheter aortic valve. We report the initial multicenter experience with the Lotus valve in the management of patients with severe aortic stenosis. Methods: Observational study that described the short and long-term results of implanting the Lotus valve in 8 Spanish and Portuguese centers from March 2014 through April 2016. Results: The study included 102 patients (mean age 80.4 ± 6.1 years; STS score 5.2% ± 3.3%) with severe symptomatic aortic stenosis (mean aortic valve area 0.66 ± 0.17 cm2, aortic gradients 74.3 / 45.6 mmHg). The valve was successfully implanted in 100 patients (98%), with significant improvement in both the peak and mean aortic valve gradients and with only one patient showing moderate paravalvular regurgitation. Upon hospital discharge, mortality rate was 3.9% while the stroke rate was 2.9%. No cases of valve embolization, ectopic valve deployment or additional valve implantation (valve-in-valve) were seen. Thirty-three patients (32.3%) received a permanent pacemaker. Conclusions: The Lotus Valve System is effective and safe for the management of patients with severe symptomatic aortic stenosis. In particular, considering the low rate of periprosthetic regurgitation and lack of complications like embolization or ectopic valve deployment; however at the expense of a high pacemaker implantation rate.Introducción y objetivos: El dispositivo Lotus (Boston Scientific, Estados Unidos) es una prótesis valvular aórtica transcatéter de segunda generación, completamente recuperable y reposicionable. Se presenta la experiencia inicial con la prótesis Lotus en un registro multicéntrico. Métodos: Estudio observacional que reporta los resultados a corto y largo plazo del implante transfemoral de prótesis Lotus entre marzo de 2014 y abril de 2016 en 8 centros de España y Portugal. Resultados: Se incluyeron 102 pacientes (edad media 80,4 ± 6,1 años, índice STS medio 5,2% ± 3,3%) con estenosis aórtica grave sintomática (área valvular media 0,66 ± 0,17 cm2, gradientes 74,3/45,6 mmHg). Se implantó con éxito el dispositivo en 100 pacientes (98%), con mejoría significativa de los gradientes máximo y medio valvular, y un solo caso de regurgitación periprotésica moderada. No hubo ninguna embolización ni necesidad de implante de una nueva prótesis intravalvular. Hasta el alta hospitalaria, la mortalidad fue del 3,9% y la tasa de ictus fue del 2,9%. En 33 pacientes (32,3%) fue necesario el implante de marcapasos definitivo. Conclusiones: La válvula Lotus es eficaz y segura para el tratamiento de pacientes con estenosis aórtica grave sintomática. Destacan la escasa tasa de insuficiencia periprotésica y la ausencia de complicaciones derivadas del mal posicionamiento o la embolización de la prótesis, a costa de un alta incidencia de implante de marcapasos

Identification and recognition of occupational diseases in seven public hospitals in Spain

Antecedentes: La infra-notificación y reconocimiento de enfermedad profesional (EP) es un problema secular en España y demás países europeos. El proyecto de Carga de la Enfermedad Profesional en España (CEPS) pretende contribuir a resolver este problema. Objetivo: Describir el proceso de identificación y reconocimiento de EP en siete hospitales españoles entre 2017 y 2019. Material y Métodos: En los siete hospitales que participan en el estudio se creó una unidad de patología laboral (UPL) la cual estimulaba en los servicios asistenciales la identificación de posibles EP atendidas en el hospital. Los pacientes confirmados por la UPL fueron acompañados en el proceso de reconocimiento. Resultados: En este periodo fueron derivados 308 casos, y en 154 (62%) se confirmó la sospecha EP. De éstos, 78 (65%) han sido reconocidos. La tasa de confirmación (casos confirmados/ derivados) varió según hospitales (de un 25% en el Badalona Serveis Assistencials a un 100% en el Hospital Universitario Fundación Jiménez Díaz) y grupos de diagnósticos (de un 13% para trastornos musculoesqueléticos a un 100% para patologías varias). La tasa de reconocimiento (casos confirmados/casos reconocidos) varió según centro, diagnóstico, sexo y edad, siendo más alta en mujeres, con ≥ 55 años y diagnosticados con patologías varias (oculares, infecciosas, mentales, entre otras). Conclusión: Las UPL contribuyen significativamente en el proceso de identificación y reconocimiento de EP, lo que los pacientes posiblemente no hubieran obtenido de otra forma.Background: Under-reporting and recognition of occupational disease (OD) is a secular problem in Spain and other European countries. The burden of occupational disease in Spain project (CEPS) aims to contribute. Objective: To describe the process of identification and recognition of OD in seven Spanish between 2017 and 2020. Material and Methods: In the seven hospitals that participate in the study an occupational pathology unit (OPU) was created. The OPU encouraged the healthcare services to identify possible OD treated in the hospital. The patients confirmed by the OPU were accompanied in the recognition process. Results: 308 cases were referred in this period and 154 OD was confirmed (62%). Of these, 78 have been recognized (65%). The confirmation rate (confirmed/ referred cases) varied according to hospitals (from 25% at the Badalona Serveis Assistencials to 100% at the Hospital Universitario Fundación Jiménez Díaz) and diagnosis groups (from 13% for musculoskeletal disorders to 100% for various pathologies). The recognition rate (confirmed/ recognized cases) varied according to hospitals, diagnosis, sex and age, being higher in women, aged ≥ 55 years and diagnosed with various pathologies (ocular, infectious, mental, among others). Conclusion: OPU contribute significantly in the process of identification and recognition of OD, which the patients might not have obtained otherwise

Prosthetic Mitral Surgical Valve in Transcatheter Aortic Valve Replacement Recipients: A Multicenter Analysis.

The aim of this study was to determine the prognosis and specific complications of patients with prosthetic mitral valves (PMVs) undergoing transcatheter aortic valve replacement (TAVR). TAVR is performed relatively often in patients with PMVs, but specific risks are not well described. A multicenter analysis was conducted, including patients with severe symptomatic aortic stenosis who underwent TAVR at 10 centers. Patients' clinical characteristics and outcomes were evaluated according to the presence of a PMV. The mean age of the study population (n = 2,414) was 81 ± 8 years, and 48.8% were men. A total of 91 patients (3.77%) had PMVs. They were more commonly women, younger, and had higher surgical risk. PMVs were implanted a median of 14 years before TAVR, and most patients had mechanical prostheses (73.6%). Eighty-six patients (94.5%) were on long-term vitamin K inhibitor therapy, and bridging antithrombotic therapy was administered in 59 (64.8%). TAVR device embolization occurred in 6.7% (vs. 3.3% in the non-PMV group; p = 0.127), in all instances when distance between the PMV and the aortic annulus was  TAVR presents similar mortality irrespective of the presence of a PMV. However, patients with PMVs had higher bleeding risk that was independently associated with higher mortality. Risk for valve embolization was relatively high, but it occurred only in patients with PMV-to-aortic annulus distances

Permanent pacemaker implantation after transcatheter aortic valve implantation: impact on late clinical outcomes and left ventricular function.

Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't;BACKGROUND Very few data exist on the clinical impact of permanent pacemaker implantation (PPI) after transcatheter aortic valve implantation. The objective of this study was to assess the impact of PPI after transcatheter aortic valve implantation on late outcomes in a large cohort of patients. METHODS AND RESULTS A total of 1556 consecutive patients without prior PPI undergoing transcatheter aortic valve implantation were included. Of them, 239 patients (15.4%) required a PPI within the first 30 days after transcatheter aortic valve implantation. At a mean follow-up of 22±17 months, no association was observed between the need for 30-day PPI and all-cause mortality (hazard ratio, 0.98; 95% confidence interval, 0.74-1.30; P=0.871), cardiovascular mortality (hazard ratio, 0.81; 95% confidence interval, 0.56-1.17; P=0.270), and all-cause mortality or rehospitalization for heart failure (hazard ratio, 1.00; 95% confidence interval, 0.77-1.30; P=0.980). A lower rate of unexpected (sudden or unknown) death was observed in patients with PPI (hazard ratio, 0.31; 95% confidence interval, 0.11-0.85; P=0.023). Patients with new PPI showed a poorer evolution of left ventricular ejection fraction over time (P=0.017), and new PPI was an independent predictor of left ventricular ejection fraction decrease at the 6- to 12-month follow-up (estimated coefficient, -2.26; 95% confidence interval, -4.07 to -0.44; P=0.013; R(2)=0.121). CONCLUSIONS The need for PPI was a frequent complication of transcatheter aortic valve implantation, but it was not associated with any increase in overall or cardiovascular death or rehospitalization for heart failure after a mean follow-up of ≈2 years. Indeed, 30-day PPI was a protective factor for the occurrence of unexpected (sudden or unknown) death. However, new PPI did have a negative effect on left ventricular function over time.Yes2014-10-0

Warfarin and Antiplatelet Therapy Versus Warfarin Alone for Treating Patients With Atrial Fibrillation Undergoing Transcatheter Aortic Valve Replacement

OBJECTIVES: The study sought to examine the risk of ischemic events and bleeding episodes associated with differing antithrombotic strategies in patients undergoing transcatheter aortic valve replacement (TAVR) with concomitant atrial fibrillation (AF). BACKGROUND: Guidelines recommend antiplatelet therapy (APT) post-TAVR to reduce the risk of stroke. However, data on the efficacy and safety of this recommendation in the setting of a concomitant indication for oral anticoagulation (due to atrial fibrillation [AF]) with a vitamin K antagonist (VKA) are scarce. METHODS: A multicenter evaluation comprising 621 patients with AF undergoing TAVR was undertaken. Post-TAVR prescriptions were used to determine the antithrombotic regimen used according to the following 2 groups: monotherapy (MT) with VKA (n = 101) or multiple antithrombotic therapy (MAT) with VKA plus 1 or 2 antiplatelet agents (aspirin or clopidogrel; n = 520). Endpoint definitions were in accordance with Valve Academic Research Consortium-2 criteria. The rate of stroke, major adverse cardiovascular events (stroke, myocardial infarction, or cardiovascular death), major or life-threatening bleeding events, and death were assessed by a Cox multivariate model regression survival analysis according to the antithrombotic regime used. RESULTS: During a median follow-up of 13 months (interquartile range: 3 to 31 months) there were no differences between groups in the rate of stroke (MT: 5%, MAT: 5.2%; adjusted hazard ratio [HR]: 1.25; 95% confidence interval [CI]: 0.45 to 3.48; p = 0.67), major adverse cardiovascular events (MT: 13.9%, MAT: 16.3%; adjusted HR: 1.33; 95% CI: 0.75 to 2.36; p = 0.33), and death (MT 22.8%, MAT: 19.2%; adjusted HR: 0.93; 95% CI: 0.58 to 1.50; p = 0.76). A higher risk of major or life-threatening bleeding was found in the MAT group (MT: 14.9%, MAT: 24.4%; adjusted HR: 1.85; 95% CI: 1.05 to 3.28; p = 0.04). These results remained similar when patients receiving VKA plus only 1 antiplatelet agent (n = 463) were evaluated. CONCLUSIONS: In TAVR recipients prescribed VKA therapy for AF, concomitant antiplatelet therapy use appears not to reduce the incidence of stroke, major adverse cardiovascular events, or death, while increasing the risk of major or life-threatening bleeding

Impact of renin-angiotensin system inhibitors on clinical outcomes and ventricular remodelling after transcatheter aortic valve implantation: rationale and design of the RASTAVI randomised multicentre study.

Transcatheter aortic valve implantation (TAVI) as a treatment in severe aortic stenosis (AS) is an excellent alternative to conventional surgical replacement. However, long-term outcomes are not benign. Renin-angiotensin system (RAS) blockade has shown benefit in terms of adverse remodelling in severe AS and after surgical replacement. The RAS blockade after TAVI (RASTAVI) trial aims to detect if there is a benefit in clinical outcomes and ventricular remodelling with this therapeutic strategy following the TAVI procedure. The study has been designed as a randomised 1:1 open-label study that will be undertaken in 8 centres including 336 TAVI recipients. All patients will receive the standard treatment. The active treatment group will receive ramipril as well. Randomisation will be done before discharge, after signing informed consent. All patients will be followed up for 3 years. A cardiac magnetic resonance will be performed initially and at 1 year to assess ventricular remodelling, defined as ventricular dimensions, ejection fraction, ventricular mass and fibrosis. Recorded events will include cardiac death, admission due to heart failure and stroke. The RASTAVI Study will improve the management of patients after TAVI and may help to increase their quality of life, reduce readmissions and improve long-term survival in this scenario. All authors and local ethics committees have approved the study design. All patients will provide informed consent. Results will be published irrespective of whether the findings are positive or negative. NCT03201185