El cambio de uso del terreno forestal incendiado: ley de montes, normativa autonómica y generación legal de incentivos perversos

La actual redacción del artículo 50.1 de la Ley de Montes es suficiente para evitar la generación intencionada de incendios con fines crematísticos. Una redacción más restrictiva del mismo generaría incentivos perversos en los administrados.The current wording of Article 50.1 of the Forestry Act is sufficient to prevent the starting of fires with profit interests. Wording it more narrowly would generate perverse incentives for the public

Preoperative Extracorporeal Membrane Oxygenation for Severe Ischemic Mitral Regurgitation - 2 case reports -

Indication for extracorporeal membrane oxygenation (ECMO) has been extended as the experience of ECMO in various clinical settings accumulates and the outcome after ECMO installation improves. We report two cases of successful mitral valve surgery for severe ischemic mitral regurgitation in patients on ECMO support for cardiogenic shock which developed upon coronary angiography

Earlier Application of Percutaneous Cardiopulmonary Support Rescues Patients from Severe Cardiopulmonary Failure Using the APACHE III Scoring System

Percutaneous cardiopulmonary support (PCPS) is a widely accepted treatment for severe cardiopulmonary failure. This system, which uses a percutaneous approach and autopriming devices, can be rapidly applied in emergency situations. We sought to identify the risk factors that could help predict in-hospital mortality, and to assess its outcomes in survivors. During a 2-yr period, 50 patients underwent PCPS for the treatment of severe cardiopulmonary failure, and of those, 22 (44%) were classified as survivors and 28 (56%) as non-survivors. We compared the 2 groups for risk factors of in-hospital mortality and to establish proper PCPS timing. Twenty patients underwent PCPS for acute myocardial infarction, 20 for severe cardiopulmonary failure after cardiac surgery, 7 for acute respiratory distress syndrome, and 3 for acute myocarditis. Multivariate analysis showed that an acute physiology, age, and chronic health evaluation (APACHE) III score ≥50 prior to PCPS was the only significant predictor of in-hospital mortality (P=0.001). Overall 18-month survival was 42.2%. Cox analysis showed patients with APACHE III scores ≥50 had a poor prognosis (P=0.001). Earlier application of PCPS, and other preemptive strategies designed to optimize high-risk patients, may improve patient outcomes. Identifying patients with high APACHE scores at the beginning of PCPS may predict in-hospital mortality. Survivors, particularly those with higher APACHE scores, may require more frequent follow-up to improve overall survival

The Usefulness of Coregistration with iFR in Tandem or Long Diffuse Coronary Lesions: The iLARDI Randomized Clinical Trial

Background. Despite technical advancements, patients with sequential or diffuse coronary lesions undergoing percutaneous coronary intervention (PCI) have an increased risk of cardiovascular events at follow-up. We aimed to analyze the utility of a SyncVision/iFR (S-iFR)-guided PCI strategy versus an angiography-guided strategy in patients with this type of lesions. Methods. Randomized, multicenter, controlled, and open-label trial to compare S-iFR versus angiography-guided PCI in patients with sequential or diffuse angiographic coronary stenosis (ClinicalTrials.gov identifier: NCT04283734). The primary endpoint was the implanted stent length. The main secondary endpoint was targeting vessel failure (TVF) at one year. Results. A total of 100 patients underwent randomization, with 49 patients assigned to the S-iFR group and 51 to the angiography-guided PCI group. There were no differences between groups regarding clinical and anatomical characteristics. The baseline iFR was 0.71 } 0.16 vs. 0.67 } 0.19 (p = 0.279) in the S-iFR and angiography group, respectively. The mean lesion length was 42.3 } 12 mm and 39.8 } 12 (p = 0.297). The implanted stent length was 32.7 } 17.2 mm in the S-iFR group and 43.1 } 14.9 mm in the angiography group (mean difference, −10.4 mm; 95% confidence interval [CI], −16.9 to −4.0; p = 0.002). At one year, target vessel failure (TVF) occurred in four patients: three (6.1%) in the S-iFR group vs. one (1.9%) in the angiography group (p = 0.319). Conclusions. Among patients with sequential or long diffuse coronary lesions, a S-iFR-guided PCI strategy resulted in a reduction of the total stent length compared to an angiography-guided PCI strategy. A nonsignificant increase in TVF was observed in the S-iFR group

Validation of quantitative flow ratio-derived virtual angioplasty with post-angioplasty fractional flow reserve—the QIMERA-I study

Producción CientíficaBackground: Quantitative flow ratio (QFR) virtual angioplasty with pre-PCI residual QFR showed better results compared with an angiographic approach to assess post-PCI functional results. However, correlation with pre-PCI residual QFR and post-PCI fractional flow reserve (FFR) is lacking. Methods: A multicenter prospective study including consecutive patients with angiographically 50–90% coronary lesions and positive QFR results. All patients were evaluated with QFR, hyperemic and non-hyperemic pressure ratios (NHPR) before and after the index PCI. Pre-PCI residual QFR (virtual angioplasty) was calculated and compared with post-PCI fractional flow reserve (FFR), QFR and NHPR. Results: A total of 84 patients with 92 treated coronary lesions were included, with a mean age of 65.5 ± 10.9 years and 59% of single vessel lesions being the left anterior descending artery in 69%. The mean vessel diameter was 2.82 ± 0.41 mm. Procedural success was achieved in all cases, with a mean number of implanted stents of 1.17 ± 0.46. The baseline QFR value was 0.69 ± 0.12 and baseline FFR and NHPR were 0.73 ± 0.08 and 0.82 ± 0.11, respectively. Mean post-PCI FFR increased to 0.87 ± 0.05 whereas residual QFR had been estimated as 0.95 ± 0.05, showing poor correlation with post-PCI FFR (0.163; 95% CI:0.078–0.386) and low diagnostic accuracy (30.9%, 95% CI:20–43%). Conclusions: In this analysis, the results of QFR-based virtual angioplasty did not seem to accurately correlate with post-PCI FFR

Use of a multimedia classroom with connection to Hemodynamic Laboratories for the comprehensive practical training of the medical student in the area of Cardiology

La aplicabilidad práctica de los conocimientos teóricos adquiridos durante las clases magistrales constituye una parte esencial en la formación del futuro médico. Sin embargo, las prácticas en quirófanos y en Laboratorios de Cardiología Intervencionista son deficientes. El aforo es limitado por motivos de seguridad. Además, la visibilidad es reducida y la comunicación entre el operador y el alumno puede ser difícil por la presencia del enfermo. Desarrollar un nuevo modelo de prácticas clínicas complementarias a las convencionales ayudaría a que los alumnos adquieran la capacitación básica requerida. El objetivo principal de este proyecto es conseguir que los alumnos obtengan una visión práctica e integral del paciente cardiológico, proporcionando las herramientas necesarias a través de un Aula Multimedia con conexión directa a los Laboratorios de Hemodinámica y a las bases de datos clínicos de la UGC de Cardiología del Hospital Universitario Reina Sofía. Esta acción de Innovación Docente pretende mejorar los procesos de enseñanza-aprendizaje de la Cardiología y realizar una simulación clínica del proceso de diagnóstico, tratamiento y alta hospitalaria de un paciente cardiológico. Adicionalmente, este sistema podría proporcionar al docente una herramienta objetiva para la evaluación de las prácticas clínicas de estudiantes del área de Ciencias de la Salud.The practical applicability of the theoretical knowledge acquired during the lectures constitutes an essential part of the training of the future doctor. However, the practices in operating rooms and Interventional Cardiology Laboratories are deficient. Capacity is limited for security reasons. In addition, visibility is reduced, and communication between the operator and the student can be difficult due to the patient's presence. Developing a new model of clinical practices complementary to conventional ones would help students acquire the basic training required. The main objective of this project is to ensure that students obtain a realistic and comprehensive view of the cardiology patient, providing the necessary tools through a Multimedia Classroom with a direct connection to the Hemodynamic Laboratories and the clinical databases of the UGC of Cardiology of the Reina Sofía University Hospital. This Teaching Innovation action aims to improve the teaching-learning processes of Cardiology and carry out a clinical simulation of the process of diagnosis, treatment, and hospital discharge of a cardiac patient. Additionally, this system could provide the teacher with an objective tool for evaluating the clinical practices of students in the area of Health Sciences

Drug eluting and bare metal stents in people with and without diabetes: collaborative network meta-analysis

Objective To compare the effectiveness and safety of three types of stents (sirolimus eluting, paclitaxel eluting, and bare metal) in people with and without diabetes mellitus