Complete Revascularization of Stable STEMI Patients Offers a Significant Benefit if Done During the Index PCI, but Not if It\u27s Done as a Staged Procedure

Background: Complete revascularization (CR) of hemodynamically stable STEMI improves outcomes when compared to culprit-only PCI. However, the optimal timing for CR (CR during index PCI [iCR] versus staged PCI [sCR]) is unknown. sCR is defined as revascularization of non-culprit lesions not done during the index procedure (mean 31.5±24.6 days after STEMI). Our goal was to determine whether iCR was the superior strategy when compared to sCR. Methods: A systematic review of Medline, Cochrane, and Embase was performed for RCTs reporting outcomes of stable STEMI patients who had undergone CR. Only RCTs with a clearly defined timing of CR, for the classification into iCR and sCR, and a follow-up of at least 12 months were included. Seven RCTs comprising 6647 patients (mean age:62.9±1.4 years, male sex:79.4%) met these criteria and were included. Results: After a mean follow-up of 25.1±9.4 months, iCR was associated with a significant reduction in cardiovascular mortality (risk ratio [RR] 0.48, 95% confidence interval [CI] 0.26-0.90, p=0.02, relative risk reduction [RRR] 52%) and non-fatal reinfarctions (RR 0.42, 95% CI 0.25-0.70, p=0.001, RRR: 58%). sCR showed a significant reduction in non-fatal reinfarctions only (RR 0.68, 95% CI 0.54-0.85, p=0.0008, RRR: 32%). There was no difference in the safety outcome of contrast-induced nephropathy between groups. Conclusion: iCR of stable STEMI patients is associated with a significant reduction in cardiovascular death and a trend towards reduction in all-cause mortality. These benefits are not seen in sCR. Both strategies are associated with a reduction in non-fatal reinfarctions

Retinoic acid reduces human neuroblastoma cell migration and invasiveness: effects on DCX, LIS1, neurofilaments-68 and vimentin expression

<p>Abstract</p> <p>Background</p> <p>Neuroblastoma is a severe pediatric tumor, histologically characterised by a variety of cellular phenotypes. One of the pharmacological approaches to neuroblastoma is the treatment with retinoic acid. The mechanism of action of retinoic acid is still unclear, and the development of resistance to this differentiating agent is a great therapy problem.</p> <p>Doublecortin, a microtubule-associated protein involved in neuronal migration, has recently been proposed as a molecular marker for the detection of minimal residual disease in human neuroblastoma. Nevertheless, no information is available on the expression of doublecortin in the different cell-types composing human neuroblastoma, its correlation with neuroblastoma cell motility and invasiveness, and the possible modulations exerted by retinoic acid treatment.</p> <p>Methods</p> <p>We analysed by immunofluorescence and by Western blot analysis the presence of doublecortin, lissencephaly-1 (another protein involved in neuronal migration) and of two intermediate filaments proteins, vimentin and neurofilament-68, in SK-N-SH human neuroblastoma cell line both in control conditions and under retinoic acid treatment. Migration and cell invasiveness studies were performed by wound scratch test and a modified microchemotaxis assay, respectively.</p> <p>Results</p> <p>Doublecortin is expressed in two cell subtypes considered to be the more aggressive and that show high migration capability and invasiveness.</p> <p>Vimentin expression is excluded by these cells, while lissencephaly-1 and neurofilaments-68 are immunodetected in all the cell subtypes of the SK-N-SH cell line. Treatment with retinoic acid reduces cell migration and invasiveness, down regulates doublecortin and lissencephaly-1 expression and up regulates neurofilament-68 expression. However, some cells that escape from retinoic acid action maintain migration capability and invasiveness and express doublecortin.</p> <p>Conclusion</p> <p>a) Doublecortin is expressed in human neuroblastoma cells that show high motility and invasiveness;</p> <p>b) Retinoic acid treatment reduces migration and invasiveness of the more aggressive cell components of SK-N-SH cells;</p> <p>c) The cells that after retinoic acid exposure show migration and invasive capability may be identified on the basis of doublecortin expression.</p

Omecamtiv mecarbil in chronic heart failure with reduced ejection fraction, GALACTIC‐HF: baseline characteristics and comparison with contemporary clinical trials

Aims: The safety and efficacy of the novel selective cardiac myosin activator, omecamtiv mecarbil, in patients with heart failure with reduced ejection fraction (HFrEF) is tested in the Global Approach to Lowering Adverse Cardiac outcomes Through Improving Contractility in Heart Failure (GALACTIC‐HF) trial. Here we describe the baseline characteristics of participants in GALACTIC‐HF and how these compare with other contemporary trials. Methods and Results: Adults with established HFrEF, New York Heart Association functional class (NYHA) ≥ II, EF ≤35%, elevated natriuretic peptides and either current hospitalization for HF or history of hospitalization/ emergency department visit for HF within a year were randomized to either placebo or omecamtiv mecarbil (pharmacokinetic‐guided dosing: 25, 37.5 or 50 mg bid). 8256 patients [male (79%), non‐white (22%), mean age 65 years] were enrolled with a mean EF 27%, ischemic etiology in 54%, NYHA II 53% and III/IV 47%, and median NT‐proBNP 1971 pg/mL. HF therapies at baseline were among the most effectively employed in contemporary HF trials. GALACTIC‐HF randomized patients representative of recent HF registries and trials with substantial numbers of patients also having characteristics understudied in previous trials including more from North America (n = 1386), enrolled as inpatients (n = 2084), systolic blood pressure &lt; 100 mmHg (n = 1127), estimated glomerular filtration rate &lt; 30 mL/min/1.73 m2 (n = 528), and treated with sacubitril‐valsartan at baseline (n = 1594). Conclusions: GALACTIC‐HF enrolled a well‐treated, high‐risk population from both inpatient and outpatient settings, which will provide a definitive evaluation of the efficacy and safety of this novel therapy, as well as informing its potential future implementation

POSTPROCEDURAL MONOTHERAPY WITH ASPIRIN VS DAPT AFTER TAVI - AN UPDATED META-ANALYSIS OF RANDOMIZED, CONTROL TRIALS

Background: Multiple studies have evaluated whether monotherapy with aspirin is superior to DAPT in patients who have undergone transcatheter aortic valve implantation (TAVI). Methods: A systematic review of Medline, Cochrane, and Embase was performed for RCTs that reported outcomes of patients undergoing TAVI who received post-procedural aspirin only vs those who received DAPT. Four RCTs met the eligibility criteria. Results: This meta-analysis includes 1,086 patients with a mean age 80.0±0.75 years; 50.3% were male. After a mean follow-up of 9.0±3.5 months, there was a significant benefit in the aspirin only group, when compared with the DAPT group, in all bleeding events (Risk Ratio [RR] 0.58, 95% Confidence Interval [CI] 0.44-0.76, p\u3c0.0001, relative risk reduction [RRR] 42%, absolute risk reduction [ARR] 9.1%). No statistically significant differences between groups were found in the other outcomes: all-cause mortality (RR 1.01, 95% CI 0.63-1.61, p=0.97), cardiovascular mortality (RR 1.07, 95% CI 0.54-2.12, p=0.84) or all stroke (RR 0.93, 95% CI 0.54-1.61, p=0.79). Conclusion: Monotherapy with aspirin following TAVI is associated with a lower risk of all bleeding events when compared with post-procedural DAPT. No differences between groups were seen in the other studied outcomes. However, the short mean follow-up period is an important limitation of the present study. Further studies with longer follow-up periods are needed before changes are implemented in the current TAVI guidelines%

Incidencia de la educación física en niños con Sindrome de Down de Séptimo y Octavo Básico

Tesis (Profesor de Educación Física para la Enseñanza Básica, Licenciado en Educación)La presente investigación tiene como propósito mostrar lo importante que puede llegar a ser la Educación Física en los niños con Síndrome de Down sobre sus aspectos Psicomotores, y Socio Afectivos. El proceso de investigación se realizó en el colegio Coocende que integra a niños con Síndrome de Down. Para su desarrollo el colegio asignó un n=lO alumnos entre séptimo y octavo básico. Con la ayuda del personal capacitado de esta institución, entre ellos Psicólogos, Psicopedagogos, Educadores Diferenciales, personal de apoyo y la recolección de información del tema se pudo plantear de mejor forma la idea a investigar y materializar el proceso investigativo, siendo la finalidad de este estudio, es aportar una serie de herramientas que permitan a estos niños fortalecer, a la vez de construir los cimientos necesarios para una mejor calidad de vida. La investigación se llevó acabo en clases de Educación Física las que estaban principalmente orientadas a juegos recreativos basados en estimular las cualidades Motrices básicas, así como también los aspectos psicomotores y Socio Afectivos. Para llevar a cabo la obtención y recolección de datos se diseñaron instrumentos de evaluación con la finalidad de medir los aspectos antes mencionados. El tipo de investigación escogido para el siguiente estudio corresponde al tipo, Exploratorio descriptivo y llevado a cabo mediante el diseño transeccional. Las pautas fueron utilizadas al inicio y al término de la investigación sirviendo para corroborar los objetivos planteados en este estudio; es aquí donde se encontraron la mayor cantidad de falencias y donde presentaron la mayor cantidad de aspectos a mejorar. Una vez obtenido los resultados, estos son tabulados, analizados y presentados en el cuerpo del informe, y a partir de estos establecer las correspondientes conclusiones

Breeding distribution and abundance of seabirds on islands off north-central Chile Distribución reproductiva y abundancia de aves marinas en islas del norte y centro de Chile

Between 1999 and 2003 we collected information on the breeding distribution and abundance of 12 seabird species occurring on nine islands off the coasts of north and central Chile (27°-33°S). The Peruvian booby Sula variegata was the most abundant seabird with a breeding population of ca. 18,000 pairs concentrated in two islands, followed by the Humboldt penguin Spheniscus humboldti with ca. 9,000 pairs, the largest colony being at Chañaral Island with ca. 7,000 pairs. Kelp gulls Larus dominicanus bred at all the surveyed sites in colonies of variable size, ranging from 40 to 2,000 pairs. Peruvian diving-petrels Pelecanoides garnotii and Peruvian pelicans Pelecanus occidentalis bred at restricted sites, but generally in large colonies. Magellanic penguins Spheniscus magellanicus, wedge-rumped storm-petrels Oceanodroma tethys, Neotropical cormorants Hypoleucos brasiliensis, guanay cormorants Leucocarbo bougainvillii, red-legged cormorants Stictocarbo gairmardi, band-tailed gulls Larus belcheri and Inca terns Larosterna inca nested at few sites forming small colonies (from a few to 150 pairs). Two new breeding sites are reported for the Peruvian diving-petrel and nesting of the wedge-rumped storm-petrel is confirmed on the Chilean coast for the first time. Despite protective status, most of the islands showed human disturbance, derived mainly from guano harvesting, egging and tourism. On at least five of these islands we were able to confirm introduced mammals including rats, rabbits and cats. These factors are likely to be detrimental to seabirds and thus demand detailed assessment. Further comprehensive ornithological surveys in other areas are needed so as to improve the scarce knowledge that we currently have on the seabird populations along the Chilean coas