Coronary microvascular dysfunction in cardiovascular disease:Lessons from large animal models

The coronary microvasculature is responsible for maintaining local matching of myocardial blood flow to myocardial demand of oxygen and nutrients. Long term adjustment of myocardial blood flow involves structural changes in microvascular density and diameter while fine-tuning of flow is achieved via adaptations in vascular smooth muscle tone in the coronary microvasculature.In the past several decades, considerable research efforts have been directed at understanding structural and functional microvascular adaptations involved in matching myocardial oxygen supply and demand and how these mechanisms are affected by various diseases. In this review we will discuss our current understanding of the mechanisms underlying the regulation of coronary microvascular tone under healthy physiological conditions, and the role of microvascular dysfunction in obstructive and non-obstructive coronary artery disease, as studied in large animal (particularly swine) models and confirmed in human studies. Future studies should be directed at further unraveling the mechanisms of coronary microvascular dysfunction in different disease entities in order to, and ultimately directed at improving microvascular function as a therapeutic target in patients with ischemic heart disease

Clinical practice guidelines for the diagnosis and treatment of patients with soft tissue sarcoma by the Spanish group for research in sarcomas (GEIS)

Soft tissue sarcomas (STS) constitute an uncommon and heterogeneous group of tumours, which require a complex and specialized multidisciplinary management. The diagnostic approach should include imaging studies and core needle biopsy performed prior to undertaking surgery. Wide excision is the mainstay of treatment for localized sarcoma, and associated preoperative or postoperative radiotherapy should be administered in high-risk patients. Adjuvant chemotherapy was associated with a modest improvement in survival in a meta-analysis and constitutes a standard option in selected patients with high-risk STS. In metastatic patients, surgery must be evaluated in selected cases. In the rest of patients, chemotherapy and, in some subtypes, targeted therapy often used in a sequential strategy constitutes the treatment of election. Despite important advances in the understanding of the pathophysiology of the disease, the advances achieved in therapeutic results may be deemed still insufficient. Moreover, due to the rarity and complexity of the disease, the results in clinical practice are not always optimal. For this reason, the Spanish Group for Research on Sarcoma (GEIS) has developed a multidisciplinary clinical practice guidelines document, with the aim of facilitating the diagnosis and treatment of these patients in Spain. In the document, each practical recommendation is accompanied by level of evidence and grade of recommendation on the basis of the available data