Papel de nuevos biomarcadores en hipertensión pulmonar SST2 y CA-125

La hipertensión pulmonar (HP) es un estado hemodinámico definido por una presión arterial pulmonar (PAP) media ≥ 25 mmHg en reposo, medida mediante cateterismo cardíaco derecho (CCD), aunque recientemente se ha propuesto un umbral inferior (> 20 mmHg). La HP puede encontrarse en varias enfermedades y se clasifica en cinco grupos en función de la hemodinámica, la etiología y los hallazgos patológicos: grupo 1, hipertensión arterial pulmonar (HAP); grupo 2, HP debida a cardiopatía izquierda; grupo 3, HP debida a enfermedad pulmonar o hipoxia; grupo 4, hipertensión pulmonar tromboembólica crónica (HPTEC); y grupo 5, HP con mecanismos poco claros o multifactoriales. Aunque el CCD es actualmente el patrón de oro para el diagnóstico de la HP, las herramientas no invasivas para la evaluación diagnóstica y pronóstica incluyen la ecocardiografía y los biomarcadores séricos. La ecocardiografía transtorácica (ETT) desempeña un papel fundamental como método de cribado y puede ser valiosa para estimar la presión arterial pulmonar (PAP) y la resistencia vascular periférica (RVP), así como para obtener información indirecta sobre la estructura y la función del corazón derecho. Las causas potenciales de la HP también pueden identificarse con la ecocardiografía. Recientemente, han surgido biomarcadores séricos para la evaluación y la valoración pronóstica de los pacientes con HAP. Hasta la fecha, el único biomarcador recomendado por las directrices de la Sociedad Europea de Cardiología (ESC) y la Sociedad Respiratoria Europea (ERS) es la concentración sérica de la porción N-terminal del péptido pro-naturético cerebral (NT-proBNP), que es secretado por el miocardio ventricular en respuesta a la estimulación mecánica. Los niveles de NT-proBNP aumentan con la edad y el peso corporal, y son mayores en las mujeres y en los individuos con insuficiencia ventricular izquierda e insuficiencia renal. Se ha propuesto un nuevo biomarcador conocido como supresión de la tumorigenicidad-2 (ST2) para estimar el riesgo pronóstico de los pacientes con HAP. El ST2 es un miembro de la familia de la interleucina 1, cuyo ligando es la IL-33. Existen dos formas de ST2, una forma unida a la membrana (ST2L) y una forma soluble (sST2), generada a través de un proceso de splicing. Se ha demostrado que la determinación de la concentración sérica de sST2 es útil para estratificar el riesgo de insuficiencia cardíaca. Los niveles séricos de sST2 están aumentados en los pacientes con HP en comparación con los controles sanos, alcanzando concentraciones plasmáticas más altas en los pacientes con mayor deterioro clínico. La adición de las concentraciones séricas de sST2 a la puntuación de riesgo del Registro REVEAL dio lugar a una mejora significativa del valor pronóstico, aunque este estudio se centró principalmente en los pacientes del grupo 1 (HAP). Las concentraciones séricas del antígeno CA-125, inicialmente consideradas sólo en la patología ginecológica, se han extendido al ámbito cardiovascular. Los resultados de diferentes estudios apoyan el valor potencial de este biomarcador en la enfermedad pulmonar obstructiva crónica (EPOC) y en la insuficiencia cardíaca descompensada. En este estudio nuestro objetivo fue doble: 1) Evaluar la especificidad de los marcadores ecocardiográficos y de las concentraciones séricas de sST2 y CA-125 en pacientes con HP en comparación con un grupo control no sano con patologías cardíacas o pulmonares que pudieran evolucionar posteriormente a HP. 2) Analizar el valor pronóstico de los marcadores ecocardiográficos y las concentraciones séricas de sST2 y CA-125 en una población de pacientes con HP, incluyendo aquellos con enfermedad vascular pulmonar subyacente (HAP y HPTC) y pacientes con HP secundaria a patologías más comunes (neumopatía y cardiopatía izquierda). La variable dependiente fue la incidencia de nuevos ingresos hospitalarios por progresión de la HP o muerte de los pacientes. Métodos. Estudio de cohorte de pacientes con HP (n=48), clínicamente estables en la evaluación inicial. Se seleccionó como control un grupo de pacientes con enfermedades cardíacas y pulmonares sin HP (n=23). Al inicio del estudio, se realizó una evaluación clínica, test de marcha de 6 minutos (TM6M), ecocardiografía y determinación de los niveles séricos de la porción NT-ProBNP, sST2 y CA-125. La variable dependiente fue la tasa de hospitalización y/o muerte por descompensación de la HP en un período de 12 meses. Resultados. En comparación con el grupo control, los pacientes con HP tenían una menor distancia recorrida en el TM6M, presiones pulmonares elevadas y deterioro del ventrículo derecho. Se observaron niveles significativamente más altos de NT-proBNP y CA-125 en pacientes con HP. La concentración de sST2 fue mayor en pacientes con HP, aunque no se alcanzó la significación estadística. Veintidós pacientes (46%) requirieron ingreso y/o fallecieron durante el seguimiento. Los parámetros asociados de forma independiente con la hospitalización y/o la muerte fueron la distancia recorrida en el TM6M, la excursión sistólica del plano anular tricuspídeo (TAPSE), los niveles de NT-ProBNP y sST2. Conclusión. Los valores de TM6M, TAPSE, NT-ProBNP y sST2 podrían considerarse marcadores pronósticos en pacientes con HP. Podrían ser útiles para modificar la terapia, evitar hospitalizaciones y muerte en estos pacientes

SITCOVER: diseño de un Sistema de Información Geográfica para el futuro Corredor Verde del Guadiamar

El Proyecto de creación de un Corredor Verde a lo largo del cauce del río Guadiamar es una propuesta interesante de aplicación metodológica e instrumental de las herramientas de análisis territorial comunmente usadas por los geógrafos. Aun sin ánimo de ser exhaustivos, pueden sistematizarse algunas de las ventajas/aptitudes más evidentes: -primero, los programas de observación espacial permiten disponer de un amplio archivo de imágenes con propiedades resolutivas muy completas. Dado que el Proyecto persigue la recuperación de la franja afectada por el vertido tóxico, es de suma importancia disponer de información registrada con anterioridad a la catástrofe con la que reconstruir el escenario que se persigue. - la cartografía digital puede contribuir a la tarea, bien aportando información adicional en lo que se refiere a las coberturas y usos del suelo anteriormente existentes como a su capacidad para construir representaciones fieles de registro-medio vivo-muestra de la capacidad de regeneración-registro de cambios -los sistemas de información geográfica son imprescindibles para una utilización eficiente de las herramientas anteriores entre sí y vinculadas a otras fuentes de información colaterales, pero sobre todo son una herramienta eficaz como apoyo en la toma de decisiones a partir de informaciones complementarias. Con nuestra aportación al Congreso del Grupo de Trabajo perseguimos mostrar algunos de los primeros análisis que estámos llevando a cabo para el desarrollo de un Sistema de Información Territorial del Corredor Verde (SITCOVER). En concreto planteamos: -una primera identificación de los usos existentes antes del vertido en la cuenca del Guadiamar, -el señalamiento, enumeración y extensión ocupada por los que se han visto afectados, -y por último, su clasificación ambiental y funcional para la identificación de aquellos que puedan constituírse en exponentes de su recuperación

Impact of interstitial lung disease on the survival of systemic sclerosis with pulmonary arterial hypertension

To assess severity markers and outcomes of patients with systemic sclerosis (SSc) with or without pulmonary arterial hypertension (PAH-SSc/non-PAH-SSc), and the impact of interstitial lung disease (ILD) on PAH-SSc. Non-PAH-SSc patients from the Spanish SSc registry and PAH-SSc patients from the Spanish PAH registry were included. A total of 364 PAH-SSc and 1589 non-PAH-SSc patients were included. PAH-SSc patients had worse NYHA-functional class (NYHA-FC), worse forced vital capacity (FVC) (81.2 +/- 20.6% vs 93.6 +/- 20.6%, P < 0.001), worse tricuspid annular plane systolic excursion (TAPSE) (17.4 +/- 5.2 mm vs 19.9 +/- 6.7 mm, P < 0.001), higher incidence of pericardial effusion (30% vs 5.2%, P < 0.001) and similar prevalence of ILD (41.8% vs. 44.9%). In individuals with PAH-SSc, ILD was associated with worse hemodynamics and pulmonary function tests (PFT). Up-front combination therapy was used in 59.8% and 61.7% of patients with and without ILD, respectively. Five-year transplant-free survival rate was 41.1% in PAH-SSc patients and 93.9% in non-PAH-SSc patients (P < 0.001). Global survival of PAH-SSc patients was not affected by ILD regardless its severity. The multivariate survival analysis in PAH-SSc patients confirmed age at diagnosis, worse NYHA-FC, increased PVR, reduced DLCO, and lower management with up-front combination therapy as major risk factors. In conclusion, in PAH-SSc cohort risk of death was greatly increased by clinical, PFT, and hemodynamic factors, whereas it was decreased by up-front combination therapy. Concomitant ILD worsened hemodynamics and PFT in PAH-SSc but not survival regardless of FVC impairment

Impact of interstitial lung disease on the survival of systemic sclerosis with pulmonary arterial hypertension

To assess severity markers and outcomes of patients with systemic sclerosis (SSc) with or without pulmonary arterial hypertension (PAH-SSc/non-PAH-SSc), and the impact of interstitial lung disease (ILD) on PAH-SSc. Non-PAH-SSc patients from the Spanish SSc registry and PAH-SSc patients from the Spanish PAH registry were included. A total of 364 PAH-SSc and 1589 non-PAH-SSc patients were included. PAH-SSc patients had worse NYHA-functional class (NYHA-FC), worse forced vital capacity (FVC) (81.2 ± 20.6% vs 93.6 ± 20.6%, P &lt; 0.001), worse tricuspid annular plane systolic excursion (TAPSE) (17.4 ± 5.2 mm vs 19.9 ± 6.7 mm, P &lt; 0.001), higher incidence of pericardial effusion (30% vs 5.2%, P &lt; 0.001) and similar prevalence of ILD (41.8% vs. 44.9%). In individuals with PAH-SSc, ILD was associated with worse hemodynamics and pulmonary function tests (PFT). Up-front combination therapy was used in 59.8% and 61.7% of patients with and without ILD, respectively. Five-year transplant-free survival rate was 41.1% in PAH-SSc patients and 93.9% in non-PAH-SSc patients (P &lt; 0.001). Global survival of PAH-SSc patients was not affected by ILD regardless its severity. The multivariate survival analysis in PAH-SSc patients confirmed age at diagnosis, worse NYHA-FC, increased PVR, reduced DLCO, and lower management with up-front combination therapy as major risk factors. In conclusion, in PAH-SSc cohort risk of death was greatly increased by clinical, PFT, and hemodynamic factors, whereas it was decreased by up-front combination therapy. Concomitant ILD worsened hemodynamics and PFT in PAH-SSc but not survival regardless of FVC impairment

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Differential cross section measurements for the production of a W boson in association with jets in proton–proton collisions at √s = 7 TeV

Measurements are reported of differential cross sections for the production of a W boson, which decays into a muon and a neutrino, in association with jets, as a function of several variables, including the transverse momenta (pT) and pseudorapidities of the four leading jets, the scalar sum of jet transverse momenta (HT), and the difference in azimuthal angle between the directions of each jet and the muon. The data sample of pp collisions at a centre-of-mass energy of 7 TeV was collected with the CMS detector at the LHC and corresponds to an integrated luminosity of 5.0 fb[superscript −1]. The measured cross sections are compared to predictions from Monte Carlo generators, MadGraph + pythia and sherpa, and to next-to-leading-order calculations from BlackHat + sherpa. The differential cross sections are found to be in agreement with the predictions, apart from the pT distributions of the leading jets at high pT values, the distributions of the HT at high-HT and low jet multiplicity, and the distribution of the difference in azimuthal angle between the leading jet and the muon at low values.United States. Dept. of EnergyNational Science Foundation (U.S.)Alfred P. Sloan Foundatio

Penilaian Kinerja Keuangan Koperasi di Kabupaten Pelalawan

This paper describe development and financial performance of cooperative in District Pelalawan among 2007 - 2008. Studies on primary and secondary cooperative in 12 sub-districts. Method in this stady use performance measuring of productivity, efficiency, growth, liquidity, and solvability of cooperative. Productivity of cooperative in Pelalawan was highly but efficiency still low. Profit and income were highly, even liquidity of cooperative very high, and solvability was good

Juxtaposing BTE and ATE – on the role of the European insurance industry in funding civil litigation

One of the ways in which legal services are financed, and indeed shaped, is through private insurance arrangement. Two contrasting types of legal expenses insurance contracts (LEI) seem to dominate in Europe: before the event (BTE) and after the event (ATE) legal expenses insurance. Notwithstanding institutional differences between different legal systems, BTE and ATE insurance arrangements may be instrumental if government policy is geared towards strengthening a market-oriented system of financing access to justice for individuals and business. At the same time, emphasizing the role of a private industry as a keeper of the gates to justice raises issues of accountability and transparency, not readily reconcilable with demands of competition. Moreover, multiple actors (clients, lawyers, courts, insurers) are involved, causing behavioural dynamics which are not easily predicted or influenced. Against this background, this paper looks into BTE and ATE arrangements by analysing the particularities of BTE and ATE arrangements currently available in some European jurisdictions and by painting a picture of their respective markets and legal contexts. This allows for some reflection on the performance of BTE and ATE providers as both financiers and keepers. Two issues emerge from the analysis that are worthy of some further reflection. Firstly, there is the problematic long-term sustainability of some ATE products. Secondly, the challenges faced by policymakers that would like to nudge consumers into voluntarily taking out BTE LEI

Search for stop and higgsino production using diphoton Higgs boson decays

Results are presented of a search for a "natural" supersymmetry scenario with gauge mediated symmetry breaking. It is assumed that only the supersymmetric partners of the top-quark (stop) and the Higgs boson (higgsino) are accessible. Events are examined in which there are two photons forming a Higgs boson candidate, and at least two b-quark jets. In 19.7 inverse femtobarns of proton-proton collision data at sqrt(s) = 8 TeV, recorded in the CMS experiment, no evidence of a signal is found and lower limits at the 95% confidence level are set, excluding the stop mass below 360 to 410 GeV, depending on the higgsino mass

Impacts of the Tropical Pacific/Indian Oceans on the Seasonal Cycle of the West African Monsoon

The current consensus is that drought has developed in the Sahel during the second half of the twentieth century as a result of remote effects of oceanic anomalies amplified by local land–atmosphere interactions. This paper focuses on the impacts of oceanic anomalies upon West African climate and specifically aims to identify those from SST anomalies in the Pacific/Indian Oceans during spring and summer seasons, when they were significant. Idealized sensitivity experiments are performed with four atmospheric general circulation models (AGCMs). The prescribed SST patterns used in the AGCMs are based on the leading mode of covariability between SST anomalies over the Pacific/Indian Oceans and summer rainfall over West Africa. The results show that such oceanic anomalies in the Pacific/Indian Ocean lead to a northward shift of an anomalous dry belt from the Gulf of Guinea to the Sahel as the season advances. In the Sahel, the magnitude of rainfall anomalies is comparable to that obtained by other authors using SST anomalies confined to the proximity of the Atlantic Ocean. The mechanism connecting the Pacific/Indian SST anomalies with West African rainfall has a strong seasonal cycle. In spring (May and June), anomalous subsidence develops over both the Maritime Continent and the equatorial Atlantic in response to the enhanced equatorial heating. Precipitation increases over continental West Africa in association with stronger zonal convergence of moisture. In addition, precipitation decreases over the Gulf of Guinea. During the monsoon peak (July and August), the SST anomalies move westward over the equatorial Pacific and the two regions where subsidence occurred earlier in the seasons merge over West Africa. The monsoon weakens and rainfall decreases over the Sahel, especially in August.Peer reviewe