Abstract The damage inflicted on the myocardium during acute myocardial infarction is the result of 2 processes: ischemia and subsequent reperfusion (ischemia/reperfusion injury). During the last 3 ...decades, therapies to reduce ischemic injury (mainly reperfusion strategies) have been widely incorporated into clinical practice. The remarkable reduction in death rates achieved with these therapies has resulted in a shift in emphasis from efforts to reduce mortality to a focus on tackling the downstream consequence of survival: post-infarction heart failure. Infarct size is the main determinant of long-term mortality and chronic heart failure, and thus, the possibility of limiting the extent of necrosis during an ST-segment elevation myocardial infarction is of great individual and socioeconomic value. After the great success of therapies to reduce ischemic injury, the time has come to focus efforts on therapies to reduce reperfusion injury, but in the recent few years, few interventions have successfully passed the proof-of-concept stage. In this review, we examine the past, present, and future therapies to reduce ischemia/reperfusion injury.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Sr. Editor: El acceso radial percutáneo es la práctica habitual para la realización de una coronariografía. Las ventajas de dicho acceso conllevan ciertas limitaciones inherentes, como el espasmo ...radial, la disfunción endotelial asociada a la inserción del introductor, las lesiones no oclusivas de la arteria radial y la oclusión de la arteria posprocedimiento1. El preacondicionamiento isquémico (PAI) es un fenómeno experimental que ha demostrado efectos protectores aplicando ciclos de isquemia-reperfusión sobre diferentes órganos diana, e incluso a distancia2. Sugerimos que el PAI podría ser relevante en la prevención del espasmo radial, así como en la prevención de las lesiones no oclusivas de la arteria radial y de la oclusión arterial poscateterismo. Presentamos un estudio piloto de bajo nivel de intervención en pacientes programados para coronariografía diagnóstica o terapéutica. Tras la canalización de la arteria radial se procedió a realizar: Tomografía de coherencia óptica (OCT) de la arteria radial tras la administración del cóctel antiespasmolítico. Protocolo PAI o intervención simulada (sham), por aleatorización. OCT de la arteria radial, tras el protocolo. OCT tras finalizar el procedimiento. El protocolo PAI consiste en hinchar el manguito de presión a 200 mmHg por 5 minutos 3 veces, con 5 minutos de descanso entre cada ciclo de isquemia...
To the Editor, Transcatheter radial access is the usual approach to perform a coronary angiography. The advantages of this access come with certain inherent limitations like radial spasm, endothelial ...dysfunction associated with the insertion of the introducer sheath, nonocclusive radial artery injuries, and postoperative artery occlusions.1 Ischemic preconditioning (IPC) is an experimental phenomenon with confirmed protective effects by applying ischemia-reperfusion cycles to different target organs even at a distance.2 We suggest that IPC may be relevant to prevent radial spasm, nonocclusive radial artery injuries, and arterial occlusion post-catheterization. This is a small pilot study of patients scheduled for diagnostic or therapeutic coronary angiography. After the radial artery catheterization we performed: An optical coherence tomography (OCT) of the radial artery after the administration of an anti-spasmolytic cocktail. An IPC protocol or sham procedure through randomization. An OCT of the radial artery after the protocol. An OCT after the procedure was completed. The PAI protocol consists of inflating the blood pressure cuff to 200 mmHg 3 times for 5 min with 5 min of rest between each ischemic cycle. The sham protocol is the same but here the cuff is inflated up to 10 mmHg only. The OCT (LightLab Imaging Inc, Abbott Vascular, United States) was performed by 2 independent...
Pulmonary embolism (PE) is a common cardiovascular emergency which can lead to pulmonary hypertension (PH) and right ventricular failure as a consequence of pulmonary arterial bed occlusion. The ...diagnosis of PE is challenging due to nonspecific clinical presentation, which results in relatively high mortality. Moreover, the pathological factors associated with PE are poorly understood. Metabolomics can provide new highlights which can help in the understanding of the processes and even propose biomarkers for its diagnosis. In order to obtain more information about PE and PH, acute PE was induced in large white pigs and plasma was obtained before and after induction of PE. Metabolic fingerprints from plasma were obtained with LC–QTOF-MS (positive and negative ionization) and GC–Q-MS. Data pretreatment and statistical analysis (uni- and multivariate) were performed in order to compare metabolic fingerprints and to select the metabolites that showed higher loading for the classification (28 from LC and 19 from GC). The metabolites found differentially distributed among groups are mainly related to energy imbalance in hypoxic conditions, such as glycolysis-derived metabolites, ketone bodies, and TCA cycle intermediates, as well as a group of lipidic mediators that could be involved in the transduction of the signals to the cells such as sphingolipids and lysophospholipids, among others. Results presented in this report reveal that combination of LC–MS- and GC–MS-based metabolomics could be a powerful tool for diagnosis and understanding pathophysiological processes due to acute PE.
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IJS, KILJ, NUK, PNG, UL, UM
Access to medical literature has seen dramatic changes over the last few years. In less than two decades it has gone from a paperbased system to an online digital sending system. The advances made on ...computing and, above all, the Internet has revolutionized not only the way manuscripts are sent, but also how fast these get to the public (including reference manager software adaptable to the different format of various journals). This revolution has also touched the way information is being accessed these days. The databases generated at the beginning of the 21st century are «prehistoric» compared to the ones we use today. The digitalization of clinical histories and the creation of software for data mining purposes have accelerated exponentially the preparation and analysis of the data included in the studies. Even researchers have a much more transversal training and it is common to see research teams that are savvy in statistics and that facilitate data analysis. However, all these important changes are nothing compared to the actual access to general medical information. Even though access to medical literature is not actually open (something we will refer to later), access to a great deal of information is just huge. And all this has resulted in an exponential increase in the amount of papers that scientific journals receive on a monthly...
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