Background
Advanced age, frailty, and age-related comorbidities are the major causes of pulmonary endarterectomy disqualification in patients with chronic thromboembolic pulmonary hypertension ...(CTEPH). Balloon pulmonary angioplasty (BPA) is an attractive and less invasive therapy for elderly patients. However, information about the safety, procedure tolerance, and effectiveness of BPA in elderly patients is limited.
Objective and methods
We aimed to analyze the safety, tolerance, and efficacy of BPA in CTEPH patients aged ≥70 years. This observational, descriptive, and retrospective series included consecutive patients aged ≥70 years, who underwent completed or interrupted BPA programs at a pulmonary hypertension reference center between May 2013 and May 2022.
Results
We enrolled 155 patients in our institution's BPA program. Among these, 33 patients were aged ≥70 years (mean age, 76.4 years; women, 75.8%) and had finished or interrupted BPA programs. In this cohort, we performed 116 BPA procedures (average, 3.6 ± 1.8 sessions/patient). Among the 33 patients, 19 (57.6%) completed treatment for all lobes, while the BPA program was interrupted in the remaining 14 (42.4%). Among all 33 patients, BPA was associated with a significant reduction in mean pulmonary arterial pressure (39.2 ± 9.3 vs. 32.8 ± 8.8 mmHg;
p
< 0.001) and pulmonary vascular resistance (6.7 ± 3.1 vs. 4.4 ± 2.0 WU;
p
< 0.001), along with an improvement in the cardiac index (2.5 ± 0.6 vs. 2.8 ± 0.7 L/min/m
2
;
p
= 0.04) with significant reductions in the N-terminal prohormone of brain natriuretic peptide level (pre-BPA, 353 pg/mL 207–1,960 pg/mL vs. post-BPA, 167 pg/mL 73–629 pg/mL;
p
= 0.03). The patients' functional class improved, and pulmonary hypertension-targeting drug requirements were significantly reduced. The pulmonary injury appeared in 3.4% of the 116 procedures, of which 50% were of grade 2. No patient of ≥70 years had grade 5 pulmonary injury. One periprocedural mortality was recorded (3%), and the median follow-up period was 2.8 years. The survival rate of the entire cohort at 1 and 3 years was 90.5 and 82.8%, respectively.
Conclusion
BPA is an effective and safe approach in patients aged ≥70 years. It significantly improves patients' functional class, hemodynamic, and biomarkers, and reduces their pulmonary hypertension-targeting medical therapy requirements. These successes were achieved even though a significant percentage of patients did not complete the therapy. The rates of procedural complications and periprocedural mortality were low. Survival at 1 and 3 years was good in comparison to that of younger patients undergoing BPA.
In 2019, Chile was struck by an uprising that shook its political structure to the core. Mobilization was so overwhelming that political elites decided—against what they had defended vigorously ...during past decades—to allow for a comprehensive reform of the Constitution enacted in 1980. Because constitutions allocate decision rights and define their political system as they do so, the process reopened the debate regarding the country’s imbalanced presidential design. This article contributes to the debate on checks and balances in the Chilean political system by examining a specific procedure that promotes imbalance: the urgency prerogative.
Esta investigación analiza el estado de la investigación producida en ciencia política y cuyo objeto de estudio es América Latina. Para ello, presentamos una base de datos inédita en la que incluimos ...los artículos publicados en revistas en español y portugués que se encuentran en los índices JCR o Scimago. En primer lugar, los resultados reflejan una disciplina dinámica, plural en términos teóricos, inclinada prioritariamente al estudio de los temas clásicos de la disciplina y con falencias en el orden metodológico. Por otro lado, constatamos que existen muy pocas revistas para la publicación, por lo que urge la creación de revistas especializadas. Además, nuestros hallazgos empíricos dan cuenta de la necesidad de incluir en las agendas de investigación tanto a países menos estudiados como temas que, a pesar de ser relevantes (v. g. corrupción), han sido poco explorados. Finalmente, este trabajo plantea la urgencia de fomentar la cooperación institucional.
El artículo se centra en analizar el estado de la investigación científica de la ciencia política en Colombia. Por lo tanto, la investigación ahonda en el examen de los grupos que se encuentran ...reconocidos y avalados por Colciencias. De esta manera, se provee de información útil sobre las áreas de estudio en las que se encuentran enfocados los grupos de investigación en el país, así como la ubicación geográfica, el carácter público o privado y el género de los miembros adscritos. Entre los principales hallazgos se da cuenta de una disciplina orientada principalmente en la investigación en conflicto, seguridad y paz, junto a relaciones internacionales. A su vez, se evidencia una desatención en los temas de política comparada, metodología y economía política. Finalmente, el estudio plantea la necesidad de propender un mayor liderazgo de mujeres frente a los grupos y consolidar la investigación en ciencia política fuera de las principales urbes de Colombia.
Un asunto clave en nuestras sociedades democráticas es el principio de representación. Razón por la cual en países de todo el mundo se han establecido cuotas para minorías en la política electoral, ...haciendo más real la suposición de que en democracia todo ciudadano es libre de elegir y ser elegido al gozar de garantías durante los procesos electorales. No obstante, es frecuente observar la exclusión y vulneración de grupos sociales como los negros, las mujeres, minorías religiosas y étnicas, junto a las de género por su situación socioeconómica como por su identidad sociocultural. Por lo tanto, en este artículo se reflexiona en torno a por qué es justo reconocer y agregar los intereses de los grupos minoritarios en el ordenamiento jurídico de un país. Todo ello a partir de los planteamientos de justicia expuestos tanto en John Rawls como en Iris Marion Young. Es así como en las siguientes líneas se provee un marco analítico en el que confluyen los fundamentos del consenso traslapado con la idea de la ciudadanía diferenciada para reconocer la necesidad de una representación especial mediante leyes de cuotas electorales para las minorías.
Only five countries have extended universal voting rights to non-citizen residents for all political spheres (local, intermediate and national): Uruguay in 1934, New Zealand in 1975, Chile in 1980, ...Malawi in 1994, and Ecuador in 2008. These cases constitute a unique intercontinental medley and an opportunity to study the conditions behind such revolutionary change. Through a calibrated comparative strategy based on most similar system designs (inspired by Mill's method of difference) using QCA, this paper finds that the extension of national voting rights to non-citizen residents transpired in two distinct scenarios. The first setting (Chile, New Zealand, and Uruguay) took place within unitary states with already-existing local voting rights for non-citizen residents and settler trajectories, but that were not undergoing a liberalisation process. On the other hand, the second configuration (Ecuador and Malawi) developed within unitary states that recognised nationality by ius soli and were going through a process of liberalisation, but without previous local voting rights for non-citizen residents or a settler trajectory. To our best knowledge, this paper offers the first cross-national explanation that involves all cases that have broadened their respective political communities (demoi) to include national voting rights to all non-citizen residents.
Biological circadian rhythms in living organisms are regulated by molecular clocks. Several of these clocks are present in blood vessels, peripheral tissues, and immune cells. There is strong ...evidence linking dysregulation of circadian rhythms to the development of cardiovascular disease. Dysregulation of circadian rhythms is believed to activate inflammatory processes at specific times of day, leading to an increased risk of thrombosis and atherosclerosis progression. Research into circadian clock genes and molecular networks has the potential to identify therapeutic targets to reduce cardiovascular risk. In this review, we summarize the evidence linking circadian rhythms to thrombosis and atherothrombotic events and discuss potential therapeutic implications.
Pulmonary artery aneurysm (PAA) is a common finding in patients with long-term pulmonary arterial hypertension (PAH). The influence of PAH severity in the development of PAA remains unclear. We ...sought to determine whether PAA development is related to PAH severity and whether treatment optimization based on risk profile estimation is effective to stop pulmonary artery (PA) enlargement. This is a retrospective study of 125 PAH patients who underwent an imaging test (computed tomography or magnetic resonance) combined with a right heart catheterization within a six-month period. A multivariate analysis was performed to identify independent risk factors for PAA. Patients who underwent an additional imaging-test and RHC during follow-up were analyzed to evaluate changes on PA dimensions. PAA was diagnosed in 42 (34%) patients. PAA was more frequent in patients with congenital heart disease and toxic oil syndrome. PAH time-course showed to be an independent risk factor for PAA (HR 1.051, 95% CI 1.013–1.091,
p
= 0.008) whereas PAH severity did not. Twenty-six patients underwent a follow-up imaging-test and catheterization. After treatment optimization, a non-significant reduction of mean PA pressure was observed (58.5 mmHg 43.5–70.8 vs. 55.5 mmHg 47.5–66.3,
p
= 0.115) and a higher proportion of patients achieved a low-risk profile (19% vs. 35%,
p
= 0.157). However, the PA diameter significantly increased (40.4 ± 10.1 mm vs. 42.1 ± 9.6 mm;
p
= 0.003). PAA is a common condition in long-standing PAH but its development is not necessarily related to PAH severity. Despite stabilization after treatment optimization, a progressive PA dilatation was observed.
Un buen plan logístico genera dentro de las compañías un adecuado desenvolvimiento de sus actividades sin tener inconveniente alguno, lo que implica mejorar la calidad de la compañía y su crecimiento ...en el mundo industrial y comercial. El proyecto que se propone generará un rendimiento y una estructuración favorable con la finalidad de permitir a los directivos dirigir y tomar decisiones con mayor eficiencia en relación a la operación de la empresa y su planeación logística, orientando los procesos a una mejor ejecución de las bodegas y del manejo de la distribución y almacenamiento de los equipos, minimizando cuellos de botella, reprocesos y acciones que aumente los costos y malgaste los recursos de la organización. Por otra parte, la metodología propuesta se basa en la unión de los diferentes procedimientos efectuados en el área operativa y la interrelación con procesos del área comercial y administrativa, para mejorar la ejecución de los procedimientos para la recepción y despacho de pedidos solicitados por distribuidores y tiendas, disminuyendo el nivel porcentual de errores cometidos por el mal manejo y control de la bodega principal de Technology World Group. S.A.S.
The limited availability of red cells with extremely rare blood group phenotypes is one of the global challenges in transfusion medicine that has prompted the search for alternative self‐renewable ...pluripotent cell sources for the in vitro generation of red cells with rare blood group types. One such phenotype is the Rhnull, which lacks all the Rh antigens on the red cell membrane and represents one of the rarest blood types in the world with only a few active blood donors available worldwide. Rhnull red cells are critical for the transfusion of immunized patients carrying the same phenotype, besides its utility in the diagnosis of Rh alloimmunization when a high‐prevalence Rh specificity is suspected in a patient or a pregnant woman. In both scenarios, the potential use of human‐induced pluripotent stem cell (hiPSC)‐derived Rhnull red cells is also dependent on ABO compatibility. Here, we present a CRISPR/Cas9‐mediated ABO gene edition strategy for the conversion of blood type A to universal type O, which we have applied to an Rhnull donor‐derived hiPSC line, originally carrying blood group A. This work provides a paradigmatic example of an approach potentially applicable to other hiPSC lines derived from rare blood donors not carrying blood type O.
CRISPR/Cas9 mediated ABO gene edition allows the conversion of blood type A to universal type O in Rhnull donor‐derived hiPSCs
A targeted knock‐in strategy allows to reproduce the c.261delG polymorphism present in the most common inactive ABO*O.01 allele
This work provides a new approach potentially applicable to cell lines established from rare blood donors not carrying blood type O
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