Background: Infective endocarditis (IE) is a feared complication after surgical aortic valve replacement (SAVR)/transcatheter aortic valve implantation (TAVI). It is not certain which procedure ...carries a higher risk. Our aim was to assess the risk of IE after SAVR/TAVI. Methods: We conducted an observational study of a prospective cohort, including patients with TAVI/SAVR, from March 2015 to December 2020. IE was defined according to the modified Duke’s criteria. IE occurring during the first 12 months of the procedure was considered early IE, and an episode occurring after 12 months was considered late IE. The propensity score was designed to include variables previously associated with TAVI/SAVR and IE. An inverse probability of treatment weight was generated. Results: In total, 355 SAVR and 278 TAVI were included. Median follow-up, 38 vs. 41 months, p = 0.550. IE occurred in 5 SAVR (1.41%, 95% CI 0.2−2.6) vs. 13 TAVI (4.65%, 95% CI 2.2−7.2), p = 0.016. TAVI patients had more frequent early IE (3.2% vs. 0.3%, p = 0.006). In the PS analyses, IE risk did not differ: OR 0.65, 95% CI 0.32−1.32. Factors associated with TAVI IE included younger age (74y vs. 83y, p = 0.030), complicated diabetes mellitus (38.5% vs. 6.8%, p = 0.002), COPD (46.2% vs. 16.3%, p = 0.015), advanced heart failure (100% vs. 52.9%, p < 0.001), and peripheral arteriopathy (61.5% vs. 26.7%, p = 0.011). Conclusions: Early IE was higher with TAVI, but in the PS analyses, the risk attributable to each procedure was similar. Studies are needed to identify and optimize the risk factors of IE prior to TAVI.
Donación en asistolia controlada: cómo iniciar un programa Villar-García, Susana; Martín-López, Carlos E.; Pérez-Redondo, Marina ...
Cirugía cardiovascular,
November-December 2022, 2022-11-00, 2022-11-01, Letnik:
29, Številka:
6
Journal Article
Recenzirano
Odprti dostop
La donación en asistolia controlada se ha convertido en una de las principales estrategias para aumentar el número de donantes. Hasta el momento el corazón de este tipo de donantes no era valorado ...por el riesgo de lesión isquémica durante la limitación del soporte vital. En los últimos años, con los sistemas de perfusión ex situ se iniciaron programas de donación cardiaca en asistolia controlada que demostraron la viabilidad miocárdica. El uso de perfusión regional normotérmica en nuestro medio y la experiencia de otros países en la recuperación cardiaca nos lleva a elaborar un protocolo de extracción cardiaca en asistolia controlada con valoración in situ y conservación en frío.
Se conforma un equipo multidisciplinar que realiza un protocolo de extracción cardiaca con donante en asistolia controlada. Tras una fase de experimentación animal, dicho protocolo es aprobado por el Comité de Ética para la Asistencia Sanitaria y por la Organización Nacional de Trasplantes.
Se realiza un protocolo que establece los criterios de selección de donantes y receptores y que regula el procedimiento de donación con perfusión toracoabdominal tras exclusión de los troncos supraaórticos. La valoración cardiaca es in situ y la conservación estática, en frío. Este protocolo se comunica al resto de hospitales donantes, y esto nos lleva a realizar el primer trasplante cardiaco en España con asistolia controlada.
El trasplante cardiaco con donación en asistolia controlada es una realidad clínica que permitirá aumentar el número de potenciales donantes. Las características técnicas del procedimiento hacen que este tipo de donación se deba concentrar en centros con experiencia.
Donation after circulatory death has become one of the main strategies to increase the number of donors. Until now, the heart of this type of donor was not evaluated due to the risk of ischaemic injury during the withdrawal of life support. In recent years, ex situ perfusion systems have initiated cardiac donation programmes after circulatory death that have demonstrated myocardial viability. The use of normothermic regional perfusion in our environment and the experience of other countries in cardiac recovery led us to develop a protocol for cardiac procurement in donation after circulatory death with in situ assessment and cold preservation.
A multidisciplinary team was formed to create a cardiac extraction protocol with donation after circulatory death. After a phase of animal experimentation, the protocol was approved by the Ethics Committee for Health Care and by the National Transplant Organization.
A protocol was drawn up establishing the criteria for donor and recipient selection and regulating the donation procedure with thoracic-abdominal perfusion after exclusion of the supra-aortic trunks. Cardiac evaluation is in situ and static preservation in cold storage. This protocol was sent to the rest of the donor hospitals and this led us to perform the first heart transplant in Spain with this donation modality.
Cardiac transplantation with donation after circulatory death is a clinical reality that will increase the number of potential donors. The technical characteristics of the procedure mean that this type of donation should be performed in experienced centres.
RESUMEN Introducción: El cáncer de pulmón constituye un problema sanitario a nivel mundial, a pesar de los avances tecnológicos y terapéuticas en oncología, hay un alto porcentaje de personas que se ...diagnostican en estadios avanzados de la enfermedad, las cuales tienen una mayor demanda de cuidados continuos. Objetivo: Identificar la necesidad de cuidados continuos en personas con cáncer de pulmón avanzado. Métodos: Revisión sistemática realizada durante enero a julio del 2021. Se realizó análisis de contenido de documentos, que incluyó artículos originales y de revisión publicados desde 2010 hasta 2021 en las bases de datos SciELO, Google Scholar y Elsevier. Se elaboró la pregunta guía a través del acrónimo PICo. La estrategia de búsqueda se realizó mediante los descriptores en Ciencias de la Salud (DeCS) “Personal de enfermería”, “Neoplasia de pulmón” y “cuidados de enfermería” y el operador booleano AND. Se utilizó el diagrama de flujo (PRISMA) para la formulación de la estrategia de búsqueda, se identificaron y revisaron 77 artículos, de los que fueron útiles 12 de la evolución de la categoría. Conclusiones: El análisis realizado referido a la necesidad de los cuidados continuos en personas con cáncer de pulmón avanzado permitió definición operativa de esta categoría, a partir de las características de esta entidad y la demanda que enfrentan los servicios de hospitalización y los profesionales de enfermería en correspondencia con la satisfacción de necesidades de estas personas, y permitió establecer un acercamiento en los referentes teóricos que sustentan el tema.
Abstract
OBJECTIVES
The goal of this study was to analyse early- and long-term outcomes of aortic valve reimplantation (David operation) in patients with heritable thoracic aortic disease.
METHODS
...This is a retrospective observational analysis using data from a prospectively maintained surgical database from March 2004 to April 2021. Patients with heritable thoracic aortic disease were included in the study.
RESULTS
A total of 157 patients with aortic root aneurysm with the diagnosis of heritable thoracic aortic disease received the David procedure. Marfan syndrome was found in 143 (91.1%) patients, Loeys-Dietz in 13 and Ehler-Danlos in 1 patient. The median age was 35.0 (IQR: 17.5) years and the median ascending aorta diameter in the Valsalva sinuses was 48 mm (IQR: 4). A Valsalva graft was used in 8 patients; the David V technique was performed in the rest of the cases. The median follow-up time was 7.3 years standard deviation: 0.58, 95% confidence interval (CI): 6.12–8.05. Only 2 patients died during the follow-up period. The overall survival was 99% (95% CI: 95%; 99%); 98% (95% CI: 92%; 99%); and 98% (95% CI: 92%; 99%) at 5, 10 and 15 years. Freedom from significant aortic regurgitation (AR> II), reintervention and postoperative type-B dissection was 90% (95% CI: 77%; 95%), 96% (95% CI: 91%; 99%) and 87% (95% CI: 68%; 95%) at 15 years, respectively. No differences were found in any outcome between Marfan syndrome and Loeys-Dietz syndrome. No statistically significant differences in survival were found when we compared expected gender- and age-specific population survival values.
CONCLUSIONS
The David operation is an excellent option for the treatment of patients with heritable thoracic aortic disease and dilatated aortic root. Surgical expertise in referral centres is essential to achieve the best long-term results.
Connective tissue syndromes are genetic disorders that frequently involve musculoskeletal, cardiovascular and ocular manifestations.
Extended septal myectomy and alcohol septal ablation are 2 invasive treatments for hypertrophic obstructive cardiomyopathy. Our goal was to compare which of these techniques achieved a higher ...reduction in gradients, improvement in New York Heart Association (NYHA) functional class and reduction in medical treatment.
It is a single-centre observational and retrospective analysis. We used multivariable regression analyses to assess the association of ablation/myectomy with different outcomes. The odds ratio or coefficient along with the 95% confidence interval was estimated according to the group and adjusted for the corresponding preprocedural variables and EuroSCORE II.
A total of 78 patients underwent septal myectomy, and 25 patients underwent alcohol septal ablation. Basal and Valsalva gradients after myectomy were reduced to a higher degree in comparison to ablation: 21.0 mmHg P < 0.001, 95% confidence interval -30.7; -11.3, and 34.3 mmHg (P < 0.001, -49.1; -19.5) respectively. Those patients who received a myectomy had a lower probability of having moderate mitral regurgitation (odds ratio = 0.18, P = 0.054). Patients after septal myectomy were more likely to be NYHA functional class I (80.4%), whereas patients after ablation were more likely to be NYHA functional class III (48%). Both groups continued with beta-blocker therapy, but disopyramide could be discontinued after the myectomy in more cases (20%-36% vs 59%-1.3%; P < 0.001), and there was a tendency to discontinue calcium channel blockers (48%-16% vs 15.4-3.8%; P = 0.054).
After adjustment using preprocedural gradients and EuroSCORE II, myectomy achieves greater reduction in left ventricular outflow tract gradients compared to septal ablation.
Decades of research on oncogene-driven carcinogenesis and gene-expression regulatory networks only started to unveil the complexity of tumour cellular and molecular biology. This knowledge has been ...successfully implemented in the clinical practice to treat primary tumours. In contrast, much less progress has been made in the development of new therapies against metastasis, which are the main cause of cancer-related deaths. More recently, the role of epigenetic and microenviromental factors has been shown to play a key role in tumour progression. Free radicals are known to communicate the intracellular and extracellular compartments, acting as second messengers and exerting a decisive modulatory effect on tumour cell signalling. Depending on the cellular and molecular context, as well as the intracellular concentration of free radicals and the activation status of the antioxidant system of the cell, the signalling equilibrium can be tilted either towards tumour cell survival and progression or cell death. In this regard, recent advances in tumour cell biology and metastasis indicate that redox signalling is at the base of many cell-intrinsic and microenvironmental mechanisms that control disseminated tumour cell fate and metastasis. In this manuscript, we will review the current knowledge about redox signalling along the different phases of the metastatic cascade, including tumour cell dormancy, making emphasis on metabolism and the establishment of supportive microenvironmental connections, from a redox perspective.
A bioassay-oriented approach led to the isolation of 11 compounds, including three new natural flavonoids, (2S)-isookanin 7-O-α-L-arabinopyranoside (1), (2S)-isookanin ...7-O-(2''-acetyl)-α-L-arabinopyranoside (2), and luteolin 7-O-β-D-glucopyranosyl-(1 → 6)-β-D-galactopyranoside (6), from Bidens humilis aerial parts. Their structures were determined via spectroscopic analyses including two-dimensional nuclear magnetic resonance. The antioxidant activity of all compounds was also tested by three different assays. The Relative Antioxidant Capacity Index (RACI) is applied herein, from the perspective of statistics, by integrating the antioxidant capacity data determined by these chemical methods.
Four sesquiterpenes and two diterpenes were isolated from the leaves of
Ambrosia arborescens. The structures were elucidated by NMR spectroscopy and ESI mass spectrometry. Compounds were evaluated ...for antiproliferative activity.
Six compounds, eudesm-11(13)-en-4β,9β-diol, 15
R,16-dihydroxy-3-oxo
isopimar-9(11)-ene, 15
S,16-dihydroxy-3-oxo
isopimar-9(11)-ene, 1α-hydroxy-7-oxo-
iso-anhydrooplopanone, 10α-hydroxy-11,13-dihydro-5-
epi-psilostachyin, and 4β-hydroxypseudoguaian-12,6-olide 4-
O-β-
d-glucopyranoside, together with 12 known sesquiterpenes, were isolated from the leaves of
Ambrosia arborescens. Structures were elucidated by 1D and 2D NMR spectroscopy including 1D-TOCSY, DQF-COSY, 2D-ROESY, HSQC, and HMBC experiments, as well as by ESI mass spectrometry. The absolute configuration of the 15,16-diol moiety in 15
R,16-dihydroxy-3-oxoisopimar-9(11)-ene and 15
S,16-dihydroxy-3-oxoisopimar-9(11)-ene was determined using Snatzke’s method. All compounds were evaluated for antiproliferative activity.
Phytochemical investigation of the leaf extracts of Clinopodium tomentosum (Kunth) Govaerts (Lamiaceae) allowed the isolation of one new compound, named 2-O-benzoyl-3-O-cinnamoyl tartaric acid, along ...with twelve known compounds, dihydrodehydroconiferyl alcohol 9'-O-β-D-glucopyranoside, blumenol c glucoside, syringaresinol 4'-O-β-D-glucopyranoside, hesperetin, pinocembrin 7-O-rutinoside, clinopodic acid E, caffeic acid, p-coumaric acid, caffeic acid methyl ester, caffeic acid ethyl ester, rosmarinic acid, and rosmarinic acid methyl ester. Their structural characterization was obtained on the basis of extensive spectroscopic analyses, including mono- and bidimensional nuclear magnetic resonance (1D and 2D NMR) experiments and high-resolution electrospray ionization mass spectrometry (HR-ESI-MS).
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