Severe focal stromal degeneration up to Descemet membrane after corneal collagen cross-linking

Corneal collagen cross-linking (CXL) is an effective treatment for arresting progression in keratoconus cases. It is considered safe despite a few complications that have been recorded earlier. In this case series, we report a rare and late complication caused due to severe stromal thinning up to Descemet's membrane in three patients who underwent CXL 3 to 6 years back for keratoconus. Deep anterior lamellar keratoplasty (DALK) was then done for the affected eye with good outcomes. This case series highlights the possible late effects of UVA irradiation post CXL.

Extracting coronary artery centerline based on improved skeleton thinning algorithm / 中国医学影像技术

Objective: To propose an automatic skeleton thinning algorithmfor accurate extracting the center line of coronary artery from CT images. Methods The region of coronary artery on CT images were segmented, and complete 3D data of coronary artery were obtained after 3D reconstruction. Then the center line of coronary artery was extracted using skeleton thinning algorithm. Dijkstra algorithm was introduced according to the characteristics of coronary artery to improve the accuracy of extraction. Results Compared with the skeleton thinning algorithm which didn't remove mini branches, the rate of overlap was increased by 2%, the average distance was reduced by 38.2%, and the average running time was 0.48 s. Conclusion Using improved skeleton thinning algorithm could effectively extract the center line of coronary arteries.

Estructura y diversidad de la vegetación leñosa en un área de matorral espinoso tamaulipeco con actividad pecuaria en Nuevo León, México / Structure and diversity of the woody vegetation in a Tamaulipas thornscrub with livestock activity in Nuevo León, Mexico

Resumen En el noreste de México existe un incremento en el establecimiento de pastizales para la ganadería, lo cual ha ocasionado cambios en la estructura y diversidad florística. El objetivo de la presente investigación fue determinar algunos parámetros dasométricos y de diversidad de los elementos leñosos presentes en un área de matorral espinoso tamaulipeco (MET), con actividad pecuaria, en el estado de Nuevo León, México, para establecer si las modificaciones realizadas contribuyen o no a la conservación de la diversidad vegetal. La actividad pecuaria que se realizaba en el área de estudio era un aprovechamiento mixto de moderada intensidad, con aclareos por lo bajo (d ˂ 5 cm). Se seleccionaron cuatro sitios de muestreo de 1 600 m2 cada uno. Se recolectaron datos sobre variables dasométricas y se obtuvieron índices ecológicos. Los resultados permitieron un registro de 8 familias, 16 géneros y 17 especies arbóreas y arbustivas. La densidad absoluta reportada fue de 309 individuos/ha, mientras que el área de copa estimada fue de 9 521.83 m2/ha. La riqueza (Da = 3.03) y diversidad (H´ = 2.31) específicas, resultaron en valores similares a matorrales sin actividad productiva. Las especies con mayor importancia dentro del área de estudio fueron características del MET: Prosopis laevigata (IVI = 28.59), Havardia pallens (IVI = 13.41) y Cordia boissieri (IVI = 8.89), de las cuales, Prosopis laevigata tiene antecedentes de uso forrajero. Se concluye que la composición de especies arbóreas y arbustivas en este sistema pecuario conserva atributos deseables de las comunidades vegetales nativas, como la riqueza de especies, diversidad, densidad y área de copa.

Abstract In the northeastern region of Mexico, there is an increase in the establishment of grasslands for livestock, which has created changes in the structure and floristic diversity of ecosystem. The aim of this study was to determine the structure and diversity of the woody species vegetation of an area of Tamaulipas thorn-scrub (MET) which was modified for livestock rising in Nuevo Leon, Mexico, to establish whether or not the changes have contributed to the conservation of plant diversity. The livestock activity practiced in the researched area is mixed purpose use at a moderate intensity, with a thinning treatment at the lower vegetation layer (d ˂ 5 cm) to create open areas for cattle grazing in the study area. Four sampling plots of 1 600 m2 each were selected. Dasometric measures were recorded and ecological indexes were estimated. The results are a record of 8 families, 16 genus and 17 species of trees and shrubs. The absolute density was 309/ha, while the estimated canopy area was 9 521.83 m2/ha. Richness (Da = 3.03) and species diversity (H' = 2.31) resulted in similar values to scrubs with nonproductive activity. Species with the greatest IVI are characteristic of the MET: Prosopis laevigata (IVI = 28.59), Havardia pallens (IVI = 13.41) and Cordia boissieri (IVI = 8.89), from which, Prosopis laevigata is considered as a species for forage use. We conclude that the composition of the tree and shrub species in this livestock rising system contributes to preserving the desirable attributes of the native vegetation communities, such as richness and species diversity, density and canopy area.

Characteristics and diagnostic value of temporal retinal thinning in young patients with Alport syndrome / 中华眼底病杂志

Objective To observe the features of temporal macular thinning and its value for the diagnosis of Alport syndrome (AS) in young patients.Methods Eighty-one young patients with AS (81 eyes) from Peking University First Hospital during January 2016 and July 2017 were included in this study.There were 67 males (67 eyes) and 14 females (14 eyes),the aged from 3 to 17 years,with the mean age of 9.6 years.Among 81 patients (81 eyes),there were 64 patients with X-linked AS (XLAS,including 53 males and 11 females),17 patients with autosomal recessive AS (ARAS,including 14 males and 3 females).One hundred healthy subjects aged 4 to 17 years were included as controls.Clinical data were retrospectively evaluated,including visual acuity,slit-lamp microscopy,dilated fundus photography,and OCT.Retinal thickness was measured with an OCT scan and the temporal thinning index (TTI) was calculated as stated in a previous study.The TTI values of each group was compared by One-way ANOVA or independent sample t test.The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic effectiveness for AS.Results The TTI of the control group,XLAS and ARAS patients were 6.46 ± 1.58,10.93 ± 3.77,12.14± 4.05,respectively.Compared with the control group,the TTI value of males were larger in the XLAS and ARAS group (F=45.056,P＜0.001),the TTI value of females were larger in the ARAS group (F=26.541,P＜0.001).The difference of TTI value in females was significant between the XLAS and ARAS groups (F=26.541,P＜0.001).In males,the area under the ROC curve was 0.896 (95％CI 0.837-0.955,P＜0.001).The optimal cutoff value of the TTI was determined as 9.47,with a sensitivity of 73.1％ and a specificity of 100％.Conclusions TTI is a common ocular finding in young patients with AS.In males,a TTI ＞ 9.47 may differentiate AS from normal males.

Evaluation of bovine pericardium performance after liquid nitrogen freezing and thinning / 生物医学工程学杂志

In the present study, the performance of the liquid nitrogen frozen and thinned bovine pericardium was studied and compared with the porcine pericardium. The microstructure and mechanical properties of the bovine pericardium were observed and tested by hematoxylin-eosin (HE) staining and tensile test respectively. In all conditions, porcine pericardium was selected as a control group. The results showed that there was little difference in the performance of bovine pericardium after being frozen by liquid nitrogen. The secant modulus and ultimate strength of the thinned bovine pericardium were similar to those of porcine pericardium, however, the elastic modulus was a little higher than porcine pericardium. The study suggested that the performance of the thinned bovine pericardium was similar to those of porcine pericardium. It was easy for the thinned bovine pericardium to obtain a relatively ideal thickness and expected performance, therefore, the thinned bovine pericardium can be used as the materials of transcatheter aortic valve leaflets.

Research progress in thin flap and flap thinning technique / 中国修复重建外科杂志

Objective: To review the historical origin and development of thin flap and flap thinning technique. Methods: A wide range of domestic and foreign literatures on thin flaps and flap thinning technique were reviewed. The background, definition, methods, problems, challenges, and future development of thin flap and flap thinning technique were summarized and analysed. Results: Thin flap and flap thinning technique play an important role in the development of flap surgery, leading flap surgery towards a more rational and refined direction. Conclusion: Thin flap and flap thinning technique are still hot topics in the future. With the development of thin flap and flap thinning technique, clinicians will have more "free" choices.

The application of micro-dissected polyfoliate anterolateral thigh perforator flap in repair of complex wound in extremities / 中华显微外科杂志

Objective To investigate the design,incisional method and clinical experiences of using the mi cro-dissected polyfoliate anterolateral thigh perforator flap to repair of complex soft tissue defect in extremities.Methods From June,2017 to September,2018,12 cases of different kinds of complex soft tissue defect in extremities were repaired by micro-dissected free polyfoliate anterolateral thigh perforator flap.Each flap was divided into two cutaneous perforators to give two separate flap with a common vascular supply.The flaps were cut from the superficial layer of the deep cervical fesciae and without fascia lata.The donor sites were treated by subcutaneous cosmetic suture.Patients were followed-up by outpatient service,telephone and WeChat video to observe and record the flap's appearance,sensory recovery,extremities function and the scars of the donor site to evaluate its clinical efficacy.Results All flaps survived without vascular crisis happened except one-leaf necrosis occurred,which healed with local flap transferring.The donor sites remained linear scars.The mean flap thickness of this group after micro-dissection was (4.5±0.5) mm.All the patients were followed-up for 5-15 months.The 2 point discrimination ranged between 0.5-2.0 cm.Sensory restoration ranking was S3-S3+.The range of montion of wrist joint was 65°-90°,and that of ankle joint was 40°-60°.Conclusion The micro-dissected polyfoliate anterolateral thigh perforator flap is an ideal method for complex and irregular multiple sites soft tissue defect in extremities as it can keep good economic benefit and minimal damage to the donor site.

Anatomic basis for flap thinning

Flap thinning is a procedure for making a thick flap thinner. This procedure does more than simply fill in the defected area, and it is better for reconstructing the area both functionally and aesthetically. However, because flap thinning is a rather blind procedure, it may have harmful effects on flap vascularity. Therefore, the vasculature of a flap must be understood before performing flap thinning. This paper analyzes the basic anatomy underlying flap thinning based on the previous anatomic study that categorized flaps into 6 types by their vascular structures. This paper also reviews specific studies of frequently practiced flap procedures (deep inferior epigastric artery perforator flap, thoracodorsal artery perforator flap, and anterolateral thigh flap) and presents important precautions for flap thinning procedures. Finally, this paper briefly examines the axiality of the subdermal plexus, which needs to be taken into account when performing flap thinning.

Flap thinning: Defatting after conventional elevation

Perforator flaps become a reliable option for coverage of various defects and the interest is change from survival of perforator flaps to make thin flaps for better aesthetic and functional outcomes. Multiple flap thinning methods have been demonstrated but it has not been widely attempted because of concerns about compromising circulation of flap thinning. This article will demonstrate the feasibility and benefits of flap thinning technique: defatting after conventional flap elevation.

Repair of wound on dorsum of foot with thin anterolateral thigh perforator flap with sensory nerve / 中华整形外科杂志

Objective@#To investigate the treatment and clinical effect of thin anterolateral thigh perforator flap with sensory nerve in the repair of soft tissue defect of dorsal foot.@*Methods@#During January 2012 to February 2017, 14 cases of soft tissue defect of dorsalis pedis were treated. The flap was designed according to the three-dimensional structure of the defect in the recipient area, and the lateral femoral cutaneous nerve was carried. Free transplantation was performed for repair of soft tissue defect of dorsal foot after fine thinning under microscope. The selected size of the flap ranged from 6 cm×4 cm to 15 cm×9 cm, 10 cases of donor site width is less than or equal to 8 cm with direct suture, 4 cases of donor site wound greater than 8 cm, Free skin graft on the wound surface.@*Results@#After operation, all flaps survived. Meanwhile, superficial necrosis occurred in the distal part of the flap in 1 case due to local infection, and healed after dressing change. All patients were followed up for 6-24 months, the appearance of the flap was pleasant, the texture, color and elasticity of the flap were satisfactory. In addition, Partial skin flap two-point discrimination was 6-10 mm with S2, S3 sensory recovery. During the follow-up, patients were able to walk with normal shoes, no ulcer occurred in the flap, and healed well in donor site.@*Conclusions@#The application of thin anterolateral thigh perforator flap with sensory nerve is safe and reliable in the repair of soft tissue defect of dorsal foot. After the repair, the skin flap has a good appearance and can restore part of the sensation.

Application of selectively thinning of free anterolateral thigh flap in repair of heel skin and soft tissue defect / 中国修复重建外科杂志

Objective: To investigate the effectiveness of selectively thinning of the free anterolateral thigh flap in repair of the heel skin and soft tissue defect.

Effects of three-area laser-assisted zona thinning in 8-cell human embryos on pregnancy outcomes in vitro fertilization / 대한생식의학회지

OBJECTIVE: This study conducted a preliminary examination of the effects of three-area laser-assisted zona thinning (LAZT) during the cleavage stage of embryo development on the hatching process in human in vitro fertilization-embryo transfer (IVF-ET) with subjects of advanced female age or frozen-thawed (FT) embryos. METHODS: Eight-cell stage embryos were treated with LAZT in three areas of the zona pellucida at 120° intervals. The control group was embryos without LAZT. Of the 72 consecutive fresh cycles and the 28 FT embryo transfer cycles, the patients in 55 fresh cycles and 17 FT cycles declined LAZT, and those cycles were defined as the control group. RESULTS: In the fresh cycles, the pregnancy rates were similar in the LAZT and control groups. However, in the FT cycles, the pregnancy rate was significantly higher in the LAZT group than in the control group (45.5% in the LAZT group vs. 23.5% in the control group, p < 0.05). CONCLUSION: These results show that multi-area LAZT resulted in significantly improved pregnancy outcomes in human 8-cell embryos compared to controls.

Utilização do óleo de coco para emagrecimento e redução da circunferência abdominal / Use of coconut oil for grinding and reducing abdominal circumference

O óleo de coco é um alimento que apresenta perfil nutracêutico com ação termogênica, e pode ser uma proposta utilizada para o processo de emagrecimento e redução da circunferência abdominal. Realizar uma revisão sistemática, com o objetivo de identificar as principais evidências do uso do óleo de coco, no processo de emagrecimento e redução de circunferência abdominal. Foram incluídos no trabalho estudos com resultados de metaanálises, ensaios clínicos, estudos de caso-controle e série de casos realizados em seres humanos, publicados nos últimos 10 anos. Foram encontradas poucas evidências a respeito dos efeitos do óleo de coco na perda de peso e redução da circunferência abdominal. São escassos ou inconclusivos os estudos que avaliam os efeitos do óleo de coco para fins estéticos como emagrecimento e redução de circunferência abdominal, associado ou não à prática de atividade física, o que coloca em dúvida o uso deste suplemento(AU)

Coconut oil is a food that presents a nutraceutical profile with thermogenic action, and can be a proposal used for the process of slimming and reduction of the waist circumference. To carry out a systematic review with the objective of identifying the main evidences of the use of coconut oil, in the process of slimming and reduction of abdominal circumference. We included studies with results of meta-analyzes, clinical trials, case-control studies and series of human cases published in the last 10 years. Little evidence was found regarding the effects of coconut oil on weight loss and reduction of waist circumference. There are few or inconclusive studies that evaluate the effects of coconut oil for aesthetic purposes such as weight loss and reduction of waist circumference, associated or not to the practice of physical activity, which questions the use of this supplement(AU)

Thinning of the free muscle flaps for the treatment of hand and foot defects / 中华整形外科杂志

Objective@#To investigate the feasibility of one-stage thinning of latissimus dorsi muscle, rectus abdominis muscle and gracilis flap in reconstruction of the hand and foot defects.@*Methods@#From June 2009 to April 2015, 24 free muscle flaps were thinned during transfer operation by removing their superficial muscle layers on the basis of their vessel pedicles running in the deep surface of flaps. The surface of the muscle flaps were covered by split-thickness skin grafts. There were 16 latissimus dorsi muscle flaps, 4 gracilis flaps and 4 rectus abdominis muscle flaps. Flap size ranged from 6 cm×4 cm to 20 cm×12 cm. Thinned muscle flaps were used to resurface 7 hand defects and 17 foot defects.@*Results@#All muscle flaps survived the thinning procedures without any circulation problems except for one case which suffered total flap necrosis due to venous thrombosis. Skins grafts on muscle flaps also took well. One patient experienced partial skin loss. Two patients underwent secondary debridement and thinning procedure for infection and bulkiness. During the 0.3-20 months follow-up, the contour of thinned muscle flaps matched well with the recipient areas. Reconstructed feet are able to wear regular shoes.@*Conclusions@#Intraoperative immediate thinning of free muscle flaps can be safely accomplished during the primary reconstruction procedure. This procedure prevents the limitations of muscle flap bulkiness and may provide an alternative for surface coverage.

Comparison of retinal nerve fiber layer thickness in elderly diabetic patients with and without peripheral neuropathy

Objectives@#The primary goal of this study was to determine the relationship between diabetic peripheral neuropathy and retinal nerve fiber layer (RNFL) thickness among elderly Filipinos with type 2 diabetes mellitus.@*Methodology@#This was a cross-sectional study involving 106 subjects aged 60 years or older with type 2 diabetes mellitus recruited from the General Medicine and Diabetes Clinics of a tertiary government hospital. The diagnosis of peripheral neuropathy was made by performing a 10-gram monofilament test. Peripapillary retinal nerve fiber layer thickness was measured using the optic disc cube 200 x 200 protocol of the Cirrus® HD-OCT. T-test was used to compare RNFL thickness in those with and without peripheral neuropathy. The effects of age, sex, duration of diabetes, presence or absence of peripheral neuropathy, and retinopathy status on global and quadrantal RNFL thickness was assessed using multivariate analysis.@*Results@#Compared to subjects without peripheral neuropathy, significant thinning of the superior (P=0.011), inferior (P=0.004), and global (P=0.008) RNFL thickness were observed in subjects with peripheral neuropathy. There were no significant differences in RNFL thickness in the temporal (P=0.211) and nasal (P=0.263) quadrants between the 2 groups. Multivariate regression analysis revealed that presence of peripheral neuropathy has a significant effect on their superior (P=0.036), inferior (P=0.010), and global (P=0.024) RNFL thickness. Other factors such as age, sex, duration of diabetes, and retinopathy had no effect on global and quadrantal RNFL thickness.@*Conclusion@#RNFL thinning in the superior, inferior, and global indices on optical coherence tomography has a significant correlation with diabetic peripheral neuropathy

Rheological study of hyaluronic acid derivatives

The viscoelastic properties of four novel, low molecular weight hyaluronic acid derivatives were investigated and compared to the parent hyaluronic acid compound. Briefly, all derivatives were synthesized by first deacetylating the parent hyaluronic acid. One sample was left as such, while two others were reacytelated. The final compound, of particular interest for its anti-inflammatory properties, was butyrylated. The compounds were dissolved in phosphate buffer solution (PBS) and studied at a concentration of 5 mg/mL. Shear thinning behaviour was observed for all compounds, however, derivative samples had a lower viscosity than the parent compound at high shear rates. Viscoelastic properties were also observed to decrease as a result of the derivative preparation method. It is believed that these changes are primarily caused by a decrease in hyaluronic acid molecular weight. By increasing the concentration of the anti-inflammatory compound, it may be possible to modulate the viscoelastic properties to more closely resemble those of commercial viscosupplements. As a result, an anti-inflammatory derivative of hyaluronic acid may potentially improve upon existing viscosupplements used to treat patients who are susceptible to flare up.

Death due to fracture of thin calvarial bones after a fall: A forensic approach / 中华创伤杂志(英文版)

A 45-year-old male was autopsied. He had fallen backwards from a two-stairs height to the ground and passed away. A skull fracture was detected in the left occipital area, extending up to the left side of the skull base. The patient's death occurred due to the very low thickness of the calvarial bones, which led to the aforementioned fracture, and in turn resulted in subarachnoid hemorrhage and death. The cortical thickness was measured and compared with average values at standardized points. Uniform bone thinning was confirmed rather than localized. Calvarial thinning may result from various conditions. In the present case study, however, the exact mechanism which led to the low thickness of the calvarial bones of the patient is undetermined. Death due to the susceptible structure and fracture of calvarial bones has rarely been reported throughout relevant literature.

Berry-cluster thinning to reduce compactness of ‘Black Star’ table grapes / Despenca como método de raleio para reduzir a compacidade de cachos da uva de mesa ‘Black Star’

ABSTRACT: The berry-cluster thinning technique was evaluated at different phenological times to prevent bunch compactness of ‘Black Star’ table grape, a new somatic mutation of ‘Brasil’ grape. The trial was carried out during 2012 and 2013 seaons in a vineyard situated in Marialva, PR, Brazil. Vines were trained in an overhead trellis system and spaced at 3x4m. The randomized block design was used as a statistical model with five replications and five treatments. The following treatments were evaluated: control; brushing prior to anthesis; and berry-cluster thinning at different times, when berries were 3-6, 7-10, or 11-15mm in diameter. The prevalence of bunch compactness was evaluated considering the levels: loose, medium loose, and dense bunches. The main physico-chemical characteristics of grapes and yield were also appraised. The data obtained were submitted to ANOVA, and toTukey’s test at 5% was applied. So, thinning is a mandatory practice to avoid bunch compactness of ‘Black Star’ grapes. The technique has to be performed, preferably, by means of brushing prior to anthesis, and the failure to accomplish this practice at this time, berry-cluster thinning when berries are 11-15mm in diameter can be used.

RESUMO: O método de raleio de bagas em diferentes fases fenológicas reduz a compactação de cachos da uva fina de mesa ‘Black Star’, uma nova mutação da uva ‘Brasil’. As videiras foram conduzidas em latada em espaçamento 3x4m, e o experimento foi realizado nas safras 2012 e 2013. O delineamento experimental consistiu em blocos casualizados, com cinco repetições e cinco tratamentos: controle sem raleio; raleio com escova plástica realizado no pré-florescimento e; despenca quando as bagas apresentavam 3-6, 7-10 ou 11-15mm de diâmetro. A compacidade predominante dos cachos foi avaliada de acordo com a seguinte classificação: cachos soltos, medianamente soltos e compactos. As características físico-químicas dos cachos e a produtividade também foram avaliadas. Os dados foram submetidos à análise de variância e as médias comparadas pelo teste de Tukey a 5%. Verificou-se que o raleio de bagas é uma prática obrigatória na uva ‘Black Star’ para diminuir a compacidade dos cachos. A operação deve ser realizada, preferencialmente, com a escova plástica no pré-florescimento, e na impossibilidade de executar ou finalizar essa prática nesta fase, pode-se empregar a despenca quando as bagas apresentarem 11-15mm de diâmetro.

Espesores parietales regionales en pacientes con y sin miocardiopatías evaluados por resonancia magnética cardíaca / Myocardial regional thickness in patients with and without cardiomyopathy assessed by cardiac magnetic resonance

Resumen Objetivo Explorar las diferencias segmentarias de los espesores parietales (EP) en las miocardiopatías más prevalentes y en individuos sin cardiopatía estructural por resonancia magnética cardíaca. Método Pacientes mayores de 18 años referidos a resonancia magnética cardíaca durante el periodo comprendido entre enero de 2014 y septiembre de 2014, con diagnóstico de miocardiopatía hipertrófica, miocardiopatía dilatada idiopática, miocardiopatía isquémico-necrótica y miocarditis fueron seleccionados retrospectivamente de nuestra base de datos. Resultados Se incluyeron 120 pacientes. El grupo control presentó un EP medio de 5.9 ± 1.1 mm, con un índice de espesor relativo de 2.9 ± 0.8. Se identificaron EP significativamente menores en los segmentos apicales tanto en el grupo control (basal 6.7 ± 1.3 vs. medio 6 ± 1.3 vs. apical 4.6 ± 1 mm, p < 0.0001) como en todas las miocardiopatías evaluadas (miocardiopatía hipertrófica: basal 10.5 ± 2.4 vs. medio 10.8 ± 2.7 vs. apical 7.3 ± 3.3 mm, p < 0.0001; miocardiopatía dilatada idiopática: basal 7.7 ± 1.7 vs. medio 7.6 ± 1.3 vs. apical 5.4 ± 1.3 mm, p < 0.0001; miocardiopatía isquémico-necrótica: basal 7.4 ± 1.7 vs. medio 7.5 ± 1.9 vs. apical 5.5 ± 1.8 mm, p < 0.0001; miocarditis: basal 7.1 ± 1.5 vs. medio 6.4 ± 1.1 vs. apical 5.1 ± 0.8, p < 0.0001). También se evidenciaron diferencias significativas entre hombres y mujeres respecto al EP tanto en el grupo control (6.5 ± 2.1 vs. 5.2 ± 1.7 mm, p < 0.0001), como en la miocardiopatía hipertrófica (10.5 ± 5.3 vs. 8.5 ± 5.7 mm, p < 0.0001) y en la miocarditis (6.6 ± 2 vs. 5.2 ± 1.6 mm, p < 0.0001). Conclusiones En este estudio observacional encontramos un prevalencia relativamente elevada de segmentos comúnmente considerados como adelgazados en individuos sin cardiopatía estructural. Además, observamos una marcada asimetría y gradiente longitudinal en cuanto a EP tanto en controles como en las distintas miocardiopatías evaluadas.

Abstract Objective To explore regional differences in myocardial wall thickness (WT) among the most prevalent cardiomyopathies and in individuals without structural heart disease using cardiac magnetic resonance. Methods Patients older than 18 years referred to cardiac magnetic resonance during the period between January 2014 and September 2014, with a diagnosis of hypertrophic cardiomyopathy, idiopathic dilated cardiomyopathy, ischemic cardiomyopathy, and myocarditis were retrospectively selected from our database. Results One hundred twenty patients patients were included. The control group had an average WT of 5.9 ± 1.1 mm, with a WT index of 2.9 ± 0.8. Significantly lower mean WT in the apical segments were identified in both the control group (basal 6.7 ± 1.3 vs. mid 6.0 ± 1.3 vs. apical 4.6 ± 1.0 mm, P < .0001) and in all evaluated cardiomyopathies (hypertrophic cardiomyopathy: basal 10.5 ± 2.4 vs. mid 10.8 ± 2.7 vs. apical 7.3 ± 3.3 mm, P < .0001; idiopathic dilated cardiomyopathy: basal 7.7 ± 1.7 vs. mid 7.6 ± 1.3 vs. apical 5.4 ± 1.3 mm, P < .0001; ischemic cardiomyopathy: basal 7.4 ± 1.7 vs. mid 7.5 ± 1.9 vs. apical 5.5 ± 1.8 mm, P < .0001; myocarditis: basal 7.1 ± 1.5 vs. mid 6.4 ± 1.1 vs. apical 5.1 ± 0.8, P < .0001). Significant gender differences were also evident regarding the mean WT both in the control group (male 6.5 ± 2.1 vs. female 5.2 ± 1.7 mm, P < .0001), as in hypertrophic cardiomyopathy (10.5 ± 5.3 vs. 8.5 ± 5.7 mm, P < .0001) and myocarditis (6.6 ± 2.0 vs. 5.2 ± 1.6 mm, P < .0001). Conclusion We found a relatively high prevalence of segments commonly deemed thinned among patients without structural heart disease. We also observed a marked asymmetry and longitudinal gradient in wall thickness both in controls and in the various cardiomyopathies evaluated.

Relevancia clínica de la interacción de la warfarina y del acetaminofén: estudio de cohortes retrospective / Clinical relevance of the interaction of warfarin and acetaminophen: retrospective cohort study

Resumen Objetivo: Evaluar el uso concomitante de la warfarina y el acetaminofén en una población ambulatoria de pacientes anticoagulados, como posible factor de riesgo en el aumento de la Relación Normalizada Internacional (INR). Métodos: Estudio de cohortes retrospectivo. Se analizó la información de 1.458 pacientes anticoagulados con la warfarina. El factor de riesgo fue la utilización conjunta de warfarina- acetaminofén; el tiempo de seguimiento fue de 1 mes y como evento final se consideró un incremento del INR igual o mayor a 0,5 unidades. La asociación del factor de riesgo con el evento final se estableció con el riesgo relativo (RR) y el riesgo atribuible poblacional (RAP). Resultados: 63 pacientes cumplieron criterios de inclusión, 21 pacientes expuestos y 42 pacientes no expuestos. En los individuos expuestos se observó un aumento estadísticamente significativo en el INR al mes siguiente de haber iniciado el tratamiento con el acetaminofén comparado con el momento de ingreso al estudio (mes 1: mediana 3,06 vs. mes 0: mediana 2,63), (valor p = 0,003). En contraste, en los sujetos no expuestos no se observaron diferencias estadísticamente significativas en los valores del INR (mes 0: mediana 2,63 vs. mes 1: mediana 2,75), (valor p = 0,115). El uso de la warfarina y el acetaminofén representó un RR de 2,5 veces mayor de incrementar el INR mayor o igual de 0,5 unidades. Conclusión: El uso concomitante de la warfarina y el acetaminofén está asociado a un aumento del INR igual o mayor de 0,5 unidades, lo cual podría generar un mayor efecto anticoagulante y, por tanto, un mayor riesgo potencial de sangrado.

Abstract Motivation: To assess concomitant use of warfarin and acetaminophen in an outpatient population of patients receiving blood-thinning drugs as a possible risk factor for the increase of International Normalised Ratio (INR). Methods: Retrospective cohort study. The information pertaining 1,458 patients receiving blood-thinning drugs with warfarin was analysed. The risk factor was the joint intake of warfarin and acetaminophen; follow-up time was 1 month and the final event considered was a INR increase of or higher than 0.5 units. The association of the risk factor with the final event was establish with the Relative Risk (RR) and the Population Attributable Risk (PAR). Results: 63 patients met the inclusion criteria, of whom 21 were exposed patients and 42 were unexposed patients. In the exposed patients a statistically significant increase of INR on the month following the onset of treatment with acetaminophen was observed, compared to the baseline values (month 1: median 3.06 vs. month 0: median 2.63), (p = 0.003). In contrast, no statistically significant differences of INR values were observed in unexposed individuals (month 0: median 2.63 vs. month 1: median 2.75) (p = 0.115). The combination of warfarin and acetaminophen represented a RR 2.5 times higher to increase INR greater than or equal to 0.5 units. Conclusion: Concomitant use of warfarin and acetaminophen is associated to an increase of INR equal to or greater than 0.5 units, which could generate a higher blood-thinning effect and, thus, cause a potentially higher risk of bleeding.