Estudio AHORA 6: Angioplastia coronaria con alta HOspitalaria RÁpida en 6 horas / Early Hospital Discharge (Within Six Hours) for Patients Undergoing Coronary Angioplasty

RESUMEN Introducción: Es de práctica habitual la internación durante 24 h en los pacientes (P) intervenidos con una angioplastia coronaria (ATC) programada. Experiencias previas proponen el alta post ATC en el mismo día en P seleccionados. Material y métodos: Estudio prospectivo, aleatorizado, controlado, simple ciego. Se incluyeron P de 18 a 75 años candidatos a una ATC programada por acceso radial, con posibilidad de acceder al sistema de emergencias en menos de 40 minutos. Se excluyeron los P con fracción de eyección ventricular izquierda < 30%, Creatinina > 1,5 mg/dL, insuficiencia cardíaca, enfermedad pulmonar obstructiva crónica, diabetes descompensada, o anatomía coronaria muy compleja. Se dividió a la población en dos grupos (G). G 1: alta en 6 horas. G2: alta al día siguiente. Punto final primario: muerte o necesidad de rehospitalización dentro de las 24 h de realizado el procedimiento. Se realizó seguimiento telefónico la noche del procedimiento y a la mañana siguiente, presencial a las 48 h, y telefónico al mes, seis meses y un año. Resultados: Se adjudicaron aleatoriamente 80 P. Seis P (7,5%) presentaron criterios de exclusión durante el procedimiento. No se produjo ninguna muerte ni evento cardiovascular mayor en ninguno de ambos grupos. Al año de seguimiento se detectó 3,75% de reestenosis intra stent. Se detectó elevación de troponina en 20 P (25%) de los cuales 4 habían sido excluidos por complicaciones durante la ATC. En los restantes 16, la elevación de la troponina no tuvo repercusión clínica. Conclusión: En una población de pacientes entre 55 y 75 años, en su mayoría de género masculino, con alta prevalencia de infarto de miocardio previo, y depresión de la función ventricular, pudo realizarse una angioplastia programada por acceso radial con alta en 6 horas, con un adecuado margen de seguridad.

ABSTRACT Background: 24-hour hospitalization is common practice in patients (P) who underwent scheduled coronary angioplasty (PCI). Previous experiences propose same-day discharge in selected P. Methods: Prospective, comparative, randomized, single-blind study. P aged 18 to 75 years were included as candidates for a scheduled radial-access PCI with the possibility of accessing the emergency system in less than 40 minutes. P with left ventricular ejection fraction <30%, creatinine >1.5 mg/dL, heart failure, chronic obstructive pulmonary disease, decompensated diabetes or very complex coronary anatomy were excluded. The population was divided in two groups (G). G 1: same-day discharge in 6 hours. G2: discharge the next day. Primary endpoint: death or need for rehospitalization within 24 hours of the procedure. Follow-up was carried out by phone the night of the procedure and the next morning, in person at 48 hours, and by telephone after a month, six months and a year. Continuous variables were expressed as median and their respective interquartile range, and qualitative variables as percentages. Results: 80 P were randomized. Six P (7.5%) presented exclusion criteria during the procedure. There were no deaths or major cardiovascular events in either groups. At one year of follow-up, 3.75% of in-stent restenosis was detected. Troponin elevation was detected in 20 P (25%); 4 were P excluded due to complications during PCI, in the remaining 16 it had no clinical repercussion. Conclusion: In a population of patients between 55 and 75 years old, mostly male, with a high prevalence of previous myocardial infarction, and ventricular function depression, a scheduled radial-access PCI could be performed with same day discharge in 6 hours, with an adequate safety margin.

Evasión de la respuesta inmune por virus herpes simplex / Immune evasion by herpes simplex viruses

Herpes simplex viruses and humans have co-existed for tens of thousands of years. This long relationship has translated into the evolution and selection of viral determinants to evade the host immune response and reciprocally the evolution and selection of host immune components for limiting virus infection and damage. Currently there are no vaccines available to avoid infection with these viruses or therapies to cure them. Herpes simplex viruses are neurotropic and reside latently in neurons at the trigeminal and dorsal root ganglia, occasionally reactivating. Most viral recurrences are subclinical and thus, unnoticed. Here, we discuss the initial steps of infection by herpes simplex viruses and the molecular mechanisms they have developed to evade innate and adaptive immunity. A better understanding of the molecular mechanisms evolved by these viruses to evade host immunity should help us envision novel vaccine strategies and therapies that limit infection and dissemination.

Los virus herpes simplex y humanos co-existen desde decenas de miles de años. Esta prolongada relación se ha traducido en la evolución y selección de determinantes virales para evadir la respuesta inmune y recíprocamente la evolución y selección de componentes inmunes del hospedero para limitar la infección viral y el daño que producen. Actualmente no existen vacunas para evitar la infección de estos virus o terapias que la curen. Los virus herpes simplex son neurotrópicos y permanecen latentes en neuronas de ganglios trigémino y dorsales, reactivándose esporádicamente. La mayoría de las recurrencias por virus herpes simplex son sub-clínicas y por tanto pasan inadvertidas. Aquí discutimos los pasos iniciales de la infección porvirus herpes simplex y los mecanismos moleculares que estos virus han desarrollado para evadir la respuesta inmune innata y adaptativa. Una mejor comprensión de los mecanismos moleculares evolucionados por estos virus para evadir la respuesta inmune del hospedero deberían ayudarnos visualizar nuevas estrategias para desarrollar vacunas y terapias que limiten su infección y diseminación.

On-line analysis of biosignals for the automation of total and specific sleep deprivation in the rat

A computer-based system that automates sleep studies, including sleep deprivation paradigms, is described. The system allows for total or REM-specific sleep deprivation and is based on a reliable, fast-responding, on-line state detection algorithm linked to a dependable intervention device. Behavioral state detection is achieved by dimension reduction of short-term EEG power spectrum. Interventions are made by serial outputs to servomotors that move a cage with different patterns and variable intensity. The system can adapt itself to individual characteristics and to changes in recording conditions. Customized protocols can be designed by defining the states or stages to be deprived, including scheduling temporal patterns. A detailed analysis of the relevant signals during and after deprivation is readily available. Data is presented from two experimental designs in rats. One consisted of specific REM-sleep short-term deprivation and the other of 10-hour total sleep deprivation. An outline of conceptual and practical considerations involved in the automation of laboratory set-ups oriented to biosignal analysis is provided. Careful monitoring of sleep EEG variables during sleep deprivation suggests peculiarities of brain functioning in that condition. A corollary is that sleep deprivation should not be considered to be merely a forced prolonged wakefulness.