Relevance of subclinical right ventricular dysfunction measured by feature-tracking cardiac magnetic resonance in non-ischemic dilated cardiomyopathy.

BACKGROUND: Right ventricular (RV) dysfunction in patients with non-ischemic dilated cardiomyopathy (NICM) is associated with cardiovascular events. To analyze the feasibility of assessing RV myocardial deformation by feature tracking (FT)-cardiac magnetic resonance (CMR), and its usefulness as a prognostic marker. METHODS: Retrospective study of NICM patients undergoing CMR. Longitudinal FT-RV free wall (LFT-RVFW) and fractional area change (FAC) were obtained. Correlation with standard RV parameters was studied. An association with combined event (heart failure (HF), ICD implantation or cardiovascular death) was assessed using a logistic regression model. RESULTS: 98 patients (64 ± 13 years) were included. Left ventricular (LV) systolic function (LVEF 29.5 ± 9.6%, 47% with LVEF ≥ 30%) and RV (RVEF 52.2 ± 14.6%, 72% with RVEF ≥ 45%). Follow-up of 38 ± 17 months, 26.5% presented at least one admission for HF. An excellent correlation of LFT-RVFW (r = 0.82) and FAC (r = 0.83) with RVEF was evident. No association of RV-FT parameters with prognosis entire study population was found. However, in patients with LVEF ≥ 30%, admissions for HF were associated with lower LFT-RVFW (-21.6 ± 6.6% vs -31.3 ± 10%; p = 0.006) and FAC (36.6 ± 9.6% vs 50.5 ± 13.4%; p < 0.001) values. Similar differences were observed when only patients with RVEF ≥ 45% were considered. An LFT-RVFW cut-off point of -19.5% and FAC of 36.5% showed good prognostic performance. Decreased LFT-RVFW or FAC represented an independent predictor of combined event in patients with LVEF ≥ 30%. CONCLUSIONS: In NICM patients without severe LV dysfunction, decreased values of LFT-RVFW and/or FAC were associated with HF admissions, independently of RVEF.

FAS system deregulation in T-cell lymphoblastic lymphoma.

The acquisition of resistance towards FAS-mediated apoptosis may be required for tumor formation. Tumors from various histological origins exhibit FAS mutations, the most frequent being hematological malignancies. However, data regarding FAS mutations or FAS signaling alterations are still lacking in precursor T-cell lymphoblastic lymphomas (T-LBLs). The available data on acute lymphoblastic leukemia, of precursor origin as well, indicate a low frequency of FAS mutations but often report a serious reduction in FAS-mediated apoptosis as well as chemoresistance, thus suggesting the occurrence of mechanisms able to deregulate the FAS signaling pathway, different from FAS mutation. Our aim at this study was to determine whether FAS-mediated apoptotic signaling is compromised in human T-LBL samples and the mechanisms involved. This study on 26 T-LBL samples confirms that the FAS system is impaired to a wide extent in these tumors, with 57.7% of the cases presenting any alteration of the pathway. A variety of mechanisms seems to be involved in such alteration, in order of frequency the downregulation of FAS, the deregulation of other members of the pathway and the occurrence of mutations at FAS. Considering these results together, it seems plausible to think of a cumulative effect of several alterations in each T-LBL, which in turn may result in FAS/FASLG system deregulation. Since defective FAS signaling may render the T-LBL tumor cells resistant to apoptotic cell death, the correct prognosis, diagnosis and thus the success of anticancer therapy may require such an in-depth knowledge of the complete scenario of FAS-signaling alterations.

Papel de los anticolinérgicos en la enfermedad asmática / No disponible

Los anticolinérgicos (AC) son escasamente utilizados en el asma a diferencia de lo que ocurre en la enfermedad pulmonar obstructiva crónica (EPOC) en la que está muy extendido su uso. Las directrices para el manejo del asma recomiendan el uso de AC únicamente durante las exacerbaciones, ya que los beneficios del uso de estos fármacos en la fase estable del asma aún no se han establecido. Estudios recientes han sugerido la implicación del sistema colinérgico en la fisiopatología y la patogenia del asma, al demostrar la capacidad de las células epiteliales bronquiales e inflamatorias para sintetizar y liberar acetilcolina (ACh) y para expresar receptores muscarínicos. La implicación de estos receptores en la modulación de determinados mecanismos inflamatorios en el asma y en los cambios estructurales que conducen al remodelado apoya este concepto. Estas consideraciones sugieren que los AC que actúan bloqueando determinados receptores muscarínicos constituirían una alternativa terapéutica en esta enfermedad. En este sentido, una serie de trabajos, recientemente publicados, han demostrado que los AC podrían ser eficaces en el tratamiento del asma estable (AU)

Anticholinergic agents are not usually chose for asthma treatment, compared with its widely use in Chronic Obstructive Pulmonary Disease. The asthma guidelines only recommend its use in acute asthma exacerbations, and has not been fully investigated its role in stable asthma. Recent studies have related the cholinergic system and asthma pathophysiology, as it has been observed the secretion of acetylcholine and the expression of muscarinic receptors by the airway ephitelium cells and inflammatory cells. These receptors play a regulatory role in inflammatory mechanisms and airway smooth muscle remodeling. These findings suggest that anticholinergics are an alternative therapeutic agent and probably are useful in stable asthma as adjuncts to other bronchodilator therapies (AU)

Traqueobroncopatía osteocondroplástica: a propósito de dos casos clínicos / Tracheopathia osteochondroplastica: based on two clinical cases

The tracheopathia osteochondroplastica (TO) is a benign and rare disorder, characterized by the deposit of cartilaginous tissue in the submucosa of the larynx, trachea and occasionally the bronchi. Both the etiology and pathogenesis, as well as the incidence and prevalence, of this disease are unknown. In a large series of 16888 bronchoscopies described, the incidence of TO was 1:1299. This is usually an incidental finding when a bronchoscopy is performed for another reason as in the cases presented. Endoscopically, a cobblestone mucosa with yellowish-white nodules protruding into the tracheal lumen and main bronchi is observed. Other symptoms have been hemoptysis and treatment-refractory cough. Despite the low prevalence of this disease, we describe two cases presented in the same hospital, diagnosed by chance when performing a fibrobroncoscopia for the study of a solitary pulmonary nodule (AU)

Pediococcus acidilactici isolated from the rumen of lambs with rumen acidosis, 16S rRNA identification and sensibility to monensin and lasalocid.

A lactic-acid producing bacterium was isolated from the rumen of lambs with rumen acidosis. The cells were gram-positive, nonmotile, nonsporing, catalase negative spherical, 1.5-2.0 µm in diameter, and occur in pairs and tetrads. Analysis of 16S ribosomal RNA indicated that the rumen bacterium was a strain of Pediococcus acidilactici with 99% of nucleotide homology. This bacterium was sensible to monensin and lasalocid at the unique dose tested of 300 ppm. The concentration of lactic acid and DM degradation decreased (P<0.05) when monensin or lasalocid were added to the culture media after 24, 48 and 72 h of incubation. In contrast, total VFA concentration and pH were higher (P<0.05) in the culture media added with the ionophores. Up to now S. bovis is considered the main ruminal bacterium related with rumen acidosis, but the importance of P. acidilactici should be also reconsidered in experimental studies focused on the control rumen acidosis.

Correlation between occlusal contact and root resorption in teeth with periodontal disease.

BACKGROUND AND OBJECTIVE: The present study was designed to investigate the influence of occlusal forces on radicular resorption in teeth with periodontal disease. The occlusal forces are a cause in the aggravation of the periodontal disease and therefore influences in the increase the extension and the depth of the radicular resorption. MATERIAL AND METHODS: We quantified radicular resorption, its extension across the radicular surface and its depth, in 88 teeth with periodontal disease with and without occlusal contact, pertaining to patients between 43 and 91 years of age. A histological method was used to obtain 6-µm-thick sections. The sections were observed under an Olympus BX40 optical microscope and processed by an image analysis program. Measurements of length and area were used to calculate the percentages of surface and volume of cement reabsorbed. RESULTS: In both groups presenting periodontal pathology (groups 2 and 3) the percentages of the surface and volume of reabsorbed cement were greater in those teeth with antagonist contact. The greatest percentages of radicular resorption were observed in teeth of group 3 showing antagonism. CONCLUSION: The severity of periodontal disease increases the extension and the depth of the radicular resorption, and the presence of antagonist forces aggravates the resorption.

Ventilación mecánica no invasiva / Non-invasive mechanical ventilation

No disponible

No disponible

Nuevos retos en el diagnóstico y tratamiento de las enfermedades pulmonares intesticiales / New challenges in the diagnosis and treatment of interstitial pulmonary diseases

No disponible

No disponible

Resultados estudio ESCASE. Estudio control del asma en España / No disponible

No disponible

Características clínico-funcionales de los pacientes asmáticos en una consulta monográfica de neumología / Clinical-functional characteristics of asthmatic patients in a monographic consultation of pneumology

Objetivo: Determinar las características sociodemográficas, clínicas, funcionales y de tratamiento de los pacientesatendidos en una consulta monográfica de asma.Metodología: De un total de 400 pacientes registrados en primera visita en nuestra consulta, se seleccionó aleatoriamenteuna muestra de 50 pacientes y se revisaron las historias clínicas.Resultados: Los pacientes evaluados presentaron una media de edad de 40,7 ± 18,9 años, siendo el 60% mujeres. El 82%estaban en situación laboral activa y en su mayoría (76%) procedían de zona urbana. Un 14% eran fumadores activos y un 24% exfumadores, siendo el resto no fumadores. La media de inicio de los síntomas fue de 24,6 ± 20 años. La mitad de los pacientes tenían antecedentes familiares de asma y/o atopia, presentando como factores asociados: sinusitis derepetición (10%), urticaria y/o eczema (8%), rinitis (38%), pólipos nasales (8%), intolerancia a la aspirina (18%) y clínica de reflujo gastroesofágico (6%). 42 pacientes tenían tests cutáneos realizados, siendo positivos en un 83%. Un 36% de los pacientes habían estado hospitalizados por asma en el último año (3 de ellos en UCI) y habían acudido a urgenciasuna media de 1,4 ± 2,04 veces. En cuanto a función pulmonar, se observó una media de FEV1 de 90 ± 21,4%, FEV1/FVC 76,6 ± 11,9. Por lo que respecta al tratamiento, un 16% tenían β2 a demanda como único tratamiento, un 16% tomaban corticoides inhalados solos y el resto tenían una combinación de β2 de larga más corticoides, siendo en un 54% del total de pacientes con corticoides a dosis altas. 14 pacientes recibían, además, antileucotrienos.Conclusiones: Encontramos un considerable número de asmáticos fumadores activos. Muchos pacientes habían sidohospitalizados en el año previo. Más de la mitad de los pacientes recibían tratamiento con corticoides inhalados a altas dosis

Introduction: The purpose of this study was to determine demographic characteristics, lung function, treatment andclinical status of asthmatics patients who were treated in an asthma monographic outpatient consult.Methods: A sample of 50 patients was randomly, select from 400 patients who had visited the asthma monographicoutpatient consult at first time with asthma symptoms. Data were registered from clinical history.Result: The mean age was 40.7 ±18.9, 60% were women. 82% were working people and most of them come from the city.Moreover a 14% were smokers, 24% ex-smokers and the remainders were non-smokers. Mean age of asthma symptomsonset was 24.6 ± 20 years. Family history of asthma and/or atopy was present in 50% cases. Other asthma associated factors were reported in form of sinusitis (10%), eczema (8%), rhinitis (38%), nasal polyposis (8%), AAS intolerance (18%) and gastroesophageal reflux symptoms (6%). An 83% of prick test performed was positive for aeroallergens. A 36% of patients have been previous hospitalized due to asthma within the last year (3 sujects at the critical care unit) and the mean of visits to emergency rooms were 1.4 ±2.04 times. Mean FEV1 was 90 ±21.4% of predicted. Mean of FEV1/FVCratio was 76.6 ± 11.9. A 16% of patients were receiving treatment with short acting β2 agonists alone; other 16% with inhaled corticosteroids (ICSs). Most of patients (57%) were receiving long acting β2-agonists combined with ICSs (54% of total patients were being treated with high doses of ICSs). 14 patients were treated with Cysteinyl leukotrienes inhibitors.Conclusions: We are found an important number of smokers between asthmatics patients. A lot of patients were hospitalized within last year. Most patients were receiving high doses of ICSs (AU)

Tiotropio: análisis crítico / No disponible

No disponible

Effect of exogenous fibrolytic enzyme on ruminal fermentation and digestibility of alfalfa and rye-grass hay fed to lambs.

This experiment was carried out to study the effect of a directly fed exogenous fibrolytic enzyme on intake and digestion of DM, OM, protein, NDF, ADF, and hemicellulose of alfalfa and ryegrass hay by sheep. Four diets were randomly assigned to four ruminally cannulated lambs using a 4 x 4 Latin square design, repeated in time, with a factorial arrangement (2 x 2) of diets: 1) alfalfa hay; 2) alfalfa hay + exogenous fibrolytic enzymes (enzyme); 3) ryegrass hay; and 4) ryegrass hay + enzyme. Lambs consumed more DM and OM from alfalfa than from ryegrass hay (P < 0.001). The ADF intake was not different between the hays, but NDF intake was lower for alfalfa (P < 0.001). For both hays, the enzyme increased intake of DM (P < 0.01), as well as OM and CP (P < 0.05); however, NDF and ADF intake were not changed. Alfalfa hay had higher apparent digestibility of DM, OM, and CP (P < 0.001), but lower digestibility for NDF, ADF, and hemicellulose. The enzyme increased apparent digestibility of CP, hemicellulose (P < 0.05), and NDF (P < 0.10) for alfalfa. Also, for both hays, the enzyme improved N balance because lambs retained more N (P < 0.05). The enzyme increased (P < 0.05) total VFA concentration (3 and 6 h) for both hays. Results from this trial indicate that directly fed exogenous fibrolytic enzymes may change ruminal fermentation, intake, and digestibility of forages with different nutritive value.

Morphological study of root surfaces in teeth with adult periodontitis.

BACKGROUND: Our study correlates the histological alterations in the cementum (especially resorption areas) of teeth with the different stages of adult periodontitis. METHODS: Sixty-seven teeth affected by adult periodontitis and 7 healthy teeth extracted from patients over 40 years old were used. The teeth were divided into 3 groups according to radiographic data: group 1: five teeth with bone loss less than one-third of the normal alveolar height; group 2: thirty-one teeth with bone loss between one and two thirds; and group 3: thirty-one teeth with bone loss greater than two thirds. The samples were prepared for light and scanning electron microscopy, considering the gingival, middle, and apical thirds in each root. RESULTS: Two control teeth, 4 teeth in group 1, and all teeth in groups 2 and 3 showed resorption areas. Regarding the gingival third, the control teeth did not show any resorption, while 25% of affected teeth in group 1, 38.7% of teeth in group 2, and 35.5% of teeth in group 3 exhibited resorption. Regarding the middle third, 50% of affected teeth belonging to the control group and group 1; 67.7% of teeth in group 2; and 87.1% of teeth in group 3 showed resorption. Regarding the apical third, all teeth belonging to the control group and group 1 showed resorption, while 93.5% and 87.1% of teeth in groups 2 and 3, respectively, exhibited resorption. Most of the resorptions did not extend beyond the cementum. However, in 29.0% of teeth in group 2 and 38.7% of teeth in group 3, resorption had spread as far as the dentin. All the lesions in the control group and group 1 were practically repaired, while only 71.0% of teeth in group 2 and 61.3% of teeth in group 3 showed some sign of reparation. However, in groups 2 and 3, practically all lesions affecting dentin were repaired. CONCLUSIONS: These data suggest that the spread of root resorption is associated with inflammation. This study also suggests that the capacity for repair of root resorption is diminished with greater severity of periodontitis.

[Congenital anomalies of the mitral valve in the adult: presentation of 3 cases]. / Anomalías congénitas de la válvula mitral en el adulto: presentación de tres casos.

Congenital mitral valve anomalies are uncommon and their incidence in adults is very unusual. Transthoracic echocardiography is essential for their diagnosis. In this study two adult patients with parachute mitral valve and one with isolated cleft of mitral valve are described. An echocardiographic exam was decisive in obtaining the diagnosis for each of these patients. Clinical aspects, typical echocardiographic findings and therapeutical approaches of these entities are discussed.

[Sleep apnea syndrome]. / Síndrome de apnea del sueño.

The increasing importance of sleep apnea syndrome (SAS) is shown by the potentially lethal consequences of the development of apneic episodes during sleep. The presentation of SAS may be manifold, and the primary health care teams play a crucial role in the detection of their basic symptoms. The adequate approach to these patients depends on primary care teams, thus facilitating early diagnosis and the most adequate therapy in all cases. In the present study we report the features of 60 patients diagnosed of SAS in our unit for the investigation of this condition, to contribute to their diffusion among the professionals of primary health care.

Systemic and regional hemodynamics in patients with liver cirrhosis and ascites with and without functional renal failure.

Systemic, femoral, and renal hemodynamics were evaluated in 7 control subjects and 20 cirrhotic patients with ascites, 14 of them without (group A) and 6 with (group B) functional renal failure. Hyperdynamic systemic circulation, increased plasma volume, and hyperreninism were present in groups A and B. These changes were more severe in group B, which showed, as compared with group A, lower total vascular resistances and mean arterial pressure together with increased cardiac index and plasma renin activity. Significant differences in regional hemodynamics were also observed between groups. In group A, femoral and renal fractions of cardiac output were respectively increased and reduced as compared with controls. By contrast, in group B, both fractions of cardiac output were reduced when compared either with controls or with group A. In the entire patient group there was a close direct correlation between femoral and renal fractions of cardiac output (r = 0.88; p less than 0.001) and both of them correlated independently with total vascular resistances (r = 0.79; p less than 0.001 in both cases). These results indicate that, in nonazotemic cirrhotics with ascites, vasodilatation in extrasplanchnic areas contributes to the genesis of the hyperdynamic circulation. The presence in group B of a reduced flow to extrasplanchnic territories, in association with an increase of the hyperdynamic circulatory status, suggests that exacerbation of splanchnic vasodilatation is involved in the development of the hepatorenal syndrome. Finally, in cirrhosis, the changes that occur in systemic hemodynamics appear to influence renal function and renal blood flow.