Eficacia de un programa de rehabilitación cardiaca en polideportivo municipal comparado con el programa hospitalario: ensayo controlado aleatorizado eCARCEX / Efficacy of a cardiac rehabilitation program in a municipal sports center compared to the hospital program: randomized controlled trial eCARCEX

Fundamento. El objetivo de este estudio es analizar los efectos de un programa de rehabilitación cardiaca (PRC) extrahospitalario en un centro municipal deportivo sobre la capacidad funcional y la adherencia al ejercicio físico, entre otras variables, en comparación con un modelo hospitalario. Métodos. Ensayo clínico aleatorizado con dos grupos paralelos de pacientes con síndrome coronario agudo que realizaron un PRC con ejercicio físico moderado interválico coordinado con educación en hábitos saludables en un centro deportivo municipal (GE) y en un hospital terciario (GC), entre septiembre de 2019 y junio de 2020. Se analizaron variables de adherencia, antropométricas, clínicas, psicológicas, de fuerza, de prevención secundaria (dieta, tabaco) y capacidad funcional en la prueba de ergoespirometría. Resultados. Veintidós pacientes completaron el PRC (GC=10, GE=12). Se observaron mejoras significativas pre-post en GC (colesterol, test de la silla, frecuencia cardiaca en VT1 y VT2, y vatios en VT1) y en GE (colesterol HDL, triglicéridos, test de la silla, y frecuencia cardiaca y vatios en VT1). Estas mejoras fueron mayores en el GC para la frecuencia cardiaca en VT2 (11,17 vs 2,88 lpm) y en el GE para el colesterol HDL (11,0 vs 0,63 mg/dL). Conclusiones. Este estudio no ha podido determinar la eficacia de los PRC extrahospitalarios por falta de potencia (abundantes abandonos debidos al confinamiento por COVID-19). A pesar de ello, en el GE se observó mayor aumento en colesterol HDL que en el GC, aunque la frecuencia cardiaca en VT2 fue mayor en el GC (AU)

Background. This study aimed to analyze the effects of an outpa-tient cardiac rehabilitation program in a municipal sports center on functional capacity and adherence to physical activity – among other variables – compared to an in-hospital program.Methods. Randomized clinical trial that included two parallel groups of acute coronary syndrome patients who performed a car-diac rehabilitation program that consisted of moderate physical ex-ercise intervals along with learning healthy habits in a municipal sports center (EG) and in a tertiary hospital (CG) between Septem-ber 2019 and June 2020. We collected the following data: compli-ance, anthropometrical, clinical, psychological variables, diet and tobacco habits, strength and functional capacity from ergospirom-etry. Results. Twenty-two patients completed the cardiac rehabilitation program (EG=12, CG=10). Significant improvement was observed for cholesterol, the sit-and-stand test, cardiac frequency in VT1 and VT2, and watts in VT1 in the CG, and for HDL-cholesterol, triglycerides, the sit-and-stand test, and frequency, and watts in VT1 in the EG. Better achievement was found in the CG for cardiac frequency in VT2 (11.17 vs 2.88 bpm) and in EG for HDL-cholesterol (11.0 vs 0.63 mg/dL).Conclusions. We are unable to determine the effectiveness of the out-of-hospital cardiac rehabilitation program due to a lack of power (high number of withdrawals caused by COVID-19 lockdown). How-ever, the EG achieved higher HDL-cholesterol levels, while cardiac frequency in VT2 was higher in the CG (AU)

Efficacy of a cardiac rehabilitation program in a municipal sports center compared to the hospital program: randomized controlled trial eCARCEX.

BACKGROUND: This study aimed to analyze the effects of an outpatient cardiac rehabilitation program in a municipal sports center on functional capacity and adherence to physical exercise - among other variables - compared to an in-hospital program. METHODS: Randomized clinical trial that included two parallel groups of acute coronary syndrome patients who performed a cardiac rehabilitation program that consisted of moderate physical exercise intervals along with learning healthy habits in a municipal sports center (experimental group) and in a tertiary hospital (control group) between September 2019 and June 2020. We collected the following data: compliance, anthropometrical, clinical, psychological variables, diet and tobacco habits, strength and functional capacity from ergospirometry. RESULTS: Twenty-two patients completed the cardiac rehabilitation program (experimental group=12, control group=10). Significant improvement was observed for cholesterol, the sit-and-stand test, cardiac frequency in VT1 and VT2, and watts in VT1 in the control group, and for HDL-cholesterol, triglycerides, the sit-and-stand test, and frequency, and watts in VT1 in the experimental group. Better achievement was found in the control group for cardiac frequency in VT2 (11.17 vs 2.88 bpm) and in EG for HDL-cholesterol (11.0 vs 0.63 mg/dL). CONCLUSIONS: We are unable to determine the effectiveness of the out-of-hospital cardiac rehabilitation program due to a lack of power (high number of withdrawals caused by COVID-19 lockdown). However, the experimented group achieved higher HDL-cholesterol levels, while cardiac frequency in VT2 was higher in the control group.

Desarrollo evolutivo humano y longevidad. Un análisis bio-psicosocial / Human evolutionary development and longevity. A bio-psychosocial analysis

En este trabajo se hace una revisión bibliográfica sobre el desarrollo evolutivo humano y longevidad, desde un enfoque biopsicosocial (Engel, 1977; Gliedt et al., 2017; Lehman et al., 2017). Tras aplicar el método de análisis PRISMA, se obtuvieron diversos resultados relacionados con un desarrollo evolutivo más longevo; así, en el área biológica, 3 factores: los SNPs, los telómeros y la química del estrés; en el área psicológica, 5 factores: la metacognición, la resiliencia, la espiritualidad, las relaciones personales y la depresión; y en el área social, 8 factores: la pseudo-heredabilidad, las relaciones conyugales, la maternidad, el nivel educativo, estilos de vida, dieta y restricción calórica, actividad física y mental y tecnología sanitaria. Ante los datos obtenidos en las tres áreas, de este enfoque biopsicosocial, y el repetido solapamiento entre factores del área psicológica y del área social, se plantea que pudieran considerarse estas dos como una conjunta, proponiéndose un enfoque explicativo con dos áreas: bio-psicosocial que, por factores encontrados en este trabajo, quedarían un 18,7% de biológica y un 81,3% psicosocial. Actualmente, hay suficiente información sobre desarrollo evolutivo humano y longevidad, pero una ausencia de investigaciones que estudien esos factores desde una perspectiva integrada. Mucha de esa información privilegiada se podría aplicar ya, psicológica y socialmente, a la población en general, para una mejora de su salud, en cualquier fase del desarrollo evolutivo humano.

In this work, a literature review on human evolutionary development and longevity is made from a biopsychosocial approach (Engel, 1977; Gliedt et al., 2017; Lehman et al, 2017). After applying the PRISMA analysis method, several results related to a more long-lived evolutionary development were obtained; thus, in the biological area, 3 factors: SNPs, telomeres and stress chemistry; in the psychological area, 5 factors: metacognition, resilience, spirituality, personal relationships and depression; and in the social area, 8 factors: pseudo-heritability, conjugal relations, motherhood, educational level, lifestyles, diet and caloric restriction, physical and mental activity and health technology. Given the data obtained in the three areas, of this biopsychosocial approach, and the repeated overlap between factors of the psychological area and the social area, it is proposed that both could be considered as a joint, proposing an explanatory approach with two areas: bio-psychosocial that, for factors found in this work, would be 18.7% biological and 81.3% psychosocial. Currently, there is enough information on human evolutionary development and longevity, but an absence of research that studies these factors from an integrated perspective. Much of this privileged information could be applied already, psychologically and socially, to the population in general, for an improvement of their health, at any stage of human evolutionary development.

Interacciones potenciales en una cohorte de pacientes VIH positivos de edad avanzada / Potential interactions in a cohort of elderly HIV-positive patients

Objetivo: El aumento de la esperanza de vida conduce a un nuevo modelo de paciente VIH positivo, con enfermedades crónicas y, en ocasiones, polimedicado. Pretendemos con este estudio conocer la complejidad de los tratamientos e identificar potenciales interacciones entre antirretrovirales y medicación domiciliaria de nuestros pacientes, con objeto de tenerlas identificadas y poder prevenirlas. Método: Estudio descriptivo, retrospectivo, en una cohorte de pacientes con tratamiento antirretroviral mayores de 50 años en un hospital de tercer grado. Resultados: Se incluyeron 242 pacientes, de los que 148 (61%) recibían algún otro tratamiento. Detectamos 243 potenciales interacciones: 197 consideradas moderadas y 46 graves; afectando a 110 pacientes. De las graves, 35 (76%) se relacionaron con inhibidores de proteasa potenciados. La principal consecuencia fue un aumento de las concentraciones plasmáticas del tratamiento domiciliario (48%). Las estatinas (24%) fueron el grupo especialmente implicado en las interacciones graves, seguidas de los corticoides inhalados (15%). Conclusiones: Prácticamente la mitad de los pacientes estaban polimedicados, observándose un elevado número de potenciales interacciones moderadas o graves. El farmacéutico de hospital debe jugar un papel crucial en su detección, manejo y comunicación precoz

Objective: An increased life expectancy leads to a new model of HIV patient with chronic diseases and occasionally polymedicated. With this study, we intend to understand treatment complexity and to identify any potential interactions between antiretroviral drugs and home medication in our patients, in order to identify and prevent them. Method: A retrospective, descriptive study carried out in a cohort of > 50-year-old patients on antiretroviral treatment in a tertiary hospital. Results: We included 242 patients; 148 (61%) of them were receiving some concomitant treatment. We detected 243 potential interactions: 197 considered moderate and 46 severe, in 110 patients. Of the severe interactions, 35 (76%) were related to boosted protease inhibitors. The main consequence of these interactions was an increase in the plasma concentrations of the home medication (48%). Statins (24%) were the group most involved in severe interactions, followed by inhaled corticosteroids (15%). Conclusions: Practically half of patients were polymedicated, and a high number of potential moderate or severe interactions were observed. The Hospital Pharmacist must play an essential role in their detection, management and early communication

Potential interactions in a cohort of elderly hiv-positive patients.

OBJECTIVE: The increase of HIV-patients life expectancy leads to a new model of patient with chronic diseases and polymedicated. For this reason we ought to  know in clinical practice the prevalence of polypharmacy and drug-drug  interactions between the antiretroviral drugs and comedication in our patients in  order to identify and prevent them. METHOD: A retrospective, descriptive study carried out in > 50 years old patients on antiretroviral treatment. Results: We included 242 patients of whom 148 (61%) were receiving concomitant treatment. 243 potential interactions were detected,  where 197 are considered moderate and 46 severe, affecting 110 patients. 35  (76%) interactions were related to boosted protease inhibitors. The main  consequence of these interactions was the increase in plasma concentrations of  comedication (48%). Statins were the comedication most involved in severe  drug-druginteractions (24%), followed by inhaled corticosteroids (15%). CONCLUSIONS: Polypharmacy was found in about half of our study population and the prevalence of drug-drug interactions was high. Hospital pharmacists may  play a crucial role in their detection, management and early communication.

Objetivo: El aumento de la esperanza de vida conduce a un nuevo modelo de  paciente VIH positivo, con enfermedades crónicas y, en ocasiones, polimedicado. Pretendemos con este estudio conocer la complejidad de los tratamientos e  identificar potenciales interacciones entre antirretrovirales y medicación  domiciliaria de nuestros pacientes, con objeto de tenerlas identificadas y poder  prevenirlas.Método: Estudio descriptivo, retrospectivo, en una cohorte de pacientes con  tratamiento antirretroviral mayores de 50 años en un hospital de tercer grado. Resultados: Se incluyeron 242 pacientes, de los que 148 (61%) recibían algún  otro tratamiento. Detectamos 243 potenciales interacciones: 197 consideradas  moderadas y 46 graves; afectando a 110 pacientes. De las graves, 35 (76%) se  relacionaron con inhibidores de proteasa potenciados. La principal consecuencia  fue un aumento de las concentraciones plasmáticas del tratamiento domiciliario  (48%). Las estatinas (24%) fueron el grupo especialmente implicado en las  interacciones graves, seguidas de los corticoides inhalados (15%). Conclusiones: Prácticamente la mitad de los pacientes estaban polimedicados, observándose un elevado número de potenciales interacciones moderadas o graves. El farmacéutico de hospital debe jugar un  papel crucial en su detección, manejo y comunicación precoz.

Massive upper gastrointestinal bleeding due to splenoportal axis thrombosis in a patient with a tested JAK2 mutation: A case report and review literature.

Portal hypertension is a clinical syndrome defined as a portal venous pressure that exceeds 10mmHg. Cirrhosis is the most common cause of portal hypertension and thrombosis of the splenoportal axis not associated with liver cirrhosis is the second cause of portal hypertension in the Western world. The primary myeloproliferative disorders are the main cause of portal venous thrombosis and somatic mutation of Janus Kinase 2 gene (JAK2 V617F) can be found in approximately 90% of polycythemia vera, 50% of essential thrombocyrosis and 50% primary myelofibrosis. A a 55-year-old man with JAK2 mutation-associated splenoportal axis hypertension and bleeding complications due to oesophageal varices is reported. A massive upper bleeding episode made an emergent surgery to be done immediatelly at seventh day. The patient was discharged home at fifteenth day after surgery.

COMT haplotypes, catecholamine metabolites in plasma and clinical response in schizophrenic and bipolar patients.

AIM: We examined the association of COMT haplotypes and plasma metabolites of catecholamines in relation to the clinical response to antipsychotics in schizophrenic and bipolar patients. PATIENTS & METHODS: We studied 165 patients before and after four weeks of treatment, and 163 healthy controls. We assessed four COMT haplotypes and the plasma concentrations of HVA, DOPAC and MHPG. RESULTS: Bipolar patients: haplotypes are associated with age at onset and clinical evolution. In schizophrenic patients, an haplotype previously associated with increased risk, is related to better response of negative symptoms. CONCLUSION: Haplotypes would be good indicators of the clinical status and the treatment response in bipolar and schizophrenic patients. Larger studies are required to elucidate the clinical usefulness of these findings.

Differential regulation of human Eag1 channel expression by serum and epidermal growth factor in lung and breast cancer cells.

Oncogenic ether à-go-go-1 (Eag1) potassium channels are overexpressed in most primary human solid tumors. Low oxygen and nutrient/growth factor concentrations play critical roles in tumorigenesis. However, the mechanisms by which tumor cells survive and proliferate under growth factor-depleted conditions remain elusive. Here, we investigated whether serum-deprived conditions and epidermal growth factor (EGF) regulate Eag1 expression in human lung and breast cancer cells. The human cancer cell lines A549 and MCF-7 (from the lungs and breast, respectively) were obtained from the American Type Culture Collection and cultured following the manufacturer's recommendations. Eag1 gene and protein expression were studied by real-time PCR and immunocytochemistry, respectively. Cell proliferation was evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, and ERK1/2 phosphorylation was investigated by Western blot. Serum-deprived conditions increased Eag1 mRNA and protein expression in both cell lines. This Eag1 upregulation was prevented by EGF and the ERK1/2 inhibitor U0126 in only lung cancer cells; vascular endothelial growth factor did not prevent Eag1 upregulation. Our results suggest that Eag1 may act as a survival and mitogenic factor under low-serum and nutrient conditions and may be a clinical target during the early stages of tumor development.

Astemizole-based anticancer therapy for hepatocellular carcinoma (HCC), and Eag1 channels as potential early-stage markers of HCC.

Hepatocellular carcinoma (HCC) has very poor prognosis. Astemizole has gained great interest as a potential anticancer drug because it targets several proteins involved in cancer including the Eag1 (ether à-go-go-1) potassium channel that is overexpressed in human HCC. Eag1 channels are regulated by cancer etiological factors and have been proposed as early tumor markers. Here, we found that HepG2 and HuH-7 HCC cells displayed Eag1 messenger RNA (mRNA) and protein expression, determined by real-time RT-PCR and immunochemistry, respectively. Astemizole inhibited human HCC cell proliferation (assessed by metabolic activity assay) and induced apoptosis (studied with flow cytometry) in both cell lines. The subcellular Eag1 protein localization was modified by astemizole in the HepG2 cells. The treatment with astemizole prevented diethylnitrosamine (DEN)-induced rat HCC development in vivo (followed by studying γ-glutamyl transpeptidase (GGT) activity). The Eag1 mRNA and protein levels were increased in most DEN-treated groups but decreased after astemizole treatment. GGT activity was decreased by astemizole. The Eag1 protein was detected in cirrhotic and dysplastic rat livers. Astemizole might have clinical utility for HCC prevention and treatment, and Eag1 channels may be potential early HCC biomarkers. These data provide significant basis to include astemizole in HCC clinical trials.

Anterior and intermediate pituitary tissues express claudin 4 in follicle stellate cells and claudins 2 and 5 in endothelial cells.

Follicle-stellate cells are pituitary non-granular cells that are arranged between secretory cells or organized in follicles with small lumens. Cells from the follicles exhibit the typical phenotype of a transporting epithelium, including apical microvilli with a cilium and tight junctions. Freeze-fracture electron microscopy images show that the tight junctions consist of 5-7 anastomosing strands and that cultured follicle-stellate cells develop a trans-epithelial electrical resistance characteristic of "tight" epithelia. Here, we investigate the molecular composition of the tight junction from follicle stellate cells. We found that the rat anterior pituitary lobe expresses mRNAs for claudins 2, 4 and 5; the proteins of all these claudins are observed in the anterior lobe, whereas the intermediate lobe expresses claudins 2 and 5 and the posterior lobe contains only claudin 5. Follicle-stellate cells, identified by their protein marker S100ß, expresses claudin 4 in the apical membrane, in co-localization with dipeptidyl-peptidase and near acetylated ß-tubulin. Claudin 4 partially co-localizes with E-cadherin, indicating that a fraction of the protein is located in the basolateral domain. Follicle-stellate-enriched cell cultures develop patches of polygonal cells expressing claudin 4 and E-cadherin, encircled by extensive monolayers of fusiform cells. Claudin 2 stains specifically blood vessels, identified by claudin 5 and VE-cadherin labels. Thus, follicles in the anterior pituitary consist of "tight" epithelia that can carry out intense vectorial transport, together with a high cation movement in blood vessels, possibly related to the ion requirements of excitable secretory cells for hormone secretion.

Eag1 channels as potential cancer biomarkers.

Cancer is a leading cause of death worldwide. New early tumor markers are needed to treat the disease at curable stages. In addition, new therapeutic targets are required to treat patients not responding to available treatments. Ion channels play major roles in health and disease, including cancer. Actually, several ion channels have been suggested as potential tumor markers and therapeutic targets for different types of malignancies. One of most studied ion channels in cancer is the voltage-gated potassium channel Eag1 (ether à go-go 1), which has a high potential to be used as a cancer biomarker. Eag1 is expressed in most human tumors, in contrast to its restricted distribution in healthy tissues. Several findings suggest Eag1 as a potential early marker for cervical, colon, and breast cancer. In addition, because Eag1 amplification/expression is associated with poor survival in leukemia, colon and ovarian cancer patients, it has also been proposed as a prognosis marker. Moreover, inhibition of either expression or activity of Eag1 leads to reduced proliferation of cancer cells, making Eag1 a potential anticancer target. Using Eag1 in cancer detection programs could help to reduce mortality from this disease.

Molecular and biochemical characterization of a beta-fructofuranosidase from Xanthophyllomyces dendrorhous.

An extracellular beta-fructofuranosidase from the yeast Xanthophyllomyces dendrorhous was characterized biochemically, molecularly, and phylogenetically. This enzyme is a glycoprotein with an estimated molecular mass of 160 kDa, of which the N-linked carbohydrate accounts for 60% of the total mass. It displays optimum activity at pH 5.0 to 6.5, and its thermophilicity (with maximum activity at 65 to 70 degrees C) and thermostability (with a T(50) in the range 66 to 71 degrees C) is higher than that exhibited by most yeast invertases. The enzyme was able to hydrolyze fructosyl-beta-(2-->1)-linked carbohydrates such as sucrose, 1-kestose, or nystose, although its catalytic efficiency, defined by the k(cat)/K(m) ratio, indicates that it hydrolyzes sucrose approximately 4.2 times more efficiently than 1-kestose. Unlike other microbial beta-fructofuranosidases, the enzyme from X. dendrorhous produces neokestose as the main transglycosylation product, a potentially novel bifidogenic trisaccharide. Using a 41% (wt/vol) sucrose solution, the maximum fructooligosaccharide concentration reached was 65.9 g liter(-1). In addition, we isolated and sequenced the X. dendrorhous beta-fructofuranosidase gene (Xd-INV), showing that it encodes a putative mature polypeptide of 595 amino acids and that it shares significant identity with other fungal, yeast, and plant beta-fructofuranosidases, all members of family 32 of the glycosyl-hydrolases. We demonstrate that the Xd-INV could functionally complement the suc2 mutation of Saccharomyces cerevisiae and, finally, a structural model of the new enzyme based on the homologous invertase from Arabidopsis thaliana has also been obtained.