Left atrial strain analysis and new-onset atrial fibrillation in patients with ST-segment elevation myocardial infarction: A prospective echocardiography study.

BACKGROUND: New-onset atrial fibrillation (NOAF) is a well-known complication of ST-segment elevation myocardial infarction (STEMI), probably due to left atrial (LA) remodelling. LA strain (LAS) can predict NOAF in several cardiovascular diseases. OBJECTIVE: To assess whether LAS predicts NOAF in sinus rhythm patients with STEMI during hospitalization. METHODS: Adults with a STEMI and transthoracic echocardiography performed within 48hours of admission were included. LAS analysis, performed by automated software, recorded LAS during the reservoir phase (LASr), the conduit phase (LAScd) and the contraction phase (LASct). RESULTS: From May 2021 to November 2022, 175 patients were included, 21 (12%) of whom developed NOAF. NOAF patients were older (median [Q1-Q3]: 67 [59-80] vs 59 [51-67]years; P=0.006) and had a higher Thrombolysis In Myocardial Infarction scores (4 [2-7] vs 3 [1-4]; P=0.005). All LAS parameters were significantly impaired in NOAF patients, especially LASr (13.0% [10.5-28.4] vs 36.6% [29.0-44.9]; P=0.001). An LASr cut-off of 27% had a sensitivity of 81% and a specificity of 80% to identify patients with NOAF. In a multivariable model, LASr was significantly associated with NOAF (odds ratio 1.18, 95% confidence interval 1.09-1.26; P=0.003). The cumulative risk of NOAF during hospital stay was 30% (18-43 with LASr<27% and 4% [1.5-8.5] with LASr≥27% [P<0.0001]). CONCLUSION: NOAF is a frequent complication of STEMI. LASr seems helpful for identifying patients at high risk of NOAF during hospitalization.

Efficacy and tolerance of methotrexate in a real-life monocentric cohort of patients with giant cell arteritis.

OBJECTIVES: To assess the indications, efficiency and tolerance profiles of methotrexate (MTX) in patients with giant cell arteritis (GCA) in a real-life setting. METHODS: From a monocentric database of >500 GCA patients, we retrospectively selected 49 patients who received MTX between 2010 and 2020. Cumulative glucocorticoid (GC) doses, the number of relapses and GC-related adverse events were recorded before, during and after MTX. We separately analyzed the 3 main indications of MTX, i.e., disease relapse, GC-sparing strategy, and GCA presentation. RESULTS: With a median follow-up of 84 [10-255] months, 25 (51%) and 18/41 (44%) patients relapsed during MTX treatment and after its discontinuation, respectively. Among the 40 patients who relapsed before MTX, 26 (65%) experienced a new relapse after MTX introduction. Once MTX was introduced, 24 (49%) patients were able to discontinue GC after 20.5 [7-64] months. No significant difference in cumulative GC doses were noted before and after MTX introduction with a total GC dose of 14.7 [1.05-69.4] grams. At the last follow-up, MTX was discontinued in 41 patients, including 13 (32%) due to clinicobiological remission, 12 (30%) due to treatment failure and 15 (36%) due to side effects. CONCLUSION: Our real-life study showed a modest beneficial effect of MTX on relapse in patients with GCA. However, we did not observe any GC-sparing effect in this study. Other studies are needed to assess the GC-sparing effect in patients in whom GC management is adapted from recent recommendations.

Intraoperative unfractionated heparin before femoral component cementation should be avoided in femoral neck fracture treated with hybrid total hip arthroplasty.

PURPOSE: To compare the incidence of perioperative thromboembolic events in femoral neck fracture (FNF) patients treated with hybrid total hip arthroplasty (THA) with intraoperative unfractionated heparin (UFH) versus a control group without intraoperative UFH before femoral component cementation. METHODS: We compared 139 cases without UFH (group A) versus 134 who received 10 UI/kg UFH (group B). Indication of UFH before cementation depended on the preferences of the anaesthesiologists in each case. We assessed intraoperative bone cement implantation syndrome (BCIS) and 30-day thromboembolic events, and 90-day and 1-year mortality. BCIS was classified as per Donaldson et al.'s classification according to the degree of hypotension, arterial desaturation or loss of consciousness. RESULTS: BCIS was observed in 51 (18%) cases, including 37 (13%) grade 1 and 14 (5%) grade 2. Forty-seven BCISs (35%) were observed in group B and 4 (3%) in group A (p < 0.001). Multivariate regression showed that intraoperative UFH (OR = 18, CI 95% 6-52) and consumption of oral anticoagulants (OR = 3.3, CI 95% 1-10) increased the risk of BCIS. Five patients further developed a 30-day pulmonary embolism in group B, while 2 presented this complication in group A (p = 0.231). No association between BCIS and 30-day thromboembolic events was found (p = 0.62). 90-day (1% each, p = 0.98) and 1-year (2% vs. 3%, p = 0.38) mortality were similar. CONCLUSIONS: BCIS was a frequent finding in FNF patients treated with hybrid THA. We found a paradoxically significant increase in BCIS with the use of UFH. Heparin did not seem to prevent BCIS, other thromboembolic events and mortality in this group of patients.

Development of HPV16 mouse and dog models for more accurate prediction of human vaccine efficacy / 한국실험동물학회지

Background@#Animal models are essential to understand the physiopathology of human diseases but also to evaluate new therapies. However, for several diseases there is no appropriate animal model, which complicates the development of effective therapies. HPV infections, responsible for carcinoma cancers, are among these. So far, the lack of relevant animal models has hampered the development of therapeutic vaccines. In this study, we used a candidate therapeutic vaccine named C216, similar to the ProCervix candidate therapeutic vaccine, to validate new mouse and dog HPV preclinical models. ProCervix has shown promising results with classical subcutaneous murine TC-1 cell tumor isografts but has failed in a phase II study. @*Results@#We first generated E7/HPV16 syngeneic transgenic mice in which the expression of the E7 antigen could be switched on through the use of Cre–lox recombination. Non-integrative LentiFlash® viral particles were used to locally deliver Cre mRNA, resulting in E7/HPV16 expression and GFP reporter fluorescence. The expression of E7/HPV16 was monitored by in vivo fluorescence using Cellvizio imaging and by local mRNA expression quantification. In the experimental conditions used, we observed no differences in E7 expression between C216 vaccinated and control groups. To mimic the MHC diversity of humans, E7/HPV16 transgenes were locally delivered by injection of lentiviral particles in the muscle of dogs. Vaccination with C216, tested with two different adjuvants, induced a strong immune response in dogs. However, we detected no relationship between the level of cellular response against E7/HPV16 and the elimination of E7-expressing cells, either by fluorescence or by RT-ddPCR analysis. @*Conclusions@#In this study, we have developed two animal models, with a genetic design that is easily transposable to different antigens, to validate the efficacy of candidate vaccines. Our results indicate that, despite being immunogenic, the C216 candidate vaccine did not induce a sufficiently strong immune response to eliminate infected cells. Our results are in line with the failure of the ProCervix vaccine that was observed at the end of the phase II clinical trial, reinforcing the relevance of appropriate animal models.

Pregnancy outcomes in women with primary Sjögren's syndrome: an analysis of data from the multicentre, prospective, GR2 study.

BACKGROUND: Adverse pregnancy outcomes in women with primary Sjögren's syndrome have only been evaluated retrospectively using heterogeneous methods and with contradictory results. We aimed to describe adverse pregnancy, delivery, and birth outcome risks in pregnant women with primary Sjögren's syndrome compared with those of a matched general population in France, and to identify factors predictive of disease flares or adverse pregnancy outcomes. METHODS: We conducted a multicentre, prospective, cohort study in France using the GR2 (Groupe de Recherche sur la Grossesse et les Maladies Rares) registry. Women from the GR2 study were eligible if they had conceived before March, 2021, had primary Sjögren's syndrome according to the American College of Rheumatology and European Alliance of Associations for Rheumatology (EULAR) 2016 classification criteria, and had an ongoing pregnancy at 12 weeks of gestation. In women who entered in the registry with pregnancies before 18 weeks of gestation, we sought to identify factors associated with primary Sjögren's syndrome flare (≥3-point increase in EULAR Sjögren's Syndrome Disease Activity Index [ESSDAI] score) or adverse pregnancy outcomes (fetal or neonatal death, placental insufficiency leading to a preterm delivery [<37 weeks of gestation], or small-for-gestational-age birthweight). A matched controlled study compared adverse pregnancy, delivery, and birth outcome rates between pregnant women with primary Sjögren's syndrome from the GR2 registry and matched controls from the general population included in the last French perinatal survey (Enquête Nationale Périnatale 2016). FINDINGS: 1944 pregnancies were identified in the GR2 cohort, of which 106 pregnancies in 96 women with primary Sjögren's syndrome were included in this analysis. The median age at pregnancy onset was 33 years (IQR 31-36). 87 (83%) of 105 pregnancies (with ethnicity data) were in White women, 18 (17%) were in Black women; 92 (90%) of 102 had previous systemic activity (ESSDAI score of ≥1; data missing in four pregnancies), and 48 (45%) of 106 had systemic activity at inclusion. Of 93 pregnancies included at week 18 of gestation or earlier, primary Sjögren's syndrome flares occurred in 12 (13%). No baseline parameters were associated with primary Sjögren's syndrome flare. Four twin pregnancies and one medical termination were excluded from the adverse pregnancy outcome analysis; of the remaining 88, adverse pregnancy outcomes occurred in six (7%). Among pregnancies in women with data for antiphospholipid antibodies (n=55), antiphospholipid antibody positivity was more frequent among pregnancies with adverse outcomes (two [50%] of four pregnancies) compared with those without adverse outcomes (two [4%] of 51 pregnancies; p=0·023). Anti-RNP antibody positivity was also more frequent among pregnancies with adverse outcomes than those without, although this was not statistically significant. In the matched controlled study, adverse pregnancy outcomes occurred in nine (9%) of 105 pregnancies in women with primary Sjögren's syndrome and 28 (7%) of the 420 matched control pregnancies; adverse pregnancy outcomes were not significantly associated with primary Sjögren's syndrome (odds ratio 1·31, 95% CI 0·53-2·98; p=0·52). INTERPRETATION: Pregnancies in women with primary Sjögren's syndrome had very good prognoses for mothers and fetuses, with no overall increase in adverse pregnancy outcome risk compared with the general population. Women with antiphospholipid antibodies or anti-RNP antibodies require close monitoring, because these factors might be associated with a higher risk of adverse pregnancy outcomes. FUNDING: Lupus France, Association des Sclérodermiques de France, Association Gougerot Sjögren, Association Francophone Contre la Polychondrite Chronique Atrophiante, AFM-Telethon, Société Nationale Française de Médecine Interne, Société Française de Rhumatologie, Cochin Hospital, French Health Ministry, Fondation for Research in Rheumatology, Association Prix Véronique Roualet, Union Chimique Belge.

Artralgias persistentes luego de infección por virus Chikungunya / Persistent arthralgia after Chikungunya virus infection

Introducción: el virus Chikungunya (CHIKV) es un virus ARN que se transmite a través de mosquitos; se asocia a manifestaciones articulares, tanto en fases agudas, como también a síntomas persistentes articulares pasada la infección. Objetivos: describir la prevalencia informada de artritis reumatoidea (AR) en la infección por CHIKV en sus diferentes fases (aguda, subaguda crónica) y la persistencia de artralgias en la fase crónica. Materiales y métodos: revisión bibliográfica, no sistemática, de artículos científicos publicados desde 2001 hasta 2022, en inglés y español, en las siguientes bases de datos: Medline, Cochrane, Lilacs y Scielo. No se hicieron restricciones en base al tipo de estudio. Se revisaron los resúmenes y, en caso de ser necesario, se evaluaron los artículos completos teniendo en cuenta para su selección los trabajos que describían la asociación de CHIKV AR en la infección por CHIKV en sus diferentes fases (aguda, subaguda y crónica) y la persistencia de artralgias en la fase crónica. Para la búsqueda de artículos en los diferentes motores de búsqueda se emplearon las siguientes ecuaciones de búsqueda: "Chikungunya virus" y "arthritis"; "Chikungunya virus" y "persistent arthralgias". Como criterio de inclusión, se aplicaron los artículos que mencionaban la infección en adultos y describieran la presencia de AR en la infección por CHIKV en sus diferentes fases (aguda, subaguda y crónica) y la persistencia de artralgias en la fase crónica. Luego de la búsqueda inicial, se seleccionaron 26 artículos que se consideraron relevantes para esta revisión. De los 26 artículos seleccionados, siete fueron revisiones bibliográficas no sistémicas, seis estudios preclínicos (tres en ratones, dos de secuenciación viral y uno de inmunidad celular), cuatro estudios corte transversal descriptivos, cuatro longitudinales prospectivos, dos estudios retrospectivos, una revisión sistémica con metaanálisis, una guía de práctica clínica y una serie de casos clínicos. Resultados: la prevalencia informada de pacientes con AR por CHIKV que progresan a una etapa crónica varía de 4,1 a 78,6%. Las rodillas, tobillos, codos, muñecas y articulaciones metacarpofalángicas son las articulaciones más frecuentemente comprometidas en la fase crónica. El mecanismo por el cual el CHIKV se induce la AR crónica aún está en investigación, y es la persistencia del virus en macrófagos y el mimetismo molecular las teorías más aceptadas hasta el momento. Con respecto al desarrollo de AR en pacientes luego de la infección por CHIKV, no hay a la fecha una postura definida. Existe consenso respecto a que la AR es la enfermedad reumática inflamatoria más frecuentemente encontrada en pacientes recuperados de CHIKV. Dos estudios demostraron que entre un 5 y un 36% de los pacientes que fueron evaluados por artralgias post-CHIKV cumplían criterios del American College of Rheumatology (ACR 2010) de AR. Conclusiones: el compromiso musculoesquelético, principalmente las artralgias crónicas son una manifestación frecuente en un gran número de pacientes recuperados de CHIKV. Si bien hay discrepancia entre los diferentes autores, existe una prevalencia aproximada del 30% de síntomas articulares crónicos posteriores a la infección viral. En general, el compromiso es poliarticular, simétrico y afecta principalmente a las articulaciones de la mano y las rodillas. Deben realizarse más investigaciones y estudios para establecer guías de abordaje de los pacientes con compromiso articular y antecedentes de infecciones por arbovirus.

Introduction: the Chikungunya virus (CHIKV) is an RNA virus that is transmitted through mosquitoes, which is associated with joint manifestations both in acute phases as well as persistent joint symptoms after the infection. Objectives: to describe the reported prevalence of arthritis in CHIKV infection in its different phases: acute, subacute, chronic, and the persistence of arthralgia in the chronic phase. Materials and methods: non-systematic bibliographic review of scientific articles published from 2001 to 2022, in English and Spanish, in the following databases: Medline, Cochrane, Lilacs, Scielo. No restrictions were made based on the type of study. The abstracts were reviewed and, if necessary, the complete articles were evaluated, taking into account for their selection the works that described the association of the CHIKV virus with arthritis in its different phases: acute, subacute, chronic, and the persistence of arthralgia in the chronic phase. To search for articles in the different search engines, the following search equations were used: "Chikungunya virus" and "arthritis"; "Chikungunya virus" and "persistent arthralgias". Articles that spoke of infection in adults and described the presence of arthritis and chronic arthralgia once the acute and subacute phases, respectively, were applied as inclusion criteria. After the initial search, 26 articles were considered relevant for this review. Of the 26 articles selected, 7 were non-systemic bibliographic reviews, 6 preclinical studies (3 in mice, 2 on viral sequencing and 1 on cellular immunity), 4 descriptive cross-sectional studies, 4 prospective longitudinal, 2 retrospective studies, 1 systemic review with meta-analysis, 1 clinical practice guideline and 1 series of clinical cases. Results: The reported prevalence of patients with CHIKV arthritis progressing to a chronic stage ranges from 4.1 to 78.6%. The knees, ankles, elbows, wrists, and metacarpophalangeal joints are the most frequently involved joints in the chronic phase. The mechanism by which CHIKV induces chronic arthritis remains under investigation, with virus persistence in macrophages and molecular mimicry being the most accepted theories to date. Regarding the development of Rheumatoid Arthritis (RA) in patients after CHIKV infection, there is no defined position to date. There is consensus that RA is the most frequently found inflammatory rheumatic disease in patients recovered from CHIKV. Two studies have shown that between 5% and 36% of patients who were evaluated for post-CHIKV arthralgia met the 2010 ACR criteria for RA. Conclusions: Musculoskeletal compromise, mainly chronic arthralgia, is a frequent manifestation in a large number of patients recovered from CHIKV. Although there is discrepancy between the different authors, there is an approximate prevalence of 30% of chronic joint symptoms after viral infection. The compromise is generally polyarticular, symmetrical and mainly affects joints of the hand and knees. More research and studies must be carried out in order to establish management guidelines for patients with joint involvement and a history of arbovirus infections.

Antineutrophil Cytoplasm Antibody-Associated Vasculitides Valvular Impairment: Multicenter Retrospective Study and Systematic Review of the Literature.

OBJECTIVE: While myocardial impairment is a predictor of poor prognosis in antineutrophil cytoplasm antibody (ANCA)-associated vasculitides (AAV), little is known about valvular involvement. This study aims at describing the clinical presentation, management, and outcome of endocarditis associated with AAV. METHODS: We conducted a multicenter retrospective study in centers affiliated with the French Vasculitis Study Group. We included patients with granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), or eosinophilic GPA with endocardial impairment. A systematic review was then performed through PubMed, Embase, and Cochrane Library from inception up to September 2020. RESULTS: The retrospective cohort included 9 patients (82%) with GPA, 1 (9%) with MPA, and 1 (9%) with unclassified AAV. Clinical presentation included acute valvular insufficiency (n = 7, 64%), cardiac failure (n = 3, 27%), dyspnea (n = 3, 27%), and no symptoms (n = 2, 18%). The aortic valve was the most frequently affected (n = 8/10, 80%), and vegetations were noted in 4 of 10 patients (40%). Six patients (55%) underwent surgical valvular replacement. No death from endocarditis was reported. The systematic review retrieved 42 patients from 40 references: 30 (71%) had GPA, 21 (50%) presented with vegetations, the aortic valve (n = 26, 62%) was the most frequently involved. Valvular replacement was required in 20 cases (48%) and 5 patients (13%) died from the endocarditic impairment. CONCLUSION: Endocarditis is a rare and potentially life-threatening manifestation of AAV. Acute valvular insufficiency may lead to urgent surgery. Implementing transthoracic echocardiography in standard assessment at baseline and follow-up of AAV might reduce the delay to diagnosis and allow earlier immunosuppressive treatment before surgery is needed.

Incidencia de litiasis vesicular asintomática en pacientes con complicaciones biliares / Incidence of asymptomatic gallstones in patients with biliary complications / Incidência de cálculos biliares asintomáticos em pacientes com complicações biliares

Introducción: Las complicaciones de la litiasis biliar (LB) son una causa importante de morbilidad en nuestro país y en el mundo entero y generan elevados costos en salud. Objetivo: El objetivo de este trabajo fue determinar, que pacientes con una complicación de su patología litiásica de la vía biliar (colecistitis, colangitis aguda, pancreatitis aguda), fueron previamente asintomáticos, resultando dicha complicación el debut de la enfermedad. Lugar: Sanatorio Asociación Española de Socorros Mutuos, Montevideo Uruguay. Diseño: Estudio observacional descriptivo, retrospectivo, análisis de historias clínicas. Materiales y Métodos: Se analizaron 234 casos clínicos. Se constató en este grupo de pacientes, características epidemiológicas, metodología diagnóstica, tratamientos recibidos y complicaciones. Resultados: Del total de pacientes (n=234), 109 (46.6%) tenían una litiasis vesicular asintomática (LVA) y la complicación biliar, fue el debut de su enfermedad. La colecistitis aguda fue la complicación más frecuente (68%), en segundo lugar, la colangitis aguda (22%) y en tercer lugar la pancreatitis aguda (10%). La edad promedio de presentación de la enfermedad fue los 59 años. Conclusiones: Casi la mitad de los pacientes (46.6%) que presentaron una complicación de su litiasis biliar eran asintomáticos. Este sería un argumento importante para indicar la colecistectomía laparoscópica con un criterio profiláctico en pacientes con una LVA.

Introduction : Complications of gallstones are an important cause of morbidity in our country and throughout the world and generate high health costs. Objective: The objective of this study was to determine which patients with a complication of their bile duct stone pathology (cholecystitis, acute cholangitis, acute pancreatitis) were previously asymptomatic, and this complication resulted in the onset of the disease. Place: Sanatorium Asociación Española de Socorros Mutuos, Montevideo Uruguay. Design: Descriptive and retrospective observational study with an analysis of medical records. Materials and Methods: 234 clinical cases were analyzed. Epidemiological characteristics, diagnostic methodology, treatments received, and complications were assessed in this group of patients. Results: Of the total number of patients (n=234), 109 (46.6%) had an asymptomatic gallbladder lithiasis and the biliary complication was the debut of their disease. Acute cholecystitis was the most frequent complication (68%), followed by acute cholangitis (22%) and third by acute pancreatitis (10%). The average age of presentation of the disease was 59 years. Conclusions: Almost half of the patients (46.6%) who presented a complication of their gallstones were asymptomatic. This would be an important argument to indicate laparoscopic cholecystectomy with a prophylactic criterion in patients with asymptomatic gallbladder lithiasis.

Introdução: As complicações dos cálculos biliares são uma importante causa de morbidade em nosso país e em todo o mundo e geram altos custos de saúde. Objetivo: O objetivo deste estudo foi determinar quais pacientes com uma complicação de sua patologia de cálculo do ducto biliar (colecistite, colangite aguda, pancreatite aguda) eram previamente assintomáticos, e essa complicação resultou no aparecimento da doença. Local: Sanatório Asociación Española de Socorros Mutuos, Montevidéu - Uruguai. Desenho: Estudo observacional descritivo, retrospectivo, análise de histórias clínicas. Materiais e Métodos: Foram analisados ​​234 casos clínicos. Características epidemiológicas, metodologia diagnóstica, tratamentos recebidos e complicações foram avaliadas neste grupo de pacientes. Resultados: Do total de pacientes (n=234), 109 (46,6%) apresentavam litíase vesicular assintomática e a complicação biliar foi o início da doença. A colecistite aguda foi a complicação mais frequente (68%), seguida da colangite aguda (22%) e a terceira da pancreatite aguda (10%). A idade média de apresentação da doença foi de 59 anos. Conclusões: Quase metade dos pacientes (46,6%) que apresentaram complicação de seus cálculos biliares eram assintomáticos. Esse seria um argumento importante para indicar a colecistectomia laparoscópica com critério profilático em pacientes com litíase vesicular assintomática.

[Septic hip arthritis after a closed acetabulum fracture treated conservatively. Case report]. / Artritis séptica de cadera luego de una fractura cerrada de acetábulo tratada en forma conservadora. Reporte de caso.

Necrotizing fasciitis is a life-threatening infection. Inmediate diagnosis and treatment are essential. Acetabulum fractures are a frequent identity in older adults today, associated with low-energy trauma. The indication for surgical or conservative treatment depends on multiple factors such as the age and comorbidities of the patient, the type and location of the fracture, and the socio-economic environment. We described an unusual case of infected hematoma, secondary to a closed acetabulum fracture, which led to septic arthritis of the hip joint.

Las fracturas de acetábulo asociadas a traumatismos de baja energía, son una identidad frecuente hoy en día en los adultos mayores. La indicación del tratamiento quirúrgico o conservador, depende de múltiples factores como la edad y las comorbilidades del paciente, el tipo y localización de la fractura, y el medio socio-económico. Independientemente del tratamiento elegido, ninguno está exento de complicaciones. Se describe a continuación un paciente con una fractura de acetábulo cerrada, de tratamiento conservador, que derivó en artritis séptica de la articulación coxofemoral.

Clues and new evidences in arterial hypertension: unmasking the role of the chloride anion.

The present review will focus on the role of chloride anion in cardiovascular disease, with special emphasis in the development of hypertensive disease and vascular inflammation. It is known that acute and chronic overload of sodium chloride increase blood pressure and have pro-inflammatory and pro-fibrotic effects on different target organs, but it is unknown how chloride may influence these processes. Chloride anion is the predominant anion in the extracellular fluid and its intracellular concentration is dynamically regulated. As the queen of the electrolytes, it is of crucial importance to understand the physiological mechanisms that regulate the cellular handling of this anion including the different transporters and cellular chloride channels, which exert a variety of functions, such as regulation of cellular proliferation, differentiation, migration, apoptosis, intracellular pH and cellular redox state. In this article, we will also review the relationship between dietary, serum and intracellular chloride and how these different sources of chloride in the organism are affected in hypertension and their impact on cardiovascular disease. Additionally, we will discuss the approach of potential strategies that affect chloride handling and its potential effect on cardiovascular system, including pharmacological blockade of chloride channels and non-pharmacological interventions by replacing chloride by another anion.

Role of natriuretic peptides in the cardiovascular-adipose communication: a tale of two organs.

Natriuretic peptides have long been known for their cardiovascular function. However, a growing body of evidence emphasizes the role of natriuretic peptides in the energy metabolism of several substrates in humans and animals, thus interrelating the heart, as an endocrine organ, with various insulin-sensitive tissues and organs such as adipose tissue, muscle skeletal, and liver. Adipose tissue dysfunction is associated with altered regulation of the natriuretic peptide system, also indicated as a natriuretic disability. Evidence points to a contribution of this natriuretic disability to the development of obesity, type 2 diabetes mellitus, and cardiometabolic complications; although the causal relationship is not fully understood at present. However, targeting the natriuretic peptide pathway may improve metabolic health in obesity and type 2 diabetes mellitus. This review will focus on the current literature on the metabolic functions of natriuretic peptides with emphasis on lipid metabolism and insulin sensitivity. Natriuretic peptide system alterations could be proposed as one of the linking mechanisms between adipose tissue dysfunction and cardiovascular disease.

Consumo de alcohol durante el embarazo y la lactancia: rol de profesionales de salud / Alcohol use during pregnancy and breastfeeding: health professionals' role

Dada la prevalencia del consumo de alcohol durante el embarazo y la lactancia y la implicancia de esta práctica para la salud de los/as bebés, se indagó sobre la información que comparten profesionales de la salud a mujeres (embarazadas o en período de lactancia) sobre el consumo de alcohol durante el embarazo y la lactancia. Para ello, se llevó a cabo un estudio observacional transversal mediante una encuesta en línea. Completaron la encuesta completa 86 profesionales de la salud (Medad=43.22, DS=9.10) y 32 sólo las preguntas sobre consumo y lactancia (n total para encuesta de lactancia=118 profesionales; Medad=44.5, DS=8.77). Los resultados arrojaron que la mayoría de los/as profesionales destaca la importancia de abordar el consumo de alcohol durante el embarazo y la lactancia, pero hay quienes permiten el consumo de alcohol durante estos períodos, a pesar de considerarse de riesgo entre moderado y alto para el/la bebé. Se concluye, entonces, que hay una necesidad de mayor formación profesional en el tema (AU)

The high prevalence of alcohol consumption during pregnancy and breastfeeding has been reported. The use of alcohol during pregnancy and breastfeeding is prejudicial for babies' health. This study inquired about the information that health professionals share with women about alcohol use during pregnancy and breastfeeding. Therefore, a cross-sectional observational study was conducted using an online survey. 86 health professionals (Mage=43.22, SD=9.10) completed the full survey and 32 health professionals completed only the questions about breastfeeding and alcohol use (total sample for these questions=118, Mage=44.5, SD=8.77). The results showed that almost every professional highlights the importance of approaching alcohol use during pregnancy and breastfeeding, but some allow alcohol use during these periods despite the fact that a large group considered that alcohol use has moderate to high risk for the baby. The conclusions of the study are that results showed the need for more professional training on alcohol drinking risk during pregnancy and breastfeeding (AU)

Cardiotoxic Effects of the Antineoplastic Doxorubicin in a Model of Metabolic Syndrome: Oxidative Stress and Transporter Expression in the Heart.

ABSTRACT: The aim of the present work was to examine whether metabolic syndrome-like conditions in rats with fructose (F) overload modify the cardiotoxic effects induced by doxorubicin (DOX) and whether the treatment altered the expression of P-gp, breast cancer resistance protein, and organic cation/carnitine transporters in the heart. Male Sprague-Dawley rats received either tap water (control group [C]; n = 16) or water with F 10% wt/vol (n = 16) during 8 weeks. Three days before being killed, the animals received a single dose of DOX (6 mg/kg, ip, md) (C-DOX and F-DOX groups) or vehicle (VEH; ISS 1 mL/kg BW; ip) (C-VEH and F-VEH groups) (n = 8 per group). F overload enhanced thiobarbituric acid-reactive substance levels in the left ventricle, and DOX injection further increased those values. DOX did not alter thiobarbituric acid-reactive substance production in C animals. DOX caused a decrease of 30% in the ejection fraction and a nearly 40% reduction in the fractional shortening in F animals, but not in C rats. Cardiac tissue levels of P-gp decreased by about 30% in F rats compared with the C groups. DOX did not modify cardiac P-gp expression. Breast cancer resistance protein and organic cation/carnitine transporter (OCTN 1/2/3) protein levels did not change with either F or DOX. It is suggested that DOX could cause greater cardiotoxicity in rats receiving F, probably due to enhanced cardiac lipid peroxidation and lower expression of cardiac P-gp. These results support the hypothesis that the cardiotoxicity of DOX could be increased under metabolic syndrome-like conditions or in other health disorders that involve cardiovascular risk factors.

Evaluation of the severe preeclampsia classification criterion for antiphospholipid syndrome in a study of 40 patients.

BACKGROUND: The criteria for antiphospholipid syndrome (APS) include severe preeclampsia and/or placental insufficiency leading to preterm delivery before 34 weeks of gestation, but this APS manifestation has been rarely studied. Thus, we report a series of severe preeclampsia occurred in patients with APS. METHODS: We retrospectively analysed data of women with APS (Sydney criteria) who experienced severe preeclampsia with delivery before 34 weeks' gestation between 2000 and 2017 at five French internal medicine departments and one Italian rheumatology unit. RESULTS: The 40 women had a mean age of 30.5 ± 4.6 years at their first episode of preeclampsia; 21 were nulligravid (52.5%), 12 (30%) had already been diagnosed with APS, and 21 (52.5%) had a triple-positive antiphospholipid (aPL) antibody test. Preeclampsia occurred at a median gestational age of 25.5 weeks (IQR 23-29). It was associated with HELLP in 18 cases (45%), eclampsia in 6 (15%), placental abruption in 3 (7.5%), catastrophic APS in 3 (7.5%), and foetal and neonatal death in 11 and 15 cases. Overall, 14 (35%) children survived, born at a median gestational age of 31 weeks. Among other APS criteria, 16 women (40%) experienced at least one thrombosis, 17 (42.5%) an intrauterine foetal death, and 19 (47.5%) at least one episode of HELLP during follow-up (median 5 years, IQR = 2-8). None had three or more consecutive miscarriages. Notably, 12 women (30%) had systemic lupus erythematosus. CONCLUSIONS: Severe preeclampsia led to high mortality in the offspring. Almost half of these women experienced other APS features, but not three consecutive miscarriages.

Tumour necrosis factor receptor-1 associated periodic syndrome (TRAPS)-related AA amyloidosis: a national case series and systematic review.

OBJECTIVES: TNF receptor-1-associated periodic syndrome (TRAPS) is a rare autosomal dominant autoinflammatory disorder associated with mutations in the TNF receptor super family 1 A (TNFRSF1A) gene. AA amyloidosis (AA) is the most severe complication of TRAPS. To study the occurrence and prognosis of AA in TRAPS, we conducted a retrospective study of all French cases and a systematic literature review. METHODS: This case series includes TRAPS patients followed by our centre from 2000 to 2020 presenting with histologically confirmed AA. We conducted a systematic literature review on the PubMed and EMBASE databases for articles published up to February 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines and using the keywords: amyloidoisis, amyloid, TNF receptor-associated periodic syndrome, TNF receptor-associated periodic syndrome, tumor necrosis factor receptor-associated periodic syndrome, TRAPS, TNFRSF1A, familial hibernian fever and hibernian familial fever. RESULTS: A total of 41 TRAPS with AA were studied: three new patients and 38 cases from the literature. AA diagnosis preceded that of TRAPS in 96% of cases, and 17/36 (47%) required renal replacement therapy. Death occurred in 5/36 (14%) with a median follow-up of 23 months. Effect of biologics on AA were available for 21 regimens in 19 patients: 10 improved renal function, seven stabilized and four worsened. Four patients (36% of transplanted patients) relapse AA on kidney graft (only one under etanercept). CONCLUSION: TRAPS is revealed by AA in most cases. Therefore, clinical features of TRAPS should be screened for in AA patients. IL-1 antagonist can help to normalize inflammation and to preserve renal function.

Arco palmar superficial: redefiniendo un clásico / Superficial palmar arch: redefining a classic

El arco palmar superficial (APS) resulta de la unión de la arteria ulnar y la rama palmar superficial de la arteria radial. Por su convexidad nacen las arterias digitales comunes. Esta descripción es la única que distintos autores han tomado como válida, por lo que se espera encontrarla durante la disección con mayor frecuencia. Esto no ha sido verificado en nuestra experiencia. Nos proponemos llevar a cabo una revisión de la descripción del APS poniéndolo en contraposición con las disecciones realizadas. Se disecaron y analizaron 61 manos cadavéricas. Estudio del arco palmar superficial: Variante clásica del APS: 23 casos (37,7 %). Variante no clásica del APS: 15 casos (24,6 %). Tipo A: 13 casos (86,7 %). Anastomosis entre arterias ulnar y metacarpiana dorsal del primer espacio. Tipo B: 2 casos (13,3 %). Anastomosis entre arterias ulnar y satélite del nervio mediano. Ausencia del arco: 23 casos (37,7 %) Tipo A: 19 casos (82,6 %). La arteria ulnar es la única estructura en el plano del APS. Tipo B: 3 casos (13 %). La arteria ulnar y la rama palmar superficial de la arteria radial están en el plano del APS sin anastomosarse entre sí. Tipo C: 1 caso (4,4 %). La arteria ulnar y la satélite del nervio mediano están en el plano del APS sin anastomosarse. Estudio de la quinta arteria digital palmar común: La quinta arteria digital palmar común se originó de las distintas variantes en 41 casos (67,2 %). Recomendamos al momento de la disección considerar que: la variante clásica no es la más frecuente de hallar; la ausencia del arco se verifica en el mismo porcentaje que la variante clásica; incluso cuando se comprueba la presencia del APS, el porcentaje de la variante no clásica es contundente; la quinta arteria digital palmar común es una rama colateral constante del APS.

The superficial palmar arch (SPA) is formed by the union of the ulnar artery and the superficial palmar branch of the radial artery. From its convexity four branches emerge, known as the common palmar digital arteries. We propose to carry out a review of the description of the SPA in contrast to the dissections carried out. Sixty-one hands were dissected and studied. Analysis of the SPA: Classic variant of the SPA: 23 cases (37.7 %). Nonclassic variant of the SPA: 15 cases (24.6 %). Type A: 13 cases (86.7 %). Anastomosis between the ulnar artery and the first dorsal metacarpal artery. Type B: 2 cases (13.3 %). Anastomosis between the ulnar artery and the satellite artery of the median nerve. Absence of the arch: 23 cases (37.7 %) Type A: 19 cases (82.6 %). The ulnar artery is the only one present in the plane of the SPA. Type B: 3 cases (13 %). The ulnar artery and the superficial palmar branch of the radial artery are in the plane of the superficial palmar arch, there is no anastomosis between them. Type C: 1 case (4.4 %). The ulnar artery and the satellite artery for the median nerve are in the plane of the SPA, there is no anastomosis between them. Analysis of the fifth common palmar digital artery: The fifth common palmar digital artery originates from the different variants in 41 cases (67.2 %). Based on the results, we recommend at the time of dissecting consider that: The classic variant is not the most frequent to find. The absence of the arch is verified in the same percentage rate as the classic variant. Even when the SPA is present, the percentage rate of the non-classic variant is significant. The fifth common palmar digital artery is a constant collateral branch of the superficial palmar arch.

Gut microbiota and chronic kidney disease: evidences and mechanisms that mediate a new communication in the gastrointestinal-renal axis.

Chronic kidney disease (CKD) represents a growing public health problem associated with loss of kidney function and cardiovascular disease (CVD), the main leading cause of morbidity and mortality in CKD. It is well established that CKD is associated with gut dysbiosis. Over the past few years, there has been a growing interest in studying the composition of the gut microbiota in patients with CKD as well as the mechanisms by which gut dysbiosis contributes to CKD progression, in order to identify possible therapeutic targets to improve the morbidity and survival in CKD. The purpose of this review is to explore the clinical evidence and the mechanisms involved in the gut-kidney crosstalk as well as the possible interventions to restore a normal balance of the gut microbiota in CKD. It is well known that the influence of the gut microbiota on the gut-kidney axis acts in a reciprocal way: on the one hand, CKD significantly modifies the composition and functions of the gut microbiota. On the other hand, gut microbiota is able to manipulate the processes leading to CKD onset and progression through inflammatory, endocrine, and neurologic pathways. Understanding the complex interaction between these two organs (gut microbiota and kidney) may provide novel nephroprotective interventions to prevent the progression of CKD by targeting the gut microbiota. The review is divided into three main sections: evidences from clinical studies about the existence of a gut microbiota dysbiosis in CKD; the complex mechanisms that explain the bidirectional relationship between CKD and gut dysbiosis; and reports regarding the effects of prebiotic, probiotic, and synbiotic supplementation to restore gut microbiota balance in CKD.