Bioinspired Electro-Organocatalytic Material Efficient for Hydrogen Production.

Commercial carbon fibers can be used as electrodes with high conductive surfaces in reduced devices. Oxidative treatment of such electrodes results in a chemically robust material with high catalytic activity for electrochemical proton reduction, enabling the measurement of quantitative faradaic yields (>95 %) and high current densities. Combination of experiments and DFT calculations reveals that the presence of carboxylic groups triggers such electrocatalytic activity in a bioinspired manner. Analogously to the known Hantzsch esters, the oxidized carbon fiber material is able to transfer hydrides, which can react with protons, generating H2 , or with organic substrates resulting in their hydrogenation. A plausible mechanism is proposed based on DFT calculations on model systems.

Utilidad de la cistatina C como marcador pronóstico en la enfermedad tromboembólica venosa / Usefulness of cystatin C as a prognostic marker in venous thromboembolism

Fundamento y objetivo: La cistatina C (cisC) es un marcador pronóstico en pacientes con hipertensión arterial, enfermedad coronaria e insuficiencia cardíaca. El objetivo de este trabajo es determinar el valor pronóstico de los valores de cisC obtenida en el momento del diagnóstico, en pacientes con enfermedad tromboembólica venosa (ETEV). Pacientes y método: Estudio retrospectivo de una cohorte de 226 pacientes consecutivos con ETEV, seguidos durante 6 meses. Se obtuvieron muestras de suero para la determinación de cisC, creatinina, y la fracción N-terminal prohormone of brain natriuretic peptide (NT-proBNP, «N-terminal del propéptido natriurético cerebral») en el momento del diagnóstico. Resultados: El valor de cisC de mayor poder discriminatorio de fallecimiento en 6meses fue de 1.175 mg/dl (sensibilidad del 76%, especificidad del 65%, valor predictivo positivo del 26%, valor predictivo negativo del 94%). Por encima del punto de corte fallecieron 17/48 pacientes frente a 9/152 que tenían niveles inferiores (odds ratio 5,98; intervalo de confianza del 95% [IC 95%] 2,50-14,29; p < 0,001). El hazard ratio ajustado en un modelo multivariante fue de 3,76 (IC 95% 1,46-9,66). La precisión de este parámetro fue similar al de creatinina (1,24 mg/dl), pero inferior al del NT-proBNP (435 pg/ml). Los pacientes que superaban los valores límite de cisC y de NT-proBNP conjuntamente no tenían mayor riesgo de fallecimiento que los que superaban solo los de NT-proBNP (odds ratio 9,43; IC 95% 3,90-22,81; p < 0,001). No hubo ningún valor que se asociara de forma significativa con los episodios de hemorragia o recidiva. Conclusión: La concentración de cisC en el momento del diagnóstico de los pacientes con ETEV tiene valor pronóstico, similar al de creatinina sérica e inferior al del NT-proBNP (AU)

Background and objective: Cystatin C (cysC) is a prognostic marker in patients with hypertension, coronary heart disease and heart failure. The aim of this study was to determine the prognostic value of cysC levels obtained at the time of diagnosis in patients with venous thromboembolism (VTE). Material and method: Retrospective study of a cohort of 226 consecutive patients with VTE, followed for 6 months. Serum samples were obtained for the determination of cysC, creatinine, and the N-terminal fraction of the brain natriuretic peptide (NT-proBNP) at the time of diagnosis. Results: The highest discriminating power value of dying at 6 months for cysC was 1,175 mg/dl (sensitivity 76%, specificity 65%, positive predictive value 26%, negative predictive value 94%). Above the cut-off, 17/48 patients died, versus 9/152 that had lower levels (odds ratio: 5.98, 95% confidence interval [95% CI]: 2.50-14.29, P < .001). The adjusted hazard ratio in a multivariate model was 3.76 (95% CI 1.46-9.66). The accuracy of this parameter was similar to that for creatinine (1.24 mg/dl) but lower than the NT-proBNP (435 pg/ml). Patients who exceeded the limit values of cysC and NT-proBNP together had no greater risk of death than those above NT-proBNP only (odds ratio: 9.43, 95% CI 3.90-22.81, P < .001). There was no value, which was significantly associated with bleeding episodes or recurrent thromboembolism. Conclusion: CysC concentration at the time of diagnosis in VTE patients has prognostic value, which is similar to that of serum creatinine and lower than that of NT-proBNP (AU)

Mastitis granulomatosa perilobulillar idiopática: descripción de un caso / Idiopathic granulomatous lobular mastitis: A case report

No disponible

[Usefulness of cystatin C as a prognostic marker in venous thromboembolism]. / Utilidad de la cistatina C como marcador pronóstico en la enfermedad tromboembólica venosa.

BACKGROUND AND OBJECTIVE: Cystatin C (cysC) is a prognostic marker in patients with hypertension, coronary heart disease and heart failure. The aim of this study was to determine the prognostic value of cysC levels obtained at the time of diagnosis in patients with venous thromboembolism (VTE). MATERIAL AND METHOD: Retrospective study of a cohort of 226 consecutive patients with VTE, followed for 6 months. Serum samples were obtained for the determination of cysC, creatinine, and the N-terminal fraction of the brain natriuretic peptide (NT-proBNP) at the time of diagnosis. RESULTS: The highest discriminating power value of dying at 6 months for cysC was 1,175mg/dl (sensitivity 76%, specificity 65%, positive predictive value 26%, negative predictive value 94%). Above the cut-off, 17/48 patients died, versus 9/152 that had lower levels (odds ratio: 5.98, 95% confidence interval [95% CI]: 2.50-14.29, P<.001). The adjusted hazard ratio in a multivariate model was 3.76 (95% CI 1.46-9.66). The accuracy of this parameter was similar to that for creatinine (1.24mg/dl) but lower than the NT-proBNP (435pg/ml). Patients who exceeded the limit values of cysC and NT-proBNP together had no greater risk of death than those above NT-proBNP only (odds ratio: 9.43, 95% CI 3.90-22.81, P<.001). There was no value, which was significantly associated with bleeding episodes or recurrent thromboembolism. CONCLUSION: CysC concentration at the time of diagnosis in VTE patients has prognostic value, which is similar to that of serum creatinine and lower than that of NT-proBNP.

Nuevos abordajes en el tratamiento de la trombosis venosa profunda / New approaches in the treatment of deep vein thrombosis

En los últimos años han concluido o están a punto de finalizar varios estudios en fase III con nuevos anticoagulantes que cambiarán el tratamiento actual de la trombosis venosa profunda. Son productos con farmacocinética y farmacodinámica muy previsibles que no necesitan monitorización, por lo que resultan muy atractivos para el tratamiento de gran número de estos pacientes. Dabigatran, edoxaban e idrabiotaparinux se han desarrollado como alternativas a warfarina, y apixaban y rivaroxaban como tratamiento único de esta enfermedad, con una fase inicial de tratamiento intensivo de 1 o 3 semanas, respectivamente. Los resultados conocidos hasta ahora muestran una eficacia y seguridad similares al tratamiento convencional, por lo que en principio estos anticoagulantes serán especialmente útiles en los pacientes con INR inestables, que toman fármacos incompatibles con los antivitaminas K o en los que no es posible la monitorización (AU)

In the last few years, several phase III clinical trials of new drug treatments for deep vein thrombosis (DVT) have been carried out or are about to finish. These drugs have a predictable and reliable pharmacokinetic and pharmacodynamic response and do not require monitoring and are consequently an attractive alternative for the treatment of a high proportion of patients with DVT. Dabigatran, edoxaban and idrabiotaparinux have been developed as an alternative to warfarin, and apixaban and rivaroxaban as onedrug only treatment for this disease, with a 1- or 3-week intensified phase of initial treatment, respectively. So far, the reported results show non-inferior efficacy and safety to warfarin or to conventional treatment. Therefore, the new anticoagulants will be particularly useful in patients with unstable INRs, warfarin incompatible pharmacologic interactions, and in those without access to regular coagulation monitoring (AU)

[New approaches in the treatment of deep vein thrombosis]. / Nuevos abordajes en el tratamiento de la trombosis venosa profunda.

In the last few years, several phase III clinical trials of new drug treatments for deep vein thrombosis (DVT) have been carried out or are about to finish. These drugs have a predictable and reliable pharmacokinetic and pharmacodynamic response and do not require monitoring and are consequently an attractive alternative for the treatment of a high proportion of patients with DVT. Dabigatran, edoxaban and idrabiotaparinux have been developed as an alternative to warfarin, and apixaban and rivaroxaban as one-drug only treatment for this disease, with a 1- or 3-week intensified phase of initial treatment, respectively. So far, the reported results show non-inferior efficacy and safety to warfarin or to conventional treatment. Therefore, the new anticoagulants will be particularly useful in patients with unstable INRs, warfarin incompatible pharmacologic interactions, and in those without access to regular coagulation monitoring.

[Rapidly destructive osteoarthritis of the hip: case presentation]. / Osteoartritis rápidamente destructiva de cadera: a propósito de un caso.

The rapidly destructive osteoarthritis of the hip is a variant of osteoarthritis that is characterized by hip pain during one to twelve months and rapid destruction of the femoral head, in absence of infectious, neurologic, metabolic or inflammatory disease. We present the case of a 66 year- old male with severe COPD that referred pain in both hips and was unable to walk. In the radiography of the pelvis complete destruction of both femoral heads was observed. The patient did not have abnormalities in blood tests that were related to infectious, neurologic or metabolic diseases. The patient underwent bilateral total hip replacement with prosthesis and physical therapy later. The patient functional status greatly improved with this treatment.

Osteoartritis rápidamente destructiva de cadera: a propósito de un caso / Rapidly destructive osteoarthritis of the hip: case presentation

La osteoartritis rápidamente destructiva de cadera es una variante de la osteoartritis caracterizada por dolor a nivel de cadera de uno a 12 meses de evolución asociada a una rápida destrucción de la cabeza femoral en ausencia de infección, enfermedad neurológica, metabólica e inflamatoria. Presentamos el caso de un varón de 66 años con EPOC severo que refería dolor en ambas caderas y dificultad para deambular de 6 meses de evolución. En la radiografía de pelvis se apreciaba la destrucción de ambas cabezas femorales. No tenía alteración analítica relacionada con enfermedad infecciosa, metabólica, inflamatoria y neurológica. El paciente fue intervenido quirúrgicamente sustituyendo ambas caderas por prótesis y posteriormente tratado con rehabilitación física presentando una notable mejoría (AU)

The rapidly destructive osteoarthritis of the hip is a variant of osteoarthritis that is characterized by hip pain during one to twelve months and rapid destruction of the femoral head, in absence of infectious, neurologic, metabolic or inflammatory disease. We present the case of a 66 year- old male with severe COPD that referred pain in both hips and was unable to walk. In the radiography of the pelvis complete destruction of both femoral heads was observed. The patient did not have abnormalities in blood tests that were related to infectious, neurologic or metabolic diseases. The patient underwent bilateral total hip replacement with prosthesis and physical therapy later. The patient functional status greatly improved with this treatment (AU)

Differential prognostic utility of NTproBNP and Cystatin C in patients with acute exacerbation of chronic pulmonary disease.

OBJECTIVES: To determine whether serum Cystatin C (CysC) and NTproBNP have prognostic value among patients with long-standing chronic lung disease. DESIGN: Prospective, observational, non-interventional study. SETTING: CysC and NTproBNP are prognostic markers in several cardiac conditions. In addition, CysC acts as an antiprotease following Cathepsin activation, which has been involved in the pathogenesis of chronic obstructive pulmonary disease. PARTICIPANTS: Patients with a basal functional status of II-IV (NYHA), admitted for an acute exacerbation of chronic pulmonary diseases and no previous history of symptoms related to pulmonary hypertension or heart failure. MAIN OUTCOME MEASURES: NTproBNP and CysC were determined at admission in 107 patients with acute exacerbation of chronic lung disease. During 12-month follow-up, mortality, new hospital admissions and prescription of diuretics were recorded. RESULTS: During follow-up there were eight patient deaths (7.5%). Mean NTproBNP among the deceased was 1510.20 pg/mL (95% CI 498.44-4628.55) vs 502.70 pg/mL (95% CI 395.44-645.48) among survivors (p = 0.01). Twenty-seven patients (25%) were prescribed loop diuretics. Mean concentration of CysC was 1.45 mg/dL (95% CI 1.21-1.69 mg/dL) vs 1.17 mg/dL (95% IC 1.09-1.25 mg/dL) in those not prescribed (p = 0.004). NTproBNP concentration was 837.14 pg/mL (95% CI 555.57-1274.10 pg/mL) in patients prescribed diuretics vs 473.42 pg/mL (95% CI 357.80-632.70 pg/mL) in those not prescribed (p = 0.03). Kaplan-Meier analysis revealed a significant difference between death and diuretic prescription during follow-up when cut-off value for NTproBNP was 550 pg/mL (p = 0.03 and p = 0.02, respectively). For 1.16mg/dL of CsysC, a significant difference was only observed in diuretic prescription (p = 0.007). CONCLUSIONS: In patients with chronic respiratory diseases NTproBNP has predictive value in terms of mortality whereas CysC does not. However, it is still possible that both can contribute to the early identification of patients at risk of developing clinical ventricular dysfunction.

Valor pronóstico del NT-proBNP en pacientes con enfermedad pulmonar crónica reagudizada / Prognostic value of NT-proBNP in chronic pulmonary disease exacerbation

Fundamentos y objetivo: Los péptidos natriuréticos (PN) han demostrado su utilidad en la insuficiencia cardiaca (IC) y algunos trastornos de la circulación pulmonar. El presente trabajo tiene por objeto conocer la utilidad de la fracción aminoterminal del péptido natriurético cerebral (NT-proBNP) como marcador pronóstico en pacientes con enfermedad pulmonar crónica reagudizada, sin semiología clínica de IC. Pacientes y método: Estudio prospectivo y observacional. Se incluyeron de forma consecutiva 192 pacientes con enfermedad pulmonar crónica ingresados por descompensación de su enfermedad respiratoria. Se determinó la concentración sanguínea de NT-proBNP en todos ellos y se realizó posteriormente un seguimiento durante los 6 meses posteriores al ingreso para detectar reingresos, prescripción de diuréticos, oxigenoterapia o muerte.Resultados: El 6,3% de los pacientes fallecieron, en un 22,9% se prescribió oxigenoterapia, en un 18,2% diuréticos y el 21,9% reingresó al menos en una ocasión durante el período de seguimiento de 6 meses. La concentración media de NT-proBNP fue de 1180pg/ml. Concentraciones de NT-proBNP superiores a 500pg/ml (odds ratio [OR] 11,0, intervalo de confianza del 95% [IC 95%] 1,39–86,99) y de 350pg/ml fueron predictoras de mortalidad y prescripción de diurético (OR 2,83; IC 95% 1,16–6,86), respectivamente. Conclusiones: El NT-proBNP podría ser un marcador pronóstico en pacientes con enfermedad pulmonar crónica, identificando a aquellos con especial riesgo de fallecer o más probabilidad de desarrollar una disfunción ventricular sintomática (AU)

Background and objective: Brain natriuretic peptide (BNP) is produced and released mainly from ventricles. BNP has been shown to be useful in diagnosis and prognosis in heart failure and some pulmonary conditions. The aim of this study is to analyse whether NT-proBNP has a prognostic value in chronic pulmonary patients without overt heart failure. Patient and method: We conducted an observational and prospective study. We included 192 patients admitted to the Internal Medicine Departments of Hospital Clinico “Lozano Blesa” (Zaragoza, Spain) and “Virgen de la Luz” (Cuenca, Spain) with acute exacerbation of pulmonary disease. Blood samples were taken to determine NT-proBNP concentrations. All patients were followed for 6 months after admission.Results: 6,3% of patients died, 22,9% were prescribed with home oxygen-therapy, 18,2% received a diuretic prescription and 21,9% were re-admitted at least once during the follow-up period. Mean NT-proBNP was 1180pg/ml. A concentration above 500pg/ml and 350pg/ml of NT-proBNP was useful to predict mortality and diuretic prescription respectively.Conclusions: Among patients with acute exacerbations of chronic pulmonary disease, NT-proBNP could be a prognostic factor to identify those at risk of death or worst clinical development (AU)

[Prognostic value of NT-proBNP in chronic pulmonary disease exacerbation]. / Valor pronóstico del NT-proBNP en pacientes con enfermedad pulmonar crónica reagudizada.

BACKGROUND AND OBJECTIVE: Brain natriuretic peptide (BNP) is produced and released mainly from ventricles. BNP has been shown to be useful in diagnosis and prognosis in heart failure and some pulmonary conditions. The aim of this study is to analyse whether NT-proBNP has a prognostic value in chronic pulmonary patients without overt heart failure. PATIENT AND METHOD: We conducted an observational and prospective study. We included 192 patients admitted to the Internal Medicine Departments of Hospital Clinico "Lozano Blesa" (Zaragoza, Spain) and "Virgen de la Luz" (Cuenca, Spain) with acute exacerbation of pulmonary disease. Blood samples were taken to determine NT-proBNP concentrations. All patients were followed for 6 months after admission. RESULTS: 6,3% of patients died, 22,9% were prescribed with home oxygen-therapy, 18,2% received a diuretic prescription and 21,9% were re-admitted at least once during the follow-up period. Mean NT-proBNP was 1180pg/ml. A concentration above 500pg/ml and 350pg/ml of NT-proBNP was useful to predict mortality and diuretic prescription respectively. CONCLUSIONS: Among patients with acute exacerbations of chronic pulmonary disease, NT-proBNP could be a prognostic factor to identify those at risk of death or worst clinical development.

Riesgo de enfermedad tromboembólica venosa y profilaxis antitrombótica en los pacientes ingresados en hospitales españoles (estudio ENDORSE) / Venous thromboembolism risk and antithrombotic prophylaxis among patients admitted to Spanish hospitals (ENDORSE study)

Fundamento y objetivo: La proporción de pacientes hospitalizados en España con riesgo de desarrollo de una enfermedad tromboembólica venosa (ETV) y la proporción que recibe profilaxis adecuada no son bien conocidas. El objetivo de este trabajo es obtener esa información analizando los datos correspondientes a los hospitales españoles participantes en el estudio internacional ENDORSE. Método: Estudio transversal realizado en 20 hospitales españoles que analiza los factores de riesgo y la profilaxis tromboembólica administrada a los pacientes mayores de 18 años ingresados en plantas quirúrgicas y mayores de 40 años en plantas médicas. Se utilizaron las guías y las recomendaciones de la 7.a Conferencia del American College of Chest Physicians (ACCP) para evaluar el riesgo de ETV de los pacientes y la adecuación de la profilaxis utilizada. Resultados: De 6.554 camas hospitalarias, se evaluó a 3.809 pacientes ingresados: 2.069 (67,5%) eran pacientes médicos y 996 (32,5%) pacientes quirúrgicos. Tenían riesgo elevado de ETV un total de 1.878 (61,3%) pacientes, de los que 1.140 (55,1%) eran pacientes médicos y 738 (74,1%) eran pacientes quirúrgicos. Recibieron profilaxis de acuerdo con las guías de la ACCP 731 pacientes médicos (el 64,1%; intervalo de confianza [IC] del 95%: del 61,3 al 66,9%) comparado con 605 pacientes quirúrgicos (el 82%; IC del 95%: del 79,2 al 84,8%) con riesgo de ETV (p<0,001). Conclusiones: La profilaxis de la ETV en los hospitales españoles es más habitual en los pacientes quirúrgicos que en los pacientes médicos. No obstante, aproximadamente el 29% de los pacientes ingresados de alto riesgo de ETV, especialmente en plantas médicas, no recibe ningún tipo de profilaxis (AU)

Background and objectives: The proportion of patients at risk of venous thromboembolism (VTE) in Spanish hospitals and, among those, the proportion who receive prophylaxis are not well known. The objective of this study was to obtain this information by means of the analysis of data from the Spanish centres that participated in the international ENDORSE study. Methods: Cross-sectional study in 20 Spanish hospitals. VTE risk factors and VTE prophylaxis were assessed in all hospital inpatients, aged 18 years or over, admitted to a surgical ward, and 40 years or over admitted to a medical ward. The 7th Conference of the American College of Chest Physicians (ACCP) guidelines and recommendations were used as a reference to assess risk categories and the prophylaxis given to patients. Results: 6.554 hospital beds were assessed, and 3.809 inpatients were enrolled; 2.069 (67,5%) were medical and 996 (32,5%) surgical. Based on the ACCP criteria, 1.878 (61,3%) were at risk for VTE, 1.140 (55,1%) were medical and 738 (74,1%) were surgical. According to the ACCP guidelines and recommendations, 731 medical patients at risk of VTE (64,1%, 95% CI 61,3%–66,9%) received appropriate prophylaxis, as compared to 605 (82%; 95% CI 79,2%–84,8%) surgical patients (p<0,001). Conclusions: VTE prophylaxis in the Spanish centres was more common in surgical patients than in medical patients. Nevertheless, it is still necessary to extend the VTE prophylaxis to a significant number of patients (29%) at high risk of VTE, particularly in medical wards (AU)

[Venous thromboembolism risk and antithrombotic prophylaxis among patients admitted to Spanish hospitals (ENDORSE study)]. / Riesgo de enfermedad tromboembólica venosa y profilaxis antitrombótica en los pacientes ingresados en hospitales españoles (estudio ENDORSE).

BACKGROUND AND OBJECTIVES: The proportion of patients at risk of venous thromboembolism (VTE) in Spanish hospitals and, among those, the proportion who receive prophylaxis are not well known. The objective of this study was to obtain this information by means of the analysis of data from the Spanish centres that participated in the international ENDORSE study. METHODS: Cross-sectional study in 20 Spanish hospitals. VTE risk factors and VTE prophylaxis were assessed in all hospital inpatients, aged 18 years or over, admitted to a surgical ward, and 40 years or over admitted to a medical ward. The 7th Conference of the American College of Chest Physicians (ACCP) guidelines and recommendations were used as a reference to assess risk categories and the prophylaxis given to patients. RESULTS: 6.554 hospital beds were assessed, and 3.809 inpatients were enrolled; 2.069 (67,5%) were medical and 996 (32,5%) surgical. Based on the ACCP criteria, 1.878 (61,3%) were at risk for VTE, 1.140 (55,1%) were medical and 738 (74,1%) were surgical. According to the ACCP guidelines and recommendations, 731 medical patients at risk of VTE (64,1%, 95% CI 61,3%-66,9%) received appropriate prophylaxis, as compared to 605 (82%; 95% CI 79,2%-84,8%) surgical patients (p<0,001). CONCLUSIONS: VTE prophylaxis in the Spanish centres was more common in surgical patients than in medical patients. Nevertheless, it is still necessary to extend the VTE prophylaxis to a significant number of patients (29%) at high risk of VTE, particularly in medical wards.