RGD-tagging of star-shaped PLA-PEG micellar nanoassemblies enhances doxorubicin efficacy against osteosarcoma.

We developed cyclic RGD-tagged polymeric micellar nanoassemblies for sustained delivery of Doxorubicin (Dox) endowed with significant cytotoxic effect against MG63, SAOS-2, and U2-OS osteosarcoma cells without compromising the viability of healthy osteoblasts (hFOBs). Targeted polymeric micellar nanoassemblies (RGD-NanoStar@Dox) enabled Dox to reach the nucleus of MG63, SAOS-2, and U2-OS cells causing the same cytotoxic effect as free Dox, unlike untargeted micellar nanoassemblies (NanoStar@Dox) which failed to reach the nucleus and resulted ineffective, demonstrating the crucial role of cyclic RGD peptide in driving cellular uptake and accumulation mechanisms in osteosarcoma cells. Micellar nanoassemblies were obtained by nanoformulation of three-armed star PLA-PEG copolymers properly synthetized with and without decoration with the cyclic-RGDyK peptide (Arg-Gly-Asp-D-Tyr-Lys). The optimal RGD-NanoStar@Dox nanoformulation obtained by nanoprecipitation method (8 % drug loading; 35 % encapsulation efficiency) provided a prolonged and sustained drug release with a rate significantly lower than the free drug under the same experimental conditions. Moreover, the nanosystem preserved Dox from the natural degradation occurring under physiological conditions (i.e., dimerization and consequent precipitation) serving as a slow-release "drug reservoir" ensuring an extended biological activity over the time.

Microplastics in seafood: Consumer preferences and valuation for mitigation technologies.

Microplastics, an emerging pollutant, have garnered widespread attention due to potential repercussions on human health and the environment. Given the critical role of seafood in food security, growing concerns about microplastics might be detrimental to meeting future global food demand. This study employed a discrete choice experiment to investigate Chilean consumers' preferences for technology aimed at mitigating microplastic levels in mussels. Using a between-subjects design with information treatments, we examined the impact of informing consumers about potential human health and environmental effects linked to microplastics pollution on their valuation for the technology. We found that the information treatments increased consumers' willingness to pay for mussels. Specifically, consumers were willing to pay a premium of around US$ 4 for 250 g of mussel meat with a 90 % depuration efficiency certification. The provision of health impact information increased the price premium by 56 %, while the provision of environmental information increased it by 21 %. Furthermore, combined health and environmental information significantly increased the probability of non-purchasing behavior by 22.8 % and the risk perception of microplastics for human health by 5.8 %. These results emphasized the critical role of information in shaping consumer preferences and provided evidence for validating investment in research and development related to microplastic pollution mitigation measures.

Assessing the incorporation of latent variables in the estimation of the value of a statistical life.

For many years, the economic literature has recognized the role of attitudes, beliefs, and perceptions in estimating the value of a statistical life (VSL). However, few applications have attempted to include them. This article incorporates the perceived controllability and concern about traffic and cardiorespiratory risks to estimate VSL using a hybrid choice model (HCM). The HCM allows us to include unobserved heterogeneity and improve behavioral realism explicitly. Using data from a choice experiment conducted in Santiago, Chile, we estimate a VSL of US$3.78 million for traffic risks and US$2.06 million for cardiorespiratory risks. We found that higher controllability decreases the likelihood that the respondents would be willing to pay for risk reductions in both risks. On the other hand, concern about these risks decreases the willingness to pay for traffic risk reductions but increases it for cardiorespiratory risk reductions.

Harnessing the power of PLA-PEG nanoparticles for Linezolid delivery against methicillin-resistant Staphylococcus aureus.

This study deals with the development of novel poly(lactic acid)-poly(ethylene glycol) nanoparticles (PLA-PEG NPs) for the efficient and prolonged delivery of Linezolid (LNZ), a synthetic antibacterial agent used against methicillin-resistant Staphylococcus aureus (MRSA). A two-step synthetic strategy based on carbodiimide coupling and copper-catalyzed azide-alkyne cycloaddition was first exploited for the conjugation of PLA with PEG. The encapsulation of LNZ into medium-molecular-weight PLA-PEG NPs was carried out by different methods including nanoprecipitation and dialysis. The optimal PLA-PEG@LNZ nanoformulation resulted in 3.5% LNZ payload (15% encapsulation efficiency, with a 10:3 polymer to drug mass ratio) and sustained release kinetics with 65% of entrapped antibiotic released within 80 h. Moreover, the zeta potential values (from -31 to -39 mV) indicated a good stability without agglomeration even after freeze-drying and lyophilization. The PLA-PEG@LNZ NPs exerted antimicrobial activity against a panel of Gram-positive bacteria responsible for human infections, such as Staphylococcus aureus including MRSA, Staphylococcus epidermidis, Staphylococcus lugdunensis and vancomycin-resistant Enterococcus faecium (VREfm). Moreover, PLA-PEG@LNZ NPs showed inhibitory activity on both planktonic growth and preformed biofilm of MRSA. The antibacterial activity of LNZ incorporated in polymeric NPs was well preserved and the nanosystem served as an antibiotic enhancer with a potential role in MRSA-associated infections management.

Three-armed RGD-decorated starPLA-PEG nanoshuttle for docetaxel delivery.

A novel star-shaped amphiphilic copolymer based on three poly(lactide)-block-poly(ethylene glycol) (PLA-PEG) terminal arms extending from a glycerol multifunctional core was newly synthesized and decorated with the tumor-targeting ligand cyclic-RGDyK peptide (Arg-Gly-Asp-D-Tyr-Lys) to be eventually formulated in polymeric micelles incorporating a suitable anticancer drug (i.e., Docetaxel, DTX; drug loading 16 %, encapsulation efficiency 69 %). The biological profile of unloaded micelles (RGD-NanoStar) was studied on Human Adipose-derived Mesenchymal Stem Cells (Ad-MSCs) as health control, pointing out the absence of toxicity. Surprisingly, an unprecedented effect on cell viability was exerted by RGD-NanoStar, comparable to that of the free DTX, on tumoral MDA-MB 468 Human Breast Adenocarcinoma cells, specifically starting from 48 h of culture (about 40 % and 60 % of dead cells at 48 and 72 h, respectively, at all tested concentrations). RGD-NanoStar reduced the cell viability also of tumoral U87 Human Glioblastoma cells, compared to cells only, at 72 h (about 25 % of dead cells) demonstrating a time-dependent effect exerted by the highest concentrations. The effects of DTX-loaded micelles (RGD-NanoStar/DTX) on U87 and MDA-MB 468 cell lines were evaluated by MTT, cell morphology analysis, and scratch test. A compromised cell morphology was observed without significant difference between DTX-treated and RGD-NanoStar/DTX - treated cells, especially in U87 cell line. Although no apparent benefit emerged from the drug incorporation into the nanosystem by MTT assay, the scratch test revealed a statistically significant inhibition of tumoral cell migration on both cell lines, confirming the well-known role of DTX in inhibiting cell movements even when loaded on polymeric micelles. Specifically, only 43 µm distance was covered by U87 cells after 30 h culture with RGD-NanoStar/DTX (30 µg/mL) compared to 73 µm in the presence of free DTX at the same concentration; more interestingly, a total absence of MDA-MB 468 cell movements was detected at 30 h compared to about 50 µm distance covered by cells in the presence of free DTX (10 µg/mL). The stronger inhibitory activity on cell migration of RGD-NanoStar/DTX compared to the free drug in both cell lines at 30 h attested for a good ability of the drug-loaded nanocarrier to reduce tumor propagation and invasiveness, enhancing the typical effect of DTX on metastatization.

Gaps, biases, and future directions in research on the impacts of anthropogenic land-use change on aquatic ecosystems: a topic-based bibliometric analysis.

Anthropogenic land use change (ALUC) satisfies human needs but also impacts aquatic ecosystems. Aquatic ecosystems are intrinsically linked with terrestrial landscapes, an association that is already recognized as a key factor to address future research and effective governance. However, the complexity and range of the impact of ALUC in aquatic ecosystems have been fundamental challenges and have implicitly routed the analysis to particular segments, drivers, management, or effects of the theme. In this study, we present an attempt to frame the subject in a broader context through a topic-based bibliometric analysis. Our aim is to identify possible biases and gaps in the current scientific literature and detect the main topics that have characterized the theme. Our results show an unequal distribution of articles by country when we analyzed the authors' affiliation and also a slight increase in contributions from social and economic disciplines, although they are still underrepresented. Moreover, we distinguish topics whose prevalence seems to change, especially those topics where the use of scenario analysis and multi-stressors are considered. We discuss the main biases and gaps revealed by our results, concluding that future studies on the impact of ALUC on aquatic ecosystems should better integrate social and economic disciplines and expand geographic frontiers.

Complicaciones del infarto agudo del miocardio tratado con trombolisis / Complications of the acute hearth attack treated with thrombolysis

RESUMEN Introducción: el infarto agudo de miocardio es una de las formas más graves de cardiopatía isquémica. Representa un problema de salud de relevancia mundial. Se realizó un estudio descriptivo con el objetivo de determinar el comportamiento de pacientes portadores de infarto agudo del miocardio tratados por trombolisis en el Hospital Provincial Docente "Amalia Simoni", de Camagüey, en el período comprendido desde 2013 a 2015. Objetivo: determinar el comportamiento de pacientes portadores de infarto agudo de miocardio, tratados por trombolisis en el Hospital Provincial Docente "Amalia Simoni", de Camagüey. Materiales y métodos: la muestra la conformó los 146 pacientes que ingresaron, en el período antes mencionado, en el Servicio de Gariatría, Hospital Provincial Docente "Amalia Simoni". Se emplearon métodos de estadística descriptiva y se determinó la frecuencia y el porcentaje. Resultados: reveló un predominio de hombres entre 60 y 79 años, con antecedentes de hipertensión arterial y en un elevado porcentaje de fumadores, clasificados en Killip Kimball I y II, con excelentes resultados los tratados antes de las 3 h, y con complicaciones inmediatas sobre el músculo cardiaco. Conclusiones: el tratamiento trombólitico es muy efectivo en las 3 h primeras del comienzo de los síntomas (AU).

ABSTRACT Introduction: the myocardial acute infarct is one of the forms of the ischemic heart disease, being a health problem around the world. The authors carried out a descriptive study with the objective of determining the behavior of patients suffering a myocardial acute infarct treated by thrombolysis in the Teaching Provincial Hospital "Amalia Simoni", of Camagüey, in the period from 2013 to 2015. Objective: to determine the behavior of patients suffering a myocardial acute infarct treated by thrombolysis in the Teaching Provincial Hospital "Amalia Simoni", of Camagüey. Material and methods: the simple was formed by all the 146 patients who entered the Teaching Provincial Hospital "Amalia Simoni" in the before-mentioned period with a diagnosis of myocardial acute infarct. Descriptive statistic methods were used and frequency and percentage were determined. Results: the study showed the predominance of men aged 60-79 years, with antecedents of arterial hypertension and a high number of cigarette smokers, classified in Killip&Kimball I and II. The patients treated before 3 hours passed showed excellent results, and with immediate complications on the heath muscle. Conclusions: thrombolytic treatment is very effective in the first 3 hours after the symptoms beginning (AU).

Complicaciones del infarto agudo del miocardio tratado con trombolisis / Complications of the acute hearth attack treated with thrombolysis

RESUMEN Introducción: el infarto agudo de miocardio es una de las formas más graves de cardiopatía isquémica. Representa un problema de salud de relevancia mundial. Se realizó un estudio descriptivo con el objetivo de determinar el comportamiento de pacientes portadores de infarto agudo del miocardio tratados por trombolisis en el Hospital Provincial Docente "Amalia Simoni", de Camagüey, en el período comprendido desde 2013 a 2015. Objetivo: determinar el comportamiento de pacientes portadores de infarto agudo de miocardio, tratados por trombolisis en el Hospital Provincial Docente "Amalia Simoni", de Camagüey. Materiales y métodos: la muestra la conformó los 146 pacientes que ingresaron, en el período antes mencionado, en el Servicio de Gariatría, Hospital Provincial Docente "Amalia Simoni". Se emplearon métodos de estadística descriptiva y se determinó la frecuencia y el porcentaje. Resultados: reveló un predominio de hombres entre 60 y 79 años, con antecedentes de hipertensión arterial y en un elevado porcentaje de fumadores, clasificados en Killip Kimball I y II, con excelentes resultados los tratados antes de las 3 h, y con complicaciones inmediatas sobre el músculo cardiaco. Conclusiones: el tratamiento trombólitico es muy efectivo en las 3 h primeras del comienzo de los síntomas.

ABSTRACT Introduction: the myocardial acute infarct is one of the forms of the ischemic heart disease, being a health problem around the world. The authors carried out a descriptive study with the objective of determining the behavior of patients suffering a myocardial acute infarct treated by thrombolysis in the Teaching Provincial Hospital "Amalia Simoni", of Camagüey, in the period from 2013 to 2015. Objective: to determine the behavior of patients suffering a myocardial acute infarct treated by thrombolysis in the Teaching Provincial Hospital "Amalia Simoni", of Camagüey. Material and methods: the simple was formed by all the 146 patients who entered the Teaching Provincial Hospital "Amalia Simoni" in the before-mentioned period with a diagnosis of myocardial acute infarct. Descriptive statistic methods were used and frequency and percentage were determined. Results: the study showed the predominance of men aged 60-79 years, with antecedents of arterial hypertension and a high number of cigarette smokers, classified in Killip&Kimball I and II. The patients treated before 3 hours passed showed excellent results, and with immediate complications on the heath muscle. Conclusions: thrombolytic treatment is very effective in the first 3 hours after the symptoms beginning.

Linking social preferences and ocean acidification impacts in mussel aquaculture.

Ocean Acidification (OA) has become one of the most studied global stressors in marine science during the last fifteen years. Despite the variety of studies on the biological effects of OA with marine commercial species, estimations of these impacts over consumers' preferences have not been studied in detail, compromising our ability to undertake an assessment of market and economic impacts resulting from OA at local scales. Here, we use a novel and interdisciplinary approach to fill this gap. We experimentally test the impact of OA on commercially relevant physical and nutritional attributes of mussels, and then we use economic discrete choice models to assess the marginal effects of these impacts over consumers' preferences and wellbeing. Results showed that attributes, which were significantly affected by OA, are also those preferred by consumers. Consumers are willing to pay on average 52% less for mussels with evidences of OA and are willing to increase the price they pay to avoid negative changes in attributes due to OA. The interdisciplinary approach developed here, complements research conducted on OA by effectively informing how OA economic impacts can be analyzed under the lens of marginal changes in market price and consumer' welfare. Thereby, linking global phenomena to consumers' wellbeing, and shifting the focus of OA impacts to assess the effects of local vulnerabilities in a wider context of people and businesses.

Aspectos novedosos de la neumonía comunitaria: [revisión] / Novel aspects of community pneumonia: [review]

A pesar de potentes antibióticos la neumonía adquirida en la comunidad se mantiene como la causa más frecuente de mortalidad por enfermedades infecciosas, y la séptima causa de mortalidad total en los Estados Unidos. Por esta razón, el interés ha sido desviado a medidas terapéuticas aparte de los antibióticos. Desarrollo: se realizó una revisión bibliográfica acerca del tema. A pesar de beneficios teóricos, la literatura existente no demuestra buenos resultados en la terapia con corticosteroides, por lo que se necesitan grandes estudios controlados. Los antiinflamatorios no esteroideo, podrían beneficiar la oxigenación pero no demuestran ningún efecto sobre la mortalidad. La activación del sistema de coagulación parece ser un evento fisiopatológico muy importante en la neumonía grave, posiblemente más que la sepsis generalizada. El subgrupo de neumonía adquirida en la comunidad en fase III de un estudio usando tanto drotrecogin alfa (activado) y tifacogin (inhibidor de la vía del factor tisular recombinante) demostró un mayor beneficio. Los efectos inmunomoduladores de los antibióticos de tipo macrólidos pueden tener un papel importante en el manejo de la neumonía adquirida en la comunidad de tipo severa. El uso del agente tensoactivo exógeno como terapia de adjunta para la lesión inflamatoria aguda del pulmón. El uso de estatinas antes del diagnóstico está relacionado con mejores resultados pero se requieren investigaciones adicionales para determinar si la indicación al tiempo del diagnóstico afectará el resultado final.

Despite powerful antibiotics, community-acquired pneumonia remains the most common cause of mortality from infectious diseases, and the seventh leading cause of death in the United States. By this reason, interest has been redirected into therapeutic measures apart from antibiotics. Development: a bibliographic review on the topic was made. Despite theoretical benefits, existing literature does not demonstrate good results in therapy with corticosteroids, which large controlled studies are needed. Non-steroidal anti-inflammatory drugs could benefit oxygenation but not show any effect on mortality. The activation of the coagulation system seems to be a very important physiopathological event in severe pneumonia, possibly more than generalized sepsis. The subgroup of acquired pneumonia in the community in phase III of a study using both drotrecogin alpha (activated) and tifacogin (recombinant tissular factor pathway inhibitor) showed a greater benefit. The immunomodulatory effects of macrolide antibiotics may have an important role in the management of severe community-acquired pneumonia. The exogenous tensio-active agent is used as adjunctive therapy for acute inflammatory lesion of the lung. Estatina use before diagnosis is associated with improved outcome but requires further research to determine if the indication at the time of diagnosis will affect the final result.

Aspectos novedosos de la neumonía comunitaria / Novel aspects of community pneumonia

A pesar de potentes antibióticos la neumonía adquirida en la comunidad se mantiene como la causa más frecuente de mortalidad por enfermedades infecciosas, y la séptima causa de mortalidad total en los Estados Unidos. Por esta razón, el interés ha sido desviado a medidas terapéuticas aparte de los antibióticos. Desarrollo: se realizó una revisión bibliográfica acerca del tema. A pesar de beneficios teóricos, la literatura existente no demuestra buenos resultados en la terapia con corticosteroides, por lo que se necesitan grandes estudios controlados. Los antiinflamatorios no esteroideo, podrían beneficiar la oxigenación pero no demuestran ningún efecto sobre la mortalidad. La activación del sistema de coagulación parece ser un evento fisiopatológico muy importante en la neumonía grave, posiblemente más que la sepsis generalizada. El subgrupo de neumonía adquirida en la comunidad en fase III de un estudio usando tanto drotrecogin alfa (activado) y tifacogin (inhibidor de la vía del factor tisular recombinante) demostró un mayor beneficio. Los efectos inmunomoduladores de los antibióticos de tipo macrólidos pueden tener un papel importante en el manejo de la neumonía adquirida en la comunidad de tipo severa. El uso del agente tensoactivo exógeno como terapia de adjunta para la lesión inflamatoria aguda del pulmón. El uso de estatinas antes del diagnóstico está relacionado con mejores resultados pero se requieren investigaciones adicionales para determinar si la indicación al tiempo del diagnóstico afectará el resultado final (AU)

Despite powerful antibiotics, community-acquired pneumonia remains the most common cause of mortality from infectious diseases, and the seventh leading cause of death in the United States. By this reason, interest has been redirected into therapeutic measures apart from antibiotics. Development: a bibliographic review on the topic was made. Despite theoretical benefits, existing literature does not demonstrate good results in therapy with corticosteroids, which large controlled studies are needed. Non-steroidal anti-inflammatory drugs could benefit oxygenation but not show any effect on mortality. The activation of the coagulation system seems to be a very important physiopathological event in severe pneumonia, possibly more than generalized sepsis. The subgroup of acquired pneumonia in the community in phase III of a study using both drotrecogin alpha (activated) and tifacogin (recombinant tissular factor pathway inhibitor) showed a greater benefit. The immunomodulatory effects of macrolide antibiotics may have an important role in the management of severe community-acquired pneumonia. The exogenous tensio-active agent is used as adjunctive therapy for acute inflammatory lesion of the lung. Estatina use before diagnosis is associated with improved outcome but requires further research to determine if the indication at the time of diagnosis will affect the final result (AU)

Aspectos novedosos de la hipertensión portal: [revisión] / Novel aspects of portal hypertension: [review]

Fundamento: la hipertensión portal es la complicación más común de la cirrosis que explica una importante morbilidad y mortalidad, principalmente debido a hemorragia por várices esofágicas, la ascitis y sus infecciones bacterianas sobreañadidas, la encefalopatía hepato-amoniacal, y el síndrome hepatorrenal. Los avances en el diagnóstico y su manejo son examinados a continuación en vistas a las perspectivas actuales. Desarrollo: la medición del gradiente de presión de la vena hepática, aporta una importante información pronóstico en estos pacientes. La prueba no invasiva con elastografía, cápsula endoscópica, y tomografía computarizada para el diagnóstico de várices esofágicas son prometedoras pero se necesita más información. Los datos clínicos en pacientes con sangramiento por várices esofágicas proveen una información importante para la terapia inicial y el pronóstico. Las nuevas terapias para pacientes con hiponatremia dilucional con antagonistas de la vasopresina son prometedoras y pueden mejorar el manejo de esta afección. Conclusiones: el terlipressin es la mejor terapia médica actualmente disponible para el manejo del síndrome hepatorrenal como se confirmó recientemente. Los pacientes con la enfermedad hepática avanzada se benefician de la administración por largos períodos del norfloxacin para prevenir el desarrollo del síndrome hepatorrenal y mejorar la supervivencia. Los avances en el diagnóstico y manejo de pacientes con cirrosis e hipertensión portal mejoraran la morbilidad y mortalidad de sus complicaciones.

Background: portal hypertension is the most common complication of cirrhosis that explains an important morbidity and mortality, mainly due to hemorrhage for esophageal varices, ascites and its superadded bacterial infections, the hepato-ammoniacal encephalopathy, and the hepatorenal syndrome. Advances in diagnosis and their management are examined next in view of current perspectives. Development: the pressure gradient mensuration of the hepatic vein, contributes an important prognostic information in these patients. The non invasive test with elastography, endoscopic capsule, and computed tomography for esophageal varices diagnosis are promising but more information is needed. Clinical data in patients with bleeding for esophageal varices provide important information for initial therapy and prognosis. New therapies for patients with dilutional hyponatremia with vasopressin antagonists are promising and may improve this affection management. Conclusions: the terlipressin is currently the best available medical therapy for the hepatorenal syndrome management as has been confirmed recently. Patients with advanced liver disease are benefiting with norfloxacin administration for long periods to prevent hepatorenal syndrome development and to improve survival. Advances in diagnosis and patients’ management with cirrhosis and portal hypertension improved morbidity and mortality of their complications.

Nuevos retos terapéuticos de la hipertensión arterial y la enfermedad cardiaca: [revisión] / New therapeutic challenges of arterial hypertension and cardiac disease: [review]

Fundamento: todos los años surgen nuevas pautas acerca del manejo de la hipertensión arterial sistémica, tanto nacional como internacional y nuevos protocolos son liberados, que en ocasiones tienden a complicar el trabajo del clínico. Desarrollo: un nuevo meta-análisis aclaró los beneficios de la inhibición de sistema renina angiotensina para el manejo de la insuficiencia cardiaca, muy importante después de los resultados poco claros del estudio. Los dos nuevos enfoques para tratar la hipertensión resistente al tratamiento, los dispositivos Rheos para la hipertensión resistente, y la denervación renal por catéter, muestran resultados muy prometedores, mientras que una vacuna contra la angiotensina II espera por resultados finales. Pacientes que tomaban el polypill fueron estudiados contra ocho grupos que tomaban por separado los componentes de las Polypill, lo cual mostró resultados muy alentadores.

Background: Every year, new national and international guidelines about systemic arterial hypertension management and new protocols are released, which tend to complicate the clinician's work at times. Development: A new meta-analysis has clarified benefits of renin-angiotensin system (RAS) inhibition for heart failure especially important after the unclear results of the study. Two new approaches to treat resistant hypertension to treatment, Rheos devices for resistant hypertension and catheter-based renal enervation have shown promising results, whereas a vaccine against angiotensin II needs further clarification. Patients taking polypill were studied against eight groups taking separately polypill components, which showed quite encouraging results.

Nuevos conceptos fisiológicos de la enfermedad ácido péptica: [revisión] / New physiologic concepts of the peptic acid disease: [review]

Fundamento: los trastornos ácido pépticos son el resultado de diferentes mecanismos patogénicos, producidos por un desbalance entre la secreción excesiva de ácido y/o la disminución de la barrera defensiva de la mucosa. Son enfermedades comúnmente presentes en la práctica médica diaria y producto a su cronicidad, representan un costo importante en la atención sanitaria. Desarrollo: los elementos claves en el éxito de controlar estas enfermedades son el desarrollo de drogas potentes y seguras sobre las bases fisiológicas. Los antagonistas de receptor de histamina II revolucionó el tratamiento de los trastornos ácido péptico debido a su inocuidad y eficacia. Los inhibidores de bomba de protón representan un avance terapéutico adicional debido a la inhibición más potente de la secreción ácida. Los datos obtenidos de los ensayos clínicos y la experiencia observacional confirman la eficacia de estos agentes en el tratamiento de la enfermedad ácido péptica con eficacia y seguridad. Los paradigmas en su velocidad y duración de acción subrayan la necesidad de nuevas variantes químicas que con sólo una dosis produzca una duración confiable del control ácido, particularmente por la noche. Conclusiones: esta evaluación provee una valoración del conocimiento en curso de la fisiología de la producción de ácido para poder enfrentar de las enfermedades ácido- pépticas, tanto como los desafíos en curso y las futuras instrucciones en el tratamiento de las enfermedades mediadas por ácido

Background: peptic acid disorders are the result of different pathogenic mechanisms, taken place by a misbalance between the acid excessive secretion and/or the decrease of the mucosa defensive barrier. These are commonly diseases in daily medical practice due to their chronicity; it represents an important cost in sanitary attention. Development: The key elements in the success of controlling these diseases are the development of potent and safe drugs on the physiologic bases. The histamine-2 receptor antagonists revolutionized the treatment of peptic acid disorders due to their innocuousness and effectiveness. The proton pump inhibitors represent an additional therapeutic advance due to the most potent inhibition in the acid secretion. The obtained data of the clinical trials and the observational experience has confirmed the effectiveness and security of these agents in the treatment of peptic acid disease. Paradigms in their speed and action duration underline the necessity of new chemical variants that just with a single dose produces a reliable duration of the acid control, particularly at night. Conclusions: this assessment provides a knowledge valuation in course of the physiology of acid production, to be able to face peptic-acid diseases as much as the challenges in course and the future instructions in the treatment of diseases mediated by acid

Nuevos conceptos fisiológicos de la enfermedad ácido péptica / New physiologic concepts of the peptic acid disease

Fundamento: los trastornos ácido pépticos son el resultado de diferentes mecanismos patogénicos, producidos por un desbalance entre la secreción excesiva de ácido y/o la disminución de la barrera defensiva de la mucosa. Son enfermedades comúnmente presentes en la práctica médica diaria y producto a su cronicidad, representan un costo importante en la atención sanitaria. Desarrollo: los elementos claves en el éxito de controlar estas enfermedades son el desarrollo de drogas potentes y seguras sobre las bases fisiológicas. Los antagonistas de receptor de histamina II revolucionó el tratamiento de los trastornos ácido péptico debido a su inocuidad y eficacia. Los inhibidores de bomba de protón representan un avance terapéutico adicional debido a la inhibición más potente de la secreción ácida. Los datos obtenidos de los ensayos clínicos y la experiencia observacional confirman la eficacia de estos agentes en el tratamiento de la enfermedad ácido péptica con eficacia y seguridad. Los paradigmas en su velocidad y duración de acción subrayan la necesidad de nuevas variantes químicas que con sólo una dosis produzca una duración confiable del control ácido, particularmente por la noche. Conclusiones: esta evaluación provee una valoración del conocimiento en curso de la fisiología de la producción de ácido para poder enfrentar de las enfermedades ácido- pépticas, tanto como los desafíos en curso y las futuras instrucciones en el tratamiento de las enfermedades mediadas por ácido(AU)

Background: peptic acid disorders are the result of different pathogenic mechanisms, taken place by a misbalance between the acid excessive secretion and/or the decrease of the mucosa defensive barrier. These are commonly diseases in daily medical practice due to their chronicity; it represents an important cost in sanitary attention. Development: The key elements in the success of controlling these diseases are the development of potent and safe drugs on the physiologic bases. The histamine-2 receptor antagonists revolutionized the treatment of peptic acid disorders due to their innocuousness and effectiveness. The proton pump inhibitors represent an additional therapeutic advance due to the most potent inhibition in the acid secretion. The obtained data of the clinical trials and the observational experience has confirmed the effectiveness and security of these agents in the treatment of peptic acid disease. Paradigms in their speed and action duration underline the necessity of new chemical variants that just with a single dose produces a reliable duration of the acid control, particularly at night. Conclusions: this assessment provides a knowledge valuation in course of the physiology of acid production, to be able to face peptic-acid diseases as much as the challenges in course and the future instructions in the treatment of diseases mediated by acid(AU)

Nuevos retos terapéuticos de la Hipertensión arterial y la Enfermedad cardiaca / New therapeutic challenges of arterial hypertension and cardiac disease

Fundamento: todos los años surgen nuevas pautas acerca del manejo de la hipertensión arterial sistémica, tanto nacional como internacional y nuevos protocolos son liberados, que en ocasiones tienden a complicar el trabajo del clínico. Desarrollo: un nuevo meta-análisis aclaró los beneficios de la inhibición de sistema renina angiotensina para el manejo de la insuficiencia cardiaca, muy importante después de los resultados poco claros del estudio. Los dos nuevos enfoques para tratar la hipertensión resistente al tratamiento, los dispositivos Rheos para la hipertensión resistente, y la denervación renal por catéter, muestran resultados muy prometedores, mientras que una vacuna contra la angiotensina II espera por resultados finales. Pacientes que tomaban el polypill fueron estudiados contra ocho grupos que tomaban por separado los componentes de las Polypill, lo cual mostró resultados muy alentadores(AU)

Background: Every year, new national and international guidelines about systemic arterial hypertension management and new protocols are released, which tend to complicate the clinician's work at times. Development: A new meta-analysis has clarified benefits of renin-angiotensin system (RAS) inhibition for heart failure especially important after the unclear results of the study. Two new approaches to treat resistant hypertension to treatment, Rheos devices for resistant hypertension and catheter-based renal enervation have shown promising results, whereas a vaccine against angiotensin II needs further clarification. Patients taking polypill were studied against eight groups taking separately polypill components, which showed quite encouraging results(AU)

Aspectos novedosos de la hipertensión portal / Novel aspects of portal hypertension

Fundamento: la hipertensión portal es la complicación más común de la cirrosis que explica una importante morbilidad y mortalidad, principalmente debido a hemorragia por várices esofágicas, la ascitis y sus infecciones bacterianas sobreañadidas, la encefalopatía hepato-amoniacal, y el síndrome hepatorrenal. Los avances en el diagnóstico y su manejo son examinados a continuación en vistas a las perspectivas actuales. Desarrollo: la medición del gradiente de presión de la vena hepática, aporta una importante información pronóstico en estos pacientes. La prueba no invasiva con elastografía, cápsula endoscópica, y tomografía computarizada para el diagnóstico de várices esofágicas son prometedoras pero se necesita más información. Los datos clínicos en pacientes con sangramiento por várices esofágicas proveen una información importante para la terapia inicial y el pronóstico. Las nuevas terapias para pacientes con hiponatremia dilucional con antagonistas de la vasopresina son prometedoras y pueden mejorar el manejo de esta afección. Conclusiones: el terlipressin es la mejor terapia médica actualmente disponible para el manejo del síndrome hepatorrenal como se confirmó recientemente. Los pacientes con la enfermedad hepática avanzada se benefician de la administración por largos períodos del norfloxacin para prevenir el desarrollo del síndrome hepatorrenal y mejorar la supervivencia. Los avances en el diagnóstico y manejo de pacientes con cirrosis e hipertensión portal mejoraran la morbilidad y mortalidad de sus complicaciones(AU)

Background: portal hypertension is the most common complication of cirrhosis that explains an important morbidity and mortality, mainly due to hemorrhage for esophageal varices, ascites and its superadded bacterial infections, the hepato-ammoniacal encephalopathy, and the hepatorenal syndrome. Advances in diagnosis and their management are examined next in view of current perspectives. Development: the pressure gradient mensuration of the hepatic vein, contributes an important prognostic information in these patients. The non invasive test with elastography, endoscopic capsule, and computed tomography for esophageal varices diagnosis are promising but more information is needed. Clinical data in patients with bleeding for esophageal varices provide important information for initial therapy and prognosis. New therapies for patients with dilutional hyponatremia with vasopressin antagonists are promising and may improve this affection management. Conclusions: the terlipressin is currently the best available medical therapy for the hepatorenal syndrome management as has been confirmed recently. Patients with advanced liver disease are benefiting with norfloxacin administration for long periods to prevent hepatorenal syndrome development and to improve survival. Advances in diagnosis and patients management with cirrhosis and portal hypertension improved morbidity and mortality of their complications(AU)

La hipersecreción ácida en la práctica médica: un reto al médico práctico: [revisión] / The acid hypersecretion in the medical practice: a challenge to the general practitioner: [review]

La hipersecreción ácida del estómago ha sido vista en numerosos procesos, incluyendo la úlcera duodenal, el síndrome de Zollinger Ellison, las gastritis asociadas al helicobacter pylori, síndrome pilórico, síndrome del intestino corto, la exclusión antral, la hiperfunción de las células G gástricas, la mástocitosis sistémica, leucemia basofílica, el síndrome carcinoide con toma gástrica, y los tumores pancreáticos no productores de gástrica. La gran mayoría de los estádos hipersecretores gástricos son ideopáticos y como la medición de está secreción no se lleva rutinariamente, el diagnóstico de estos estádos generalmente se pierde.

Gastric acid hypersecretion is seen in several disorders, including duodenal ulcers, Zollinger-Ellison Syndrome (ZES), Helicobacter pylori–associated gastritis, gastric outlet obstruction, short gut syndrome, antral exclusion, gastric G-cell hyperfunction, systemic mastocytosis, basophilic leukemia, gastric carcinoids with carcinoid syndrome, and non–gastrin producing pancreatic tumors. Most incidences of gastric acid hypersecretion are idiopathic. As gastric acid secretion is not routinely measured, the diagnosis of a gastric acid hypersecretory state can often be missed in many cases.

La hipersecreción ácida en la práctica médica: Un reto al médico práctico / The acid hypersecretion in the medical practice: a challenge to the general practitioner

La hipersecreción ácida del estómago ha sido vista en numerosos procesos, incluyendo la úlcera duodenal, el síndrome de Zollinger Ellison, las gastritis asociadas al helicobacter pylori, síndrome pilórico, síndrome del intestino corto, la exclusión antral, la hiperfunción de las células G gástricas, la mástocitosis sistémica, leucemia basofílica, el síndrome carcinoide con toma gástrica, y los tumores pancreáticos no productores de gástrica. La gran mayoría de los estádos hipersecretores gástricos son ideopáticos y como la medición de está secreción no se lleva rutinariamente, el diagnóstico de estos estádos generalmente se pierde (AU)

Gastric acid hypersecretion is seen in several disorders, including duodenal ulcers, Zollinger-Ellison Syndrome (ZES), Helicobacter pylori–associated gastritis, gastric outlet obstruction, short gut syndrome, antral exclusion, gastric G-cell hyperfunction, systemic mastocytosis, basophilic leukemia, gastric carcinoids with carcinoid syndrome, and non–gastrin producing pancreatic tumors. Most incidences of gastric acid hypersecretion are idiopathic. As gastric acid secretion is not routinely measured, the diagnosis of a gastric acid hypersecretory state can often be missed in many cases (AU)

Enfermedad por reflujo esófago gástrico: una entidad a tener en cuenta / Gastroesophageal reflux disease: an entity to take into account

La patogénesis de la esofagitis de reflujo está fundamentalmente relacionada a la ruptura de mecanismos de defensa normales que evitan el paso en exceso de ácido gástrico o pepsina a la porción inferior del esófago. Esto involucra una serie de defectos de los mecanismos anti reflujos y de limpieza del esófago. El conocimiento de estos componentes subyacentes, estructurales, funcionales, celulares y moleculares de la patogenia de la esofagitis de reflujo nos ayudará a mejorar el manejo de esta entidad y así evitar su progresión (AU)

The pathogenesis of the reflux esophagitis is fundamentally related to the rupture of normal defense mechanisms that avoid the pass in excess of gastric acid or pepsin to the inferior portion of the esophagus. This involves a series of defects of the antireflux and esophageal cleaning mechanisms. The knowledge of these subjacent, structural, functional, cellular and molecular components of the reflux esophagitis pathogeny will help us to improve the management of this entity and this way to avoid its progression (AU)