Antiplatelet therapy at discharge and long-term prognosis in Takotsubo syndrome: Insights from the Spanish National Registry (RETAKO).

INTRODUCTION: Endothelial dysfunction and platelet activation have been highlighted as possible mediators in Takotsubo syndrome (TTS). Nevertheless, to date, evidence on the usefulness of antiplatelet therapy in TTS remains controversial. The aim of our study is to evaluate long-term prognosis in TTS patients treated with antiplatelet therapy (APT) at hospitalization discharge. MATERIAL AND METHODS: An ambispective cohort study from the Spanish National Takotsubo Registry database was performed (June 2002 to March 2017). Patients were divided into two groups: those who received APT at hospital discharge (APT cohort) and those who did not (non-APT cohort). Primary endpoint was all-cause death. Secondary endpoints included the composite of recurrence or readmission and a composite of death, recurrence or readmission. RESULTS: From a total of 741 patients, 728 patients were alive at discharge. Follow-up was performed in 544 patients, who were included in the final analysis: 321 patients (59.0%) in the APT cohort and 223 patients (41.0%) in the non-APT cohort. The APT cohort had a better clinical presentation and received more heart failure and acute coronary syndrome-like therapies (angiotensin converting enzyme inhibitors/angiotensin receptor blockers: 75.1% vs. 51.1%; p<0.001, betablockers: 71.3% vs. 50.7%; p<0.001, statins: 67.9% vs. 33.2%; p<0.001). After adjusting for confounder factors, APT at discharge was a protective factor for all-cause death (adjusted hazard ratio (HR) 0.315, 95% confidence interval (CI): 0.106-0.943; p=0.039) and the composite endpoint of all-cause death, recurrence or readmission (adjusted HR 0.318, 95% CI: 0.164-0.619; p=0.001) at month 25 of follow-up. CONCLUSION: Patients with TTS receiving APT at discharge presented better prognosis up to two-years of follow-up compared with their counterparts not receiving APT.

Signal processing for slug flow analysis: MATLAB algorithm.

This paper presents an easy-to-use MATLAB© program to characterize slug flow, one of the most observed gas-liquid flow patterns in pipes. "BSignalProcessing2020.m" based on the study reported in [1] is a flexible, expandable, and adaptable statistical algorithm used to calculate the film and slug cut threshold values, the disregard cut value to group slug pulses, and the disregard cut value to remove slug pulses, which are required to determine the slug characteristics. The code is provided for unlimited and unrestricted use. • The statistical algorithm does not depend on any subjective criteria. • The methodology is illustrated using voltage time-series, but it is applicable without changes to instantaneous liquid holdup time-series.

CFD study and experimental validation of low liquid-loading flow assurance in oil and gas transport: studying the effect of fluid properties and operating conditions on flow variables.

Low liquid-loading flow frequently occurs during the transport of gas products in various industries, such as in the Oil & Gas, the Food, and the Pharmaceutical Industries. Even small amounts of liquid can have a significant effect on the flow conditions inside the pipeline, such as increased pressure loss, pipe wall stresses and corrosion, and liquid holdup along the pipeline. However, most studies that analyze this type of flow only use atmospheric pressures and horizontal 1-in or 2-in pipes, which do not accurately represent the range of operating conditions present in industrial applications. Therefore, this study focused on modeling low liquid-loading flow in medium-sized (6-10 in) pipes, using CFD simulations and experimental data from the University of Tulsa, and then applying it to real operating conditions from a Colombian gas pipeline. An acceptable difference was observed between experimental and CFD data, both for the liquid holdup (18%) and for the pressure drop (12%). Variables like pressure drop and wall shear stress increase with phase velocity, operating pressure, and pipe inclination. Liquid holdup increases with liquid velocity but decreases with all other factors. The relation of flow variables with phase velocities is of particular interest: Doubling the gas velocity decreased holdup 70% and increased pressure drop tenfold. On the other hand, the presence of the liquid phase seems to be more influential on process variables than its exact flowrate; the introduction of the liquid phase to a single-phase gas causes an increase in pressure loss by a factor of three, but doubling the liquid velocity only increases the pressure loss by a further 30%.

Proyectos de gobierno y desarrollo de institucionalidad juvenil: intensidades y tensiones del vínculo en Argentina (1989-2015) / Government projects and development of youth institutions: intensities and tensions Argentina (1989-2015) / Projetos do governo e desenvolvimento da institucionalidade da juventude: intensidades e tensões do vínculo na Argentina (1989-2015)

Resumen (descriptivo) En su carácter de revisión de tema, el objetivo central del artículo consiste en indagar sobre el vínculo existente entre un tipo de proyecto de gobierno y el desarrollo que el Estado nacional hace de institucionalidad juvenil. Centrándose en el caso argentino, se analiza si, dado el «giro a la izquierda¼ que representó el proyecto de gobierno kirchnerista (2003-2015), existieron rupturas significativas en la producción de institucionalidad pública juvenil en el ámbito nacional, en comparación con lo desarrollado en la materia por los gobiernos durante la «larga década neoliberal¼ (1989-2003). El presente trabajo estudia, a partir de fuentes secundarias, el nivel de la administración que se ocupa específicamente de los problemas de la juventud, es decir, los organismos gubernamentales de juventud. Para ello se incluye un análisis cualitativo de las lógicas con que se aborda la cuestión juvenil en los programas y dispositivos que el organismo implementa, capacidades estatales desarrolladas y el rol y peso político del organismo en el entramado institucional general de las políticas juveniles implementadas por el Estado nacional.

Abstract (descriptive) The main objective of the article is to investigate the links between a type of government project and the development of youth institutions. Focusing on Argentina, the article analyzes whether in the «shift to the left¼ represented by the Kirchner governments (2003-2015) there were importante shifts in the work of youth public institutions at a national level compared to what was achieved by different national governments during the «long neoliberal decade¼ (1989-2003). The present study is limited to analyzing secondary sources to identify the level of public administration specifically focused on youth issues, Government Youth Organizations. A qualitative analysis has been included on the logic of addressing youth issues using the programs and mechanisms employed by the agency, developing state capacities and the role and political weight of the agency in the general institutional framework of youth policies implemented by the State.

Resumo (descritivo) Em sua natureza de revisão de assunto, o principal objetivo do artigo é investigar a ligação entre um tipo de projeto governamental e o desenvolvimento de instituições de juventude pelos Estados nacionais. Focalizando o caso argentino, analisa-se que diante da «curva esquerda¼ representada pelo projeto do governo Kirchnerista (2003-2015) ocorreram importantes interrupções na produção da institucionalidade pública juvenil em nível nacional, em relação ao que foi implantado pelos governos durante a «longa década neoliberal¼ (1989-2003). O presente trabalho limita-se à abordagem, a partir de fontes secundárias, do nível da administração especificamente ocupada com problemas da juventude, isto é, às Organizações Juvenis do Governo. Para este propósito, uma análise qualitativa é realizada sobre a lógica de abordar a questão da juventude através dos programas e dispositivos que o organismo implementa, capacidades do estado desenvolvido e o papel e peso político do organismo no quadro institucional geral das políticas de juventude desde o estado nacional.

Short- and Long-Term Prognostic Relevance of Cardiogenic Shock in Takotsubo Syndrome: Results From the RETAKO Registry.

OBJECTIVES: This study sought to describe the incidence, determinants, and prognostic impact of cardiogenic shock (CS) in takotsubo syndrome (TTS). BACKGROUND: TTS can be associated with severe hemodynamic instability. The prognostic implication of CS has not been well characterized in large studies of TTS. METHODS: We analyzed patients with a definitive TTS diagnosis (modified Mayo criteria) who were recruited for the National RETAKO (Registry on Takotsubo Syndrome) trial from 2003 to 2016. Cox and competing risk regression models were used to identify factors associated with mortality and recurrences. RESULTS: A total of 711 patients were included, 81 (11.4%) of whom developed CS. Male sex, QTc interval prolongation, lower left ventricular ejection fraction at admission, physical triggers, and presence of "a significant" left intraventricular pressure gradient, were associated with CS (C index = 0.85). In-hospital complication rates, including mortality, were significantly higher in patients with CS. Over a median follow-up of 284 days (interquartile range: 94 to 929 days), CS was the strongest independent predictor of long-term, all-cause mortality (hazard ratio [HR]: 5.38; 95% confidence interval [CI]: 2.60 to 8.38); cardiovascular (CV) death (sub-HR: 4.29; 95% CI: 2.40 to 21.2), and non-CV death (sub-HR: 3.34; 95% CI: 1.70 to 6.53), whereas no significant difference in the recurrence rate was observed between groups (sub-HR: 0.76; 95% CI: 0.10 to 5.95). Among patients with CS, those who received beta-blockers at hospital discharge experienced lower 1-year mortality compared with those who did not receive a beta-blocker (HR: 0.52; 95% CI: 0.44 to 0.79; pinteraction = 0.043). CONCLUSIONS: CS is not uncommon and is associated with worse short- and long-term prognosis in TTS. CS complicating TTS may constitute a marker of underlying disease severity and could identify a masked heart failure phenotype with increased vulnerability to catecholamine-mediated myocardial stunning.

Síndrome de tako-tsubo en varones: infrecuente, pero con mal pronóstico / Tako-tsubo syndrome in men: rare, but with poor prognosis

Introducción y objetivos: El síndrome de tako-tsubo es un proceso patológico potencialmente grave durante la fase aguda. Simula un infarto de miocardio, sin que haya lesiones coronarias potencialmente responsables. El objetivo de este trabajo es analizar la evolución y el pronóstico de los pacientes con síndrome de tako-tsubo en función del sexo. Métodos: Se analizaron las características de los pacientes incluidos en el registro RETAKO durante los años 2003 a 2015, un registro multicéntrico en el que participaron 32 hospitales españoles. Resultados: De los 562 pacientes incluidos, 493 (87,7%) eran mujeres. El dolor torácico fue menos frecuente como síntoma inicial en los varones que en las mujeres (43 [66,2%] frente a 390 [82,8%]; p < 0,01). El pronóstico fue peor en los varones, con mayor mortalidad intrahospitalaria (3 [4,4%] frente a 1 [0,2%]; p < 0,01), duración más prolongada de ingreso en cuidados intensivos (4,2 ± 3,7 frente a 3,2 ± 3,2 días; p = 0,03) y mayor frecuencia de insuficiencia cardiaca grave (22 [33,3%] frente a 95 [20,3%]; p = 0,02). Sin embargo la aparición de obstrucción dinámica a nivel del tracto de salida del ventrículo izquierdo se observó exclusivamente en mujeres (39 [7,9%] frente a 0 [0,0%]; p = 0,02) y la incidencia de insuficiencia mitral funcional también fue mayor en ellas (52 [10,6%] frente a 2 [2,9%]; p = 0,04). Conclusiones: El síndrome de tako-tsubo es una enfermedad que muestra grandes diferencias en función del sexo en cuanto a su incidencia, presentación y evolución, con un peor pronóstico en los varones

Introduction and objectives: Tako-tsubo syndrome is a potentially serious disease during the acute phase. It mimics myocardial infarction, but with no potentially causative coronary lesions. The aim of this study was to analyze the clinical course and outcome of patients with tako-tsubo syndrome by sex. Methods: We analyzed the characteristics of patients included in the RETAKO registry from 2003 to 2015, a multicenter registry with participation of 32 Spanish hospitals. Results: Of 562 patients included, 493 (87.7%) were women. Chest pain was less frequent as an initial symptom in men than in women (43 [66.2%] vs 390 [82.8%]; P < .01). The prognosis was worse in men, with higher in-hospital mortality (3 [4.4%] vs 1 [0.2%]; P < .01), longer intensive care stay (4.2 ± 3.7 vs 3.2 ± 3.2 days; P = .03) and a higher frequency of severe heart failure (22 [33.3%] vs 95 [20.3%]; P = .02). However, dynamic obstruction at the left-ventricular outflow tract occurred exclusively in women (39 [7.9%] vs 0 [0.0%]; P = .02). The incidence of functional mitral regurgitation was also higher in women (52 [10.6%] vs 2 [2.9%]; P = .04). Conclusions: Tako-tsubo syndrome shows wide differences by sex in terms of its incidence, presentation, and outcomes. Prognosis is worse in men

Tako-tsubo Syndrome in Men: Rare, but With Poor Prognosis.

INTRODUCTION AND OBJECTIVES: Tako-tsubo syndrome is a potentially serious disease during the acute phase. It mimics myocardial infarction, but with no potentially causative coronary lesions. The aim of this study was to analyze the clinical course and outcome of patients with tako-tsubo syndrome by sex. METHODS: We analyzed the characteristics of patients included in the RETAKO registry from 2003 to 2015, a multicenter registry with participation of 32 Spanish hospitals. RESULTS: Of 562 patients included, 493 (87.7%) were women. Chest pain was less frequent as an initial symptom in men than in women (43 [66.2%] vs 390 [82.8%]; P < .01). The prognosis was worse in men, with higher in-hospital mortality (3 [4.4%] vs 1 [0.2%]; P < .01), longer intensive care stay (4.2 ± 3.7 vs 3.2 ± 3.2 days; P = .03) and a higher frequency of severe heart failure (22 [33.3%] vs 95 [20.3%]; P = .02). However, dynamic obstruction at the left-ventricular outflow tract occurred exclusively in women (39 [7.9%] vs 0 [0.0%]; P = .02). The incidence of functional mitral regurgitation was also higher in women (52 [10.6%] vs 2 [2.9%]; P = .04). CONCLUSIONS: Tako-tsubo syndrome shows wide differences by sex in terms of its incidence, presentation, and outcomes. Prognosis is worse in men.