Abscisic acid mimic-fluorine derivative 4 alleviates water deficit stress by regulating ABA-responsive genes, proline accumulation, CO2 assimilation, water use efficiency and better nutrient uptake in tomato plants.

Water deficit represents a serious limitation for agriculture and both genetic and chemical approaches are being used to cope with this stress and maintain plant yield. Next-generation agrochemicals that control stomatal aperture are promising for controlling water use efficiency. For example, chemical control of abscisic acid (ABA) signaling through ABA-receptor agonists is a powerful method to activate plant adaptation to water deficit. Such agonists are molecules able to bind and activate ABA receptors and, although their development has experienced significant advances in the last decade, few translational studies have been performed in crops. Here, we describe protection by the ABA mimic-fluorine derivative 4 (AMF4) agonist of the vegetative growth in tomato plants subjected to water restriction. Photosynthesis in mock-treated plants is markedly impaired under water deficit conditions, whereas AMF4 treatment notably improves CO2 assimilation, the relative plant water content and growth. As expected for an antitranspirant molecule, AMF4 treatment diminishes stomatal conductance and transpiration in the first phase of the experiment; however, when photosynthesis declines in mock-treated plants as stress persists, higher photosynthetic and transpiration parameters are recorded in agonist-treated plants. Additionally, AMF4 increases proline levels over those achieved in mock-treated plants in response to water deficit. Thus water deficit and AMF4 cooperate to upregulate P5CS1 through both ABA-independent and ABA-dependent pathways, and therefore, higher proline levels are produced Finally, analysis of macronutrients reveals higher levels of Ca, K and Mg in AMF4- compared to mock-treated plants subjected to water deficit. Overall, these physiological analyses reveal a protective effect of AMF4 over photosynthesis under water deficit and enhanced water use efficiency after agonist treatment. In summary, AMF4 treatment is a promising approach for farmers to protect the vegetative growth of tomatoes under water deficit stress.

An incidental finding during cardiac catheterization.

Coronary artery obstruction during cardiac catheterization is rare. It is a serious complication and has been reported to occur in 0.15 to 0.5% of cases. Thromboembolism, air embolism and coronary dissection have been described as the most common causes of intraprocedural coronary occlusion. Aortic valve masses can also cause coronary obstruction. We report the case of a young woman with a complication and an incidental finding during angiographic procedure. A surgical treatment was needed.

[Cardiac catheterization via the right radial artery with a Judkins left catheter. A prospective study]. / Cateterismo cardíaco por vía radial derecha con catéter Judkins izquierdo. Estudio prospectivo.

Radial artery access improves the patient's well-being, permits earlier ambulation and diminishes vascular complications after cardiac catheterization. Using the same catheter to study the left and right coronary arteries may facilitate the technique. In a cohort of 100 patients we prospectively analyzed the possibility of studying both coronary arteries with a Judkins left 3.5 catheter. The variables studied were percentage of successful access, complications, and procedural time from insertion of the guiding catheter to the end of ventriculography. It was possible to catheterize both coronary arteries with the same catheter in 94 cases (94%) with a procedural time of 16.7 (6.8) min. In 6 patients a JR4 catheter was required, in one of them due to severe spasm of the right coronary artery ostium and due to impossibility to catheterize the ostium in the other 5. There were no cases of severe radial artery spasm.

Cateterismo cardíaco por vía radial derecha con catéter Judkins izquierdo. Estudio prospectivo / Cardiac catheterization via the right radial artery with a Judkins left catheter. A prospective study

La vía radial favorece el bienestar del paciente, la deambulación precoz y las complicaciones vasculares tras el cateterismo cardíaco. El estudio de las 2 arterias coronarias con un único catéter puede facilitar la realización de la técnica. Se analiza prospectivamente, en una cohorte de 100 pacientes, el abordaje de ambas coronarias con un único catéter Judkins izquierdo 3,5. Las variables estudiadas fueron el porcentaje de éxito, las complicaciones y el tiempo empleado desde la inserción del introductor hasta la finalización de la ventriculografía. Se consiguió cateterizar ambas arterias con el mismo catéter en 94 casos (94%) con un tiempo de 16,7 ± 6,8 min. En 6 casos se requirió un catéter Judkins derecho 4, en uno de ellos por espasmo severo del origen de la coronaria derecha y por imposibilidad de sondar el ostium en los otros 5. No se registraron casos de espasmo severo de arteria radial

Radial artery access improves the patient's well-being, permits earlier ambulation and diminishes vascular complications after cardiac catheterization. Using the same catheter to study the left and right coronary arteries may facilitate the technique. In a cohort of 100 patients we prospectively analyzed the possibility of studying both coronary arteries with a Judkins left 3.5 catheter. The variables studied were percentage of successful access, complications, and procedural time from insertion of the guiding catheter to the end of ventriculography. It was possible to catheterize both coronary arteries with the same catheter in 94 cases (94%) with a procedural time of 16.7 (6.8) min. In 6 patients a JR4 catheter was required, in one of them due to severe spasm of the right coronary artery ostium and due to impossibility to catheterize the ostium in the other 5. There were no cases of severe radial artery spasm

[Direct stenting in saphenous vein grafts. Immediate and long-term results]. / Implante de stent directo en puentes de safena. Resultados inmediatos y a largo plazo.

INTRODUCTION AND OBJECTIVES: Percutaneous interventions on saphenous vein grafts are associated with a worse outcome than in native vessels, mainly because of the risk of embolization. Direct stenting may diminish aggression to the vessel. This study reports the results of direct stenting in saphenous vein grafts. PATIENTS AND METHOD: We compared 2 cohorts of consecutive patients treated with direct stenting (DS) and stenting with predilatation (PD) in saphenous vein grafts between September 1998 and March 2003. In-hospital and long-term results and predictors of mortality were analyzed. RESULTS: The DS group contained 71 patients with 83 lesions, and the PD group contained 46 patients with 54 lesions. There were no differences in age, risk factors, age of the graft, ejection fraction, stent length, need for postdilatation or number of stents per lesion, although the DS group contained more women (DS=38%, PD=17%, P=.02), and stent diameter was larger (DS=3.59 [0.59] mm, PD=3.21 [0.59] mm, P=.001) in the DS group. Creatine phosphokinase elevation was > or =2-fold in 10% (DS=7%, PD=16%, P=.1). One patient died in the hospital. Median follow-up time was 36.1 months. Survival was 94+/- 2% at 12 months, 87+/-3% at 24 months, 82+/-17% at 36 months, 67+/-8% at 48 months and 58+/-7% at 60 months. Revascularization rate was 14% for the target lesion and 20.5% for the target vessel, with no differences between groups in mortality or revascularization success rate. Predictors of mortality were ejection fraction and smoking habit. CONCLUSIONS: Survival after stenting in saphenous vein grafts is similar with direct and conventional techniques, although there was a tendency toward a lower incidence of myocardial infarction with the former. Although the in-hospital results were favorable, long-term survival was less favorable with both techniques.

[Drug-eluting stents in patients with left main coronary lesions who are not candidates for surgical revascularization]. / Stent liberador de fármacos en lesiones de tronco coronario izquierdo en pacientes no candidatos a revascularización quirúrgica.

INTRODUCTION AND OBJECTIVES: Surgical revascularization is the treatment of choice in patients with left main coronary artery stenosis. Conventional stents are not a valid alternative because of the rate of restenosis and sudden cardiac death. Drug-eluting stents, which reduce the rate of restenosis, may represent an alternative to cardiac surgery. The objective of this study was to describe the results with drug-eluting stents in patients with left main coronary artery stenosis who were poor candidates for surgical revascularization. PATIENTS AND METHOD: We prospectively followed a consecutive series of patients who were poor candidates for surgical revascularization and were treated with implantation of a drug-eluting stent in the left main coronary artery between May 2002 and April 2004. In-hospital and long-term results were analyzed. Follow-up included angiographic and intravascular ultrasound (IVUS) studies. RESULTS: Forty-two patients (25 men, 59.5%) with a mean age of 70.1 (10.5) years were studied. Fourteen (33%) had diabetes, and 7 (16.7%) had a protected left main coronary artery. The reasons for ruling out surgery were poor distal vessels in 19 (45.2%), previous surgery in 9 (21.4%), age in 6 (14.3%), primary angioplasty in 5 (11.4%), and other reasons in 3 (7.2%). Four patients (9.5%) died before discharge, three of them after primary angioplasty. No in-hospital revascularization procedures were needed. Median follow-up time was 288 days; mean follow-up time was 315 (241) days. Another four patients died after discharge (9.5%) on days 5, 24, 34 and 115. Angioplasty was repeated in one patient, and another was referred for heart transplantation. CONCLUSIONS: Drug-eluting stents represent a valid alternative in patients with left main coronary artery stenosis who are poor candidates for surgical revascularization. Randomized studies with a longer follow-up should be performed to evaluate their benefits in patients eligible for surgery.

Implante de stent directo en puentes de safena. Resultados inmediatos y a largo plazo / Direct stenting in saphenous vein grafts. Immediate and long-term results

Introducción y objetivos. Las intervenciones percutáneas en los injertos de vena safena se asocian con peores resultados que las efectuadas en los vasos nativos, fundamentalmente por el riesgo de embolización. El stenting directo puede disminuir la agresión sobre el vaso. Se estudian los resultados del stenting directo en las safenas. Pacientes y método. Se comparan 2 cohortes de pacientes consecutivos conimplante de stent en las safenas mediante técnica directa (SD) y predilatación (PD) realizado entre septiembre de 1998 y marzo de 2003. Se analizan los resultados intrahospitalarios y a largo plazo y los predictores de mortalidad. Resultados. Se utilizó la SD en 71 pacientes con 83 lesiones y la PD en 46pacientes con 54 lesiones. No hubo diferencias en cuanto a la edad, los factores de riesgo, la edad del injerto, la fracción de eyección, la longitud del stent, la situación pos-dilatación y número de stents por lesión, aunque sí en las mujeres (SD en el 38% y PD en el 17%; p = 0,02) y el diámetro del stent (SD, 3,59 ± 0,59 mm; y PD, 3,21 ± 0,59 mm; p = 0,001).Se observó una elevación del doble de los valores normales de lacreatincinasa en el 10% de los pacientes (el 7% en el grupo SD y el 16% enel grupo PD; p = 0,1). Se produjo un caso de mortalidad intrahospitalaria.La mediana de seguimiento fue de 36,1 meses. La supervivencia global de laserie a los 12, 24, 36, 48 y 60 meses fue del 94 ± 2, el 87 ± 3, el 82 ± 17,el 67 ± 8 y el 58 ± 7%, respectivamente. La tasa de revascularización de la lesión tratada fue del 14% y la del vaso tratado del 20,5%, sin diferencias entre los grupos en la mortalidad y la revascularización. Los predictores de mortalidad fueron la fracción de eyección y el tabaquismo. Conclusiones. La supervivencia después de implante de un stent en injertos de safena es similar con SD y PD, aunque se observa una menor tendencia hacia la incidencia de infarto con la primera. Aunque los resultados intrahospitalarios son favorables, la supervivencia a largo plazo es menos favorable con ambas técnicas

Introduction and objectives. Percutaneous interventions on saphenous vein grafts are associated with a worse outcome than in native vessels, mainly because of the risk of embolization. Direct stenting may diminish aggression to the vessel. This study reports the results of direct stenting in saphenous vein grafts. Patients and method. We compared 2 cohorts of consecutive patients treated with direct stenting (DS) and stenting with predilatation (PD) in saphenous vein grafts between September 1998 and March 2003. In-hospital and long-term results and predictors of mortality were analyzed. Results. The DS group contained 71 patients with 83 lesions, and the PD group contained 46 patients with 54 lesions. There were no differences image, risk factors, age of the graft, ejection fraction, stent length, need for post dilatation or number of stents per lesion, although the DS group contained more women (DS=38%, PD=17%, P=.02), and stent diameter was larger(DS=3.59 [0.59] mm, PD=3.21 [0.59] mm, P=.001) in the DS group. Creatine phosphokinase elevation was ?2-fold in 10% (DS= 7%, PD=16%, P=.1). One patient died in the hospital. Median follow-up time was 36.1 months. Survival was 94± 2% at 12 months, 87±3% at 24 months, 82±17% at 36 months,67±8% at 48 months and 58±7% at 60 months. Revascularization rate was 14%for the target lesion and 20.5% for the target vessel, with no differences between groups in mortality or revascularization success rate. Predictors of mortality were ejection fraction and smoking habit. Conclusions. Survival after stenting in saphenous vein grafts is similar with direct and conventional techniques, although there was a tendency toward a lower incidence of myocardial infarction with the former. Although the in-hospital results were favorable, long-term survival was less favorable with both techniques

[Percutaneous treatment of thoracic aorta diseases. A multidisciplinary approach]. / Tratamiento percutáneo de las afecciones de la aorta torácica. Una labor multidisciplinaria.

INTRODUCTION AND OBJECTIVES: The purpose of this study was to evaluate the experience of a multidisciplinary team in the percutaneous treatment of thoracic aorta disease. PATIENTS AND METHOD: Between December 2001 and January 2004, 15 patients were selected for percutaneous treatment at the Thoracic Aorta Unit of the Hospital Universitario Central de Asturias. The motives for stent implantation were: degenerative aneurysm (n=7), acute dissection (n=4), penetrating atherosclerotic ulcer (n=1), posttraumatic aneurysm (n=2) and postsurgery pseudoaneurysm (n=1). Four procedures were considered emergencies. Another two patients underwent prior surgery of the supra-aortic branches. Previous computed tomographic angiography and arteriography were performed, and in complex cases of dissection, magnetic resonance imaging was used. All stent placement procedures were performed in the hemodynamics laboratory. All patients underwent computed tomographic angiography during follow-up. RESULTS: Stent positioning was technically successful in 14 patients. The mean length of aortic coverage was 230 +/- 110 mm (range 110-440 mm). No intraoperative deaths occurred. There was one in-hospital death. Transient postimplantation syndrome was presented in three patients. Two type I endoleaks, one type II endoleak and one thrombosis of the superior mesenteric artery were found on computed tomographic angiography at one month. One type III endoleak and one type II endoleak were found during subsequent follow-up. CONCLUSIONS: Endovascular stent-grafting is a valid alternative in the treatment of aortic disease in high-risk patients. Coordination between different medical specialties and appropriate selection of patients are needed. Long-term follow-up is necessary to ensure the usefulness and efficacy of the procedure.

Stent liberador de fármacos en lesiones de tronco coronario izquierdo en pacientes no candidatos a revascularización quirúrgica / Drug-eluting stents in patients with left main coronary lesions who are not candidates for surgical revascularization

Introducción y objetivos. La cirugía es el tratamiento de elección de la estenosis del tronco. Los stents convencionales no son una alternativa debido a la reestenosis e incidencia de muerte súbita. Los stents liberadores de fármacos, al disminuir la reestenosis, pueden ser una terapia válida. El objetivo del estudio es describir los resultados del stent con liberación de fármacos en pacientes con lesión en tronco no candidatos a tratamiento quirúrgico. Pacientes y método. Se analizó la evolución de una serie de pacientes consecutivos no candidatos a cirugía a los que se implantó un stent liberador de fármacos entre mayo de 2002 y abril de 2004 por lesión en el tronco. Se analizaron los resultados intrahospitalarios y a largo plazo. Se realizó un seguimiento angiográfico y con ultrasonidos intracoronarios. Resultados. Se estudió a 42 pacientes, con una edad de 70,1 ± 10,5 años, 25 (59,5%) varones, y 14 (33%) diabéticos;7 (16,7%) tenían tronco protegido. El motivo de imposibilidad de cirugía fue por malos vasos en 19(45,2%) casos, cirugía previa en 9 (21,4%), edad en 6(14,3%), angioplastia primaria en 5 (11,4%) y otras causasen 3 (7,2%) pacientes. Cuatro (9,5%) pacientes fallecieron antes del alta; a 3 de ellos se les practicó una angioplastia primaria, y no hubo necesidad de nueva revascularización. La mediana de seguimiento fue de 288días (media, 315 ± 241). Otros 4 (9,5%) fallecieron después del alta, en los días 5, 24, 34 y 115. Se repitió la angioplastia en un caso y en otro se practicó un trasplante. Conclusiones. Los stents liberadores de fármacos representan una alternativa para los pacientes con lesiones en el tronco que no son candidatos a cirugía. Se deberían hacer estudios aleatorizados con seguimiento a largo plazo para valorar su validez en pacientes elegibles para cirugía

Introduction and objectives. Surgical revascularization is the treatment of choice in patients with left main coronary artery stenosis. Conventional stents are not a valid alternative because of the rate of restenosis and sudden cardiac death. Drug-eluting stents, which reduce the rate of restenosis, may represent an alternative to cardiac surgery. The objective of this study was to describe the results with drug-eluting stents in patients with left main coronary artery stenosis who were poor candidates for surgical revascularization. Patients and method. We prospectively followed a consecutive series of patients who were poor candidates for surgical revascularization and were treated with implantation of a drug-eluting stent in the left main coronary artery between May 2002 and April 2004. In-hospital and long-term results were analyzed. Follow-up included angiographic and intravascular ultrasound (IVUS) studies. Results. Forty-two patients (25 men, 59.5%) with a mean age of 70.1 (10.5) years were studied. Fourteen(33%) had diabetes, and 7 (16.7%) had a protected left main coronary artery. The reasons for ruling out surgery were poor distal vessels in 19 (45.2%), previous surgery in 9 (21.4%), age in 6 (14.3%), primary angioplasty in 5(11.4%), and other reasons in 3 (7.2%). Four patients(9.5%) died before discharge, three of them after primary angioplasty. No in-hospital revascularization procedures were needed. Median follow-up time was 288 days; mean follow-up time was 315 (241) days. Another four patients died after discharge (9.5%) on days 5, 24, 34 and 115.Angioplasty was repeated in one patient, and another was referred for heart transplantation. Conclusions. Drug-eluting stents represent a valid alternative in patients with left main coronary artery stenosis who are poor candidates for surgical revascularization. Randomized studies with a longer follow-up should be performed to evaluate their benefits in patients eligible for surgery

Tratamiento percutáneo de las afecciones de la aorta torácica. Una labor multidisciplinaria / Percutaneous treatment of thoracic aorta diseases. A multidisciplinary approach

Introducción y objetivos. El objetivo del presente estudio es presentar la experiencia de un equipo multidisciplinario en el tratamiento percutáneo de las afecciones de la aorta torácica. Pacientes y método. Entre diciembre de 2001 y enero de 2004 se seleccionó, en la Unidad de Aorta Torácica del Hospital Universitario Central de Asturias, a 15 pacientes para tratamiento percutáneo. Las causas fueron: aneurisma degenerativo (n = 7), disección aguda (n = 4), úlcera penetrante (n = 1), postraumatismo (n = 2) y seudoaneurisma posquirúrgico (n = 1). Cuatro procedimientos fueron urgentes. En 2 casos se realizó una cirugía previa de los troncos supraaórticos. Los pacientes fueron estudiados mediante estudio angiográfico por tomografía computarizada (angio-TC) y arteriografía. En disecciones complejas se practicó una resonancia magnética. Los procedimientos se desarrollaron en el laboratorio de hemodinámica bajo anestesia general. El seguimiento se realizó mediante angio-TC. Resultados. El tratamiento se realizó con éxito en 14 pacientes. La longitud media de aorta recubierta fue de 230 ± 110 mm (rango, 110-440 mm). No hubo complicaciones intraoperatorias. Se produjo 1 fallecimiento durante el ingreso. Tres pacientes presentaron síndrome postimplantación. En la tomografía computarizada de control se detectaron 1 endofuga de tipo II, 2 de tipo I y 1 trombosis de la arteria mesentérica superior. En el seguimiento se produjeron 2 endofugas, 1 de tipo III y 1 de tipo II. Conclusiones. La técnica endovascular es una alternativa válida aplicable en pacientes de alto riesgo. Su empleo requiere una labor coordinada de varias especialidades médicas y una correcta selección de los casos. Es necesario realizar un seguimiento a largo plazo para asegurar su utilidad y eficacia

Introduction and objectives. The purpose of this study was to evaluate the experience of a multidisciplinary team in the percutaneous treatment of thoracic aorta disease. Patients and method. Between December 2001 and January 2004, 15 patients were selected for percutaneous treatment at the Thoracic Aorta Unit of the Hospital Universitario Central de Asturias. The motives for stent implantation were: degenerative aneurysm (n=7), acute dissection (n=4), penetrating atherosclerotic ulcer (n=1), posttraumatic aneurysm (n=2) and postsurgery pseudoaneurysm (n=1). Four procedures were considered emergencies. Another two patients underwent prior surgery of the supra-aortic branches. Previous computed tomographic angiography and arteriography were performed, and in complex cases of dissection, magnetic resonance imaging was used. All stent placement procedures were performed in the hemodynamics laboratory. All patients underwent computed tomographic angiography during follow-up. Results. Stent positioning was technically successful in 14 patients. The mean length of aortic coverage was 230 ± 110 mm (range 110-440 mm). No intraoperative deaths occurred. There was one in-hospital death. Transient postimplantation syndrome was presented in three patients. Two type I endoleaks, one type II endoleak and one thrombosis of the superior mesenteric artery were found on computed tomographic angiography at one month. One type III endoleak and one type II endoleak were found during subsequent follow-up. Conclusions. Endovascular stent-grafting is a valid alternative in the treatment of aortic disease in high-risk patients. Coordination between different medical specialties and appropriate selection of patients are needed. Long-term follow-up is necessary to ensure the usefulness and efficacy of the procedure

Percutaneous intervention over the origin of a saphenous vein graft anastomosed with the St. Jude Medical Symmetry Aortic Connector System.

We describe a percutaneous intervention performed over the proximal anastomoses of an aortocoronary saphenous vein graft that had been attached to the aorta 3 months before with the St. Jude Medical Symmetry Aortic Connector System. Technical aspects of procedure are discussed, and the experience previously reported in the literature related to this issue is reviewed.