Enhancement of nonlinear functionality of step-index silica fibers combining thermal poling and 2D materials deposition.

This work proposes a new route to overcome the limits of the thermal poling technique for the creation of second order nonlinearity in conventional silica optical fibers. We prove that it is possible to enhance the nonlinear behavior of periodically poled fibers merging the effects of poling with the nonlinear intrinsic properties of some materials, such as MoS2, which are deposited inside the cladding holes of a twin-hole silica fiber. The optical waves involved in a second harmonic generation process partially overlap inside the thin film of the nonlinear material and exploit its higher third order susceptibility to produce an enhanced SHG.

[A prospective study on trimetazidine effectiveness and tolerability in diabetic patients in association to the previous treatment of their coronary disease. DIETRIC study]. / Estudio prospectivo en pacientes diabéticos de la efectividad y la tolerabilidad de la trimetazidina en asociación al tratamiento previo de su enfermedad coronaria. Estudio DIETRIC.

INTRODUCTION AND OBJECTIVES: Diabetics frequently suffer diffuse coronary disease with difficulties for coronary artery bypass graft, which means that they require multiple medical treatment. Trimetazidine is an anti-ischemic agent that improves the myocardial metabolism and that can be especially useful in the ischemic myocardium of diabetic patients. The objective of this study is to evaluate in diabetic patients the anti-ischemic effectiveness of trimetazidine associated with regular medical treatment. METHODS: In the DIETRIC study 580 patients with diabetes type 2 and coronary disease have been included for the assessment of antianginous effect of trimetazidine (20 mg/8 h). Basal clinical record, physical examination, laboratory evaluation, ECG and exercise test were carried out, with 6-month follow-up. In this article the clinical and exercise test response to the treatment is analyzed. RESULTS: A reduction of angina episodes was observed (2.8 vs 0,9; p < 0.001), in addition to a reduction of the number of weekly nitroglycerin tablets (2.5 vs 0,7; p < 0.001). In the exercise test carried out at 6-month follow-up an increase in its length was observed (441 vs 391 s; p < 0.001); also an increase of the time up to the decline of ST segment (214 vs 209 s; p = 0.02); at the same time a smaller decline of ST segment occurred (1.7 vs 1,2; p < 0.001). Tolerance was excellent. CONCLUSIONS: In this group of patients with diabetes mellitus type 2 and coronary artery disease, trimetazidine associated with regular medical treatment decreased the incidence of angina episodes and the ischemic response in the exercise test with an excellent tolerance.

[Limited application of prevention measures in patients with diabetes mellitus type 2 and coronary artery disease in Spain. DIETRIC study]. / Escasa aplicación de las medidas de prevención en los pacientes con diabetes mellitus tipo 2 y enfermedad arterial coronaria en España. Estudio DIETRIC.

INTRODUCTION AND OBJECTIVES: Diabetes is a disease with high prevalence that involves high mortality. The control of risk factors reduces the cardiovascular complications. The objective of this study is to define the control degree of cardiovascular risk factors in patients with diabetes and coronary artery disease. METHODS: In DIETRIC study 628 patients with diabetes type 2 and coronary artery disease have been included with the aim to study the antianginous effect of trimetazidine. Patients were studied basally with clinical history, physical exploration, laboratory testing, ECG and exercise test, with 6-month follow-up. In this article the profile of cardiovascular risk and the level of control of the risk factors in the basal study are analyzed. RESULTS: More than 80% of patients showed excess weight or obesity, 73% dyslipemia and 59% hypertension. More than 60% of patients showed 3 or more related risk factors. Only 15% had adequate control of blood pressure, and the control of diastolic pressure (55%) was most frequent than that of systolic (17%). Only 7.5% had adequate control of plasma lipids. Many patients did not take drugs to reduce mortality, as aspirin and statins. CONCLUSIONS: Most of these diabetic patients with coronary artery disease do not have adequate control of risk factors. A limited use of drugs that have proven to reduce cardiovascular mortality in these patients is observed.

Estudio prospectivo en pacientes diabéticos de la efectividad y la tolerabilidad de la trimetazidina en asociación al tratamiento previo de su enfermedad coronaria. Estudio DIETRIC / A prospective study on trimetazidine effectiveness and tolerability in diabetic patients in association to the previous treatment of their coronary disease. DIETRIC study

Introducción y objetivos. Los diabéticos tienen con frecuencia enfermedad coronaria difusa, difícilmente revascularizable, por lo que requieren tratamiento médico múltiple. La trimetazidina es un fármaco antiisquémico que mejora el metabolismo miocárdico y puede ser especialmente útil en el miocardio isquémico del diabético. El objetivo de este estudio es evaluar en pacientes diabéticos la eficacia antiisquémica de la trimetazidina asociada al tratamiento médico habitual. Métodos. En el estudio DIETRIC se han incluido580 pacientes con diabetes tipo 2 y enfermedad coronaria para estudiar el efecto antianginoso de la trimetazidina (20 mg/8 h). Se les realiza basalmente historia clínica, exploración física, analítica, electrocardiogama (ECG) y prueba de esfuerzo, y son seguidos durante 6 meses. En este artículo se analiza la respuesta clínica y en la prueba de esfuerzo al tratamiento. Resultados. Se observó una disminución de los episodios de angina (2,8 frente a 0,9; p <0,001), así como del número de comprimidos de nitroglicerina utilizados a la semana (2,5 frente a 0,7; p < 0,001).En la prueba de esfuerzo realizada a los 6 meses se observó un incremento de la duración de la prueba de esfuerzo (441 frente a 391 s; p < 0,001) y del tiempo hasta el descenso del segmento ST (214 frente a 209 s; p = 0,02); simultáneamente se produjo un menor descenso del ST (1,7 frente a 1,2; p<0,001).La tolerancia fue excelente. Conclusiones. En este grupo de pacientes con diabetes mellitus tipo 2 y enfermedad arterial coronaria la trimetazidina asociada al tratamiento médico habitual disminuye el número de episodios anginosos y la respuesta isquémica en la prueba de esfuerzo con una excelente tolerancia

Introduction and objectives. Diabetics frequently suffer diffuse coronary disease with difficulties for coronary artery bypass graft, which means that they require multiple medical treatment. Trimetazidineis an anti-ischemic agent that improves the myocardial metabolism and that can be especially useful in the ischemic myocardium of diabetic patients. The objective of this study is to evaluate in diabetic patients the anti-ischemic effectiveness of trimetazidine associated with regular medical treatment. Methods. In the DIETRIC study 580 patients with diabetes type 2 and coronary disease have been recluted for the assessment of antianginous effect oftrimetazidine (20 mg/8 h). Basal clinical record, physical examination, laboratory evaluation, ECGand exercise test were carried out, with 6-monthfollow-up. In this article the clinical and exercise testresponse to the treatment is analyzed. Results. A reduction of angina episodes was observed (2.8 vs 0,9; p < 0.001), in addition to areduction of the number of weekly nitrogly cerintablets (2.5 vs 0,7; p < 0.001). In the exercise test carried out at 6-month follow-up an increase in its lenght was observed (441 vs 391 s; p < 0.001); also an increase of the time up to the decline of ST segment (214 vs 209 s; p = 0.02); at the same timea smaller decline of ST segment occurred(1.7 vs 1,2; p < 0.001). Tolerance was excellent. Conclusions. In this group of patients with diabetes mellitus type 2 and coronary artery disease, trimetazidine associated with regular medical treatment decreased the incidence of angina episodes and the ischemic response in the exercise test with an excellent tolerance

Escasa aplicación de las medidas de prevención en los pacientes con diabetes mellitus tipo 2 y enfermedad arterial coronaria en España. Estudio DIETRIC / Limited application of prevention measures in patients with diabetes mellitus type 2 and coronary artery disease in Spain. DIETRIC study

Introducción y objetivos. La diabetes es una enfermedad de elevada prevalencia que conlleva una elevada mortalidad. El control de los factores de riesgo reduce las complicaciones cardiovasculares. El objetivo de este estudio es conocer el grado de control de los factores de riesgo cardiovascular en pacientes con diabetes y enfermedad arterial coronaria. Métodos. En el estudio DIETRIC se han incluido 628 pacientes con diabetes tipo 2 y enfermedad arterial coronaria para estudiar el efecto antianginoso de la trimetazidina. Se les realiza basalmente historia clínica, exploración física, analítica, ECG y prueba de esfuerzo y son seguidos durante 6 meses. En este artículo se analiza el perfil de riesgo cardiovascular y el grado de control de los factores de riesgo en el estudio basal. Resultados. Más del 80% de los pacientes tenía sobrepeso u obesidad, el 73% dislipidemia y el 59% hipertensión arterial. Más del 60% de los pacientes tenía tres o más factores de riesgo asociados. Sólo el 15% tenía un adecuado control de las cifras de presión arterial, siendo más frecuente el control de la presión diastólica (55%) que el de la sistólica (17%). Sólo el 7,5% tiene un control adecuado de los lípidos plasmáticos. Muchos pacientes no toman fármacos que disminuyen la mortalidad, como la aspirina y las estatinas. Conclusiones. La mayoría de estos pacientes diabéticos con enfermedad arterial coronaria no tiene un control adecuado de los factores de riesgo. Se observa un escaso uso de fármacos que han demostrado reducir la mortalidad cardiovascular en estos pacientes

Introduction and objectives. Diabetes is a disease with high prevalence that involves high mortality. The control of risk factors reduces the cardiovascular complications. The objective of this study is to define the control degree of cardiovascular risk factors in patients with diabetes and coronary artery disease. Methods. In DIETRIC study 628 patients with diabetes type 2 and coronary artery disease have been included with the aim to study the antianginous effect of trimetazidine. Patients were studied basally with clinical history, physical exploration, laboratory testing, ECG and exercise test, with 6-month follow-up. In this article the profile of cardiovascular risk and the level of control of the risk factors in the basal study are analyzed. Results. More than 80% of patients showed excess weight or obesity, 73% dyslipemia and 59% hypertension. More than 60% of patients showed 3 or more related risk factors. Only 15% had adequate control of blood pressure, and the control of diastolic pressure (55%) was most frequent than that of systolic (17%). Only 7.5% had adequate control of plasma lipids. Many patients did not take drugs to reduce mortality, as aspirin and statins. Conclusions. Most of these diabetic patients with coronary artery disease do not have adequate control of risk factors. A limited use of drugs that have proven to reduce cardiovascular mortality in these patients is observed

[Efficacy of oral sildenafil as rescue therapy in patients with severe pulmonary arterial hypertension chronically treated with prostacyclin. Long-term results]. / Eficacia del sildenafilo por vía oral como terapia de rescate en pacientes con hipertensión arterial pulmonar severa en tratamiento crónico con prostaciclina. Resultados a largo plazo.

INTRODUCTION AND OBJECTIVE: Prostacyclin therapy is an effective treatment for severe pulmonary hypertension. Sildenafil, a selective phosphodiesterase type 5 inhibitor, induces selective vasodilatation of the pulmonary vessels. A synergistic effect has been described for these two drugs. The aim of this study was to evaluate the efficacy and safety of sildenafil as rescue therapy in patients with severe pulmonary hypertension on chronic treatment with prostacyclin whose clinical or functional course was unsatisfactory. PATIENTS AND METHOD: Observational study of 11 patients (7 men, 4 women, mean age 42 [8] years) diagnosed as having severe idiopathic pulmonary hypertension, who were receiving chronic prostacyclin therapy. Sildenafil was started after a worsening of their clinical or functional status. Baseline, 3-month and 12-month follow-up evaluations were based on functional status (NYHA functional class and 6-minute walking test), the presence of decompensated right heart failure and echocardiogram. RESULTS: Seven of the 11 patients showed significant improvements in exercise capacity (distance walked in 6 minutes) at 3 (+25 m) and 12 months' follow-up (+36 m). Improvements in functional class were seen, and heart failure disappeared. No significant adverse effects of sildenafil were detected. The echocardiographic parameters showed a significant reduction in right ventricular end-diastolic diameter and left ventricular diastolic eccentricity index. One patient died after 4 months of follow-up from sudden cardiac death. CONCLUSIONS: The addition of oral sildenafil to chronic prostacyclin treatment in patients with severe pulmonary hypertension improved functional capacity and reduced episodes of decompensated right heart failure, with good tolerance and no significant adverse effects.

[Diastolic dysfunction in human immunodeficiency virus infection]. / Disfunción diastólica en la infección por el virus de la inmunodeficiencia humana.

AIMS: We sought to determine the prevalence and characteristics of echocardiographic abnormalities (systolic and/or diastolic dysfunction, pericardial effusion) in patients with human immunodeficiency virus infection (HIV) with no symptoms or previous history of cardiac disease, and compare them with a healthy control group. PATIENTS AND METHOD: Transthoracic echocardiography was performed in 125 patients (73% male, mean age 33.2 +/- 6.6 years) with HIV infection without cardiac involvement and 47 age and sex-matched healthy volunteers (78% male, 31.6 +/- 7.3 years). The immunologic situation was determined by CD4 lymphocyte counts. RESULTS: Abnormal left ventricular relaxation and filling patterns (E/A relation 1.31 +/- 0.35 in HIV group, 1.66 +/- 0.38 in control group, p < 0.001; pressure half-time 57.5 +/- 13 in HIV group, 50.6 +/- 6.6 in control group, p < 0.001), segmental wall-motion abnormalities (15%) and pericardial effusion (7.2%) were found in patients with HIV infection. Systolic function (EF 64.8 +/- 8.3) and left ventricular dimension (diastolic diameter 4.94 +/- 0.55, systolic diameter 3.17 +/- 0.51) showed normal patterns and did not significantly differ from those of the control group. CONCLUSIONS: Silent echocardiographic abnormalities in patients with HIV infection are frequent suggesting a direct myocardial effect of the virus. The development of diastolic dysfunction is directly related to a worse immunologic situation. Prospective studies are needed to clarify the clinical prognosis of these asymptomatic abnormalities.

[Elective primary angioplasty in cardiogenic shock: results from a single center]. / Angioplastia primaria electiva en el shock cardiogénico: resultados de un estudio unicéntrico.

INTRODUCTION: Cardiogenic shock is the leading cause of death among patients hospitalized for acute myocardial infarction. Conventional treatment for acute myocardial infarction does not achieve a better outcome in these patients, but prior studies with emergency revascularization by coronary angioplasty seem to provide encouraging results. PATIENTS AND METHOD: A retrospective study of the clinical and angiographic results of elective primary angioplasty in 48 patients with cardiogenic shock complicating acute myocardial infarction of less than 12 hours is described. Intraaortic balloon counterpulsation was used in 79% of the patients. Patients with cardiogenic shock secondary to mechanical complications were excluded. RESULTS: Angiographic success, defined as a residual stenosis < 50% and final TIMI flow >/= 2, was achieved in 85% of the culprit lesions, and stents were implanted in 76%. Multivessel angioplasty was performed in 25% of the patients, and abciximab was used in 35% of the cases. Mean time from the onset of symptoms to angioplasty was 7.4 +/- 3.1 hours. In-hospital survival was 58%, and was 54% at six months follow-up. CONCLUSIONS: Emergency coronary revascularization with primary angioplasty and intracoronary stenting is effective in patients with acute myocardial infarction and cardiogenic shock. TIMI flow >/= 2 is achieved in most patients, and mortality is reduced when compared with conservative treatment in historical series.

Guías de práctica clínica de la Sociedad Española de Cardiología en tromboembolismo e hipertensión pulmonar / Guidelines of the Spanish Society of Cardiology for Pulmonary Thromboembolism and Hypertension

La hipertensión pulmonar primaria es una enfermedad de carácter progresivo, más frecuente en mujeres jóvenes y de mediana edad. Su etiología se desconoce, aunque existe una predisposición familiar hasta en un 6 por ciento de los casos. Las teorías patogénicas actuales se centran en la existencia de disfunción endotelial y fallos en los canales iónicos de las fibras musculares lisas del vaso. Las pruebas diagnósticas se dirigen a descartar las causas secundarias y a evaluar la gravedad de la enfermedad. El test vasodilatador agudo es imprescindible para la elección del tratamiento más adecuado. La anticoagulación oral está indicada en todos los pacientes. El trasplante de pulmón queda reservado a aquellos casos en los que fracasa el tratamiento médico. La septostomía auricular es un procedimiento paliativo útil en casos seleccionados. La hipertensión pulmonar tromboembólica crónica es una forma especial de hipertensión pulmonar secundaria; aunque indistinguible clínicamente de la hipertensión pulmonar primaria, su diagnóstico resulta crucial, ya que es posible su curación mediante la realización de tromboendarterectomía pulmonar. El tromboembolismo pulmonar es frecuente en pacientes hospitalizados, presentando elevadas tasas de mortalidad (el 30 por ciento en pacientes no tratados). El diagnóstico es difícil, ya que puede acompañar o simular otras enfermedades cardiopulmonares. Las pruebas diagnósticas no invasivas tienen una baja sensibilidad y especificidad. Nuevas alternativas como la determinación de dímero D o la TAC helicoidal incrementan la precisión diagnóstica. El tratamiento estándar consiste en la administración de heparina durante 5-10 días y posteriormente anticoagulantes orales durante 3-6 meses. La prevención con heparinas o dextranos en los pacientes de alto riesgo ha demostrado claros beneficios (AU)

[Hypertension and dyslipidemia]. / Hipertensión y dislipemia.

Hypertension is a very important cardiovascular risk factor and directly leads to major atherosclerotic cardiovascular diseases, including coronary artery disease, stroke cardiac failure and peripheral artery disease. Hypertension tends to cluster with other atherogenic risk factors like dyslipidemia, insulin resistance, obesity and others. The association between hypertension and dyslipidemia is very frequent and the risk is more than additive and its possible pathogenesis may be of a common mechanism. Insulin resistance is the main cause of both risk factors. Endothelium dysfunction is present in arterial hypertension and dyslipidemia and the pathogenesis of atherosclerosis. The treatment of hypertensive patients must be individualized to accommodate both the concomitant dyslipidemia and other atherogenic factors.