Registro de fibrilación auricular en servicios de urgencias del Institut Català de la Salut (URGFAICS): análisis en función del tipo de fibrilación auricular y de la reconsulta a urgencias relacionada a los 30 días / Emergency Atrial Fibrillation Registry of the Catalan Institute of Health (URGFAICS): analysis by type of atrial fibrillation and revisits within 30 days

Objetivos: Estudiar las características de los pacientes que consultan por un episodio de fibrilación auricular (FA) en los servicios de urgencias hospitalarios (SUH), en función de si la FA es de novo o conocida previamente, y la reconsulta relacionada con la FA a los 30 días (R30d). Método: Estudio observacional de cohorte prospectivo y multicéntrico que incluyó a todos los pacientes ≥ 18 años que consultaron por síntomas relacionados con una FA o el hallazgo de una FA en 5 SUH catalanes. Se recogieron variables demográficas, del episodio agudo, de manejo en urgencias y la R30d. Resultados: De los 1.199 pacientes, 1.052 tuvieron seguimiento a 30 días. La edad media fue de 73 (DE 13) años y 646 (53,9%) eran mujeres. Seiscientos cincuenta y dos pacientes (54,4%) tenían una FA conocida, los cuales tenían mayor edad, presencia de comorbilidades y uso de antiarrítmicos y anticoagulantes orales. Hubo escasas diferencias en el manejo farmacológico en urgencias. La R30d fue de un 7,9%, y fue más frecuente cuando se usó digoxina en urgencias y bloqueadores de los canales del calcio al alta. Conclusiones: Existen diferencias basales entre los pacientes con FA de novo y conocida, pero estas son escasas en el manejo en urgencias. En pacientes atendidos por fibrilación auricular en urgencias, la R30d se relacionó con el uso de digoxina en urgencias y de bloqueadores de los canales del calcio al alta

Objectives: To study the characteristics of patients attending a hospital emergency department (ED) with de novo or previously diagnosed atrial fibrillation (AF), and to determine the rate of revisits for AF within 30 days of discharge. Methods: Prospective multicenter, observational cohort study of patients aged 18 years or older who came to 5 Catalan EDs with symptoms of AF or who were found to have AF on examination. We recorded demographic information and data related to the acute episode and ED management on the first or other visits within 30 days. Results: We had complete follow-up data for 1052 of the 1199 patients initially registered. The mean (SD) age was 73 (13) years, and 646 (53.9%) were women. AF had already been diagnosed in 652 (54.4%). Patients with diagnosed AF were older, had more concomitant conditions, and were more likely to be taking antiarrhythmic and/or anticoagulant drugs. Pharmacologic management in the ED was similar. The 30-day revisiting rate was 7.9% , and revisits were more frequent when digoxin was used in the ED and/or calcium channel blockers were prescribed on discharge. Conclusions: We detected differences between ED patients with de novo FA and previously diagnosed FA, but management of the 2 groups was similar. The 30-day revisiting rate was associated with use of digoxin in the ED and the prescription of calcium channel blockers on discharge

Construction of a catsper1 DNA vaccine and its antifertility effect on male mice.

Cation channel of sperm 1 (CATSPER1) is a unique sperm cation channel protein, and essential for sperm function and male fertility. CATSPER1 exclusively expresses in meiotic and postmeiotic spermatogenic cells, thus belongs to the spermatogenesis-specific antigen that escape central tolerance. We have previously demonstrated the immunocontraceptive potential of its transmembrane domains and pore region, and reported the antifertility effects of its B-cell epitopes on male mice. Aiming to develop DNA vaccine targeting CATSPER1 for male contraception, here the whole open reading frame of mouse Catsper1 was cloned into the plasmid pEGFP-N1 to obtain a DNA vaccine pEGFP-N1-Catsper1. The vaccine was confirmed to be transcribed and translated in mouse N2a cell in vitro and mouse muscle tissue in vivo. Intramuscular injection with the vaccine on male mice induced specific immune reaction and caused significant inhibition on sperm hyperactivated motility and progressive motility (P<0.001 for both), and consequently reduced male fertility. The fertility rate of experimental group was 40.9%, which was significant lower (P=0.012) than control group (81.8%). No significant change in mating behavior, sperm production and histology of testis/epididymis was observed. Given that Catsper1 exhibits a high degree of homology among different species, Catsper1 DNA vaccine might be a good strategy for developing an immunocontraceptive vaccine for human and animal use.

Hypertension control in the elderly.

Hypertension is highly prevalent in older persons and most often presents as isolated systolic hypertension. Systolic blood pressure (BP) is a stronger predictor of risk than diastolic BP in persons older than 50 years. Most of these patients will require multiple drug therapies to achieve the substantial reductions in systolic BP needed to reach target levels. Clinical trials have demonstrated that antihypertensive therapy with beta-blockers and diuretics as well as with calcium channel blockers, angiotensin-converting enzyme inhibitors, and angiotensin II type 1 receptor blockers reduces cardiovascular risk in older patients. Studies examining safety and BP-lowering efficacy have shown that a renin-angiotensin-aldosterone system blocker plus a calcium channel blocker as well as a combination of diuretics and beta-blockers or diuretics plus an angiotensin-converting enzyme inhibitor or angiotensin II type 1 receptor blocker achieves greater BP reductions than monotherapy. Such multiple drug regimens are well tolerated in older patients.

Statin use is associated with enhanced collateralization of severely diseased coronary arteries.

BACKGROUND: The presence of coronary collateral vessels has been associated with improved clinical outcome in patients with coronary artery disease. Animal experiments have shown that hydroxymethyl glutaryl coenzyme A reductase inhibitors (statins) can promote angiogenesis in ischemic tissues in a cholesterol-independent manner. We hypothesized that statin therapy is associated with increased coronary collateral formation in patients with severe coronary artery disease. METHODS AND RESULTS: Patients undergoing clinically indicated coronary angiography at the Tufts-New England Medical Center from September 2000 to April 2001 who had at least 1 major coronary artery occlusion, or a stenosis of > or =95% with Thrombolysis In Myocardial Infarction (TIMI) trial grade < or =1 anterograde flow on their angiograms, were included. Fifty-one patients were taking statins before admission, and 43 patients were not. Their angiograms were reviewed and coronary collaterals were graded from 0 to 3 according to the Cohen-Rentrop method. The statin-treated group had a significantly higher mean collateral score compared with the patients not taking statins (2.05 vs 1.52, P =.005). Multivariate analysis supported the significance of the effect of statin therapy on the collateral score. There was no relation between collateral score and low-density lipoprotein levels (r = -0.06, P =.64). The statin-treated group also had a significantly higher left ventricular ejection fraction compared to the patients not taking statins (51% vs 44%, P <.05). CONCLUSIONS: Statin therapy is associated with enhanced coronary collateral formation in patients with severely diseased coronary arteries.

Hypertension and diabetic nephropathy: relationship, significance and management - abstract

During the past 10 years, several investigators have accumulated evidence for defining the relationship between systematic blood pressure levels and diabetic nephropathy. Studies showing the presence of insulin resistance in obese normotensive individuals, non-obese hypertensives, and in non-insulin-dependent diabetes mellitus (NIDDM) raise the possibility of shared pathogenic mechanisms in essential hypertension and diabetes mellitus. It is accepted that control of hypertension retards the progress of renal functional impairment in Diabetic Nephropathy (DN); what remains unknown is the class of antihypertensive agent best suited to this clinical situation. A case has been made for the angiotensin-converting enzyme inhibitors (ACE-Is) which have been demonstrated to have a renoprotective effect greater than can be attributed to lowering systemic blood pressure levels alone. Microalbuminuria is accepted as being an index of glomerular damage and a prognostic indicator for the development of DN and dip-stick detectable proteinuria. The ACE-I enalapril was shown to be more effective in reducing proteinuria than metoprolol, although both drugs reduced systemic blood pressure levels to a similar degree in the patients studied. On the other hand, the dihydropyridine calcium channel blocking agent (CCB), nifedipine, increased albuminuria whereas non-dihydropyridine CCBs did not. The animal experimental evidence suggesting glomerular hypertension as the mechanism through which albuminuria and subsequent glomerulosclerosis develop is persuasive. The differential renoprotective effects of the various hypertensive agents have therefore been related to their differing abilities to modulate both afferent and efferent glomerular arteriolar tone in a manner which produces net reduction in intraglomerular pressure. In clinical circumstances, selection of antihypertensive agents will be guided by the metabolic neutrality of the agent among other attributes, and ACE-Is and CCBs appear to have the most favourable profiles. Finally, the questions of how soon and how far to treat systemic hypertension in diabetics remain to be answered. Does one use ACE-iS to treat microalbuminuric and proteinuric patients who are still normotensive? To what level does one reduce the blood pressure in order to achieve optimal renoprotection in DN? There are now several survival studies of hypertensive patients which purport to show declining mortality with reduction of Diastolic Blood Pressure (DBP) levels to certain end-points, with a subsequent rise in mortality when DBP has been further reduced below approximately 85 mm Hg. The caveat of the "J-shaped" curve applies primarily to those patients with associated ischaemic heart disease, a condition which is frequently encountered in diabetes mellitus. Presumably, in those patients with associated left ventricular hypertrophy, reduction of DBP below a critical level compromises the coronary artery reserve and the blood supply to a mismatched ventricular mass. The ideal blood pressure lowering agent in DN is therefore one which reduces intraglomerular as well as systemic blood pressures, reduces albuminuria, is metabolically neutral, and reduces left ventricular mass. The ACE-Is and the CCBs fulfil these requirements but only ACE-Is decrease insulin resistance. Whether this latter "plus" will be shown to be critical is yet to be demonstrated (AU)