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The number of depression sufferers is rising globally. In the United States, 8% of adults over 20 years of age suffer from it, making it the most prevalent mental disorder in the country. Some lifestyle habits have been shown to favor or prevent the onset of depression; for instance, physical inactivity is associated with an increased likelihood of suffering depression, whilst multiple benefits have been attributed to performing physical activity (PA). This study aims to test whether there is a dependence between the prevalence of depression and PA, age, gender and educational level. The secondary objective was to identify the differentiating variables for depression and non-depression. This cross-sectional study is based on data from the NHANES 2013-2014, 2015-2016 and 2017-2018 editions. Some of the items in this survey were taken from preexisting questionnaires: the Patient Health Questionnaire-9 for depression screening and the Global Physical Activity Questionnaire (GPAQ) for the PA groups. The final sample was formed of 15,574 United States residents over 18 years old. After testing the data normality (p < 0.001), a descriptive analysis and the non-parametric chi-square test was conducted, as well as discriminant analysis. The results showed that there was an association between depression prevalence and PA (p < 0.001) in the general population and for both genders. Inactive participants had the highest prevalence of major depression and other depressive disorders. The discriminant analysis identified PA group (0.527), education level (0.761) and gender (-0.505) as significant variables that differentiate between participants with and without depression. The results of this research confirmed that a dependency relationship between PA group according to the GPAQ and depression prevalence according to the PHQ-9 existed in the United States adult population, and that PA group is a relevant variable to differentiate between depression sufferers and non-sufferers.
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Epoxy resin coatings are commonly used to protect concrete structures due to their excellent chemical corrosion resistance and strong adhesion capacity. However, these coatings are susceptible to damage by surface abrasion and long-term contact with marine climate conditions, deteriorating their appearance and performance. This study aims to optimize the performance of cement-based epoxy resin coatings, bisphenol-A and polyol, in aggressive environments by functionalizing the selected systems with different nanoparticles such as activated carbon, surface modified nanoclay, silica and zinc oxide. Nanomodified coatings were applied to concrete specimens and subjected to three weeks in a spray salt chamber and three weeks in a QUV chamber. They were found to present improved thermal resistance and curing degree after the weathering test. Their water permeability, adhesion, and abrasion resistance properties were evaluated before and after this test. The results showed that the nature of the nanocomposites determined their water permeability; the bare resin presented the worst result. Additionally, nanomodified composites with activated carbon and silica showed the best adherence and abrasion resistance properties, due to the effect of this aging test on their thermal stability and curing degree.
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Introducción y objetivos Algunos estudios indican que los parámetros de strain por speckle-tracking pueden ser una alternativa no invasiva a la biopsia endomiocárdica para excluir el rechazo celular agudo (RCA) moderado o grave (≥ 2R) tras el trasplante cardiaco (TxC). En una cohorte inicial, unos puntos de corte del 15,5% para el strain longitudinal global del ventrículo izquierdo (SLGVI) y el 17% para el strain de pared libre del ventrículo derecho mostraron un valor predictivo negativo del 100% para excluir RCA ≥ 2R. Nuestro objetivo es analizar la utilidad del strain y validar estos puntos de corte en una cohorte multicéntrica prospectiva externa.MétodosEstudio multicéntrico y prospectivo que incluyó a pacientes con seguimiento el primer año tras el TC. Se compararon los resultados de biopsias electivas con ecocardiogramas realizados el mismo día.ResultadosSe incluyó a 99 pacientes y 501 pares de biopsias-ecocardiogramas. El RCA ≥ 2R en las biopsias fue del 7,4%. El SLGVI y el strain longitudinal de pared libre del ventrículo derecho fueron menores durante los RCA ≥ 2R en el análisis univariante. En el análisis multivariante, el SLGVI se asoció de manera independiente con el RCA ≥ 2R. Los puntos de corte originales mostraron un valor predictivo negativo del 94,3% el RCA ≥ 2R.ConclusionesEste estudio mantiene un alto valor predictivo negativo para excluir RCA ≥ 2R tras el TxC y el SLGVI se asoció de manera independiente con el RCA ≥ 2R. El strain y, principalmente, el SLGVI pueden ser de utilidad en el diagnóstico y el tratamiento no invasivo del RCA. (AU)
Introduction and objectives Two-dimensional speckle-tracking echocardiography has emerged as a promising alternative to endomyocardial biopsy to rule out acute cellular rejection after orthotopic heart transplantation (OHT) in single center studies. In an original cohort, 15.5% and 17% of cutoff points for left ventricular global longitudinal strain (LVGLS) and free-wall right ventricular longitudinal strain, respectively, achieved 100% negative predictive value to exclude moderate or severe acute cellular rejection (ACR ≥ 2R). Our objective was to demonstrate the usefulness of speckle-tracking and validate these cutoff points in an external cohort.MethodsA prospective, multicenter study that included patients who were monitored during their first year after OHT was conducted. Echocardiographic studies analyzed by local investigators were compared with simultaneous paired endomyocardial biopsies samples.ResultsA total of 501 endomyocardial biopsy-echocardiographic studies were included in 99 patients. ACR≥2R was present in 7.4% of samples. LVGLS and free-wall right ventricular longitudinal strain were significantly reduced during ACR≥2R on univariate analysis. On multivariate analysis, LVGLS was independently associated with the presence of ACR≥2R. The original cutoff points demonstrated a negative predictive value of 94.3% to exclude ACR≥2R.ConclusionsThis study maintained a strong negative predictive value to exclude ACR≥2R after OHT and LVGLS was independently associated with the presence of ACR≥2R. We propose the use of speckle-tracking, especially LVGLS, as part of the noninvasive diagnosis and management of ACR. (AU)
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Trasplante de Corazón/efectos adversos , Rechazo de Injerto/complicaciones , Ventrículos Cardíacos/diagnóstico por imagen , Ecocardiografía , Estudios ProspectivosRESUMEN
INTRODUCTION AND OBJECTIVES: Two-dimensional speckle-tracking echocardiography has emerged as a promising alternative to endomyocardial biopsy to rule out acute cellular rejection after orthotopic heart transplantation (OHT) in single center studies. In an original cohort, 15.5% and 17% of cutoff points for left ventricular global longitudinal strain (LVGLS) and free-wall right ventricular longitudinal strain, respectively, achieved 100% negative predictive value to exclude moderate or severe acute cellular rejection (ACR ≥ 2R). Our objective was to demonstrate the usefulness of speckle-tracking and validate these cutoff points in an external cohort. METHODS: A prospective, multicenter study that included patients who were monitored during their first year after OHT was conducted. Echocardiographic studies analyzed by local investigators were compared with simultaneous paired endomyocardial biopsies samples. RESULTS: A total of 501 endomyocardial biopsy-echocardiographic studies were included in 99 patients. ACR≥2R was present in 7.4% of samples. LVGLS and free-wall right ventricular longitudinal strain were significantly reduced during ACR≥2R on univariate analysis. On multivariate analysis, LVGLS was independently associated with the presence of ACR≥2R. The original cutoff points demonstrated a negative predictive value of 94.3% to exclude ACR≥2R. CONCLUSIONS: This study maintained a strong negative predictive value to exclude ACR≥2R after OHT and LVGLS was independently associated with the presence of ACR≥2R. We propose the use of speckle-tracking, especially LVGLS, as part of the noninvasive diagnosis and management of ACR.
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Trasplante de Corazón , Ecocardiografía , Rechazo de Injerto/diagnóstico , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Estudios ProspectivosRESUMEN
Nowadays millions of oil tons are spilled into the environment causing important damage. Therefore, the development of new technologies and materials are needed to remediate this problem. In this study, hydroxyethyl cellulose alumina-based aerogels are synthesized by an environmentally friendly freeze-drying process to be used as sorbents for oil spills. It is demonstrated that the oil retention coefficient depends on the viscosity of the oil and the amount of hydroxyethyl cellulose contained in the aerogel, being 10% the optimal proportion. The aerogel synthetized with this content of hydroxyethyl cellulose displays the most favourable physicochemical and morphological properties to retain different oil spills, achieving 5.5 times its weight in comparison to its dry state. In addition, reusability experiments washing the aerogel with acetone or ethanol after the oil retention are carried out. Results show an improvement after a long washing of the sorbent with acetone, resulting in an oil weight gain of 38.7%.
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Restauración y Remediación Ambiental/métodos , Geles/química , Contaminación por Petróleo , Adsorción , Óxido de Aluminio/química , Celulosa/análogos & derivados , Celulosa/química , LiofilizaciónRESUMEN
Pulmonary regurgitation (PR) is a frequent complication after repair of congenital heart disease. Three different GRK isoforms (GRK2, GRK5, and GRK3) and two ß-adrenoceptors (ß1-AR and ß2-AR) are present in peripheral blood mononuclear cells (PBMC) and their expression changes as a consequence of the hemodynamic and neurohumoral alterations that occur in some cardiovascular diseases. Therefore, they could be useful as biomarkers in PR. A prospective study was conducted to describe the expression (TaqMan Gene Expression Assays) of ß-ARs and GRKs in PBMC isolated (Ficoll® gradient) from patients with severe PR before and after pulmonary valve replacement and establish if this expression correlates to clinical status. 23 patients with severe PR were included and compared with 22 healthy volunteers (controls). PR patients before the PVR had a significantly lower expression of ß2-AR (513.8 ± 261.2 mRNA copies) vs. controls (812.5 ± 497.2 mRNA copies), so as GRK2 expression (503.4 ± 364.9 copies vs. 858.1 ± 380.3 mRNA copies). The expression of ß2-AR and GRK2 significantly decreases in symptomatic and asymptomatic patients, as well as in patients under treatment with beta-blockers and non-treated patients. The expression of ß2-AR and GRK2 in PR patients recovers the normal values after pulmonary valve replacement (754,8 ± 77,1 and 897,8 ± 87,4 copies, respectively). Therefore, changes in the expression of ß2-AR and GRK2 in PBMC of PR patients, could be considered as potential biomarkers to determine clinical decisions.
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PURPOSE: Radiation exposure (RE) is a matter of concern for patients with congenital heart disease (CHD) who not infrequently need multiple interventional procedures under fluoroscopy guidance. We sought to evaluate the safety and feasibility of a minimally fluoroscopic approach in patients with CHD undergoing catheter ablation using a new image integration module (IIM). METHODS: Consecutive patients with CHD undergoing catheter ablation using the Carto Univu™ IIM were included. A near-zero fluoroscopy procedure was defined by an effective dose (ED) ≤ 1 mSv. RE parameters (total fluoroscopy time [TFT], total dose area product [tDAP], and ED), ablation outcomes, and complications were evaluated. RESULTS: Fifty-five patients with CHD underwent 63 ablation procedures (supraventricular tachycardia, n = 53; ventricular tachycardia, n = 10). The CHD was simple in 25%, moderate in 42%, and complex in 33%. The use of the IIM resulted in very low levels of RE (median TFT 0.13 min [IQR 0-1.04], median tDAP 54.5 cGy cm2 [IQR 9.5-176.4], median ED 0.136 mSv [IQR 0.02-0.49]). Patients with complex CHD had significantly higher RE when compared with patients with simple and moderate defects. A total of 56/63 ablation procedures (89%) were performed with an ED ≤ 1 mSv. One patient developed sinus node dysfunction requiring pacemaker implantation. CONCLUSIONS: The use of a minimally fluoroscopic approach was safe and feasible resulting in very low RE during catheter ablation of patients with CHD. A near-zero fluoroscopy ablation was possible in up to 89% of the procedures.
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Ablación por Catéter/métodos , Cardiopatías Congénitas/cirugía , Adulto , Mapeo Epicárdico , Estudios de Factibilidad , Femenino , Fluoroscopía , Humanos , MasculinoRESUMEN
The prevalence of adults with congenital heart disease has dramatically increased during the last decades due to significant advances in the surgical correction of these conditions. As a result, patient's survival has been prolonged and arrhythmias have become one of the principal causes of morbidity and mortality for these patients. The surface 12-lead ECG may play a critical role in the identification of the underlying heart disease of the patient, the recognition of the arrhythmia mechanism and may also help in the planification of the ablation procedure in this setting. Finally, important prognostic information can be also obtained from the ECG in these patients. The present review will offer an overview of the principal utilities of the surface ECG in the diagnosis and management of patients with CHD and arrhythmias.
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Electrocardiografía/métodos , Bloqueo Cardíaco/complicaciones , Bloqueo Cardíaco/diagnóstico , Cardiopatías Congénitas/complicaciones , Cardiopatías Congénitas/diagnóstico , Síndrome del Seno Enfermo/complicaciones , Síndrome del Seno Enfermo/diagnóstico , Diagnóstico Diferencial , Humanos , Persona de Mediana EdadRESUMEN
Introducción y objetivos: La insuficiencia pulmonar es una complicación frecuente en pacientes con tetralogía de Fallot o estenosis pulmonar congénita reparada. Se han correlacionado variables electrocardiográficas con parámetros de función del ventrículo derecho. Proponemos analizar el valor diagnóstico de la anchura y la fragmentación del electrocardiograma en la identificación de pacientes con disfunción y/o dilatación del ventrículo derecho. Métodos: Seleccionamos a 107 pacientes consecutivos diagnosticados de insuficiencia pulmonar grave tras reparación de estenosis pulmonar o tetralogía de Fallot. Se les realizó electrocardiograma, ecocardiograma y resonancia magnética. Cada electrocardiograma se analizó manualmente midiendo la duración del QRS. Definimos fragmentación del QRS como la presencia de ondas de bajo voltaje en la porción terminal del QRS en al menos dos derivaciones contiguas. Resultados: Se obtuvo una correlación negativa y significativa entre anchura del QRS y función del ventrículo derecho, así como una correlación positiva con el volumen de este. De la curva ROC se obtuvo el punto de corte en 140 ms de anchura del QRS, que mostró buena sensibilidad para el diagnóstico de dilatación (> 80%) y disfunción (> 95%) del ventrículo derecho. En los modelos de regresión logística, QRSd > 140 ms se mostró como el único predictor independiente de dilatación y disfunción del ventrículo derecho. Conclusiones: El electrocardiograma es una herramienta rápida, disponible y reproducible. La anchura del QRS permite predecir de manera independiente la presencia de dilatación y disfunción del ventrículo derecho. Este es el primer estudio que propone un punto de corte en la anchura del QRS para el cribado de afección del ventrículo derecho (AU)
Introduction and objectives. Pulmonary regurgitation is a common complication in patients with repaired tetralogy of Fallot or congenital pulmonary stenosis. Electrocardiographic variables have been correlated with parameters used to evaluate right ventricular function. We aimed to analyze the diagnostic value of the width and fragmentation of the electrocardiogram in the identification of patients with right ventricular dysfunction and/or dilation. Methods. We selected 107 consecutive patients diagnosed with severe pulmonary insufficiency after repair of pulmonary stenosis or tetralogy of Fallot. The tests included electrocardiography, echocardiography, and magnetic resonance. Each electrocardiogram was analyzed manually to measure QRS duration. We defined QRS fragmentation as the presence of low-voltage waves in the terminal portion of the QRS complex in at least 2 contiguous leads. Results. We found a significant negative correlation between QRS width and right ventricular function, as well as a positive correlation with right ventricular volume. The receiver operating characteristic curve indicated a cut-off point for QRS width of 140 ms, which showed good sensitivity for a diagnosis of right ventricular dilation (> 80%) and dysfunction (> 95%). In logistic regression models, a QRS duration > 140 ms was found to be the only independent predictor of right ventricular dilation and dysfunction. Conclusions. Electrocardiography is a rapid, widely available, and reproducible tool. QRS width constitutes an independent predictor of the presence of right ventricular dilation and dysfunction. This study is the first to provide a cutoff value for QRS width to screen for right ventricle involvement (AU)
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Humanos , Disfunción Ventricular Derecha/diagnóstico , Tetralogía de Fallot/fisiopatología , Insuficiencia de la Válvula Pulmonar/diagnóstico , Electrocardiografía/métodos , Estudios RetrospectivosRESUMEN
INTRODUCTION AND OBJECTIVES: Pulmonary regurgitation is a common complication in patients with repaired tetralogy of Fallot or congenital pulmonary stenosis. Electrocardiographic variables have been correlated with parameters used to evaluate right ventricular function. We aimed to analyze the diagnostic value of the width and fragmentation of the electrocardiogram in the identification of patients with right ventricular dysfunction and/or dilation. METHODS: We selected 107 consecutive patients diagnosed with severe pulmonary insufficiency after repair of pulmonary stenosis or tetralogy of Fallot. The tests included electrocardiography, echocardiography, and magnetic resonance. Each electrocardiogram was analyzed manually to measure QRS duration. We defined QRS fragmentation as the presence of low-voltage waves in the terminal portion of the QRS complex in at least 2 contiguous leads. RESULTS: We found a significant negative correlation between QRS width and right ventricular function, as well as a positive correlation with right ventricular volume. The receiver operating characteristic curve indicated a cut-off point for QRS width of 140ms, which showed good sensitivity for a diagnosis of right ventricular dilation (> 80%) and dysfunction (> 95%). In logistic regression models, a QRS duration > 140ms was found to be the only independent predictor of right ventricular dilation and dysfunction. CONCLUSIONS: Electrocardiography is a rapid, widely available, and reproducible tool. QRS width constitutes an independent predictor of the presence of right ventricular dilation and dysfunction. This study is the first to provide a cutoff value for QRS width to screen for right ventricle involvement.
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Electrocardiografía , Ventrículos Cardíacos/fisiopatología , Insuficiencia de la Válvula Pulmonar/complicaciones , Volumen Sistólico , Disfunción Ventricular Derecha/diagnóstico , Función Ventricular Derecha/fisiología , Femenino , Humanos , Masculino , Insuficiencia de la Válvula Pulmonar/diagnóstico , Insuficiencia de la Válvula Pulmonar/fisiopatología , Reproducibilidad de los Resultados , Estudios Retrospectivos , Disfunción Ventricular Derecha/etiología , Disfunción Ventricular Derecha/fisiopatologíaRESUMEN
Left ventricular free wall rupture and acute ischaemic mitral regurgitation are nowadays rare, but still potentially lethal mechanical complications after acute myocardial infarction. We report a case of a sequential left ventricular free wall rupture, anterolateral papillary muscle disruption, secondary severe mitral regurgitation and subsequent posteromedial papillary muscle head rupture in a single patient during the same ischaemic episode after myocardial infarction, and their related successful surgical procedures and management until discharge. Prompt bedside diagnosis and emergent consecutive surgical procedures, as well as temporary left ventricular assistance, were crucial in the survival of this patient.
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Rotura Cardíaca Posinfarto/etiología , Ventrículos Cardíacos , Insuficiencia de la Válvula Mitral/etiología , Infarto del Miocardio/complicaciones , Músculos Papilares , Procedimientos Quirúrgicos Cardíacos , Taponamiento Cardíaco/etiología , Puente Cardiopulmonar , Angiografía Coronaria , Stents Liberadores de Fármacos , Ecocardiografía , Oxigenación por Membrana Extracorpórea , Rotura Cardíaca Posinfarto/diagnóstico , Rotura Cardíaca Posinfarto/fisiopatología , Rotura Cardíaca Posinfarto/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Ventrículos Cardíacos/fisiopatología , Ventrículos Cardíacos/cirugía , Hemodinámica , Humanos , Contrapulsador Intraaórtico , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/diagnóstico , Insuficiencia de la Válvula Mitral/fisiopatología , Insuficiencia de la Válvula Mitral/cirugía , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/terapia , Músculos Papilares/fisiopatología , Músculos Papilares/cirugía , Intervención Coronaria Percutánea/instrumentación , Reoperación , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
La función del ventrículo derecho tiene un importante papel en la morbilidad y la mortalidad de los pacientes sometidos a cirugía cardiaca. En este artículo se hace una revisión de las diferentes herramientas diagnósticas disponibles en quirófano, entre las que destacan la visión directa del corazón, la ecocardiografía en sus distintas modalidades (transesofágica, epicárdica), el estudio hemodinámico invasivo con el catéter de Swan-Ganz y, en casos de infarto del ventrículo derecho, el electrocardiograma. Los diferentes métodos diagnósticos disponibles son complementarios y no excluyentes, ya que cada uno de ellos aporta información que subsana las limitaciones de los diferentes sistemas de monitorización hemodinámica (AU)
Right ventricular function has a substantial effect on morbidity and mortality in patients undergoing cardiac surgery. This article contains a review of the range of diagnostic tools available in the operating room, including those that provide a direct view of the heart, different types of echocardiography (e.g. transesophageal and epicardial), invasive hemodynamic measurement using a Swan-Ganz catheter and, in patients with right ventricular infarction, electrocardiography. The various diagnostic methods available are complementary and none should be used exclusively since each provides information that compensates for the limitations of other hemodynamic monitoring techniques (AU)
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Humanos , Monitoreo Intraoperatorio/métodos , Insuficiencia Cardíaca/cirugía , Ventrículos Cardíacos/cirugía , Hipertensión Pulmonar/complicaciones , Cateterismo de Swan-Ganz/métodos , Ecocardiografía/métodos , Función Ventricular Derecha/fisiología , Volumen Sistólico/fisiología , Hemodinámica/fisiologíaRESUMEN
No disponible
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Femenino , Adulto , Humanos , Epoprostenol/farmacocinética , Hipertensión Pulmonar/tratamiento farmacológico , HemodinámicaRESUMEN
The purpose of this study was to evaluate whether high levels and small isoforms of lipoprotein (a) [Lp(a)] are markers of risk of early myocardial infarction and markers of the severity of coronary atherosclerosis. Lp(a) levels and small apo(a) isoforms were higher in 222 patients than in 199 controls (p<0.001). In patients, Lp(a)> or =30 mg/dL was associated with the presence of coronary lesions (p=0.007) and the severity of coronary atherosclerosis (p=0.002). The present study suggests that Lp(a) levels and small isoforms are markers of early myocardial infarction and that Lp(a) levels > or =30 mg/dL are associated with severe patterns of coronary atherosclerosis.
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Lipoproteína(a)/sangre , Isquemia Miocárdica/patología , Adulto , Biomarcadores/sangre , Estudios de Casos y Controles , Enfermedad de la Arteria Coronaria , Femenino , Humanos , Masculino , Persona de Mediana Edad , Isquemia Miocárdica/diagnóstico , Isoformas de Proteínas , Índice de Severidad de la EnfermedadRESUMEN
Epsilon wave is an unusual electrocardiographical finding, which may appear in other pathological conditions besides the arrhythmogenic right ventricular dysplasia, particularly in the acute myocardial infarction of the right ventricle, the inferior, or the posterior wall of the left ventricle. Its real incidence in these acute coronary syndromes remains unknown and will be probably difficult to assert, since it may be unnoticed by inexperienced physicians because of its little voltage. The outstanding interest of this case lies in the clear electrocardiographical images and in the step-by-step differential diagnosis discussed by the authors.
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Displasia Ventricular Derecha Arritmogénica/diagnóstico , Infarto del Miocardio/diagnóstico , Anciano , Displasia Ventricular Derecha Arritmogénica/fisiopatología , Diagnóstico Diferencial , Electrocardiografía , Femenino , Humanos , Infarto del Miocardio/fisiopatologíaRESUMEN
Objetivo: Estudio de los cánceres de intervalo registrados en el Programa de Prevención de Cáncer de Mama de Navarra desde 1990 hasta 2000. Material y método: Revisión retrospectiva de los 253 casos registrados en nuestro programa en 10 años. Clasificación en categorías. Hallazgos radiológicos en las mamografías de diagnóstico y en las realizadas en el screening previo, tanto de forma ciega como retrospectiva. Resultados de la anatomía patológica en cuanto a tipo y grado histológico, tamaño tumoral y presencia de adenopatías axilares metastásicas. Resultados: Clasificación en categorías: 50,19 por ciento intervalo verdadero, 10,67 por ciento falso negativo, 13,04 por ciento signos mínimos y 13,04 por ciento ocultos. Las lesiones radiológicas más frecuentes en intervalos verdaderos y signos mínimos han sido densidades asimétricas en 31,49 por ciento y 36,36 por ciento, respectivamente, y en falsos negativos nódulos espiculados en un 29,62 por ciento. Las microcalcificaciones como único hallazgo son infrecuentes entre los cánceres de intervalo. Por tipo histológico: carcinoma ductal infiltrante el 77,5 por ciento de los tumores, carcinoma lobulillar infiltrante 9,6 por ciento y, únicamente, 4,9 por ciento de cánceres intraductales. Los tumores de alto grado histológico y con ganglios axilares metastásicos son más frecuentes entre los intervalos verdaderos. Conclusiones: La revisión de los cánceres de intervalo debe formar parte del trabajo de una unidad de screening de cáncer de mama, tanto para el control de calidad como con fines de aprendizaje y entrenamiento de radiólogos. En nuestro trabajo proponemos un sistema de revisión de casos que sea sencillo de realizar y nos permita conocer qué tumores han aparecido como cánceres de intervalo en las distintas categorías y si estamos en unos índices adecuados (AU)
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Femenino , Humanos , Mamografía/estadística & datos numéricos , Intervalos de Confianza , Neoplasias de la Mama/epidemiología , Estudios Retrospectivos , Tamizaje Masivo/métodos , Reacciones Falso Negativas , Neoplasias de la Mama/prevención & controlRESUMEN
AIM: To evaluate the pattern of brain natriuretic peptide (BNP) concentration in heart transplant (HT) recipients and its relation to the degree of graft rejection determined by endomyocardial biopsy specimen. METHODS: We studied 71 consecutive HT recipients (62 men, 53 +/- 11 years). The patients underwent 383 biopsies. Creatinine and BNP concentrations and hemodynamic parameters were determined along with the degree of graft rejection using endomyocardial biopsy specimens. We considered treatable rejection as International Society for Heart and Lung Transplantation Grade >or=2 in the first 90 days and >or=3A thereafter. We included a control group of 36 healthy individuals. RESULTS: Brain natriuretic peptide concentration was significantly greater among HT recipients (264 +/- 318 pg/ml) than in controls (17 +/- 16 pg/ml). In the first 90 days, BNP concentration was significantly greater among the patients with graft rejection (510 +/- 470, n = 84, vs 278 +/- 255, n = 87; p < 0.0001), although the corresponding discriminatory capacity was small. After the first 90 days, BNP values were similar in patients with and without graft rejection (170 +/- 297, n = 17, vs 142 +/- 203, n = 195; p = not significant). Creatinine concentration increased with time after transplantation and did not correlate with BNP concentration. We observed significant positive correlation between BNP concentration and hemodynamic parameters. CONCLUSIONS: Brain natriuretic peptide concentration remains increased after HT, with stabilization after the 4th month. Brain natriuretic peptide concentrations are slightly greater among patients with treatable rejection, particularly in the first 90 days, although BNP concentration lacks discriminatory capacity to serve as a guide to performing biopsy.
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Rechazo de Injerto/sangre , Trasplante de Corazón/inmunología , Péptido Natriurético Encefálico/sangre , Adolescente , Adulto , Anciano , Femenino , Trasplante de Corazón/fisiología , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sensibilidad y Especificidad , Factores de TiempoRESUMEN
A prospective study of 81 heart transplant (HT) patients was carried out in order to evaluate the evolution of brain natriuretic peptide (BNP) levels in HT patients and compare them with the degree of rejection as determined by endomyocardial biopsy. All patients were subjected to endomyocardial biopsy (532), and determination of BNP and creatinine levels as well as hemodynamic parameters. A control group of 36 volunteers was included. BNP values were significantly greater in HT patients than in healthy volunteers. In the first 3 months, BNP levels in patients with treatable rejection were significantly greater than in patients without graft rejection, although evident overlapping was observed in both distributions and discriminatory potential was low. After the third month, BNP values were similar in patients with and without rejection. Creatinine levels were observed to increase over time after transplantation, but no correlation was observed between the creatinine and BNP levels. A significant positive correlation was observed between BNP and right ventricle and pulmonary arterial pressures.
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Endocardio/metabolismo , Rechazo de Injerto/sangre , Trasplante de Corazón , Miocardio/metabolismo , Péptido Natriurético Encefálico/sangre , Adolescente , Adulto , Anciano , Biopsia , Creatinina/sangre , Femenino , Rechazo de Injerto/fisiopatología , Hemodinámica , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Valores de Referencia , Factores de TiempoRESUMEN
Thrombin-activatable fibrinolysis inhibitor (TAFI) is a fibrinolytic inhibitor. Studies in coronary artery disease have reported increased TAFI activity (TAFI Act) and low TAFI antigen (TAFI Ag) levels. This controversy might be explained by the polymorphisms of its gene. Only the Thr325Ile polymorphism modulates both TAFI Ag and Act levels in vitro. This study assessed TAFI Ag and Act levels, TAFI Thr325Ile polymorphism, the fibrinolytic and protein C systems and some prothrombotic mutations in a young patient group (n = 127, aged < 51 years, with myocardial infarction) and a control group (n = 99) with similar characteristics. Patients exhibited hypofibrinolysis and higher plasminogen activator inhibitor-1 (PAI-1) levels. Although TAFI Ag was lower, TAFI Act level was significantly higher in patients and positively correlated with PAI-1, protein C inhibitor and the euglobulin lysis time. No differences between groups were found according to the Thr325Ile polymorphism. Irrespective of the genotype, patients had higher TAFI Act levels. The Ile-325 variant exhibited lower TAFI Ag levels. We suggest that the hypofibrinolysis observed in these patients results from an increase in both PAI-1 and TAFI Act, which is not related to the Thr325Ile polymorphism. Patients have high TAFI Act with low TAFI Ag levels, probably because of an increased stability of TAFI related to a fibrinolytic hypofunction.