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BACKGROUND: Up to 30% of patients with Guillain-Barré syndrome require mechanical ventilation and 5% die due to acute complications of mechanical ventilation. There is a considerable group of patients that will need prolonged mechanical ventilation (considered as >14 days) and should be considered for early tracheostomy. The objective of this study is to identify risk factors for prolonged mechanical ventilation. METHODS: We prospectively analyzed patients with Guillain-Barré diagnosis with versus without prolonged mechanical ventilation. We considered clinical and electrophysiological characteristics and analyzed factors associated with prolonged mechanical ventilation. RESULTS: Three hundred and three patients were included; 29% required mechanical ventilation. When comparing the groups, patients with prolonged invasive mechanical ventilation (IMV) have a lower score on the Medical Research Council score (19.5 ± 16.2 vs 27.4 ± 17.5, p = 0.03) and a higher frequency of dysautonomia (42.3% vs 19.4%, p = 0.037), as well as lower amplitudes of the distal compound muscle action potential (CMAP) of the median nerve [0.37 (RIQ 0.07-2.25) vs. 3.9 (RIQ1.2-6.4), p = <0.001] and ulnar nerve [0.37 (RIQ0.0-3.72) vs 1.5 (RIQ0.3-6.6), p = <0.001], and higher frequency of severe axonal damage in these nerves (distal CMAP ≤ 1.0 mV). Through binary logistic regression, severe axonal degeneration of the median nerve is an independent risk factor for prolonged IMV OR 4.9 (95%CI 1.1-21.5) p = 0.03, AUC of 0.774, (95%CI 0.66-0.88), p = < 0.001. CONCLUSIONS: Severe median nerve damage is an independent risk factor for prolonged mechanical ventilation.

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Pericardial effusions requiring pericardiocentesis have multiple causes that vary among geographical regions and health contexts. This procedure can be performed for diagnostic or therapeutic indications. The purpose of this study was to identify the principal causes of pericardial effusions and indications for pericardiocentesis, exploring differences among groups. This was a retrospective case series of patients who underwent pericardiocentesis for pericardial effusion in a single center in Latin America. Demographic, clinical, echocardiographic, and procedural variables were recorded and analyzed. The primary outcome was to determine the causes of pericardial effusions in these patients and the indication (diagnostic, therapeutic, or both). The results are presented in two groups (inflammatory and noninflammatory) according to the cause of the pericardial effusion. One hundred sixteen patients with pericardial effusion underwent pericardiocentesis. The median age was 58 years (IQR 46.2-70.7), and 50% were male. In the noninflammatory pericardial effusion group, there were 61 cases (53%), among which neoplastic pericardial effusion was the most frequent cause (n = 25, 40.9%). In the inflammatory group, there were 55 cases (47%), and the main cause was postpericardiectomy syndrome after cardiac surgery (n = 31, 56.4%). In conclusion, the principal indication for pericardiocentesis was therapeutic (n = 66, 56.8%). Large pericardial effusion without hemodynamic effect of cardiac tamponade was significantly more frequent in the inflammatory group (p = 0.03). The principal cause of pericardial effusion in patients who underwent pericardiocentesis was postpericardiectomy syndrome after cardiac surgery, followed by neoplastic pericardial effusion. Pericardiocentesis is mainly a therapeutic procedure.

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Introduction: Previously, a physical-mathematical law was developed for the evaluation of continuous electrocardiographic and Holter registers, with which all cardiac attractors were deduced and normality, pathological states and evolution between states were differentiated.There were taken 200 cardiac dynamics, 150 with different types of cardiac pathologies and 50 normal ones, to which the exponential law was applied in 18 and 21 hours. For this, a sequence of heart rates was simulated, with which the chaotic attractor was constructed. Next, the mathematical diagnosis was determined with the law based on the spatial occupation of the attractor, and the fractal dimension was calculated. Finally, statistical validation of the mathematical method in 18 hours was performed against the Gold Standard. Results: Subjects with normal chaotic cardiac dynamics presented values in the Kp grid between 205 and 384, whereas subjects with pathological dynamics presented values between 61 and 191 in 18 hours. The evaluation of the concordance between the mathematical diagnosis in 18 hours and the conventional evaluation, taken as Gold Standard resulted in sensitivity and specificity values of 100% and a Kappa coefficient of 1. Conclusion: It was confirmed the clinical capacity of the law to diagnose objectively and with reproducibility in 18 hours.

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BACKGROUND: Gastroesophageal reflux disease (GERD) is a common disease among patients with obesity, with an associated prevalence of 39 to 61% between the population who attends a bariatric surgery evaluation. Laparoscopic sleeve gastrectomy (LSG) has become a popular and valid option for obesity treatment, even though the literature is ambivalent regarding the increase or decrease in GERD after this surgery. Thus, it is necessary to propose new surgical techniques as a solution to GERD in patients with a concomitant LSG or with a history of it. Therefore, we present a modified technique based on Hill's gastropexy described originally in 1967. OBJECTIVE: Describe and propose a surgical procedure for GERD management based on the Hill technique that can be applied in all patients who undergo an LSG or with a history of it. METHODS: Retrospective observational study with a prospective database in which we described, Hill modified technique in a group of 16 patients with GERD who underwent this procedure concomitantly with an LSG or who presented with GERD after LSG with a 3-year follow-up. The surgical technique is based on an intra-abdominal esophageal length of a minimum of 3 cm and posterior fixation of the gastroesophageal junction to the crus. RESULTS: Postoperative controls have shown satisfactory results in the control and management of GERD symptoms in this group of patients, with very few to no complications associated with the procedure and without reintervention or medication out of the standard protocol. CONCLUSION: Hill modified technique can be used and presented as an option for GERD control in patients with LSG.

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Currently, traditional and non-traditional risk factors for cardiovascular disease have been established. The first group includes age, which constitutes one of the most important factors in the development of chronic diseases. The second group includes inflammation, the pathophysiology of which contributes to an accelerated process of vascular remodelling and atherogenesis in autoimmune diseases. Indeed, the term inflammaging has been used to refer to the inflammatory origin of ageing, explicitly due to the chronic inflammatory process associated with age (in healthy individuals). Taking this into account, it can be inferred that people with autoimmune diseases are likely to have an early acceleration of vascular ageing (vascular stiffness) as evidenced in the alteration of non-invasive cardiovascular tests such as pulse wave velocity. Thus, an association is created between autoimmunity and high morbidity and mortality rates caused by cardiovascular disease in this population group. The beneficial impact of the treatments for rheumatoid arthritis at the cardiovascular level has been reported, opening new opportunities for pharmacotherapy.

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Breast reconstruction using contralateral autologous tissue, also known as breast sharing, is a viable option previously described in the literature, whereby flaps based on perforators of the internal mammary artery (internal mammary artery pedicle) are used. We report a postoncological breast reconstruction case using a microvascular flap taken from the lateral pole of the contralateral breast. We highlight the importance of preserving the medial pole of the donor breast for improving cosmesis, avoiding symmastia, and preserving the intermammary sulcus, as a difference with flaps based on the internal mammary artery pedicle flaps. Breast sensation could be recovered by neurotization of the lateral intercostal nerve, which may be included in the contralateral breast flap to be transferred. Contralateral breast free flaps could be an alternative to reconstruct the breast in selected patients. Oncological risk factors are discussed. Advances in genetic testing and tumor cell biology could help us to select the accurate candidates for this reconstructive technique.

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Resumen El estudio de la rigidez arterial, en los últimos años ha sido de gran interés en la comunidad científica, siendo un indicador importante de riesgo cardiovascular y de mortalidad, además es un predictor de progresión para ciertas enfermedades crónicas. Con el fin de comprender la interpretación de la medición de la rigidez vascular, se describen 12 casos de pacientes con diferentes condiciones fisiopatológicas, que reflejan la práctica clínica diaria, en los que se evaluó la rigidez arterial mediante un método oscilométrico (Arteriograph®, TensioMed, Budapest-Hungría, Ltd.), calculando la velocidad de onda de pulso, presiones arteriales periféricas y centrales, presión de pulso, e índices de aumentación. La medición e interpretación adecuada de esta información puede ayudar a entender y resolver dudas frente a diferentes condiciones fisiopatológicas asociadas a las enfermedades cardiovasculares, mejorando la toma de decisiones terapéuticas, el seguimiento de pacientes y optimizar la prevención cardiovascular.

Abstract The study of arterial stiffness has been in recent years of great interest in the scientific community, being an important indicator of cardiovascular risk and mortality, in addition to being a predictor of progression for certain chronic diseases. In order to understand the interpretation of the measurement of vascular rigidity, 12 cases of patients with different physiopathological conditions are described, thus reflecting the daily clinical practice, in which the arterial stiffness was evaluated by means of an oscillometric method (Arteriograph®, TensioMed , Budapest-Hungary, Ltd.), calculating the pulse wave velocity, peripheral and central arterial pressures, pulse pressure, and augmentation indices. The adequate measurement and interpretation of this information can help to understand and resolve doubts in the face of different physiopathological conditions associated with cardiovascular diseases, improving therapeutic decision-making, following-up of patients and optimizing cardiovascular prevention.

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BACKGROUND: Choosing a cardioplegic solution is a significant issue in modern cardiac surgery. Although different options are available, the optimal strategy for myocardial protection has not been established. The aim of this study was to compare intraoperative and postoperative effects of histidine-tryptophan-ketoglutarate (HTK) solution with those of standard blood cardioplegia with St Thomas No 2 solution. The study was conducted using a large cohort of adult patients undergoing complex cardiac surgery. METHODS: This study was a single center retrospective review of prospectively collected data. Between January 2008 and December 2015, 4480 patients underwent cardiac surgery using cardiopulmonary bypass (CPB) and cardioplegic arrest. Patients were divided into a blood cardioplegia group (n = 3852) and an HTK solution group (n = 628). Propensity score matching was used to adjust for differences between the two groups, and 292 matched pairs were identified. The primary end point was Intensive Care Unit (ICU) length of stay (LOS). Secondary end points included intraoperative changes in serum sodium concentration, readmission to ICU, transfusion of blood products, 30-day hospital readmission, 30-day mortality, and the incidence of major postoperative complications. Results: No significant differences were found between the matched groups with regard to baseline characteristics. Aortic cross-clamp and CPB times were longer for the blood cardioplegia (147.4 versus 132.8 min; P < .001). Administration of HTK solution was associated with acute and transient hyponatremia (141 versus 130 mmol/L; P < .001). ICU LOS was comparable between the groups (5.4 versus 5.4 days; P = .585). No significant differences were noted in any other secondary end point. CONCLUSIONS: During complex cardiac surgery, both cardioplegia techniques were equivalent in terms of early clinical outcomes.

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INTRODUCTION: Peripheral and central blood pressures are parameters of arterial stiffness and important cardiovascular risk markers. Today, there are non-invasive methods that measure these pressures. AIM: To validate the non-invasive oscillometric method, compared with invasive pressure measurements obtained by cardiac catheterization. METHODS: An open, prospective cohort clinical study in 100 patients, 64 ± 11 years old. The measurement of peripheral and central blood pressures obtained using the Arteriograph® system oscillometric method, (TensioMed, Budapest-Hungary, Ltd.) was validated in an adult population undergoing simultaneous, contralateral left cardiac catheterization (gold standard) using the radial technique, evaluating the correlation and agreement between the two methods. This study fulfils the latest standardized protocol for central blood pressure validation published by ARTERY Society. RESULTS: The pressures obtained with the Arteriograph® show a high correlation with the pressures measured using the gold standard. Overall, the intraclass correlation coefficient for brachial pressures was 0.80 (p < 0.001), and 0.91 (p < 0.001) for central pressures. The good agreement between the two methods was demonstrated equally by the Bland-Altman method and independent linear regressions for each variable. CONCLUSIONS: The oscillometric noninvasive method employed is easy to use and valid for estimating hemodynamic variables such as central and peripheral arterial pressure, having good agreement and conformity with the gold standard in a different type of patients and conditions. This technique can help optimize cardiovascular assessment in primary and secondary prevention, enhance treatment in selected patients and it could be an important element for future cardiovascular prevention.

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Resumen Introducción: Un estilo de vida saludable es determinante para la salud cardiovascular. Existe controversia en los efectos vasculares benéficos del ejercicio físico. Objetivo: Evaluar el comportamiento de los parámetros de rigidez vascular en una población sana que practica ejercicio aeróbico rutinario en comparación con una población sana sedentaria. Métodos: Estudio de 32 sujetos sanos, pareados por edad y sexo: 12 hombres y 20 mujeres (46,3 ± 9,7 años), en el cual se evaluaron y compararon los parámetros de rigidez arterial (presión sistólica y diastólica braquial, índices de aumentación braquial y central, velocidad de onda de pulso, presión sistólica y diastólica central, y presión de pulso braquial y central). Las mediciones se hicieron con el método no invasivo-oscilométrico, Arteriograph® (TensioMed Budapest Hungría, Ltd.). Resultados: Se compararon los parámetros de rigidez arterial entre los dos grupos (16 sujetos activos vs. 16 sedentarios), y se encontraron diferencias significativas en los siguientes: frecuencia cardiaca de 53,25 ± 8,0 lpm vs. 59,75± 8,6 lpm (p = 0,034), presión arterial diastólica braquial de 70,0 (4,5) mm Hg vs. 77,5 (8,3) mm Hg (p = 0,043), presión arterial diastólica central de 70,0 (4,5) mm Hg vs. 77,5 (8,1) mm Hg (p = 0,043) y velocidad de onda de pulso de 6,70 (1,1) m/s vs. 7,75 (1,1) m/s (p = 0,001). Conclusiones: La actividad física aeróbica rutinaria tiene un efecto benéfico sobre la rigidez vascular en una población sana, a expensas de una disminución significativa de la velocidad de onda de pulso, la frecuencia cardiaca y la presión arterial diastólica (braquial y central). Estos hallazgos ayudan a explicar los beneficios del ejercicio aeróbico sobre el sistema cardiovascular.

Abstract Introduction: A healthy lifestyle is key for cardiovascular health. There is controversy about beneficial vascular effects of physical exercise. Motivation: To assess the behaviour of vascular stiffness parametres in a healthy population group that practices routine aerobic exercise in comparison with another group of healthy population with a sedentary lifestyle. Methods: Study of 32 healthy individuals, paired according to age and gender: 12 men and 20 women (46.3±9.7 years old); the study assessed and compared arterial stiffness parametres (brachial systolic and diastolic blood pressure, brachial and central augmentation index, pulse wave velocity, central systolic and diastolic blood pressure and brachial and central pulse pressure).Measurements were conducted using the noninvasive oscillometric method Arteriograph® (TensioMed Budapest Hungary, Ltd.). Results: Arterial stiffness parametres were compared between both groups (16 active individuals vs. 16 sedentary ones), and the following significant differences were found: heart rate 53.25 ± 8.0 bpm vs. 59.75 ± 8.6 bpm (p = 0.034), brachial diastolic blood pressure of 70.0 (4.5) mmHg vs. 77.5 (8.3) mmHg (p = 0.043), central diastolic blood pressure of 70.0 (4.5) mmHg vs. 77.5 (8.1) mmHg (p = 0.043) and pulse wave velocity of 6.70 (1.1) m/s vs. 7.75 (1.1) m/s (p = 0.001). Conclusions: Routine aerobic exercise has a beneficial effect on vascular stiffness in a healthy population group, at the expense of a significant decrease in pulse wave velocity, heart rate and diastolic blood pressure (both brachial and central). These findings help explain the benefits of aerobic exercise on the cardiovascular system.

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Surgical resection guided by intraoperative electrocorticography (iECoG) has been in clinical use for many decades. The use of the bispectral index (BIS) for monitoring depth of anesthesia during different types of surgery, including epilepsy surgery, is increasing nowadays. The BIS is an EEG-derived variable indicating cortical electrical activity. However, the correlation between the BIS score and the iECoG score, with the purpose of optimizing the quality and time of the iECoG recordings in epilepsy surgery is unknown. The goal of this study was to evaluate the correlation between BIS values and iECoG parameters during the epilepsy surgery under anesthesia with propofol and fentanyl. This is a prospective study that included patients with epilepsy who underwent epilepsy surgery guided by BIS and iECoG (September 2008 to October 2013). Clinical, physiological, and sociodemographic characteristics are shown. We correlated the iECoG parameters (presence of burst suppressions [BS], suppression time [seconds], background frequency [Hz], and type of iECoG score by Mathern et al) with BIS values. We included 28 patients, 15/28 (53.5%) female, general mean age of 30.5 years (range 13-56 years). Patients underwent epilepsy surgery: 22/28 (79%) temporal and 6/28 (21%) extratemporal. We found a nonlinear polynomial cubic relationship between the mentioned variables noting that a BIS range of 40 to 60 gave the following results: iECoG BS periods <5 seconds, background frequency 10 to 17 Hz, and iECoG score 2 characterized by lack of >20-Hz background frequencies. No BS were observed with a BIS > 60. In conclusion BIS values and iECoG parameters during the epilepsy surgery under anesthesia with propofol and fentanyl have a nonlinear correlation. BS patterns were not found with a BIS > 60. These findings show that BIS is a nonlinear multidimensional measure, which possesses high variability with the iECoG parameters. BS patterns are not found with BIS > 60.

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