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Usefulness of Impella support in different clinical settings in cardiogenic shock

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Journal of Geriatric Cardiology 2022年第2期19卷 115-124页

作者： maría isabel barrionuevo-sánchez Albert Ariza-solé Daniel Ortiz-Berbel JoséGonzález-Costello Joan Antoni Gómez-Hospital Victòria Lorente Oriol Alegre Isaac Llaó JoséCarlos sánchez-salado Josep Gómez-Lara Arnau Blasco-Lucas Josep Comin-Colet Cardiology Department Intensive Cardiac Care UnitBellvitge University HospitalL’Hospitalet de LlobregatBarcelonaSpain Cardiac surgery Department Heart Disease InstituteBellvitge University HospitalL’Hospitalet de LlobregatBarcelonaSpain

BACKGROUND The Impella pump has emerged as a promising tool in patients with cardiogenic shock(Cs).Despite its attractive properties,there are scarce data on the specific clinical setting and the potential role of Impella devices in Cs patients from routine clinical practice.METHODs This is an observational,retrospective,single center,cohort study.All consecutive patients with diagnosis of Cs and undergoing support with Impella 2.5?,Impella CP?or Impella 5.0?from April 2015 to December 2020 were included.Baseline characteristics,management and outcomes were assessed according to Cs severity,age and cause of Cs.Main outcome measured was in-hospital mortality.REsULTs A total of 50 patients were included(median age:59.3±10 years).The most common cause of Cs was acute coronary syndrome(ACs)(68%),followed by decompensation of previous cardiomyopathy(22%).A total of 13 patients(26%)had profound Cs.Most patients(54%)improved pulmonary congestion at 48 h after Impella support.A total of 19 patients(38%)presented significant bleeding.In-hospital mortality was 42%.Among patients with profound Cs(n=13),five patients were previously supported with venoarterial extracorporeal membrane oxygenation.A total of eight patients(61.5%)died during the admission,and no patient achieved ventricular recovery.Older patients(≥67 years,n=10)had more comorbidities and the highest mortality(70%).Among patients with ACs(n=34),35.3%of patients had profound Cs;and in most cases(52.9%),Impella support was performed as a bridge to recovery.In contrast,only one patient from the decompensated cardiomyopathy group(n=11)presented with profound Cs.In 90.9%of these cases,Impella support was used as a bridge to cardiac transplantation.There were no cases of death.CONCLUsIONs In this cohort of real-life Cs patients,Impella devices were used in different settings,with different clinical profiles and management.Despite a significant rate of complications,mortality was acceptable and lower than those observed in other series.

关键词： Impella clinical routine

Role of climatic variability in shaping intraspecific variation of thermal tolerance in Mediterranean water beetles

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Insect science 2024年第1期31卷 285-298页

作者： susana Pallarés David Garoffolo Belén Rodríguez David sánchez-Fernández Department of Zoology University of SevilleSevilleSpain Faculty of Biology Department of Ecology and HydrologyUniversity of MurciaCampus EspinardoMurciaSpain

The climatic variability hypothesis(CVH)predicts that organisms in more thermally variable environments have wider thermal breadths and higher thermal plasticity than those from more stable environments.However,due to evolutionary trade-offs,taxa with greater absolute thermal limits may have little plasticity of such limits(trade-off hypothesis).The CVH assumes that climatic variability is the ultimate driver of thermal tolerance variation across latitudinal and altitudinal gradients,but average temperature also varies along such gradients.We explored intraspecific variation of thermal tolerance in three typical Mediterranean saline water beetles(families Hydrophilidae and Dytiscidae).For each species,we compared two populations where the species coexist,with similar annual mean temperature but contrasting thermal variability(continental vs.coastal population).We estimated thermal limits of adults from each population,previously acclimated at 17,20,or 25℃.We found species-specific patterns but overall,our results agree with the CVH regarding thermal ranges,which were wider in the continental(more variable)population.In the two hydrophilid species,this came at the cost of losing plasticity of the upper thermal limit in this population,supporting the trade-off hypothesis,but not in the dytiscid one.Our results support the role of local adaptation to thermal variability and trade-offs between basal tolerance and physiological plasticity in shaping thermal tolerance in aquatic ectotherms,but also suggest that intraspecific variation of thermal tolerance does not fit a general pattern among aquatic insects.Overlooking such intraspecific variation could lead to inaccurate predictions of the vulnerability of aquatic insects to global warming.

关键词： acclimation capacity aquatic insects climate change heat coma temperature supercooling point thermal plasticity

Effect of Aspergillus niger prolyl endopeptidase in patients with celiac disease on a long-term gluten-free diet

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World Journal of Gastroenterology 2024年第11期30卷 1545-1555页

作者： Juan Pablo stefanolo Verónica segura martina Grizzuti Abel Heredia isabel Comino Ana Florencia Costa Roberto Puebla maría Paz Temprano sonia isabel Niveloni Gabriel de Diego maría E Oregui Edgardo Gustavo smecuol Mauricio C de marzi Elena F Verdú Carolina sousa Julio César Bai small Bowel section Department of MedicineGastroenterology Hospital of Buenos Aires“Dr.C.Bonorino Udaondo”Buenos Aires 1264Argentina Department of Microbiology and Parasitology Faculty of PharmacyUniversity of SevilleSeville 41080Spain Department of Medicine Dr.C.Bonorino Udaondo Gastroenterology HospitalBuenos Aires 1264Argentina Basic and Applied Research Group in Immunology and Bioactives(GIBAIB) Institute of Ecology and Sustainable Development(INEDES)National University of LujanLuján 6700Buenos AiresArgentina Department of Medicine Farncombe Family Digestive Health Research InstituteMcMaster UniversityHamilton L8S 4L8OntarioCanada Facultad de Medicina Universidad del SalvadorBuenos Aires C1051ABBArgentina

BACKGROUND The gluten-free diet(GFD)has limitations,and there is intense research in the development of adjuvant therapies.AIM To examine the effects of orally administered Aspergillus niger prolyl endopeptidase protease(AN-PEP)on inadvertent gluten exposure and symptom prevention in adult celiac disease(CeD)patients following their usual GFD.METHODs This was an exploratory,double-blind,randomized,placebo-controlled trial that enrolled CeD patients on a long-term GFD.After a 4-wk run-in period,patients were randomized to 4 wk of two AN-PEP capsules(GliadinX;AVI Research,LLC,United states)at each of three meals per day or placebo.Outcome endpoints were:(1)Average weekly stool gluten immunogenic peptides(GIP)between the run-in and end of treatments and between AN-PEP and placebo;(2)celiac symptom index(CsI);(3)CeD-specific serology;and(4)quality of life.stool samples were collected for GIP testing by ELIsA every Tuesday and Friday during run-ins and treatments.REsULTs Forty patients were randomized for the intention-to-treat analysis,and three were excluded from the per-protocol assessment.Overall,628/640(98.1%)stool samples were collected.GIP was undetectable(samples,and no differences between treatment arms were detected.Only 0.5%of samples had GIP concentrations sufficiently high(>0.32μg/g)to potentially cause mucosal damage.Median GIP concentration in the AN-PEP arm was 44.7%lower than in the run-in period.One-third of patients exhibiting GIP>0.08μg/g during run-in had lower or undetectable GIP after AN-PEP treatment.Compared with the run-in period,the proportion of symptomatic patients(CsI>38)in the AN-PEP arm was significantly lower(Psult in changes in specific serologies.CONCLUsION This exploratory study conducted in a real-life setting revealed high adherence to the GFD.The AN-PEP treatment did not significantly reduce the overall GIP stool concentration.However,given the observation of a significantly lower prevalence of patients with severe symptoms in the AN-P

关键词： Celiac disease Aspergillus niger prolyl endoprotease Gluten immunogenic peptides Trial symptoms Real-life trial

Does enhanced recovery after surgery programs improve clinical outcomes in liver cancer surgery?

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World Journal of Gastrointestinal Oncology 2024年第2期16卷 255-258页

作者： Belinda sánchez-Pérez JoséM Ramia Department of General Digestive and Transplantation SurgeryUniversity Regional HospitalMálaga 29010MálagaSpain Department of surgery Hospital General Universitario Dr.BalmisAlicante 03010Spain

Enhanced recovery after surgery(ERAs)programs have been widely applied in liver surgery since the publication of the first ERAs guidelines in 2016 and the new recommendations in 2022.Liver surgery is usually performed in oncological patients(liver metastasis,hepatocellular carcinoma,cholangiocarcinoma,etc.),but the real impact of liver surgery ERAs programs in oncological outcomes is not clearly defined.Theoretical advantages of ERAs programs are:ERAs decreases postoperative complication rates and has been demonstrated a clear relationship between complications and oncological outcomes;a better and faster posto-perative recovery should let oncologic teams begin chemotherapeutic regimens on time;prehabilitation and nutrition actions before surgery should also improve the performance status of the patients receiving chemotherapy.so,ERAs could be another way to improve our oncological results.We will discuss the literature about liver surgery ERAs focusing on its oncological implications and future investigations projects.

关键词： Enhanced recovery after surgery programs Liver surgery Key components Long-term oncological outcomes Enhanced recovery after surgery compliance

From prediction to prevention:Machine learning revolutionizes hepatocellular carcinoma recurrence monitoring

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World Journal of Gastroenterology 2024年第7期30卷 631-635页

作者： mariana Michelle Ramírez-Mejía Nahum Méndez-sánchez Plan of Combined studies in Medicine Faculty of MedicineNational Autonomous University of MexicoDistrito Federal 04510Mexico Liver Research Unit Medica Sur Clinic&FoundationDistrito Federal 14050Mexico Faculty of Medicine National Autonomous University of MexicoDistrito Federal 04510Mexico

In this editorial,we comment on the article by Zhang et al entitled Development of a machine learning-based model for predicting the risk of early postoperative recurrence of hepatocellular carcinoma.Hepatocellular carcinoma(HCC),which is characterized by high incidence and mortality rates,remains a major global health challenge primarily due to the critical issue of postoperative recurrence.Early recurrence,defined as recurrence that occurs within 2 years posttreatment,is linked to the hidden spread of the primary tumor and significantly impacts patient survival.Traditional predictive factors,including both patient-and treatment-related factors,have limited predictive ability with respect to HCC recurrence.The integration of machine learning algorithms is fueled by the exponential growth of computational power and has revolutionized HCC research.The study by Zhang et al demonstrated the use of a groundbreaking preoperative prediction model for early postoperative HCC recurrence.Challenges persist,including sample size constraints,issues with handling data,and the need for further validation and interpretability.This study emphasizes the need for collaborative efforts,multicenter studies and comparative analyses to validate and refine the model.Overcoming these challenges and exploring innovative approaches,such as multi-omics integration,will enhance personalized oncology care.This study marks a significant stride toward precise,efficient,and personalized oncology practices,thus offering hope for improved patient outcomes in the field of HCC treatment.

关键词： Hepatocellular carcinoma Early recurrence Machine learning XGBoost model Predictive precision medicine Clinical utility Personalized interventions

New therapeutic strategy with extracorporeal membrane oxygenation for refractory hepatopulmonary syndrome after liver transplant: A case report

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World Journal of Transplantation 2024年第1期14卷 210-214页

作者： Belinda sánchez Pérez maría Pérez Reyes Jose Aranda Narvaez Julio santoyo Villalba Jose Antonio Perez Daga Claudia sanchez-Gonzalez Julio santoyo-santoyo Hepatobiliary and Trasplantation Unit General and Digestive Surgery DepartmentUniversity Regional HospitalMalaga 29010Spain Department of General and Digestive surgery Regional University Hospital of MalagaMalaga 29010Spain

BACKGROUND Due to the lack of published literature about treatment of refractory hepatopulmonary syndrome(HPs)after liver transplant(LT),this case adds information and experience on this issue along with a treatment with positive outcomes.HPs is a complication of end-stage liver disease,with a 10%-30%incidence in cirrhotic patients.LT can reverse the physiopathology of this process and restore normal oxygenation.However,in some cases,refractory hypoxemia persists,and extracorporeal membrane oxygenation(ECMO)can be used as a rescue therapy with good results.CAsE sUMmarY A 59-year-old patient with alcohol-related liver cirrhosis and portal hypertension was included in the LT waiting list for HPs.He had good liver function(Model for End-stage Liver Disease score 12,Child-Pugh class B7).He had pulmonary fibrosis and a mild restrictive respiratory pattern with a basal oxygen saturation of 82%.The macroaggregated albumin test result was>30.spirometry demonstrated a forced expiratory volume in one second(FEV1)of 78%,forced vital capacity(FVC)of 74%,FEV1/FVC ratio of 81%,diffusion capacity for carbon monoxide of 42%,and carbon monoxide transfer coefficient of 57%.He required domiciliary oxygen at 2 L/min(16 h/d).The patient was admitted to the intensive care unit(ICU)and extubated in the first 24 h,needing high-flow therapy and non-invasive ventilation and inhaled nitric oxide afterwards.Reintubation was needed after 72 h.Due to the non-response to supportive therapies,installation of ECMO was decided with progressive recovery after 9 d.Extubation was possible on the tenth day,maintaining a high-flow nasal cannula and de-escalating to conventional oxygen therapy after 48 h.He was discharged from ICU on postoperative day(POD)20 with a 90%-92%oxygen saturation.steroid recycling was needed twice for acute rejection.The patient was discharged from hospital on POD 27 with no symptoms,with an 89%-90%oxygen saturation.CONCLUsION Due to the favorable results observed,ECMO could become the central axis of treatment of HPs and ref

关键词： Liver transplantation Hepatopulmonary syndrome Refractory hypoxemia Treatment Extracorporeal membrane oxygenation Case report

Assessing the energy saving potential of using adaptive setpoint temperatures:The case study of a regional adaptive comfort model for Brazil in both the present and the future

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Building simulation 2024年第3期17卷 459-482页

作者： Daniel sánchez-García David Bienvenido-Huertas Carlos Rubio-Bellido Ricardo Forgiarini Rupp Department of Electrical Engineering University Carlos III of MadridMadridSpain Department of Building simulation ZEROCEM SLSevilleSpain Department of Building Constructions University of GranadaGranadaSpain Department of Building Constructions II University of SevilleSevilleSpain section of Design for sustainability Department of Civil and Mechanical EngineeringTechnical University of DenmarkKgs.LyngbyDenmark

It has been found in recent years that using setpoint temperatures based on adaptive thermal comfort models is a successful method of energy conservation.Recent studies using adaptive setpoint temperatures incorporate international models from AsHRAE standard 55 and EN16798-1.This study,however,has instead considered a regional Brazilian adaptive comfort model.This study investigates the energy demand arising from the use of a local Brazilian comfort model in order to assess the energy implications from the use of the worldwide AsHRAE standard 55 adaptive model and various fixed setpoint temperatures.All of Brazil’s climate zones,full air-conditioning,mixed-mode building operating modes,present-day climate change scenarios,and future scenarios—specifically Representative Concentration Pathways(RCP)2.6,4.5,and 8.5 for the years 2050 and 2100—have all been taken into account in building energy simulations.The use of adaptive setpoint temperatures based on the Brazilian local model considering mixed-mode has been found to significantly reduce energy consumption when compared to static setpoint temperatures(average energy-saving values ranging from 52%to 58%)and the AsHRAE 55 adaptive model(average values ranging from 15%to 21%).Considering climate change and the mixed-mode Brazilian model,the overall energy demand for the three groups of climatic zones(annual average outdoor temperatures≤21℃,>21 and≤25℃and>25℃)ranged between 2%decrease and 5%increase,4%and 27%increase,and 13%and 45%increase,respectively.It is concluded as a consequence that setting setpoint temperatures based on the Brazilian local adaptive comfort model is a very efficient energy-saving method.

关键词： adaptive thermal comfort building energy simulation energy efficiency climate change adaptive setpoint temperatures local comfort mode

Twenty years of population dynamics in European beech-oak forest at their rear range margin anticipate changes in its structure and composition

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Forest Ecosystems 2024年第3期11卷 358-370页

作者： álvaro Rubio-Cuadrado Iciar Alberdi isabel Canellas Fernando Montes Jesús Rodríguez-Calcerrada Rosana López Guillermo G.Gordaliza maría Valbuena-Carabana Nikos Nanos Ramón Perea Luis Gil Departamento de dinamica y gestion forestal Instituto de Ciencias Forestales(ICIFOR-INIA)CSICCtra.La Coruna km 7.528040MadridSpain Departamento de sistemas y Recursos Naturales Escuela Tecnica Superior de Ingeniería de MontesForestal y del Medio NaturalUniversidad Politecnica de Madrid.Ciudad Universitaria s/n28040MadridSpain school of Forestry and Natural Environment Aristotle University of ThessalonikiUniversity Campus54124ThessalonikiGreece

There is an increasing interest in restoring degraded forests,which occupy half of the forest areas.Among the forms of restoration,passive restoration,which involves the elimination of degrading factors and the free evolution of natural dynamics by applying minimal or no management,is gaining attention.Natural dynamics is difficult to predict due to the influence of multiple interacting factors such as climatic and edaphic conditions,composition and abundance of species,and the successional character of these species.Here,we study the natural dynamics of a mixed forest located in central spain,which maintained an open forest structure,due to intensive use,until grazing and cutting were banned in the 1960s.The most frequent woody species in this forest are Fagus sylvatica,Quercus petraea,Quercus pyrenaica,Ilex aquifolium,sorbus aucuparia,sorbus aria and Prunus avium,with contrasting shade and drought tolerance.These species are common in temperate European deciduous forest and are found here near their southern distribution limit,except for Q.pyrenaica.In order to analyze forest dynamics and composition,three inventories were carried out in 1994,2005 and 2015.Our results show that,despite the Mediterranean influence,the natural dynamics of this forest has been mainly determined by different levels of shade tolerance.After the abandonment of grazing and cutting,Q.pyrenaica expanded rapidly due to its lower shade tolerance,whereas after canopy closure and forest densification,shade-tolerant species gained ground,particularly F.sylvatica,despite its lower drought and late-frost tolerance.If the current dynamics continue,F.sylvatica will overtake the rest of the species,which will be relegated to sites with shallow soils and steep slopes.simultaneously,all the multi-centennial beech trees,which are undergoing a rapid mortality and decline process,will disappear.

关键词： Forest succession secondary forest Woodland Mixed forest Competition Recruitment

The dorsal root ganglion as a target for neurorestoration in neuropathic pain

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Neural Regeneration Research 2024年第2期19卷 296-301页

作者： Guillermo Estivill-Torrús Ana Belen martínez-Padilla Lourdes sánchez-salido Anne Baron-Van Evercooren Beatriz García-Díaz Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina(IBIMA Plataforma BIONAND) MálagaSpain Unidad Clínica de Neurociencias Hospital Regional Universitario de MálagaMálagaSpain Departamento de Biología Molecular y Bioquímica Universidad de MálagaSpain sorbonne Université Institut du Cerveau-Paris Brain Institute-ICMINSERMCNRSAP-HPHôpital Pitié-SalpêtrièreParisFrance

Neuropathic pain is a severe and chronic condition widely found in the general population.The reason for this is the extensive variety of damage or diseases that can spark this unpleasant constant feeling in patients.During the processing of pain,the dorsal root ganglia constitute an important region where dorsal root ganglion neurons play a crucial role in the transmission and propagation of sensory electrical stimulation.Furthermore,the dorsal root ganglia have recently exhibited a regenerative capacity that should not be neglected in the understanding of the development and resolution of neuropathic pain and in the elucidation of innovative therapies.Here,we will review the complex interplay between cells(satellite glial cells and inflammatory cells)and factors(cytokines,neurotrophic factors and genetic factors)that takes place within the dorsal root ganglia and accounts for the generation of the aberrant excitation of primary sensory neurons occurring in neuropathic pain.More importantly,we will summarize an updated view of the current pharmacologic and nonpharmacologic therapies targeting the dorsal root ganglia for the treatment of neuropathic pain.

关键词： cytokines dorsal root ganglia genetic factors neuropathic pain neurotrophic factors pharmacologic and nonpharmacologic therapies satellite glial cells sensory neurons