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Significant lead-induced tricuspid regurgitation after cardiovascular implantable electronic devices is not uncommon. Absolute or relative contraindications to place the lead in the right ventricle after tricuspid valve (TV) surgery still remains a challenge. We report about successful lead extraction followed by transvenous implantable cardioverter defibrillator lead placement in the side branches of coronary sinus after TV reconstruction. Furthermore, we discuss therapeutic options to deliver concomitant anti-bradycardia therapy, technical pitfalls, and surgical approaches.

Pig pregnancy succeeds thanks to a well-coordinated system ruling both maternal immune activation and embryonic antigen tolerance. In physiological pregnancies, the maternal immune system should tolerate the presence of hemi-allogeneic conceptuses from the pre-implantation phase to term, while maintaining maternal defence against pathogens. Allogeneic pregnancies, as after embryo transfer (ET), depict high embryo mortality during the attachment phase, calling for studies of the dynamic modifications in immune processes occurring at the maternal-foetal interface, for instance, of interferon (IFN)-stimulated genes (ISGs). These ISGs are generally activated by IFN secreted by the conceptus during the process of maternal recognition of pregnancy (MRP) and responsible for recruiting immune cells to the site of embryo attachment, thus facilitating cell-antigen presentation and angiogenesis. We performed RNA-Seq analysis in peri-implantation (days 18 and 24) endometrial samples retrieved from artificially inseminated sows (hemi-allogeneic embryos (HAL) group) or sows subjected to ET (allogeneic embryos (AL) group) to monitor alterations of gene expression that could be jeopardising early pregnancy. Our results showed that endometrial gene expression patterns related to immune responses differed between hemi- or allogeneic embryo presence, with allogeneic embryos apparently inducing conspicuous modifications of immune-related genes and pathways. A decreased expression (P

On December 30, 2019, the city of Wuhan, China, experienced an outbreak of unexplained pneumonia. From January 7, 2020, a new betacoronavirus, severe acute respiratory syndrome coronavirus was identified (SARS-CoV-2). The World Health Organization (WHO) has since declared a pandemic with millions of confirmed cases worldwide. As part of the fight against the epidemic, laboratories have a critical role in assessing the reliability of new serological assays before taking part of diagnostic protocols or made available broader to the community and to evaluate commutability between assays.The aim of this study was to perform a comparison between two automated assays for SARS-CoV-2 IgG testing, the MAGLUMI ® 800 and the LIAISON ® XL.Among the patients confirmed positive for COVID-19, the two automated assays were significantly correlated (r = 0.811; p

The improvement in porcine embryo preservation and non-surgical embryo transfer (ET) procedures achieved in recent years represents essential progress for the practical use of ET in the pig industry. This study aimed to evaluate the effects of parity, weaning-to-estrus interval (WEI) and season on reproductive and embryonic parameters at day 6 after insemination of donor sows superovulated after weaning. The selection of donor sows was based on their reproductive history, body condition and parity. The effects of parity at weaning (2 to 3, 4 to 5 or 6 to 7 litters), season (fall, winter and spring), and WEI (estrus within 3 to 4 days), and their interactions on the number of corpus luteum, cysts in sows with cysts, number and quality of viable and transferable embryos, embryo developmental stage and recovery and fertilization rates were evaluated using linear mixed effects models. The analyses showed a lack of significant effects of parity, season, WEI or their interactions on any of the reproductive and embryonic parameters examined. In conclusion, these results demonstrate that fertilization rates and numbers of viable and transferable embryos collected at day 6 of the cycle from superovulated donor sows are not affected by their parity, regardless of the time of the year (from fall to spring) and WEI (3 or 4 days).

Spontaneous or nosocomial Escherichia coli meningitis remains rare in healthy adults but is still carrying a high mortality rate despite adapted antimicrobial treatment for susceptible strains. A 39-year-old woman was admitted to the hospital with severe subarachnoid haemorrhage complicated by acute hydrocephalus. On hospital day 10, she developed Streptococcus anginosus septicaemia and urinary tract infection due to a multisensitive strain of E. coli. This infection was successfully controlled by antimicrobial therapy. As a late complication in the neurosurgical ward (day 39), she developed fever, alteration of consciousness, and shock, leading to the diagnosis of bacterial meningitis. The culture of blood, cerebrospinal fluid, and urine grew positive for a multisensitive E. coli. The strain was identified as O117:K52:H, a serotype that was until now never associated with acute meningitis or brain abscesses. The source appeared to be the urinary tract with the demonstration of acute pyelonephritis. The patient died on day 94 from delayed complications of multiple brain abscesses.

Disseminated abscesses due to group G β-hemolytic Streptococcus dysgalactiae were observed in a 57-year-old cirrhotic patient with the skin being the putative way of entry for the pathogen. S. dysgalactiae is a rare agent in human infections responsible for acute pyogenic meningitis. The mortality rate associated with S. dysgalactiae bacteraemia and meningitis may be as high as 50%, particularly in the presence of endocarditis or brain abscesses. In our patient, main sites of infections were meningitis and ventriculitis, spondylodiscitis, septic arthritis, and soft-tissue infections. In contrast, no endocarditis was evidenced. Cirrhosis-related immune suppression was considered as a pathophysiological cofactor for the condition. Fortunately, clinical status improved after long-term (3 months) antimicrobial therapy.

Here, we present the electrical properties of the compound Cu3BiS3 deposited by co-evaporation. This new compound may have the properties necessary to be used as an absorbent layer in solar cells. The samples were characterized by Hall effect and transient surface photovoltage (SPV) measurements. Using Hall effect measurements, we found that the concentration of n charge carriers is in the order of 1016 cm-3 irrespective of the Cu/Bi mass ratio. We also found that the mobility of this compound (μ in the order of 4 cm2 V-1s-1) varies according to the transport mechanisms that govern it and are dependent on temperature. Based on the SPV, we found a high density of surface defects, which can be passivated by superimposing a buffer layer over the Cu3BiS3 compound.

Chagas' myocardiopathy, caused by the intracellular protozoan Trypanosoma cruzi, is characterized by microvascular alterations, heart failure and arrhythmias. Ischemia and arrythmogenesis have been attributed to proteins shed by the parasite, although this has not been fully demonstrated. The aim of the present investigation was to study the effect of substances shed by T. cruzi on ischemia/reperfusion-induced arrhythmias. We performed a triple ischemia-reperfusion (I/R) protocol whereby the isolated beating rat hearts were perfused with either Vero-control or Vero T. cruzi-infected conditioned medium during the different stages of ischemia and subsequently reperfused with Tyrode's solution. ECG and heart rate were recorded during the entire experiment. We observed that triple I/R-induced bradycardia was associated with the generation of auricular-ventricular blockade during ischemia and non-sustained nodal and ventricular tachycardia during reperfusion. Interestingly, perfusion with Vero-infected medium produced a delay in the reperfusion-induced recovery of heart rate, increased the frequency of tachycardic events and induced ventricular fibrillation. These results suggest that the presence of parasite-shed substances in conditioned media enhances the arrhythmogenic effects that occur during the I/R protocol.

We report the first case of human infection caused by Streptococcus minor in a 51-year-old immunocompetent woman admitted for dog bite injuries. At present, the role of Streptococcus minor in bite wound infections is unknown. Further studies on virulence factors are needed to elucidate its pathogenicity mechanisms.

Characteristic of Thai swamp buffalo bulls semen used for artificial insemination (AI) in Thailand, aspects relevance in freezing and thawing of semen are review. Semen and sperm characteristics were evaluated included sperm count, motility (assessed subjectively and by CASA), morphology (using phase-contrast light microscopy and SEM), plasma membrane integrity (PMI) (using a hypo-osmotic swelling test [HOST]) and SYBR- 14/propidium iodide [PI]), plasma membrane stability (PMS) (using Annexin-V/PI) and deoxyribonucleic acid (DNA) integrity (using SCSA and flow cytometry [FCM]). The average ejaculate volume was about 3.0–4.0 mL, with good viability (PMI measured by the HOST) and motility (>65% and >70%, respectively). Sperm concentration ranged from 1.1 to 1.2 billion/mL, being also affected by bull age. Whereas semen quality (including sperm output, pH and initial sperm motility) did not differ between the seasons. Few spermatozoa (

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Modern biotechnologies are used extensively in the animal breeding industry today. Therefore, it is essential that sperm handling procedures do not modulate the normal physiological mechanisms occurring in the female reproductive tract. In this paper, the different selection mechanisms occurring in vivo are described briefly, together with their relevance to artificial insemination, followed by a detailed description of the different selection processes used in reproductive biotechnologies. These selection methods included fractionated semen collection, cryopreservation, biomimetic sperm selection, selection based on hyaluronic acid binding, and last, but not least, sperm sex selection. Biomimetic sperm selection for AI or for cryopreservation could improve pregnancy rates and help to reverse the decline in fertility seen in several domestic species over the recent decades. Similarly, selection for hyaluronic acid binding sites may enable the most mature spermatozoa to be selected for IVF or ICSI.

On-stud assessment of stallion sperm quality can be problematic. A new instrument, the Nucleocounter SP-100, was validated for measuring stallion sperm concentration and viability. It was subsequently used to evaluate sperm viability in Kenney's extender and INRA96. There was a strong correlation between sperm concentrations measured by the Nucleocounter SP-100 and by the Bürker counting chamber (𝑟=0.84; 𝑃

The research aimed to generate bioelectricity using pepper waste and the microalgae Spirulina sp by a double-chamber microbial fuel cell (dcMFC). A dcMFC was constructed with Cu and Zn electrodes, where organic waste and microalgae were placed in the anodic and cathodic chambers, respectively. Also, electrochemical parameters were measured for 35 days. Finally, possible electrogenic microorganisms were isolated and identified. It was possible to generate maximum values of current (6.04414 ± 0.2145 mA) and voltage (0.77328 ± 0.213 V). The maximum conductivity value was 134.1636 ± 7.121 mS/cm, while the internal resistance value was 83.784 ±7.147Ω. The values of power and current density reached were 584.45 ± 19.14 mW/cm 2 and 5.983 A/cm 2, respectively. The optimal operating pH was 4.59 ± 0.14. From the microbial growth on the anode, the yeast Yarrowia phangngaensis (1) and Pseudomonas stutzeri (2) were identified, which may be involved in the transfer of electrons to the electrode. In conclusion, it was possible to generate clean energy in a laboratory-scale dcMFC when pepper waste and Spirulina sp. were used. These results are promising because organic waste can generate sustainable and environmentally friendly energy.

Abstract Purpose The aim of this work was to investigate the association between anticholinergic burden or anticholinergic drug use and xerostomia and/or xerophtalmia in elderly through a systematic review of the published literature. Methods A search was carried out in 3 databases (CINAHL, Embase and Pubmed). Studies conducted in people ≥65 years of age, who took anticholinergic medications, and measured the association between the anticholinergic burden or the use of these medications with the prevalence of xerostomia and / or xerophthalmia, published up to August 2022, were selected. Studies published in languages other than Spanish and/or English were excluded. Results One thousand two hundred eleven articles were identified, 10 were selected for this review: six cross-sectional studies, two cohorts, one case-control and one randomized controlled clinical trial. A total of 3535 patients included in the different studies were studied. The most used scales were the Anticholinergic Drug Scale (ADS) and the Anticholinergic Risk Scale (ARS). Four articles studied the relationship between the use of anticholinergic medication and the prevalence of xerostomia and / or xerophthalmia, finding a positive relationship with xerostomia in all of them. Another 6 measured the relationship between anticholinergic burden and xerostomia and / or xerophthalmia. Four found a positive relationship between anticholinergic burden and xerostomia and/or xerophthalmia. Conclusions Our findings suggest a clear relationship between the use of anticholinergic drugs or anticholinergic burden and the presence of xerostomia. This relationship was less conclusive in the case of xerophthalmia.

Resumen: El término colestasis se refiere a la retención de ácidos biliares ya sea dentro del hepatocito o en los ductos biliares de cualquier calibre. Por laboratorio, se define por la elevación de fosfatasa alcalina arriba de 1.67 veces su valor normal. Las enfermedades colestásicas pueden asociarse a un proceso inflamatorio de la glándula hepática que provoca destrucción de los hepatocitos (hepatitis), a ictericia (coloración amarillenta de piel y mucosas asociada a elevación en niveles séricos de bilirrubinas) o ambas, aunque estos tres conceptos no deben considerarse sinónimos. Los padecimientos colestásicos pueden clasificarse como intra o extrahepáticos dependiendo de su etiología, y esto es importante para elegir los estudios diagnósticos adecuados y la terapéutica indicada en cada uno de los casos. Una historia clínica completa, aunada a exploración física exhaustiva y estudios iniciales básicos como el ultrasonido hepático y las pruebas de funcionamiento del hígado, pueden ayudar al clínico a decidir el camino a seguir al enfrentarse al paciente con colestasis. La Asociación Mexicana de Hepatología, la Asociación Mexicana de Gastroenterología y la Asociación Mexicana de Endoscopia Gastrointestinal decidieron trabajar en el primer posicionamiento científico mexicano sobre este tema. Abstract: The term cholestasis refers to bile acid retention, whether within the hepatocyte or in the bile ducts of any caliber. Biochemically, it is defined by a level of alkaline phosphatase that is 1.67-times higher than the upper limit of normal. Cholestatic diseases can be associated with an inflammatory process of the liver that destroys hepatocytes (hepatitis), with jaundice (yellowing of the skin and mucus membranes, associated with elevated serum bilirubin levels), or with both, albeit the three concepts should not be considered synonymous. Cholestatic diseases can be classified as intrahepatic or extrahepatic, depending on their etiology. Knowing the cause of the condition is important for choosing the adequate diagnostic studies and appropriate treatment in each case. A complete medical history, together with a thorough physical examination and basic initial studies, such as liver ultrasound and liver function tests, aid the clinician in deciding which path to follow, when managing the patient with cholestasis. In a joint effort, the Asociación Mexicana de Hepatología (AMH), the Asociación Mexicana de Gastroenterología (AMG) and the Asociación Mexicana de Endoscopia Gastrointestinal (AMEG) developed the first Mexican scientific position statement on said theme.

The term cholestasis refers to bile acid retention, whether within the hepatocyte or in the bile ducts of any caliber. Biochemically, it is defined by a level of alkaline phosphatase that is 1.67-times higher than the upper limit of normal. Cholestatic diseases can be associated with an inflammatory process of the liver that destroys hepatocytes (hepatitis), withjaundice (yellowing of the skin and mucus membranes, associated with elevated serum bilirubin levels), or with both, albeit the three concepts should not be considered synonymous. Cholestatic diseases can be classified as intrahepatic or extrahepatic, depending on their etiology. Knowing the cause of the condition is important for choosing the adequate diagnostic studies and appropriate treatment in each case. A complete medical history, together with a thorough physical examination and basic initial studies, such as liver ultrasound and liver function tests, aid the clinician in deciding which path to follow, when managing the patient with cholestasis. In a joint effort, the Asociación Mexicana de Hepatología (AMH), the Asociación Mexicana de Gastroenterología (AMG) and the Asociación Mexicana de Endoscopia Gastrointestinal (AMEG) developed the first Mexican scientific position statement on said theme. Resumen: El término colestasis se refiere a la retención de ácidos biliares ya sea dentro del hepatocito o en los ductos biliares de cualquier calibre. Por laboratorio, se define por la elevación de fosfatasa alcalina arriba de 1.67 veces su valor normal. Las enfermedades colestásicas pueden asociarse a un proceso inflamatorio de la glándula hepática que provoca destrucción de los hepatocitos (hepatitis), a ictericia (coloración amarillenta de piel y mucosas asociada a elevación en niveles séricos de bilirrubinas) o ambas, aunque estos tres conceptos no deben considerarse sinónimos. Los padecimientos colestásicos pueden clasificarse como intra o extrahepáticos dependiendo de su etiología, y esto es importante para elegir los estudios diagnósticos adecuados y la terapéutica indicada en cada uno de los casos. Una historia clínica completa, aunada a exploración física exhaustiva y estudios iniciales básicos como el ultrasonido hepático y las pruebas de funcionamiento del hígado pueden ayudar al clínico a decidir el camino a seguir al enfrentarse al paciente con colestasis. La Asociación Mexicana de Hepatología, la Asociación Mexicana de Gastroenterología y la Asociación Mexicana de Endoscopia Gastrointestinal decidieron trabajar en el primer posicionamiento científico mexicano sobre este tema.

More than 30 million persons worldwide take nonsteroidal anti-inflammatory drugs (NSAIDs) on a daily basis, and annual consumption is increasing. In addition to their analgesic and anti-inflammatory properties, NSAIDs also produce well-known gastrointestinal adverse events. There is no consensus in Mexico on the diagnosis, treatment, and prevention of NSAID-induced gastropathy and enteropathy, and so the Asociación Mexicana de Gastroenterología brought together a group of experts to establish useful recommendations for the medical community. Thirty-three recommendations were formulated in the present consensus, highlighting the fact that the risk for NSAID-induced gastrointestinal toxicity varies according to the drug employed and its pharmacokinetics, which should be taken into account at the time of prescription. The risk factors for gastroduodenal complications due to NSAIDs are: a history of peptic ulcer, age above 65 years, high doses of NSAIDs, Helicobacter pylori infection, and the presence of severe comorbidities. The symptoms and gastroduodenal damage induced by NSAIDs vary, ranging from an asymptomatic course to the presentation of iron-deficiency anemia, bleeding, stricture, and perforation. Capsule endoscopy and enteroscopy are direct diagnostic methods in NSAID enteropathy. Regarding prevention, the minimum dose of an NSAID needed to achieve the desired effect, administered for the shortest period of time, is the recommendation. Finally, proton pump inhibitors are the gold standard for the prophylaxis and treatment of gastroduodenal effects, but they are not useful in enteropathy. Resumen: Más de 30 millones de personas consumen diariamente antiinflamatorios no esteroideos (AINE) en el mundo, y este consumo se ve incrementado anualmente. Aunque los AINE poseen propiedades analgésicas y antiinflamatorias, sus eventos adversos gastrointestinales son bien reconocidos. En nuestro país no existía un consenso respecto al diagnóstico, tratamiento y prevención de la gastropatía y la enteropatía por AINE, por lo que la Asociación Mexicana de Gastroenterología reunió a un grupo de expertos para establecer recomendaciones de utilidad para la comunidad médica. En este consenso se emitieron 33 recomendaciones. El consenso destaca que el riesgo de toxicidad gastrointestinal de los AINE varía según el fármaco empleado y su farmacocinética, lo cual debe ser considerado al momento de su prescripción. Los factores de riesgo de complicación gastroduodenal por AINE son: antecedente de úlcera péptica, edad mayor a 65 años, dosis altas del AINE, infección por Helicobacter pylori (H.pylori), y presencia de comorbilidades graves. Los síntomas y el daño gastroduodenal inducido por AINE son variables ya que puede cursar asintomático o manifestarse como anemia por deficiencia de hierro, hemorragia, estenosis y perforación. La cápsula endoscópica y la enteroscopia son métodos diagnósticos directos en la enteropatía por AINE. Respecto a la prevención, se recomienda prescribir la dosis mínima necesaria de un AINE para obtener el efecto deseado y durante el menor tiempo. Finalmente, los inhibidores de la bomba de protones (IBP) representan el estándar de oro para la profilaxis y tratamiento de los efectos gastroduodenales, mas no son útiles en la enteropatía.

Resumen: Más de 30 millones de personas consumen diariamente antiinflamatorios no esteroideos (AINE) en el mundo y este consumo se ve incrementado año tras año. Aunque los AINE poseen propiedades analgésicas y antiinflamatorias, sus eventos adversos gastrointestinales son bien reconocidos. En nuestro país no existía un consenso respecto al diagnóstico, tratamiento y prevención de la gastropatía y la enteropatía por AINE, por lo que la Asociación Mexicana de Gastroenterología reunió a un grupo de expertos para establecer recomendaciones de utilidad para la comunidad médica. En este consenso se emitieron 33 recomendaciones. El consenso destaca que el riesgo de toxicidad gastrointestinal de los AINE varía según el fármaco empleado y su farmacocinética, lo cual debe ser considerado al momento de su prescripción. Los factores de riesgo de complicación gastroduodenal por AINE son: antecedente de úlcera péptica, edad mayor de 65 años, dosis altas del AINE, infección por Helicobacter pylori y presencia de comorbilidades graves. Los síntomas y el daño gastroduodenal inducido por AINE son variables, ya que puede cursar asintomático o manifestarse como anemia por deficiencia de hierro, hemorragia, estenosis y perforación. La cápsula endoscópica y la enteroscopia son métodos diagnósticos directos en la enteropatía por AINE. Respecto a la prevención, se recomienda prescribir la dosis mínima necesaria de un AINE para obtener el efecto deseado y durante el menor tiempo. Por último, los inhibidores de la bomba de protones representan el estándar de oro para la profilaxis y tratamiento de los efectos gastroduodenales, mas no son útiles en la enteropatía. Abstract: More than 30 million persons worldwide take nonsteroidal anti-inflammatory drugs (NSAIDs) on a daily basis, and annual consumption is increasing. In addition to their analgesic and anti-inflammatory properties, NSAIDs also produce well-known gastrointestinal adverse events. There is no consensus in Mexico on the diagnosis, treatment, and prevention of NSAID-induced gastropathy and enteropathy, and so the Asociación Mexicana de Gastroenterología brought together a group of experts to establish useful recommendations for the medical community. Thirty-three recommendations were formulated in the present consensus, highlighting the fact that the risk for NSAID-induced gastrointestinal toxicity varies according to the drug employed and its pharmacokinetics, which should be taken into account at the time of prescription. The risk factors for gastroduodenal complications due to NSAIDs are: a history of peptic ulcer, age above 65 years, high doses of NSAIDs, Helicobacter pylori infection, and the presence of severe comorbidities. The symptoms and gastroduodenal damage induced by NSAIDs vary, ranging from an asymptomatic course to the presentation of iron-deficiency anemia, bleeding, stricture, and perforation. Capsule endoscopy and enteroscopy are direct diagnostic methods in NSAID enteropathy. Regarding prevention, the minimum dose of an NSAID needed to achieve the desired effect, administered for the shortest period of time, is the recommendation. Finally, proton pump inhibitors are the gold standard for the prophylaxis and treatment of gastroduodenal effects, but they are not useful in enteropathy. Palabras clave: Gastropatía, Enteropatía, Antiinflamatorio, No Esteroideo, Úlcera, México, Keywords: Gastropathy, Enteropathy, Anti-inflammatory, Nonsteroidal, Ulcer, Mexico

Se propone un control no lineal para regular la velocidad y la alimentación de flujo de aire en un motor de combustión interna diésel con sistema de recirculación de gases de escape. El esquema de control propuesto utiliza una realimentación estática de los estados para linealizar de manera exacta al sistema motor-turbocompresor evitando la linealización por retroalimentación de estados dinámica. El esquema de control propuesto se complementa con un estimador para el par de carga del motor basado en la técnica de Inmersión e Invariancia. El análisis de estabilidad permite concluir estabilidad asintótica cuando el esquema de control utiliza el par de carga estimado. Por medio de una serie de simulaciones numéricas se evalúan las propiedades del esquema de control propuesto.

Resumen: La enfermedad por hígado graso no alcohólico (EHGNA) afecta prácticamente a un tercio de la población mundial. México es uno de los países cuya población reúne varios factores de riesgo para esta enfermedad y su prevalencia podría superar el 50%; es por eso que el panorama a mediano plazo es muy pesimista si no se toman acciones inmediatas para contrarrestar lo que ya se considera un problema de salud nacional.De ahí el interés de la Asociación Mexicana de Gastroenterología y de la Asociación Mexicana de Hepatología para realizar el Consenso mexicano de EHGNA, en el cual se hizo una revisión actualizada y a fondo de temas como epidemiología, fisiopatología, formas clínicas, diagnóstico y tratamiento, con el objetivo de ofrecer al médico mexicano una herramienta útil para la prevención y el manejo de esta enfermedad. Abstract: Nonalcoholic fatty liver disease (NAFLD) affects nearly one third of the population worldwide. Mexico is one of the countries whose population has several risk factors for the disease and its prevalence could surpass 50%. If immediate action is not taken to counteract what is now considered a national health problem, the medium-term panorama will be very bleak.This serious situation prompted the Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Hepatología to produce the Mexican Consensus on Fatty Liver Disease. It is an up-to-date and detailed review of the epidemiology, pathophysiology, clinical forms, diagnosis, and treatment of the disease, whose aim is to provide the Mexican physician with a useful tool for the prevention and management of nonalcoholic fatty liver disease. Palabras clave: Enfermedad por hígado graso no alcohólico, Consenso mexicano, Keywords: Nonalcoholic fatty liver disease, Mexican consensus

Nonalcoholic fatty liver disease (NAFLD) affects nearly one third of the population worldwide. Mexico is one of the countries whose population has several risk factors for the disease and its prevalence could surpass 50%. If immediate action is not taken to counteract what is now considered a national health problem, the medium-term panorama will be very bleak.This serious situation prompted the Asociación Mexicana de Gastroenterología and the Asociación Mexicana de Hepatología to produce the Mexican Consensus on Fatty Liver Disease. It is an up-to-date and detailed review of the epidemiology, pathophysiology, clinical forms, diagnosis, and treatment of the disease, whose aim is to provide the Mexican physician with a useful tool for the prevention and management of nonalcoholic fatty liver disease. Resumen: La enfermedad por hígado graso no alcohólico (EHGNA) afecta prácticamente a un tercio de la población mundial. México es uno de los países cuya población reúne varios factores de riesgo para esta enfermedad y su prevalencia podría superar el 50%; es por eso que el panorama a mediano plazo es muy pesimista si no se toman acciones inmediatas para contrarrestar lo que ya se considera un problema de salud nacional.De ahí el interés de la Asociación Mexicana de Gastroenterología y de la Asociación Mexicana de Hepatología para realizar el Consenso mexicano de EHGNA, en el cual se hizo una revisión actualizada y a fondo de temas como epidemiología, fisiopatología, formas clínicas, diagnóstico y tratamiento, con el objetivo de ofrecer al médico mexicano una herramienta útil para la prevención y el manejo de esta enfermedad. Keywords: Nonalcoholic fatty liver disease, Mexican consensus, Palabras clave: Enfermedad por hígado graso no alcohólico, Consenso mexicano

En este trabajo se presenta el diseño de un sistema de control difuso PD+I embebido aplicado en el control de voltaje de un convertidor electrónico de potencia bidireccional multi-fase CD-CD. El controlador difuso cuenta con dos entradas, la primera se le denomina Error y es la diferencia entre el valor de voltaje deseado en la salida del convertidor y el voltaje medido en la salida del mismo; la segunda entrada es definida por las variaciones en el voltaje medido. La salida del controlador difuso define las variaciones en el ciclo de trabajo de los interruptores de potencia que controlan el convertidor. El sistema de control difuso se embebió en la tarjeta de desarrollo NI myRIO-1900 utilizando como software de programación LabVIEW, empleando el sistema embebido para realizar pruebas experimentales con el prototipo del convertidor. Con este sistema de control de voltaje se logra estabilizar el convertidor en los modos de operación reductor y elevador, demostrando un adecuado comportamiento del convertidor en el arranque y ante cambios de carga resistiva, manteniendo tiempos aceptables para aplicaciones futuras en micro-redes de CD conectando el bus de CD con un banco de super-capacitores o un banco de baterías.

The possibility of extracting useful information about the state of the lower troposphere from the surface reflections that are often detected during GPS radio occultations (GPSRO) is explored. The clarity of the reflection is quantified, and can be related to properties of the surface and the low troposphere. The reflected signal is often clear enough to show good phase coherence, and can be tracked and processed as an extension of direct non-reflected GPSRO atmospheric profiles. A profile of bending angle vs. impact parameter can be obtained for these reflected signals, characterized by impact parameters that are below the apparent horizon, and that is a continuation at low altitude of the standard non-reflected bending angle profile. If there were no reflection, these would correspond to tangent altitudes below the local surface, and in particular below the local mean sea level. A forward operator is presented, for the evaluation of the bending angle of reflected GPSRO signals, given atmospheric properties as described by a numerical weather prediction system. The operator is an extension, at lower impact parameters, of standard bending angle operators, and reproduces both the direct and reflected sections of the measured profile. It can be applied to the assimilation of the reflected section of the profile as supplementary data to the direct section. Although the principle is also applicable over land, this paper is focused on ocean cases, where the topographic height of the reflecting surface, the sea level, is better known a priori.

Human infections associated with Corynebacterium kroppenstedtii are rarely reported, and this organism is usually described as antibiotic sensitive. Almost all published cases of C. kroppenstedtii infections have been associated with breast pathology in women and have been described in New Zealand, France, Canada, India and Japan. Here we describe the microbiologic characteristics of two strains isolated from two women diagnosed of granulomatous mastitis in Spain. One C. kroppenstedtii isolate was antibiotic sensitive while the other was multidrug resistant. Biochemical identification was possible using a wide battery of methods including API Coryne V2.0, API Strep, API NH, API NE, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and 16S rRNA gene amplification and sequencing. Antimicrobial susceptibility to 28 antibiotics as determined by Etest showed one isolate being sensitive to benzylpenicillin, ciprofloxacin, moxifloxacin, gentamicin, vancomycin, clindamycin, tetracycline, linezolid and rifampin. The second isolate showed resistance to ciprofloxacin, moxifloxacin, clindamycin, tetracycline and rifampin. The multidrug-resistant isolate contained the erm(X), tet(W), cmx, aphA1-IAB, strAB and sul1 resistance genes known from the R plasmid pJA144188 of Corynebacterium resistens. These genes were absent in the genome of the antibiotic-sensitive isolate. This report confirms the tropism of this microorganism for women's breasts and presents the first description of a multidrug-resistant C. kroppenstedtii strain.

Background. Fish have photoperiod-dependent rhythms (circadian cycle of about 24 h), including the enzymatic secretion cycles, and this information has not been available for Nile tilapia, Oreochromis niloticus (Linnaeus, 1758). The knowledge on the digestive enzymes in Nile tilapia may have practical implications in fish nutrition. The aim of the presently reported study was to determine the circadian cycle of digestive enzyme production of Nile tilapia, in fasting and feeding regimes, in hope to receive information that might improve feeding schedules of this fish in aquaculture. Materials and methods. In juvenile Nile tilapia the circadian cycle of concentrations of total soluble protein, protease, pepsin-like, trypsin, chymotrypsin, amylase, and lipase were determined. The baseline (fasting) and feeding conditions (ad libitum) were sampled and monitoring every hour for 24 h. Results. The basal peak of enzyme activity in the intestine occurred at 18:44 h for amylase, at 19:57 h for proteases, and 20:29 for trypsin. The minimal activity for most enzymes, appeared between 4:51 h (amylase) and 10:13 h (lipases). In the feeding treatment (ad libitum), stomach activity (pepsin-like) had maximal activity at 20:06 h and minimal activity 05:46 h. Intestinal amylase activity covered an extended period of low enzymatic activity beginning at the 05:46 h and ending at 12:59 h. The peak of digestive enzyme activity occurred within 18:44–20:29 h. In general, secretion of digestive enzymes was positively stimulated by food, for all enzymes assayed. Conclusion. Nile tilapia has a higher digestive enzyme activity at night than during the day. Knowledge of the circadian cycle of digestive enzymes, and modifications initiated by food, is useful to establish feeding times. If feeding schedules are adjusted to coincide with maximum natural peaks, feed efficiency will increase, which will be reflected in weight gain of the fish and provide more profitable yields for aquaculture.

Chagas' myocardiopathy, caused by the intracellular protozoan Trypanosoma cruzi, is characterized by microvascular alterations, heart failure and arrhythmias. Ischemia and arrythmogenesis have been attributed to proteins shed by the parasite, although this has not been fully demonstrated. The aim of the present investigation was to study the effect of substances shed by T. cruzi on ischemia/reperfusion-induced arrhythmias. We performed a triple ischemia-reperfusion (I/R) protocol whereby the isolated beating rat hearts were perfused with either Vero-control or Vero T. cruzi-infected conditioned medium during the different stages of ischemia and subsequently reperfused with Tyrode's solution. ECG and heart rate were recorded during the entire experiment. We observed that triple I/R-induced bradycardia was associated with the generation of auricular-ventricular blockade during ischemia and non-sustained nodal and ventricular tachycardia during reperfusion. Interestingly, perfusion with Vero-infected medium produced a delay in the reperfusion-induced recovery of heart rate, increased the frequency of tachycardic events and induced ventricular fibrillation. These results suggest that the presence of parasite-shed substances in conditioned media enhances the arrhythmogenic effects that occur during the I/R protocol.

Este artículo ofrece un esquema para el cálculo de la movilidad de electrones en una estructura de pozo delta dopado, a bajas temperaturas y para campos eléctricos aplicados no muy intensos. El análisis se hace para un sistema dopado tipo n , considerando una lámina de impurezas de silicio en una muestra de GaAs . Se tiene en cuanta explícitamente el carácter tridimensional de los estados electrónicos y de las magnitudes que se miden – en lugar de realizar aproximaciones en que se reduzcan las dimensiones del sistema – , lo que facilita la ejecución del cálculo. Se exponen los resultados de otros esquemas utilizados y se dan las fórmulas que se emplearán para comprobar y comparar nuestros cálculos con los reportados previamente. En la actualidad, se está en el proceso de implementación del cálculo numérico, del que se expone el algoritmo que se tiene en ejecución.

Se comparó el efecto de la inclusión dietética del 10% de quistes decapsulados de Artemia (qda) y una dieta comercial (dc), en el crecimiento y supervivencia de crías de O. niloticus, por 30 días. El peso promedio de los peces al inicio del experimento fue: 0.0173 ± 0.005 g. Las crías alimentadas con la dieta 90% dc + 10% qda fueron 0.6 g más pesadas, comparadas con dc; registrando un peso final de 1.3 ± 0.15 g. Se observaron diferencias significativas (P < 0.05) en la ganancia diaria de peso, el crecimiento específico y la conversión alimenticia entre las dietas.

La parte baja de la Cuenca del Guayalejo en el sur del Estado de Tamaulipas, México se ha beneficiado por el agua que capta la “Reserva de la Biosfera El Cielo”, el presente trabajo tuvo como objetivo estimar el costo por servicios ambientales hidrológicos, por uso de agua. Se realizó un seguimiento en cuatro sitios al cultivo de la caña de azúcar. Se obtuvo información estadística con relación a la disponibilidad y uso del agua en la Cuenca, para el análisis se aplicaron los métodos; cambios en la producción (uso agrícola) y el valor de recuperación (uso potable e industrial). Los resultados mostraron que los sistemas de riego presurizados influyeron en el mayor rendimiento de caña y eficiencia en el uso de agua, el sitio Katanga tuvo una producción de 126,25 t ha-1, en el predio Mexicali con 0,7 cm de agua produjo una tonelada de caña. El análisis mostró que el costo por servicios ambientales hidrológicos por uso del agua para la agricultura fue de $0,39 (pesos mexicanos) por metro cúbico de agua utilizado y para uso potable el costo de recuperación fue de $0,12 por metro cúbico de agua potable e industrial consumido.

Antecedentes: Es alta la frecuencia de complicaciones y muerte temprana en pacientes con desnutrición a quienes se les realiza cistectomía radical con conducto ileal. El papel del soporte nutricional artificial aún es controversial sobre sus efectos a corto plazo. Objetivo: Determinar si la nutrición parenteral total reduce la frecuencia de complicaciones y muerte cuando es administrada en el periodo postoperatorio inmediato. Diseño: Cohorte. Ubicación: Hospital de referencia de tercer nivel. Sujetos: Ciento catorce pacientes consecutivos tratados con cistectomía radical y conducto ileal entre enero de 2000 a Junio de 2004. Intervenciones: Ochenta y un pacientes recibieron nutrición parenteral total postoperatoria durante un promedio de 9.2 días y 33 controles recibieron solución glucosada 5% + salina 0.9%. Principales resultados y mediciones: Treinta y seis (31.6%) pacientes se complicaron y once murieron (9.6%).Las principales complicaciones relacionadas con muerte fueron quirúrgicas. Después de un análisis multivariado de regresión logística, y de acuerdo al riesgo e intervención nutricional se encontró en el grupo con desnutrición grave una reducción importante (RR=0.09, IC95%=0.02-0.33,p=0.008) en la frecuencia de muerte temprana. La dehiscencia de anastomosis en presencia de sepsis abdominal fue el factor predictor más importante de muerte temprana(RR=5.0; IC95%=1.45-17-3; p=0.007). Conclusiones: El grupo sin desnutrición o con desnutrición leve no se beneficia de la nutrición parenteral total postoperatoria.Background: The frequency of complications and early death in patients with hyponutrition and total radical cystectomy with ileal duct is high. The role of artificial nutritional support on short-term outcomes is still controversial. Objective: to determine whether total parenteral nutrition reduces the frequency of complications and death when it is administered during the immediate post-surgical period. Design: cohort study. Setting: third-level reference hospital. Subjects: One hundred and fourteen consecutive patients having radical cystectomy and ileal duct between January of 2000 and June of 2004. Interventions: Eight-one patients received post-surgical total parenteral nutrition for an average of 9.2 days, and 33 controls received 5% dextrose solution + 0.9% saline solution. Main results and measurements: thirty-six (31.6%) patients had complications and 11 (9.6%) died. The main death-related complications were of surgical origin.After a multiple regression multivariate analysis, and according to risk and nutritional intervention, an important reduction of early death was found in the group with severe hyponutrition (RR = 0.09; 95% CI =0.02-0.33; p = 0.008). Anastomosis dehiscence in the presence of abdominal sepsis was the most important predictive factor of early death (RR = 5.0; 95% CI = 1.45-17.3; p = 0.007). Conclusions: The group with no hyponutrition or with mild hyponutrition does not benefit from post-surgical total parenteral nutrition.

Se estudiaron 91 aislamientos de Pseudomonas aeruginosa resistentes a carbapenemes con el objetivo de conocer la prevalencia de metalo-β-lactamasas y evaluar la habilidad del ensayo de inhibición empleando discos de EDTA (1 µmol) en su detección. Se determinó la presencia de carbapenemasas en 10 (11%) de los aislamientos recuperados. La sensibilidad a aztreonam en los aislamientos resistentes a ambos carbapenemes resultó un buen predictor de la presencia de estas enzimas. Dichas carbapenemasas correspondieron a la enzima VIM-2 en tres de ellos y a VIM-11 en otros siete. En todos los casos los genes codificantes de estas enzimas se encontraron localizados en integrones de clase 1 seguidos corriente abajo de genes codificantes de enzimas acetilantes de antibióticos aminoglucosídicos. El ensayo de detección fenotípica de metalo-β-lactamasas empleando discos de EDTA mostró un 100% de especificidad y sensibilidad en la detección de estas enzimas en la población de Pseudomonas aeruginosa analizadas.The present study was conducted to estimate the prevalence of metallo-β-lactamases in 91 consecutive carbapenem resistant Pseudomonas aeruginosa isolates, recovered from inpatients at Hospital de Clínicas in Buenos Aires. Both, phenotypic and genotypic methods detected the presence of carbapenemases in 10 (11%) isolates, corresponding to VIM-11 in 7/10 and VIM-2 in the others. Codifying genes were all included in class 1 integrons, upstream genes coding for aminoglycoside modifying enzymes. One hundred percent sensitivity and specificity was achieved by the metallo-β-lactamases phenotypic screening method using EDTA (1 µmol) disks in the Pseudomonas aeruginosa isolates included in this study. Sensitivity to aztreonam in carbapenem resistant isolates was suspicious of the presence of these enzymes.

Introducción: No existe un método de valoración nutricional universalmente aceptado. Los expertos de ASPEN (2002) sugieren utilizar la valoración subjetiva global (VSG), mientras que los de ESPEN (2002) recomiendan el sistema NRS-2002. Objetivos y ámbito: Este estudio transversal tiene como objetivos: 1) conocer la prevalencia de malnutrición al ingreso hospitalario en un hospital terciario y 2) conocer el grado de asociación entre dos herramientas utilizadas para valorar el estado de nutrición: la VSG y el sistema NRS-2002. Material y métodos: Se estudian 135 pacientes (42,2 % mujeres y 58,8 % varones, edad 62,1 ± 14,5 años) en los tres primeros días del ingreso hospitalario, ingresados en camas de Medicina Interna y Cirugía. Se analizan diferentes variables del estado nutricional. Se compara las necesidades calóricas (Harris Benedict x factor de agresión) y la ingesta calórica del día anterior al ingreso, mediante recordatorio de 24 horas. Se calcula la prevalencia de malnutrición al ingreso con dos herramientas de screening: VSG y el sistema NRS-2002. Resultados: El 42,2 % de los pacientes reconocen haber perdido peso y el 39,3 % ingieren una dieta inferior a sus necesidades al ingreso en el hospital. Según el método utilizado de valoración nutricional, la prevalencia de malnutrición es del 40,7 y del 45,1/100 pacientes ingresados con el VSG y el NRS-2002, respectivamente. Existe una asociación significativa entre los resultados obtenidos con ambas herramientas (p = 0,000). Los niveles de albúmina sérica y linfocitos totales son inferiores en los pacientes malnutridos. Conclusiones: La prevalencia de malnutrición al ingreso hospitalario es elevada. Existe una asociación estrecha entre los resultados obtenidos con la VSG y el sistema NRS-2002. Aunque en la práctica clínica cualquiera de los dos métodos puede ser utilizado para valorar el estado de nutrición, consideramos que el sistema NRS-2002, aunque más complejo, es menos subjetivo.Introducion: There is no "gold standar" for identification of malnutrition. The ASPEN board of directors (2002) suggest the subjective global assessment (SGA) and ESPEN (2002) recommend the nutritional risk screening-2002 (NRS-2002) to detect the prevalence of malnutrition. Aims: This cross-sectional study aims 1) to assess the prevalence of malnutrition on admission and 2) to know association between two tools used to evaluate nutritional risk. Material and methods: 135 patients (42.2% women and 58.8% men, 62.1 ± 14.4 years) are studied at admission. Different parameters are assessed to evaluate nutritional state. Patient's energy requirements (Harris Benedict x Long's factor) and energy intake, calculated as 24 h-recall, are compared. The prevalence of malnutrition is assessed with two screening tools: SGA and NRS-2002. Results: 42.2% of the patients had lost more than 5% body weight and 39.3% had an intake lower than required at admission. The prevalence of malnutrition is 40.7 and 45.1/100 patients admitted at hospital, if SGA or NRS-2002 are used, respectivility. There is strong agreement between results of two nutritional assessment methods (p = 0.000). Serum albumin and protein concentrations and linfocytes count are less in the malnourished patients. Conclusions: The prevalence of malnutrition is elevated. In clinical practice, both methods could be used to identify patients at nutritional risk, but the NRS-2002 is a less subjective method.

Abstract Leukemias and their bone marrow microenvironments undergo dynamic changes over the course of disease. However, little is known about the circulation kinetics of leukemia cells, nor the impact of specific factors on the clearance of circulating leukemia cells (CLCs) from the blood. To gain a basic understanding of CLC dynamics over the course of disease progression and therapeutic response, we apply a blood exchange method to mouse models of acute leukemia. We find that CLCs circulate in the blood for 1–2 orders of magnitude longer than solid tumor circulating tumor cells. We further observe that: (i) leukemia presence in the marrow can limit the clearance of CLCs in a model of acute lymphocytic leukemia (ALL), and (ii) CLCs in a model of relapsed acute myeloid leukemia (AML) can clear faster than their untreated counterparts. Our approach can also directly quantify the impact of microenvironmental factors on CLC clearance properties. For example, data from two leukemia models suggest that E-selectin, a vascular adhesion molecule, alters CLC clearance. Our research highlights that clearance rates of CLCs can vary in response to tumor and treatment status and provides a strategy for identifying basic processes and factors that govern the kinetics of circulating cells.

Background Socioeconomic factors may lead to a disproportionate impact on health care usage and death among individuals with congenital heart defects (CHD) by race, ethnicity, and socioeconomic factors. How neighborhood poverty affects racial and ethnic disparities in health care usage and death among individuals with CHD across the life span is not well described. Methods and Results Individuals aged 1 to 64 years, with at least 1 CHD‐related International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM) code were identified from health care encounters between January 1, 2011, and December 31, 2013, from 4 US sites. Residence was classified into lower‐ or higher‐poverty neighborhoods on the basis of zip code tabulation area from the 2014 American Community Survey 5‐year estimates. Multivariable logistic regression models, adjusting for site, sex, CHD anatomic severity, and insurance‐evaluated associations between race and ethnicity, and health care usage and death, stratified by neighborhood poverty. Of 31 542 individuals, 22.2% were non‐Hispanic Black and 17.0% Hispanic. In high‐poverty neighborhoods, non‐Hispanic Black (44.4%) and Hispanic (47.7%) individuals, respectively, were more likely to be hospitalized (adjusted odds ratio [aOR], 1.2 [95% CI, 1.1–1.3]; and aOR, 1.3 [95% CI, 1.2–1.5]) and have emergency department visits (aOR, 1.3 [95% CI, 1.2–1.5] and aOR, 1.8 [95% CI, 1.5–2.0]) compared with non‐Hispanic White individuals. In high poverty neighborhoods, non‐Hispanic Black individuals with CHD had 1.7 times the odds of death compared with non‐Hispanic White individuals in high‐poverty neighborhoods (95% CI, 1.1–2.7). Racial and ethnic disparities in health care usage were similar in low‐poverty neighborhoods, but disparities in death were attenuated (aOR for non‐Hispanic Black, 1.2 [95% CI=0.9–1.7]). Conclusions Racial and ethnic disparities in health care usage were found among individuals with CHD in low‐ and high‐poverty neighborhoods, but mortality disparities were larger in high‐poverty neighborhoods. Understanding individual‐ and community‐level social determinants of health, including access to health care, may help address racial and ethnic inequities in health care usage and death among individuals with CHD.

In an increasingly aging world, the effort to automate tasks associated with the care of elderly dependent individuals becomes more and more relevant if quality care provision at sustainable costs is desired. One of the tasks susceptible to automation in this field is the automatic detection of falls. The research effort undertaken to develop automatic fall detection systems has been quite substantial and has resulted in reliable fall detection systems. However, individuals who could benefit from these systems only consider their use in certain scenarios. Among them, a relevant scenario is the one associated to semi-supervised patients during the night who wake up and get out of bed, usually disoriented, feeling an urgent need to go to the toilet. Under these circumstances, usually, the person is not supervised, and a fall could go unnoticed until the next morning, delaying the arrival of urgently needed assistance. In this scenario, associated with nighttime rest, the patient prioritizes comfort, and in this situation, body-worn sensors typical of wearable systems are not a good option. Environmental systems, particularly visual-based ones with cameras deployed in the patient’s environment, could be the ideal option for this scenario. However, it is necessary to work with far-infrared (FIR) images in the low-light conditions of this environment. This work develops and implements, for the first time, a fall detection system that works with FIR imagery. The system integrates the output of a human pose estimation neural network with a detection methodology which uses the relative movement of the body’s most important joints in order to determine whether a fall has taken place. The pose estimation neural networks used represent the most relevant architectures in this field and have been trained using the first large public labeled FIR dataset. Thus, we have developed the first vision-based fall detection system working on FIR imagery able to operate in conditions of absolute darkness whose performance indexes are equivalent to the ones of equivalent systems working on conventional RGB images.

Dengue is a significant disease transmitted by Aedes mosquitoes in the tropics and subtropics worldwide. The disease is caused by four virus (DENV) serotypes and is transmitted to humans by female Aedes aegypti mosquito bites infected with the virus and vertically to their progeny. Current strategies to control dengue transmission focus on the vector. In this study, we describe an indirect Enzyme-Linked Immunosorbent Assay (ELISA), using a monoclonal antibody against the non-structural dengue virus protein 1 (NS1), to detect DENV2 in Ae. aegypti eggs. The assay detects NS1 in eggs homogenates with 87.5% sensitivity and 75.0% specificity and it is proposed as a tool for the routine entomovirological surveillance of DENV 2 in field mosquito populations.

La válvula ATS 3f Enable® (Medtronic) es una prótesis biológica de pericardio, diseñada como una válvula tubular para optimizar sus características hemodinámicas y disminuir el estrés. Descripción de las posibles indicaciones de la válvula aórtica 3f Enable® sin sutura seg?estra experiencia. Material y métodos: Desde mayo de 2010 se han implantado 10 válvulas 3f Enable®, eligiendo pacientes con anillo aórtico pequeño (< 21 mm) e índice de masa corporal (IMC) igual o superior a 30 o con estenosis protésica de 19 mm. El tamaño de los implantes fue: 19 mm: 5, 21 mm: 4, y 23 mm: 1. Perfil clínico de los pacientes: edad media: 72 años. Estenosis aórtica protésica: 2 pacientes. EuroSCORE medio: 6,3. El IMC medio de los pacientes con estenosis nativa: 32. En tres pacientes se realizaron injertos concomitantes. Resultados: Todos los implantes se realizaron con éxito. En dos pacientes fue necesaria la recolocación de la prótesis por insuficiencia antes de descontinuar la circulación extracorpórea. El tiempo medio de isquemia fue de 61 min, con un rango de 22–81 min. Los gradientes pico obtenidos fueron 21 ± 6 mmHg y los gradientes medios de 11 ± 3 mmHg. Un paciente requirió reintervención por insuficiencia grave debido a inframedición de la prótesis. Conclusiones: La prótesis 3f Enable® presenta un excelente comportamiento hemodinámico en pacientes con anillo aórtico pequeño y con un IMC igual o superior a 30 y consiguiente riesgo de mismatch. La estenosis protésica de 19 mm también se podría considerar como indicación de implante de esta válvula.

La sustitución valvular mitral es el tratamiento estandarizado en caso de endocarditis mitral, pero no son pocos los inconvenientes de las prótesis valvulares como reinfección, trombosis o degeneración. Presentamos nuestra serie de pacientes con endocarditis en los cuales se reparó la válvula mitral en los últimos 5 años. Ciento cinco pacientes intervenidos de endocarditis de los cuales 63 presentaban infección mitral; en 15 pacientes (24%), tras resecar todo el tejido infectado, se reparó la válvula mitral mediante resección cuadrangular del velo posterior, comisuroplastia, parche de pericardio o implante de neocuerdas. Edad media: 64,9 ± 17,3. Varones: 57%. Hipertensión pulmonar: 2 (13%). Insuficiencia renal: 3 (20%). Disfunción ventricular: 2 (13%). EuroSCORE medio: 26%. Resultados: Mortalidad hospitalaria: 1 (6,5%). Seguimiento: 100% de los pacientes. Seguimiento medio: 27 ± 15 meses. Endocarditis recurrente: 1 (6,5%). Sustitución valvular por disfunción de la plastia: 1 (6,5%). Mortalidad en el seguimiento: 1 paciente de causa no cardíaca ni infecciosa. Pacientes libres de endocarditis e insuficiencia mitral: 85,7%. Pacientes no anticoagulados: 92,9%. Conclusiones: Con la suficiente experiencia en reparación mitral, la reparación de la válvula mitral con endocarditis se puede realizar con una baja mortalidad quirúrgica además de aportar las ventajas de conservar la válvula nativa con una baja tasa de reoperación.

En la actualidad existe controversia acerca del tipo adecuado de canulación para los dispositivos de asistencia circulatoria izquierda. Algunos autores defienden la superioridad de la canulación apical, en cuanto a la optimización de flujos medios del dispositivo y sangrado perioperatorio1,2. En los últimos 2 años se han implantado en nuestro centro un total de 22 dispositivos Abiomed BVS 5000, 18 de ellos fueron canulados por el ápex del ventrículo izquierdo (grupo I), mientras que 4 fueron canulados por la aurícula izquierda (grupo II). Del total de enfermos, el 59,09% llegaron al trasplante cardíaco, falleciendo el 30% de los trasplantados; la mortalidad global fue del 54,55%. Analizando comparativamente las cifras de sangrado medio en 24 h y el flujo medio del dispositivo en nuestra serie, el grupo I presentó unas cifras de flujo medio significativamente mayores (4,8 1/min en el grupo I frente a 4,1 1/min en el grupo II), así como menos sangrado 24 h. La mortalidad del grupo I fue del 50% (9 de 18), frente al 75% del grupo II (1 de 4). A pesar del reducido número de enfermos, los datos obtenidos en nuestro centro insinúan mejores parámetros hemodinámicos usando la canulación apical. Sería necesario realizar estudios posteriores con un mayor tamaño muestral para obtener conclusiones definitivas.

El vídeo muestra la cirugía de una enferma de 42 años que acude a nuestro centro diagnosticada de hidatidosis miocárdica. Bajo anestesia general, hipotermia moderada y circulación extracorpórea se realiza una pericistectomía completa, con instilación de suero hipertónico dentro del quiste y con reconstrucción posterior de la pared ventricular. La película incluye clips de ecocardiograma pre y postoperatorio, así como la cardiorresonancia.