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The gas-phase reaction networks are the backbone of astrochemical models. However, due to their complexity and non-linear impact on the astrochemical modeling, they can be the first source of error in the simulations if incorrect reactions are present. Over time, following the increasing number of species detected, astrochemists have added new reactions, based on laboratory experiments and quantum mechanics (QM) computations as well as reactions inferred by chemical intuition and similarity principle. However, sometimes no verification of their feasibility in the interstellar conditions, namely their exothermicity, was performed. In this work, we present a new gas-phase reaction network, GRETOBAPE, based on the KIDA2014 network and updated with several reactions, cleaned from endothermic reactions not explicitly recognized as such. To this end, we characterized all the species in the GRETOBAPE network with accurate QM calculations. We found that 5% of the reactions in the original network are endothermic although most of them are reported as barrierless. The reaction network of Si-bearing species is the most impacted by the endothermicity cleaning process. We also produced a cleaned reduced network, GRETOBAPE-red, to be used to simulate astrochemical situations where only C-, O-, N- and S- bearing species with less than 6 atoms are needed. Finally, the new GRETOBAPE network, its reduced version, as well as the database with all the molecular properties are made publicly available. The species properties database can be used in the future to test the feasibility of possibly new reactions., Comment: ApJS submitted

Poster presented at the Fifth Congress of the International BioIron Society (2013) that took place in the University College London (London, United Kingdom) during 14-18th April 2013., [Introduction] Iron oxide nanoparticles (IONP) have become a powerful platform for several biomedical and environmental applications. The potential of IONP to act as contrast agent, drug and/or gene carrier, biological sensing, or hyperthermia mediator have been proved, however, the assessment of their safety and biocompatibility is mandatory prior to extending theiruse. Thus, the toxicity, biodistribution and excretion after long term exposure of IONP have to be elucidated, [Methods and Materials] The present study reports the iron bioavailability of ingested maghemite (gamma-Fe2O3) IONP. We use chickens as suitable animal model to determine iron availability from maghemite IONP. Thus, we test the effect of a 14 days sustained ingestion of maghemite IONP (sized 6.5 and 12 nm) on plasma haemoglobin, iron excretion and accumulation in spleen and liver.Four experimental diets were fed ad libitum to chickens (12 per experimental group) from 7 to 21 days of age. One of the four groups received a basal iron-deficient diet (with no supplemental iron) while the other three groups were fed with iron-sufficient diets formulated to meet iron requirements by adding a commercial iron source (FeSO4) and two different size (6.5 and 12nm) IONP to the basal diet., [Results] After 14 days, faeces were collected and blood was sampled after an overnight fast to determine haemoglobin concentration with the cyanmethemoglobin method. Then, birds were euthanized and liver and spleen were collected, weighed and lyophilized for iron and IONP detection and quantification by atomic absorption spectrophotometry and magnetic susceptibility, respectively. Body and organ weight, and feed intake were similar among the four experimental groups. However, chickens fed the iron-deficient diet showed a reduction in plasma haemoglobin and haematocrit values and a lower iron concentration in faeces, liver and spleen than that of chickens fed ironsufficient diets, irrespective of the iron source., [Conclusion] For all parameters studied, no differences were observed among chickens fed diets supplemented with different iron sources. The latter result reflects a similar iron bioavailability from IONP than that from FeSO4, in agreement with a previous studies reporting no histological accumulation of IONP in tissues of rats fed diets containing iron based nanostructures. The size of IONP does not affect the iron bioavailability. In conclusion, our results indicate that iron from IONP is bioavailable, with no IONP accumulation in the liver or the spleen.

The Last Interglacial is considered the most suitable episode from which to infer patterns of rapid sea-level change since its climatic conditions were similar to those of the present interglacial. However, specifying the true position of its sea level with high accuracy is very troublesome in the absence of sedimentological, erosional or even palaeontological markers. This study investigates the morphosedimentary evidence (beach deposits, cliff, notch and shore platform) of two highstands registered and dated during MIS 5 stage by U-series dating in the North of Morocco (Strait of Gibraltar). Bioerosive notches and mixed siliciclastic and carbonate deposits, high energy beaches with algal bioherms, were formed in coastal environments during MIS 5a. A sea-level height of +10 m asl can be inferred for this substage. The record of MIS 5e substage is less defined in the geomorphological record, consisting of backshore/foreshore deposits located at +13 to +15 m asl. A tectonic uplift rate of ~0.1 mm/yr has been estimated for the last 130 kyr. These data are consistent with models of coastal uplifting calculated for the Strait of Gibraltar. Ministerio de Ciencia e Innovación CGL2010-15810/BTE

Introducción: La Gastrostomía Percutánea Endoscópica (PEG), es un método seguro y efectivo que ofrece claras ventajas respecto a la alimentación por sonda naso-gástrica para conseguir una nutrición adecuada en pacientes con problemas de deglución, pero que mantienen intacto el sistema digestivo. Sin embargo, a pesar de ser considerada una técnica segura no está exenta de complicaciones graves. Presentamos una paciente con disfagia que tras la práctica de la gastrostomía endoscópica percutánea desarrolla una anemización severa con gran hematoma subcutáneo, dado lo excepcional del caso y revisamos la literatura. Endoscopic percutaneous gastrostomy (PEG) is a safe and effective procedure that offers clear advantages over nasogastric tube feeding to ensure adequate nutrition in patients with swallowing problems who have an intact digestive tract. With proper placement and monitoring methodology there are few complications in both the peritrack procedure as in the long run. However, despite being considered a safe technique it is not devoided of serious complications. We report a patient with dysphagia, requiring percutaneous endoscopic gastrostomy placement developing a severe anemia with severe subcutaneous hematoma, given the exceptional case and literature review.

We here report the leaf-cutter bee Megachile (Eutricharaea) timberlakei Cockerell1920 (Megachilidae) as a third bee species in the Gala´pagos. The species is currentlyknown from the Hawaiian Islands and was collected during floral inventories on SanCristo´ bal. We provide floral records as well as a diagnosis and comparativecomments that will assist bee researchers to easily recognize this species from othernative and adventive Megachile Latreille to the Americas. We also discuss thepossible routes to the Gala´pagos.

Introducción: La Gastrostomía Percutánea Endoscópica (PEG), es un método seguro y efectivo que ofrece claras ventajas respecto a la alimentación por sonda naso-gástrica para conseguir una nutrición adecuada en pacientes con problemas de deglución, pero que mantienen intacto el sistema digestivo. Sin embargo, a pesar de ser considerada una técnica segura no está exenta de complicaciones graves. Presentamos una paciente con disfagia que tras la práctica de la gastrostomía endoscópica percutánea desarrolla una anemización severa con gran hematoma subcutáneo, dado lo excepcional del caso y revisamos la literatura.

This study investigates the morpho-sedimentary evidence of two highstands registered and dated during MIS 5 stage by U-series dating in the North of Morocco (Strait of Gibraltar). Bioerosive notch and mixed siliciclastic and carbonate deposits, high energy beaches with algal bioherms, were formed in coastal environments during MIS 5a. A sea-level altitude of +10 m asl was inferred for this substage. The record of MIS 5e-2 substage is less complete, consisting in upper foreshore and storm deposits located some meters above the sea-level (+13-15 m asl). A tectonic uplift rate of ~0.1 mm/yr has been estimated for the last 130 ky. This data is consistent with models of coastal uplifts elaborated for the Gibraltar Strait. Este trabajo analiza las evidencias morfosedimentarias de dos altas paradas del nivel marino datadas en el MIS 5 mediante series de U en el Norte de Marruecos. Durante el MIS 5a se formaron socaves bioerosivos (notches) y facies de playas de alta energía constituidas por depósitos mixtos siliciclástico-carbonatados. Una altura de 10 m snm ha sido estimada para esta etapa. El registro del MIS 5e-2 es menos completo, constituidos por depósitos de foreshore y de tormenta formados varios metros sobre el nivel del mar (+13-15 m snm). Se ha deducido una tasa de elevación tectónica de 0.1 mm/año para los últimos 130 ka. Estos datos son consistentes con los modelos previos de levantamiento tectónico elaborados para el Estrecho de Gibraltar. Ministerio de Ciencia, Innovación y Universidades CGL2010-15810/BTE

La Ciudad Autónoma de Ceuta posee un litoral con una longitud de más 25 km donde se concentra gran parte de su población. En estas costas se describen numerosos procesos geológicos que conllevan una importante peligrosidad potencial para la vida humana e infraestructuras. El objetivo de este trabajo es describir y analizar cada uno de estos procesos mediante la construcción de mapas de peligrosidad de inundaciones y avenidas fluviales; deslizamientos y caída de rocas; y temporales, tsunamis y ascenso del nivel del mar. Aunque aproximadamente sólo el 15% del territorio de Ceuta se encuentra afectada potencialmente por algún tipo de proceso peligroso, hay que destacar que más del 70% de la superficie de su litoral sí se encuentra expuesto. Las zonas consideradas de mayor peligrosidad coinciden con espacios donde se concentran varios tipos de procesos que actúan con grados de peligrosidad alta a muy alta. Son sectores costeros relativamente planos, aunque anexos a zonas más escarpadas, donde desembocan arroyos y barrancos que presentan un comportamiento de marcado carácter estacional., The coastal line of Ceuta is more than 25 km length, where a great amount of population is placed. Along this coast many geological processes have been described and imply a great threat for both human and infrastructure. The aim of this work is to analyse these processes by means of geological hazard mapping focused on flooding and flash flood, landslide and rock fall, storms, tsunamis and sea-level rise. These maps are valuable tools to predict and reduce the response-time with respect to catastrophic natural processes and territorial management. Although approximately only 15% of the Ceuta territory is exposed, more than 70% of its coastal area is exposed to geological hazards. Zones of higher hazard are located where several -high to very high degree- hazard processes could take place even simultaneously. This scenario is mainly found in relatively flat coastal sectors but attached to steep zones, where stream mouths and gorges are placed and display a strong seasonal behaviour.

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Cardiac valve lesions after a blunt chest trauma are rare and less than 1% of cardiac lesions because of chest trauma affect the tricuspid valve. We report a 70 year-old female that suffered a severe chest trauma in a car accident. During the repair of the multiple skeletal lesions, the patient had a severe hemodynamic decompensation. A myocardial trauma with pericardial effusion and massive tricuspid insufficiency, due to anterior leaflet prolapse, was diagnosed on echocardiography. After discharge the patient remained in functional class II, with hepatomegaly, jugular ingurgitation and lower limb edema. A control echocardiogram, performed six months after the accident, showed dilatation of right heart chambers and massive tricuspid insufficiency. The patient was operated, and a tricuspid valve repair was performed suturing the ruptured papillary muscle to the ventricular wall and performing a tricuspid annuloplasty with a prosthetic ring. After 15 months of follow up, the patient remains asymptomatic.

Cardiac valve lesions after a blunt chest trauma are rare and lessthan 1% of cardiac lesions because of chest trauma affect the tricuspid valve. We report a 70year-old female that suffered a severe chest trauma in a car accident. During the repair of themultiple skeletal lesions, the patient had a severe hemodynamic decompensation. A myocardialtrauma with pericardial effusion and massive tricuspid insufficiency, due to anterior leafletprolapse, was diagnosed on echocardiography. After discharge the patient remained infunctional class II, with hepatomegaly, jugular ingurgitation and lower limb edema. A controlechocardiogram, perfomed six months after the accident, showed dilatation of right heartchambers and massive tricuspid insufficiency. The patient was operated, and a tricuspid valverepair was performed suturing the ruptured papillary muscle to the ventricular wall andperforming a triscuspid annuloplasty with a prosthetic ring. After 15 months of follow up, thepatient remains asymptomatic (Rev Med Chile 2008; 136: 1034-8).(

Cardiac valve lesions after a blunt chest trauma are rare and less than 1% of cardiac lesions because of chest trauma affect the tricuspid valve. We report a 70 year-old female that suffered a severe chest trauma in a car accident. Duríng the repair of the múltiple skeletal lesions, the patient had a severe hemodynamic decompensation. A myocardial trauma with pericardial effusion and massive tricuspid insufficiency, due to anterior leaflet prolapse, was diagnosed on echocardiography. After discharge the patient remained in functional class II, with hepatomegaly, jugular ingurgitation and lower limb edema. A control echocardiogram, perfomed six months after the accident, showed dilatation of right heart chambers and massive tricuspid insufficiency. The patient was operated, and a tricuspid valve repair was performed suturing the ruptured papillary muscle to the ventricular wall and performing a triscuspid annuloplasty with a prosthetic ring. After 15 months of follow up, the patient remains asymptomatic.

In this issue of the journal Lanas et al report an estimation ofpopulation attributable risk (PAR) for myocardial infarction (MI) derived from different riskfactors in Chile. Cigarette smoking, dyslipidemia and hypertension accounted for 71% of totalPAR. Mortality from MI has decreased in Chile, but epidemiologic surveys carried out indifferent hospitals across the country, strongly support that most of this effect comes from bettertreatment of MI. Recent changes in public health policies, favoring the treatment of hypertensionand diabetes may help control cardiovascular morbidity and mortality. However, a reallysignificant impact will be obtained when the development of the disease may be halted. Toevaluate this possibility, newer methods to diagnose atherosclerosis non invasively may come toour rescue. On the other hand, pharmacologic treatment of dyslipidemia and hypertensioncontinue to offer the most powerful way to decrease levels of cardiovascular risk factors.According to current knowledge, wise balance of non pharmacologic and pharmacologicmeans of primary prevention, with due respect for ethic aspects, is the most effective way tocurve the epidemic of coronary artery disease in Chile (Rev Med Chile 2008; 136: 551-4).(

In this issue of the journal Lanas et al report an estimation of population attributable risk (PAR) for myocardial infarction (MI) derived from different risk factors in Chile. Cigarette smoking, dyslipidemia and hypertension accounted for 71% of total PAR. Mortality from MI has decreased in Chile, but epidemiologic surveys carried out in different hospitals across the country, strongly support that most of this effect comes from better treatment of MI. Recent changes in public health policies, favoring the treatment of hypertension and diabetes may help control cardiovascular morbidity and mortality. However, a really significant impact will be obtained when the development of the disease may be halted. To evaluate this possibility, newer methods to diagnose atherosclerosis non invasively may come to our rescue. On the other hand, pharmacologic treatment of dyslipidemia and hypertension continue to offer the most powerful way to decrease levels of cardiovascular risk factors. According to current knowledge, wise balance of non pharmacologic and pharmacologic means of primary prevention, with due respect for ethic aspects, is the most effective way to curve the epidemic of coronary artery disease in Chile

The micro-morphologic and bioerosive features, analyzed in the Benzú shelter (Ceuta), allow us to deduce an erosion marine surface elaborated onto dolomite triassic substrate. The Entobia-Gastrochaenolites Ichnoassociation and Entobia ichnofacies denote high energy coastal or shallow marine environment with low sedimentation rates. Two phases are differentiated in the evolution of these bioerosive structures: the first one defined by great borings of Gastrochaenolites, and the second recorded by bioerosive activity of Entobia and truncation of both, the previous borings and the cliff surface.

SWC3 is a porcine CD that has been the reference marker of myeloid lineage. It is expressed in every myelomonocytic cell from early bone marrow precursors. We have identified the molecule recognized by anti-SWC3 antibodies as a member of the signal-regulatory proteins (SIRPs)α family. Here, we describe the cloning of a cDNA coding for a porcine SIRPα protein. The sequence is 2470 nucleotides long and contains an open reading frame encoding a 507 amino acid sequence. The predicted polypeptide was composed of a 30 amino acids putative signal peptide, a 342 amino acid extracellular region, a 23 amino acid transmembrane segment and a 112 amino acid cytoplasmic domain. Analysis of the sequence reveals a high degree of homology with known SIRPs in other species, being easily identified the three extracellular Ig type domains and two cytoplasmic ITIM motifs characteristic of this molecule. The gene coding for porcine SIRPα has been mapped to porcine chromosome 17, in a region syntenic to the human chromosome 20 where SIRP genes have been mapped. During the analysis of SIRP gene expression in tissues by RT-PCR, we noticed the existence of a shorter mRNA, and cloned the corresponding cDNA. This coded for a splicing variant of SIRPα that lacked the two membrane proximal Ig domains. In transfection experiments, we have been able to show that anti-SWC3 antibodies recognize both forms of the molecule, mapping the SWC3 epitopes to the N-terminal IgV type domain. © 2006 Elsevier Ltd. All rights reserved.

An experiment was conducted to determine the effects of source of protein (soybean vs sunflower meal) and enzyme supplementation (no enzyme vs protease addition vs protease + xylanase addition) on digestion and growth traits of rabbits. Treatments were arranged factorially in six isonutritive diets. Two hundred and forty rabbits weaned at 25 or 35 days were used to measure dry matter and crude protein apparent ileal digestibility of diets at 35 or 45 days of age, respectively. Another one hundred and eighty animals weaned at 35 days were fed ad libitum in individual cages during four weeks to determine fattening performance. Source of protein did not affect digestion efficiency or feed conversion rate in the whole fattening period, but animals fed soybean meal-based diets showed higher feed intake, grew faster and had higher mortality than those fed sunflower meal-based diets. Addition of enzymes increased ileal apparent digestibility, especially in youngest animals when supplements contained xylanase besides protease activity. Enzyme supplementation did not affect any of the growth traits studied, but decreased fattening mortality in sunflower meal-based diets., Se realizó un experimento para determinar los efectos de la fuente de proteína (harina de soja vs harina de girasol) y de la suplementación enzimática (no suplementación vs adición de proteasas vs adición de proteasas + xilanasas) sobre parámetros digestivos y de crecimiento en conejos en cebo. Los tratamientos se estructuraron factorialmente en seis piensos isonutritivos. Se usaron doscientos cuarenta conejos destetados a los 25 ó 35 días de edad para medir la digestibilidad ileal aparente de la materia seca y de la proteína bruta de los piensos a los 35 ó 45 días de edad, respectivamente. Un grupo adicional de 180 animales destetados a los 35 días de edad fue alimentado ad libitum en jaulas individuales durante 4 semanas para determinar rendimientos productivos en el periodo de cebo. La fuente de proteína no afectó a la eficacia digestiva o a la conversión del alimento en el conjunto del periodo de cebo, pero los animales alimentados con piensos basados en soja crecieron más rápido y presentaron una mayor mortalidad que los que recibían dietas basadas en harina de girasol. La adición de enzimas incrementó la digestibilidad ileal aparente, cuando los suplementos contenían actividad xilanásica además de proteásica, especialmente en los animales más jóvenes. La suplementación con enzimas no afectó a ninguno de los parámetros de crecimiento estudiados, pero redujo la mortalidad en cebo en piensos basados en harina de girasol.

Surgery of the aortic arch is a very complex procedure since it requires protective strategies for the brain, heart and rest of the body.To communicate our experience in the first 23 total or partial replacements of aortic arch.Retrospective search in the database of the Cardiovascular Surgery Unit for patients subjected to partial or total replacement of the aortic arch since 1998.Between 1988 and 2002, 23 patients were operated. Seventeen had aortic dissection (10 acute and 7 chronic), five had an atherosclerotic aneurysm and one had a traumatic lesion. Thirteen patients were subjected to a replacement of the arch plus ascending aorta, six to a replacement of the arch plus descending aorta and four to a replacement of the arch, ascending and descending aorta. Seven patients had previous operation of the thoracic aorta. Arterial perfusion was done via the femoral artery, axillary artery or a combination of both. A hypothermic circulatory arrest was induced in 22; it was associated with cerebral retro perfusion alone in 8 patients, antegrade cerebral perfusion in 5; isolated or associated axillary perfusion was used in five patients. In seven, procedures on the aortic or mitral valve, or coronary artery operations were added. Operative mortality was 26%, 3 of the 8 patients operated as an emergency and 3 of 15 elective operations. There was no mortality among those without dissection and of 7 chronic dissections, one died. All patients were followed for an average of 45 months. Two patients required reinterventions on the aorta and one for colon cancer. There was one late death of unknown cause. Postoperative complications were agitation, bleeding and temporary vocal cord dysfunction.There is a learning curve, where more extensive operations, particularly those done as emergency or for dissections, had an increased operative risk.

Background: Surgery of the aortic arch is a very complex procedure since it requires protective strategies for the brain, heart and rest of the body. Aim: To communicate our experience in the first 23 total or partial replacements of aortic arch. Material and methods: Retrospective search in the database of the Cardiovascular Surgery Unit for patients subjected to partial or total replacement of the aortic arch since 1998. Results: Between 1988 and 2002, 23 patients were operated. Seventeen had aortic dissection (10 acute and 7 chronic), five had an atherosclerotic aneurysm and one had a traumatic lesion. Thirteen patients were subjected to a replacement of the arch plus ascending aorta, six to a replacement of the arch plus descending aorta and four to a replacement of the arch, ascending and descending aorta. Seven patients had previous operation of the thoracic aorta. Arterial perfusion was done via the femoral artery, axillary artery or a combination of both. A hypothermic circulatory arrest was induced in 22; it was associated with cerebral retro perfusion alone in 8 patients, antegrade cerebral perfusion in 5; isolated or associated axillary perfusion was used in five patients. In seven, procedures on the aortic or mitral valve, or coronary artery operations were added. Operative mortality was 26%, 3 of the 8 patients operated as an emergency and 3 of 15 elective operations. There was no mortality among those without dissection and of 7 chronic dissections, one died. All patients were followed for an average of 45 months. Two patients required reinterventions on the aorta and one for colon cancer. There was one late death of unknown cause. Postoperative complications were agitation, bleeding and temporary vocal cord dysfunction. Conclusions: There is a learning curve, where more extensive operations, particularly those done as emergency or for dissections, had an increased operative risk

A cDNA containing the porcine Toll-like receptor 4 (TLR4) coding sequence has been cloned by RT-PCR from alveolar macrophages mRNA, and its complete sequence has been determined. The predicted amino acid sequence comprises an extracellular domain with 21 leucine-rich repeats (LRR) and a LRR-C-terminal (LRR-CT) motif, followed by a 30 amino acid transmembrane segment, and a 179 amino acid intracytoplasmic region containing the Toll/IL-1R domain. Pig TLR4 shows 63-80% amino acid sequence identity with those of cow, horse, cat, human, rabbit and mouse. The degree of sequence identity rises to over 90% in the TIR domain. The whole TLR4 sequence and its ectodomain were expressed as GFP fusion proteins in CHO cells. Using RT-PCR analysis, porcine TLR4 transcripts were detected in DCs, monocytes and macrophages, and in tissue samples of bone marrow, thymus, lymph node, spleen, brain, liver, kidney and ovary. The expressed protein will be used for the development of reagents. Knowledge of TLR4 expression will help to address mechanisms of immune induction by antigens and vaccines. © 2005 Elsevier Ltd. All rights reserved.

Mitral valve repair is considered better than mitral valve replacement for degenerative mitral regurgitation. Aim: To evaluate late clinical results of mitral valve repair as compared to mitral valve replacement in patients with degenerative mitral regurgitation. Patients and methods: All patients subjected to open heart surgery for degenerative mitral regurgitation between 1990 and 2002 were assessed for surgical mortality, late cardiac and overall mortality, reoperation, readmission to hospital, functional capacity and anticoagulant therapy. Eighty eight patients (48 males) had mitral valve repair and 28 (19 males) had mitral valve replacement (23 with a mechanical prosthesis). Mean age was 59.9 ± 14.8 (SD) and 61.3 ± 14.6 years, respectively. Sixty three percent of patients with repair and 50% of those with valve replacement were in functional class III or IV before surgery. Results: Operative mortality was 2.3% for mitral valve repair and 3.6% for mitral valve replacement (NS). Also, there was no statistical difference in the need of reoperation during the follow-up period between both procedures (2.3% and 0%, respectively). Ninety four percent of the replacement patients but only 26% of the repair patients were in anticoagulant therapy at the end of the follow-up period (p

International studies show a low compliance with norms for the management of cardiovascular risk factors. Aim: To assess the prevalence of risk factors in patients admitted for a coronary or vascular event and to evaluate the proportion of patients that normalize these factors after one year of follow up. Material and Methods: Three hundred and fifty seven patients aged 64±13 years (264 males), admitted to a University Clinical Hospital for a coronary or vascular event were studied. They were educated about cardiovascular risk factors and followed by their treating physicians for a mean of 11.9±2 months. During this period, smoking habits, body mass index. blood pressure, serum lipid levels, blood glucose and the appearance of new cardiovascular events were registered. Results: One year survival was 96% (all 13 deaths were of cardiac origin). Eighty seven percent of patients were free of major cardiovascular events. At discharge from hospital and at the end of follow up 49% and 44% had a total cholesterol over 200 mg/dl respectively, 9,6% and 20,8% had systolic pressure over 140 mmHg. There was no diastolic hypertension in these patients, 27% and 31% had a body mass index over 25 kg/m² and 2% smoked (versus 32% before the event). Conclusions: After one year of follow up, the prevalence of risk factors in patients that had suffered a cardiovascular event, continues to be high (Rev Méd Chile 2005; 133: 1147-52)

Mitral valve repair is considered better than mitral valve replacement for degenerative mitral regurgitation. Aim: To evaluate late clinical results of mitral valve repair as compared to mitral valve replacement in patients with degenerative mitral regurgitation. Patients and methods: All patients subjected to open heart surgery for degenerative mitral regurgitation between 1990 and 2002 were assessed for surgical mortality, late cardiac and overall mortality, reoperation, readmission to hospital, functional capacity and anticoagulant therapy. Eighty eight patients (48 males) had mitral valve repair and 28 (19 males) had mitral valve replacement (23 with a mechanical prosthesis). Mean age was 59.9 ± 14.8 (SD) and 61.3 ± 14.6 years, respectively. Sixty three percent of patients with repair and 50% of those with valve replacement were in functional class III or IV before surgery. Results: Operative mortality was 2.3% for mitral valve repair and 3.6% for mitral valve replacement (NS). Also, there was no statistical difference in the need of reoperation during the follow-up period between both procedures (2.3% and 0%, respectively). Ninety four percent of the replacement patients but only 26% of the repair patients were in anticoagulant therapy at the end of the follow-up period (p

Background: Surgical valve repair is a good alternative for correction of incompetent bicuspid aortic valve. Aim: To report the early and late surgical, clinical and ecochardiographic results of surgical repair of incompetent bicuspid aortic valves. Patients and methods: Retrospective review of medical records of 18 patients aged 19 to 61 years, with incompetent bicuspid aortic valve in whom a valve repair was performed. Four patients had infectious endocarditis and 17 were in functional class I or II. Follow up ranged from 3 to 113 months after surgery. Results: A triangular resection of the prolapsing larger cusp, which included the middle raphe, was performed in 17 cases; in 13 of these, a complementary subcommisural annuloplasty was performed. In the remaining case, with a perforation of the non-coronary cusp, a pericardial patch was implanted; this procedure was also performed in 2 other cases. In 3 cases large vegetations were removed. Postoperative transesophageal echocardiography showed no regurgitation in 11 patients (62%) and mild regurgitation in 7 (38%). There was no operative morbidity or mortality. There were no deaths during the follow-up period. In 3 patients (17%) the aortic valve was replaced with a mechanical prosthesis, 8 to 108 months after the first operation. Reoperation was not needed in 93%±6,4% at 1 year and 85%±9,5% at 5 years, these patients were all in functional class I at the end of the follow-up period. 60% had no aortic regurgitation, 20% had mild and 20% moderate aortic regurgitation on echocardiographic examination. A significant reduction of the diastolic diameter of the left ventricle was observed, but there were no significant changes in systolic diameter or shortening fraction. Conclusions: Surgical repair of incompetent bicuspid aortic valves has low operative morbidity and mortality and has a low risk of reoperation (Rev Med Chile 2005; 133: 279-86)

Background: Surgical valve repair is a good alternative for correction of incompetent bicuspid aortic valve. Aim: To report the early and late surgical, clinical and ecochardiographic results of surgical repair of incompetent bicuspid aortic valves. Patients and methods: Retrospective review of medical records of 18 patients aged 19 to 61 years, with incompetent bicuspid aortic valve in whom a valve repair was performed. Four patients had infectious endocarditis and 17 were in functional class I or II. Follow up ranged from 3 to 113 months after surgery. Results: A triangular resection of the prolapsing larger cusp, which included the middle raphe, was performed in 17 cases; in 13 of these, a complementary subcommisural annuloplasty was performed. In the remaining case, with a perforation of the non-coronary cusp, a pericardial patch was implanted; this procedure was also performed in 2 other cases. In 3 cases large vegetations were removed. Postoperative transesophageal echocardiography showed no regurgitation in 11 patients (62%) and mild regurgitation in 7 (38%). There was no operative morbidity or mortality. There were no deaths during the follow-up period. In 3 patients (17%) the aortic valve was replaced with a mechanical prosthesis, 8 to 108 months after the first operation. Reoperation was not needed in 93%±6,4% at 1 year and 85%±9,5% at 5 years, these patients were all in functional class I at the end of the follow-up period. 60% had no aortic regurgitation, 20% had mild and 20% moderate aortic regurgitation on echocardiographic examination. A significant reduction of the diastolic diameter of the left ventricle was observed, but there were no significant changes in systolic diameter or shortening fraction. Conclusions: Surgical repair of incompetent bicuspid aortic valves has low operative morbidity and mortality and has a low risk of reoperation (Rev Méd Chile 2005; 133: 279-86)

Background: Valve replacement has been the treatment of choice for patients with valvular complications of infectious endocarditis (IE). However, excellent results with valve repair allowed it to become a new therapeutic alternative for these patients. Aim: To evaluate the results of valve repair in patients with valvular complications of IE. Patients and Methods: From January 1991 to December 2000, 14 patients with valvular complications of IE underwent valve repair. Mean age was 37.9 ± 14.9. Results: New York Heart Association (NYHA) class was 2.8 ± 0.9. IE was located in the aortic in 6 (42%), in the mitral valve in 4 (29%) and in both valves in 4 cases (29%). Surgical indication was hemodynamic in 50% of the cases, echocardiographic in 29% and septic in 21%. Five aortic valves were bicuspid, 3 mitral valves were myxomatous and the rest were normal. The most common septic lesions were vegetations and leaflet perforations. A total of 23 aortic and 21 mitral valve repair procedures were performed. There were no deaths. Only 1 patient had a surgical complication (renal failure and prolonged mechanical ventilation). Follow-up was 100% complete. There was not late mortality. One patient with bone marrow aplasia required reoperation for a new episode of IE 19 months later. At the end of the follow-up NYHA class was 1.3 ± 0.6 and echocardiography showed a mild or absence of valve regurgitation in most patients. Conclusions: Valve repair surgery in IE has good results, with advantages over valve replacement (Rev Méd Chile 2004; 132: 307-15).

Background: Valve replacement has been the treatment of choice for patients with valvular complications of infectious endocarditis (IE). However, excellent results with valve repair allowed it to become a new therapeutic alternative for these patients. Aim: To evaluate the results of valve repair in patients with valvular complications of IE. Patients and Methods: From January 1991 to December 2000, 14 patients with valvular complications of IE underwent valve repair. Mean age was 37.9 ± 14.9. Results: New York Heart Association (NYHA) class was 2.8 ± 0.9. IE was located in the aortic in 6 (42%), in the mitral valve in 4 (29%) and in both valves in 4 cases (29%). Surgical indication was hemodynamic in 50% of the cases, echocardiographic in 29% and septic in 21%. Five aortic valves were bicuspid, 3 mitral valves were myxomatous and the rest were normal. The most common septic lesions were vegetations and leaflet perforations. A total of 23 aortic and 21 mitral valve repair procedures were performed. There were no deaths. Only 1 patient had a surgical complication (renal failure and prolonged mechanical ventilation). Follow-up was 100% complete. There was not late mortality. One patient with bone marrow aplasia required reoperation for a new episode of IE 19 months later. At the end of the follow-up NYHA class was 1.3 ± 0.6 and echocardiography showed a mild or absence of valve regurgitation in most patients. Conclusions: Valve repair surgery in IE has good results, with advantages over valve replacement (Rev Med Chile 2004; 132: 307-15). (Key Words: Cardiovascular surgical procedures; Endocarditis, bacterial; Surgical procedures, operative)

Background: Mitral valve repair is probably the procedure of choice for the surgical treatment of degenerative mitral insufficiency. Aim: To evaluate the late results of mitral valve repair in degenerative mitral insufficiency. Patients and method: The records of 88 patients who underwent mitral valve repair for degenerative mitral insufficiency from December 1991 through June 2002 were reviewed. Mean age was 59.9 years (range 22 to 82). At least moderate mitral insufficiency was present in every patient. Mean left atrial diameter was 55 mm and mean end diastolic and end systolic left ventricular diameters were 61 and 37 mm respectively. Results: The most common underlying lesion was ruptured chordae tendineae (66%) and posterior leaflet prolapse (68%). The surgical procedure most frecuently performed was quadrilateral resection of the posterior leaflet (68%). A Carpentier-Edwards ring was placed in 97% of patients. An associated procedure was performed in 34%. Operative mortality was 2.3%. A complete follow up was obtained in 93% of cases with a mean of 54±36 months. Overall survival rate was 98% at one year, 88% at 5 and 82% at 10 years. Free of cardiac death rates were 94% at 5 and 89% at 10 years. Only 2 patients were reoperated during follow up, resulting in a 98% reoperation free rate follow up. Functional class improved in all patients at the end of follow up. Late echocardiographic evaluation showed absent or minimal mitral regurgitation in 83% and mild mitral regurgitation in 17%. Conclusion: Good late results have been obtained with mitral valve repair, avoiding the inconveniencies of prosthetic replacement. Therefore, mitral valve repair should be the procedure of choice to treat degenerative mitral insufficiency (Rev Med Chile 2003; 131: 1355-64). (Key Words: Mitral valve insufficiency)

Background: Mitral valve repair is probably the procedure of choice for the surgical treatment of degenerative mitral insufficiency. Aim: To evaluate the late results of mitral valve repair in degenerative mitral insufficiency. Patients and method: The records of 88 patients who underwent mitral valve repair for degenerative mitral insufficiency from December 1991 through June 2002 were reviewed. Mean age was 59.9 years (range 22 to 82). At least moderate mitral insufficiency was present in every patient. Mean left atrial diameter was 55 mm and mean end diastolic and end systolic left ventricular diameters were 61 and 37 mm respectively. Results: The most common underlying lesion was ruptured chordae tendineae (66%) and posterior leaflet prolapse (68%). The surgical procedure most frecuently performed was quadrilateral resection of the posterior leaflet (68%). A Carpentier-Edwards ring was placed in 97% of patients. An associated procedure was performed in 34%. Operative mortality was 2.3%. A complete follow up was obtained in 93% of cases with a mean of 54±36 months. Overall survival rate was 98% at one year, 88% at 5 and 82% at 10 years. Free of cardiac death rates were 94% at 5 and 89% at 10 years. Only 2 patients were reoperated during follow up, resulting in a 98% reoperation free rate follow up. Functional class improved in all patients at the end of follow up. Late echocardiographic evaluation showed absent or minimal mitral regurgitation in 83% and mild mitral regurgitation in 17%. Conclusion: Good late results have been obtained with mitral valve repair, avoiding the inconveniencies of prosthetic replacement. Therefore, mitral valve repair should be the procedure of choice to treat degenerative mitral insufficiency (Rev Méd Chile 2003; 131: 1355-64).

Background: The implantation of pacemakers improves cardiac function and quality of life, in particular with dual chamber DDD and DDDR modes. Aim: To evaluate our clinical experience and results on pacemaker implantation, from 1963 to 1998. Material and methods: Computerized data collected from 2,445 consecutive paced patients was reviewed. A total of 3,554 operative procedures were performed, including 412 procedures for complications and 697 pacemaker replacement. Patient survival was determined from clinical records, inquiry to pacemaker manufacturers and death certificates from Servicio de Registro Civil e Identificacion de Chile (Chilean Civil and Identification Registry). Results: Use of dual chamber (DDD and DDDR) pacemakers increased progressively up to 74% from 1988 to 1998. Complication rate was 42% in the 1963-1976 study period, it decreased to 10.6% in the 1977-1987 study period, and to 5.6% by 1988-1998. Only two patients died during surgery in the study period (0.08%). In the 1977-1987 period, pacemakers lasted 10.6 years. Survival rates were 52% at ten years, 33% at 15 years, and 21% at 20 years, with a median survival of 11.7 years, and 7.24 years in patients over 80 years old. Conclusions: Transvenous permanent pacing can be accomplished today with a low complication rate, mainly due to better technology and surgical procedures (Rev Med Chile 2002; 130: 132-42)

Background. Ischemic mitral regurgitation (IMR) is a severe condition which may be best treated by surgery, nowithstanding a relatively high mortality rate. Objectives. To evaluate the results of mitral valve replacement or repair in patients with IMR. Patients and methods. Retrospective review of the clinical records in 29 patients with IMR who were surgically treated from 1990 to 1999. They represent 8% of surgical procedures on the mitral valve. Results. Mean age was 67 ± 9 years. Surgery was performed urgently in 19 patients (66,5%). NYHA functional class was 3.4 ± 0.8. The mechanism of IMR was annular dilatation and spreading of papillary muscles in 18 patients, papillary muscle rupture in 9 and fibrosis in 2. Mitral valve replacement was performed in 14 patients and mitral valve repair in 15. Twenty four patients (83%) had concomitant myocardial revascularization. Overall surgical mortality was 24%; 26% for mitral replacement and 13% for mitral valve repair (p=0.215). On follow up of 26±33 months, one year survival was 76±0.8% and 5 years survival was 59±12%. Excluding in hospital mortality, survival was 100% at one year and 78±14% at 5 years. Functional class improved in all survivors, to 1.4±0.5. Late echocardiographic evaluation of patients with mitral valve repair showed absence of mitral regurgitation in 58%, 1+ MR in 17% and 2+ MR in 25%. Conclusion. In spite of a high perioperative mortality, surgery for IMR is a valuable procedure for patients with an otherwise highly lethal disease (Rev Med Chile 2002; 130: 9-16)

The echocardiographic identification of cardiac tumors as cause of embolic episodes is infrequent, and the finding of multiple papillary fibroelastoma is even less common. We report a 70 years old female with a history of a rheumatic mitral valve lesion, subjected to a commissurotomy in 1970. She was admitted with a cerebrovascular accident and the transesophageal echocardiogram revealed the presence of a multiple papillary fibroelastoma in the aortic valve. The patient was operated and the tumor excised, the pathological analysis confirmed the diagnosis. The patient was discharged in good conditions and after 8 months of follow up, she has no neurological abnormality and is in functional class I (Rev Méd Chile 2001; 129: 1056-60).

The echocardiographic identification of cardiac tumors as cause of embolic episodes is infrequent, and the finding of multiple papillary fibroelastoma is even less common. We report a 70 years old female with a history of a rheumatic mitral valve lesion, subjected to a commissurotomy in 1970. She was admitted with a cerebrovascular accident and the transesophageal echocardiogram revealed the presence of a multiple papillary fibroelastoma in the aortic valve. The patient was operated and the tumor excised, the pathological analysis confirmed the diagnosis. The patient was discharged in good conditions and after 8 months of follow up, she has no neurological abnormality and is in functional class I (Rev Méd Chile 2001; 129: 1056-60).

Background: Heart transplantation currently provides the most effective treatment for advanced heart failure. However, medical therapy for this condition has also improved, heart donors are scarce and the cost of the procedure is high. Therefore the indications and management of these patients need reevaluation. Aim: To analyze the results of 24 patients submitted to heart transplantation for end-stage heart failure needing repeated hospitalizations and i.v. inotropes for compensation. Patients and methods: The group was comprised by 21 men and 3 women with a mean age of 36.8 years, mean left ventricular ejection fraction 19±4.5%, mean systolic pulmonary artery pressure 48±13 mmHg (24-70) and mean pulmonary vascular resistance 2.6 Wood Units (1-5). Fourteen patients (58%) had a previous median sternotomy. Immunosupression did not include induction therapy and steroids were discontinued early. Results: Operative mortality was 4% at 30 days. Actuarial survival at one year was 90% and at 5 years 72%. Freedom from rejection at one year was 76% and at 5 years 50%. Freedom from infection was 70% at one year and 56.5% at five years. All patients with more than 3 months of follow-up were in functional class I. Conclusions: These results justify the proposed modifications for transplantation protocols (Rev Méd Chile 2001; 129: 9-17).

Background: Early diagnosis, an effective treatment and prompt recognition of complications are essential to improve the prognosis of infective endocarditis (IE) Aim: To report the results of a multidisciplinary approach to diagnosis and management of patients with IE at the Universidad Católica de Chile Hospital. Patients and methods: The clinical history, diagnosis, treatment and outcome of 261 episodes (Duke criteria) of IE admitted between January 1980 and January 1999 were analyzed. These included 185 episodes of native, 73 of prosthetic valve and 3 of nonvalvular IE. Results: Sixty nine percent of patients were men and the mean age was 49 ± 16 years. Seventy five percent had a definite diagnosis of IE (Duke). S. viridans, staphylococci and enterococci together constituted 85% of the isolated bacterial strains. Twenty seven had culture-negative IE, related to a high incidence of antibiotic therapy prior to diagnosis. Transesophageal echocardiography was performed in 102 cases and it detected vegetations in 91% of aortic and 96% of mitral IE, rupture or prosthesis dehiscence in 67% of aortic and 52% of mitral IE and abscesses in 51% of aortic and 15% of mitral IE. Fifty one percent developed heart failure and 34% had embolic events. S. aureus IE was associated to a higher incidence of embolic events, complications which contraindicated surgery and increased mortality rate (27%). Of all patients, 40% were treated exclusively with antibiotics, 52% were operated on and 8% had surgical indication but were nonoperable because of serious complications. The overall mortality was 16.3%: 13% in the medical, 9% in the surgical and 81% in the non-operable groups. The type of treatment and mortality rates did not differ between IE of native valves and prosthetic valves. Long term follow up showed survival rates of 73% at 5 years and 66% at 10 years. Conclusion: A multidisciplinary approach may be very helpful to improve the prognosis of IE. (Rev Méd Chile 2000; 128: 708-20).

Background: Surgical repair is the procedure of choice for mitral insufficiency since it preserves better left ventricular structure and function. Aim: To assess the long term clinical and echocardiographic results of mitral valve reconstructive surgery. Material and methods: A review of clinical and echocardiographic data of 68 patients (34 male, age range 17 to 82 years), subjected to surgical mitral valve repair between December 1991 and March 1998. Preoperative functional capacity of these patients was 2.96 ± 0.7. Surgical repair was assessed using transesophagic echocardiography in all subjects. Results: The etiology of mitral insufficiency was degenerative in 43 patients, rheumatic in 10, infectious in 6, ischemic in 5 and miscellaneous in 4. The most frequent pathological findings were dilatation of the mitral ring in 42% of patients, chordae tendinae rupture in 32% and enlargement in 24%. A mitral anuloplasty was done in 90% of patients, a cuadrilateral resection of posterior leaflet in 52% and chordae tendinae transference in 12%. An additional surgical procedure was done in 34% of subjects. Three patients died during hospitalization (4.4%). During the follow up of 36.5 ± 22.3 months, five patients died and one required a mitral valve replacement. The actuarial survival probability was 95.3 ± 2.6% at one year and 83.5 ± 6.5% at five years. The reoperation free survival was 100% at one year and 97.4 ± 2.5% at five years. At the end of follow up the functional capacity improved to 1.25 ± 0.4. Echocardiography showed absence of mitral insufficiency in 48.4% of patients, minimal, mild and moderate insufficiency in 35.5, 14.5 and 1.6% of patients respectively. Conclusions: Surgical valve reconstruction in mitral insufficiency has satisfactory long term results and should be the procedure of choice for eligible patients.

Unexplained syncope or presyncope are rather common problems in children, whose evaluation is not simple. In adults, the t i l t test a'lows to reproduce symptoms and some associated hernodynamic mechanisms in 30 to 75% of the patients with this condition. The purpose of this wox has been to analyze hernodynamic responses during 70 tilt test in 26 consecutive patients younger than 19 years, refered to our center with the diagnosis of unexplained syncope in a period of 2 years. Fifty percent of the tilt test were positive, most of them using isoproterenol (mean dose ± 0.4 micrograms/minute), increasing heart rate by 41%. Systolic arterial pressure decreased significantly in all patients with a positive t i l t test to less than 70 mmHg. Reduction or heart rate was also observed, rarely to marked bradycardia by the end of tne test. Original symptoms were always reproduced during the test. It is concluded that tit test may constitute an imoortant test in the clinical workup of unexpkcined syncope in children and adolescents. This method reproduces clinical symptoms associated 'o syncope or presyncope and precises their hernodynamic mechanisms in aporoxima'e'y 50% of hese patients.

Disentangling the different stages of the star-formation process, in particular in the high-mass regime, is a challenge in astrophysics. Chemical clocks could help alleviating this problem, but their evolution strongly depends on many parameters, leading to degeneracy in the interpretation of the observational data. One of these uncertainties is the degree of CO depletion. We present here the first self-consistent magneto-hydrodynamic simulations of high-mass star-forming regions at different scales, fully coupled with a non-equilibrium chemical network, which includes C-N-O bearing molecules. Depletion and desorption processes are treated time-dependently. The results show that full CO-depletion (i.e. all gas-phase CO frozen-out on the surface of dust grains), can be reached very quickly, in one third or even smaller fractions of the free-fall time, whether the collapse proceeds on slow or fast timescales. This leads to a high level of deuteration in a short time both for typical tracers like N$_2$H$^+$, as well as for the main ion H$_3^+$, the latter being in general larger and more extended. N$_2$ depletion is slightly less efficient, and no direct effects on N-bearing molecules and deuterium fractionation are observed. We show that CO depletion is not the only driver of deuteration, and that there is a strong impact on $D_{frac}$ when changing the grain-size. We finally apply a two-dimensional gaussian Point Spread Function to our results to mimic observations with single-dish and interferometers. Our findings suggest that the low-values observed in high-mass star-forming clumps are in reality masking a full-depletion stage in the inner 0.1 pc region., accepted on ApJ

Summary Background Elevated proinflammatory cytokines are associated with greater COVID-19 severity. We aimed to assess safety and efficacy of sarilumab, an interleukin-6 receptor inhibitor, in patients with severe (requiring supplemental oxygen by nasal cannula or face mask) or critical (requiring greater supplemental oxygen, mechanical ventilation, or extracorporeal support) COVID-19. Methods We did a 60-day, randomised, double-blind, placebo-controlled, multinational phase 3 trial at 45 hospitals in Argentina, Brazil, Canada, Chile, France, Germany, Israel, Italy, Japan, Russia, and Spain. We included adults (≥18 years) admitted to hospital with laboratory-confirmed SARS-CoV-2 infection and pneumonia, who required oxygen supplementation or intensive care. Patients were randomly assigned (2:2:1 with permuted blocks of five) to receive intravenous sarilumab 400 mg, sarilumab 200 mg, or placebo. Patients, care providers, outcome assessors, and investigators remained masked to assigned intervention throughout the course of the study. The primary endpoint was time to clinical improvement of two or more points (seven point scale ranging from 1 [death] to 7 [discharged from hospital]) in the modified intention-to-treat population. The key secondary endpoint was proportion of patients alive at day 29. Safety outcomes included adverse events and laboratory assessments. This study is registered with ClinicalTrials.gov, NCT04327388; EudraCT, 2020-001162-12; and WHO, U1111-1249-6021. Findings Between March 28 and July 3, 2020, of 431 patients who were screened, 420 patients were randomly assigned and 416 received placebo (n=84 [20%]), sarilumab 200 mg (n=159 [38%]), or sarilumab 400 mg (n=173 [42%]). At day 29, no significant differences were seen in median time to an improvement of two or more points between placebo (12·0 days [95% CI 9·0 to 15·0]) and sarilumab 200 mg (10·0 days [9·0 to 12·0]; hazard ratio [HR] 1·03 [95% CI 0·75 to 1·40]; log-rank p=0·96) or sarilumab 400 mg (10·0 days [9·0 to 13·0]; HR 1·14 [95% CI 0·84 to 1·54]; log-rank p=0·34), or in proportions of patients alive (77 [92%] of 84 patients in the placebo group; 143 [90%] of 159 patients in the sarilumab 200 mg group; difference −1·7 [−9·3 to 5·8]; p=0·63 vs placebo; and 159 [92%] of 173 patients in the sarilumab 400 mg group; difference 0·2 [−6·9 to 7·4]; p=0·85 vs placebo). At day 29, there were numerical, non-significant survival differences between sarilumab 400 mg (88%) and placebo (79%; difference +8·9% [95% CI −7·7 to 25·5]; p=0·25) for patients who had critical disease. No unexpected safety signals were seen. The rates of treatment-emergent adverse events were 65% (55 of 84) in the placebo group, 65% (103 of 159) in the sarilumab 200 mg group, and 70% (121 of 173) in the sarilumab 400 mg group, and of those leading to death 11% (nine of 84) were in the placebo group, 11% (17 of 159) were in the sarilumab 200 mg group, and 10% (18 of 173) were in the sarilumab 400 mg group. Interpretation This trial did not show efficacy of sarilumab in patients admitted to hospital with COVID-19 and receiving supplemental oxygen. Adequately powered trials of targeted immunomodulatory therapies assessing survival as a primary endpoint are suggested in patients with critical COVID-19. Funding Sanofi and Regeneron Pharmaceuticals.