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Pesquisas anteriores caracterizaram a literatura mais antiga (anterior a 2010) acerca da relação política-administração, concluindo que a estrutura de conhecimento dessa literatura se podia classificar como pré-paradigmática, pouco estruturada e muito assente em ensaios e não em evidência recolhida a partir de estudos empíricos. O conhecimento acerca da relação política-administração é fundamental para melhorar a eficiência da Administração Pública, assegurar o controlo democrático e a neutralidade da mesma, etc. O estudo que agora se apresenta retoma essas investigações anteriores, mas agora centrando-se na literatura mais recente, e tem por objetivo avaliar a literatura mais recente sobre o tema e perceber se se observam evoluções de natureza paradigmática face à literatura de períodos anteriores. O estudo incidiu sobre uma amostra de 20 artigos, publicados após 2010, e obtidos por pesquisa na Web of Science. Conclui-se que depois de 2010, o novo conhecimento resulta principalmente de estudos empíricos, e estes vão revelando que na prática da Administração Pública se vão alternando, consoante a situação, os modelos dicotómico e de complementaridade, criando-se assim uma configuração variável, no tempo e decorrente do tema, para o relacionamento política-administração. Não se podendo ainda falar da existência de um paradigma, mas parece ser possível falar-se de um protoparadigma, uma proposição que pode ser avaliada e caso se venha a confirmar, assumir-se efetivamente como um primeiro paradigma em Administração Pública. Essa proposição assenta na ideia da distinção, mas também da necessidade de trabalho em conjunto, dos dois corpos – eleitos e gestores públicos – e na ideia de alguma fluidez e variabilidade no modo como esse trabalho em conjunto ocorre.

Within the world of disability, we have several degrees. In the most extreme cases, such as ALS (amyotrophic lateral sclerosis) or very severe trauma that can cause tetraplegia, people become totally dependent. With devices like this, we try to improve the quality of life of these people and, above all, we increase their autonomy and freedom. This simple device allows to control using the voice, by means of a tablet or a computer any device that can be operated using an infrared light controller, which currently represents the majority of the electronic devices or appliances that are in a house.

In this paper we discuss the goals, motivations and other particularities of a visual exploratory analysis tool for historical dictionaries of the Bavarian dialects in Austria. As an input data set we employ the digitized version of the Historical Dictionary of Bavarian Dialects in Austria (Wo¨rterbuch der bairischen Mundarten in O¨ sterreich or WBO¨ ), an initiative started in 1963 which compiles more than five million paper slips collected during the years 1911-1998 in different areas of current Austria, the Czech Republic, Hungary and northern Italy. In the 1990s these paper slips started to be progressively digitized, becoming part of the Database of Bavarian Dialects (DBO¨ ) and in 2010 nearly 32.000 records related to plant names were made available online on the DB¨O electronically-mapped (dbo@ema) platform1. In more recent efforts, the project exploreAT!: Exploring Austria’s Culture Through the Language Glass, which this work is part of, started in 2015. Its aim is “to reveal unique insights into the rich texture of the German Language, especially in Austria, by providing state of the art tools for exploring the unique collection (1911-1998) of the Bavarian Dialects in the region of the Austro-Hungarian Empire”, and it has originated other publications in conference proceedings that we encourage the reader to review [8, 19].

Accessibility or Universal Accessibility should be a condition that any device, place or job permit to a user, however this is not this way. Conquer the highest possible grade of usability is a challenge to which everyone should try, only for the humanity health. The development of software and hardware that permits increase the usability grades is nowadays essential. Within this paper it is explained what it is Hauria, the technological solution that allows to do the actual homes accessible using mixed technologies.

Since the 1960s, identity politics, the proliferation of new subjects of emancipation, and the abandonment of a ‘statocentric’ concept of power have shaped alternative theoretical paradigms within the liberal arts field, especially in the USA. These critical trends have re-enabled and reshaped potential approaches to Galician Studies, which had a constant presence in the English-speaking world since the 1980s. In light of the epistemological, symbolical, and theoretical challenges Galician Studies faces in the USA, this essay reflects on the process of institutionalization of the field, on the level of autonomy it possesses within the English-speaking academic context, and on the consequences and conflicts involved in scholarly attempts to locate and legitimate Galician Studies within and beyond the university.

[ES] La forma más frecuente de espina bífida es el mielomeningocele, para el que no existe un tratamiento postnatal óptimo. Además del trastorno motor o sensitivo dependiente del nivel de la lesión, los niños suelen tener asociada la malformación de Arnold Chiari ii. El mielomeningocele presenta una alta mortalidad y puede acompañarse, hasta en el 80-90%, de hidrocefalia que es responsable de la gran afectación neurocognitiva, precisando de derivación para su supervivencia. La reparación intrauterina de malformaciones fetales mediante acceso abierto a través de histerotomía se ha convertido en una opción terapéutica gracias a la mejora de las técnicas quirúrgicas y anestésicas, y de la correspondiente instrumentación, que han convertido este tipo de intervenciones en una práctica relativamente frecuente. El tratamiento anestésico debe orientarse tanto a la madre como al feto, siendo importante mantener controlados los factores hemodinámicos que regulan el flujo placentario, la dinámica uterina, las pérdidas sanguíneas y el bienestar fetal. Dentro de nuestro Programa de Medicina y Terapia Fetal se han realizado 21 procedimientos de cirugía fetal abierta, 17 procedimientos EXIT y 4 procedimientos para la corrección intrauterina de mielomeningocele fetal. Describimos nuestra experiencia en la corrección intrauterina de mielomeningocele fetal mediante cirugía fetal abierta., [EN] The most frequent form of spina bifida is myelomeningocele. There is no optimal postnatal treatment for this defect. In addition to the motor or sensory deficits, which depend on the location of the lesion, the defect is usually associated with Chiari ii malformation in affected children. Myelomeningocele has high mortality and, in up to 80% to 90% of patients, can be accompanied by hydrocephalus, which causes severe neurocognitive impairment and requires the patient to be shunted for survival. Intrauterine repair of fetal malformations employing open access through hysterotomy has become a therapeutic option due to improved anesthetic and surgical techniques and instrumentation, which have allowed this type of intervention to become relatively frequent. Anesthetic treatment should focus on both the mother and fetus and the hemodynamic factors regulating placental flow, uterine dynamics, blood loss and fetal well-being must remain well-controlled. Within our Program for Fetal Medicine and Therapy, 21 open fetal interventions have been performed: 17 EXIT procedures and 4 procedures for the intrauterine correction of fetal myelomeningocele. We describe our experience of the intrauterine repair of fetal myelomeningocele through open fetal surgery.

Background: Advances in perinatal care have led to a significant reduction in morbidity and mortality among very-low-birth-weight (VLBW) infants. Much of this progress is related to the prevention and management of respiratory disease. Objectives: To evaluate changes in perinatal care and its influence on respiratory morbidity and mortality among VLBW infants in Spain in 2 consecutive periods (2002-2006 and 2007-2011). Methods: This is a retrospective analysis of data prospectively collected of all VLBW infants included in the Spanish SEN1500 network. Patients with major congenital anomalies, those who died in the delivery room (DR) and infants 0 or >346 weeks of gestational age (GA) were excluded. Results: During the study period, out of 27,205 eligible VLBW infants, 24,598 (90.4%) met inclusion criteria. The most striking and statistically significant results found in the second period were: (i) reduction in the proportion of “outborn” patients; (ii) an increase in prenatal steroid administration; (iii) enhanced non-invasive respiratory support in the DR and NICU; (iv) reduction in invasive mechanical ventilation, surfactant administration, and steroids for bronchopulmonary dysplasia (BPD). Moreover, survival to hospital discharge increased (83.5 vs. 84.7%; p = 0.015); however, survival without BPD increased only among the most immature (230 to 266 weeks' GA) from 26.6 to 31.6% (p < 0.001). Conclusions: Enhanced adherence to international recommendations in perinatal care and a significant reduction in mortality were found during the second period. Survival without BPD increased only among the most immature. Further investigation is needed to optimize the strategies to prevent and manage respiratory disease in this group of patients.

PurposeThis paper aims to inspire and support leaders wanting to change the culture of large and complex organizations by sharing what HSBC experienced in Argentina, describing how and why an entire organization recently went through 100 days of intense activity, significantly changing the culture of over 6,000 employees.Design/methodology/approachDetails of this case study are given using two different “voices” and perspectives: one from the CEO and the other one from a program implementation angle. The connection between the people and business perspectives runs throughout, describing the major elements of the culture change program used and the results achieved.FindingsThe experience provides evidence that it is possible to change the culture of an organization in about three months, regardless of how challenging it might seem at the start. Most importantly, the new culture can be sustained over time when a tipping point is reached across the organization.Originality/valueThe program described here challenges traditional culture change approaches, presenting a concrete and proven method that does not rely on communication campaigns or rewards strategies to drive real change in record time.

Context Insulin-like growth factor 1 (IGF-I) and organochlorine pesticides (OCs) have been involved in the pathogenesis of several diseases like cancer, diabetes and growth disorders. Objective and design The potential relationship between the serum levels of various OCs and serum IGF-I was investigated in adults (176 men and 247 women) from a representative sample of the general population of the Canary Islands (Spain). Results After adjustment for potential confounders, which include body mass index, age, and IGF-binding protein-3 (IGFBP-3), IGF-I levels were significantly lower in the 247 women who showed detectable levels of p , p ′-DDD (a DDT-metabolite) than in women who presented non-detectable levels of this pesticide ( p = 0.030), specially in 36–50 years old women. A similar negative relationship was also found between IGF-I and aldrin (a non-DDT-derivative) in women ( p = 0.049). In the group of 176 men, aldrin seemed to exert a similar negative effect on IGF-I ( p = 0.046) and this effect was clearly significant in the oldest group (51–65 years) ( p = 0.009). A non-linear dose–response curve was observed between Total Cyclodienes Body Burden (Total Cyclodienes; sum of aldrin, dieldrin and endrin) and IGF-I in men ( p = 0.024). These findings suggest that OCs could modulate the IGF-system in a way that is highly influenced by gender, age and by chemical or combination of chemicals implicated. Such circumstances may contribute to the development of a number of diseases related to IGF-I and should be taken into account in public health decisions.

Introduction and objectives An analysis was made of variability in the measurement of the angiographic index blush between a university hospital and an independent core laboratory, as well as its correlation with perfusion analised by intracoronary myocardial contrast echocardigraphy (MCE) and the ventricular function at the sixth month. Methods The study comprised 40 patients with a first ST-segment elevation myocardial infarction, single-vessel disease and open infarct-related artery. Perfusion was quantified by angiography (median fifth day, range 3-7) with blush in our laboratory and in an independent core laboratory. MCE was performed. Ejection fraction at the sixth month was determined with magnetic resonance imaging. Results We found a weak correlation (r=0.38) between both laboratories. In the comparison of blush measurements concordance was 80%, kappa=0.43 if normality was defined by blush 2-3; and concordance 55%, kappa=0.1 for blush 3. Neither perfusion analised by MCE (r= 0.23, P=.2) nor ejection fraction by resonance (r=0.20, P=.3) did correlate to blush. Conclusions After infarction in patients with TIMI 3, variability is observed in blush measurements between a university hospital and an independent core laboratory, therefore it seems advisable to centralize blush measures in highly specialized core laboratories. A weak correlation was detected with perfusion analised by MCE and with late systolic function.

Introduccion y objetivos Analizamos la variabilidad en la medicion del indice angiografico de blush entre un hospital universitario y un laboratorio central independiente, asi como su correlacion con la perfusion analizada mediante ecocardiografia miocardica con contraste intracoronario (EMC) y con la funcion ventricular a los 6 meses Metodos Se incluyo en el estudio a 40 pacientes con un primer infarto agudo de miocardio con elevacion del segmento ST, enfermedad de un vaso y arteria relacionada con el infarto abierta. La perfusion se cuantifico por angiografia (mediana quinto dia, rango de 3-7) mediante el blush miocardico en nuestro laboratorio y en un laboratorio central independiente. Se realizo EMC. Se cuantifico la fraccion de eyeccion al sexto mes mediante resonancia magnetica. Resultados Hallamos una correlacion debil (r = 0,38) entre los 2 laboratorios. La concordancia en las medidas de blush fue del 80%, con un indice kappa de 0,43 si se definia como perfusion normal un blush 2-3, y una concordancia del 55% y un indice kappa de 0,1 para un blush 3. Ni la perfusion analizada mediante EMC (r = 0,23; p = 0,2) ni la fraccion de eyeccion al sexto mes por resonancia (r = 0,20; p = 0,3) se correlacionaron con el blush. Conclusiones Tras un infarto en pacientes con flujo TIMI 3 hemos encontrado una variabilidad considerable en las medidas del blush entre un hospital universitario y un laboratorio central independiente, por lo que parece aconsejable realizar la medida de este indice en laboratorios de referencia altamente especializados. La correlacion con la perfusion analizada mediante EMC y con la funcion sistolica fue escasa.

ObjectivesWe sought to evaluate the usefulness of a comprehensive assessment of four cardiovascular magnetic resonance imaging (CMR)-derived myocardial viability indexes in the setting of myocardial stunning.BackgroundCardiovascular magnetic resonance imaging allows the simultaneous assessment of several viability indexes.MethodsWe studied 40 patients with a first ST-segment elevation myocardial infarction (MI) and an open infarct-related artery. At the first week, using CMR, wall motion (WM), and four viability indexes were determined: wall thickness, WM improvement with low-dose dobutamine, perfusion, and transmural extent of necrosis. We created a comprehensive score based on the presence and the relative power of these viability indexes for predicting normal WM at the sixth month.ResultsOf 153 dysfunctional segments at the first week, 59 (39%) exhibited normal WM at the sixth month. According to the odds ratio of viability indexes for predicting normal WM, we developed a five-level predictive score. The proportions of segments showing normal WM at sixth month were as follows; Level 1 (0 indexes): 0 of 13 (0%); Level 2 (normal thickness and/or perfusion): 14 of 82 (17%); Level 3 (dobutamine response): 5 of 11 (45%); Level 4 (non-transmural necrosis): 20 of 26 (77%); Level 5 (non-transmural necrosis and dobutamine response): 20 of 21 (95%), p < 0.0001 for the trend. These proportions were similar in a matched prospective validation group comprising 16 patients (0%, 18%, 62%, 77%, and 90% for levels 1 to 5, respectively, p < 0.0001 for the trend).ConclusionsA comprehensive analysis of the four more widely used CMR-derived viability indexes is useful for predicting late systolic function after myocardial infarction.

Aims The significance of exercise-induced ST segment elevation in Q leads in patients with a recent myocardial infarction and without significant residual stenosis in the infarct-related artery has not been defined. We aimed to elucidate the role of myocardial perfusion and viability in this scenario. Methods and Results Sixty-six patients with a first myocardial infarction, single-vessel disease and an open artery were studied. Myocardial perfusion was assessed with angiographic blush, intracoronary myocardial contrast echocardiography and magnetic resonance. Myocardial viability was quantified by means of magnetic resonance (transmural extent of necrosis). Exercise-induced ST elevation in Q leads was observed only in 13 cases (20%); 53 patients (80%) did not show this finding. The group with ST elevation had fewer cases with normal perfusion: Blush 3 (15% vs. 74%, p =0.001), myocardial contrast echocardiography score >0.75 (8% vs. 81%, p =0.001) and magnetic resonance score >0.75 (31% vs. 68%, p =0.03). Similarly, myocardial viability (necrosis p =0.001). Conclusion In patients with a first myocardial infarction and without residual ischemia, exercise-induced ST segment elevation in Q leads is an uncommon finding and it is related to a more damaged coronary microcirculation and to less viable myocardium.

Introduccion y objetivos. Tras un infarto de miocardio el dano en la microcirculacion indica un peor pronostico. Investigamos la utilidad del estudio cuantitativo de la ecografia miocardica con inyeccion de contraste por via intravenosa (EMC-i.v.) para analizar la perfusion coronaria en comparacion con la inyeccion intracoronaria (EMC-i.c.). Pacientes y metodo. Estudiamos a 42 pacientes con un primer infarto con elevacion del segmento ST, enfermedad de un vaso y arteria abierta (TIMI 3, estenosis 0,75) y EMC-i.v. (perfusion de SonoVue, imagenes unicas capturando 1 de cada 6 ciclos con trigger en telesistole, perfusion normal si > 0,9). Se considero que un paciente tenia perfusion alterada si 2 o mas segmentos estaban afectados. Resultados. La cuantificacion de EMC-i.v. se realizo en 5 ± 1 min. No se detectaron efectos secundarios. De los 176 segmentos del area infartada, 141 (80%) presentaron una EMC-i.c. normal y 35 (20%), alterada. Por pacientes, la EMC-i.c. fue normal en 31 (74%) casos y estaba afectada en 11 (26%). Una perfusion normal con EMC-i.v. mostro una sensibilidad del 91%, una especificidad del 84% y un indice kappa del 0,67 para predecir una perfusion normal con EMC-i.c. (r = 0,86; p < 0,0001 entre ambas tecnicas). Conclusiones. Un analisis cuantitativo de imagenes unicas capturadas durante una perfusion intravenosa de contraste es un metodo sencillo, rapido y valido para el analisis de la perfusion coronaria postinfarto al compararlo con EMC-i.c.

Introduction and objectives. After a myocardial infarction, damage to the microcirculation indicates a worse prognosis. We compared the usefulness of the quantitative analysis of myocardial contrast echocardiography with intravenous injection of contrast (MCE-iv) with intracoronary injection (MCE-ic) for analyzing coronary perfusion. Patients and method. We studied 42 patients with a first ST-elevation myocardial infarction, single-vessel disease and a patent artery (TIMI 3, stenosis 0.75) and MCE-iv (perfusion of SonoVue, singleimage capture in 1 out of each 6 cycles with trigger set at end-systole, perfusion considered normal if >0.9). Perfusion was considered abnormal if 2 or more segments showed altered perfusion. Results. Quantification with MCE-iv took 5±1 minutes. No side effects were observed. MCE-ic was normal in 141 segments (80%) out of 176 segments included in the infarcted area, whereas 35 segments (20%) showed abnormal perfusion. MCE-ic was normal in 31 patients (74%) and was altered in 11 cases (26%). Normal perfusion with MCE-iv had a sensitivity of 91%, a specificity of 84%, and a kappa index of 0.67 for predicting normal perfusion with MCE-ic (r=0.86; P

Introduction and objective. To assess the reliability of early analysis of the most frequently used cardiac magnetic resonance (CMR)-derived indexes for predicting systolic function recovery and ventricular remodeling in patients after a first acute myocardial infarction with a patent culprit artery. Patients and method. 17 patients were studied with an initial CMR protocol that included regional assessment of wall thickness and wall thickening, low-dose dobutamine response, first-pass gadolinium myocardial perfusion imaging and delayed enhancement. These results were compared with those obtained for segmental and global function in a second CMR study 6 months later. Results. Of the 272 myocardial segments evaluated in the initial study, 73 showed severe systolic dysfunction. The findings were used to calculate sensitivity and specificity of each of the indexes mentioned above for predicting myocardial viability. The sensitivities and specificities for each index were wall thickness ≥5.5 mm, 100% and 12%; low-dose dobutamine response, 41% and 93%; normal myocardial perfusion, 78% and 68%; delayed enhancement, 81% and 95%. Multivariate analysis showed that delayed enhancement was the only independent predictor of contractility (r=‐0.83, P=.0001), ventricular volumes (enddiastolic: r=0.61, P=.009, end-systolic: r=0.67, P=.003) and ejection fraction (r=‐0.73, P=.001) at 6 months. Conclusions. Delayed enhancement seen in CMR is a reliable, quantifiable index for predicting recovery of systolic function and ventricular remodeling in patients after a first infarction with a patent culprit artery.

38 Objetivos. Analizamos la aplicabilidad y seguridad de la ecografia miocardica con inyeccion intracoronaria de contraste, su papel en la remodelacion ventricular y en la funcion sistolica, asi como su relacion con la angiografia y la resonancia magnetica para valorar la microcirculacion coronaria postinfarto. Pacientes y metodo. Se estudio a 30 pacientes con un primer infarto de miocardio con elevacion del segmento ST y arteria responsable abierta. Con inyeccion intracoronaria de contraste se determino la puntuacion media de perfusion en la zona infartada. Mediante angiografia se cuantificaron los grados TIMI y Blush. Se utilizo la resonancia magnetica para determinar la puntuacion media de perfusion (RM-perfusion), el indice de volumen telediastolico y la fraccion de eyeccion. Al sexto mes se repitieron

Introduccion y objetivo. Analizar la fiabilidad del analisis precoz de los indices mas ampliamente utilizados en resonancia magnetica cardiaca (RMC) para predecir la recuperacion de la funcion sistolica y el remodelado ventricular en pacientes con un primer infarto agudo de miocardio y arteria causante del infarto permeable. Pacientes y metodo. Se estudio a 17 pacientes mediante RMC en la que se valoro el grosor de la pared, la respuesta a bajas dosis de dobutamina, la perfusion miocardica de primer paso con gadolinio y el porcentaje de captacion tardia de contraste. Los hallazgos de la RMC inicial se correlacionaron con la funcion segmentaria y global obtenida en la RMC al sexto mes. Resultados. De los 272 segmentos de la RMC inicial, 73 mostraron disfuncion sistolica severa, a partir de los cuales se calcularon la sensibilidad y especificidad de cada unos de los indices para predecir viabilidad miocardica. Un grosor diastolico = 5,5 mm obtuvo una sensibilidad del 100% y una especificidad del 12%; en la respuesta a la dobutamina, estas fueron del 41 y el 93%; en una perfusion normal, del 78 y el 68%, y en una captacion tardia < 50%, del 81 y el 95%, respectivamente. La captacion tardia fue el unico predictor independiente de la contractilidad (r = ­-0,83; p = 0,0001), de los volumenes ventriculares (telediastolico, r = 0,61; p = 0,009; telesistolico, r = 0,67; p = 0,003) y la fraccion de eyeccion (r = ­-0,73, p = 0,001) al sexto mes. Conclusiones. La captacion tardia mediante RMC es un indice cuantificable y fiable para predecir la mejoria de la funcion sistolica y el remodelado ventricular en pacientes tras un primer infarto con arteria abierta.

The C677T transition of methylenetetrahydrofolate reductase (MTHFR) gene causes a moderate increase in total plasma homocysteine (tHcy). We studied the effect of MTHFR TT homozygosity and mild hyperhomocysteinemia on arterial hypertension. Normotensive controls (n = 223) and hypertensive subjects (n = 235) were matched for age, gender, and history of cardiovascular disease. Homocysteine levels were measured by a polarization immunoassay method. Methylenetetrahydrofolate reductase we determined by polymerase chain reaction and restriction fragment analysis. Hypertensives showed elevated tHcy compared to normotensive group in men (P = 0.039). Homocysteine values higher than 15 micromol/L were associated with increased hypertensive risk in the male population [odds ratios (OR) = 1.63; 95% confidence interval (CI) = 1.06-2.52; P = 0.027]. In multivariate analysis, TT genotype was associated with an increased risk of hypertension in males (OR = 2.27; 95% CI = 1.12-4.60; P = 0.022) An increased hypertensive risk was observed in those TT males with tHcy levels higher than 15 micromol/L (OR = 2.78; 95% CI = 1.05-7.3; P = 0.032) but not in those non-TT males with tHcy levels higher than 15 micromol/L (P = 0.33). Our findings do not support the possibility that mild hyperhomocysteinemia my solely account for the hypertensive risk associated to the TT genotype.

BACKGROUND Apoptosis is a programmed cell death, genetically controlled, that can be activated by physiological and pathophysiological events and by the administration of several drugs, including the exogenous administration of corticosteroids. The aim of this study was to develop a rat model of intestinal lymphocytic apoptosis induced by dexamethasone to determine if apoptosis could be prevented by enteral or parenteral nutrition. METHODS Male Sprague-Dawley rats were used. On day 0, the right internal jugular vein was catheterized for parenteral nutrition, and a silicone tube was inserted into the duodenum for enteral feeding. Animals (n = 6/group) were randomly assigned to one of the following 3 feeding regimens: an immune-enhancing enteral diet; its placebo (the same formula without immunonutrients); and isocaloric isonitrogenous parenteral nutrition. On the seventh day, 200 microg of dexamethasone or vehicle were administered by i.v. bolus, and the diets were continued for 1 more day. Intestinal Peyer patches and thymic lymphocytic apoptosis were determined both by flow-cytometry and immunohistochemistry. RESULTS A single dexamethasone dose (200 microg/rat) administered to surgically treated rats fasted for 18 hours, 24 hours later, caused massive intestinal and Peyer patches lymphocytic apoptosis (96 +/- 2% and 85 +/- 5%, respectively; p < .0001 versus vehicle in both kinds of tissue). Lymphocytic apoptosis was reduced to almost indetectable levels in intestinal and lamina propia lymphocytes (from 96 +/- 2% to

OBJECTIVES We examined the relationship between the angiotensinogen (AGT) gene M235T polymorphism, the variant promoter of the AGT gene A(-6)G and the angiotensin-converting enzyme (ACE) gene insertion/deletion (I/D) polymorphism and coronary heart disease (CHD) in native Gran Canaria Island habitants, who have the highest rates of CHD in Spain. BACKGROUND Some studies subject that the ACE (I/D) polymorphism could be associated with CHD, while AGT (M235T) has been related to essential hypertension. METHODS We studied 304 subjects with angiographic evidence of coronary artery disease and a clinical diagnosis of myocardial infarction or unstable angina and 315 age- and gender-matched controls. Blood was drawn and DNA extracted. Angiotensin-converting enzyme (I/D) gene polymorphism was analyzed by polymerase chain reaction (PCR) and AGT gene polymorphisms by restriction fragment length polymorphism-PCR and mutagenically-separated PCR. RESULTS The ACE (I/D) polymorphism showed no association with CHD, whereas the frequency distribution of AGT (M235T) genotypes among patients and controls (235T: 29.1% and 19.0%; M235T: 48.5% and 50.2%; M235: 22.4% and 30.8%, respectively) was statistically different (p = 0.005) and not related to the presence of essential hypertension. Similar results were observed with the AGT A(-6)G polymorphism. In multiple logistic regression analysis, CHD odds ratio associated with 235T and M235 homozygotes were 1.7 (1.1 to 2.6) and 0.54 (0.36 to 0.82), respectively. CONCLUSIONS This study shows that genetic variation of the AGT (M235T), but not the ACE (I/D), genotypes contributes to the presence of CHD independently of blood pressure profile in a subset of the Spanish population with a high prevalence of cardiovascular disease.

Introduccion y objetivos Analizar la influencia de las variaciones de los ciclos cardiacos en la determinacion del area valvular mitral mediante el tiempo de hemipresion en pacientes con estenosis mitral y fibrilacion auricular. Metodos En 59 pacientes con estenosis mitral se ha obtenido el registro del flujo transmitral utilizando la tecnica de Doppler desde la ventana apical. En cada uno de ellos se ha cuantificado el tiempo de hemipresion en un numero minimo de treinta ciclos consecutivos. Resultados Teniendo en cuenta todas las mediciones efectuadas en cada paciente la correlacion entre el tiempo de hemipresion y los ciclos cardiacos ha sido significativa en 20 pacientes (34%). Los coeficientes de variacion del tiempo de hemipresion son significativamente mayores cuando se incluyen los valores correspondientes a los ciclos mas cortos. Asi, para ciclos ≥ 800, 700, 600, 500 y 400 ms, los valores medios son 0,096 ± 0,041, 0,106 ± 0,042 (NS), 0,128 ± 0,032 (p Conclusiones En los pacientes con estenosis mitral y fibrilacion auricular existe una variacion en las determinaciones del tiempo de hemipresion que puede dificultar el calculo del area valvular mitral. Ademas de la variabilidad inherente al metodo de medida existe otra que es dependiente de la duracion de los ciclos cardiacos y que se puede soslayar realizando las determinaciones en ciclos mayores de 800 ms.

La presencia de quistes cardiacos nos obliga a plantearnos la posibilidad diagnostica de una hidatidosis cardiaca, incluso en ausencia de afectacion de otros organos. Las tecnicas de diagnostico por la imagen nos orientan en el diagnostico inicial, siendo muy caracteristico el hallazgo de vesiculas hijas o la presencia de multiples quistes. Presentamos el caso de un paciente con hidatidosis cardiaca en forma de quistes cardiacos multiples, sin afectacion extracardiaca, que presento dolor toracico de perfil pericardico y que recibio tratamiento quirurgico, para evitar las complicaciones derivadas de una posible rotura de los quistes.

The development of flat angiomas in the form of a «port-wine stain» is an infrequent event in adults. We describe two cases of acquired flat angioma in the form of a «port-wine stain,» which began in the second decade of life and grew slowly and steadily until reaching a large size. In the first case, it affected the front and back of the trunk, and in the second patient, the neck and left shoulder. Histopathology showed ectatic vessels in the papillary and reticular dermis, with no proliferation of endothelial cells.