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ABSTRACT Introduction and objectives: Functional assessment of coronary stenosis severity with the piezo-electric sensor pressure wire has shown a discrepancy of up to 20% between hyperemic and nonhyperemic indexes. No data are available with fiber-optic pressure wires. The aim of this study was to evaluate the incidence and factors related to the diagnostic discordance between these indexes with a fiber-optic pressure wire. Secondary aims were to assess diagnostic reproducibility in 2 consecutive measurements of fractional flow reserve (FFR) and diastolic pressure ratio (dPR) and evaluate the drift rate. Methods: We conducted a prospective, observational multicenter study in patients undergoing functional assessment with a fiber-optic pressure wire. We took 2 consecutive measurements of the dPR (cutoff point 0.89) and FFR (cut-off point 0.80) in each lesion analyzed. The diagnostic correlation between 2 measurements with the same technique and between the 2 techniques (dPR and FFR) was assessed. Clinical and angiographic factors associated with discordance (FFR−/dPR+ and FFR+/dPR−) between the 2 techniques were analyzed. Results: We included 428 cases of stenosis (361 patients). Diagnostic reproducibility was 95.8% for the dPR, with a correlation coefficient between the 2 measurements (dPR1 and dPR2) of 0.974 (P 60%. The drift rate was 5.7%. Conclusions: Although FFR and dPR measurements with a fiber-optic pressure wire have excellent reproducibility and a low drift rate, the discordance rate remains similar to those in previous studies with a piezo-electric pressure wire. FFR−/dPR+ discordance is associated with intracoronary adenosine and hypertension. FFR+/dPR− discordance is related to age < 75 years old and stenosis > 60%.

RESUMEN Introducción y objetivos: La valoración funcional de las estenosis coronarias con guías de presión de sensor piezoeléctrico ha mostrado hasta un 20% de discordancia entre los índices hiperémico y no hiperémico. No hay datos disponibles con guía de presión de sensor óptico. El objetivo del estudio es evaluar la incidencia y los factores relacionados con la discordancia diagnóstica entre estos índices con guía de presión de sensor óptico. Como objetivos secundarios se evaluó la reproducibilidad diagnóstica en dos determinaciones consecutivas de la reserva fraccional de flujo (RFF) y la diastolic pressure ratio (dPR). También se evaluó la tasa de drift. Métodos: Estudio observacional, prospectivo, multicéntrico, en pacientes a quienes se realiza una valoración funcional con guía de presión de sensor óptico. Se hicieron dos mediciones consecutivas de dPR (umbral 0,89) y RFF (umbral 0,80) en cada lesión analizada. Se valoró la correlación diagnóstica entre dos mediciones con la misma técnica y entre ambas técnicas (dPR y RFF). Se analizaron factores clínicos y angiográficos asociados a la discordancia (RFF−/dPR+ y RFF+/dPR−) entre ambas técnicas. Resultados: Se incluyeron 428 estenosis (361 pacientes). La reproducibilidad diagnóstica fue del 95,8% para dPR, con un coeficiente de correlación entre ambas mediciones (dPR1 y dPR2) de 0,974 (p < 0,0001). Para RFF la reproducibilidad diagnóstica fue del 94,9%, con un coeficiente de correlación (RFF1 y RFF2) de 0,942 (p < 0,0001). La discordancia diagnóstica fue del 18,2% (RFF+/dPR− 8,2% y RFF−/dPR+ 10%). Entre las variables analizadas, en el análisis multivariado, la hipertensión arterial y la administración intracoronaria de adenosina se asociaron de manera significativa con la discordancia RFF−/dPR+. Solo la edad < 75 años y la estenosis > 60% se asociaron de manera significativa con la discordancia RFF+/dPR−. La tasa de drift fue del 5,7%. Conclusiones: Aunque las mediciones de RFF y dPR con guía de presión de sensor óptico tienen una excelente reproducibilidad y una baja incidencia de drift, la tasa de discordancia permanece similar a la de estudios previos con guía de presión de sensor piezoeléctrico. La adenosina intracoronaria y la hipertensión arterial se asocian con la discordancia RFF−/dPR+. La edad < 75 años y la estenosis > 60% se asocian a discordancia RFF+/dPR−.

This study aimed to determine the incidence of post-chikungunya chronic rheumatism (pCHIK-CR) and its impact on quality of life (QoL) and chronic fatigue in adults seven years after the 2014–2015 CHIKV outbreak in Piedecuesta, Colombia. We evaluated 78 adults (median age: 30 years, IQR: 21.0; women 60.3%) with confirmed CHIKV infection. In 2022, participants underwent a GALS examination and completed surveys on disability, stiffness, health status, and fatigue. A rheumatologist evaluated patients who reported arthralgia, morning stiffness, and abnormal GALS examination. Chronic fatigue was defined as fatigue persisting for over six months. Seven years after infection, 14.1% of participants were classified as pCHIK-CR cases, 41.0% as having non-inflammatory pain, likely degenerative (NIP-LD), and 44.9% without rheumatic disease (Wo-RM). Patients with pCHIK-CR and NIP-LD exhibited significantly worse QoL compared to Wo-RM cases. Chronic fatigue prevalence increased from 8.6% in Wo-RM patients to 25.0% in NIP-LD and 54.6% in pCHIK-CR cases. This study implemented a comprehensive clinical assessment to objectively estimate and characterize the incidence of chronic rheumatological disease attributed to CHIKV infection. One in seven cases with CHIKV infection develops pCHIK-CR, which impacts both QoL and chronic fatigue. This study contributes to understanding the burden of these arboviruses in the medium term.

Computational modeling (CM) is a versatile scientific methodology used to examine the properties and behavior of complex systems, such as polymeric materials for biomedical bioengineering. CM has emerged as a primary tool for predicting, setting up, and interpreting experimental results. Integrating in silico and in vitro experiments accelerates scientific advancements, yielding quicker results at a reduced cost. While CM is a mature discipline, its use in biomedical engineering for biopolymer materials has only recently gained prominence. In biopolymer biomedical engineering, CM focuses on three key research areas: (A) Computer-aided design (CAD/CAM) utilizes specialized software to design and model biopolymers for various biomedical applications. This technology allows researchers to create precise three-dimensional models of biopolymers, taking into account their chemical, structural, and functional properties. These models can be used to enhance the structure of biopolymers and improve their effectiveness in specific medical applications. (B) Finite element analysis, a computational technique used to analyze and solve problems in engineering and physics. This approach divides the physical domain into small finite elements with simple geometric shapes. This computational technique enables the study and understanding of the mechanical and structural behavior of biopolymers in biomedical environments. (C) Molecular dynamics (MD) simulations involve using advanced computational techniques to study the behavior of biopolymers at the molecular and atomic levels. These simulations are fundamental for better understanding biological processes at the molecular level. Studying the wide-ranging uses of MD simulations in biopolymers involves examining the structural, functional, and evolutionary aspects of biomolecular systems over time. MD simulations solve Newton’s equations of motion for all-atom systems, producing spatial trajectories for each atom. This provides valuable insights into properties such as water absorption on biopolymer surfaces and interactions with solid surfaces, which are crucial for assessing biomaterials. This review provides a comprehensive overview of the various applications of MD simulations in biopolymers. Additionally, it highlights the flexibility, robustness, and synergistic relationship between in silico and experimental techniques.

Abstract Balamuthia mandrillaris is a pathogenic protozoan that causes a rare but almost always fatal infection of the central nervous system and, in some cases, cutaneous lesions. Currently, the genomic data for this free-living amoeba include the description of several complete mitochondrial genomes. In contrast, two complete genomes with draft quality are available in GenBank, but none of these have a functional annotation. In the present study, the complete genome of B. mandrillaris isolated from a freshwater artificial lagoon was sequenced and assembled, obtaining an assembled genome with better assembly quality parameter values than the currently available genomes. Afterward, the genome mentioned earlier, along with strains V039 and 2046, were subjected to functional annotation. Finally, comparative genomics analysis was performed, and it was found that homologous genes in the core genome potentially involved in the virulence of Acanthamoeba spp. and Trypanosoma cruzi. Moreover, eleven of fifteen genes were identified in the three strains described as potential target genes to develop new treatment approaches for B. mandrillaris infections. These results describe proteins in this protozoan's complete genome and help prioritize which target genes could be used to develop new treatments.

El objetivo de la presente investigación es asociar el aprendizaje, los problemas de concentración, la integración escolar, la participación negativa y las aspiraciones con la propensión de deserción escolar en los alumnos de un colegio militarizado. El estudio fue no experimental, descriptivo y correlacional con una muestra de 350 estudiantes. Se propone un modelo empírico donde se muestran los resultados obtenidos: las asociaciones negativas del aprendizaje y las aspiraciones del estudiante con la inclinación por desertar y las asociaciones positivas de los problemas de concentración, integración escolar negativa y la participación inadecuada con el abandono escolar.

Objetivo: Señalar la asociación que existe entre los factores personal docente facilitador, convivencia escolar. personas tutoras supervisoras con la baja resiliencia en una institución de bachillerato militarizado en el estado de Nuevo León, México. Metodología: El estudio fue científico, no experimental, descriptivo y correlacional con una población de 484 estudiantes de los tres últimos semestres de tres planteles. Se propuso un modelo teórico que refleja las variables comprendidas en los constructos independientes y en el dependiente, así como un modelo empírico que relaciona los factores por medio de una técnica de modelado con ecuaciones estructurales. Resultados: Existe correlación entre las variables o adecuación de muestreo Kaiser-Meyer-Olkin (KMO), el cual fue de 0.809. Se obtuvo una Chi-cuadrada de 478.9, gl = 4.98, p-value < 0.001, el error cuadrático de medida de aproximación fue de 0.093, con intervalo de 0.085 y 0.101, lo que indica que los datos no están sesgados. Los índices de validación esperada, normado de ajuste, Tucker Lewis y ajuste normado de Parsimonia fueron: 0.743; 0.695; 0.545 y 0.906, respectivamente. Las β de los factores propuestos fueron de 0.45 para personal docente facilitador, -0,85 para la convivencia escolar y -0,31 para personas tutoras supervisoras. Conclusiones: Cuando la planta docente busca la participación del alumnado, invita al aprendizaje, da explicaciones de clase, resuelve dudas y preguntas, y se esmera por hacer la clase interesante; si el estudiantado muestra mayor enojo, lo consideran algo inesperado y piensan que no lograrán enfrentar las cosas; cuando las madres o padres supervisan los resultados, las tareas, trabajos y las actividades que sus hijas e hijos realizan fuera de casa, el estudiantado beneficia su capacidad de resiliencia. Las relaciones entre la planta docente, directiva y estudiantil favorecen la resiliencia del alumnado, lo cual disminuye sus enojos y afecciones, y favorece la capacidad de afrontar las cosas.

RESUMEN Introducción y objetivos: La posdilatación de stents coronarios con balones no distensibles mejora los resultados clínicos. Los balones no distensibles normales (RegNC) presentan peor navegabilidad y tienen una punta cónica que puede dificultar la posdilatación exitosa. Las condiciones mecánicas de un nuevo balón no distensible con punta esférica (EsfNC) podrían facilitar la posdilatación del stent. Evaluamos la efectividad del EsfNC en la posdilatación coronaria para la intervención coronaria percutánea en la práctica clínica habitual. Métodos: Registro técnico prospectivo y multicéntrico para evaluar la efectividad de un nuevo EsfNC en posdilatación coronaria, con 2 grupos de estudio: uso de EsfNC como primera opción o uso de EsfNC ante el fracaso de RegNC. El evento primario fue el éxito técnico, definido como conseguir avanzar el EsfNC hasta el segmento que posdilatar dentro del stent. Los eventos secundarios fueron el éxito angiográfico, definido como éxito técnico junto con estenosis residual < 30% con flujo final TIMI 3, y el éxito del procedimiento, definido como éxito angiográfico sin complicación mecánica del stent ni eventos cardiovasculares mayores periprocedimiento. Resultados: Se usó EsfNC en 263 lesiones (en 177 como primera opción y en 86 tras el fracaso de RegNC), en 250 procedimientos. Se usaron técnicas complejas para avanzar el EsfNC en el 9,9% de los procedimientos. Los porcentajes de éxito técnico, angiográfico y de procedimiento fueron del 98,9%, el 98,3% y el 98,3% como primera opción, y del 98,8%, el 97,7% y el 96,5% tras fracaso de RegNC, respectivamente. Los EsfNC tuvieron similar calibre (3,39 ± 0,6 frente a 3,34 ± 0,6 mm; p = no significativo) y longitud más corta (11 ± 2 frente a 12 ± 3 mm; p = 0,005) que los RegNC. No se comunicaron complicaciones mecánicas del stent. Conclusiones: La posdilatación coronaria con EsfNC para la intervención coronaria percutánea en la práctica clínica habitual muestra un porcentaje muy alto de éxito técnico, tanto en primera opción (98,9%) como en casos de fracaso de RegNC (98,8%), con baja necesidad de técnicas complejas y buen perfil de seguridad.

ABSTRACT Introduction and objectives: Noncompliant balloon postdilatation of coronary stents improves clinical results. Regular noncompliant balloons (RegNC) have less crossability and a tapered-tip that can complicate successful stent postdilatation. The mechanical conditions of a new spherical tip non-compliant balloon (SphNC) could facilitate stent postdilatation. We tried to evaluate the effectiveness of a new SphNC in the routine percutaneous coronary intervention (PCI) practice. Methods: Prospective multicenter technical registry to assess the effectiveness of a new SphNC for stent postdilatation with 2 study arms: use of SphNC as the first choice or as the secondary choice after RegNC failure. The primary endpoint was technical success defined as advancing the SphNC across the stent segment. Secondary endpoints were angiographic success defined as technical success and residual stenosis < 30% with final TIMI grade-3 flow, and procedural success defined as angiographic success without mechanical stent complications or any perioperative major adverse cardiovascular events. Results: The SphNC was used in 263 lesions (177 lesions as first choice, and 86 after RegNC failure) in 250 procedures. The use of the complex technique to advance the SphNC was low (9.9%). Technical, angiographic, and procedural success rates were 98.9%, 98.3%, and 98.3%, respectively, as the first choice, and 98.8%, 97.7%, and 96.5%, respectively, after RegNC failure. SphNC had similar size (3.39 mm ± 0.6 mm vs 3.34 mm ± 0.6 mm; P = nonsignificant), and shorter lengths (11 mm ± 2 mm vs 12 mm ± 3 mm; P = .005) compared to RegNC. No stent-related mechanical complications were reported. Conclusions: SphNC for coronary stent postdilatation in the routine PCI clinical practice has a very high technical success rate as the first choice (98.9%), as well as in cases of RegNC failure (98.8% with low complex technique requirements, and a safe profile).

There are abundant examples of negative assessments of cultic honors to Roman emperors by nineteenth- and twentieth-century researchers. In the minds of historians raised in modern societies, in which monotheistic Abrahamic religions usually reign supreme, this is a completely understandable a priori approach; nevertheless, it hinders a correct understanding of Roman society in antiquity. This paper examines the need to provide a complex answer to the question of whether the inhabitants of the Roman world really believed in the divinity of their rulers. A complex answer to the question can only emerge from a historical contextualization of the phenomenon under analysis, an examination of the imperial cult within the wider changes that were taking place in Roman religion at the time, and application of the necessary empathetic approach.

IntroductionNanomedicine provides a promising platform for manipulating dendritic cells (DCs) and the ensuing adaptive immune response. For the induction of regulatory responses, DCs can be targeted in vivo with nanoparticles incorporating tolerogenic adjuvants and auto-antigens or allergens.MethodsHere, we investigated the tolerogenic effect of different liposome formulations loaded with vitamin D3 (VD3). We extensively phenotyped monocyte-derived DCs (moDCs) and skin DCs and assessed DC-induced regulatory CD4+ T cells in coculture. ResultsLiposomal VD3 primed-moDCs induced the development of regulatory CD4+ T cells (Tregs) that inhibited bystander memory T cell proliferation. Induced Tregs were of the FoxP3+ CD127low phenotype, also expressing TIGIT. Additionally, liposome-VD3 primed moDCs inhibited the development of T helper 1 (Th1) and T helper 17 (Th17) cells. Skin injection of VD3 liposomes selectively stimulated the migration of CD14+ skin DCs. DiscussionThese results suggest that nanoparticulate VD3 is a tolerogenic tool for DC-mediated induction of regulatory T cell responses.

RESUMEN Introducción y objetivos: Los pacientes con estenosis en el tronco coronario izquierdo (TCI) han sido excluidos de los ensayos que apoyan la no inferioridad del cociente de presiones en el índice diastólico instantáneo sin ondas (iFR) respecto a la reserva fraccional de flujo (RFF) en la toma de decisiones sobre revascularización coronaria. El presente estudio propone valorar de manera prospectiva la concordancia entre los dos índices en lesiones del TCI y validar el valor de corte del iFR de 0,89 para su uso clínico. Métodos: Registro multicéntrico nacional, prospectivo, observacional, con la inclusión de 300 pacientes consecutivos con lesiones intermedias (estenosis angiográfica 25-60%) en el TCI. Se realizará un estudio con guía de presión y determinación de RFF e iFR. En caso de resultado concordante negativo (RFF > 0,80 / iFR > 0,89), no se realizará tratamiento; en caso de resultado concordante positivo (RFF ≤ 0,80 / iFR ≤ 0,89), se realizará revascularización; en caso de resultado discordante (RFF > 0,80 / iFR ≤ 0,89 o RFF ≤ 0,80 / iFR > 0,89), se realizará estudio con ecocardiografía intravascular y se considerará diferir la revascularización si el área luminal mínima es > 6 mm2. El criterio de valoración clínico primario será la incidencia del combinado de muerte cardiovascular, infarto no mortal relacionado con la lesión del TCI o necesidad de revascularización de la lesión del TCI a los 12 meses. Conclusiones: La demostración de la seguridad clínica en la toma de decisiones del iFR en pacientes con lesiones intermedias en el TCI tendría un impacto clínico importante y justificaría su uso sistemático para la decisión del tratamiento en estos pacientes de potencial alto riesgo. Registrado en ClinicalTrials.gov (identificador: NCT03767621).

ABSTRACT Introduction and objectives: Patients with left main coronary artery (LMCA) stenosis have been excluded from the trials that support the non-inferiority of the instantaneous wave-free ratio (iFR) compared to the fractional flow reserve (FFR) in the decision-making process of coronary revascularization. This study proposes to prospectively assess the concordance between the two indices in LMCA lesions and to validate the iFR cut-off value of 0.89 for clinical use. Methods: National, prospective, and observational multicenter registry of 300 consecutive patients with intermediate lesions in the LMCA (angiographic stenosis, 25% to 60%. A pressure gudiewire study and determination of the RFF and the iFR will be performed: in the event of a negative concordant result (FFR > 0.80/iFR > 0.89), no treatment will be performed; in case of a positive concordant result (FFR ≤ 0.80/iFR ≤ 0.89), revascularization will be performed; In the event of a discordant result (FFR> 0.80/iFR ≤ 0.89 or FFR ≤ 0.80/iFR> 0.89), an intravascular echocardiography will be performed and revascularization will be delayed if the minimum lumen area is > 6 mm2. The primary clinical endpoint will be a composite of cardiovascular death, LMCA lesion-related non-fatal infarction or need for revascularization of the LMCA lesion at 12 months. Conclusions: Confirm that an iFR-guided decision-making process in patients with intermediate LMCA stenosis is clinically safe and would have a significant clinical impact. Also, justify its systematic use when prescribing treatment in these potentially high-risk patients. Registered at ClinicalTrials.gov ( Identifier: NCT03767621).

ABSTRACT Introduction and objectives: After the positive pre-clinical and clinical results with Angiolite, a cobalt-chromium sirolimus-eluting stent, we decided to analyze its performance in a non-selected, real-world population: the RANGO registry. Methods: We conducted an observational, prospective, multicenter registry of patients with different clinical indications. All consecutive patients treated with percutaneous coronary intervention with, at least, 1 Angiolite stent and who gave their informed consent were included. The registry primary endpoint was the occurrence of target lesion failure (TLF) at 6, 12, and 24 months defined as cardiovascular death, myocardial infarction (MI) related to target vessel, and clinically driven target lesion revascularization. The secondary endpoints were the individual components of the primary endpoint, major adverse cardiovascular events (MACE: all-cause mortality, any MI, or any revascularization), and stent thrombosis. We describe the 2-year clinical results of the RANGO study in the entire population, in those who only received Angiolite stents, and in 2 predefined subgroups: diabetics and patients with small-vessels (≤ 2.5mm). Results: 646 patients (426 of them only received Angiolite stents) with a high-risk profile were recruited: prevalence of previous MI (18.4%), previous coronary revascularization (23.4%), clinical presentation as ST-segment elevation MI (23.1%), and multivessel disease (47.8%). At the 2-year follow-up, the rates of TLF, MACE, and stent thrombosis were 3.4%, 9.6%, and 0.9%, respectively. Similar results were observed among patients treated with Angiolite stents only: TLF, 3.1%; MACE, 8.0%; thrombosis, 0.7%. The rates were not significantly different for the diabetic (TLF, 3.0%; MACE, 14.1%; thrombosis, 1.0%), and small-vessel subgroups (TLF, 4.3%; MACE, 12.1%; thrombosis, 0%). Conclusions: In conclusion, the results of this observational registry on the use of Angiolite in a real-world population, including a high-risk population, corroborate the excellent results observed in previous studies, up to a 2-year follow-up. An extended 5-year follow-up is planned to discard the occurrence of late events.

(1) Background: Non-pharmacological interventions have demonstrated efficacy in the prevention, management, and control of hypertension. Multicomponent training confers a host of benefits to the general populace. The aim of this research was to assess the impact of multicomponent training on the blood pressure of adults with hypertension and ascertain the nature of the dose–response relationship. (2) Methods: This systematic review adhered to the PRISMA guidelines and was registered in PROSPERO. Eight studies were included, following a literature search across PubMed, Web of Science, Cochrane, and EBSCO. Randomized controlled trials implementing multicomponent training interventions on adults with hypertension were considered for inclusion. A quality assessment was performed using the PEDro scale, with a random-effects model utilized for all analyses. (3) Results: Multicomponent training yielded a significant reduction in systolic (MD = −10.40, p < 0.001) and diastolic (MD = −5.97, p < 0.001) blood pressure relative to the control group. Interventions lasting over 14 weeks with a minimum frequency of three sessions per week, each lasting 60 min, were deemed most effective. (4) Conclusion: An optimal training intensity was achieved with 30 min of aerobic exercise at 75% of the heart rate reserve, whereas sets of 10 repetitions at 75% of one repetition maximum produced the best outcomes in strength training.

Abstract Background During COVID-19 pandemic, elective invasive cardiac procedures (ICP) have been frequently cancelled or postponed. Consequences may be more evident in patients with diabetes. Objectives The objective was to identify the peculiarities of patients with DM among those in whom ICP were cancelled or postponed due to the COVID-19 pandemic, as well as to identify subgroups in which the influence of DM has higher impact on the clinical outcome. Methods We included 2,158 patients in whom an elective ICP was cancelled or postponed during COVID-19 pandemic in 37 hospitals in Spain. Among them, 700 (32.4%) were diabetics. Patients with and without diabetes were compared. Results Patients with diabetes were older and had a higher prevalence of other cardiovascular risk factors, previous cardiovascular history and co-morbidities. Diabetics had a higher mortality (3.0% vs. 1.0%; p = 0.001) and cardiovascular mortality (1.9% vs. 0.4%; p = 0.001). Differences were especially important in patients with valvular heart disease (mortality 6.9% vs 1.7% [p

RESUMEN La enfermedad del tronco coronario izquierdo ha permanecido muchos años como la última frontera que se resistía al intervencionismo coronario percutáneo. Hasta hace poco tiempo, los estudios clínicos más relevantes en este campo, así como las guías clínicas, han sido favorables a la revascularización quirúrgica casi como forma exclusiva de tratamiento de esta patología. Los cambios ocurridos en los últimos 10-15 años, desde la aparición de los stents farmacoactivos y su mejora tecnológica, han sido vertiginosos. La realización de estudios aleatorizados que han comparado ambas modalidades de revascularización ha llevado al intervencionismo percutáneo a la altura de la cirugía en un alto porcentaje de pacientes. Los aspectos anatómicos, técnicos y de estrategia son fundamentales en el tratamiento percutáneo de estas lesiones, dada su enorme variabilidad clínica. En tanto los estudios clínicos futuros no se decanten definitivamente...

.special th, .special td { vertical-align: text-top; } ABSTRACT For many years, left main coronary artery disease has remained as the last frontier resisting percutaneous coronary intervention. Until recently, the most relevant clinical studies in this regard as well as clinical practice guidelines favored surgical revascularization almost as the only treatment pathway for the management of this condition. The changes that have occurred over the last 10 to 15 years since the appearance of drug-eluting stents and their technological advances have been extraordinary. This, added to the publication of randomized clinical trials that compared both revascularization modalities, has placed percutaneous coronary interventions at a similar level to surgery in a large number of patients. The anatomical, technical, and strategic aspects are essential for the percutaneous management of left main coronary artery lesions given their tremendous clinical variability. In this article we will be reviewing their anatomy, angiography, intracoronary diagnostic techniques, and different percutaneous revascularization strategies. As long as future clinical studies do not definitively favor percutaneous over surgical revascularization or vice versa, individual discussions on each particular case by the heart team and our patients’ preferences should guide our clinical decision-making process.

Objetivos: Examinar los niveles de participación parental en los estudios de sus hijas e hijos, el clima familiar, la confianza del estudiantado y la propensión de deserción escolar en el alumnado del CBM y asociar la participación parental en los estudios de sus hijas e hijos, el clima familiar y la confianza del estudiantado con la propensión de deserción escolar en el CBM. Metodología :El estudio fue descriptivo y correlacional con una muestra de 350 estudiantes. Resultados: La media de la participación parental fue de 3.87; del clima familiar 4.11; de la confianza del estudiantado 3.76, y de la propensión de deserción escolar 1.69. Resaltaron las correlaciones entre clima familiar y participación parental con 0.43; confianza del estudiantado con participación parental y clima familiar, 0.21 y 0.36, respectivamente, y la correlación negativa entre confianza del estudiantado con la propensión de deserción escolar de -0.25. El modelo solo explicó el 5.4% del fenómeno con asociaciones de forma negativa de la confianza y el clima familiar con un peso de -0.246 y -0.014, con la inclinación por abandonar los estudios. Conclusiones: Se cumplieron los objetivos de la investigación, los cuales indicaron que el clima familiar y la confianza de las alumnas y los alumnos del CBM favorecen la permanencia escolar, mientras que la participación de las madres y los padres en los estudios de sus hijas e hijos es recomendable. Además, se identificó que las propensiones de desertar por el alumnado del CBM son escasas. Se recomienda fomentar la participación parental en el desempeño académico de sus hijas e hijos, propiciar espacios familiares de estimulación para la lectura, reflexión y el aprendizaje, concientizar sobre la importancia del estudio e integrar al alumnado en actividades académicas, deportivas, culturales y artísticas organizadas por la institución para acrecentar el sentido de pertenencia, entre otras.

Resumen: Objetivo: encontrar una relación entre los niveles de proteína C reactiva (PCR) y fibrinógeno, y la extensión de la aterosclerosis en el síndrome coronario agudo. Métodos: estudio observacional prospectivo, en el que se incluyeron 873 pacientes con síndrome coronario atendidos en un hospital entre 2016 y 2018. Se analizaron niveles de PCR y fibrinógeno, marcadores metabólicos y extensión de la aterosclerosis coronaria. Resultados: no se halló correlación positiva entre los niveles de PCR y fibrinógeno y los marcadores metabólicos, así como tampoco con enfermedad de uno, dos y tres vasos (p 0,829; p 0,810). Conclusiones: los niveles sanguíneos de PCR y fibrinógeno se relacionan con la tasa de eventos cardiovasculares, pero no se ha podido demostrar que exista relación entre estos y la severidad de la aterosclerosis coronaria. Abstract: Objective: To determine whether there is a relationship between C - reactive protein and fibrinogen levels and the extent of atherosclerosis in acute coronary syndrome. Methods: A prospective observational study was conducted that include 873 patients with coronary syndrome treated in a hospital between the years 2016 and 2018. An analysis was made that included C - reactive protein and fibrinogen levels, metabolic markers, extent of coronary atherosclerosis. Results: No positive correlation was found between the C - reactive protein and fibrinogen levels and the metabolic markers, nor with one, two, or three vessel disease (P = .829; P = .810). Conclusions: Although blood C-Reactive Protein and fibrinogen levels are associated with the rate of cardiovascular events, this study was unable to demonstrate whether there is a relationship between these and the severity of the coronary atherosclerosis.

Considering the important role that wastewater reuse plays in the water cycle and in the current water scenario immersed in a severe drought, the search for technologies that allow obtaining quality water for reuse is increasingly relevant. In this sense, the membrane biological reactor (MBR) is an alternative to traditional activated sludge systems, in which the separation of biomass and treatment water is carried out by membrane filtration instead of decantation. This study made it possible to confirm the presence of emerging pollutants in the wastewater entering the WWTPs under study, to study the behavior and performance of MBR systems with hollow fiber membranes and flat membranes in obtaining reclaimed wastewater for subsequent reuse, and to compare it with the degree of elimination obtained in conventional biological treatment. It has been demonstrated that this technology is almost 100% effective in the elimination of nutrients, organic matter, pathogens, organic micropollutants, metals, etc., and has achieved different percentages of success in eliminating emerging pollutants depending on their nature: 35% in insecticides and herbicides, 45% in anxiolytics, psychiatric drugs, and industrial disinfectants, 75% in antibiotics, and around 100% in analgesics, anti-inflammatory drugs, and hormones. It has also contributed to the establishment of monitoring protocols for emerging pollutants in the WWTPs under study and to the evaluation of their risks, as well as the development and implementation of advanced regeneration systems that are economically favorable for increasing the quality of WWTP effluents for their reuse.

In the present study, the nematicidal and acaricidal activity of three Enterobacter endophytic strains isolated from Mimosa pudica nodules was evaluated. The percentages of mortality of Enterobacter NOD4 against Panagrellus redivivus was 81.2%, and against Nacobbus aberrans 70.1%, Enterobacter NOD8 72.4% and 62.5%, and Enterobacter NOD10 64.8% and 58.7%, respectively. While against the Tyrophagus putrescentiae mite, the mortality percentages were 68.2% due to Enterobacter NOD4, 64.3% due to Enterobacter NOD8 and 77.8% due to Enterobacter NOD10. On the other hand, the ability of the three Enterobacter strains to produce indole acetic acid and phosphate solubilization, characteristics related to plant growth-promoting bacteria, was detected. Bioinformatic analysis of the genomes showed the presence of genes related to IAA production, phosphate solubilization, and nitrogen fixation. Phylogenetic analyzes of the recA gene, phylogenomics, and average nucleotide identity (ANI) allowed us to identify the strain Enterobacter NOD8 related to E. mori and Enterobacter NOD10 as E. asburiae, while Enterobacter NOD4 was identified as a possible new species of this species. The plant growth-promoting, acaricidal and nematicidal activity of the three Enterobacter strains makes them a potential agent to include in biocontrol alternatives and as growth-promoting bacteria in crops of agricultural interest.

Gasification studies were performed on sub-bituminous coal of the province Centro in Boyacá state of Colombia, vegetable biomass Chenopodium album (cenizo) and co-gasification of coal-biomass mixtures agglomerated with paraffin in a thermogravimetric analyzer. Biomass synergistically promoted thermochemical transformation of the coal was observed. Experimental results were compared to equilibrium composition simulations. Ash fusibility tests of the coal-biomass mixture were carried out, which allowed to clarify its behavior, such as dry or fluid ash according to own chemical composition, during the gasification process. The experimental tests allowed determining the differences in thermal decomposition, between coal, cenizo and coal-biomass blend, which are attributable to the physicochemical properties of each one solid fuel. During the tests, gas chromatography analyses were performed to establish the compositions of the syngas. The syngas obtained from biomass had the highest concentration of CO and the lowest H2; the coal and the coal-biomass mixture were slightly minor respectively. Concentrations of CH4, CO2 and C2H4 were similar between coal and biomass. This result is consistent with the higher calorific value of the coal syngas. The production of syngas from the coal-biomass mixture had the lowest contents of H2 and CO due to synergistic phenomena that occur with the fuel mixture. The co-gasification of the mixture gave the highest syngas production, carbon conversion, and thermal efficiency. These results indicate the viability of co-gasification of coal-Chenopodium album agglomerated mixtures. In gasification of non-agglomerated mixtures of coal-cenizo, the biomass can be burned directly without producing syngas.

Esta aportación presenta los resultados de los proyectos de Innovación docente gestionados por miembros del Dpto. de H.ª Antigua en 2011 y 2017 para generar nuevas dinámicas de aprendizaje en nuestras materias y cambiar los materiales que utilizamos en las mismas a fin de modernizarlos y adecuarlos a las nuevas necesidades del alumnado. El primero de los proyectos realizó una labor de investigación para identificar las necesidades a nivel de contenidos del alumnado de la asignatura de Fundamentos de Historia en el grado de Educación Primaria, mientras que el segundo se centró en crear un nuevo modelo de manual universitario adecuado a las necesidades tanto de este alumnado como el de otros grados en los que el Dpto. imparte clases. Los objetivos que nos marcamos fueron identificar las características del alumnado y su grado de conocimientos, valorar el proceso de aprendizaje, identificar las principales dificultades que tienen frente a los contenidos de nuestras materias, diseñar unos nuevos materiales que las solucionaran y valorar el grado de éxito de los mismos. Para ello diseñamos un cuestionario que se pasó a todos los grupos que cursan la asignatura, teniendo la suerte de tener una muestra significativa de entre quinientos a seiscientos alumnos y durante varios años procuramos diseñar los nuevos materiales que vieron la luz en forma de libro electrónico maquetado y publicado gracias al proyecto de Innovación docente de 2016/17/ y que comenzó a usarse en el cuso 2016/17, presentando un aumento en el índice de aprobados y permitiéndonos reflexionar sobre la necesidad de continuar el proceso de reforma de contenidos, materiales y metodologías para estas asignaturas.

RESUMEN Introducción y objetivos: Tras los resultados de varios estudios aleatorizados, la tromboaspiración (TA) sistemática ha sido relegada a un segundo plano por no mejorar el pronóstico de los pacientes con infarto agudo de miocardio con elevación del segmento ST e incluso aumentar sus complicaciones. El objetivo de este trabajo fue evaluar el impacto de la TA selectiva durante la angioplastia primaria (ICPp), su seguridad y sus beneficios clínicos tras 1 año de seguimiento. Métodos: El registro TAPER (eficacia y seguridad de la tromboaspiración selectiva en la práctica clínica real) incluyó retrospectivamente pacientes con infarto de miocardio con elevación del segmento ST tratados con ICPp. Se evaluaron las características clínicas y de los procedimientos, así como la presentación del evento combinado de muerte cardiovascular, infarto de miocardio no fatal, trombosis de stent, necesidad de revascularización de la lesión tratada o ictus tras 1 año de seguimiento. Resultados: Se analizaron 687 pacientes (76,9% varones, 64 ± 12 años). La TA se realizó en el 40,3% de los casos (89,9% como estrategia inicial y 10,1% como rescate) y fue exitosa en el 93,8%. El predictor más importante de uso de TA fue un alto grado de trombo inicial según la escala TIMI (Thrombolysis in Myocardial Infarction) (odds ratio = 3,2; intervalo de confianza del 95%, 2,5-3,9; p < 0,0001). La TA consiguió una mejora significativa del flujo de 2,4 puntos en la escala TIMI de flujo y una reducción significativa del grado de trombo de 2,6 puntos en la escala TIMI de trombo. En 1 año de seguimiento no se observó ningún ictus en el grupo de TA y la tasa del evento combinado fue similar en ambos grupos (grupo de TA 8% y grupo de no-TA 5,7%; p = 0,24). Conclusiones: La TA selectiva se usa con frecuencia en la práctica clínica actual, con una alta tasa de éxito y pocas complicaciones asociadas. La TA selectiva reduce significativamente la carga de trombo y mejora el flujo coronario. Tras 1 año de seguimiento, se observó una tasa similar de eventos adversos en los pacientes a quienes se realizó ICPp con independencia del uso de TA.

ABSTRACT Introduction and objectives: After the results of several randomized trials, routine thrombus aspiration (TA) has remained out of the spotlight after not improving the prognosis of patients with ST-segment elevation myocardial infarction and even increasing their complications. The goal here was to assess the impact of selective TA during primary percutaneous coronary intervention (pPCI), its safety and clinical benefits at 1-year follow-up. Methods: The TAPER registry (efficacy and safety of selective Thrombus Aspiration in Real clinical Practice) retrospectively included patients with ST-segment elevation myocardial infarction treated with pPCI. The clinical and procedural characteristics and the composite endpoint of cardiovascular mortality, non-fatal myocardial infarction, stent thrombosis, target lesion revascularization or stroke were evaluated after at 1-year follow-up. Results: 687 patients (76.9% males, 64 ± 12 years) were analyzed. The TA was performed in 40.3% of cases (in 89.9% as the initial strategy and in 10.1% as the bailout strategy) and it was successful in 93.8% of them. The most important predictor of TA use was a higher initial Thrombolysis in Myocardial Infarction (TIMI) thrombus grade (OR, 3.2; 95%CI, 2.5-3.9; P < .0001). TA achieved a significant improvement of TIMI-flow (2.4 points) and a significant reduction of the TIMI thrombus grade (2.6 points). At 1-year follow-up, no stroke was observed in the TA-group and the rate of the composite endpoint (cardiovascular mortality, non-fatal myocardial infarction, stent thrombosis, target lesion revascularization or stroke) was similar in both groups (TA-group 8% vs non-TA-group 5.7%; P = .24). Conclusions: Selective TA is frequently used in the current clinical practice with a high success rate and a low rate of associated complications. It significantly reduces thrombotic burden and improves coronary flow. At 1-year follow-up, a similar rate of adverse events was observed regardless of the use of TA.

Abstract Background The objective was to analyze the effectiveness and safety of dual therapy with rilpivirine plus boosted-darunavir (RPV + bDRV) in real-life patients. Methods Observational, retrospective, multi-center study in HIV+ patients who had received RPV + bDRV for 24 weeks to optimize/simplify their previous antiretroviral treatment. We determined the percentage of patients without virologic failure (2 consecutive viral loads > 50 copies/mL) at 24 weeks of treatment. Results The study included 161 patients from 15 hospitals with median age of 49 years; 29.3% had previous AIDS stage and median CD4+ lymphocyte nadir of 170 cells/uL. They had been diagnosed with HIV for a median of 17 years and had received 14 years of ART, with five previous treatment combinations, and 36.6% had a history of virological failure. The reasons for the switch were simplification/optimization (49.7%), toxicity/intolerance (17.4%), or inadequate effectiveness of previous ART (10.6%). Baseline VL of 50–1000 copies/mL was recorded in 25.5% of the patients. In the“intention-to-treat” analysis at 24 weeks, 87.6% of 161 patients continued the study treatment without virologic failure criteria. In the “on treatment” analysis (excluding patients who discontinued treatment with dual therapy for any reason other than virologic failure) the efficacy was 94.6% (141/149 patients). Conclusions Dual therapy with RPV + DRVb proved to be effective and safe in patients with advanced HIV infection, long exposure to ART, low CD4 nadir, previous virologic failure, and/or history of ineffective ART.

Neonatal sepsis is a major cause of death and disability in newborns. Commonly used biomarkers for diagnosis and evaluation of treatment response lack sufficient sensitivity or specificity. Additionally, new targets to treat the dysregulated immune response are needed, as are methods to effectively screen drugs for these targets. Available research methods have hitherto not yielded the breakthroughs required to significantly improve disease outcomes, we therefore describe the potential of zebrafish (Danio rerio) larvae as preclinical model for neonatal sepsis. In biomedical research, zebrafish larvae combine the complexity of a whole organism with the convenience and high-throughput potential of in vitro methods. This paper illustrates that zebrafish exhibit an immune system that is remarkably similar to humans, both in terms of types of immune cells and signaling pathways. Moreover, the developmental state of the larval immune system is highly similar to human neonates. We provide examples of zebrafish larvae being used to study infections with pathogens commonly causing neonatal sepsis and discuss known limitations. We believe this species could expedite research into immune regulation during neonatal sepsis and may hold keys for the discovery of new biomarkers and novel treatment targets as well as for screening of targeted drug therapies.

BackgroundWe aimed to compare the performance of the recent CASTLE score to J-CTO, CL and PROGRESS CTO scores in a comprehensive database of percutaneous coronary intervention of chronic total occlusion procedures.MethodsScores were calculated using raw data from 1,342 chronic total occlusion procedures included in REBECO Registry that includes learning and expert operators. Calibration, discrimination and reclassification were evaluated and compared.ResultsMean score values were: CASTLE 1.60±1.10, J-CTO 2.15±1.24, PROGRESS 1.68±0.94 and CL 2.52±1.52 points. The overall percutaneous coronary intervention success rate was 77.8%. Calibration was good for CASTLE and CL, but not for J-CTO or PROGRESS scores. Discrimination: the area under the curve (AUC) of CASTLE (0.633) was significantly higher than PROGRESS (0.557) and similar to J-CTO (0.628) and CL (0.652). Reclassification: CASTLE, as assessed by integrated discrimination improvement, was superior to PROGRESS (integrated discrimination improvement +0.036, pConclusionProcedural percutaneous coronary intervention difficulty is not consistently depicted by available chronic total occlusion scores and is influenced by the characteristics of each chronic total occlusion cohort. In our study population, including expert and learning operators, the CASTLE score had slightly better overall performance along with CL score. However, we found only intermediate performance in the c-statistic predicting chronic total occlusion success among all scores.

BackgroundSince 1996, the standard of care (SOC) therapy for HIV treatment has consisted of a backbone of two nucleoside analogue reverse transcriptase inhibitors (NRTI) paired with a third agent. Use of two-drug combinations (2DC) has been considered for selected patients to avoid toxicities associated with the use of NRTIs. This study aimed to compare the real-world outcomes of integrase strand transfer inhibitor (INSTI)-containing triple therapy (TT) to dolutegravir- (DTG) and/or boosted protease inhibitor (bPI)-based 2DC in a large Spanish cohort of HIV patients.MethodsA retrospective analysis was performed using data from the VACH cohort, a prospective multicentre Spanish cohort of adult HIV patients. All treatment experienced patients initiating a TT of an INSTI combined with two NRTIs or a 2DC-containing DTG and/or a bPI between 01/01/2012 and 01/06/2017 were included. The unit of analysis was patient-regimens. The overall sample analysis was complemented with two sub-analyses. The first sub-analysis focused on patients treated with a backbone plus DTG compared to those treated with DTG+ one other antiretroviral. The second sub-analysis focused on patients with HIV RNAResultsOverall 7,481 patients were included in the analysis, contributing to 9,243 patient-regimens. Patient characteristics at baseline differed among groups, with the 2DC group being significantly older and having a higher proportion of women, a longer time on ART and a higher number of previous virologic failures. Median (95% Confidence Interval [C.I.]) time to switch was 2.5 years (2.3, 2.7) in 2DC group versus 2.9 years (2.7, 3.0) in TT. Adjusted hazard ratios (95% C.I.) for discontinuation due to any reason, virologic failure and toxicity in the 2DC vs TT group were 1.29 (1.15; 1.44), 2.06 (1.54; 2.77) and 1.18 (0.94; 1.48), respectively. Results were consistent in the two sub-analyses.ConclusionIn this analysis, time to discontinuation and probability of remaining free of virologic failure were significantly higher in patients on INSTI-based TT compared to DTG- and/or bPI-containing 2DC, with no differences in toxicity.