Role of Chrononutrition in the Antihypertensive Effects of Natural Bioactive Compounds

Hypertension (HTN) is one of the main cardiovascular risk factors and is considered a major public health problem. Numerous approaches have been developed to lower blood pressure (BP) in hypertensive patients, most of them involving pharmacological treatments. Within this context, natural bioactive compounds have emerged as a promising alternative to drugs in HTN prevention. This work reviews not only the mechanisms of BP regulation by these antihypertensive compounds, but also their efficacy depending on consumption time. Although a plethora of studies has investigated food-derived compounds, such as phenolic compounds or peptides and their impact on BP, only a few addressed the relevance of time consumption. However, it is known that BP and its main regulatory mechanisms show a 24-h oscillation. Moreover, evidence shows that phenolic compounds can interact with clock genes, which regulate the biological rhythm followed by many physiological processes. Therefore, further research might be carried out to completely elucidate the interactions along the time–nutrition–hypertension axis within the framework of chrononutrition.     

Translumbar retroperitoneal endoscopy: an alternative in the follow-up and management of drained infected pancreatic necrosis

BACKGROUND: The follow-up of drained infected pancreatic necrosis (IPN) is usually done with data on the patient's clinical evolution and information obtained from serial helical computed tomographic scans. Management often requires necrosectomies and periodic debridements. HYPOTHESIS: Translumbar retroperitoneal endoscopy is effective in the management of drained IPN. DESIGN: A prospective observational study. SETTING: University tertiary care hospital. PATIENTS: A series of 11 consecutive patients with drained IPN undergoing postoperative follow-up with translumbar retroperitoneal endoscopy. INTERVENTIONS: Initially, the IPN was drained via the posterior extraperitoneal translumbar approach; then, a superficial necrosectomy was performed during the same surgical intervention by flushing and endoscopic aspiration; and, finally, a lavage and drainage system was fitted. In the immediate postoperative period, for management of the IPN, we removed the drainage tube and inserted a flexible endoscope as far as the pancreatic area to eliminate the infected necrotic material by flushing and aspiration. MAIN OUTCOME MEASURES: In these patients, we studied control of the infection of the pancreatic area, quantification variables of the necrosectomy, technique-related morbidity and mortality, and the need for subsequent operations. RESULTS: The 11 patients studied showed good results regarding the control and complete elimination of the infected necrosis. There was no technique-related morbidity or mortality or need for subsequent operations. CONCLUSION: Translumbar retroperitoneal endoscopy allows exploration of the retroperitoneal space under direct visual guidance, facilitates lavage and aspiration, avoids subsequent surgical operations for debridement, decreases the need for repeated computed tomographic scans to evaluate the evolution of the IPN, and has no added morbidity or mortality.     

Insuficiencia cardiaca y trasplante

The mission of the Heart Failure and Heart Transplantation Section of the Spanish Society of Cardiology is to study, promote interest in, and disseminate information about all aspects of myocardial dysfunction and heart transplantation. Heart failure is a highly prevalent disorder that consumes a substantial proportion of healthcare resources. Consequently, there is a very high level of interest in the condition and a wide range of preclinical and clinical research is being carried out, including research into new ways of looking at the disease that will increase our understanding. The aim of this article was to describe current developments concerning this disease and its treatment. Firstly, the latest publications on heart failure are summarized. Then, the most recent studies on advanced heart failure and ventricular assist devices are reviewed. Finally, the latest findings on heart transplantation are reported.     

Últimos avances en pancreatitis crónica

The most important advances in chronic pancreatitis concern its etiopathogenesis, nutritional aspects, and improvements in diagnostic techniques and some treatment options. In the etiopathogenesis of this disease, the importance of smoking and its association with alcohol have been confirmed. Exocrine pancreatic insufficiency (EPI) secondary to chronic pancreatitis is associated with bone metabolism alterations (osteopenia and osteoporosis), a reduction in liposoluble vitamins and alterations in essential amino acid levels. Endoscopic ultrasound has been confirmed as the most highly developed technique for the diagnosis of chronic pancreatitis, especially due to new image optimization technologies. Breath tests for the diagnosis of EPI continue to be developed (optimization of the C-13 mixed triglyceride test and the development of a new test based on C-13-labelled bicarbonate determination). Modest results in pain treatment have been achieved with the use of antioxidants, pancreatic enzymes and/or intravenous secretin. The association of chronic pancreatitis with pancreatic cancer requires strict follow-up, especially in patients with inflammatory masses in the context of chronic pancreatitis.