Cambios en la selección e impacto potencial de los inhibidores de neprilisina y del receptor de la angiotensina en los pacientes sometidos a reparación mitral percutánea borde a borde

Introduction and objectivesTranscatheter edge-to-edge repair (TEER) should be considered in patients with heart failure and secondary mitral regurgitation (MR). Angiotensin receptor-neprilysin inhibitors (ARNIs) have been demonstrated to improve prognosis in heart failure. We aimed to evaluate the impact ARNIs on patient selection and outcomes.MethodsThe population of the Spanish TEER prospective registry (March 2012 to January 2021) was divided into 2 groups: a) TEER before the ARNI era (n = 450) and b) TEER after the recommendation of ARNIs by European Guidelines (n = 639), with further analysis according to intake (n = 52) or not (n = 587) of ARNIs.ResultsA total of 1089 consecutive patients underwent TEER for secondary MR. In the ARNI era, there was a reduction in left ventricle dilation (82 mL vs 100 mL, P = .025), and better function (35% vs 38%, P = .011). At 2 years of follow-up, mortality (10.6% vs 17.3%, P < .001) and heart failure readmissions (16.6% vs 27.8%, P < .001) were lower in the ARNI era, but not recurrent MR. In the ARNI era, 1- and 2-year mortality were similar irrespective of ARNI intake but patients on ARNIs had a lower risk of readmission + mortality at 2 years (OR, 0.369; 95%CI, 0.137-0.992; P = .048), better NYHA class, and lower recurrence of MR III-IV (1.9% vs 14.3%, P = .011).ConclusionsBetter patient selection for TEER has been achieved in the last few years with a parallel improvement in outcomes. The use of ARNIs was associated with a significant reduction in overall events, better NYHA class, and lower MR recurrence.     

Bowel Ultrasound in Crohn Disease: Current Role and Future Applications

Background: The majority of hemochromatosis patients are homozygous for the HFE-C282Y mutation. However, less than half of C282Y homozygous subjects identified by population screening studies actually develop the disease. The cytokine TNF- &;#33 is implicated in the regulation of iron metabolism at different levels. Our aim was to study the role of TNF- &;#33 and its promoter polymorphisms in the phenotypic expression of hemochromatosis in individuals with and without the C282Y mutation. Methods: We studied 4 groups of 10 subjects each: ( 1 ) C282Y homozygotes without clinical hemochromatosis; ( 2 ) C282Y homozygotes with hemochromatosis; ( 3 ) secondary hemochromatosis (without C282Y mutation); and ( 4 ) controls. Groups were age-matched and sex-matched. Peripheral blood mononuclear cells (PBMC) were stimulated with lipopolysaccharide (LPS) and the release of TNF- &;#33 was measured. Additionally, the G/A polymorphisms at position -238 and -308 of the TNF- &;#33 gene were determined by PCR and RFLP analysis in 178 hemochromatosis patients and 41 controls. Results: TNF- &;#33 production from PBMC at 8 and 24 &;#114 h after increasing concentrations of LPS stimulation were similar in the four groups. The prevalence of TNF- &;#33 polymorphisms was similar in patients and controls. The prevalences of cirrhosis, siderosis, median s-ferritin and median ALT values were similar in patients with and without the TNF- &;#33 polymorphisms. Conclusions: Neither TNF- &;#33 released from PBMC nor the presence of TNF- &;#33 polymorphisms seem to be associated with disease manifestation in hemochromatosis.     

DNA Polymorphism Studies. Approaches to Elucidating Multifactorial Ischaemic Heart Disease: the Apo B Gene as an Example

It is well established that elevated plasma levels of low-density lipoprotein (LDL) particles are a risk factor for ischaemic heart disease with the distribution in LDL levels seen in the general population being the result of interaction between environmental factors, such as dietary fat intake, and genetic variation that is present in different individuals. One of the candidate genes where such variation is likely to occur, is the gene coding for apolipoprotein B (apo B). Many studies have reported an association between a common polymorphism of the apo B gene, detected using the restriction enzyme Xbal, and differences in plasma lipid levels, explaining 3-5% of the variance in LDL-cholesterol levels in samples representative of the healthy population. It has been proposed that the mechanism of this association is due to functional amino acid changes within the apo B protein, that affect LDL catabolism by altering binding affinity to the LDL-receptor. Several amino acid substitutions in the apo B gene have now been characterized, and these form the basis of the different epitopes that create the Ag marker system. Previous studies have reported that the Ag(x) epitope is associated with lower plasma lipid levels, and until recently the molecular basis for this association has been unclear. We have determined that the Ag(x) epitope is associated with both a Pro-Leu₂₇₁₂, and Asn-Ser₄₃₁₁ substitution, with the Leu-Ser allele being associated with significantly lower levels of plasma lipids in a sample of healthy individuals from Sweden. The association between these two amino acids is present in all ethnic groups so far studied, and appears to have been maintained throughout the recent evolutionary history of the human species. Since this amino acid polymorphism explains only part of the differences in plasma lipid levels detected using the Xbal polymorphism, this suggests that there are other functionally important sequence changes that remain to be detected, which will be associated with lipid-raising effects. The identification of these functional changes, and the mechanism by which they act will help in our understanding of the role of gene-environment interaction in determining plasma lipid levels in healthy individuals and in patients.     

Tratamiento de la hepatitis C en grupos de pacientes especiales

The treatment plan for chronic hepatitis C in special populations varies according to comorbidity and the current evidence on treatment. In patients with hepatitis C virus and HIV coinfection, the results of dual therapy (pegylated interferon plus ribavirin) are poor. In patients with genotype 1 infection, triple therapy (dual therapy plus boceprevir or telaprevir) has doubled the response rate, but protease inhibitors can interact with some antiretroviral drugs and provoke more adverse effects.These disadvantages are avoided by the new, second-generation, direct-acting antiviral agents. In patients who are candidates for liver transplantation or are already liver transplant recipients, the optimal therapeutic option at present is to combine the new antiviral agents, with or without ribavirin and without interferon. The treatment of patients under hemodialysis due to chronic renal disease continues to be dual therapy (often with reduced doses of pegylated interferon and ribavirin), since there is still insufficient information on triple therapy and the new antiviral agents. In mixed cryoglobulinemia, despite the scarcity of experience, triple therapy seems to be superior to dual therapy and may be used as rescue therapy in non-responders to dual therapy. However, a decision must always be made on whether antiviral treatment should be used concomitantly or after immunosuppressive therapy.     

Once-monthly radiotherapy for the palliation of pelvic gynecological malignancy

Twenty-seven patients with advanced pelvic gynecological malignancies were treated using a once-monthly fractionation scheme of 10 Gy to a total dose of 30 Gy to the whole pelvis. This course was well tolerated and provided effective palliation with a minimum of hospitalization. The results obtained suggest this course merits consideration for the palliation of other pelvic malignancies.     

Recommended structure for reporting economic evaluation on pharmaceuticals in Belgium

Pharmacoeconomic evaluations become more important for the reimbursement of pharmaceuticals, and will be obligatory for new pharmaceutical drugs for which an added therapeutic value is claimed and a price premium is proposed by the manufacturer. Therefore, it is important to guide purchasers and providers of pharmaceutical care in their efforts related to the evaluation process. Standard Report Format can support the quality, transparency and exhaustiveness of the data submitted. A multidisciplinary task force developed a Standard Report Format for pharmacoeconomic evaluations in Belgium.     

双泵化疗在大肠癌肝转移中的应用

目的 探讨肝动脉加门静脉灌注化疗（双泵化疗）在大肠癌肝转移中的价值。方法 30例大肠癌肝转移患者术后2周开始接受灌注化疗。其中采用双泵化疗（I组）12例,肝动脉灌注化疗（Ⅱ组）10例,门静脉灌注化疗（Ⅲ组）8例。3组化疗方案的剂量频次均相同。结果 肝转移灶治疗有效率（CR＋PR）Ⅰ组为66．7％,Ⅱ组为60．0％,Ⅲ组为37．5％。0．5,1,2年生存率I组分别为100．0％、75．0％、41．7％;Ⅱ组为90．0％、60．0％、30．0％;Ⅲ组为87．5％、50．0％、25．0％。结论 双泵灌注化疗是大肠癌肝转移治疗和预防的一种有效辅助手段,其疗效优于单纯肝动脉灌注化疗或门静脉灌注化疗。     

杭州市某城区居民贫血状况调查分析

目的初步调查杭州市区居民贫血的流行情况,为预防部门开展贫血的防治提供依据,同时增强社区居民对贫血的认识.方法利用调查表对杭州市某城区3个社区卫生点共1 060名居民(成年人)进行问卷和个别咨询调查,调查内容包括贫血症状、相关病因学因素及实验室检查情况.同时在调查过程中对社区居民进行有关贫血知识及合理膳食的宣教.结果该城区居民(成年人)贫血患病率为2.83%,贫血分度以轻度为主;不同年龄的居民贫血患病率间差别有显著性意义(P＜0.05);男、女患病率分别为2.48%、3.13%,差别无显著性意义(P＞0.05).结论杭州市区成年居民贫血易患人群以老年为主,防治工作应以老年人群为主要对象,应采取普及营养知识、改善膳食结构、尽早发现慢性病,尽早治疗等综合防治策略.     

Multi-disciplinary clinical protocol for the diagnosis of bulbar amyotrophic lateral sclerosis

Introduction and objectives

The objective of this study was to examine the role of different specialists in the diagnosis of amyotrophic lateral sclerosis (ALS), to understand changes in verbal expression and phonation, respiratory dynamics and swallowing that occurred rapidly over a short period of time.

Diagnostic accuracy and utility of fine-needle aspiration cytology in therapeutic management of parotid gland tumours

Introduction and objectives

The utility of fine-needle aspiration cytology (FNAC) in parotid tumours remains widely debated. This study aims to evaluate the accuracy of FNAC in diagnosing parotid tumours.