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Sanchez-Quintana D.,University of Extremadura | Lopez-Minguez J.R.,Hospital Universitario Infanta Cristina | Pizarro G.,European University at Madrid | Murillo M.,University of Extremadura | Cabrera J.A.,European University at Madrid
Current Cardiology Reviews | Year: 2012

The definition of atrial fibrillation (AF) as a functional electrical disorder does not reflect the significant underlying structural abnormalities. Atrial and Pulmonary Vein (PV) muscle sleeve microstructural remodeling is present, and establishes a vulnerable substrate for AF maintenance. In spite of an incomplete understanding of the anatomo-functional basis for AF, current evidence demonstrates that this arrhythmia usually requires a trigger for initiation and a vulnerable electrophysiological and/or anatomical substrate for maintenance. It is still unclear whether the trigger mechanisms include focal enhanced automaticity, triggered activity and/or micro re-entry from myocardial tissue. Initiation of AF can be favored by both parasympathetic and sympathetic stimulation, which also seem to play a role in maintaining AF. Finally, evolving clinical evidence demonstrates that inflammation is associated with new-onset and recurrent AF through a mechanism that possibly involves cellular degeneration, apoptosis, and subsequent atrial fibrosis. © 2012 Bentham Science Publishers.

Alfonso F.,Hospital Universitario Of La Princesa | Perez-Vizcayno M.J.,Hospital Universitario Clinico San Carlos | Cardenas A.,Hospital Universitario Clinico San Carlos | Garcia Del Blanco B.,Hospital Universitario Vall dHebron | And 17 more authors.
Journal of the American College of Cardiology | Year: 2015

Background Treatment of patients with drug-eluting stent (DES) in-stent restenosis (ISR) remains a major challenge. Objectives This study evaluated the comparative efficacy of drug-eluting balloons (DEB) and everolimus-eluting stents (EES) in patients presenting with DES-ISR. Methods The study design of this multicenter randomized clinical trial assumed superiority of EES for the primary endpoint, in-segment minimal lumen diameter at the 6- to 9-month angiographic follow-up. Results A total of 309 patients with DES-ISR from 23 Spanish university hospitals were randomly allocated to DEB (n = 154) or EES (n = 155). At late angiography (median 247 days; 90% of eligible patients), patients in the EES arm had a significantly larger minimal lumen diameter (2.03 ± 0.7 mm vs. 1.80 ± 0.6 mm; p < 0.01) (absolute mean difference: 0.23 mm; 95% CI: 00.7 to 0.38), net lumen gain (1.28 ± 0.7 mm vs. 1.01 ± 0.7 mm; p < 0.01), and lower percent diameter stenosis (23 ± 22% vs. 30 ± 22%; p < 0.01) and binary restenosis rate (11% vs. 19%; p = 0.06), compared with patients in the DEB arm. Consistent results were observed in the in-lesion analysis. At the 1-year clinical follow-up (100% of patients), the main clinical outcome measure (composite of cardiac death, myocardial infarction, and target vessel revascularization) was significantly reduced in the EES arm (10% vs. 18%; p = 0.04; hazard ratio: 0.58; 95% CI: 0.35 to 0.98), mainly driven by a lower need for target vessel revascularization (8% vs. 16%; p = 0.035). Conclusions In patients with DES-ISR, EES provided superior long-term clinical and angiographic results compared with DEB. (Restenosis Intra-Stent of Drug-Eluting Stents: Drug-Eluting Balloon vs Everolimus-Eluting Stent [RIBS IV]; NCT01239940) © 2015 American College of Cardiology Foundation.

Fernandez-Rodriguez S.,University of Extremadura | Tormo-Molina R.,University of Extremadura | Maya-Manzano J.M.,University of Extremadura | Silva-Palacios I.,University of Extremadura | Gonzalo-Garijo T.,Hospital Universitario Infanta Cristina
Fungal Ecology | Year: 2014

Volume assessments of the concentration of airborne fungi may provide different results depending on the methodology used. This work simultaneously analyses two methods for samples obtained outdoors and analysed in the context of meteorological conditions. The study was carried out in Badajoz (SW Spain) from Mar. 2009 to Jul. 2011. A Burkard fixed spore trap was used for the non-viable sampling, and three different methods were used for the viable sampling: a Burkard portable spore trap with two inlet port types and a Sampl'air AES trap. Daily average total concentrations of 285CFUm-3 and 1954sporesm-3 were recorded for the viable and non-viable methods, respectively. The spore/colony ratio showed important differences among the most relevant fungal types: Alternaria (2.6), Aspergillus-Penicillium (2.0) and Cladosporium (11.1). Although the two sampling types were essentially equivalent at showing temporal variations in outdoor airborne fungi, quantitative differences in the number of total colonies recorded depended on the culture media and conditions used. © 2013 Elsevier Ltd and The British Mycological Society.

Beltran L.M.,Hospital Universitario La Paz | Garcia-Casasola G.,Hospital Universitario Infanta Cristina
Revista Clinica Espanola | Year: 2014

Ultrasonography in the hands of the internist can answer important clinical questions quickly at the point of patient care. This technique "enhance" the senses of the physicians and improves their ability to solve the problems of the patient. Point of care ultrasonography performed by clinicians has shown good accuracy in the diagnosis of diverse cardiac, abdominal and vascular pathologic conditions. It may also be useful for evaluation of thyroid, osteoarticular and soft tissue diseases. Furthermore, the use of ultrasound to guide invasive procedures (placement of venous catheters, thoracentesis, paracentesis) reduces the risk of complications. We present 5 cases to illustrate the usefulness of this technique in clinical practice: (i) peripartum cardiomyopathy; (ii) subclinical carotid artery atherosclerosis; (iii) asymptomatic abdominal aortic aneurysm; (iv) tendinitis of long head of biceps brachii and supraspinatus, and (v) spontaneous soleus muscle haematoma.

Bethencourt A.,Hospital Universitario Son Dureta | Sievert H.,CardioVascular Center Sankt Katharinen | Santoro G.,Azienda Ospedaliera Universitaria Careggi | Meier B.,University of Bern | And 5 more authors.
Catheterization and Cardiovascular Interventions | Year: 2011

Background: In most patients with atrial fibrillation (AF) and stroke, there is thrombotic embolization from the left atrial appendage (LAA). Percutaneous closure of the LAA is a novel alternative for the treatment of patients with AF at a high risk of stroke, in whom long-term anticoagulation therapy is not possible or not desired. This study details the initial experience with the Amplatzer Cardiac Plug (ACP) in humans. Methods: Investigator-initiated retrospective preregistry data collection to evaluate procedural feasibility and safety up to 24 hr after implantation of the ACP, a nitinol device designed for percutaneous trans-septal implantation in LAA of patients with paroxysmal, permanent, or persistent AF. Results: In 137 of 143 patients, LAA occlusion was attempted, and successfully performed in 132 (96%). There were serious complications in 10 (7.0%) patients (three patients with ischemic stroke; two patients experienced device embolization, both percutaneously recaptured; and five patients with clinically significant pericardial effusions). Minor complications were insignificant pericardial effusions in four, transient myocardial ischemia in two, and loss of the implant in the venous system in one patient. Conclusion: The implantation of the ACP device is a feasible method for percutaneous occlusion of the LAA. © 2011 Wiley-Liss, Inc.

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