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Barcelona, Spain

Hemodynamic monitoring offers valuable information on cardiovascular performance in the critically ill, and has become a fundamental tool in the diagnostic approach and in the therapy guidance of those patients presenting with tissue hypoperfusion. From introduction of the pulmonary artery catheter to the latest less invasive technologies, hemodynamic monitoring has been surrounded by many questions regarding its usefulness and its ultimate impact on patient prognosis. The Cardiological Intensive Care and CPR Working Group (GTCIC-RCP) of the Spanish Society of Intensive Care and Coronary Units (SEMICYUC) has recently impulsed the development of an updating series in hemodynamic monitoring. Now, a final series of recommendations are presented in order to analyze essential issues in hemodynamics, with the purpose of becoming a useful tool for residents and critical care practitioners involved in the daily management of critically ill patients. © 2013 Elsevier España, S.L. and SEMICYUC. Source


Consolini A.E.,National University of La Plata | Consolini A.E.,Institute Recerca | Ragone M.I.,National University of La Plata | Bonazzola P.,University of Buenos Aires
Canadian Journal of Physiology and Pharmacology | Year: 2011

High-K+-cardioplegia (CPG) and pyruvate (Pyr) are used as cardioprotective agents. Considering that mitochondria play a critical role in cardiac dysfunction, we investigated the effect of CPG on mitochondrial Ca2+ uptake and sarcorreticular (SR) calcium handling. Cytosolic and mitochondrial Ca2+, as well as mitochondrial membrane potential (Dψm) were assessed in rat cardiomyocytes by confocal microscopy. Mechano-calorimetrical correlation was studied in perfused hearts. CPG did not modify JC-1 (Dψm), but transiently increased, by up to 1.8 times, the Fura-2 (intracellular Ca concentration, [Ca2+]i) and Rhod-2 (mitochondrial free Ca concentration [Ca2+]m) fluorescence of resting cells, with exponential decays. The addition of 5 μmol·L-1 thapsigargin (Tpg) increased the Rhod-2 fluorescence in a group of cells without any effect on the Fura-2 signal. In rat hearts perfused with CPG, 1 μmol·L-1 Tpg decreased resting heat rate (ΔHr:-0.44 ± 0.07 mW·g-1), while the addition of 5 μmol·L-1 KB-R7943 increased resting pressure (DrLVP by +5.26 ± 1.10 mm Hg; 1 mm Hg = 133.322 Pa). The addition of 10 mmol·L-1 Pyr to CPG increased Hr (+3.30 ± 0.24 mW·g-1) and DrLVP (+2.2 ± 0.4 mm Hg), which are effects potentiated by KB-R7943. The results suggest that under CPG, (i) there was an increase in [Ca2+]i and [Ca2+]m (without changing Dψm) that decayed by exothermic removal mechanisms; (ii) mitochondrial Ca2+ uptake contributed to the removal of cytosolic Ca2+, in a process that was potentiated by inhibition of sarco-endoplasmic reticulum Ca2+-ATPase (SERCA), and reduced by KB-R7943; (iii) under these conditions, SERCA represents the main energetic consumer; (iv) Pyr increased the energetic performance of hearts,mainly by inducing mitochondrial metabolism. Source


Zamora C.,Institute Recerca | Canto E.,Institute Recerca | Nieto J.C.,Institute Recerca | Angels Ortiz M.,Institute Recerca | And 5 more authors.
Journal of Leukocyte Biology | Year: 2013

Expression of the scavenger receptor CD36 on lymphocytes is intriguing. We observed that a minor subpopulation of lymphocytes expressed CD36 on the cell surface. We investigated the source of CD36 and also the proliferation and cytokine production of these CD36+ CD4++ lymphocytes. Flow cytometry analysis and immunofluorescence microscopy showed that CD36+ platelets were responsible for CD36 detection on lymphocytes. CD36 was then used as a tool to characterize lymphocytes with bound platelets. Activation-induced proliferation was lower in CD4++ lymphocytes with bound platelets than lymphocytes without bound platelets. IL-17 and IFN-γ production was also reduced in lymphocytes with bound platelets. We then studied the presence of CD36+ CD4++ lymphocytes in RA patients. We observed that the percentage of CD4++ lymphocytes with bound platelets was higher on RA patients than in healthy donors. RA patients with higher titers of anti-CCP, RF levels, and cardiovascular risk index presented a lower percentage of CD4++ lymphocytes with bound platelets. These patients also had higher IL-17 and IFN-γ production. These results suggest that platelet-binding modifies lymphocyte function. This binding could be a regulatory mechanism in RA that confers a less severe phenotype. © Society for Leukocyte Biology. Source


Roldan C.,Institute Recerca | Roldan C.,Autonomous University of Barcelona | Mirabet S.,Sant Pau Hospital | Cecilia C.,Institute Recerca | And 5 more authors.
Transplantation | Year: 2015

Background Cardiac allograft vasculopathy (CAV) is a major limitation in long-term graft survival after heart transplantation (HTx). Its prediction and detection at an early stage is a challenge because an accurate, minimally invasive blood test is lacking. The aim of this study was to analyze the relationship of Tact (CD4+CD45RO+CD25-/lowCD127+) cells, Th1 cells, and thymus-derived regulatory (Treg) (CD4+CD45RO+CD25hiCD127-/low) cells in peripheral blood with the development of CAV in HTx patients. Methods First, we performed a cross-sectional study in 29 patients at least 2 years after HTx, 17 with CAV and 12 without CAV. We then prospectively followed a group of 38 patients for 2 years immediately after HTx surgery. In both groups, we analyzed the relationship between CAV and the effector-to-regulatory T cellratio. Results In the cross-sectional study, patients with CAV showed statistically significant higher values of Th1-to-FoxP3+Treg and Tact-to-CD127-/lowTreg ratios than non-CAV patients, with P less than 0.01 and P less than 0.001, respectively. Receiver operating characteristic curve analysis showed that the Tact:CD127-/lowTreg ratio was a potential biomarker of CAV, clearly discriminating CAV and non-CAV patients (area under curve [AUC] = 0.955; P = 0.001). In the prospective part of the study, we monitored the Th1:FoxP3+Treg and Tact:CD127-/lowTreg ratios using the best tradeoff between anterior receiver operating characteristic sensitivity and specificity as a cutoff. Changes in the Tact:CD127-/lowTreg ratio were detected earlier than changes in the Th1:FoxP3+Treg ratio. Both ratios were higher in HTx patients with CAV. Conclusion The Tact-to-Treg ratio is a valuable follow-up marker to detect HTx patients at risk of developing CAV. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved. Source

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