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Background and purpose: The risk of recurrent stroke amongst patients with symptomatic carotid near‐occlusion (SCNO) has not been clearly established, and its management remains controversial. The aim was to define the 24‐month risk of recurrent stroke and to analyse the effect of the different treatment modalities (medical treatment and revascularization) in a population of patients with SCNO. Methods: A multicentre, nationwide, prospective study from January 2010 to May 2016 was performed. Patients with angiography‐confirmed SCNO were included. The primary end‐point was ipsilateral ischaemic stroke including periprocedural events within 24 months following the presenting event. Revascularization results and periprocedural complications, ipsilateral transient ischaemic attack, disabling or fatal stroke, and mortality were also noted. Results: The study population comprised 141 patients from 17 Spanish centres. Seventy patients (49.6%) were treated by revascularization (carotid stenting in 47, endarterectomy in 23). Complete revascularization was achieved in 58 patients (83%). Periprocedural stroke or death occurred in 5.7%. The 24‐month cumulative incidence of the primary end‐point was 11.1% (95% confidence interval 5.8–16.4; n = 15), 12% in the medical treatment group and 10.2% in the revascularization group, log‐rank P = 0.817. The cumulative rates of ipsilateral ischaemic stroke or transient ischaemic attack, disabling or fatal stroke, and mortality, were 17%, 4.5% and 7.5%, respectively. Conclusions: The rate of ipsilateral ischaemic stroke in patients with SCNO seems to be lower than the known rate associated with severe carotid stenosis without near‐occlusion. The potential benefit of revascularization in the prevention of stroke in patients with SCNO may be influenced by the effectiveness and safety of the procedure. [ABSTRACT FROM AUTHOR]

Background Postoperative blood loss may be a risk factor for allogeneic blood transfusion ( ABT) in patients undergoing subcapital hip fracture ( SHF) repair. We investigated the utility and costs of using a low-vacuum reinfusion drain (Bellovac ABT) within a blood management protocol for reducing ABT requirements in consecutive SHF. Methods The blood management protocol consisted of the application of a restrictive transfusion trigger (Hb < 8 g/dl), the peri-operative administration of IV iron sucrose (3 × 200 mg/48 h) ± recombinant erythropoietin (1 × 40 000 IU sc) and the use of Bellovac ABT (Group 2, n = 117). An immediate previous SHF series managed without Bellovac ABT served as control (Group 1, n = 138). Results Overall, 72 out of 255 (28%) received at least one ABT unit (2·1 ± 1·0 U/transfused patient) without differences between groups. However, in the subgroup of patients with admission Hb < 13 g/dl, the use of Bellovac ABT reduced postoperative ABT rates (16% vs. 46%, for groups 2 and 1, respectively; P = 0·001), although only 3 were reinfused, and was cost-saving. The use of Bellovac ABT also resulted in fewer wound bleeding complications, but there were no differences in Hb at postoperative days 7 and 30 between groups. Conclusions In SHF patients with admission Hb < 13 g/dl and managed with peri-operative IV iron ± recombinant erythropoietin plus restrictive transfusion indication, the use of Bellovac ABT was associated with reduced ABT requirements, without increasing postoperative complications, and cost-savings. [ABSTRACT FROM AUTHOR]

Background Preoperative anaemia is a major risk factor for allogeneic blood transfusion (ABT) in patients undergoing hip fracture repair. We investigated the efficacy of preoperative recombinant human erythropoietin (rHuEPO) administration for reducing ABT requirements in a series of consecutive hip fracture patients presenting with haemoglobin (Hb) between 10 g/dl and 13 g/dl. Methods The blood conservation protocol consisted of the application of a restrictive transfusion trigger (Hb < 8 g/dl) and the perioperative administration of intravenous iron sucrose (3 × 200 mg/48 h) (group 1, n = 115). Additionally, some patients received preoperative rHuEPO (40 000 IU sc) on admission to the orthopaedic ward (group 2, n = 81). Results Overall, 103 of 196 patients (52·5%) received at least one ABT unit (2·1 ± 1·0 U/patient). However, there were significant differences in perioperative ABT rates between groups (60% vs. 42%, for groups 1 and 2, respectively; P = 0·013). Postoperative Hb on postoperative days 7 and 30 was higher in group 2 than in group 1. In addition, in group 2, Hb levels were higher on postoperative day 30 than on admission (12·7 ± 1·0 g/dl vs. 11·9 ± 0·8 g/dl, respectively; P = 0·030). Administration of rHuEPO did not increase postoperative complications or 30-day mortality rate. Only three mild intravenous iron adverse effects were witnessed. Conclusions In anaemic hip fracture patients managed with perioperative intravenous iron and restrictive transfusion protocol, preoperative administration of rHuEPO is associated with reduced ABT requirements. However, appropriate training, education and awareness are needed to avoid protocol violations and to limit further exposure to ABT and ABT-related risks. [ABSTRACT FROM AUTHOR]

Background and purpose:Resistance blood vessels are innervated by sympathetic and primary sensory nerves, which modulate vascular tone through the release of noradrenaline and calcitonin gene-related peptide (CGRP), respectively. Moreover, electrical stimulation of the perivascular sensory outflow in pithed rats results in vasodepressor responses which are mainly mediated by CGRP release. The present study has investigated the role of α2-adrenoceptors in the inhibition of these vasodepressor responses.Experimental approach:144 pithed male Wistar rats were pretreated with hexamethonium (2 mg kg−1 min−1) followed by i.v. continuous infusions of either methoxamine (15 and 30 μg kg−1 min−1) or clonidine (3, 10 and 30 μg kg−1 min−1). Under these conditions, electrical stimulation (0.56–5.6 Hz; 50 V and 2 ms) of the spinal cord (T9–T12) resulted in frequency-dependent decreases in diastolic blood pressure.Key results:The infusion of clonidine (10 μg kg−1 min−1), as compared to those of methoxamine (15 or 30 μg kg−1 min−1), inhibited the vasodepressor responses to electrical stimulation without affecting those to i.v. bolus injections of α-CGRP (0.1–1 μg kg−1). This inhibition by clonidine was: (i) antagonized by 300 μg kg−1 rauwolscine (α2A/2B/2C), 300 and 1000 μg kg−1 BRL44408 (α2A), or 10 and 30 μg kg−1 MK912 (α2C); and (ii) unaffected by 1 ml kg−1 saline, 100 μg kg−1 BRL44408, 3000 and 10000 μg kg−1 imiloxan (α2B) or 3 μg kg−1 MK912.Conclusions and implications:The inhibition produced by 10 μg kg−1 min−1 clonidine on the vasodepressor (perivascular) sensory outflow in rats may be mainly mediated by prejunctional α2A/α2C-adrenoceptors.British Journal of Pharmacology (2008) 154, 51–59; doi:10.1038/bjp.2008.49; published online 25 February 2008 [ABSTRACT FROM AUTHOR]

In unilateral total knee replacement (TKR), perioperative blood loss, low transfusion thresholds and short hospital stay result in patients being discharged with low haemoglobin (Hb). We assessed the effects of perioperative administration of intravenous iron, with or without erythropoietin, plus a restrictive transfusion threshold (Hb <80 g L-1) both on transfusion rate and recovery from post-operative anaemia. TRK patients received iron sucrose (2 × 200 mg per 48 h, iv) (Group IVI, n = 129). Patients with admission Hb < 130 g L-1, also received erythropoietin (1 × 40 000 IU, sc) (Group EPO, n = 19). Perioperative clinical and laboratory data were obtained. Mean Hb loss was 36 g L-1, but only seven patients were transfused (5%). Pre-operatively, 66 (45%) patients did not have enough stored iron to compensate Hb loss. At post-operative day 30, only 15% were anaemic, 70% of Hb loss and 92% of pre-operative Hb were recovered and ferritin increased by 73 μg L-1 (P < 0.01), although erythropoietic response was higher in patients receiving erythropoietin (P < 0.05). No adverse effects of iron sucrose or erythropoietin were witnessed. This protocol seems to reduce allogeneic blood transfusion rate and may hasten the recovery from post-operative anaemia in TKR patients, without depleting iron stores. Further studies are needed to ascertain which patients may benefit of extended intravenous iron and/or erythropoietin administration. [ABSTRACT FROM AUTHOR]

Background and purpose:It has been suggested that during a migraine attack capsaicin-sensitive trigeminal sensory nerves release calcitonin gene-related peptide (CGRP), resulting in cranial vasodilatation and central nociception; hence, trigeminal inhibition may prevent this vasodilatation and abort migraine headache. This study investigated the effects of the agonists sumatriptan (5-HT1B/1D water-soluble), donitriptan (5-HT1B/1D lipid-soluble), PNU-142633 (5-HT1D water-soluble) and PNU-109291 (5-HT1D lipid-soluble) on vasodilator responses to capsaicin, α-CGRP and acetylcholine in dog external carotid artery.Experimental approach:59 vagosympathectomized dogs were anaesthetized with sodium pentobarbitone. Blood pressure and heart rate were recorded with a pressure transducer, connected to a cannula inserted into a femoral artery. A precalibrated flow probe was placed around the common carotid artery, with ligation of the internal carotid and occipital branches, and connected to an ultrasonic flowmeter. The thyroid artery was cannulated for infusion of agonists.Key results:Intracarotid infusions of capsaicin, α-CGRP and acetylcholine dose-dependently increased blood flow through the carotid artery. These responses remained unaffected after intravenous (i.v.) infusions of sumatriptan, PNU-142633, PNU-109291 or physiological saline; in contrast, donitriptan significantly attenuated the vasodilator responses to capsaicin, but not those to α-CGRP or acetylcholine. Only sumatriptan and donitriptan dose-dependently decreased the carotid blood flow. Interestingly, i.v. administration of the antagonist, SB224289 (5-HT1B), but not of BRL15572 (5-HT1D), abolished the inhibition by donitriptan.Conclusions and implications:Our results suggest that the inhibition produced by donitriptan of capsaicin-induced external carotid vasodilatation is mainly mediated by 5-HT1B, rather than 5-HT1D, receptors, probably by a central mechanism.British Journal of Pharmacology (2006) 149, 82–91. doi:10.1038/sj.bjp.0706839; published online 31 July 2006 [ABSTRACT FROM AUTHOR]

An important percentage of patients undergoing total hip replacement (THR) receive allogeneic blood transfusion (ABT) to avoid the risks of acute anaemia. However, concerns about the risks of ABT have led to the search for alternatives, such as stimulation of erythropoiesis. We prospectively investigated the effect of postoperative administration of 300 mg of intravenous iron sucrose on ABT requirements in THR patients (group 2; n = 24). A previous series of 22 THR patients served as the control group (group 1). All patients were operated on by the same surgeon, using the same implant, and a set of clinical data was gathered. No adverse reactions to iron administration were observed. The group-given iron showed a trend to a lower transfusion rate (46 vs. 73%; P = 0·067) and lower transfusion index (0·96 vs. 1·68 units/patient; P = 0·038). Moreover, amongst the non-transfused patients, admission haemoglobin levels were lower in those coming from the iron group than those from the control group (12·7 ± 0·9 vs. 14·0 ± 1·2 g dL−1, respectively; P = 0·017). Postoperative parenteral iron administration could be a safe and effective way to reduce ABT requirements in the THR patients. A large, randomized controlled trial to confirm these results is warranted. [ABSTRACT FROM AUTHOR]

Patients undergoing surgery for hip fracture (HF) often receive perioperative allogeneic blood transfusions (ABT) to avoid anaemia. However, concerns about the adverse effects of ABT have prompted the review of transfusion practice and the search for a safer treatment of perioperative anaemia.We prospectively investigated the effect of a blood-saving protocol of perioperative iron sucrose (3 × 200 mg/48 h, intravenously) plus erythropoietin (1 × 40 000 IU, subcutaneously) if admission haemoglobin level< 130 g/l, on transfusion requirements and postoperative morbid-mortality in patients with HF (group 2;n= 83). A parallel series of 41 HF patients admitted to another surgical unit within the same hospital served as the control group (group 1). Perioperative blood samples were taken for haematimetric, iron metabolism and inflammatory parameter determination.This blood-saving protocol reduced the number of transfused patients (P < 0·001), the number of transfused units (P < 0·0001), increased the reticulocyte count and improved iron metabolism. In addition, the blood-saving protocol also reduced the rate of postoperative infections (P = 0·016), but not the 30-day mortality rate or the mean length of hospital stay.The blood-saving protocol implemented seems to reduce ABT requirements in patients with HF, and is associated with a lower postoperative morbidity. The possible mechanisms involved in these effects are discussed. [ABSTRACT FROM AUTHOR]

Computational systems are nowadays composed of basic computational components that share multiprocessors and coprocessors of different types, typically several graphics processing units (GPUs) or many integrated cores (MICs), and those computational components are combined in heterogeneous clusters of nodes with different characteristics, including coprocessors of different types, with varying numbers of nodes at different speeds. The software previously developed and optimized for simpler system needs to be redesigned and reoptimized for these new, more complex systems. The adaptation to hybrid multicore + multiGPU and multicore + multiMIC of autotuning techniques for basic linear algebra routines is analyzed. The matrix-matrix multiplication kernel, which is optimized for different computational system components through guided experimentation, is studied. The routine is installed for each node in the cluster, and the information generated from individual installations may be used for a hierarchical installation in a cluster. The basic matrix-matrix multiplication may, in turn, be used inside higher level routines, which delegate their efficient execution to the optimization of the lower level routine. Experimental results are satisfactory in different multicore + multiGPU and multicore + multiMIC systems. So the guided search of execution configurations for satisfactory execution times proves to be a useful tool for heterogeneous systems, where the complexity of the system means a correct use of highly efficient routines and libraries is difficult. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the article "Tranexamic Acid for Reducing Transfusion Requirements After Total Knee Arthroplasty: Can and Cost Ratios be improved?," by M. Muñoz, J. A. Garcia-Erce and J. Cuenca.

A letter to the editor is presented in response to the article about the preoperative autologous blood donation in Spain in the February 2007 issue.

Reports on cases of cystic fibrosis patients with anti-neutrophil autoantibodies in Spain. Clinical manifestations; Diagnosis; Cytoplasmic patterns.

Objective: Evidence suggests that intima-media thickness (IMT) and plasma homocysteine (Hcy) levels are associated with one another, and both appear to be related to cognitive dysfunction. However, no connection between both factors taken together and mild cognitive impairment (MCI) has been established. This study analysed potential relationships between IMT, Hcy and MCI., Methods: We included 105 patients with MCI and 76 controls with no history of vascular disease. All participants underwent laboratory analyses, a carotid ultrasound, and clinical and neuropsychological assessment. We used the Mantel-Haenszel test (MHT), ANCOVA and multiple linear regression models (MLRM) to examine any associations between IMT, Hcy and cognitive state., Results: The MHT revealed a significant association between IMT and risk of MCI (z = 4.285, P < 0.0001). The OR for the upper quartile vs the lower quartile was 5.12 (95% CI: 2.12-12.36). MHT also showed a clear association between Hcy levels and risk of MCI (z = 3.01, P = 0.003). OR for the upper vs the lower quartile was 3.39 (95% CI: 1.41-8.12). Additionally, we found a correlation between IMT and Hcy (r = 0.162, P = 0.032)., Conclusions: Our results suggest that there is a connection between IMT, Hcy levels and presence of amnestic MCI in a population with no history of clinically manifest atherosclerosis. Furthermore, there is also a connection between the IMT and Hcy levels themselves., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The present study aimed to investigate the possible influence of several inhibitors and blockers on the vascular effect produced by the acute in vitro application of rosuvastatin to phenylephrine-precontracted aortic rings from rats with a semi-solid, cafeteria-style (CAF) diet. It also aimed to examine the effects of rosuvastatin on the expression of endothelial nitric oxide synthase (eNOS), inducible nitric oxide synthase, constitutive cyclooxygenase, and inducible cyclooxygenase in aortic rings from rats with a CAF diet. From comparisons of the effect on phenylephrine-precontracted aortic rings extracted from rats with two different diets (a standard and a CAF diet), it was found that 10(-9) -10(-5) -mol/L rosuvastatin produced lower concentration-dependent vasorelaxation on rings from the CAF diet group. The vasorelaxant effect was unaffected by the vehicle, but it was significantly attenuated by 10(-5) -mol/L N(G) -nitro-l-arginine methyl ester, 10(-2) -mol/L tetraethylammonium, 10(-3) -mol/L 4-aminopyridine, 10(-7) -mol/L apamin plus 10(-7) -mol/L charybdotoxin, 10(-5) -mol/L indomethacin, or 10(-5) -mol/L cycloheximide. Moreover, in aortic rings from rats with a CAF diet, rosuvastatin enhanced the expression of eNOS, inducible nitric oxide synthase, constitutive cyclooxygenase, and inducible cyclooxygenase. The acute in vitro application of rosuvastatin to phenylephrine-precontracted aortic rings from rats with a CAF diet had a vasorelaxant effect. Overall, the present results suggest that the stimulation of eNOS, the opening of Ca(2+) -activated and voltage-activated K(+) channels, the stimulation of prostaglandin synthesis and enhanced protein levels of eNOS, inducible nitric oxide synthase, constitutive cyclooxygenase, and inducible cyclooxygenase are involved in this relaxant effect., (© 2015 The Authors. Clinical and Experimental Pharmacology and Physiology Published by Wiley Publishing Asia Pty Ltd.)

Heart transplantation is a successful therapeutic option for patients with end-stage heart cardiomyopathy. From April 1991 to December 2000, 345 patients underwent heart transplantation at the Juan Canalejo Hospital. The mean age of recipients was 54.5 +/- 11.4 years; 286 (83%) were male patients. Idiopathic (52.2%) and ischemic (34.9%) end-stage cardiomyopathy were the main causes leading to transplantation. Ninety-four patients had undergone a previous heart operation. The mean left ventricular ejection fraction was 22.8 +/- 11.4. Forty patients (11.5%) were transplanted in urgent (status I) condition. The mean time spent on the waiting list was 35.9 days. In-hospital mortality was 10.6% and 24% for transplantations performed on an elective and urgent basis, respectively. Operative (30-day), one-year and six-year survival was 87.2%, 81.3% and 64%, respectively. In terms of actuarial survival, there were no significant differences with regard to the recipient's age, sex, previous cardiac surgery, and the etiology of the end-stage cardiomyopathy. The six-year actuarial survival for recipients receiving hearts from female donors was 59% compared with 72% for male donors (p = 0.05). There has been a low incidence of rejection, as well as cardiac graft vasculopathy. Actuarial survival at six years was 66% for patients transplantated on an elective basis compared with 57% for patients transplanted on an urgent basis (p = 0.04). The aim of the study was to evaluate long-term results for patients who underwent orthotopic heart transplantation. In our experience, status I is associated with a higher mortality.

Immunofluorescent techniques have been used in the analysis of DNA-RNA hybrids occurrence and its relationship to transcriptional events on polytene chromosomes of Drosophila subobscura. We have studied the distribution of these hybrids on uninduced/induced chromosomes. Two different indirect immunofluorescence methods for the detection of DNA-RNA hybrids were used. Our data confirm the positive correlation between localization of DNA-RNA hybrids and transcriptional activity by following the Büsen et al procedure (1982). Using the other protocol, which allows chromosomal DNA-RNA to denature and renature, makes DNA-RNA hybrids detectable not exclusively in active chromosomal regions. Taking Büsen as method of choice, this technique allowed to localize the exact transcriptional active sites on puffs: hybrid fluorescence was restricted to marginal or central puff areas. Moreover, no correlation between fluorescence and puffs size was found. However, our studies on induced chromosomes indicate that: 1) the 15DE puff, previously described as t-puff, was not really a heat shock puff, since no transcriptional activity was detected; 2) hybrid fluorescence at 2C and 31CD regions was observed. No labelling was found in these loci in the autoradiography data, reported by other authors.

The ultrastructure of the Drosophila subobscura chromosome regions around the breakpoints of the complex E1 + 2 + 9 + 12 gene arrangement was analyzed. This overlapping inversion is formed by the association of the E1, E2, E9, and E12 simple inversions. Ultrastructure of sections involving 58D/59A, 61C/D, 62D/63A, 64B/C, 67A/B, and 68B/C breakpoints on Est chromosomes were compared with the ultrastructure of sections involving chromosomes were compared with the ultrastructure of sections involving 58D/68B, 62D/64C, 59A/63A, 64B/68C, 67B/61C, and 67A/61B breakpoints on E1 + 2 + 9 + 12 chromosomes. No detectable changes of structural organization on banding patterns induced by the E1 + 2 + 9 + 12 inversion were found. Ultrastructural analysis of the two E12 breakpoints has, however, facilitated the analysis of the left boundary of E12 inversion. Accordingly, we propose 61B/C as a new breakpoint instead of 61C/D.

Revision of the reference map of the polytene chromosomes of Drosophila subobscura was started by means of the electron microscope. We present a map of regions 70B to 72D of the E chromosome obtained from squashed and thin-sectioned salivary glands. It was observed that the total number of bands in divisions 70B to 72D is considerably higher than those depicted in the reference map of Kunze-Mühl and Müller. Functional considerations are made of some regions that show puff structures.