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Resumen Introduccion y objetivos HeartLogic es un algoritmo multiparametrico incorporado a desfibriladores automaticos implantables (DAI). La alerta asociada predice descompensaciones de insuficiencia cardiaca (IC). Nuestro objetivo es analizar la asociacion entre alertas y eventos clinicos bajo un protocolo de seguimiento comun en un registro multicentrico. Metodos Se evaluaron la fase 1 (investigadores ciegos al estado de la alerta) y las fases 2 y 3 (tras la activacion de HeartLogic, segun practica local y un protocolo comun respectivamente). Resultados Se incluyo a 288 pacientes en 15 centros. En fase 1, tras una media de observacion de 10 meses, hubo 73 alertas (0,72 alertas/paciente-ano), con 8 hospitalizaciones y 2 visitas a urgencias por IC (0,10 eventos/ano-paciente). No hubo hospitalizaciones fuera del periodo de alerta. Las fases activas tuvieron una media de seguimiento de 16 (IC95%, 15-22) meses, con 277 alertas (0,89 alertas/ano-paciente); 33 se asociaron con hospitalizaciones o muerte por IC, 46 con descompensaciones menores y 78 con otros eventos. La tasa de alertas inexplicables fue 0,39/ano-paciente. Fuera del estado de alerta solo hubo una hospitalizacion y una descompensacion menor. La mayoria de las alertas (el 82% en fase 2 y el 81% en fase 3; p = 0,861) se gestionaron a distancia. La mediana de NT-proBNP fue superior en estado de alerta que fuera de el (7.378 frente a 1.210 pg/ml; p Conclusiones El indice HeartLogic se asocio con descompensaciones de IC y otros eventos relevantes, con baja tasa de alertas inexplicables. Un protocolo estandarizado permitio detectar y actuar a distancia con seguridad sobre las alertas.

Summary Water‐soluble polymers (WSPs) are a versatile group of chemicals used across industries for different purposes such as thickening, stabilizing, adhesion and gelation. Synthetic polymers have tailored characteristics and are chemically homogeneous, whereas plant‐derived biopolymers vary more widely in their specifications and are chemically heterogeneous. Between both sources, microbial polysaccharides are an advantageous compromise. They combine naturalness with defined material properties, precisely controlled by optimizing strain selection, fermentation operational parameters and downstream processes. The relevance of such bio‐based and biodegradable materials is rising due to increasing environmental awareness of consumers and a tightening regulatory framework, causing both solid and water‐soluble synthetic polymers, also termed ‘microplastics’, to have come under scrutiny. Xanthan gum is the most important microbial polysaccharide in terms of production volume and diversity of applications, and available as different grades with specific properties. In this review, we will focus on the applicability of xanthan gum in agriculture (drift control, encapsulation and soil improvement), considering its potential to replace traditionally used synthetic WSPs. As a spray adjuvant, xanthan gum prevents the formation of driftable fine droplets and shows particular resistance to mechanical shear. Xanthan gum as a component in encapsulated formulations modifies release properties or provides additional protection to encapsulated agents. In geotechnical engineering, soil amended with xanthan gum has proven to increase water retention, reduce water evaporation, percolation and soil erosion – topics of high relevance in the agriculture of the 21st century. Finally, hands‐on formulation tips are provided to facilitate exploiting the full potential of xanthan gum in diverse agricultural applications and thus providing sustainable solutions.

Aims: There are controversial data on the ability of the components of mineral metabolism (vitamin D, phosphate, parathormone [PTH], fibroblast growth factor-23 [FGF23], and klotho) to predict cardiovascular events. In addition, it is unknown whether they add any prognostic value to other well-known biomarkers. Methods and results: In 969 stable coronary patients, we determined plasma levels of all the aforementioned components of mineral metabolism with a complete set of clinical and biochemical variables, including N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity troponin I (hs-TnI), and high-sensitivity C-reactive protein. Secondary outcomes were ischaemic events (any acute coronary syndrome, stroke, or transient ischaemic attack) and heart failure or death. The primary outcome was a composite of the secondary outcomes. Median follow-up was 5.39 years. Age was 60 (52–72) years. Median glomerular filtration rate was 80.4 (65.3–93.1) mL/min/1.73 m2. One-hundred and eighty-five patients developed the primary outcome. FGF23, PTH, hs-TnI, and NT-proBNP were directly related with the primary outcome on univariate Cox analysis, while Klotho and calcidiol were inversely related. On multivariate analysis, only PTH (HR 1.058 [CI 1.021–1.097]; P = 0.002) and NT-proBNP (HR 1.020 [CI 1.012–1.028]; P 85.5 RU/mL) (P, This work was supported by grants from Instituto de Salud Carlos III (ISCIII) and Fondos FEDER (Fondo Europeo de Desarrollo Regional) European Union (PI05/0451, PI14/1567, PI17/01615, and PI17/01495); Spanish Society of Cardiology; Spanish Society of Arteriosclerosis; RECAVA (Red Temática de Investigación Cooperativa en Enfermedades Cardiovasculares) (RD06/0014/0035); and Instituto de Salud Carlos III FEDER (FJD biobank: RD09/0076/00101). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Background and importance Deep brain stimulation of the posteromedial hypothalamus (PMH DBS) appears to be an effective treatment for drug-resistant aggressiveness. Weaver syndrome (WS) is a rare genetic disorder in which patients develop some degree of intellectual disability and rarely severe behavioral alterations that may benefit from this procedure. Clinical presentation We present the case of a 26-yr-old man diagnosed with WS presenting with uncontrollable self and heteroaggressiveness and disruptive behavior refractory to pharmacological treatment and under severe physical and mechanical restraining measures. The patient was successfully treated with bilateral PMH DBS resulting in affective improvement, greater tolerance for signs of affection, regularization in his sleep pattern and appetite disturbances at 12-mo follow-up. A detailed description and video of the procedure are presented, and a review of the clinical characteristics of WS and the utility and benefits of PMH DBS for refractory aggressiveness are reviewed. Conclusion To our knowledge, this is the first case of refractory aggressiveness described in WS as well as the first patient with WS successfully treated with PMH DBS.

Background Several studies suggest that statins, besides reducing cardiovascular disease, have anti-inflammatory properties which might provide a benefit in downregulating the immune response after a respiratory viral infection (RVI) and, hence, decreasing subsequent complications. We aim to analyse the effect of statins on mortality after RVI. Methods A single-centre, observational and retrospective study was carried out including all adult patients with a RVI confirmed by PCR tests from October 2, 2017 to May 20, 2018. Patients were divided between statin users and non-statin users and followed-up for 1 year, and all causes of death were recorded. In order to analyse the effect of statin treatment on mortality after RVI we planned two different approaches, a multivariate Cox regression model with the overall population and a univariate Cox model with a propensity-score matched population. Results We included 448 patients, 154 (34.4%) of whom were under statin treatment. Statin users had a worse clinical profile (older population with more comorbidities). During the 1-year follow-up, 67 patients died, 17 (11.0%) in the statin group and 50 (17.1%) in the non-statin group. Multivariate Cox analysis showed that statins were associated with mortality benefit (HR 0.47, 95% CI 0.26–0.83; p=0.01). In a matched population (101 statins users and 101 non-statins users) statins also remained associated with mortality benefit (HR 0.32, 95% CI 0.14–0.72; p=0.006). Differences were mainly driven by non-cardiovascular mortality (HR 0.31, 95% CI 0.13–0.73; p=0.004). Conclusions Chronic statin treatment was associated with reduced 1-year mortality in patients with laboratory-confirmed RVI. Further studies are needed to determine the exact role of statin therapy after RVI., Statin treatment is associated with reduced 1-year mortality after respiratory viral infections, despite the higher risk profile of patients on statins. Statins seem a good candidate to be tested during the current global pandemic. https://bit.ly/36t0tDh

Introduction There is scarce real-world experience regarding direct oral anticoagulants (DOACs) perioperative management. No study before has linked bridging therapy or DOAC-free time (pre-plus postoperative time without DOAC) with outcome. The aim of this study was to investigate real-world management and outcomes. Methods RA-ACOD is a prospective, observational, multicenter registry of adult patients on DOAC treatment requiring surgery. Primary outcomes were thrombotic and hemorrhagic complications. Follow-up was immediate postoperative (24–48 hours) and 30 days. Statistics were performed using a univariate and multivariate analysis. Data are presented as odds ratios (ORs [95% confidence interval]). Results From 26 Spanish hospitals, 901 patients were analyzed (53.5% major surgeries): 322 on apixaban, 304 on rivaroxaban, 267 on dabigatran, 8 on edoxaban. Fourteen (1.6%) patients suffered a thrombotic event, related to preoperative DOAC withdrawal (OR: 1.57 [1.03–2.4]) and DOAC-free time longer than 6 days (OR: 5.42 [1.18–26]). Minor bleeding events were described in 76 (8.4%) patients, with higher incidence for dabigatran (12.7%) versus other DOACs (6.6%). Major bleeding events occurred in 17 (1.9%) patients. Bridging therapy was used in 315 (35%) patients. It was associated with minor (OR: 2.57 [1.3–5.07]) and major (OR: 4.2 [1.4–12.3]) bleeding events, without decreasing thrombotic events. Conclusion This study offers real-world data on perioperative DOAC management and outcomes in a large prospective sample size to date with a high percentage of major surgery. Short-term preprocedural DOAC interruption depending on the drug, hemorrhagic risk, and renal function, without bridging therapy and a reduced DOAC-free time, seems the safest practice.

Introduction and objectives Information regarding long-term outcomes in patients surviving out-of-hospital cardiac arrest (OHCA) is scarce. Our aim was to study the long-term clinical outcomes of a large cohort of OHCA patients surviving until hospital discharge and to identify predictors of mortality and cardiovascular events. Methods Consecutive OHCA patients admitted in the Acute Cardiac Care Unit who survived at least until hospital discharge between 2007 and 2019 were included. All received therapeutic hypothermia according to the local protocol. Pre- and intra-hospital clinical and analytical variables were analyzed, as well as the clinically relevant events during follow-up. Results A total of 201 patients were included, with a mean age of 57.6 ± 14.2 years, 168 (83.6%) were male. Thirty-six (17.9%) died during a median follow-up of 40.3 months (18.9–69.1), the most frequent causes of death being cardiovascular and neurological, followed by cancer. We calculated a predictive model for mortality during follow-up using Cox regression that included the following variables: poor neurological outcome [HR 3.503 (1.578–7.777)], non-shockable rhythm [HR 2.926 (1.390–6.163)], time to onset of CPR [HR 1.063 (0.997–1.134)], older age [1.036 (1.008–1.064)) and worse ejection fraction at discharge [1.033 (1.009–1.058)]. Conclusions Even though few patients experience recurrent cardiac arrest events, survivors after OHCA face high morbidity and mortality during long-term follow-up. Therefore, they may benefit from multidisciplinary teams providing an integral management and ensuring continuity of care.

Background High incidence of cardiovascular events has been described among patients with COVID-19 and since the beginning of the pandemic concerns have been expressed with medical treatments for cardiovascular disease, as they could contribute to the severity of illness in patients with COVID-19. We aim to analyze the effect of chronic treatment with calcium channel blockers and beta-blockers on COVID 19 severity in a Spanish cohort during the 2020 pandemic. Methods Observational study including all consecutive patients (≥40 years old) diagnosed with SARS-CoV-2 through PCR in the microbiology laboratory of our hospital, from March 2nd to 20th 2020. Clinical characteristics and drugs were recorded. The Primary end-point (PE) was all-cause death and the secondary end-point (SE) was the combined of death or the need for orotracheal intubation until 30 days of infection symptoms onset. Results We included 704 patients in our study. Baseline characteristics of the overall cohort can be seen in the table. Median age was 61 years old (IQR 52.9–72.9); 52.7% were female. 34.7% and 12.6% had hypertension and diabetes respectively. After a median follow-up of 111.5 days, 58 patients (8.2%) needed orotracheal intubation and 133 patients (18.9%) died. Secondary endpoint (all-cause death or need for orotracheal intubation) was reached by 164 patients (23.3%). The table described clinical differences between survivors and deceased patients. After multivariate Cox modeling, age, male gender, diabetes, previous lung disease, BMI and the chronic intake of calcium channel blockers (HR 1.74, 95% CI (1.11–2.75), p=0.016) and beta-blockers (HR 1.71, 95% CI (1.07–2.76), p=0.026) were independently related with mortality. Other cardiovascular drugs (Antiplatelets, anticoagulants, diuretics, mineralcorticoid-receptor antagonists, angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors and statins) did not influence survival after SARS-CoV 2 infection (Figure). The secondary outcome was reached by 164 patients (23.3%) and chronic treatment with calcium channel blockers remains as an independent predictor of mortality (HR 1.55, 95% CI (1.01–2.37), p=0.044). Conclusions Chronic treatment with calcium channel blockers and beta-blockers are independent predictors of mortality after SARS-CoV-2 infection. Further studies are needed to confirm these results. Funding Acknowledgement Type of funding sources: None. Description of studied populationOdds-ratio and CI for all-cause death

Background On January 2020, the first patient with coronavirus 2 (SARS-CoV-2) was detected in Spain. Since then, 3 280 000 cases have been confirmed and 75.305 people have died. We aimed to clarify the epidemiological and clinical characteristics related with poor short-term prognosis in patients diagnosed with SARS-CoV-2. Methods Observational, retrospective single-center study including consecutive patients (≥40yo) diagnosed with SARS-CoV-2 through PCR, since March 2nd to 20th 2020 in our center in Spain. The primary endpoint (PE) was the combined of all-cause death or need for orotracheal intubation within the first 30 days of infection symptoms. Results 704 patients were included (table). A follow-up period of thirty-days was fully completed in 692 of 704 patients (98.3%). At the end of this period, 148 patients (21.4%) met the PE; they were older, more frequently male, obese and smokers. Patients who met the PE had a higher prevalence of hypertension, diabetes, dyslipidemia, ischemic heart disease, heart failure, peripheral and cerebrovascular disease, cancer and lung pathologies. They received more frequently therapies with renin-angiotensin system inhibitors, betablockers, calcium channel blockers and statins, as well as antiplatelet and anticoagulant therapies Multivariate analysis showed that age (OR 1.99 for every 10 years, 95% CI [1.637–2.4], p Conclusion In our group of patients with SARS-CoV-2, age, male sex, diabetes, lung disease and obesity were found to be independent predictors of the combined of all case death or need for orotracheal intubation within the first 30 days of infection symptoms. Larger studies are needed to confirm these results. Funding Acknowledgement Type of funding sources: None. Description of studied populationOdds-ratio and CI for the combined PE

Background Questions emerged about safety renin-angiotensin system (RAS) inhibitors (angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs)) in patients diagnosed with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Our objective was to evaluate the safety of this treatment in a Spanish cohort during 2020 pandemic. Methods Observational study including all consecutive patients (≥40 years old) diagnosed with SARS-CoV-2 through PCR in the microbiology laboratory of our hospital, since March 2nd to 20th 2020. Clinical characteristics and drugs were recorded. Primary end-point (PE) was the combined of all-cause death or need for orotracheal intubation until 30 days of infection symptoms onset. To assess the effect of RAS inhibitors, we performed a double statistical approach, with multivariate logistic regression and propensity-score matching. Results We included 704 patients (table). Median age was 61 years old (IQR 52.9–72.9); 52.7% were female. 34.7% and 12.6% had hypertension (HTA) and diabetes (DM) respectively. 92 patients (13.1%) and 87 patients (12.4%) were taking ACEI and ARB respectively. Baseline characteristics of both subgroups are shown in the table. Patients on RAS inhibitors treatment had a worse clinical profile: were older, more males and with higher prevalence of HTA, DM, dyslipemia, ischemic heart disease and heart failure. There were no differences in terms of respiratory nor neoplasic disease. After 30 days, 112 patients (15.9%) had died, 148 (21.4%) had died or had required invasive mechanical ventilation (PE); 390 patients (55.4%) had needed hospital admission. PE was reached in 33.3% patients under ACEI treatment (vs. 19.6% in control group, p=0.005) and in 41.9% patients under ARB treatment (vs. 18.5% in control group, p Using a propensity-score approach 79 patients under ACEI treatment and 72 patients under ARB treatment were matched 1:1 with control patients (characteristics of matched population are described in the table) Logistic binary regression showed no significant differences on incidence of the PE in patients under ACEI treatment (OR 0.84, 95% CI [0.43–1.63], p=0.613) nor ARB treatment (OR 1.82, 95% CI [0.92–3.60], p=0.085). Nevertheless, there was a trend towards worse prognosis in ARB patients. Kaplan-Meier curves of survival free of death or need for mechanical ventilation in matched population (ACEI and ARB treatment) are shown in the figure. Conclusions We have not found any correlation between the severity of the disease and the treatment with ACEI nor ARB. We do not recommend the withdrawal of these drugs during the current epidemic situation. Further studies are needed to assess this finding. Funding Acknowledgement Type of funding sources: None. Description of studied populationKaplan-Meier curve in matched population

N-terminal pro-brain natriuretic peptide (NT-proBNP) plasma levels are increased in patients with cancer. In this paper, we test whether NT-proBNP may identify patients who are going to receive a future cancer diagnosis (CD) in the intermediate-term follow-up. We studied 962 patients with stable coronary artery disease and free of cancer and heart failure at baseline. This sample represents a re-analysis of a previous work expanding the sample size and the follow-up. NT-proBNP, galectin-3, monocyte chemoattractant protein-1, high-sensitivity C-reactive protein, high-sensitivity cardiac troponin I (hsTnI), and calcidiol (vitamin D) plasma levels were assessed. The primary outcome was new CD. After 5.40 (2.81–6.94) years of follow-up, 59 patients received a CD. NT-proBNP [HR 1.036 CI (1.015–1.056) per increase in 100 pg/mL, p = 0.001], previous atrial fibrillation (HR 3.140 CI (1.196–8.243), p = 0.020), and absence of previous heart failure (HR 0.067 CI (0.006–0.802), p = 0.033) were independent predictors of receiving a CD in the first three years of follow-up. None of the variables analyzed predicted a CD beyond this time. The number of patients developing heart failure during follow-up was 0 (0.0%) in patients receiving CD in the first three years of follow-up, 2 (6.9%) in those receiving a CD diagnosis beyond this time, and 40 (4.4%) in patients not developing cancer (p = 0.216). These numbers suggest that future heart failure was not a confounding factor. In patients with coronary artery disease, NT-proBNP was an independent predictor of CD in the first three years of follow-up but not later, suggesting that it could be detecting subclinical undiagnosed cancers.

Clinical data indicate that patients with C-reactive protein (CRP) levels higher than 2 mg per liter suffer from persistent inflammation, which is associated with high risk of cardiovascular disease (CVD). We determined whether a panel of biomarkers associated with CVD could predict recurrent events in patients with low or persistent inflammation and coronary artery disease (CAD). We followed 917 patients with CAD (median 4.59 ± 2.39 years), assessing CRP, galectin-3, monocyte chemoattractant protein-1 (MCP-1), N-terminal fragment of brain natriuretic peptide (NT-proBNP) and troponin-I plasma levels. The primary outcome was the combination of cardiovascular events (acute coronary syndrome, stroke or transient ischemic event, heart failure or death). Patients with persistent inflammation (n = 343) showed higher NT-proBNP and MCP-1 plasma levels compared to patients with CRP &lt, 2 mg/L. Neither MCP-1 nor NT-proBNP was associated with primary outcome in patients with CRP &lt, 2 mg/L. However, NT-proBNP and MCP-1 plasma levels were associated with increased risk of the primary outcome in patients with persistent inflammation. When patients were divided by type of event, MCP-1 was associated with an increased risk of acute ischemic events. A significant interaction between MCP-1 and persistent inflammation was found (synergy index: 6.17 (4.39–7.95)). In conclusion, MCP-1 plasma concentration is associated with recurrent cardiovascular events in patients with persistent inflammation.

This data article contains the data related to the research article entitled “Long-term neurological outcomes in out-of-hospital cardiac arrest patients treated with targeted-temperature management” (Caro-Codon et al., 2018). In this dataset, we report details regarding the flow chart of the included patients and the specific exclusion criteria. We also include information on the difference between the patients who attended the structured personal interview (and therefore were finally included in the study) and those who did not attend. Neuropsychiatric and functional data before and after cardiac arrest are also reported. Finally, we list all the “de novo” focal neurological deficits identified after cardiac arrest in the related population.

Target temperature management (TTM) has shown to reduce brain damage after an out-of-hospital cardiac arrest (CA), but the time to neurological recovery is not defined yet. We sought to determine the time these patients need to regain consciousness, as well as factors associated with a late post-arrest awakening.We performed a retrospective analysis of patients cooled to 32-34°C during 24h after CA, who regained neurological responsiveness after rewarming. We measured the time until awakening, defined as obedience to verbal commands.We included 163 CA survivors (84.7% male, 60.2 years) who regained consciousness after TTM: target temperature was either 32°C (36.2%), 33°C (56.4%) or 34°C (6.7%). Mean time of awakening was 3.8 days. Thirty-four patients (20.9%) regained neurological responsiveness after 5 days after CA. All of them had been cooled to either 32°C (18 patients) or 33°C (16), and no patient cooled to 34°C awakened after day 5. A lower target temperature was associated with a later awakening (p0.001). The time to advanced cardiopulmonary resuscitation (CPR) was shorter among the early awakers (p=0.04), but we found no other predictors of an earlier awakening.A high proportion of CA survivors induced to TTM regained consciousness after 5 days, and cooling to a lower target temperature may influence on a late neurological recovery. Therefore, withdrawal of life supporting treatment should be delayed to more than 5 days in patients cooled to 33°C or less. Time to advanced CPR was found to be a predictor of early awakening.

Introduction: Type-2 diabetes mellitus (T2DM) is associated with early and severe atherosclerosis. However, few biomarkers can predict cardiovascular events in this population. Methods: We followed 964 patients with coronary artery disease (CAD), assessing plasma levels of galectin-3, monocyte chemoattractant protein-1 (MCP-1), and N-terminal fragment of brain natriuretic peptide (NT-proBNP) at baseline. The secondary outcomes were acute ischemia and heart failure or death. The primary outcome was the combination of the secondary outcomes. Results. Two hundred thirty-two patients had T2DM. Patients with T2DM showed higher MCP-1 (144 (113&ndash, 195) vs. 133 (105&ndash, 173) pg/mL, p = 0.006) and galectin-3 (8.3 (6.5&ndash, 10.5) vs. 7.8 (5.9&ndash, 9.8) ng/mL, p = 0.049) levels as compared to patients without diabetes. Median follow-up was 5.39 years (2.81&ndash, 6.92). Galectin-3 levels were associated with increased risk of the primary outcome in T2DM patients (Hazard ratio (HR) 1.57 (1.07&ndash, 2.30), p = 0.022), along with a history of cerebrovascular events. Treatment with clopidogrel was associated with lower risk. In contrast, NT-proBNP and MCP-1, but not galectin-3, were related to increased risk of the event in nondiabetic patients (HR 1.21 (1.04&ndash, 1.42), p = 0.017 and HR 1.23 (1.05&ndash, 1.44), p = 0.012, respectively), along with male sex and age. Galectin-3 was also the only biomarker associated with the development of acute ischemic events and heart failure or death in T2DM patients, while, in nondiabetics, MCP-1 and NT-proBNP, respectively, were related to these events. Conclusion: In CAD patients, galectin-3 plasma levels are associated with cardiovascular events in patients with T2DM, and MCP-1 and NT-proBNP in those without T2DM.

Background This study aimed to assess long-term cognitive and functional outcomes in out-of-hospital cardiac arrest (OHCA) patients treated with targeted-temperature management, investigate the existence of prognostic factors that could be assessed during initial admission and evaluate the usefulness of classic neurological scales in this clinical scenario. Methods Patients admitted due to OHCA from August 2007 to November 2015 and surviving at least one year were included. Each patient completed a structured interview focused on the collection of clinical, social and demographic data. All available information in clinical records was reviewed and a battery of neurocognitive and psychometric tests was performed. Results Seventy-nine patients were finally included in the analysis. Forty-three patients (54.4%) scored below the usual cut-off points for the diagnosis of mild cognitive impairment, even though most of these deficits went unnoticed when patients were assessed using CPC and modified Rankin scale. Nineteen (24%) developed certain degree of impairment in their attention capacity and executive functions. A significant proportion developed new memory-related disorders (43%), depressive symptoms (17.7%), aggressive/uninhibited behavior (12.7%) and emotional lability (8.9%). A greater number of weekly hours of intellectual activity and a qualified job were independent protective factors for the development of cognitive impairment. However, being older at the time of the cardiac arrest was identified as a poor prognostic factor. Conclusions There is a high prevalence of long-term cognitive deficits and functional limitations in OHCA survivors. Most commonly used clinical scales in clinical practice are crude and lack sensitivity to detect most of these deficits.

Objective To determine the influence of demographics, medical, and surgical variables on 30-day mortality in patients who need continuous renal replacement therapy (CRRT). Materials and methods A retrospectively-followed study was conducted using the data of 112 patients admitted to the postoperative intensive care unit who required CRRT, between August 2006 and August 2011, and followed-up for 30 days. The following information was collected: age, gender, history of HBP, DM, cardiovascular disease, CKD, urgent surgery, surgical speciality, organic dysfunction according to the SOFA scale, the number of organs with dysfunction, use of mechanical ventilation, diagnostic and origin of sepsis, type of CRRT, and 30-day mortality. General linear models were used for estimating the strength of association (relative risk [RR], and 95% confidence interval [CI]) between variables and 30-day mortality. Results In the univariant analysis, the following variables were identified as risk factors for 30-day mortality: age (RR 1.04; 95% CI 1.01–1.06; p = .0005), and history of cardiovascular disease (RR 1.57; 95% CI 1.02–2.41; p = .039). Among the variables included in the multivariable analysis (age, history of cardiovascular disease, sepsis, and number of organs with dysfunction), only age was identified as an independent risk factor for 30-day mortality (RR 1.03; 95% CI 1.00–1.05; p = .007). Conclusion Thirty-day mortality in postoperative, critically ill patients who require CRRT is high (41.07%). Age has been identified as an independent risk factor, with renal failure as the most common indication for the use of these therapies.

Resumen Objetivo Determinar la influencia de las variables demograficas, medicas y quirurgicas sobre la mortalidad a 30 dias en pacientes que requieren la aplicacion de tecnicas continuas de reemplazo renal (TCRR) en la Unidad de Cuidados Intensivos Posquirurgicos. Materiales y metodos Estudio de seguimiento retrospectivo. Datos de 112 pacientes admitidos en la Unidad de Cuidados Intensivos que requirieron TCRR, entre agosto de 2006 y agosto de 2011 y seguidos durante 30 dias. Se recogio la siguiente informacion: edad, genero, historia de HTA, DM, enfermedad cardiovascular e IRC, cirugia urgente, especialidad quirurgica, disfuncion organica de acuerdo con la escala SOFA, numero de organos con disfuncion, uso de ventilacion mecanica, diagnostico y origen de la sepsis, modalidad de TCRR y mortalidad a 30 dias. Se utilizaron modelos lineales generales para estimar la fuerza de la asociacion (riesgo relativo [RR] e intervalo de confianza [IC] al 95%) entre las diferentes variables y la mortalidad a 30 dias. Resultados En el analisis univariante se identificaron como factores de riesgo para la mortalidad a 30 dias la edad (RR 1,04; IC 95% 1,01-1,06; p = 0,0005) y la presencia de enfermedad cardiovascular previa (RR 1,57; IC 95% 1,02-2,41; p = 0,039). Entre las variables incluidas en el analisis multivariante (edad, historia de enfermedad cardiovascular previa, presencia de sepsis y numero de organos con disfuncion), solo la edad se identifico como factor de riesgo independiente para mortalidad a 30 dias (RR 1,03; IC 95% 1,00-1,05; p = 0,007). Conclusion La mortalidad a 30 dias en los pacientes criticos posquirurgicos que necesitan TCRR es alta (41,07%), identificandose la edad como factor de riesgo independiente, siendo la insuficiencia renal aguda la principal indicacion para el uso de estas terapias.

Summary The application of beneficial, plant‐associated microorganisms is a sustainable approach to improving crop performance in agriculture. However, microbial inoculants are often susceptible to prolonged periods of storage and deleterious environmental factors, which negatively impact their viability and ultimately limit efficacy in the field. This particularly concerns non‐sporulating bacteria. To overcome this challenge, the availability of protective formulations is crucial. Numerous parameters influence the viability of microbial cells, with drying procedures generally being among the most critical ones. Thus, technological advances to attenuate the desiccation stress imposed on living cells are key to successful formulation development. In this review, we discuss the core aspects important to consider when aiming at high cell viability of non‐sporulating bacteria to be applied as microbial inoculants in agriculture. We elaborate the suitability of commonly applied drying methods (freeze‐drying, vacuum‐drying, spray‐drying, fluidized bed‐drying, air‐drying) and potential measures to prevent cell damage from desiccation (externally applied protectants, stress pre‐conditioning, triggering of exopolysaccharide secretion, ‘helper’ strains). Furthermore, we point out methods for assessing bacterial viability, such as colony counting, spectrophotometry, microcalorimetry, flow cytometry and viability qPCR. Choosing appropriate technologies for maintenance of cell viability and evaluation thereof will render formulation development more efficient. This in turn will aid in utilizing the vast potential of promising, plant beneficial bacteria as sustainable alternatives to standard agrochemicals.

Summary Background Current guideline recommendations encourage culprit vessel only percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. However, recent studies have shown a better clinical outcome in patients who receive multivessel PCI. Aim To measure and compare clinical outcomes between partial revascularization (PR) versus complete revascularization (CR) in patients with STEMI and multivessel disease who underwent a cardiac rehabilitation programme. Methods We retrospectively reviewed the medical records of 282 patients with STEMI and multivessel disease who received PR or CR and were subsequently enrolled in a cardiac rehabilitation programme between July 2006 and November 2013 at La Paz University Hospital. The incidences of cardiovascular events, new PCI, hospital admissions for cardiovascular reasons and mortality were compared between the PR and CR groups. Results Overall, 143 patients received PR and 139 received CR. Baseline characteristics were similar in both groups, except for mean age (59.3 vs. 56.7 years; P = 0.02), diabetes mellitus prevalence (34.3% vs. 20.1%; P = 0.01) and number of arteries with stenosis (2.6 vs. 2.3; P = 0.001). During the mean follow-up of 48.0 ± 25.9 months, a cardiovascular event occurred in 23 (16.1%) PR patients and 20 (14.4%) CR patients, with no statistically significant differences in the early (hazard ratio: 0.61, 95% confidence interval: 0.19–1.89) or late (hazard ratio: 1.40, 95% confidence interval: 0.62–3.14) follow-up periods. Cox regression, adjusted for age, sex, presence of diabetes mellitus and number of affected coronary vessels, showed no difference in new cardiovascular event risk. Conclusions There were no statistical differences in clinical outcomes between PR and CR among patients who received cardiac rehabilitation.

The factors that influence decision making in severe aortic stenosis (AS) are unknown. Our aim was to assess, in patients with severe AS, the determinants of management and prognosis in a multicenter registry that enrolled all consecutive adults with severe AS during a 1-month period. One-year follow-up was obtained in all patients and included vital status and aortic valve intervention (aortic valve replacement [AVR] and transcatheter aortic valve implantation [TAVI]). A total of 726 patients were included, mean age was 77.3 ± 10.6 years, and 377 were women (51.8%). The most common management was conservative therapy in 468 (64.5%) followed by AVR in 199 (27.4%) and TAVI in 59 (8.1%). The strongest association with aortic valve intervention was patient management in a tertiary hospital with cardiac surgery (odds ratio 2.7, 95% confidence interval 1.8 to 4.1, p

10 páginas, 7 figuras, 7 tablas., An experimental study based on the effects of fire on soil hydrology was developed at the Experimental Station of 'La Concordia' (Valencia, Spain). It is located on a calcareous hillside facing SSE and composed of nine erosion plots (4 x 20 m). In summer 2003, after eight years of soil and vegetation recovery from previous fires in 1995 (with three fire treatments: T1 high-intensity fire, T2 moderate intensity, and T3 not burnt), experimental fires of low intensity were again conducted on the plots already burnt, to study the effects of repeated fires on the soil water infiltration, soil water content and runoff. Infiltration rates and capacities were measured by the mini-disk infiltrometer method (MDI), assessing the effects of vegetation cover by comparing the under-canopy microenvironment (UC) and its absence on bare soil (BS), immediately before and after the fire experiments. Soil properties like water retention capacity (SWRC) and water content (SWC) were also determined for the different fire treatments (T1, T2 and T3) and microsites (UC and BS). Hydrological parameters, such as runoff and infiltration rate, were monitored at plot scale from July 2002 to July 2004. In the post-fire period, data displayed a 20% runoff increase and a decrease in infiltration (18%). Differences in the steady-state infiltration rate (SSI) and infiltration capacity (IC) were tested with the MDI on the different treatments (T1, T2 and T3), and between the UC and BS microsites of each treatment. After fire, the SSI of the UC soil declined from 16 mm h(-1) to 12 mm h(-1) on T1, and from 24 mm h(-1) to 19 mm h(-1) on T2. The IC was reduced by 2/3 in the T1 UC soil, and by half on T2 UC soil. On the BS of T1 and T2, the fire effect was minimal, and higher infiltration rates and capacities were reached. Therefore, the presence/absence of vegetation when burnt influenced the post-burnt infiltration patterns at soil microscale. On the T3, different rates and capacities were obtained depending on the microsites (UC and BS), with higher SSI (25 mm h(-1)) and IC (226 mm h(-1)) on BS than on UC (SSI of 18 mm h(-1) and IC of 136 mm h(-1)). The SWRC and SWC were recovered from 1995 to 2003 (prior to the fires). The 2003 fire promoted high variability on the SWC at pF 0.1, 2 and 2.5, and the SWRC on burnt soils were reduced. To summarize, the IC and SSI post-fire decreases were related to the lower infiltration rate at plot scale, the significant differences in the SWRC between burnt and control treatments, and the increase in the runoff yield (20%). According to the results, the MDI was a useful tool to characterize the soil infiltration on the vegetation patches of the Mediterranean maquia, and contrary to other studies, on the UC soil, the infiltration rate and IC, when soil was dry, were lower than that obtained on BS. Once the soil gets wet, similar values were found on both microenvironments., We thank the financial support from the Agreement Generalitat Valenciana - CSIC (2005020112) ‘Impacto de los incendios forestales repetidos sobre los procesos de erosión hídrica del suelo y la recuperación de la cubierta vegetal. Seguimiento y evaluación en una estación permanente de campo’, and the Ministerio de Educación y Ciencia of the Spanish Government project ‘Procesos y balances hidrológicos y de sedimentos a diferentes escalas espaciales en ambientes mediterráneos: Efectos de la variabilidad climática y los cambios de uso del suelo’ (PROBASE CGL2006-11619).

Introduccion: Los agonistas de dopamina (AD) son actualmente la primera linea de tratamiento en macroprolactinomas y han desplazado a la cirugia como manejo primario de esta condicion, aun en presencia de compromiso visual. Varios estudios han demostrado la efectividad de los AD en reducir el tamano tumoral, con la consiguiente mejoria visual. Objetivo: Estudiar los resultados visuales en pacientes con macroprolactinomas tratados exclusivamente con AD. Material y metodo: Estudio de cohorte retrospectivo que incluyo a pacientes con macroprolactinoma controlados en la Unidad de Neuroendocrinologia y Neuro-oftalmologia del Instituto de Neurocirugia Asenjo entre 1997 y 2011, y que fueron tratados exclusivamente con AD (bromocriptina y/o cabergolina). Se excluyeron pacientes con cirugia o radioterapia previa y aquellos con seguimiento incompleto. Se analiza y compara el estado visual antes y posterior al inicio del tratamiento con AD. Resultados: Se incluyeron 31 pacientes cuya edad promedio fue de 32 anos (8-59). Dieciocho pacientes (58%) tenian compromiso visual al momento del diagnostico (Grupo 1) y 13 estaban sin deterioro (Grupo 2). El seguimiento promedio fue de 36,5 meses. Quince pacientes del Grupo 1 (83%) tuvieron mejoria visual, 2 se mantuvieron estables (11%) y 1 tuvo deterioro visual (6%). En el Grupo 2, solo 1 paciente presento deterioro visual, atribuible a mala adhesion a la terapia. Conclusiones: Los AD son efectivos en el manejo de las complicaciones neuro-oftalmologicas asociadas a macroprolactinomas y deben considerarse como terapia de primera eleccion en este tipo de tumores.

The freshwater microalga Haematococcus pluvialis exhibits a unique morphological response to environmental stress, accumulating carotenoid pigment during encystment. The complexity of characterizing the different cell stages and monitoring the pigment cell content during the life cycle of this microalga is one of the main problems reported when assessing astaxanthin accumulation and degradation. Therefore, with the aim of studying the potential encystment response in this microalga by means of flow cytometry (FCM), we induced oxidative stress in cultures of vegetative growing cells by treating them with paraquat, a known generator of superoxide anion radicals. Two flow cytometric approaches were successfully used to monitor the effect of oxidative stress on morphological changes and genesis of carotenoids in H. pluvialis: (1) a cytometric characterization of different cell types based on analysis of the fluorescence of chlorophyll a vs the fluorescence of astaxanthin, and (2) staining with the fluorochromes hydroethidium (HE) and dihydrorhodamine 123 (DHR), in order to measure the in vivo intracellular levels of reactive oxygen species (ROS). FCM data showed that astaxanthin accumulation during encystment hampers the production of ROS. Furthermore, the cell content of astaxanthin seems to be a good indicator of the extent to which H. pluvialis cells undergo oxidative stress, and also of how the cells defend themselves under stress conditions. Xunta de Galicia; INCITE08ENA103032ES