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Key points Trabecular meshwork (TM) is a highly mechanosensitive tissue in the eye that regulates intraocular pressure through the control of aqueous humour drainage. Its dysfunction underlies the progression of glaucoma but neither the mechanisms through which TM cells sense pressure nor their role in aqueous humour outflow are understood at the molecular level. We identified the Piezo1 channel as a key TM transducer of tensile stretch, shear flow and pressure. Its activation resulted in intracellular signals that altered organization of the cytoskeleton and cell-extracellular matrix contacts and modulated the trabecular component of aqueous outflow whereas another channel, TRPV4, mediated a delayed mechanoresponse. This study helps elucidate basic mechanotransduction properties that may contribute to intraocular pressure regulation in the vertebrate eye. Abstract Chronic elevations in intraocular pressure (IOP) can cause blindness by compromising the function of trabecular meshwork (TM) cells in the anterior eye, but how these cells sense and transduce pressure stimuli is poorly understood. Here, we demonstrate functional expression of two mechanically activated channels in human TM cells. Pressure-induced cell stretch evoked a rapid increase in transmembrane current that was inhibited by antagonists of the mechanogated channel Piezo1, Ruthenium Red and GsMTx4, and attenuated in Piezo1-deficient cells. The majority of TM cells exhibited a delayed stretch-activated current that was mediated independently of Piezo1 by TRPV4 (transient receptor potential cation channel, subfamily V, member 4) channels. Piezo1 functions as the principal TM transducer of physiological levels of shear stress, with both shear and the Piezo1 agonist Yoda1 increasing the number of focal cell-matrix contacts. Analysis of TM-dependent fluid drainage from the anterior eye showed significant inhibition by GsMTx4. Collectively, these results suggest that TM mechanosensitivity utilizes kinetically, regulatory and functionally distinct pressure transducers to inform the cells about force-sensing contexts. Piezo1-dependent control of shear flow sensing, calcium homeostasis, cytoskeletal dynamics and pressure-dependent outflow suggests potential for a novel therapeutic target in treating glaucoma.

Contains fulltext : 219877.pdf (Publisher’s version ) (Open Access) OBJECTIVE: It was previously determined that group-based face-to-face Mindfulness-Based Cognitive Therapy (MBCT) and individual internet-based MBCT (eMBCT) are equally efficacious compared with treatment as usual (TAU) in reducing psychological distress. In this study, the incremental cost-utility of both interventions compared with TAU was assessed. METHODS: This cost-utility study included 245 self-referred heterogeneous cancer patients with psychological distress who were randomized to MBCT, eMBCT or TAU. Healthcare costs and (informal) work-related productivity losses were assessed by interview. Outcomes were expressed in EuroQol-5D-3L utility scores and quality-adjusted life years (QALY). An economic evaluation with a time-horizon of 3 months was conducted from the societal perspective in the intention-to-treat sample. In addition, secondary explorative analyses of costs and quality of life during the 9-month follow-up were conducted based on linear extrapolation of TAU. RESULTS: Paid work-related productivity losses and societal costs were lower in both intervention conditions compared with TAU during the 3-month intervention period. Moreover, quality of life (utility scores) improved in eMBCT versus TAU (Cohen's d: .54) and MBCT versus TAU (.53). At a willingness to pay of euro20000 per QALY, the mean incremental net monetary benefit was euro1916 (SD=euro783) in eMBCT and euro2365 (SD=euro796) in MBCT versus TAU. Exploration of costs demonstrated an equal pattern of eMBCT and MBCT being superior to TAU. Quality of life at 9-month follow-up remained improved in both interventions. CONCLUSIONS: Results indicate that eMBCT and MBCT are cost-saving treatments whilst simultaneously improving quality of life for distressed cancer patients.

Mindfulness-based cognitive therapy (MBCT) is an innovative evidence-based intervention in mental and somatic health care. Gaining knowledge of therapeutic factors associated with treatment outcome can improve MBCT. This study focused on predictors of treatment outcome of MBCT for cancer patients and examined whether group cohesion, therapeutic alliance, and therapist competence predicted reduction of psychological distress after MBCT for cancer patients. Moreover, it was examined whether therapist competence facilitated therapeutic alliance or group cohesion. Multilevel analyses were conducted on a subsample of patients collected in a larger randomized controlled trial on individual internet-based versus group-based MBCT versus treatment as usual in distressed cancer patients. The current analyses included the 84 patients who completed group-based MBCT out of 120 patients who were randomized to group-based MBCT. Group cohesion and therapist competence did not predict reduction in psychological distress, whereas therapeutic alliance did. In addition, therapist competence did not predict therapeutic alliance but was associated with reduced group cohesion. Our findings revealed that therapeutic alliance significantly contributed to reduction of psychological distress in MBCT for cancer patients. Elaborating the clinical implications of the predictive significance of therapeutic alliance might be of added value to enhance the potential effect of MBCT.

BACKGROUND: Over the past two decades there has been a growing number of randomized clinical trials supporting the efficacy of mindfulness-based cognitive therapy (MBCT) in the treatment of several psychiatric disorders. Since evidence for its effectiveness in routine clinical practice is lagging behind, we aimed to examine adherence, outcome and predictors of MBCT in a well-characterized, heterogeneous outpatient population in routine clinical practice.METHODS: Data were collected from a naturalistic uncontrolled cohort of 998 patients formally diagnosed with mainly depression, anxiety disorders, personality disorders, somatoform disorders and/or ADHD. Patients received protocolized MBCT and completed self-report questionnaires pre- and post-treatment on overall functioning (Outcome Questionnaire, primary outcome), depressive symptoms, worry, mindfulness skills and self-compassion. Pre-to post-treatment changes were analysed for the overall sample and each diagnostic category separately with paired sample t-tests, reliable change indices (only overall sample) and repeated measures ANOVA for groups with and without comorbidity. Multiple linear regression was carried out to assess possible predictors of adherence and change in overall functioning.RESULTS: Adherence was high (94%) but negatively affected by lower levels of education, more comorbidity and presence of ADHD. Outcome in terms of improvement in overall functioning was good in the overall sample (Cohen's d = 0.50, 30% showed reliable improvement vs. 3.5% reliable deterioration) and within each diagnostic category (Cohen's d range = 0.37-0.61). Worse overall functioning at baseline was the only predictor for a larger treatment effect.CONCLUSIONS: After MBCT, overall functioning improved in a large heterogeneous psychiatric outpatient population independent of diagnosis or comorbidity.

Mechanosensitivity of the trabecular meshwork (TM) is a key determinant of intraocular pressure (IOP) yet our understanding of the molecular mechanisms that subserve it remains in its infancy. Here, we show that mechanosensitive Piezo1 channels modulate the TM pressure response via calcium signaling and dynamics of the conventional outflow pathway. Pressure steps evoked fast, inactivating cation currents and calcium signals that were inhibited by Ruthenium Red, GsMTx4 and Piezo1 shRNA. Piezo1 expression was confirmed by transcript and protein analysis, and by visualizing Yoda1-mediated currents and [Ca2+]i elevations in primary human TM cells. Piezo1 activation was obligatory for transduction of physiological shear stress and was coupled to reorganization of F-actin cytoskeleton and focal adhesions. The importance of Piezo1 channels as pressure sensors was shown by the GsMTx4 -dependence of the pressure-evoked current and conventional outflow function. We also demonstrate that Piezo1 collaborates with the stretch-activated TRPV4 channel, which mediated slow, delayed currents to pressure steps. Collectively, these results suggest that TM mechanosensitivity utilizes kinetically, regulatory and functionally distinct pressure transducers to inform the cells about force-sensing contexts. Piezo1-dependent control of shear flow sensing, calcium homeostasis, cytoskeletal dynamics and pressure-dependent outflow suggests a novel potential therapeutic target for treating glaucoma.Significance StatementTrabecular meshwork (TM) is a highly mechanosensitive tissue in the eye that regulates intraocular pressure through the control of aqueous humor drainage. Its dysfunction underlies the progression of glaucoma but neither the mechanisms through which TM cells sense pressure nor their role in aqueous humor outflow are understood at the molecular level. We identified the Piezo1 channel as a key TM transducer of tensile stretch, shear flow and pressure. Its activation resulted in intracellular signals that altered organization of the cytoskeleton and cell-extracellular matrix contacts, and modulated the trabecular component of aqueous outflow whereas another channel, TRPV4, mediated a delayed mechanoresponse. These findings provide a new mechanistic framework for trabecular mechanotransduction and its role in the regulation of fast fluctuations in ocular pressure, as well as chronic remodeling of TM architecture that epitomizes glaucoma.

Objective Oral antiplatelet drugs are a key to modern pharmacotherapy in cardiovascular atherothrombotic diseases. Clopidogrel (CLO) constitutes the main preventive treatment of atherothrombosis. However, a considerable inter-individual variation in CLO response has been documented, resulting in suboptimal therapy and an increased risk of recurrent adverse effects in some patients. The enzyme CYP2C19 has been reported to be the CYP isoform that activates CLO to its active metabolite. Several single nucleotide polymorphisms in the CYP2C19 gene have been identified as strong predictors of CLO-impaired pharmacological response. At least 16 variants have been associated with changes in CYP2C19 activity. Materials and methods The following research was composed of a total of 102 subjects with high cardiovascular risk in the northeast of Mexico, with a maintenance dose of 75 mg of CLO per day. The platelet reactivity was measured with VerifyNow P2Y12 assay, while the presence of CYP2C19*2 was identified by real-time polymerase chain reaction. Results Patients were categorized by CYP2C19 metabolizer status based on *2 genotypes using the common consensus star allele nomenclature as normal metabolizer (G/G), intermediate metabolizer (G/A), and poor metabolizer (A/A), respectively. The phenotype frequency for CYP2C19*2 was 74.5% (G/G), 21.6% (G/A), and 3.9% (A/A). The subjects with the A allele presented ≥235 P2Y12 reaction unit levels, classifying them how poor metabolizer. The prevalence of reduced CLO effectiveness was associated with the presence of CYP2C19*2 polymorphism among Mexican patients. Conclusion The presence of the CYP2C19*2 allele is related to resistance to the antiplatelet effect of CLO (p = 0.003).

Background Meta-analyses show efficacy of mindfulness-based cognitive therapy (MBCT) in terms of relapse prevention and depressive symptom reduction in patients with major depressive disorder (MDD). However, most studies have been conducted in controlled research settings. Aims We aimed to investigate the effectiveness of MBCT in patients with MDD presenting in real-world clinical practice. Moreover, we assessed whether guideline recommendations for MBCT allocation in regard to recurrence and remission status of MDD hold in clinical practice. Method This study assessed a naturalistic cohort of patients with (recurrent) MDD, either current or in remission (n = 765), who received MBCT in a university hospital out-patient clinic in The Netherlands. Outcome measures were self-reported depressive symptoms, worry, mindfulness skills and self-compassion. Predictors were MDD recurrence and remission status, and clinical and sociodemographic variables. Outcome and predictor analyses were conducted with linear regression. Results MBCT adherence was high (94%). Patients with a lower level of education had a higher chance of non-adherence. Attending more sessions positively influenced improvement in depressive symptoms. Depressive symptoms significantly reduced from pre- to post-MBCT (Δ mean = 7.7, 95%CI = 7.0–8.5, Cohen's d = 0.75). Improvement of depressive symptoms was independent from MDD recurrence and remission status. Unemployed patients showed less favourable outcomes. Worry, mindfulness skills and self-compassion all significantly improved. These improvements were related to changes in depressive symptoms. Conclusions Previous efficacy results in controlled research settings are maintained in clinical practice. Results illustrate that MBCT is effective in routine clinical practice for patients suffering from MDD, irrespective of MDD recurrence and remission status.

Background One in three cancer patients experience high psychological distress. Mindfulness-based interventions are effective in reducing psychological distress in this patient group. However, these interventions lack availability and flexibility, which may compromise participation in the intervention for cancer patients experiencing late symptoms like fatigue or pain. Therefore, mindfulness-based interventions are increasingly offered via the internet. However, little is known about the usage of these online mindfulness-based interventions. Objective The aim of this study was to (1) predict uptake of and adherence to online mindfulness-based cognitive therapy (eMBCT) using baseline patient characteristics (demographic, cancer-related, personality, and psychological variables) and (2) examine the relations between adherence and treatment outcomes in eMBCT for cancer patients. Methods A total of 125 cancer patients were assigned to eMBCT in a parent randomized controlled trial comparing MBCT and eMBCT with treatment as usual in distressed cancer patients. Various usage measures of eMBCT were automatically tracked within the online program. Based on activity of use, participants were classified as nonusers, minimal users, low users, and intended users. Questionnaires were used to assess baseline characteristics (preintervention) and outcomes (pre- and postintervention). To answer the research questions, data were analyzed with t tests, χ2 tests, and linear regression models. Results Based on weekly activity, participants were classified as nonusers (n=17, 13.6%), who completed no exercises in MBCT; minimal users (n=31, 24.8%), who completed at least one exercise of one to three sessions; low users (n=12, 9.6%), who completed at least one exercise of four to seven sessions; and intended users (n=65, 52.0%), who completed at least one exercise of eight to nine sessions. Nonusers had more fear of cancer recurrence at baseline than users (uptake), and intended users were more conscientious than minimal and low users (adherence). Intended users reported a larger reduction in psychological distress and more improvement of positive mental health (ie, emotional, psychological, and social well-being) after the intervention than other participants. Conclusions This study showed that adherence was related to improved patient outcomes. Patients with strong fear of recurrence or low levels of conscientiousness should receive extra attention, as they are less likely to respectively start or complete eMBCT. Future research may focus on the development of flexible and adaptive eMBCT programs to fit individual needs.

El estudio de la rigidez arterial, en los últimos años ha sido de gran interés en la comunidad científica, siendo un indicador importante de riesgo cardiovascular y de mortalidad, además es un predictor de progresión para ciertas enfermedades crónicas. Con el fin de comprender la interpretación de la medición de la rigidez vascular, se describen 12 casos de pacientes con diferentes condiciones fisiopatológicas, que reflejan la práctica clínica diaria, en los que se evaluó la rigidez arterial mediante un método oscilométrico (Arteriograph®, TensioMed, Budapest-Hungría, Ltd.), calculando la velocidad de onda de pulso, presiones arteriales periféricas y centrales, presión de pulso, e índices de aumentación. La medición e interpretación adecuada de esta información puede ayudar a entender y resolver dudas frente a diferentes condiciones fisiopatológicas asociadas a las enfermedades cardiovasculares, mejorando la toma de decisiones terapéuticas, el seguimiento de pacientes y optimizar la prevención cardiovascular.

Contains fulltext : 197566.pdf (Publisher’s version ) (Open Access) Background: Group face-to-face and individual internet-based mindfulness-based cognitive therapy (MBCT and eMBCT) have been demonstrated to reduce psychological distress for distressed cancer patients in a randomized controlled trial (RCT). This study focused on the long-term effects of this RCT during the nine-month follow-up period, and on possible predictors, moderators and working mechanisms. Methods: Distressed cancer patients (n = 245) were randomized to MBCT or eMBCT. Data were collected at baseline, post-treatment, three- and nine-month follow-up. Data were analyzed with linear mixed effect models and (hierarchical) linear regressions. Results: Analyses revealed long-term reductions in psychological distress and rumination, and long-term increases in positive mental health and mental health-related quality of life (QoL) in both interventions over the course of the nine-month follow-up. Interestingly, patients reported less psychological distress in the follow-up period after eMBCT in comparison to MBCT. Less psychological distress, rumination and neuroticism, and more extraversion and agreeableness at baseline predicted less psychological distress at the nine-month follow-up after both interventions. Less mindful and conscientious patients at baseline benefited more from eMBCT than from MBCT. Regarding working mechanisms, changes in mindfulness skills, fear of cancer recurrence and rumination during both interventions predicted less psychological distress at follow-up. Conclusions: Our findings suggest most improvements in cancer patients' increase over time after both interventions. Furthermore, patients seemed to benefit more from eMBCT than MBCT based on psychological distress levels, especially those patients with low levels of mindfulness skills and conscientiousness. 10 p.

Purpose Mindfulness-based cognitive therapy (MBCT) has been shown to alleviate psychological distress in patients with cancer. However, patients experience barriers to participating in face-to-face MBCT. Individual Internet-based MBCT (eMBCT) could be an alternative. The study aim was to compare MBCT and eMBCT with treatment as usual (TAU) for psychological distress in patients with cancer. Patients and Methods We obtained ethical and safety approval to include 245 patients with cancer with psychological distress (≥ 11 on the Hospital Anxiety and Depression Scale) in the study. They were randomly allocated to MBCT (n = 77), eMBCT (n = 90), or TAU (n = 78). Patients completed baseline (T0) and postintervention (T1) assessments. The primary outcome was psychological distress on the Hospital Anxiety and Depression Scale. Secondary outcomes were psychiatric diagnosis, fear of cancer recurrence, rumination, health-related quality of life, mindfulness skills, and positive mental health. Continuous outcomes were analyzed using linear mixed modeling on the intention-to-treat sample. Because both interventions were compared with TAU, the type I error rate was set at P < .025. Results Compared with TAU, patients reported significantly less psychological distress after both MBCT (Cohen’s d, .45; P < .001) and eMBCT (Cohen’s d, .71; P < .001) . In addition, post-treatment prevalence of psychiatric diagnosis was lower with both MBCT (33% improvement; P = .030) and eMBCT (29% improvement; P = .076) in comparison with TAU (16%), but these changes were not statistically significant. Both interventions reduced fear of cancer recurrence and rumination, and increased mental health–related quality of life, mindfulness skills, and positive mental health compared with TAU (all Ps < .025). Physical health–related quality of life did not improve ( P = .343). Conclusion Compared with TAU, MBCT and eMBCT were similarly effective in reducing psychological distress in a sample of distressed heterogeneous patients with cancer.

Unesterified cholesterol controls the fluidity, permeability and electrical properties of eukaryotic cell membranes. Consequently, cholesterol levels in the retina and the brain are tightly regulated whereas depletion or oversupply caused by diet or heredity contribute to neurodegenerative diseases and vision loss. Astroglia play a central role in the biosynthesis, uptake and transport of cholesterol and also drive inflammatory signaling under hypercholesterolemic conditions associated with high-fat diet (diabetes) and neurodegenerative disease. A growing body of evidence shows that unesterified membrane cholesterol modulates the ability of glia to sense and transduce ambient information. Cholesterol-dependence of Muller glia - which function as retinal sentinels for metabolic, mechanical, osmotic and inflammatory signals - is mediated in part by transient receptor potential V4 (TRPV4) channels. Cholesterol supplementation facilitates, whereas depletion suppresses, TRPV4-mediated transduction of temperature and lipid agonists in Muller cells. Acute effects of cholesterol supplementation/depletion on plasma membrane ion channels and calcium homeostasis differ markedly from the effects of chronic dyslipidemia, possibly due to differential modulation of modality-dependent energy barriers associated with the functionality of polymodal channels embedded within lipid rafts. Understanding of cholesterol-dependence of TRP channels is thus providing insight into dyslipidemic pathologies associated with diabetic retinopathy, glaucoma and macular degeneration.

Contains fulltext : 196791.pdf (Publisher’s version ) (Open Access) 4 p.

Resumen Introduccion Un estilo de vida saludable es determinante para la salud cardiovascular. Existe controversia en los efectos vasculares beneficos del ejercicio fisico. Objetivo Evaluar el comportamiento de los parametros de rigidez vascular en una poblacion sana que practica ejercicio aerobico rutinario en comparacion con una poblacion sana sedentaria. Metodos Estudio de 32 sujetos sanos, pareados por edad y sexo: 12 hombres y 20 mujeres (46,3 ± 9,7 anos), en el cual se evaluaron y compararon los parametros de rigidez arterial (presion sistolica y diastolica braquial, indices de aumentacion braquial y central, velocidad de onda de pulso, presion sistolica y diastolica central, y presion de pulso braquial y central). Las mediciones se hicieron con el metodo no invasivo-oscilometrico, Arteriograph® (TensioMed Budapest Hungria, Ltd.). Resultados Se compararon los parametros de rigidez arterial entre los dos grupos (16 sujetos activos vs. 16 sedentarios), y se encontraron diferencias significativas en los siguientes: frecuencia cardiaca de 53,25 ± 8,0 lpm vs. 59,75 ± 8,6 lpm (p = 0,034), presion arterial diastolica braquial de 70,0 (4,5) mm Hg vs. 77,5 (8,3) mm Hg (p = 0,043), presion arterial diastolica central de 70,0 (4,5) mm Hg vs. 77,5 (8,1) mm Hg (p = 0,043) y velocidad de onda de pulso de 6,70 (1,1) m/s vs. 7,75 (1,1) m/s (p = 0,001). Conclusiones La actividad fisica aerobica rutinaria tiene un efecto benefico sobre la rigidez vascular en una poblacion sana, a expensas de una disminucion significativa de la velocidad de onda de pulso, la frecuencia cardiaca y la presion arterial diastolica (braquial y central). Estos hallazgos ayudan a explicar los beneficios del ejercicio aerobico sobre el sistema cardiovascular.

Background: In low- and middle-income countries emergency surgery represents a higher proportion of the total number of surgeries and is associated with greater morbidity/mortality. Study aims were to determine if emergency department length of stay (ED-LOS) was associated with adverse perioperative outcomes and if such association varied across patient's risk categories. Methods: A retrospective cohort study was conducted of adult patients who underwent orthopedic or abdominal emergency surgery at two Colombian University hospitals. The population comprised a mix of a representative sample of eligible cases, with unselected patients (2/3), enriched with a high-risk subset (1/3). ED-LOS was defined as the interval between emergency department arrival and surgery start time. Our primary outcome was an adverse perioperative outcome during hospitalization, which was a composite of in-hospital mortality or severe complications such as major cardiovascular adverse events, infection, renal failure and bleeding. Results: Among 1487 patients analyzed, there were 519 adverse perioperative outcomes including 150 deaths. In the unselected sample (n = 998) 17.9% of patients presented an adverse perioperative outcome with a mortality of 4.9%. The median ED-LOS was 24.6 (IQR 12.5-53.2) hours. ED-LOS was associated with age, comorbidities and known risk factors for 30-day mortality. Patients developing an adverse perioperative outcome started surgery 27.1 h later than their counterparts. Prolonged ED-LOS increased the risk of an adverse perioperative outcome in patients without risk factors (covariate-adjusted OR = 2.52), while having 1-2 or 3+ risk factors was negatively associated (OR = 0.87 and 0.72, respectively, p less than 0.001 for the interaction). Conclusion: Prolonged ED-LOS is associated with increased adverse perioperative outcome for patients without risk factors for mortality, but seems protective and medically justified for more complex cases. © 2019 The Author(s).

Background Mindfulness Based Cognitive Therapy (MBCT) has been adopted as an evidence-based treatment for unipolar depressive disorder (UDD). Although MBCT has not been included in the treatment guidelines for bipolar disorder (BD), MBCT is regularly being offered to patients with BD in routine clinical practice. In this pilot study we used routine outcome monitoring (ROM) data to explore whether there are indications that patients with BD might benefit less from MBCT than patients with UDD in terms of feasibility and effectiveness. Methods The study population consisted of patients with BD (n = 30) or UDD (n = 501) who received MBCT at the Radboudumc Centre for Mindfulness in Nijmegen, the Netherlands. Patients completed self-report measures of depressive symptom severity, worry, well-being, mindfulness skills and self-compassion pre- and post MBCT as part of the ROM. Results There were significant less patients with BD who decided to start MBCT after intake than patients with UDD. No differences in dropout between groups were found. Results showed significant moderate to large improvements in both groups after MBCT, while no differences between groups were found, on all outcome measures. Conclusions This study demonstrates that there are no indications that MBCT, when delivered in heterogeneous patient groups in routine clinical practice, is less beneficial for patients with BD than patients with UDD in terms of feasibility and effectiveness. This lends support to conduct an adequately powered RCT to examine the (cost-)effectiveness of MBCT in BD as the next step before implementing MBCT on a larger scale in patients with BD.

Background Mindfulness-based cognitive therapy (MBCT) is an evidence-based group-based psychological treatment in oncology, resulting in reduction of depressive and anxiety symptoms. Internet-based MBCT (eMBCT) has been found to be an effective alternative for MBCT. The therapeutic alliance (the bond between therapist and patient,) is known to have a significant impact on psychological treatment outcomes, including MBCT. A primary concern in the practice of eMBCT is whether a good therapeutic alliance can develop. Although evidence for the beneficial effect of therapist assistance on treatment outcome in internet-based interventions (IBIs) is accumulating, it is still unclear whether the therapeutic alliance is related to outcome in IBIs. Objective This study aimed to (1) explore whether early therapeutic alliance predicts treatment dropout in MBCT or eMBCT, (2) compare the development of the therapeutic alliance during eMBCT and MBCT, and (3) examine whether early therapeutic alliance is a predictor of the reduction of psychological distress and the increase of mental well-being at posttreatment in both conditions. Methods This study was part of a multicenter randomized controlled trial (n=245) on the effectiveness of MBCT or eMBCT for distressed cancer patients. The therapeutic alliance was measured at the start of week 2 (ie, early therapeutic alliance), week 5, and week 9. Outcome measures were psychological distress, measured with the Hospital Anxiety and Depression Scale, and mental well-being, measured with the Mental Health Continuum-Short Form. Results The strength of early therapeutic alliance did not predict treatment dropout in MBCT or eMBCT (B=−.39; P=.21). Therapeutic alliance increased over time in both conditions (F2,90=16.46; Wilks λ=0.732; P Conclusions A therapeutic alliance can develop in both eMBCT and MBCT. Findings revealed that the strength of early alliance did not predict treatment dropout. Furthermore, the level of therapeutic alliance predicted reduced psychological distress and increased mental well-being at posttreatment in both conditions. Interestingly, the strength of therapeutic alliance appeared to be more related to treatment outcome in group-based MBCT than in eMBCT. Trial Registration ClinicalTrials.gov NCT02138513; https://clinicaltrials.gov/ct2/show/NCT02138513

Stress cardiomyopathy, or Takotsubo syndrome, is a widely recognized cardiac pathology with a clinical presentation similar to acute coronary syndrome and related to physical or emotional stress. Perioperatively, it is challenging to identify it given the variety of forms and scenarios in which it can present. We describe a 22-year-old patient with an atypical presentation of Takotsubo syndrome during anesthesia induction, which highlights the usefulness of transesophageal echocardiography for the initial diagnosis.

Objective: To determine the prognostic relevance, clinical characteristics, and 30-day outcomes associated with myocardial injury after noncardiac surgery (MINS) in vascular surgical patients. Background: MINS has been independently associated with 30-day mortality after noncardiac surgery. The characteristics and prognostic importance of MINS in vascular surgery patients are poorly described. Methods: This was an international prospective cohort study of 15,102 noncardiac surgery patients 45 years or older, of whom 502 patients underwent vascular surgery. All patients had fourth-generation plasma troponin T (TnT) concentrations measured during the first 3 postoperative days. MINS was defined as a TnT of 0.03 ng/mL of higher secondary to ischemia. The objectives of the present study were to determine (i) if MINS is prognostically important in vascular surgical patients, (ii) the clinical characteristics of vascular surgery patients with and without MINS, (iii) the 30-day outcomes for vascular surgery patients with and without MINS, and (iv) the proportion of MINS that probably would have gone undetected without routine troponin monitoring. Results: The incidence of MINS in the vascular surgery patients was 19.1% (95% confidence interval (CI), 15.7%-22.6%). 30-day all-cause mortality in the vascular cohort was 12.5% (95% CI 7.3%-20.6%) in patients with MINS compared with 1.5% (95% CI 0.7%-3.2%) in patients without MINS (P < 0.001). MINS was independently associated with 30-day mortality in vascular patients (odds ratio, 9.48; 95% CI, 3.46-25.96). The 30-day mortality was similar in MINS patients with (15.0%; 95% CI, 7.1-29.1) and without an ischemic feature (12.2%; 95% CI, 5.3-25.5, P = 0.76). The proportion of vascular surgery patients who suffered MINS without overt evidence of myocardial ischemia was 74.1% (95% CI, 63.6-82.4). Conclusions: Approximately 1 in 5 patients experienced MINS after vascular surgery. MINS was independently associated with 30-day mortality. The majority of patients with MINS were asymptomatic and would have gone undetected without routine postoperative troponin measurement.

Introduction: Previous studies show contradictory results related to the vascular effects of coffee; they suggest that caffeine increases arterial stiffness and negatively impacts vascular health, the aim of this study is to evaluate the acute coffee effects on the vascular stiffness. Methods and materials: We carried out a controlled, blind, cohort study in healthy subjects. The acute effect of coffee (caffeinated vs. decaffeinated) was evaluated on arterial stiffness parameters, using a oscillometric method known as Arteriograph® (TensioMed-Budapest-Hungary, Ltd.). Each subject received 14 gr. of caffeinated excelso-coffee (caffeine-151.2 mg) and decaffeinated excelso-coffee (caffeine-3.92 mg), two weeks apart in a random order. The parameters were obtained under stable baseline conditions before drinking the coffee, 30 and 60 min later. Results: Thirty-two subjects were included, with an age of 46.2 ± 10.4 years, sixteen men. Consumption of caffeinated-coffee at 30 and 60 min increased statistically significant (p < 0.05) brachial-systolic-blood-pressure in 3.9 mmHg and 3.8 mmHg, brachial-diastolic-blood-pressure in 4.1 mmHg and 3.2 mmHg, mean-arterial-pressure in 4.0 mmHg and 3.3 mmHg, central-systolic-blood-pressure in 5.8 mmHg and 7.6 mmHg, brachial-AIX 9.9% and 12.3%, aortic-AIX 5.1% and 6.3%, decreased heart-rate by 4 beats/min and 5 beats/min respectively, and it not demonstrated that had an impact on the pulse wave velocity (p = 0.861). Decaffeinated-coffee increased the braquial-AIX (7.1–10.5%) and aortic-AIX (3.55–5.3%) and decreased the heart-rate (3–4 beats/min). Conclusions: This study suggests for the first time that drinking caffeinated coffee slightly increases peripheral arterial stiffness at the expense of increased vascular tone in distal arteries without changes in central stiffness. Further studies are needed to clarify whether these effects induced by coffee have an impact on the population health.

Background: The number of patients living with cancer is growing, and a substantial number of patients suffer from psychological distress. Mindfulness-based interventions (MBIs) seem effective in alleviating psychological distress. Unfortunately, several cancer patients find it difficult, if not impossible, to attend a group-based course. Internet-based MBIs (eMBIs) such as Internet-based mindfulness-based cognitive therapy (eMBCT) may offer solutions. However, it is yet to be studied what facilitators and barriers cancer patients experience during eMBCT. Objective: This study aimed to explore facilitators and barriers of individual asynchronous therapist-assisted eMBCT as experienced by both patients and therapists. Methods: Patients with heterogeneous cancer diagnoses suffering from psychological distress were offered eMBCT. This 9-week intervention mirrored the group-based MBCT protocol and included weekly asynchronous written therapist feedback. Patients were granted access to a website that contained the eMBCT protocol and a secured inbox, and they were asked to practice and fill out diaries on which the therapist provided feedback. In total, 31 patients participated in an individual posttreatment interview on experienced facilitators and barriers during eMBCT. Moreover, eight therapists were interviewed. The data were analyzed with qualitative content analysis to identify barriers and facilitators in eMBCT. Results: Both patients and therapists mentioned four overarching themes as facilitators and barriers: treatment setting (the individual and Internet-based nature of the treatment), treatment format (how the treatment and its guidance were organized and delivered), role of the therapist, and individual patient characteristics. Conclusions: The eMBCT provided flexibility in when, where, and how patients and therapists engage in MBCT. Future studies should assess how different eMBCT designs could further improve barriers that were found. [J Med Internet Res 2017;19(12):e407]

Environment/Objectives: Several studies in different populations and conditions shown contradictory results about the effect of coffee on arterial stiffness (AS). Coffee consumption is high around the world and it is very important to define its CV effects. To evaluate the acute effects on haemodynamic parameters and AS, after consumption of regular coffee or, decaffeinated coffee. Methods: In a prospective, self controlled cohort study we included 32 healthy p. (46.2±10.4y.o., 16 men (53.5±18) and 16 women (43.0±21)(p=0,186)). Fourteen regular coffee consumers (87.5%) (p=NS). Haemodynamic parameters and AS were assessed non invasively using oscilometric Arteriograph® (TensioMed Budapest, Hungary Ltd.). Each subject received 14 gr. of excelso coffee (151.2 mg caffeine) and two weeks apart, 14 gr of decaf coffee (3.92 mg) in random order. Baseline, 30 and 60 min parameters are reported. Results: SBP increased at 30 and 60 min 3.9 mmHg (p=0.013) y 3.8 mmHg (p=0.002) respectively, la DBP increased 4.1 mmHg (p=0.001) y 3.2 mmHg (p=0.003), MAP 4.0 mmHg (p

Introduction The use of statins and medicated stents (MS) is the best available therapy for the treatment of severe coronary disease in selected cases. However, the vascular effects of the simultaneous use of both therapies are unknown. Materials and methods An experimental study was carried out on 60 NZ rabbits with advanced atherosclerosis, distributed in four groups of 15 animals each. Group 1: Control. Group 2: paclitaxel-eluting stent (PES) in the thoracic aorta. Group 3: Atorvastatin 2.5 mg/day po + PES implant, and Group 4: Atorvastatin 2.5 mg/day po. They were followed up at 30, 60 and 90 days. Histo-morphometric analyses were carried out. Results A total of 60 PES were successfully implanted. One animal from Group 3 died due to respiratory infection. PES increased the lumen diameter and area, as well as the vessel area; atorvastatin induced a potent plaque regression. In the PES group, the lumen diameter was 4.25 ± 0.0 mm, lumen area was 14.2 ± 0.4 mm 2 , vessel area was 16.7 ± 0.0 mm 2 , and plaque/media area ratio was 0.1 ± 0.0. In the PES + atorvastatin group the measurements were 4.9 ± 0.1 mm ( p 2 ( p = 0.005), 21.6 ± 0.9 mm 2 ( p = 0.007) and 0.8 ± 0.08 ( p = 0.032), respectively. Conclusions Our results confirm the potent synergistic mechanical effect of the PES and plaque regression of the statins in an animal model with advanced atherosclerosis.

Pharmaceutical and Personal Care Products (PPCPs) are considered emerging contaminants, and their efficient removal from water is going to be a challenging endeavor. Microporous adsorbent materials, including pillared clays, could offer a potential solution if tailored properly. Although pillared clays have been employed previously for the removal of organics, the effective removal of PPCPs will only be possible if their surface and textural properties are manipulated from the bottom-up. This work presents the use of modified inorganic–organic pillared clays (IOCs) for the adsorption of salicylic acid, clofibric acid, carbamazepine, and caffeine. The IOCs have been modified with Co 2+ , Cu 2+ , or Ni 2+ to induce complexation-like adsorbate–adsorbent interactions at ambient conditions, in an attempt to provide an efficient and yet reversible driving force in the sub-ppm concentration range. Furthermore, the IOCs were partially calcined to increase effective surface area by an order of magnitude while preserving some hydrophobicity. In general, the Ni 2+ IOCs exhibited the greatest interaction with salicylic and clofibric acids, respectively, while the Co 2+ adsorbents excelled at adsorbing caffeine at low concentrations. All of the metal-modified IOCs showed comparable adsorption capacities for the case of carbamazepine, probably due to the lack of availability of particular functional groups in this adsorbate.

ResumenLa práctica clínica perioperatoria en Latinoamérica está influenciada por investigación generada y publicada en países desarrollados. Afortunadamente, las condiciones económicas cada vez más favorables para la ciencia en los países en vías de desarrollo, sumado al incremento en la visibilidad de nuestras publicaciones científicas, han desencadenado un incremento en el interés por mejorar los estándares de la calidad de la investigación local y a su vez en los trabajos de grado que se generan durante los estudios de posgrado en anestesiología. El presente documento es el resultado de la participación y discusión activa de los expositores y asistentes al evento: «Simposio de investigaciones en Anestesia: El camino para participar en la sociedad del conocimiento», organizado por la Sociedad Antioqueña de Anestesiología y Reanimación (SADEA) y la Sociedad Colombiana de Anestesiología y Reanimación (SCARE) en el año 2011. El objetivo del documento es plantear estrategias para ajustar, planificar y mejorar los procesos de investigación, así como la creación y la divulgación del conocimiento generado en anestesiología, medicina del dolor y cuidado intensivo para Colombia y países afines. Incluimos recomendaciones para los programas de posgrado, las instituciones prestadoras de salud y sociedades de anestesiología.AbstractPerioperative clinical practice in Latin America is influenced by research developed and published in developed countries. Fortunately, the increasingly favorable economic conditions for science in the developing countries, in addition to the heightened visibility of our scientific publications has triggered greater interest in improving the quality standards of local research and of the graduate theses generated in the course of graduate studies in anesthesiology. This document is the result of the active participation and discussion among the speakers attending the «Symposium on Research in Anesthesia: the path to participation in the society of knowledge», organized by the Society of Anesthesiology and Resuscitation of Antioquia (SADEA) and the Colombian Society of Anesthesiology and Resuscitation (SCARE) in 2011. The purpose of the document is to discuss the strategies to adjust, plan and improve the research processes, as well as the creation and dissemination of knowledge generated in Anesthesiology, Pain Medicine and Intensive Care in Colombia and other developing countries. Recommendations have been included for graduate programs, health care providers and the societies of anesthesiology.

Introducción: El reparo endovascular de la aorta torácica (REVAT) se ha incrementado en el mundo en los últimos años con relación al abierto.Objetivo: Comparar los resultados clínicos del REVAT frente al reparo abierto en la Fundación Cardio Infantil (Bogotá, Colombia) entre 2002 y 2011.Metodología: Análisis retrospectivo de la cohorte de pacientes sometidos a reparo abierto (grupo 1) en comparación de REVAT (grupo 2). En cada uno de los grupos se evaluó tiempo quirúrgico, tasa de morbilidad, mortalidad, reintervención y estancia hospitalaria. Resultados: Se incluyeron 57 pacientes en el análisis (26 % reparo abierto; 74 % REVAT). Se reintervinieron dos pacientes por endofugas tipo 1 en el grupo 2 y un caso por sangrado en el grupo 1. La mortalidad operatoria fue para el grupo 1 de 20 %, y para el grupo 2, de 2,3 %. El tiempo quirúrgico fue de 398 ± 180 min (grupo 1) versus 85,5 ± 35 min (grupo 2 (p = 0,0001) y el tiempo de estancia hospitalaria promedio fue de 9,8 días (grupo 1) y 5,3 días (grupo 2) [p = 0,01]). El tiempo promedio de seguimiento fue 4,8 ± 3,1 años.Conclusiones: El REVAT parece ofrecer menor morbilidad, mortalidad, tiempo quirúrgico y estancia hospitalaria respecto al reparo abierto, aunque las poblaciones de pacientes incluidos no fueron estrictamente comparables. Se requieren nuevos análisis en un diseño prospectivo, idealmente aleatorizado para documentar los beneficios a largo plazo de este tipo de reparo.