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The RECALCAR project (Resources and Quality in Cardiology), an initiative of the Spanish Society of Cardiology, aims to standardize information to generate evidence on cardiovascular health outcomes. The objective of this study was to analyze trends in the resources and activity of cardiology units and/or services and to identify the results of cardiovascular care during the last decade in Spain.The study was based on the 2 annual data sources of the RECALCAR project: a survey on resources and activity of cardiology units and/or services (2011-2020) and the minimum data set of the National Health System (2011-2019), referring to heart failure (HF), STEMI, and non-STEMI.The survey included 70% of cardiology units and/or services in Spain. The number of hospital beds and length of stay decreased, while there was a notable increase in the number of cardiac imaging studies and percutaneous therapeutic procedures performed. Age- and sex-adjusted admissions for HF tended to decrease, despite an increase in mortality and the percentage of readmissions. In contrast, the trend in mortality and readmissions was highly favorable in STEMI; in non-STEMI, although positive, the trend was less marked.The information provided by the RECALCAR project shows a favorable trend in the last decade in resources, activity and results of certain cardiovascular processes and constitutes an essential source for future improvements and decision-making in health policy.

Last year’s Editor’s page discussed the emerging quality of our publication that celebrated its first anniversary at that time. Also, the fast and effective response of the journal at the early and confusing times of the COVID-19 crisis should be noted, publishing—in record time—consensus documents written by the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) in collaboration with other medical societies. A clear example of this was the article describing the effects of the COVID-19 pandemic on the healthcare situation in interventional cardiology in Spain that has been cited numerous times in some of today’s most prestigious medical journals.1 Over the last year, special articles elaborated by the ACI-SEC or by some of its working groups have been published such as “Update on requirements and equipment in interventional cardiology”,2 and the article on the assessment of endothelial function and spasm provocation test.3 Both documents are of great interest to the entire cardiovascular community, not only from the clinical but also from the administrative point of view. The main protagonists of such a satisfactory trajectory have been the authors, both those who have submitted their manuscripts in different formats as well as those invited by the editorial committee to write...

En la página del editor publicada el pasado año destacábamos el carácter naciente de la revista y celebrábamos su primer año de andadura. También señalábamos su rápida y eficaz respuesta en los momentos iniciales y confusos de la crisis de la COVID-19, al publicar en un tiempo récord los documentos de consenso elaborados por la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología (ACI-SEC) en colaboración con otras asociaciones. Una clara muestra de esta acertada actuación es el artículo que describía el efecto de la pandemia de la COVID-19 sobre la actividad asistencial en cardiología intervencionista en España, que ha recibido numerosas citas en las publicaciones de mayor prestigio1. Durante este último periodo anual se han publicado artículos especiales elaborados por la ACI-SEC, o por sus grupos de trabajo, como el de actualización de las recomendaciones sobre requisitos y equipamiento en cardiología intervencionista2 y el de la valoración de la función endotelial y provocación de vasoespasmo coronario3. Estos documentos son de gran interés para toda la comunidad cardiológica a afectos clínicos, pero también administrativos. Los principales protagonistas de esta trayectoria tan satisfactoria han sido los autores, tanto los que nos han enviado sus manuscritos bajo los diferentes formatos como los...

Di(2-ethylhexyl) phthalate (DEHP) is a chemical commonly used as a plasticizer to render polyvinyl chloride products more durable and flexible. Although exposure to DEHP has raised many health concerns due to the identification of DEHP as an endocrine disruptor, it is still used in consumer products, including polyvinyl chloride plastics, medical tubing, car interiors, and children’s toys. To investigate the impact of early life exposure to DEHP on the ovary and testes, newborn piglets were orally dosed with DEHP (20 or 200 mg/kg/day) or vehicle control (tocopherol-stripped corn oil) for 21 days. Following treatment, ovaries, testes, and sera were harvested for histological assessment and measurement of steroid hormone levels. In male piglets, progesterone and pregnenolone levels were significantly lower in both treatment groups compared to control, whereas in female piglets, progesterone was significantly higher in the 20 mg group compared to control, indicating sex-specific effects in a non-monotonic manner. Follicle numbers and gene expression of steroidogenic enzymes and apoptotic factors were not altered in treated ovaries compared to controls. In DEHP-treated testes, germ cell migration was impaired and germ cell death was significantly increased compared to controls. Overall, the results of this study suggest that neonatal exposure to DEHP in pigs leads to sex-specific disruption of the reproductive system.

Resumen Introduccion y objetivos Si bien la utilizacion de anticoagulantes orales directos (ACOD) en pacientes con fibrilacion auricular (FA) y protesis valvular biologica como alternativa a los antagonistas de la vitamina K (AVK) esta recogida en las guias, en la practica real son escasos los estudios que recogen estos pacientes, mas aun en nuestro pais, dadas las restricciones que existen a su prescripcion. Metodos Se analizo a los pacientes intervenidos de forma consecutiva en nuestro hospital de sustitucion valvular aortica por protesis biologica con indicacion de anticoagulantes orales por FA durante los anos 2013-2018. Comparamos caracteristicas clinicas basales, asi como tasas de eventos cerebrovasculares, hemorragias mayores y menores, y mortalidad de los tratados con ACOD frente a los tratados con AVK. Resultados Incluimos 132 pacientes tratados con AVK (62,6%) y 79 con ACOD (37,4%; apixaban 20%, edoxaban 10%, rivaroxaban 6% y dabigatran 3%). No hubo diferencias significativas en sus caracteristicas clinicas basales en cuanto a edad, sexo, funcion renal o escalas de riesgo embolico. El seguimiento medio fue de 32,85 ± 15 meses. La tasa de incidencia de ictus isquemico/accidente isquemico transitorio (AIT) fue de 1,5/100 pacientes/ano en el grupo ACOD frente a 1,32 en AVK. La tasa de incidencia de sangrado mayor fue de 2,02/100 pacientes/ano en el grupo ACOD frente a 3,7 en AVK. Los pacientes con AVK presentaron 6 ictus hemorragicos frente a ninguno en el grupo de pacientes con ACOD. Conclusiones La utilizacion de ACOD en pacientes con protesis cardiaca biologica e indicacion de ACO permanente por FA parece una alternativa eficaz y segura al uso de AVK.

Background In developed countries, health care delivery in dermatology is hampered by the low availability of dermatologists. Objective To analyze the feasibility of a teledermatology-based action plan to provide initial dermatologic care in areas with low availability of dermatologists. Methods A cross-sectional study describing the feasibility and cost of a 12-month action plan based on a store-and-forward teledermatology (TD) connecting primary care centers and a TD center. Teleconsultations from patients complaining of any cutaneous condition were included. The primary outcome measure was the percentage of patients not referred to the local dermatologist. Results Among the total of 15,523 teleconsultations attended in the TD-based action plan, 3360 (21.65%) required a face-to-face visit with a local dermatologist. In 32.32% (n = 5017) of the cases, a therapeutic and follow-up plan report was issued. The most common conditions managed were melanocytic nevi (15.63%, n = 2426), followed by seborrheic keratosis (14.89%, n = 2312), and actinic keratosis (8.65%, n = 1342). The average response time was 14.52 days (95% CI 14.35-15.23). The additional total investment in this action plan was $142,681.01, with a unit cost of 9.20$/patient. Limitations Noncontrolled study. Conclusions Experienced dermatologists working with store-and-forward TD can deliver a fast and effective response in health care areas with access limitations.

Mars rover Perseverance landed on 18 February 2021 on Jezero crater. It carries a weather station that has measured, among other quantities, surface atmospheric pressure. This study covers the first 460 sols or Martian days, a period that comprises a large part of the Martian year, including spring, summer and a part of autumn. Each sol, the pressure has significant changes, and those can be understood as a result of the so-called thermal tides, oscillations of pressure with periods that are fractions of one sol. The mean value of pressure each sols changes with the season, driven by the CO2 sublimation in summer and condensation in winter at both poles. We report oscillations of the mean daily pressure with periods of a few sols, related to waves at distant parts of the planet. Within single sols, we find oscillations of night pressure with periods of tens of minutes, caused by gravity waves. Looking at shorter time intervals, we find the signature of the close passage of vortices such as dust devils, and very rapid daytime turbulent fluctuations. We finally analyze the effects on all these phenomena produced by a regional dust storm that evolved over Jezero in early January 2022. The pressure sensors on Mars rover Perseverance measure the pressure field in the Jezero crater on regular hourly basis starting in sol 15 after landing. The present study extends up to sol 460 encompassing the range of solar longitudes from Ls ∼ 13°–241° (Martian Year (MY) 36). The data show the changing daily pressure cycle, the sol-to-sol seasonal evolution of the mean pressure field driven by the CO2 sublimation and deposition cycle at the poles, the characterization of up to six components of the atmospheric tides and their relationship to dust content in the atmosphere. They also show the presence of wave disturbances with periods 2–5 sols, exploring their baroclinic nature, short period oscillations (mainly at night-time) in the range 8–24 min that we interpret as internal gravity waves, transient pressure drops with duration ∼1–150 s produced by vortices, and rapid turbulent fluctuations. We also analyze the effects on pressure measurements produced by a regional dust storm over Jezero at Ls ∼ 155°. The UPV/EHU team (Spain) is supported by Grant PID2019-109467GB-I00 funded by 1042 MCIN/AEI/10.13039/501100011033/ and by Groups Gobierno Vasco IT1742-22. GM wants to acknowledge JPL funding from USRA Contract Number 1638782. A. Vicente-Retortillo is supported by the Spanish State Research Agency (AEI) Project No. MDM-2017-0737 Unidad de Excelencia “María de Maeztu”- Centro de Astrobiología (INTA-CSIC). Part of the research was carried out at the Jet Propulsion Laboratory, California Institute of Technology, under a contract with the National Aeronautics and Space Administration (80NM0018D0004). GM wants to acknowledge JPL funding from USRA Contract Number 1638782. Peerreview

Introduction Complex high-risk indicated percutaneous coronary intervention (CHIP-PCI) is a poorly defined concept. A recent large-scale study identified various patient- and procedure-related factors that were associated with in-hospital major adverse cardiac or cerebrovascular events (MACCE), which were used to construct a CHIP-score [1]. Purpose To investigate the predictive value of patient- and procedure related risk factors, based on the CHIP-score, in a large cohort of elderly patients. Methods This is a retrospective multicenter study of 20 centers, including patients of ≥75 years of age, that underwent PCI in the period of 2012–2019. The primary endpoint of MACCE was defined as cardiovascular death, myocardial infarction, revascularization or stroke. The follow-up time was 1 year. We created univariate and multivariate Cox regression models in order to investigate the predictive value of the CHIP-score variables (other than age, Table 2). Results A total of 2724 patients with a mean age of 81 (± 4.3) years were included in the study. Baseline characteristics are depicted in Table 1. The mean CHIP score was 1.74 (± 1.2) and 2262 (83%) had at least one CHIP criteria. At 1-year follow-up, 267 (9.8%) met the primary endpoint. Out of 11 investigated CHIP-score variables, only 5 were independent predictors of 1-year MACCE in adjusted regression models: Prior myocardial infarction (HR 1.56 (95% CI: 1.10–1.90), p=0.009), left ventricular ejection fraction Conclusions The CHIP-score retains significant prognostic value in the elderly population. The implication of a CHIP-score might be a future tool for risk stratification in clinical practice, not only for in-hospital MACCE but also on long-term follow-up. In the special population of elderly patients, 3 patient related and 2 procedure related factors showed to be especially helpful for risk assessment. Funding Acknowledgement Type of funding sources: None.

Introducción: El tratamiento del valgo severo es complejo. El abordaje externo descrito por Keblish es ventajoso para tratar estas deformidades. Evaluamos nuestros resultados utilizando un abordaje externo en artroplastias de rodilla con genu valgo severo. Materiales y Métodos: De 795 artroplastias primarias realizadas entre enero de 2012 y marzo de 2020, analizamos 40 que tenían un abordaje externo. Todos los pacientes tenían una deformidad en valgo >20° y un ligamento colateral medial suficiente. Se incluyó a 33 mujeres (3 bilaterales) y 4 hombres, el promedio de edad era de 71 años. La causa fue fundamentalmente osteoartrosis (82%). La deformidad prequirúrgica era de 27°. Las mediciones preoperatorias eran: KSS 15 (rango 5-42) y KFS 17 (rango 0-40). El tiempo promedio de cirugía fue de 91 minutos y el seguimiento, de 37 meses. Resultados: El ángulo femorotibial posoperatorio fue de 6,2° (rango 4-40), el KSS posoperatorio fue de 79 (rango 46-95) y el KFS, de 82 (rango 60-100). Hubo tres complicaciones (7%): una infección, un mal posicionamiento de componentes y uno de neuropraxia peronea. Conclusiones: En la artroplastia de rodilla por genu valgo, este abordaje permite restituir el eje femorotibial, lograr una adecuada estabilidad de la prótesis, aun con implantes sin mayor grado de constreñimiento, con una tasa de complicaciones equiparable a la de otras técnicas.

Introduction and objectives The pocket sized KardiaMobile (KM) is a monitoring device for ECG recording through a smartphone-based application. This system is generally aimed as screening tool to detect alterations in cardiac rhythm but its diagnostic potential for detection of ST changes remains largely unknown. This study sought to assess the diagnostic sensitivity of the KM system for detection of ST changes in patients with ST elevated myocardial infarction (STEMI). Methods Patients admitted with diagnosis of STEMI were consecutively included. Recordings with KM were obtained in leads I, II and anterior precordial. KM recordings were obtained as well from healthy individuals. All recordings were submitted for blinded assessment. Results A total of 112 patients with STEMI and 25 healthy individuals were included. Among those showing ST changes, these consisted mostly in depression (75%). Sensitivity was modest for individual leads (57-58%). The combination of 2-leads, when including the precordial, and the combination of 3-leads markedly increased sensitivity (88-98% and 100% respectively) for both inferior and anterior STEMI. Specificity was very high (96-100%) and the Youden's J statistic was excellent for the 2-leads combinations that included the precordial lead (0.84-0.94) and for the 3-leads combination (0.96). Conclusions The Kardia Mobile system with the combination of 2-leads (I + precordial or II + precordial) or 3-leads shows a very high sensitivity for both anterior and inferior STEMI.

The impact of nutritional status at diagnosis of childhood acute lymphoblastic leukemia (ALL) on survival rates was assessed in a Hispanic cohort. Children

Artificial intelligence (AI) offers great promise in cardiology, and medicine broadly, for its ability to tirelessly integrate vast amounts of data. Applications in medical imaging are particularly attractive, as images are a powerful means to convey rich information and are extensively utilized in cardiology practice. Departing from other AI approaches in cardiology focused on task automation and pattern recognition, we describe a digital health platform to synthesize enhanced, yet familiar, clinical images to augment the cardiologist’s visual clinical workflow. In this article, we present the framework, technical fundamentals, and functional applications of the methodology, especially as it pertains to intravascular imaging. A conditional generative adversarial network was trained with annotated images of atherosclerotic diseased arteries to generate synthetic optical coherence tomography and intravascular ultrasound images on the basis of specified plaque morphology. Systems leveraging this unique and flexible construct, whereby a pair of neural networks is competitively trained in tandem, can rapidly generate useful images. These synthetic images replicate the style, and in several ways exceed the content and function, of normally acquired images. By using this technique and employing AI in such applications, one can ameliorate challenges in image quality, interpretability, coherence, completeness, and granularity, thereby enhancing medical education and clinical decision-making.

Central aortic blood pressure could be helpful in the evaluation of patients with aortic stenosis (AS). The SphygmoCor XCEL device estimates central blood pressure (BP) measurement with its easy-to-use, operator-independent procedure. However, this device has not been properly validated against invasive measurement in patients with severe AS. We evaluated the relationship between cuff-brachial BP, transfer function- estimated and invasively measured central aortic pressure in patients with severe AS before and after transcatheter aortic valve replacement (TAVR). Agreement between techniques was analyzed and, according to the ARTERY Society recommendations, the minimum acceptable error was a mean difference ± SD ≤5 ± ≤8 mm Hg. A total of 94 patients with AS undergoing TAVR had simultaneous non-invasive and invasive measurements of central BP before and after the procedure. Before TAVR central systolic BP was in average slightly underestimated, though with wide variability, when using the default calibration of brachial-cuff SBP (mean difference ± SD, −3 ± 15 mm Hg), and after TAVR the degree of underestimation increased (mean difference ± SD, −9 ± 13 mm Hg). The agreement tended to improve for those patients with low aor- tic gradient stenosis compared to those with high gradient at baseline (mean dif- ference ± SD, −2 ± 11 mm Hg vs. −4 ± 17, respectively, p = .3). The cuff-brachial systolic BP yielded numerically lower degree of agreement and weaker correlation with invasive measurements than SphygmoCor XCEL. In patients with severe AS the SphygmoCor XCEL cuff device, despite showing strong correlation, does not meet the ARTERY Society accuracy criteria for non-invasive measurement of central SBP.

University systems with a high level of academic inbreeding tend to be closed to attracting (inter)national talent, while instead prioritizing retention of the human factor in the institution and t...

Data Availability Statement All Mars 2020 MEDA data necessary to reproduce each figure shown in this manuscript are available via the Planetary Data System (PDS) Atmospheres node (Rodriguez-Manfredi & de la Torre Juarez, 2021). An exception to this are the LWd values in the 5–80 μm range (Figures 8, 9, and 10 top, Figure 11 top, and Figure 15), and the aerosol opacity values derived from TIRS (Figure 10, middle and Figure 11, top), which are publicly available via the USRA Houston Repository (Martinez et al., 2022). THEMIS retrievals of thermal inertia shown in Figure 7 and TES retrievals of albedo in Figure 14 can be queried and processed using the open-source JMARS (Christensen et al., 2009) and MARSTHERM (Putzig et al., 2013) software. The Mars Environmental Dynamics Analyzer (MEDA) on board Perseverance includes first-of-its-kind sensors measuring the incident and reflected solar flux, the downwelling atmospheric IR flux, and the upwelling IR flux emitted by the surface. We use these measurements for the first 350 sols of the Mars 2020 mission (Ls ∼ 6°–174° in Martian Year 36) to determine the surface radiative budget on Mars and to calculate the broadband albedo (0.3–3 μm) as a function of the illumination and viewing geometry. Together with MEDA measurements of ground temperature, we calculate the thermal inertia for homogeneous terrains without the need for numerical thermal models. We found that (a) the observed downwelling atmospheric IR flux is significantly lower than the model predictions. This is likely caused by the strong diurnal variation in aerosol opacity measured by MEDA, which is not accounted for by numerical models. (b) The albedo presents a marked non-Lambertian behavior, with lowest values near noon and highest values corresponding to low phase angles (i.e., Sun behind the observer). (c) Thermal inertia values ranged between 180 (sand dune) and 605 (bedrock-dominated material) SI units. (d) Averages of albedo and thermal inertia (spatial resolution of ∼3–4 m2) along Perseverance's traverse are in very good agreement with collocated retrievals of thermal inertia from Thermal Emission Imaging System (spatial resolution of 100 m per pixel) and of bolometric albedo in the 0.25–2.9 μm range from (spatial resolution of ∼300 km2). The results presented here are important to validate model predictions and provide ground-truth to orbital measurements. Germán Martínez wants to acknowledge JPL funding from USRA Contract Number 1638782. A. V. R. is supported by the Spanish State Research Agency (AEI) Project MDM-2017-0737, Unidad de Excelencia “María de Maeztu”—Centro de Astrobiología (INTA-CSIC), and by the Comunidad de Madrid Project S2018/NMT-4291 (TEC2SPACE-CM). J. J. acknowledges funding from Mastcam-Z ASU subcontract 15-707. R. H., A. S. L., and A. M. were supported by Grant PID2019-109467GB-I00 funded by MCIN/AEI/10.13039/501100011033/ and by Grupos Gobierno Vasco IT1742-22. F. G. acknowledges financial support from the Agencia Estatal de Investigación of the Ministerio de Ciencia e Innovación and the European Regional Development Fund “A way of making Europe” through project the Centre of Excellence “María de Maeztu” award to the Centro de Astrobiología (MDM-2017-0737), and from the Instituto Nacional de Técnica Aeroespacial through Project S.IGS22001. L. M. was supported by CNES and IRIS-OCAV. J. P., M. H., and A.-M. H. are thankful for the Finnish Academy Grant 310509. M.-P. Z. was supported by Grant PID2019-104205GB-C21 funded by MCIN/AEI/10.13039/501100011033. M. de la T. J. acknowledges partial funding from the National Aeronautics and Space Administration (80NM0018D0004). The JPL co-authors acknowledge funding from NASA's Space Technology Mission Directorate and the Science Mission Directorate. Peerreview

We characterize vortex and dust devils (DDs) at Jezero from pressure and winds obtained with the Mars Environmental Dynamics Analyzer (MEDA) instrument on Mars 2020 over 415 Martian days (sols) (Ls = 6°–213°). Vortices are abundant (4.9 per sol with pressure drops >0.5 Pa correcting from gaps in coverage) and they peak at noon. At least one in every five vortices carries dust, and 75% of all vortices with Δp > 2.0 Pa are dusty. Seasonal variability was small but DDs were abundant during a dust storm (Ls = 152°–156°). Vortices are more frequent and intense over terrains with lower thermal inertia favoring high daytime surface-to-air temperature gradients. We fit measurements of winds and pressure during DD encounters to models of vortices. We obtain vortex diameters that range from 5 to 135 m with a mean of 20 m, and from the frequency of close encounters we estimate a DD activity of 2.0–3.0 DDs km−2 sol−1. A comparison of MEDA observations with a Large Eddy Simulation of Jezero at Ls = 45° produces a similar result. Three 100-m size DDs passed within 30 m of the rover from what we estimate that the activity of DDs with diameters >100 m is 0.1 DDs km−2sol−1, implying that dust lifting is dominated by the largest vortices in Jezero. At least one vortex had a central pressure drop of 9.0 Pa and internal winds of 25 ms−1. The MEDA wind sensors were partially damaged during two DD encounters whose characteristics we elaborate in detail. The authors are very grateful to the entire Mars 2020 science operations team. The authors would also like to thank Lori Fenton and an anonymous reviewer for many suggestions that greatly improved the manuscript. This work was supported by Grant PID2019-109467GB-I00 funded by MCIN/AEI/10.13039/501100011033/ and by Grupos Gobierno Vasco IT1742-22 and by the Spanish National Research, Development and Innovation Program, through the Grants RTI2018-099825-B-C31, ESP2016-80320-C2-1-R, and ESP2014-54256-C4-3-R. Baptiste Chide is supported by the Director's Postdoctoral Fellowship from the Los Alamos National Laboratory. M. Lemmon is supported by contract 15-712 from Arizona State University and 1607215 from Caltech-JPL. R. Lorenz was supported by JPL contract 1655893. Germán Martínez acknowledges JPL funding from USRA Contract Number 1638782. A. Munguira was supported by Grant PRE2020-092562 funded by MCIN/AEI and by “ESF Investing in your future.” A. Vicente-Retortillo is supported by the Spanish State Research Agency (AEI) Project No. MDM-2017-0737 Unidad de Excelencia “María de Maeztu”-Centro de Astrobiología (INTA-CSIC), and by the Comunidad de Madrid Project S2018/NMT-4291 (TEC2SPACE-CM). Part of the research was carried out at the Jet Propulsion Laboratory, California Institute of Technology, under a contract with the National Aeronautics and Space Administration (80NM0018D0004). Finnish researchers acknowledge the Academy of Finland Grant 328 310529. Researchers based in France acknowledge support from the CNES for their work on Perseverance.

Funding Information: The authors would like to thank the MCAM and Rover Environmental Monitoring Station Teams. Comments and suggestions by the M. Battalio and M. Mischna were very useful and are gratefully acknowledged. The authors also thank support from the Spanish Ministry of Science, Innovation and Universities, project No RTI2018-098728-B-C31, and the Instituto Nacional de Técnica Aeroespacial. A portion of this work was performed at the Jet Propulsion Laboratory, California Institute of Technology, under a contract with NASA. The US coauthors performed their work under sponsorship from NASA's Mars Science Laboratory project. Funding Information: The authors would like to thank the MCAM and Rover Environmental Monitoring Station Teams. Comments and suggestions by the M. Battalio and M. Mischna were very useful and are gratefully acknowledged. The authors also thank support from the Spanish Ministry of Science, Innovation and Universities, project No RTI2018‐098728‐B‐C31, and the Instituto Nacional de Técnica Aeroespacial. A portion of this work was performed at the Jet Propulsion Laboratory, California Institute of Technology, under a contract with NASA. The US coauthors performed their work under sponsorship from NASA's Mars Science Laboratory project. Publisher Copyright: © 2022. The Authors. Modeling and observations have long demonstrated that Martian dust storms strongly interfere with global circulation patterns and change the diurnal and semidiurnal pressure variability as well as oscillations with periods greater than one sol associated with planetary waves. As of early 2022, five Mars years of pressure data have been collected by the Curiosity Rover in Gale crater with the Rover Environmental Monitoring Station (REMS). A combination of signal filtering techniques is used to search for pressure signatures that might warn large-scale dust storms reaching Gale. The analysis combines an exploration of changes in both baroclinic waves and thermal tides for the first time to our knowledge. Focusing on the periods preceding local opacity increases as detected by Curiosity's Mastcam observations, the pressure analysis shows changes in the coupling between the diurnal pressure tide and quasi-diurnal Kelvin wave, as well as in the temporal evolution of baroclinic waves that are harbingers of the larger dust storms. Changes in the phasing between Kelvin waves and diurnal tides are found to be precursors for the growth phase of periods Z (defined here as Ls ∼ 120°–160°), A (Ls ∼ 190°–240°), and C (Ls ∼ 300°–335°) dust storms. Changes in multi-sol pressure oscillations also help predict the occurrence of A, B (Ls ∼ 245°–295°), and C storms. The specific pressure oscillations preceding each storm period are likely to be signatures of the large-scale circulation patterns that enable the growth and propagation of the storm fronts.

Hormesis occurs as a result of biphasic dose relationship resulting in stimulatory responses at low doses and inhibitory ones at high doses. In this framework, environmental factors are often studied to understand how this exposure benefits the animal. In the current study we used anoxia, the total absence of oxygen, as the most extreme version of low oxygen hormesis. Our goal was to determine the dose, the extent of the effect, and the cost of that response in Tenebrio molitor. We identified that the hormetic range (1 to 3 h of anoxia) was similar to that of other insects. Individuals that were exposed to 3 h had high emergence, increased activity throughout life, and lived longer. Beetles that experienced 1 h of anoxia performed better than the controls while the 6-h group had compromised performance. These boosts in performance at 3 h were accompanied by significant costs. Treated individuals had a delay in development and once matured they had decreased fitness. There were also transgenerational effects of hormesis and F

Contains fulltext : 283507.pdf (Publisher’s version ) (Open Access) Background: Data to support the routine use of embolic protection devices for stroke prevention during transcatheter aortic valve replacement (TAVR) are controversial. Identifying patients at high risk for peri-procedural cerebrovascular events may facilitate effective patient selection for embolic protection devices during TAVR. Aim: To generate a risk score model for stratifying TAVR patients according to peri-procedural cerebrovascular events risk. Methods and results: A total of 8779 TAVR patients from 12 centers worldwide were included. Peri-procedural cerebrovascular events were defined as an ischemic stroke or a transient ischemic attack occurring ≤24 h from TAVR. The peri-procedural cerebrovascular events rate was 1.4% (n = 127), which was independently associated with 1-year mortality (hazards ratio (HR) 1.78, 95% confidence interval (CI) 1.06-2.98, p < 0.028). The TASK risk score parameters were history of stroke, use of a non-balloon expandable valve, chronic kidney disease, and peripheral vascular disease, and each parameter was assigned one point. Each one-point increment was associated with a significant increase in peri-procedural cerebrovascular events risk (OR 1.96, 95% CI 1.56-2.45, p < 0.001). The TASK score was dichotomized into very-low, low, intermediate, and high (0, 1, 2, 3-4 points, respectively). The high-risk TASK score group (OR 5.4, 95% CI 2.06-14.16, p = 0.001) was associated with a significantly higher risk of peri-procedural cerebrovascular events compared with the low TASK score group. Conclusions: The proposed novel TASK risk score may assist in the pre-procedural risk stratification of TAVR patients for peri-procedural cerebrovascular events.

Many tourism agglomerations are situated near natural resources, which implies a need to balance business growth with environmental preservation. Our analysis of the location decisions of 295 luxury beach hotels in Spain between 1960 and 2015 reveals two main findings. First, we confirm the positive relationship between the existence of demandrelated urbanization services around natural resources and the attractiveness of agglomerations to new entrants. Second, we find that an agglomeration’s attractiveness negatively affects the density of firms in the agglomeration if that attractiveness hinders firms’ access to the same natural resources. Our results contribute to the strategy literature on agglomerations and provide a better understanding of how the tourism industry can work toward achieving the sustainable development goals (SDGs)., Spanish State Research AgencyInnovation and Science Ministry PID2019-106725GB-I00, Ministry of Science and Innovation through the FEDER funds from the Spanish Pluriregional Operational Program 2014-20, LifeWatch-ERIC action line LifeWatch-2019-10-UGR-01

[EN] Trial Design: An interventional, phase 4, single group assignment, without masking (open label), preventive clinical trial was carried out in health workers with biological risk in their tasks, who have been filed as non-responders to conventional vaccination against Hepatitis B. Methods: 67 health workers with biological risk in their tasks, who have been filed as non-responders to conventional vaccination against Hepatitis B, were enrolled in the Clinical Trial. All participants were from 18 years up to 64 years old. Inclusion Criteria: NHS workers -including university students doing their internships in health centres dependent on the National Health System (inclusion of students is regulated and limited by specific instructions on labour prevention in each autonomous community)- classified as non-responders. The criteria defining them as non-responders to the conventional hepatitis B vaccine is anti HBsAb titers < 10 mUI/ml following the application of six doses of conventional vaccine at 20 lg doses (two complete guidelines). The objective of this study was to provide Health workersstaff with an additional protection tool against hepatitis B infection, and to evaluate the efficacy of the adjuvanted vaccine in healthy non-responders to conventional hepatitis B vaccine. The primary outcome was the measurement of antibody antiHBs before the first Fendrix dose and a month after the administration of each dose. Other outcome was collection of adverse effects during administration and all those that could be related to the vaccine and that occur within 30 days after each dose. In this study, only one group was assigned. There was no randomization or masking. Results: The participants were recruited between April 13, 2018 and October 31, 2019. 67 participants were enrolled in the Clinical Trial and included the analyses. The primary immunisation consists of 4 separate 0.5 ml doses of Fendrix , administered at the following schedule: 1 month, 2 months and 6 months from the date of the first dose. Once the positivity was reached in any of the doses, the participant finished the study and was not given the following doses. 68.66% (46 out 67) had a positive response to first dose of Fendrix. 57.14% (12 out 21) had a positive response to second dose of Fendrix . 22.22% (2 out 9) had a positive response to third dose of Fendrix and 42.96% (3 out 7) had a positive response to last dose of Fendrix. Overall, 94.02% (64 out 67) of participants had a positive response to Fendrix . No serious adverse event occurred. Conclusions: The use of Fendrix , is a viable vaccine alternative for NHS workers classified as ‘‘nonresponders”. Revaccination of healthy non-responders with Fendrix, resulted in very high proportions of responders without adverse events. Trial registration: The trial was registered in the Spanish National Trial Register (REEC), ClinicalTrials.gov and inclusion has been stopped (identifier NCT03410953; EudraCT-number 2016-004991-23). Funding: GRS 1360/A/16: Call for aid for the financing of research projects in biomedicine, health management and socio-health care to be developed in the centres of the Regional Health Management of Autonomous Community of Castile-Leon. In addition, this work has been supported by the Spanish Platform for Clinical Research and Clinical Trials, SCReN (Spanish Clinical Research Network), funded by the Subdirectorate General for Research Evaluation and Promotion of the Carlos III Health Institute (ISCIII), through the project PT13/0002/0039 and project PT17/0017/0023 integrated in the State Plan for R&D&I 2013–2016 and co-financed by and the European Regional Development Fund (ERDF).

Objectives This study sought to evaluate the incidence and causes of percutaneous coronary intervention (PCI) at different time periods following transcatheter aortic valve replacement (TAVR). Background Coronary artery disease (CAD) and aortic stenosis frequently coexist, but the optimal management of CAD following TAVR remains incompletely elucidated. Methods Patients undergoing unplanned PCI after TAVR were retrospectively included in an international multicenter registry. Results Between July 2008 and March 2019, a total of 133 patients (0.9%; from a total cohort of 15,325) underwent unplanned PCI after TAVR (36.1% after balloon-expandable bioprosthesis, 63.9% after self-expandable bioprosthesis). The median time to PCI was 191 days (interquartile range: 59 to 480 days). The daily incidence of PCI was highest during the first week after TAVR and then declined over time. Overall, the majority of patients underwent PCI due to an acute coronary syndrome, and specifically 32.3% had non–ST-segment elevation myocardial infarction, 15.4% had unstable angina, 9.8% had ST-segment elevation myocardial infarction, and 2.2% had cardiac arrest. However, chronic coronary syndromes are the main indication beyond 2 years. PCI success was reported in almost all cases (96.6%), with no significant differences between patients treated with balloon-expandable and self-expandable bioprostheses (100% vs. 94.9%; p = 0.150). Conclusions Unplanned PCI after TAVR is rare, with an incidence declining over time after TAVR. The main indication to PCI is acute coronary syndrome in the first 2 years after TAVR, and thereafter chronic coronary syndromes become prevalent. Unplanned PCIs are frequently successfully performed after TAVR, with no apparent differences between balloon-expandable and self-expandable bioprostheses. (Revascularization After Transcatheter Aortic Valve Implantation [REVIVAL]; NCT03283501 )

Back in May 2019 at the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC), we presented the first issue of REC: Interventional Cardiology (figure 1). A dream we had been dreaming for years was finally coming true. And it was coming to life the way we thought was the most suitable one, as a free of charge, open-access, bilingual (Spanish and English) publication with an optimal digital and print presentation. Figure 1. Presentation of the journal in 2019. A: at the editorial office; from left to right: Iria del Río, María González Nogal, Helena Gómez-Lobo, Belén Juan, and Eva M. Cardenal. B: Official Congress of the Spanish Society of Cardiology (2019); from left to right: José M. de la Torre-Hernández, Raúl Moreno, Fernando Alfonso, and Juan Sanchis. Since then, 7 issues have been published including original articles, clinical cases, letters, review articles, clinical trial reviews, editorials, debates, and news that have covered all aspects of interventional cardiology both coronary and structural. The...

En mayo de 2019, coincidiendo con la reunión de la Asociación de Cardiología Intervencionista (ACI) de la Sociedad Española de Cardiología (SEC), presentamos el primer número de REC: Interventional Cardiology (figura 1). Se cumplía así un sueño albergado durante años y hecho finalmente realidad. Además, lo hacía de la forma que habíamos considerado más idónea, como publicación de acceso totalmente libre y gratuito, en formato bilingüe (español e inglés) y con una óptima presentación tanto en su versión electrónica como en su formato impreso. Figura 1. Presentación de la revista en 2019. A: en la oficina editorial; de izquierda a derecha, Iria del Río, María González Nogal, Helena Gómez-Lobo, Belén Juan y Eva M. Cardenal. B: Congreso de las Enfermedades Cardiovasculares SEC 2019; de izquierda a derecha, José M. de la Torre-Hernández, Raúl Moreno, Fernando Alfonso y Juan Sanchis. Desde entonces ya se han publicado 7 números, en los que se han presentado estudios originales, casos clínicos, imágenes, cartas, revisiones temáticas, revisiones de ensayos, artículos especiales, editoriales, debates y noticias, que han cubierto todos los aspectos del intervencionismo cardiológico, tanto coronario como estructural. Los principales protagonistas de esta andadura inicial tan satisfactoria han sido los autores, tanto aquellos que nos han enviado sus...

Introduction and objectives: Chronic total coronary occlusion (CTO) is often a complex entity to deal with through a percutaneous coronary intervention, and the clinical benefits of successful recanalization still remain uncertain. Most registries feature data in limited time periods and do not reflect the impact that specific dedicated programs have on recanalization. Our study evaluates the results of a CTO program on a long-term period of time. Methods: All patients’ CTOs treated with percutaneous coronary interventions at our center from 2002 through 2017 were prospectively included in the registry. The clinical, angiographic and procedural data were collected, and clinical follow-up was conducted. Three consecutive periods of time were considered for the analysis of temporal trends. Results: Atotal of 424 CTOs (408 patients) were included. In 339 patients (80%) the procedure was successful. The rate of success increased over time, from 57% in 2002-2006 to 87% in 2012-2017 (P = .001). The most important independent predictor of procedural failure was lesion tortuosity. After a median follow-up of 39.7 months, the rates of major adverse cardiovascular events and cardiovascular mortality in success vs failed groups were 13.9% vs 24.7% (P = .015) and 3.6% vs 14.1% (P = .001), respectively. These were the independent predictors of cardiovascular mortality: chronic kidney disease, left anterior descending artery occlusion, and procedural failure. Conclusions: Our series shows a high rate of success in CTO recanalization, which has increased over the last few years due to greater expertise and improved program-specific technical advances. Several angiographic and procedural variables have been identified as predictors of failure. Successful procedures, especially on the left anterior descendent coronary artery, were associated with lower rates of cardiovascular mortality.

Introduction and objectives: This study primary endpoint was to present the in-hospital all-cause mortality of the Spanish TAVI registry from its inception until 2018. Secondary endpoints included other in-hospital clinical events, 30-day all-cause mortality, and an assessment of the time trend of this registry. Methods: All consecutive patients included in the Spanish TAVI registry were analyzed. In this time-based analysis, the population was been divided into patients treated before 2014 (cohort A: 2009-2013) and patients treated between 2014 and 2018 (cohort B). Results: From August 2007 to June 2018, 7180 patients were included. The mean age was 81.2 ± 6.5 years and 53% were women. The logistic EuroSCORE was 12% (8-20). Transfemoral access was used in 89%. In-hospital and 30-day all-cause mortality was 4.7% and 5.7%, respectively. On the time-based analyses during the hospital stay, the rate of myocardial infarction, stroke, need for pacemakers, tamponade, coronary obstruction, and vascular complications was similar between both groups. However, cohort B showed less need for conversion to surgery and malapposition of the valve. Also, the implant success rate increased from 93% to 96% (P< .001). In-hospital and 30-day all-cause mortality was significantly lower in cohort B, ([OR, 0.65; IC95%, 0.48-0.86; P= .003] and [OR, 0.71; IC95%, 0.54-0.92; P= .002], respectively). Conclusions: The time trend analysis of the Spanish TAVI registry showed a change in the patients’ clinical profile and an improvement in the in-hospital clinical outcomes and 30-day all-cause mortality in patients treated more recently.

Objectives This study sought to assess the efficacy of the drug-coated balloon (DCB) ESSENTIAL for the treatment of in-stent restenosis (ISR). Background DCBs have proven a valid therapeutic option for the management of ISR in several clinical trials, yet no class effect can be claimed. Accordingly, every new DCB model has to be individually evaluated through clinical studies. Methods This is a prospective, multicenter study including consecutive patients undergoing percutaneous coronary intervention for ISR with the ESSENTIAL DCB. A 6-month quantitative coronary angiography (QCA)/optical coherence tomography (OCT) follow-up was scheduled. The primary endpoint was OCT-derived in-segment maximal area stenosis. Secondary endpoints included QCA-derived in-segment late lumen loss (LLL) and target lesion failure (TLF) rates at 6, 12, and 24 months. TLF was defined as the composite of cardiac death, target vessel myocardial infarction, and target lesion revascularization . Results A total of 31 patients were successfully treated with DCB, with 67% of ISR corresponding to drug-eluting stents (DES). At 6 months, 26 patients underwent the scheduled angiographic follow-up. The mean value for in-segment maximal area stenosis was 51.4 ± 13% and the median value was 53% (IQR 46.4–59.5). In the DES-ISR subgroup, these parameters were 52.6 ± 10% and 55.2% (IQR 49.3–58.5), respectively. In-segment LLL was 0.25 ± 0.43 mm with only 2 (7.7%) patients showing binary restenosis (>50%). The incidence of TLF was 10% at 6 months, 13.3% at 12 months, and 13.3% at 24 months. Conclusions In this study, the ESSENTIAL DCB showed sustained efficacy in the prevention of recurrent restenosis after treatment of ISR. Summary We sought to assess the efficacy of the drug-coated balloon ESSENTIAL for the treatment of in-stent restenosis through a prospective, multicenter study including QCA and OCT assessment at 6-month follow-up. The primary endpoint was in-segment maximal area stenosis. Among the 31 patients successfully treated with the ESSENTIAL DCB, an angiographic follow-up was conducted in 26. Mean in-segment maximal area stenosis was 51.4 ± 13% and the median value was 53% (IQR 46.4–59.5). In the DES-ISR subgroup, corresponding values were 52.6 ± 10% and 55.2% (IQR 49.3–58.5), respectively. The observed in-segment LLL was 0.25 ± 0.43 mm and binary restenosis rate was 7.7%. TLF was 10% at 6 months and 13.3% at 12 and 24 months.

Tributyltin (TBT) chloride is an endocrine disrupting chemical associated with reproductive complications. Studies have shown that TBT targets the reproductive tract, impairing ovarian folliculogenesis, and uterine morphophysiology. In this investigation, we assessed whether subchronic and low dose of TBT exposure results in abnormal ovarian follicular reserve and other irregularities in female mice. TBT was administered to female mice (500 ng/kg/day for 12 days via gavage), and reproductive tract morphophysiology was assessed. We further assessed reproductive tract inflammation and oxidative stress. Improper functioning of the reproductive tract in TBT mice was observed. Specifically, irregular estrous cyclicity and abnormal ovarian morphology coupled with reduction in primordial and primary follicle numbers was observed, suggesting ovarian reserve depletion. In addition, improper follicular development and a reduction in antral follicles, corpora lutea, and total healthy ovarian follicles together with an increase in cystic follicles were apparent. Evidence of uterine atrophy, reduction in endometrial gland number, and inflammation and oxidative stress were seen in TBT mice. Further, strong negative correlations were observed between testosterone levels and primordial, primary, and total healthy ovarian follicles. Thus, these data suggest that the subchronic and low dose of TBT exposure impaired ovarian follicular reserve, uterine gland number, and other reproductive features in female mice.

Resumen Este articulo presenta una revision de las publicaciones y los estudios de mayor relevancia en el ambito de la cardiologia intervencionista en el ano 2019. Dentro del intervencionismo coronario, el tratamiento del paciente con enfermedad multivaso, tanto en el contexto del sindrome coronario agudo como cronico, ha sido objeto de estudios de gran relevancia y con resultados solidos que potencialmente cambiaran nuestra practica clinica. Por otro lado, la comparacion entre diferentes estrategias de antiagregacion en pacientes con sindrome coronario agudo ha puesto de manifiesto la importancia de la individualizacion. Algunos sustratos anatomicos particulares, como el tratamiento de la oclusion cronica y las lesiones calcificadas siguen generando un buen numero de publicaciones. Los avances en el campo del intervencionismo en cardiopatia estructural han seguido aumentando exponencialmente en este ultimo ano. Destaca la aparicion de nuevas evidencias en el implante percutaneo de valvula aortica en pacientes de bajo riesgo, asi como los resultados en reparacion valvular percutanea mitral y tricuspide.

This study sought to determine, in patients with new-onset persistent left bundle branch block (NOP-LBBB) after transcatheter aortic valve implantation (TAVI), the incidence and factors associated with (i) LBBB recovery and (ii) permanent pacemaker implantation (PPI) at 1-year follow-up. This was a multicenter study including 153 patients (mean age: 81 ± 5 years, 56% of women) with NOP-LBBB post-TAVI (balloon-expandable valve in 112 patients). Delta PR (ΔPR) and delta QRS (ΔQRS) were defined as the difference in PR and QRS length between baseline and hospital discharge ECG, and the relative ΔPR and ΔQRS as absolute ΔPR and ΔQRS divided by baseline PR and QRS length, respectively. The patients had a clinical visit and 12-lead ECG at 1-year follow-up. LBBB recovery was observed in 50 patients (33%), and 14 patients (9%) had advanced conduction disturbances requiring PPI during the follow-up period. No clinical or ECG variables were associated with LBBB recovery, including prosthesis type (self- or balloon-expandable valve, p = 0.563), QRS width at baseline/discharge or absolute/relative ΔQRS (p >0.10 for all). The presence of atrial fibrillation at baseline (0.026), a longer PR interval at discharge (0.009), and a longer absolute and relative ΔPR (p = 0.002 and p = 0.004, respectively) were associated with an increased risk of PPI at 1-year follow-up. In conclusion, NOP-LBBB post-TAVI resolved in one-third of patients at 1-year follow-up, but no clinical or ECG variables were associated with LBBB recovery. Conversely, a nonsinus rhythm at baseline and a longer ΔPR were associated with an increased risk of PPI within the year after TAVI.

Percutaneous coronary intervention (PCI) with drug-eluting stent (DES) implantation is a widely adopted strategy for the treatment of de novo coronary artery disease. DES implantation conveys an inherent risk for short- and long-term complications, including in-stent restenosis and stent thrombosis. Drug-coated balloons are emerging as an alternative approach to fulfill the "leaving nothing behind" principle and avoid long-term DES-related complications.TRANSFORM II is an investigator-initiated, multicenter, noninferiority, randomized clinical trial, testing a sirolimus-coated balloon (SCB) versus the standard of care for native coronary vessels with a 2-3 mm diameter, in terms of 12-month target lesion failure (TLF; primary endpoint) and net adverse cardiovascular events (coprimary endpoint). Patients undergoing PCI will be randomized to be treated with either SCB or new-generation everolimus-eluting stent and will be followed up clinically for up to 60 months. Assuming a TLF rate of 8% at 12 months with DES, a sample size of 1325 patients was chosen to ensure an 80% power to detect a 1.5% lower incidence in the SCB group with a type I error rate of 0.05. The TRANSFORM II trial is registered on clinicaltrials.gov (identification number NCT04893291). Several substudies, including an optical coherence tomography assessment at 9 months (intracoronary imaging substudy), will investigate the study device in different clinical and lesion settings.The randomized TRANSFORM II trial will determine whether a novel SCB is noninferior to a current everolimus-eluting stent when adopted for the treatment of de novo lesions in coronary vessels with a diameter between 2 and 3 mm.

Widespread use of phthalates as solvents and plasticizers leads to everyday human exposure. The mechanisms by which phthalate metabolites act as ovarian toxicants are not fully understood. Thus, this study tested the hypothesis that the phthalate metabolites monononyl phthalate (MNP), monoisononyl phthalate (MiNP), mono(2-ethylhexyl) phthalate (MEHP), monobenzyl phthalate (MBzP), monobutyl phthalate (MBP), monoisobutyl phthalate (MiBP), and monoethyl phthalate (MEP) act through peroxisome proliferator-activated receptors (PPARs) in mouse granulosa cells. Primary granulosa cells were isolated from CD-1 mice and cultured with vehicle control (dimethyl sulfoxide) or MNP, MiNP, MEHP, MBzP, MBP, MiBP, or MEP (0.4-400 μM) for 24 h. Following culture, qPCR was performed for known PPAR targets, Fabp4 and Cd36. Treatment with the phthalate metabolites led to significant changes in Fabp4 and Cd36 expression relative to control in dose-dependent or nonmonotonic fashion. Primary granulosa cell cultures were also transfected with a DNA plasmid containing luciferase expressed under the control of a consensus PPAR response element. MNP, MiNP, MEHP, and MBzP caused dose-dependent changes in expression of luciferase, indicating the presence of functional endogenous PPAR receptors in the granulosa cells that respond to phthalate metabolites. The effects of phthalate metabolites on PPAR target genes were inhibited in most of the cultures by co-treatment with the PPAR-γ inhibitor, T0070907, or with the PPAR-α inhibitor, GW6471. Collectively, these data suggest that some phthalate metabolites may act through endogenous PPAR nuclear receptors in the ovary and that the differing structures of the phthalates result in different levels of activity.