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The purpose of this study was to evaluate the inductive effect of starch and maltose, and the repressive/inhibitory effect of glucose, on amy-1 gene expression and α-amylase production by Wickerhamia sp., using continuous culture under transient-state conditions at a dilution rate (D) of 0.083 h−1. Induction and repression kinetics of α-amylase were studied by changing the medium feed from glucose to maltose or starch in the induction experiments and vice versa in the repression experiments. Expression levels of amy-1 gene were measured by RT-qPCR. Results showed that starch was a more efficient inducer of α-amylase synthesis compared to maltose, with maximum accumulation rate constants of 0.424 and 0.191 h−1, respectively. In contrast, α-amylase synthesis in starch and maltose cultures was partially repressed by glucose as indicated by a specific activity close to basal levels and a decay constant rate (− 0.065 and − 0.069 h−1, respectively) higher than − D. A linear dependence of the specific rate of α-amylase production on mRNA relative abundance of amy-1 gene was observed. An inhibitory effect of glucose was not observed even at a concentration of 30 g L−1. In conclusion, the transient continuous culture is a useful tool to determine the qualitative and quantitative effects of maltose and starch on α-amylase induction and of glucose on enzyme repression, as well as to obtain a detailed understanding of the dynamic behavior of the yeast culture. Furthermore, results showed that amylaceous substrates can be very effective carbon sources for the production of α-amylase without being inhibited by glucose.

[EN] Objective: To identify preoperative parameters of anatomo-electrical atrial remodelling in order to identify the subgroup of patients more favourable to long-term sinus rhythm (SR) re-establishment after concomitant ablation of persistent-permanent atrial fibrillation (AF). Methods: The study included 50 consecutive patients undergoing concomitant surgical ablation of persistent-permanent AF with cryoablation and bipolar radiofrequency Maze IV pattern. The variables collected before the operation were: demographic variables, morbidity, AF evolution time, transthoracic echocardiographic study, and digital electrocardiogram register for f-wave signal organisation analysis (sample entropy [SampEn]). An assessment was also made of the individual and combined association of atrial remodelling parameters with SR restoration by area under ROC curve (AUC). Results: Follow-up 22.32 +/- 3.19 months. Mean AF onset time 4.00 +/- 4.28 years. Mean left atrium diameter 49.90 +/- 8.18 mm (range = 32 - 81 mm), and SR restoration of 62% at the end of follow-up. Parameters best linked to postoperative SR restoration were left atrium diameter (AUC = 0.848)and SampEn (AUC = 0.845). Cut-off points were 50 mm and 0.0857, respectively, obtaining a model with a predictive accuracy when both parameters combined with an AUC = 0.893. Conclusions: Preoperative anatomo-electrical remodelling analysis through indirect non-nvasive variables could be useful to select patients more favourable to SR restoration after concomitant ablation of AF., [ES] Objetivo: Identificación de parámetros de remodelado auricular anatomoeléctrico preoperatorios que permitan seleccionar un subgrupo de pacientes favorable al restablecimiento del ritmo sinusal (RS) a largo plazo tras ablación quirúrgica concomitante de fibrilación auricular (FA) persistente-permanente. Métodos: Cincuenta pacientes consecutivos sometidos a ablación quirúrgica concomitante de FA persistente-permanente por patrón Maze IV mediante crioblación y radiofrecuencia bipolar. Preoperatorio: se consideraron variables demográficas, morbilidad, tiempo de evolución de FA, estudio de ecocardiografía transtorácica y registro de electrocadiograma digital para análisis de organización de señal de ondas f (entropía muestral [SampEn]). Valoración de la asociación individual y conjunta de los parámetros de remodelado auricular con la restauración de RS mediante área bajo la curva ROC (ABC). Resultados: Seguimiento medio 22,32 ± 3,19 meses. Tiempo medio de evolución de FA 4,00 ± 4,28 años. Diámetro auricular izquierdo medio 49,90 ± 8,18 mm (rango = 32–81 mm). Restauración RS 62% al cierre del seguimiento. Los parámetros que mejor se asociaron con la restauración de RS postoperatorio fueron el diámetro auricular izquierdo (ABC = 0,848) y SampEn (ABC = 0,845). Hallados puntos de corte para ambos en 50 mm y 0,0857, respectivamente; se obtuvo un modelo con capacidad predictiva ABC = 0,893. Conclusiones: El análisis del grado de remodelado auricular anatomoeléctrico preoperatorio mediante variables indirectas incruentas podría ser útil para seleccionar los pacientes más favorables para el restablecimiento de RS tras ablación concomitante de FA.

et al., [Objective]: Peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α) is a transcriptional coactivator that has been proposed to play a protective role in mouse models of cardiac ischemia and heart failure, suggesting that PGC-1α could be relevant as a prognostic marker. Our previous studies showed that the estimation of peripheral mRNA PGC-1α expression was feasible and that its induction correlated with the extent of myocardial necrosis and left ventricular remodeling in patients with myocardial infarction. In this study, we sought to determine if the myocardial and peripheral expressions of PGC-1α are well correlated and to analyze the variability of PGC-1α expression depending on the prevalence of some metabolic disorders. [Methods]: This was a cohort of 35 consecutive stable heart failure patients with severe aortic stenosis who underwent an elective aortic valve replacement surgery. mRNA PGC-1α expression was simultaneously determined from myocardial biopsy specimens and blood samples obtained during surgery by quantitative PCR, and a correlation between samples was made using the Kappa index. Patients were divided into two groups according to the detection of baseline expression levels of PGC-1α in blood samples, and comparisons between both groups were made by chi-square test or unpaired Student’s t-test as appropriate. [Results]: Based on myocardial biopsies, we found that mRNA PGC-1α expression in blood samples showed a statistically significant correlation with myocardial expression (Kappa index 0.66, p, Grant from Sociedad Valenciana de Cardiología, 2013 to Óscar Fabregat-Andrés.

ResumenIntroducción y objetivosComparar requerimientos transfusionales intra y postoperatorios inmediatos entre pacientes sometidos a recambio valvular aórtico por miniesternotomía en «J» y por esternotomía media longitudinal.MétodosEstudiados 655 pacientes sometidos a recambio valvular aórtico entre 2005 y 2013, 498 por abordaje convencional (grupoC) y 120 por abordaje mínimamente invasivo (grupoM). Confeccionados 120 emparejamientos mediante propensity score matching, basado en 18 variables preoperatorias. Analizado número de transfusiones de hemoderivados intraoperatoriamente y hasta 72 h del postoperatorio.ResultadosNo se encontraron diferencias significativas en variables preoperatorias, incluidos valores de hemoglobina, hematocrito y recuento de plaquetas. El porcentaje de pacientes transfundidos del grupo M fue menor: 52,5% vs. 63,3% (p = 0,089) para concentrado de hematíes 11,6% vs. 24,1% (p = 0,012) para unidades de plaquetas y 14,5% vs. 27,5% (p = 0,011) para plasma fresco congelado. La cantidad de hemoderivados transfundidos también fue menor en el grupo M: 1,74±2,17 vs. 2,23±2,57 (p = 0,112) para concentrado de hematíes; 0,13±0,38 vs. 0,32±0,38 (p = 0,007) para unidades de plaquetas y 0,30±0,77 vs. 0,59±1,12 (p = 0,002) para plasma fresco congelado. El abordaje mínimamente invasivo se presenta como factor protector ante la necesidad transfusional de unidades de plaquetas y plasma fresco congelado: OR 0,414 (0,206-0,832) p = 0,013 y OR 0,435 (0,227-0,834) p = 0,012. En el análisis de morbimortalidad, la transfusión de plasma fresco congelado se presenta como factor de riesgo positivo: OR 4,182 (1,287-13,588), p = 0,017.ConclusiónEl abordaje mínimamente invasivo disminuye las necesidades transfusionales de hemoderivados y de esta manera las complicaciones asociadas a las mismas.AbstractIntroduction and objectivesTo compare intraoperative and postoperative transfusion requirements in patients undergoing aortic valve replacement by mini-sternotomy in “J” vs conventional sternotomy.MethodsThe study included 655 patients who underwent aortic valve replacement between 2005 and 2013, with 498 patients by the conventional approach (groupC) and 120 by a minimally invasive approach (groupM). A propensity score matching was performed to find 120 matched pairs based on 18 preoperative variables. An analysis was made of the number of blood units transfused intraoperatively and up to 72hours postoperatively.ResultsNo significant differences were found in preoperative variables, including hemoglobin, hematocrit, and platelet count. The percentage of transfused patients in group M was lower: 52.5% vs 63.3% (P=.089) for packed red blood cells (RBC); 11.6% vs 24.1% (P=.012) for platelet pool, and 14.5% vs 27.5% (P=.011) for fresh frozen plasma (FFP). The number of units of blood transfused was also lower in the M group: 1.74±2.17 vs 2.23±2.57 (P=.112) for RBC; 0.13±0.38 vs 0.32±0.38 (P=.007) for platelet units and 0.30±0.77 vs 0.59±1.12 (P=.002) for FFP. The minimally invasive approach shows to be a protective factor for platelets and FFP transfusion: OR 0.414 (0.206 to 0.832), P=.013 and OR 0.435 (0.227 to 0.834), P=.012, respectively. In the analysis of mortality, FFP transfusion was a risk factor for mortality: OR 4.182 (1.287 to 13.588) P=.017.ConclusionThe minimally invasive approach reduces blood transfusion requirements and thus the complications related to it.

Objectives Neochordal repair is particularly limited in case of large prolapse with absence of a reference point on a nearby segment. Our aim was to overcome these limitations by means of a simple technique: the 'Folding Leaflet'. Methods Ninety-six patients underwent this technique between January 2009 and August 2012 from a global mitral valve (MV) repair group of 384 patients. A subgroup of 68 patients with complex lesions, bileaflet, commissural or multisegment prolapse, was selected. These more challenging patients were considered as the study group in order to assess the efficacy of our technique. The neochordae were fixed to the papillary muscle with a simple stitch and then were passed through the free margin of the prolapsing leaflet. Free-edge remodelling was achieved weaving this suture and surpassing the coaptation line. Then, the leaflet was folded and its free margin was temporarily approximated edge-to-edge to the adjacent annulus. This was used as the reference point while the neochordae were tied without the need for adjacent healthy chordae or use of callipers. Complete echocardiographic follow-up was obtained at 6-month intervals. Results All patients had ≥ 2 prolapsed segments: posterior leaflet (40 patients), anterior leaflet (13 patients) or both leaflets (15 patients). Annuloplasty was routinely used and the mean number of neochordae per patient was 4.1 ± 2.2 (2-13). Mean follow-up was 28 ± 14 months (5-49 months). There was only one in-hospital death. Another patient died by pneumoniae (15th postoperative month). At the first-month follow-up, 51 patients had no mitral regurgitation (MR) and 16 patients had Grade 1 MR. Only 1 patient had more than mild regurgitation at the 6-month follow-up. There was no evidence of Grade 3 or 4 MR in any patient. At the 2-year follow-up, 34 patients remained with no MR or trace MR and 7 patients had Grade 1 MR. Conclusions MV repair for complex degenerative MR using this technique of neochordal repair results in excellent early and mid-term outcomes. This technique facilitates the extensive use of neochordae in case of large areas of prolapse.

Resumen Introduccion y objetivos El objetivo es comparar resultados clinicos intrahospitalarios entre pacientes sometidos a recambio valvular aortico aislado por abordaje minimamente invasivo frente a esternotomia estandar. Metodos Se incluyo a 615 pacientes sometidos a recambio valvular aortico entre 2005 y 2012, 532 mediante abordaje estandar (grupo E) y 83 mediante miniesternotomia en «J» (grupo M). Resultados No se encontraron diferencias significativas en cuanto a edad (69,27 ± 9,31 frente a 69,40 ± 10,24 anos) y EuroSCORE logistico (6,27 ± 2,91 frente a 5,64 ± 2,17) entre los grupos E y M. Tampoco en la incidencia de diabetes mellitus, hipercolesterolemia, hipertension arterial y enfermedad pulmonar obstructiva cronica o el tamano de valvulas implantadas (grupo E frente a grupo M, 21,94 ± 2,04 y 21,79 ± 2,01 mm). Si las hubo en los tiempos de circulacion extracorporea y de pinzamiento aortico, mayores en el grupo E: 102,90 ± 41,68 frente a 81,37 ± 25,41 min (p Conclusiones El abordaje minimamente invasivo presenta resultados al menos equiparables al estandar en cuanto a morbimortalidad y tiempos quirurgicos, y en nuestra serie ha permitido disminuir significativamente la estancia hospitalaria. Dado que el estudio es retrospectivo, creemos que se debe confirmar estos hallazgos en estudios prospectivos aleatorizados.

Introduction and objectives The aim of this study was to compare the in-hospital clinical outcomes of minimally invasive, isolated aortic valve replacement vs median sternotomy. Methods Between 2005 and 2012, 615 patients underwent aortic valve replacement at a single institution, 532 by a median sternotomy (E group) and 83 by a J-shaped ministernotomy (M group). Results No significant differences were found between the E and M groups in terms of age (69.27 [9.31] years vs 69.40 [10.24] years, respectively), logistic EuroSCORE (6.27 [2.91] vs 5.64 [2.17], respectively), size of implanted valve prosthesis (21.94 [2.04] mm vs 21.79 [2.01] mm, respectively), or the incidence of diabetes, hypercholesterolemia, high blood pressure, or chronic obstructive pulmonary disease. Mean cardiopulmonary bypass time was 102.90 (41.68) min for the E group vs 81.37 (25.41) min for the M group (P

Objetivo: Describir nuestra experiencia y evaluar los resultados a corto y mediano plazo de la miecto-mía videoasistida en el tratamiento de la obstrucción del tracto de salida del ventrículo izquierdo (OTSVI) en pacientes con miocardiopatía hipertrófica. Materiales y métodos: 52 pacientes con edad media de 56,2 (rango 12 - 83) y Euroscore de riesgo de 4,1 ± 1,92 con diagnóstico de OTSVI fueron intervenidos de manera consecutiva en un mismo centro mediante miectomía videoasistida. Se realizó seguimiento clínico y ecocardiográfico con controles al mes y al año del postoperatorio. Resultados: Entre las patologías asociadas encontramos 11 pacientes con valvulopatía aórtica, 2 con valvulopatía mitral, 3 con cardiopatía isquémica, 1 con aneurisma de aorta ascendente y 1 con foramen oval permeable resueltos en el mismo acto quirúrgico. La mortalidad hospitalaria global fue de 5,8% (3 pacientes). En el momento de la intervención, 8 (15,4%) se encontraban en clase funcional II de la NYHA, 42 (80,8%) en clase III y 2 (3,8%) en clase IV. El gradiente máximo subaórtico disminuyó de 80,7 mmHg ± 29,43 en el preoperatorio a 19,0 mmHg ± 15,57 (p

Cytogenetics is the most important prognostic factor in acute myeloid leukemia (AML). However, a high proportion of patients show normal or intermediate-risk karyotypes. In these patients, other determinants could help to identify those with a higher risk of relapse. Recently, internal tandem duplications (ITD) and D835 mutations in FLT3 tyrosine kinase receptor have been shown to confer a bad prognosis in AML.We analyzed the incidence of these mutations in a total of 208 patients of different AML subsets and their prognostic relevance in non-promyelocytic de novo AML.FLT3 mutations were detected in 24% of de novo AML, 42% of acute promyelocytic leukemia (APL) and 17% of secondary AML. Four patients showed both ITD and D835 mutations. Ninety-four per cent of the patients with FLT3 alterations were classified into the intermediate-risk group. There was no association between the presence of FLT3 alterations and response to induction while the alterations were associated with a worse disease-free survival and event-free survival in both the overall and intermediate-risk patients.Our data confirm that any of the mutations in FLT3 confer a bad prognosis in AML. Because of the high prevalence of these mutations within the intermediate-risk group, their detection could be useful to identify patients with a poor prognosis.