Search

Sr. Editor: El riesgo perioperatorio asociado a la estenosis aórtica durante la cirugía no cardiaca (CNC) depende de la presencia de síntomas, la gravedad de la estenosis, la coexistencia de cardiopatías y el riesgo asociado a la comorbilidad no cardiaca. La estenosis aórtica sintomática grave es un importante factor de riesgo de insuficiencia cardiaca en el posoperatorio y un predictor de mortalidad a 30 días y a largo plazo tras una cirugía no cardiaca; por ello, es esencial una estrategia perioperatoria adecuada cuando los pacientes van a ser intervenidos en una cirugía no cardiaca de riesgo intermedio o alto1,2. Las fracturas de cadera o vertebrales son muy prevalentes en la población anciana, habitualmente por caídas accidentales, y son consideradas como una intervención de riesgo intermedio3. No obstante, estos pacientes se caracterizan por su senectud y por presentar enfermedades concomitantes, que incrementan el riesgo quirúrgico. En este escenario, el tratamiento de la estenosis aórtica se asocia a una reducción de la morbimortalidad de los pacientes sometidos a cirugía no cardiaca de riesgo intermedio o alto4,5. El tratamiento perioperatorio de los pacientes con estenosis aórtica grave sintomática que precisan una cirugía traumatológica incierta supone un reto. Presentamos una serie de 4 pacientes incluidos de...

To the Editor, The perioperative risk associated with aortic stenosis during noncardiac surgery (NCS) depends on the presence of symptoms, the severity of aortic stenosis, concomitant cardiovascular diseases, and the risk associated with noncardiac comorbidity. Severe symptomatic aortic stenosis is a major risk factor for postoperative heart failure and a predictor of 30-day and long-term mortality after noncardiac surgery; therefore, an appropriate perioperative strategy is essential in patients undergoing intermediate- or high-risk noncardiac surgery.1,2 Hip and vertebral fractures, which are highly prevalent in the elderly population, are usually due to accidental falls and considered intermediate-risk interventions.3 Nonetheless, these patients are characterized by their advanced age and the presence of concomitant diseases, which increases their surgical risk. In this context, the management of aortic stenosis is associated with reduced morbidity and mortality rates in patients undergoing intermediate or high-risk noncardiac surgery.4,5 The perioperative management of patients with severe symptomatic aortic stenosis requiring uncertain trauma surgery is challenging. We present a series of 4 consecutive patients with a past medical history of severe symptomatic aortic stenosis with a trauma emergency, 3 of them due to hip fracture and 1 due to vertebral fracture, all after accidental falls, in whom perioperative management of aortic stenosis...

ABSTRACT Introduction and objectives: Functional assessment of coronary stenosis severity with the piezo-electric sensor pressure wire has shown a discrepancy of up to 20% between hyperemic and nonhyperemic indexes. No data are available with fiber-optic pressure wires. The aim of this study was to evaluate the incidence and factors related to the diagnostic discordance between these indexes with a fiber-optic pressure wire. Secondary aims were to assess diagnostic reproducibility in 2 consecutive measurements of fractional flow reserve (FFR) and diastolic pressure ratio (dPR) and evaluate the drift rate. Methods: We conducted a prospective, observational multicenter study in patients undergoing functional assessment with a fiber-optic pressure wire. We took 2 consecutive measurements of the dPR (cutoff point 0.89) and FFR (cut-off point 0.80) in each lesion analyzed. The diagnostic correlation between 2 measurements with the same technique and between the 2 techniques (dPR and FFR) was assessed. Clinical and angiographic factors associated with discordance (FFR−/dPR+ and FFR+/dPR−) between the 2 techniques were analyzed. Results: We included 428 cases of stenosis (361 patients). Diagnostic reproducibility was 95.8% for the dPR, with a correlation coefficient between the 2 measurements (dPR1 and dPR2) of 0.974 (P 60%. The drift rate was 5.7%. Conclusions: Although FFR and dPR measurements with a fiber-optic pressure wire have excellent reproducibility and a low drift rate, the discordance rate remains similar to those in previous studies with a piezo-electric pressure wire. FFR−/dPR+ discordance is associated with intracoronary adenosine and hypertension. FFR+/dPR− discordance is related to age < 75 years old and stenosis > 60%.

RESUMEN Introducción y objetivos: La valoración funcional de las estenosis coronarias con guías de presión de sensor piezoeléctrico ha mostrado hasta un 20% de discordancia entre los índices hiperémico y no hiperémico. No hay datos disponibles con guía de presión de sensor óptico. El objetivo del estudio es evaluar la incidencia y los factores relacionados con la discordancia diagnóstica entre estos índices con guía de presión de sensor óptico. Como objetivos secundarios se evaluó la reproducibilidad diagnóstica en dos determinaciones consecutivas de la reserva fraccional de flujo (RFF) y la diastolic pressure ratio (dPR). También se evaluó la tasa de drift. Métodos: Estudio observacional, prospectivo, multicéntrico, en pacientes a quienes se realiza una valoración funcional con guía de presión de sensor óptico. Se hicieron dos mediciones consecutivas de dPR (umbral 0,89) y RFF (umbral 0,80) en cada lesión analizada. Se valoró la correlación diagnóstica entre dos mediciones con la misma técnica y entre ambas técnicas (dPR y RFF). Se analizaron factores clínicos y angiográficos asociados a la discordancia (RFF−/dPR+ y RFF+/dPR−) entre ambas técnicas. Resultados: Se incluyeron 428 estenosis (361 pacientes). La reproducibilidad diagnóstica fue del 95,8% para dPR, con un coeficiente de correlación entre ambas mediciones (dPR1 y dPR2) de 0,974 (p < 0,0001). Para RFF la reproducibilidad diagnóstica fue del 94,9%, con un coeficiente de correlación (RFF1 y RFF2) de 0,942 (p < 0,0001). La discordancia diagnóstica fue del 18,2% (RFF+/dPR− 8,2% y RFF−/dPR+ 10%). Entre las variables analizadas, en el análisis multivariado, la hipertensión arterial y la administración intracoronaria de adenosina se asociaron de manera significativa con la discordancia RFF−/dPR+. Solo la edad < 75 años y la estenosis > 60% se asociaron de manera significativa con la discordancia RFF+/dPR−. La tasa de drift fue del 5,7%. Conclusiones: Aunque las mediciones de RFF y dPR con guía de presión de sensor óptico tienen una excelente reproducibilidad y una baja incidencia de drift, la tasa de discordancia permanece similar a la de estudios previos con guía de presión de sensor piezoeléctrico. La adenosina intracoronaria y la hipertensión arterial se asocian con la discordancia RFF−/dPR+. La edad < 75 años y la estenosis > 60% se asocian a discordancia RFF+/dPR−.

Current clinical guidelines support the concomitant administration of seasonal influenza vaccines and COVID-19 mRNA boosters vaccine. Whether dual vaccination may impact vaccine immunogenicity due to an interference between influenza or SARS-CoV-2 antigens is unknown. We aimed to understand the impact of mRNA COVID-19 vaccines administered concomitantly on the immune response to influenza vaccines. For this, 128 volunteers were vaccinated during the 22-23 influenza season. Three groups of vaccination were assembled: FLU vaccine only (46, 35%) versus volunteers that received the mRNA bivalent COVID-19 vaccines concomitantly to seasonal influenza vaccines, FluCOVID vaccine in the same arm (42, 33%) or different arm (40, 31%), respectively. Sera and whole blood were obtained the day of vaccination, +7, and +28 days after for antibody and T cells response quantification. As expected, side effects were increased in individuals who received the FluCOVID vaccine as compared to FLU vaccine only based on the known reactogenicity of mRNA vaccines. In general, antibody levels were high at 4 weeks post-vaccination and differences were found only for the H3N2 virus when administered in different arms compared to the other groups at day 28 post-vaccination. Additionally, our data showed that subjects that received the FluCOVID vaccine in different arm tended to have better antibody induction than those receiving FLU vaccines for H3N2 virus in the absence of pre-existing immunity. Furthermore, no notable differences in the influenza-specific cellular immune response were found for any of the vaccination groups. Our data supports the concomitant administration of seasonal influenza and mRNA COVID-19 vaccines.

Abstract Background In vitro embryo production is a highly demanded reproductive technology in horses, which requires the recovery (in vivo or post-mortem) and in vitro maturation (IVM) of oocytes. Oocytes subjected to IVM exhibit poor developmental competence compared to their in vivo counterparts, being this related to a suboptimal composition of commercial maturation media. The objective of this work was to study the effect of different concentrations of secretome obtained from equine preovulatory follicular fluid (FF) on cumulus-oocyte complexes (COCs) during IVM. COCs retrieved in vivo by ovum pick up (OPU) or post-mortem from a slaughterhouse (SLA) were subjected to IVM in the presence or absence of secretome (Control: 0 µg/ml, S20: 20 µg/ml or S40: 40 µg/ml). After IVM, the metabolome of the medium used for oocyte maturation prior (Pre-IVM) and after IVM (Post-IVM), COCs mRNA expression, and oocyte meiotic competence were analysed. Results IVM leads to lactic acid production and an acetic acid consumption in COCs obtained from OPU and SLA. However, glucose consumption after IVM was higher in COCs from OPU when S40 was added (Control Pre-IVM vs. S40 Post-IVM: 117.24 ± 7.72 vs. 82.69 ± 4.24; Mean µM ± SEM; p

PurposeNatural killer (NK) cells are traditionally identified by flow cytometry using a combination of markers (CD16/CD56/CD3), because a specific NK-cell marker is still missing. Here we investigated the utility of CD314, CD335 and NKp80, compared to CD16/CD56/CD3, for more robust identification of NK-cells in human blood, for diagnostic purposes.MethodsA total of 156 peripheral blood (PB) samples collected from healthy donors (HD) and patients with diseases frequently associated with loss/downregulation of classical NK-cell markers were immunophenotyped following EuroFlow protocols, aimed at comparing the staining profile of total blood NK-cells for CD314, CD335 and NKp80, and the performance of distinct marker combinations for their accurate identification.ResultsNKp80 showed a superior performance (vs. CD314 and CD335) for the identification of NK-cells in HD blood. Besides, NKp80 improved the conventional CD16/CD56/CD3-based strategy to identify PB NK-cells in HD and reactive processes, particularly when combined with CD16 for further accurate NK-cell-subsetting. Although NKp80+CD16 improved the identification of clonal/tumor NK-cells, particularly among CD56- cases (53%), aberrant downregulation of NKp80 was observed in 25% of patients, in whom CD56 was useful as a complementary NK-cell marker. As NKp80 is also expressed on T-cells, we noted increased numbers of NKp80+ cytotoxic T-cells at the more advanced maturation stages, mostly in adults.ConclusionHere we propose a new robust approach for the identification of PB NK-cells, based on the combination of NKp80 plus CD16. However, in chronic lymphoproliferative disorders of NK-cells, addition of CD56 is recommended to identify clonal NK-cells, due to their frequent aberrant NKp80- phenotype.

Wildlife veterinarians are necessary for zoonotic diseases and species loss management, and there is a rising interest to enroll at veterinary schools with the wish to work in zoo and wildlife medicine. However, teaching wildlife is challenging due to the difficulty faced by universities to work with wild animal specimens. The aim of the present was to evaluate the understanding efficiency of some anatomical and behavioral aspects using 3D printed models of four wildlife species skulls, the kinkaju ("Potos flavus"), the white-nosed coati ("Nasua narica"), the northern anteater ("Tamandua mexicana"), and the nine-banded armadillo ("Dasypus novemcinctus"). This study was performed on 85 third-year veterinary students, divided into an experimental and a control group, who used and not used 3D printed skulls, respectively. Results show that the experimental group shows higher scores, in three of the four variables evaluated, than the control group. Then, 3D wildlife printed skulls constitute a promising teaching tool for veterinary students. In fact, it may be as good as real skulls, since new 3D printers can print on high endurance and firmness stock with high accuracy at reduced costs. In this context, it is important to encourage its use for the training of new generations and keep professionals up to date.

The video-game industry has become a significant force in the business and entertainment world. Video games have become so widespread and pervasive that they are now considered a part of the mass media, a common method of storytelling and representation. Despite the massive popularity of video games, their increasing variety, and the diversification of the player base, until very recently little attention was devoted to understanding how playing video games affects the way people think and collaborate across cultures. This paper examines the recent literature regarding the impact of video games on players from an intercultural perspective. Sixty-two studies are identified whose aim is to analyze behavioral-change, content understanding, knowledge acquisition, and perceptional impacts. Their findings suggest that video games have the potential to help to acquire cultural knowledge and develop intercultural literacy, socio-cultural literacy, cultural awareness, self-awareness, and the cultural understanding of different geopolitical spaces, to reinforce or weaken stereotypes, and to some extent also facilitate the development of intercultural skills. The paper provides valuable insights to the scholars, teachers, and practitioners of cultural studies, education, social studies, as well as to the researchers, pointing out areas for future research.