Atrial Fibrillation and Non-cardiovascular Diseases: A Systematic Review

Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with an unfavorable prognosis, increasing the risk of stroke and death. Although traditionally associated with cardiovascular diseases, there is increasing evidence of high incidence of AF in patients with highly prevalent noncardiovascular diseases, such as cancer, sepsis, chronic obstructive pulmonary disease, obstructive sleep apnea and chronic kidney disease. Therefore, considerable number of patients has been affected by these comorbidities, leading to an increased risk of adverse outcomes.The authors performed a systematic review of the literature aiming to better elucidate the interaction between these conditions.Several mechanisms seem to contribute to the concomitant presence of AF and noncardiovascular diseases. Comorbidities, advanced age, autonomic dysfunction, electrolyte disturbance and inflammation are common to these conditions and may predispose to AF.The treatment of AF in these patients represents a clinical challenge, especially in terms of antithrombotic therapy, since the scores for stratification of thromboembolic risk, such as the CHADS2 and CHA2DS2VASc scores, and the scores for hemorrhagic risk, like the HAS-BLED score have limitations when applied in these conditions.The evidence in this area is still scarce and further investigations to elucidate aspects like epidemiology, pathogenesis, prevention and treatment of AF in noncardiovascular diseases are still needed.

Cytochemical study of Rhodnius neglectus and Rhodnius prolixus salivary gland cells (Hemiptera, Triatominae)

Triatomines are hematophagous bugs of medical interest in South and Central America, where they may act as invertebrate hosts of the hemoflagellate protozoa Trypanosoma cruzi (the causative of Chagas’ disease) and Trypanosoma rangeli (Tejera, 1920). Triatomines of Rhodnius genus have salivary gland formed by two close and independent units: the principal and the accessory. This gland secretes saliva that abounds in substances that facilitate and permit feeding. Despite this importance, there are few reports on its cytochemistry. In purpose of amplifying this understanding, in this work it was investigated the nuclear structures (chromatin and nucleolar corpuscles) of salivary gland cells of Rhodnius neglectus (Lent, 1954) and Rhodnius prolixus (Stål, 1859). The salivary glands were removed from adult insects, fixed and submitted to different cytochemical methods: lacto-acetic orcein, silver ion impregnation, Feulgen reaction, Toluidine Blue, Variant method of critical electrolyte concentration and C-banding. The results evidenced predominance of binucleated cells, with bulky and polyploid nucleus, decondensed chromatin and a large nucleolar area. In addition, cytoplasmic metachromasy and a clear association between nucleolar and heterochromatic corpuscles were observed. Such characteristics were associated with intense synthesis activity to produce saliva. Besides, the heterochromatic corpuscles observed with C Banding permitted the differentiation of sexes and species.

Metoprolol prevents sodium retention induced by lower body negative pressure in healthy men.

BACKGROUND: Lower body negative pressure (LBNP) has been shown to induce a progressive activation of neurohormonal systems, and a renal tubular and hemodynamic response that mimics the renal adaptation observed in congestive heart failure (CHF). As beta-blockers play an important role in the management of CHF patients, the effects of metoprolol on the renal response were examined in healthy subjects during sustained LBNP. METHODS: Twenty healthy male subjects were randomized in this double blind, placebo versus metoprolol 200 mg once daily, study. After 10 days of treatment, each subject was exposed to 3 levels of LBNP (0, -10, and -20 mbar) for 1 hour, each level of LBNP being separated by 2 days. Neurohormonal profiles, systemic and renal hemodynamics, as well as renal sodium handling were measured before, during, and after LBNP. RESULTS: Blood pressure and heart rate were significantly lower in the metoprolol group throughout the study (P < 0.01). GFR and RPF were similar in both groups at baseline, and no change in renal hemodynamic values was detected at any level of LBNP. However, a reduction in sodium excretion was observed in the placebo group at -20 mbar, whereas no change was detected in the metoprolol group. An increase in plasma renin activity was also observed at -20 mbar in the placebo group that was not observed with metoprolol. CONCLUSION: The beta-blocker metoprolol prevents the sodium retention induced by lower body negative pressure in healthy subjects despite a lower blood pressure. The prevention of sodium retention may be due to a blunting of the neurohormonal response. These effects of metoprolol on the renal response to LBNP may in part explain the beneficial effects of this agent in heart failure patients.

Rapid high-performance liquid chromatographic determination with fluorescence detection of furosemide in human body fluids and its confirmation by gas chromatography-mass spectrometry.

Furosemide (FD: Lasix) is a loop diuretic which strongly increases both urine flow and electrolyte urinary excretion. Healthy volunteers were administered 40 mg orally (dissolved in water) and concentrations of FD were determined in serum and urine for up to 6 h for eight subjects, who absorbed water at a rate of 400 ml/h. Quantification was performed by HPLC with fluorescence detection (excitation at 233 nm, emission at 389 nm) with a limit of detection of 5 ng/ml for a 300-microliters sample. The elution of FD was completed within 4 min using a gradient of acetonitrile concentration rising from 30 to 50% in 0.08 M phosphoric acid. The delay to the peak serum concentration ranged from 60 to 120 min. FD was still easily measurable in the sera from all subjects 6 h after administration. In urine, the excretion rates reached their maximum between 1 and 3 h. The total amount of FD excreted in the urine averaged 11.2 mg (range 7.6-14.0 mg), with a mean urine volume of 3024 ml (range 2620-3596 ml). Moreover, the urine density was lower than 1.010 (recommended as an upper limit in doping analysis to screen diuretics) only for 2 h. An additional volunteer was administered 40 mg of FD and his urine was collected over a longer period. FD was still detectable 48 h after intake. Gas chromatography-mass spectrometry with different types of ionization was used to confirm the occurrence of FD after permethylation of the extract. Negative-ion chemical ionization, with ammonia as reactant gas, was found to be the most sensitive method of detection.

The anabolic androgenic steroid fluoxymesterone inhibits 11β-hydroxysteroid dehydrogenase 2-dependent glucocorticoid inactivation.

Anabolic androgenic steroids (AAS) are testosterone derivatives used either clinically, in elite sports, or for body shaping with the goal to increase muscle size and strength. Clinically developed compounds and nonclinically tested designer steroids often marketed as food supplements are widely used. Despite the considerable evidence for various adverse effects of AAS use, the underlying molecular mechanisms are insufficiently understood. Here, we investigated whether some AAS, as a result of a lack of target selectivity, might inhibit 11β-hydroxysteroid dehydrogenase 2 (11β-HSD2)-dependent inactivation of glucocorticoids. Using recombinant human 11β-HSD2, we observed inhibitory effects for several AAS. Whereas oxymetholone, oxymesterone, danazol, and testosterone showed medium inhibitory potential, fluoxymesterone was a potent inhibitor of human 11β-HSD2 (half-maximal inhibitory concentration [IC(50)] of 60-100nM in cell lysates; IC(50) of 160nM in intact SW-620, and 530nM in MCF-7 cells). Measurements with rat kidney microsomes and lysates of cells expressing recombinant mouse 11β-HSD2 revealed much weaker inhibition by the AAS tested, indicating that the adverse effects of AAS-dependent 11β-HSD2 inhibition cannot be investigated in rats and mice. Furthermore, we provide evidence that fluoxymesterone is metabolized to 11-oxofluoxymesterone by human 11β-HSD2. Structural modeling revealed similar binding modes for fluoxymesterone and cortisol, supporting a competitive mode of inhibition of 11β-HSD2-dependent cortisol oxidation by this AAS. No direct modulation of mineralocorticoid receptor (MR) function was observed. Thus, 11β-HSD2 inhibition by fluoxymesterone may cause cortisol-induced MR activation, thereby leading to electrolyte disturbances and contributing to the development of hypertension and cardiovascular disease.

Muntatge i caracterització d'una placa DSSC: Buscant potència

Treball de recerca realitzat per alumnes d'ensenyament secundari i guardonat amb un Premi CIRIT per fomentar l'esperit científic del Jovent l'any 2009. Els objectius inicials foren la construcció d una 'Cèl•lula Solar Sensibilitzada mitjançant un Colorant’ (DSSC) amb el tint d una col llombarda i posterior caracterització segons el dossier 'Nanocrystalline Solar Cell Kit: Recreating Photosynthesis’. Les DSSC (Dye Sensitized Solar Cell) són un tipus de cèl•lules que imiten els principis que la fotosíntesis ha fet servir exitosament durant més de 3,5 bilions d anys. S’han construït algunes DSSC i se n’ha provat la seva eficiència. El seu funcionament es basa en l’energia d’un fotó que excita un electró i el fa saltar de nivell energètic fins que es desprèn de l’àtom de colorant, deixant un forat en la molècula. Aquest electró lliure passa a través de la capa de TiO2 fins arribar a la càrrega on es genera el corrent elèctric. Tot seguit, l’electró arriba al contra-elèctrode i és aquí on entra en contacte amb l’electròlit, el mediador iode/triiode. Aquest regenera l’electró, que anteriorment ha saltat del colorant, oxidant-se ell mateix.

Development of an optimized methodology for tensile testing of carbon steels in hydrogen environment

The study was performed at OCAS, the Steel Research Centre of ArcelorMittal for the Industry market. The major aim of this research was to obtain an optimized tensile testing methodology with in-situ H-charging to reveal the hydrogen embrittlement in various high strength steels. The second aim of this study has been the mechanical characterization of the hydrogen effect on hight strength carbon steels with varying microstructure, i.e. ferrite-martensite and ferrite-bainite grades. The optimal parameters for H-charging - which influence the tensile test results (sample geometry type of electrolyte, charging methods effect of steel type, etc.) - were defined and applied to Slow Strain Rate testing, Incremental Step Loading and Constant Load Testing. To better understand the initiation and propagation of cracks during tensile testing with in-situ H-charging, and to make the correlation with crystallographic orientation, some materials have been analyzed in the SEM in combination with the EBSD technique. The introduction of a notch on the tensile samples permits to reach a significantly improved reproducibility of the results. Comparing the various steel grades reveals that Dual Phase (ferrite-martensite) steels are more sensitive to hydrogen induced cracking than the FB (ferritic-bainitic) ones. This higher sensitivity to hydrogen was found back in the reduced failure times, increased creep rates and enhanced crack initiation (SEM) for the Dual Phase steels in comparison with the FB steels.

Segmental bioelectrical impedance analysis to assess perioperative fluid changes.

OBJECTIVES: Perioperative fluid accumulation determination is a challenge for the clinician. Bioelectrical impedance analysis (BIA) is a noninvasive method based on the electrical properties of tissues, which can assess body fluid compartments. The study aimed at assessing their changes in three types of surgery (thoracic, abdominal, and intracranial) requiring various regimens of fluid administration. DESIGN: Prospective descriptive trial. PATIENTS: A total of 26 patients scheduled for elective surgery were separated into three groups according to site of surgery: thoracic (n = 8), abdominal aortic (n = 8), and brain surgery (n = 10). SETTING: University teaching hospital. INTERVENTION: None. MEASUREMENTS: Whole body, segmental (arm, trunk, and legs) BIA at multiple frequency (0.5, 50, 100 kHz) was used to assess perioperative fluid accumulation after surgery. The fluid balances were calculated from the charts. RESULTS: The patients were aged 62+/-4 yrs. Fluid balances were 4.8+/-1.0 L, 4.1+/-0.5 L, and 1.9+/-0.3 L, respectively, in the three groups. In trunk surgery patients, fluid accumulation was detected as a drop in impedance in the operated area at all frequencies. In the operated area, there was an expansion of both intra- and extracellular compartments. A reduction in high frequencies' impedance in the legs was only detected after aortic surgery. Fluid accumulation and trunk impedance changes were strongly correlated. Neurosurgery only induced minor body fluid changes. CONCLUSIONS: Segmental BIA is able to detect and localize perioperative fluid accumulation. It may become a bedside tool to quantify and to localize fluid accumulation.

Therapeutic hypothermia for traumatic brain injury.

Experimental evidence demonstrates that therapeutic temperature modulation with the use of mild induced hypothermia (MIH, defined as the maintenance of body temperature at 32-35 °C) exerts significant neuroprotection and attenuates secondary cerebral insults after traumatic brain injury (TBI). In adult TBI patients, MIH has been used during the acute "early" phase as prophylactic neuroprotectant and in the sub-acute "late" phase to control brain edema. When used to control brain edema, MIH is effective in reducing elevated intracranial pressure (ICP), and is a valid therapy of refractory intracranial hypertension in TBI patients. Based on the available evidence, we recommend: applying standardized algorithms for the management of induced cooling; paying attention to limit potential side effects (shivering, infections, electrolyte disorders, arrhythmias, reduced cardiac output); and using controlled, slow (0.1-0.2 °C/h) rewarming, to avoid rebound ICP. The optimal temperature target should be titrated to maintain ICP <20 mmHg and to avoid temperatures <35 °C. The duration of cooling should be individualized until the resolution of brain edema, and may be longer than 48 h. Patients with refractory elevated ICP following focal TBI (e.g. hemorrhagic contusions) may respond better to MIH than those with diffuse injury. Randomized controlled trials are underway to evaluate the impact of MIH on neurological outcome in adult TBI patients with elevated ICP. The use of MIH as prophylactic neuroprotectant in the early phase of adult TBI is not supported by clinical evidence and is not recommended.

Análisis del ciclo de vida de sistemas de tratamiento de aguas residuales: influencia de los materiales utilizados

En este proyecto se tiene como objetivo comparar una EDAR específica con otras tres, desde el punto de vista ambiental, y establecer diferentes alternativas. En particular, se ha evaluado la mejor alternativa en la obtención de energía eléctrica para la propia utilización de la planta de tratamiento de aguas residuales, a partir del biogás generado en el digestor en la línea de lodos. En este tipo de instalaciones, entre las alternativas tanto en su uso actual como en fase de desarrollo, el motor de cogeneración de electricidad y el calor es el más utilizado para obtener simultáneamente la electricidad necesaria para las instalaciones y el calor necesario para mantener el digestor de lodos a la temperatura de trabajo (36ºC aproximadamente). Las otras alternativas evaluadas en este estudio son las pilas de biogás de membrana electrolítica polimérica (en inglés Polymeric Electrolyte Membrane, PEM) y las pilas de óxidos sólidos (en inglés Solid Oxide Fuel Cells, SOFC) con una turbina de gas (sistema híbrido SOFC-GT). Por otro lado, se estudian las características de los materiales que componen los dispositivos MEC (microbial electrolysis cell) y las pilas PEM y SOFC, así como las ventajas e inconvenientes de usar estas nuevas tecnologías en el tratamiento de aguas residuales, así como la evaluación del impacto ambiental de la EDAR objeto de estudio, que se ha llevado a cabo utilizando el análisis de ciclo de vida (ACV). El ACV es una herramienta que permite comparar diferentes procesos o productos que tengan la misma función, y así evaluar la alternativa que conlleve una mejora en el medio ambiental. La metodología de ACV pretende evaluar en detalle el ciclo de vida completo de un producto o proceso. Un ACV se suele definir de tipo "cradle to grave" o "desde la cuna hasta la tumba" o bien de tipo "gate to gate", o "de puerta a puerta". En el primer caso el estudio analiza el ciclo de vida completo del sistema, dese el origen hasta el final, mientras que en el segundo caso el ACV no tiene en cuenta su disposición final (vertedero, reciclaje, etc.). Un estudio de ACV del primer tipo conlleva hacer un estudio muy detallado, que en la práctica puede resultar muy largo y laborioso por la dificultad de encontrar todos los datos necesarios. Por ello, muchos estudios de ACV que se encuentran en la literatura suelen ser del tipo "gate to gate". Además, hay que esablecer las fronteras del sistema a estudiar, ya que hay procesos que tienen muy poca contribución a las categorías de impacto ambiental. En una EDAR los principales procesos considerados en el ACV llevado a cabo son el consumo de productos químicos, de electricidad, la producción de lodos y su utilización como composta, el biogás y su utilización para producir electricidad, los residuos sólidos y las distintas emisiones al medio producidas por el propio funcionamiento de la EDAR. Las operaciones relacionadas indirectamente como el transporte de los lodos, de productos químicos, de los residuos sólidos y la infraestructura con una vida media de 30 años no influyen significativamente en los resultados, por ejemplo el transporte de los lodos con un camión a 30km contribuyen en menos de 1% en todas las categorías de impacto. De acuerdo con las normativas ISO series 14040 que regulan las pautas de un ACV, se establece una unidad funcional apropiada, o sea habitante equivalente, ya que es la más apropiada por tener en cuenta la carga contaminante en el agua a tratar, parámetro imprescindible para comparar EDARs. Redefiniendo las fronteras, se realiza un ACV del depósito del biogás sin tener en cuenta el resto de la instalación y se toma como unidad funcional m3 de biogás, en el caso concreto de obtener biogás mediante un dispositivo MEC, que maximiza la cantidad de hidrógeno en detrimento de la cantidad de metano contenido en el biogás, observándose que la contribución de un biogás con un alto contenido en hidrógeno y, por tanto bajo en metano, produce una mejora ambiental. Las categorías de impacto ambiental que tienen contribución son el calentamiento global y la oxidación fotoquímica; el dispositivo MEC hace quela contribución a estas categorías de impacto sea de un orden de magnitud inferior con respecto al biogás generado en un digestor. Además, si se produce la combustión del biogás, la única categoría de impacto que tiene contribución es la de calentamiento global; para una dispositivo MEC la contribución sigue siendo un orden de magnitud inferior con respecto al biogás de un digestor de lodos.

Preparació de puntes de tungstè per a microscòpia d'efecte túnel (STM)

Es presenten els resultats experimentals obtinguts durant l’estudi sistemàtic realitzat de la preparació electroquímica de puntes de tungstè per al Microscopi d’Efecte Túnel (STM), fent servir dos electròlits: KOH i NaOH. L’estudi sobre la morfologia, longitud de la punta i radi de curvatura de la punta en funció del voltatge aplicat i les concentracions de l’electròlit es descriu al capítol 3. La caracterització de les puntes es va dur a terme, per una part, mitjançant un microscòpic electrònic de rastreig (SEM) i per l’altre banda, amb el ús de les puntes obtingudes al STM. En resumen, els resultats mostren que ambdós electròlits permeten obtenir puntes que es poden fer servir amb èxit per l’obtenció d’imatges amb l’STM. Les millors puntes són aquelles que s’obtenen dins de rangs de concentracions d’electròlit baixes, entre valor de 10 a 15% en pes pel NaOH i entre 10 i 20% pel KOH i rangs de voltatge entre 3 a 7 V pel NaOH i 4 a 8 V pel KOH. S’observa que es requereixen temps d’atac electroquímic menors fent servir com a electròlit NaOH. S’estudia, en el capítol 4, el tractament que requereix la punta per tal d’eliminar les impureses de la seva superfície. Es realitzen diferents proves amb tres mètodes de neteja: (1) tractament químic, (2) bombardeig iònic i (3) tractament tèrmic de recuit. En el capítol 5 del projecte s’analitzen les imatges d’una mostra d’or, Au(110), d’estructura coneguda, amb el microscopi d’efecte túnel STM) del laboratori fent servir les puntes obtingudes sota les condicions considerades òptimes. El resultat confirma el bon comportament de les puntes obtingudes sota les condicions descrites en els capítols anteriors i establert una pauta a seguir per obtenir puntes d’una manera senzilla i reproduïble.

Water as an essential nutrient: the physiological basis of hydration.

How much water we really need depends on water functions and the mechanisms of daily water balance regulation. The aim of this review is to describe the physiology of water balance and consequently to highlight the new recommendations with regard to water requirements. Water has numerous roles in the human body. It acts as a building material; as a solvent, reaction medium and reactant; as a carrier for nutrients and waste products; in thermoregulation; and as a lubricant and shock absorber. The regulation of water balance is very precise, as a loss of 1% of body water is usually compensated within 24 h. Both water intake and water losses are controlled to reach water balance. Minute changes in plasma osmolarity are the main factors that trigger these homeostatic mechanisms. Healthy adults regulate water balance with precision, but young infants and elderly people are at greater risk of dehydration. Dehydration can affect consciousness and can induce speech incoherence, extremity weakness, hypotonia of ocular globes, orthostatic hypotension and tachycardia. Human water requirements are not based on a minimal intake because it might lead to a water deficit due to numerous factors that modify water needs (climate, physical activity, diet and so on). Water needs are based on experimentally derived intake levels that are expected to meet the nutritional adequacy of a healthy population. The regulation of water balance is essential for the maintenance of health and life. On an average, a sedentary adult should drink 1.5 l of water per day, as water is the only liquid nutrient that is really essential for body hydration.

Pharmacokinetics of synthetic atrial natriuretic peptides in normal men.

The kinetics of atrial natriuretic peptides (ANP) and the kinetic profile of their effect on blood pressure and renal hemodynamic and electrolyte excretion were investigated in 20 salt-loaded healthy volunteers during and after constant rate infusion. At steady state, mean plasma concentrations of ANP were measured at 210, 430, and 2990 pg/ml and mean systemic clearance was 2.6, 2.5, and 1.7 L/min for ANP infusion rates of 0.5, 1, and 5 micrograms/min, respectively, which corresponds to the clearance rate of other vasoactive peptide hormones. The apparent volume of distribution averaged 17 L and the mean half-life was 4.5 minutes. ANP induced dose-related effects on systemic and renal hemodynamic, as well as urinary electrolyte excretion, albeit with a time lag between onset and full effect.

Circadian regulation of renal function.

Urinary excretion of water and all major electrolytes exhibit robust circadian oscillations. The 24-h periodicity has been well documented for several important determinants of urine formation, including renal blood flow, glomerular filtration, tubular reabsorption, and tubular secretion. Disturbance of the renal circadian rhythms is increasingly recognized as a risk factor for hypertension, polyuria, and other diseases and may contribute to renal fibrosis. The origin of these rhythms has been attributed to the reactive response of the kidney to circadian changes in volume and/or in the composition of extracellular fluids that are entrained by rest/activity and feeding/fasting cycles. However, numerous studies have shown that most of the renal excretory rhythms persist for long periods of time, even in the absence of periodic environmental cues. These observations led to the hypothesis of the existence of a self-sustained mechanism, enabling the kidney to anticipate various predictable circadian challenges to homeostasis. The molecular basis of this mechanism remained unknown until the recent discovery of the mammalian circadian clock made of a system of autoregulatory transcriptional/translational feedback loops, which have been found in all tissues studied, including the kidney. Here, we present a review of the growing evidence showing the involvement of the molecular clock in the generation of renal excretory rhythms.

New insights in carbohydrate-deficient transferrin analysis with capillary electrophoresis-mass spectrometry

Capillary zone electrophoresis (CZE) with UV detection has been widely used for the determination of carbohydrate-deficient transferrin (CDT), an indirect marker of the chronic alcohol consumption (≥60-80g/day). A commercially available method (CEofix? CDT kit), containing a bilayer anionic coating, allows for the analysis of CDT with a high resolution between transferrin (Tf) glycoforms with reduced protein adsorption onto the capillary wall. Although widely used in routine analysis, this procedure presents some limitations in terms of selectivity and sensitivity which may be overcome with mass spectrometry (MS). However, the available method is not MS-compatible due to the non-volatile coating as well as the phosphate and borate buffers present in the background electrolyte (BGE). This study firstly consisted in developing MS-compatible separation conditions, i.e., coating and BGE compositions. Numerous cationic, neutral, and anionic coatings were evaluated in combination with BGEs covering a broad range of pH values. A bilayer coating composed of a cationic layer of 10% polybrene (m/v) and an anionic layer of 10% dextran sulfate (m/v) combined with a BGE composed of 20mM ammonium acetate at pH 8.5 provided the best results in terms of glycoforms' resolution, efficiency, adsorption reduction, migration times' repeatability, and coating stability. The method was then transferred to CZE-MS after investigations of the electrospray ionization (ESI) source, equipped with a sheath-flow interface, and the time-of-flight (TOF/MS) parameters. A successful MS detection of tetrasialo-Tf was obtained during infusion, while the experiments highlighted the challenges and issues encountered with intact glycoprotein analysis by CZE-ESI-MS.