Ablación cardiaca en niños y adolescentes: experiencia en la Fundación Cardioinfantil-IC años 2010 -2013

Introducción: Se ha demostrado que la técnica de radiofrecuencia en ablación cardiaca es altamente efectiva en el tratamiento de arritmias cardiacas en pediatría, además de tener un mínimo de complicaciones. En este estudio se exponen los resultados de este procedimiento en un grupo de pacientes pediátricos en la Fundación Cardioinfantil. Población y Métodos: Entre enero de 2010 y diciembre de 2013 se realizaron un total de 231 ablaciones cardiacas. Al aplicar criterios de inclusión y exclusión se obtienen 192 pacientes, de los cuales 58% eran de sexo masculino y 42% de sexo femenino, 43.2% pertenecían a un rango de edad entre 11-15 años. Resultados: La ablación fue exitosa en 185/192 pacientes (Tasa de éxito global 96.3%). Pérdidas durante el seguimiento al primer día 0%, tasa de éxito 100% con cero recurrencias. Control de los 30 días: pérdidas del 8.3%, tasa de éxito del 90.6% y dos recurrencias. Control de los 90 días se tuvieron pérdidas de 30.2%, tasa de éxito de 95.4% y seis recurrencias, finalmente a los 180 días con un porcentaje de pérdidas de 51.5% y siete recurrencias, la tasa de éxito es de 92.5%. En el seguimiento se encontraron 7 recurrencias, las cuales fueron llevadas a un segundo procedimiento que fue efectivo en 7/7 (100)%. No hubo complicaciones ni muertes. Conclusiones: Los resultados obtenidos no difieren de los resultados de estudios de ablación pediátrica en el mundo, definiéndose así como un procedimiento seguro y eficaz en la Fundación Cardioinfantil.

Angiorresonancia versus angiografía por sustracción digital en el seguimiento de aneurismas intracraneales embolizados. Comparación del desempeño diagnóstico

Introducción: La DSA es el método de elección para el seguimiento de pacientes con aneurismas intracraneales embolizados; esta se puede asociar a complicaciones incapacitantes o mortales. La MRA se ha propuesto como método alternativo por menor costo y menos morbi-mortalidad, aunque su desempeño diagnóstico permanece en discusión debido al desarrollo de nuevos protocolos, resonadores más potentes y nuevas aplicaciones de la DSA. Metodología: Exploramos la literatura hasta la actualidad y comparamos el desempeño diagnóstico de la MRA con la DSA para detectar flujo residual posterior a la embolización terapéutica de aneurismas intracraneales. Realizamos una revisión sistemática de la literatura y meta-análisis basados en 34 artículos detectados en la búsqueda que incluyó las bases de datos PubMed, Scopus, ScIELO y BVS. Resultados: La TOF-MRA demostró sensibilidad de 86.8% (84.3%-89.1%) y especificidad de 91.2% (89%-93.1%); la SROC para TOF-MRA demostró un AUC de 0.95. El desempeño de la CE-MRA demostró sensibilidad de 88.1% (84.6%-91.1%) y especificidad de 89.1% (85.7%-91.9%); la SROC presentó una AUC de 0.93. El análisis estratificado por potencia del resonador encontró que la TOF-MRA tiene mejor desempeño con el resonador de 3T, aunque no es estadísticamente significativo. La concordancia interobservador con TOF-MRA y CE-MRA fue moderada a muy buena. Discusión: El desempeño diagnóstico de la MRA en el seguimiento de aneurismas intracraneales embolizados demostró ser bueno, con sensibilidad mayor a 84%, siendo ligeramente mejor con TOF-MRA, sin lograr reemplazar la DSA. Sin embargo, los resultados deben ser evaluados con precaución por la heterogeneidad de los resultados de los estudios incluidos. (Abreviaturas: DSA: Angiografía por Sustracción Digital; MRA: Angiografía por Resonancia Magnética; TOF-MRA: Angiorresonancia por Tiempo de Vuelo; CE-MRA: Angiorresonancia contrastada).

Aislamiento de venas pulmonares en el Centro Internacional de Arritmias ‘Andrea Natale’ - Fundación Cardio infantil

Introducción: El Aislamiento de Venas Pulmonares (AVP) es un procedimiento de alto costo al cual son sometidos pacientes con riesgo cardiovascular elevado. Requiere un alto grado de especialización en el personal médico y paramédico que lo ejecuta, con curvas de aprendizaje que sobrepasan los dos años de formación académica y entrenamiento específico. Metodología: Se realizó un estudio de cohorte retrospectivo, donde se incluyeron 88 sujetos sometidos al procedimiento en el lapso comprendido entre el 1º de enero y el 31 de diciembre de 2013, con el objetivo de evaluar su proceso de atención en el Centro Internacional de Arritmias ‘Andrea Natale’ de la FCI – Instituto de Cardiología. Se realizó análisis de regresión lineal y logística múltiple. Resultados: Se encontró que en el 97,73%% de los pacientes el diagnóstico principal era algún tipo de Fibrilación Auricular (FA); a su vez, la comorbilidad más frecuente fue HTA en el 30,68% y ningún paciente presentaba enfermedad coronaria, no hubo diferencias significativas por sexo. La complicación peri operatoria tuvo una incidencia del 3,41%, el 22,73% requirió ingreso a UCI con un promedio de días estancia 0,25+0,51. El 98,86% de la población estudiada recibió educación pos procedimiento acerca de sus cuidados y signos de alarma. Los factores encontrados en el estudio que afectan la duración del procedimiento y la estancia hospitalaria son las interconsultas pre procedimiento, el manejo médico de la cardiomiopatía de base y el uso de anti agregantes plaquetarios pre procedimiento; los cuales, son puntos por mejorar previo al ingreso o programación del paciente para ser llevado a AVP. Discusión: Como recomendaciones específicas se destacan: La necesidad de incluir en el protocolo de preparación para ablación de venas pulmonares la realización de interconsultas a las especialidades requeridas, antes de su ingreso para la realización del procedimiento. Es importante que el paciente que lo amerite haga parte de un programa de falla cardiaca previamente al procedimiento

Caracterización de las variantes anatómicas de las venas pulmonares en pacientes candidatos a aislamiento de venas pulmonares en Colombia

Introducción y objetivos: El conocimiento de la anatomía de las venas pulmonares y de la aurícula izquierda es fundamental para la planeación y prevención de posibles complicaciones durante la ablación de las venas pulmonares, procedimiento realizado para el manejo de la fibrilación auricular. Este estudio pretende caracterizar la anatomía (tamaño y forma) de las venas pulmonares y determinar las variantes anatómicas más comunes de las mismas. Métodos: Se analizaron 277 estudios de angioresonancia tridimensional y tomografía computarizada realizados previo al procedimiento de aislamiento de venas pulmonares. Se evaluaron los diámetros de la aurícula izquierda, de los ostia de las venas pulmonares y se determinaron la presencia de venas pulmonares comunes, accesorias y ramificaciones tempranas. Resultados: 75% de nuestros pacientes presentaron la anatomía normal de dos venas pulmonares derechas y dos izquierdas. En un 10,1% de los casos se encontraron venas supernumerarias y en un 11,2% se encontró un tronco común. En un 61% de los pacientes se encontraron ramas ostiales, las cuales en un 39,4% de los casos se presentaron en la vena pulmonar inferior derecha. Conclusiones: La evaluación de la morfología de la aurícula derecha y las venas pulmonares por medio de angioresonancia o tomografía computarizada, es necesaria para la realización de ablación por radiofrecuencia dada la alta frecuencia de variantes anatómicas y presencia de ramas ostiales.

Comparación de cambios clínicos y hemodinámicos en pacientes con insuficiencia venosa mixta según tipo de manejo.

Existen varias causas de la insuficiencia venosa profunda, la insuficiencia venosa superficial es una de ellas; por tal motivo, una intervención activa de la insuficiencia superficial ya sea cirugía convencional, esclerosis o radiofrecuencia mejora el reflujo del sistema venoso profundo. En nuestro medio no se acostumbra a intervenir los pacientes con insuficiencia venosa mixta bajo la creencia de exacerbar la enfermedad o generar complicaciones. Se pretende documentar los cambios clínicos y hemodinámicos en pacientes con insuficiencia venosa mixta según tipo de manejo, médico vs quirúrgico

A novel copper(I) complex that is a monomeric single helix in solid state but a dimeric double helix in solution

Single helical [(CuL)-L-I]ClO4.12CH(2)Cl(2) (L=1:2 condensate of benzil dihydrazone and 2-acetylpyridine) unfolds and coils up in CH2Cl2 solution to generate double helical [(Cu2L2)-L-I](2+).

All-or-none (or something in between) transition of DNA

DNA compaction can be caused by multivalent ions as condensing agents. Both discontinuous (all-or-none) and continuous (pearl-necklace structure) transitions have been observed in experiments as the concentration of the condensing agent was increased. We have investigated the DNA transition by analytical calculations in the infinite-chain limit. A mechanism for pearl-necklace structures could be a combinatorial entropy term, which favours a mixture of globules and coils in a single chain. However, when a surface term is taken into account, it gives rise to a discontinuous transition. We also consider the role of surface charges on the globule.

The diversity of arbuscular mycorrhizas of selected Australian Fabaceae

Members of the Australian native perennial Fabaceae have been little explored with regard to their root biology and the role played by arbuscular mycorrhizal (AM) fungi in their establishment, nutrition and long-term health. The ultimate goal of our research is to determine the dependency of native perennial legumes on their co-evolved AM fungi and conversely, the impact of AM fungal species in agricultural fields on the productivity of sown native perennial legume pastures. In this paper we investigate the colonisation morphology in roots and the AMF, identified by spores extracted from rhizosphere soil, from three replicate plots of each of the native legumes, Cullen australasicum, C. tenax and Lotus australis and the exotic legumes L. pedunculatus and Medicago sativa. The plants were grown in an agricultural field. The level and density of colonisation by AM fungi, and the frequency of intraradical and extraradical hyphae, arbuscules, intraradical spores and hyphal coils all differed between host plants and did not consistently differ between native and exotic species. However, there were strong similarities between species in the same genus. The three dominant species of AM fungi in rhizosphere soil also differed with host plant, but one fungus (Glomus mosseae) was always the most dominant. Sub-dominant AM species were the same between species in the same genus. No consistent differences in dominant spores were observed between the exotic and native Fabaceae species. Our results suggest that plant host influences the mycorrhizal community in the rhizosphere soil and that structural and functional differences in the symbiosis may occur at the plant genus level, not the species level or due to provenance.

Host-parasite-environment relationship, morphology and molecular analyses of Henneguya eirasi n. sp parasite of two wild Pseudoplatystoma spp. in Pantanal Wetland, Brazil

A new myxosporean species, Henneguya eirasi n. sp., is described parasitizing the gill filaments of Pseudoplatystoma corruscans and Pseudoplatystoma fasciatum (Siluriformes: Pimelodidae) caught in the Patanal Wetland of the state of Mato Grosso, Brazil. The parasite formed white, elongated plasmodia measuring up to 3 mm. Mature spores were ellipsoidal in the frontal view, measuring 37.1 +/- 1.8 mu m in total length, 12.9 +/- 0.8 mu m in body length, 3.4 +/- 0.3 mu m in width, 3.1 +/- 0.1 mu m in thickness and 24.6 +/- 2.2 mu m in the caudal process. Polar capsules were elongated and equal in size, measuring 5.4 +/- 0.5 mu m in length and 0.7 +/- 0.1 mu m in width. Polar filaments had 12-13 coils. Histopathological analysis revealed that the parasite developed in the sub-epithelial connective tissue of the gill filaments and the plasmodia were surrounded by a capsule of host connective tissue. The plasmodia caused slight compression of the adjacent tissues, but no inflammatory response was observed in the infection site. Ultrastructure analysis revealed a single plasmodial wall connected to the ectoplasmic zone through numerous pinocytotic canals. The plasmodial wall exhibited numerous projections and slightly electron-dense material was found in the ectoplasm next to the plasmodial wall, forming a line just below the wall. Partial sequencing of the 18S rDNA gene of H. eirasi n. sp. obtained from P. fasciatum resulted in a total of 1066 bp and this sequence did not match any of the Myxozoa available in the GenBank. Phylogenetic analysis revealed the Henneguya species clustering into clades following the order and family of the host fishes. H. eirasi n. sp. clustered alone in one clade, which was the basal unit for the clade composed of Henneguya species parasites of siluriform ictalurids. The prevalence of the parasite was 17.1% in both fish species examined. Parasite prevalence was not influenced by season, host sex or host size. (C) 2011 Elsevier B.V. All rights reserved.

Solid-state NMR characterization of a series of copolymers containing fluorene, phenylene and thiophene units

Fluorene and thiophene units are commonly used in polymeric materials for electro-optical applications. Due to differences in reactivity, the final composition of polymers containing these components often differs from that used in their preparation. This contribution describes the synthesis of PPV type terpolymers built by fluorene, phenylene and thiophene units and their quantification by CPMAS NMR. The similarity of the three aromatic co-monomers makes it difficult to separate the analytical responses that would allow quantification of each copolymer unit in the chain. In this sense, we show that the combination of dipolar dephased CPMAS with radiofrequency ramp and proper spectral treatment allows a good estimation and quantification of the copolymer constitution. (C) 2011 Elsevier Ltd. All rights reserved.

Deciphering the role of the electrostatic interactions in the alpha-tropomyosin head-to-tail complex

Skeletal alpha-tropomyosin (Tm) is a dimeric coiled-coil protein that forms linear assemblies under low ionic strength conditions in vitro through head-to-tail interactions. A previously published NMR structure of the Tin head-to-tail complex revealed that it is formed by the insertion of the N-terminal coiled-coil of one molecule into a cleft formed by the separation of the helices at the C-terminus of a second molecule. To evaluate the contribution of charged residues to complex stability, we employed single and double-mutant Tm fragments in which specific charged residues were changed to alanine in head-to-tail binding assays, and the effects of the mutations were analyzed by thermodynamic double-mutant cycles and protein-protein docking. The results show that residues K5, K7, and D280 are essential to the stability of the complex. Though D2, K6, D275, and H276 are exposed to the solvent and do not participate in intermolecular contacts in the NMR structure, they may contribute to head-to-tail complex stability by modulating the stability of the helices at the Tm termini.

Structure, processing and midgut secretion of putative peritrophic membrane ancillary protein (PMAP) from Tenebrio molitor larvae

A cDNA coding for a Tenebrio molitor midgut protein named peritrophic membrane ancillary protein (PMAP) was cloned and sequenced. The complete cDNA codes for a protein of 595 amino acids with six insect-allergen-related-repeats that may be grouped in A (predicted globular)- and B (predicted nonglobular)-types forming an ABABAB structure. The PMAP-cDNA was expressed in Pichia pastoris and the recombinant protein (64 kDa) was purified to homogeneity and used to raise antibodies in rabbits. The specific antibody detected PMAP peptides (22 kDa) in the anterior and middle midgut tissue, luminal contents, peritrophic membrane and feces. These peptides derive from PMAP, as supported by mass spectrometry, and resemble those formed by the in vitro action of trypsin on recombinant PMAP. Both in vitro and in vivo PMAP processing seem to occur by attack of trypsin to susceptible bonds in the coils predicted to link AB pairs, thus releasing the putative functional AB structures. The AB-domain structure of PMAP is found in homologous proteins from several insect orders, except lepidopterans that have the apparently derived protein known as nitrile-specifier protein. Immunocytolocalization shows that PMAP is secreted by exocytosis and becomes entrapped in the glycocalyx, before being released into midgut contents. Circumstantial evidence suggests that PMAP-like proteins have a role in peritrophic membrane type 2 formation. (C) 2007 Elsevier Ltd. All rights reserved.

Replacing Finned Copper withCorrugated Stainless Steel, forthe Heat Exchangers of a SolarCombisystem Store : Performance and EconomicEvaluation

The importance of investigating cost reduction in materials and components for solar thermal systems is crucial at the present time. This work focuses on the influence of two different heat exchangers on the performance of a solar thermal system. Both heat exchangers studied are immersed helically coiled, one made with corrugated stainless steel tube, and the other made with finned copper tube with smooth inner surface.A test apparatus has been designed and a simple test procedure applied in order to study heat transfer characteristics and pressure drop of both coils. Thereafter, the resulting experimental data was used to perform a parameter identification of the heat exchangers, in order to obtain a TRNSYS model with its corresponding numerical expression. Also a representative small-scale combisystem model was designed in TRNSYS, in order to study the influence of both heat exchangers on the solar fraction of the system, when working at different flow rates.It has been found that the highest solar fraction is given by the corrugated stainless steel coil, when it works at the lowest flow rate (100 l/hr). For any higher flow rate, the studied copper coil presents a higher solar fraction. The advantageous low flow performance of stainless steel heat exchanger turns out to be beneficial for the particular case of solar thermal systems, where it is well known that low flow collector loops lead to enhanced store stratification, and consequently higher solar fractions.Finally, an optimization of the stainless steel heat exchanger length is carried out, according to economic figures. For the given combisystem model and boundary conditions, the optimum length value is found between 10 and 12 m.

Caracterização de compósitos Nb-20%cu obtidos por moagem de alta energia e sinterizados por fase líquida

In this work, was studied the formation of a composite of the refractory metal niobium with copper, through the process of high-energy milling and liquid phase sintering. The HEM can be used to synthesize composite powders with high homogeneity and fine size particle distribution. It may also produce the solid solubility in immiscible systems such as Nb-Cu, or extend the solubility of systems with limited solubility. Therefore, in the immiscible system Cu-Nb, the high-energy milling was successfully used to obtain the composite powder particles. Initially, the formation of composite particles during the HEM and the effect of preparation technique on the microstructure of the material was evaluated. Four loads of Nb and Cu powders containing 20%wt Cu were synthesized by MAE in a planetary type ball mill under different periods of grinding. The influence of grinding time on the metal particles is evaluated during the process by the withdrawal of samples at intermediate times of milling. After compaction under different forces, the samples were sintered in a vacuum furnace. The liquid phase sintering of these samples prepared by HEM produced a homogeneous and fine grained. The composite particles forming the sintered samples are the addition of a hard phase (Nb) with a high melting point, and a ductile phase (Cu) with low melting point and high thermal and electrical conductivities. Based on these properties, the Nb-Cu system is a potential material for many applications, such as electrical contacts, welding electrodes, coils for generating high magnetic fields, heat sinks and microwave absorbers, which are coupled to electronic devices. The characterization techniques used in this study, were laser granulometry, used to evaluate the homogeneity and particle size, and the X-ray diffraction, in the phase identification and to analyze the crystalline structure of the powders during milling. The morphology and dispersion of the phases in the composite powder particles, as well the microstructures of the sintered samples, were observed by scanning electron microscopy (SEM). Subsequently, the sintered samples are evaluated for density and densification. And finally, they were characterized by techniques of measuring the electrical conductivity and microhardness, whose properties are analyzed as a function of the parameters for obtaining the composite

Efeitos biológicos in vitro de agentes físicos utilizados em fisioterapia

The uses of radiobiocomplexes labeled with technetium-99m contributed to health science advances. Stannous chloride (SnCl2) has been used as a reducing agent for the labeling process. Cytotoxic and genotoxic effect of the SnCl2 have been described in several studies and with this experimental models alterations in molecular and cellular level can be evaluated. In the last years the physicals therapists acquired new devices which emits electromagnetic radiation such us Extremely Low Frequency Pulsated Electromagnetic Fields (E.L.F. P.E.M.F.), radiofrequency, Intense Pulsed Light (I.P.L.) and others which emits sonic waves such us Biorresonance. Scientific evidence of the effects and dosage is important to protect public health and to reach exposition levels that result in significant biological effects. The aim of this project is to verify the effects of these physical agents in plasmid DNA and E. coli AB1157 cultures in presence or absence of SnCl2 and the effects in blood constituents labeled with technetium-99m. Wistar rats blood was exposed to the cited sources and the labelling of blood constituents with 99mTc was carried through. Cultures of E. coli AB1157 and plasmidial samples DNA had been also exposed the physical agents. The results suggest that these agents are capable of altering neither the survival of E. coli cells or plasmid DNA electrophoresis mobility. The multidiscipline character was clearly in this study due the interaction between Nuclear Medicine department of the UERJ and the Laboratory of Physical Agents of the Maimonides University in Argentina until the union between the teacher (biomedical and physiotherapist) and student (physiotherapist), besides collaborators of the area of Physics and Biology, promoting new ideas and perspectives and also adding the knowledge of different areas and origins