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Mira JJ, Torres D, Gil V, Carratalá C. Loneliness impact on healthcare utilization in primary care: A retrospective study. J Healthc Qual Res 2024:S2603-6479(24)00027-7. [PMID: 38670900 DOI: 10.1016/j.jhqr.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/13/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND An increased number of patients seek help for loneliness in primary care. OBJECTIVE To analyze whether loneliness was associated with a higher utilization of healthcare facilities. METHODS Observational, retrospective study based on the review of routinely coded data in the digital medical record system in a random sample of patients aged 65 or older, stratified by population size of their residence area. A minimum sample size was estimated at 892 medical records. Loneliness was defined as the negative feeling that arises when there is a mismatch between the quantity and quality of a person's social relationships and those, they desire. Thirty-three primary care nurses (30 females and 3 males) were reviewing the data. RESULTS A total of 932 medical records of patients were reviewed (72% belonged to female patients). Of these, 657 individuals were living alone (71.9%). DeJong Scale average scores was 8.9 points (SD 3.1, 95CI 8.6-9.1). The average annual attendance to primary care ranged from 12.2 visits per year in the case of family practice, 10.7 nurse, 0.7 social workers. The average number of home visits was 3.2, and the urgent consultations attended at health centers were 1.5 per year. Higher feelings of loneliness were associated with extreme values in the frequency of healthcare resource usage. Compared to their peers of the same age, the additional healthcare resource consumption amounted to €802.18 per patient per year. CONCLUSION Loneliness is linked to higher healthcare resource usage in primary care, with individuals experiencing poorer physical and mental health utilizing these resources up to twice as much as their peers of the same age.
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Affiliation(s)
- J J Mira
- Healthcare District Alicante-Sant Joan, Fisabio, Alicante, Spain; Health Psychology Department, Universidad Miguel Hernandez, Elche, Spain; RICAPPS (Research Network on Chronicity, Primary Care, and Prevention and Health Promotion), Spain.
| | - D Torres
- Healthcare District Alicante-Sant Joan, Fisabio, Alicante, Spain
| | - V Gil
- RICAPPS (Research Network on Chronicity, Primary Care, and Prevention and Health Promotion), Spain; Medicine Department, Universidad Miguel Hernandez, Sant Joan, Spain
| | - C Carratalá
- RICAPPS (Research Network on Chronicity, Primary Care, and Prevention and Health Promotion), Spain; Medicine Department, Universidad Miguel Hernandez, Sant Joan, Spain
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2
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Martín-Mojarro E, Gil V, Llorens P, Flores-Quesada S, Troiano-Ungerer OJ, Alquézar-Arbé A, Jacob J, Herrero P, Sánchez C, Miró Ò. Factors associated with unjustified chronic treatment with digoxin in patients with acute heart failure and relationship with short-term prognosis. Rev Clin Esp 2023; 223:532-541. [PMID: 37716426 DOI: 10.1016/j.rceng.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 08/18/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVES To analyze the factors related to inadequate chronic treatment with digoxin and whether the inadequacy of treatment has an impact on short-term outcome. METHOD Patients diagnosed with AHF who were in chronic treatment with digoxin, were selected. Digoxin treatment was classified as adequate or inadequate. We investigated factors associated to inadequacy and whether such inadequacy was associated with in-hospital and 30-day mortality, prolonged hospital stay (>7 days) and combined adverse event (re-consultation to the ED or hospitalization for AHF or death from any cause) during the 30 days after discharge. RESULTS We analyzed 2,366 patients on chronic digoxin treatment (median age = 83 years, women = 61%), which was considered adequate in 1,373 cases (58.0%) and inadequate in 993 (42.0%). The inadequacy was associated with older age, less comorbidity, less treatment with beta-blockers and renin-angiotensin inhibitors, better ventricular function, and worse Barthel index. In-hospital and 30-day mortality was higher in patients with inadequate digoxin treatment (9.9% versus 7.6%, p = 0.05; and 12.6% versus 9.1%, p < 0.001, respectively). No differences were recorded in prolonged stay (35.7% versus 33.8%) or post-discharge adverse events (32.9% versus 31.8%). In the model adjusted for baseline and decompensation episode differences, inadequate treatment with digoxin was not significantly associated with any outcome, with an odds ratio of 1.31 (95%CI = 0.85-2.03) for in-hospital mortality; 1.29 (0.74-2.25) for 30-day mortality; 1.07 (0.82-1.40) for prolonged stay; and 0.88 (0.65-1.19) for post-discharge adverse event. CONCLUSION There is a profile of patients with AHF who inadequately receive digoxin, although this inadequateness for chronic digitalis treatment was not associated with short-term adverse outcomes.
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Affiliation(s)
- E Martín-Mojarro
- Servicio de Urgencias, Hospital Sant Pau i Santa Tecla, Tarragona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - V Gil
- Área de Urgencias, Hospital Clínic Barcelona, IDIBAPS, Universitat de Barcelona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General Dr. Balmis, Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - S Flores-Quesada
- Servicio de Urgencias, Hospital Sant Pau i Santa Tecla, Tarragona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - O J Troiano-Ungerer
- Servicio de Urgencias, Hospital Sant Pau i Santa Tecla, Tarragona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - A Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - J Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - P Herrero
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - C Sánchez
- Servicio de Urgencias, Hospital Universitari de Vic, Barcelona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain
| | - Ò Miró
- Área de Urgencias, Hospital Clínic Barcelona, IDIBAPS, Universitat de Barcelona, Spain; Servicio de Urgencias, Consorci Hospitalari de Terrassa, Barcelona, Spain.
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3
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Kozmai A, Porozhnyy M, Gil V, Dammak L. Phenylalanine Losses in Neutralization Dialysis: Modeling and Experiment. Membranes (Basel) 2023; 13:membranes13050506. [PMID: 37233567 DOI: 10.3390/membranes13050506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023]
Abstract
A non-steady state mathematical model of an amino acid (phenylalanine (Phe)) and mineral salt (NaCl) solution separation by neutralization dialysis (ND) carried out in a batch mode is proposed. The model takes into account the characteristics of membranes (thickness, ion-exchange capacity, and conductivity) and solutions (concentration, composition). As compared to previously developed models, the new one considers the local equilibrium of Phe protolysis reactions in solutions and membranes and the transport of all the phenylalanine forms (zwitterionic, positively and negatively charged) through membranes. A series of experiments on ND demineralization of the NaCl and Phe mixed solution was carried out. In order to minimize Phe losses, the solution pH in the desalination compartment was controlled by changing the concentrations of the solutions in the acid and alkali compartments of the ND cell. The validity of the model was verified by comparison of simulated and experimental time dependencies of solution electrical conductivity and pH, as well as the concentration of Na+, Cl- ions, and Phe species in the desalination compartment. Based on the simulation results, the role of Phe transport mechanisms in the losses of this amino acid during ND was discussed. In the experiments carried out, the demineralization rate reached 90%, accompanied by minimal Phe losses of about 16%. Modeling predicts a steep increase in Phe losses when the demineralization rate is higher than 95%. Nevertheless, simulations show that it is possible to achieve a highly demineralized solution (by 99.9%) with Phe losses amounting to 42%.
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Affiliation(s)
- Anton Kozmai
- Membrane Institute, Kuban State University, 149, Stavropolskaya Str., 350040 Krasnodar, Russia
| | - Mikhail Porozhnyy
- Membrane Institute, Kuban State University, 149, Stavropolskaya Str., 350040 Krasnodar, Russia
| | - Violetta Gil
- Membrane Institute, Kuban State University, 149, Stavropolskaya Str., 350040 Krasnodar, Russia
| | - Lasaad Dammak
- Institut de Chimie et des Materiaux Paris-Est (ICMPE), UMR 7182 CNRS-Universite Paris-Est Creteil, 2 Rue Henri Dunant, 94320 Thiais, France
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4
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Carratalá-Perales JM, Gil V, Andueza JA. Comments on "Characteristics of prolonged non-invasive ventilation in hospital emergency departments and their impact on efficacy. Analysis of the VNICat registry". Med Intensiva 2022; 46:658-659. [PMID: 36257881 DOI: 10.1016/j.medine.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/23/2022] [Indexed: 06/16/2023]
Affiliation(s)
- J M Carratalá-Perales
- Urgencias y Unidad Corta Estancia, Hospital General Universitario de Alicante, ISABIAL, Alicante, Spain
| | - V Gil
- Àrea d'Urgències, Hospital Clínic Barcelona; "Emergencies: processes and pathologies" Research Group, IDIBAPS, Universidad de Barcelona, Barcelona, Spain.
| | - J A Andueza
- Servicio de Urgencias, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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5
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Gil V, Oshchepkov M, Ryabova A, Trukhina M, Porozhnyy M, Tkachenko S, Pismenskaya N, Popov K. Application and Visualization of Fluorescent-Tagged Antiscalants in Electrodialysis Processing of Aqueous Solutions Prone to Gypsum Scale Deposition. Membranes (Basel) 2022; 12:1002. [PMID: 36295761 PMCID: PMC9607176 DOI: 10.3390/membranes12101002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 10/05/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
Membrane scaling is a serious problem in electrodialysis. A widely used technique for controlling scale deposition in water treatment technologies is the application of antiscalants (AS). The present study reports on gypsum scale inhibition in electrodialysis cell by the two novel ASs: fluorescent-tagged bisphosphonate 1-hydroxy-7-(6-methoxy-1,3-dioxo-1Hbenzo[de]isoquinolin-2(3H)-yl)heptane-1,1-diyl-bis(phosphonic acid), HEDP-F and fluorescein-tagged polyacrylate, PAA-F2 (molecular mass 4000 Da) monitored by chronopotentiometry and fluorescent microscopy. It was found that cation-exchange membrane MK-40 scaling is sufficiently reduced by both ASs, used in 10-6 mol·dm-3 concentrations. PAA-F2 at these concentrations was found to be more efficient than HEDP-F. At the same time, PAA-F2 reveals gypsum crystals' habit modification, while HEDP-F does not noticeably affect the crystal form of the deposit. The strong auto-luminescence of MK-40 hampers visualization of both PAA-F2 and HEDP-F on the membrane surface. Nevertheless, PAA-F2 is proved to localize partly on the surface of gypsum crystals as a molecular adsorption layer, and to change their crystal habit. Crystal surface coverage by PAA-F2 appears to be nonuniform. Alternatively, HEDP-F localizes on the surface of a deposit tentatively in the form of [Ca-HEDP-F]. The proposed mechanisms of action are formulated and discussed. The application of antiscalants in electrodialysis for membrane scaling mitigation is demonstrated to be very promising.
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Affiliation(s)
- Violetta Gil
- Department of Physical Chemistry, Kuban State University, 149 Stavropolskaya Str., 350040 Krasnodar, Russia
| | - Maxim Oshchepkov
- Department of Physical Chemistry, Kuban State University, 149 Stavropolskaya Str., 350040 Krasnodar, Russia
- Department of Chemical and Pharmaceutical Technologies and Biomedical Pharmaceuticals, Mendeleev University of Chemical Technology of Russia, Miusskaya Sq. 9, 125047 Moscow, Russia
| | - Anastasia Ryabova
- Prokhorov General Physics Institute of the Russian Academy of Sciences, Vavilov Str., 38, 119991 Moscow, Russia
| | - Maria Trukhina
- JSC “Fine Chemicals R&D Centre”, Krasnobogatyrskaya, Str. 42, b 1, 107258 Moscow, Russia
| | - Mikhail Porozhnyy
- Department of Physical Chemistry, Kuban State University, 149 Stavropolskaya Str., 350040 Krasnodar, Russia
| | - Sergey Tkachenko
- Department of Chemical and Pharmaceutical Technologies and Biomedical Pharmaceuticals, Mendeleev University of Chemical Technology of Russia, Miusskaya Sq. 9, 125047 Moscow, Russia
- JSC “Fine Chemicals R&D Centre”, Krasnobogatyrskaya, Str. 42, b 1, 107258 Moscow, Russia
| | - Natalia Pismenskaya
- Department of Physical Chemistry, Kuban State University, 149 Stavropolskaya Str., 350040 Krasnodar, Russia
| | - Konstantin Popov
- JSC “Fine Chemicals R&D Centre”, Krasnobogatyrskaya, Str. 42, b 1, 107258 Moscow, Russia
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R Santos R, Abecasis J, Maltes S, Mendes GS, Guerreiro S, Padrao C, Freitas P, Ferreira A, Ribeiras R, Andrade MJ, Cardim N, Gil V, Neves JP, Ramos S, Mendes M. Relative apical sparing in severe aortic stenosis: does it mean concomitant amyloid cardiomyopathy? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Relative apical sparing (RAS) of left ventricular (LV) longitudinal strain (LS) is a red flag marker for the suspicion of amyloid cardiomyopathy. However, it has also been described in patients with severe aortic stenosis (AS).
Aim
To assess the prevalence of RAS in patients with severe symptomatic AS referred for surgical aortic valve replacement (AVR), to evaluate its clinical significance and assess its presence after surgery.
Methods
We prospectively studied 135 consecutive patients (age: 73 y [IQR 68–77 y], 49% men) with severe symptomatic AS – mean transaortic pressure gradient (AVmean): 60.9±17.7 mmHg; mean aortic valve area: 0.7±0.2 cm2, referred for surgical AVR with no previous history of ischemic cardiomyopathy or other. Beyond 12 lead-ECG and transthoracic echocardiography (TTE), all patients underwent cardiac magnetic resonance (CMR) before surgery. RAS was defined by the ratio >1 of average LS at apical segments/sum of the average basal and mid LS at speckle tracking analysis. AVR with septal myocardial biopsy, for investigational purposes, was performed in 80 patients. AS severity indexes, LV remodeling and tissue characterization parameters were compared in both groups of patients, with and without RAS. LS deformation pattern was reassessed at 3–6 months after AVR.
Results
RAS was present in 24 patients (18%). In the whole cohort there were neither pseudoinfarct pattern or low voltage ECG criteria, nor infiltration suspicion from CMR (native T1 value 1053 ms [IQR 1025–1071 ms] for institutional reference values: 972–1070 ms; ECV 24% [IQR 21–27%]). None of the patients had amyloid deposition at histopathology. Overall, mean CMR LV ejection fraction (LVEF) was 59.6±10.5% and 98 patients (74%) had non-ischemic delayed enhancement, with a median fibrosis fraction of 4.1% [IQR 1.6–7.8%]. RAS cohort had a significantly higher AVmean gradient, relative wall thickness, maximum septal thickness, peak systolic dispersion, with lower global LS at TTE, as well as higher LV mass and lower LVEF at CMR. RAS group has also higher NT-proBNP ambulatory values (Table 1). Follow-up evaluation after AVR revealed RAS disappearance in 19 patients (79.2%).
Conclusions
RAS occurs in almost one-fifth of the patients in this cohort despite the absence of signs of myocardial infiltration. This deformation pattern elapses with worse indexes of LV remodeling consistent with a more advanced stage of the disease, being reversible after AVR, which stands for the absence of concomitant myocardial infiltration.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - S Maltes
- Hospital Santa Cruz , Lisbon , Portugal
| | | | | | - C Padrao
- Hospital Santa Cruz , Lisbon , Portugal
| | - P Freitas
- Hospital Santa Cruz , Lisbon , Portugal
| | | | | | | | - N Cardim
- Nova Medical School , Lisbon , Portugal
| | - V Gil
- Hospital da Luz, SA , Lisbon , Portugal
| | - J P Neves
- Hospital Santa Cruz , Lisbon , Portugal
| | - S Ramos
- Hospital Santa Cruz , Lisbon , Portugal
| | - M Mendes
- Hospital Santa Cruz , Lisbon , Portugal
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7
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R Santos R, Abecasis J, Maltes S, Mendes GS, Oliveira L, Horta E, Guerreiro S, Freitas P, Ferreira A, Ribeiras R, Andrade MJ, Cardim N, Gil V, Mendes M, Neves JP. Left ventricular remodeling in aortic stenosis patients referred for surgical aortic valve replacement. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Left ventricular (LV) hypertrophy is a common expected finding in aortic stenosis (AS) patients. Cardiac magnetic resonance (CMR) plays an important role as a non-invasive method for determining LV mass and volume, and to characterize the LV remodeling response in AS.
Aim
To assess the prevalence, to describe the patterns and evolution of LV remodeling (by CMR) in AS patients referred for surgical aortic valve replacement (AVR).
Methods
Single-center prospective cohort of 132 consecutive patients (73 years [68–77 years], 49% men] with severe AS: mean transaortic pressure gradient (AVmean): 61±1.5 mmHg; aortic valve area (AVA): 0.7±0.1 cm2, referred for surgical AVR, with no previous history of ischemic cardiomyopathy. Before surgery, all patients underwent electrocardiogram, complete transthoracic echocardiogram (TTE) and CMR for LV assessment and tissue characterization (mean LV indexed mass [LVMi]: 80.3±26.5 g/m2; mean end-diastolic LV indexed volume [LVEDVi]: 84.4±24.5 mL/m2 and median geometric remodeling ratio [M/V]: 0.95 g/mL [IQR 0. 81–1.08 g/mL]). Patterns of LV remodeling were investigated before and after AVR by CMR measurements of LVMi, LVEDVi and M/V. Besides normal LV ventricular structure, four other patterns were considered: concentric remodeling, concentric hypertrophy, eccentric hypertrophy, and adverse remodeling (Figure 1).
Results
Overall, 43% (n=58) of the patients had concentric hypertrophy, 30% (n=40) concentric remodeling, 22% (n=29) normal ventricular geometry, 4% (n=5) eccentric hypertrophy and in two patients we observed an adverse remodeling pattern. AVR was performed in 80 patients. At the 3rd to 6th month post-AVR assessment, LV remodeling changed to: normal ventricular geometry in 46%, concentric remodeling in 31%, concentric hypertrophy in 19%, eccentric hypertrophy in 3% and adverse remodeling in only one patient (Figure 1).
Conclusions
In this group of patients with severe aortic stenosis, concentric hypertrophy was not the sole pattern of LV remodeling and two out of every five still presented a normal ventricular geometry and mass as assessed by CMR. LV response was dynamic after AVR which stands for complex and multifactorial interaction in these group of patients despite similar valvular pathophysiology and therapeutic intervention.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - S Maltes
- Hospital Santa Cruz , Lisbon , Portugal
| | | | - L Oliveira
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - E Horta
- Hospital Santa Cruz , Lisbon , Portugal
| | | | - P Freitas
- Hospital Santa Cruz , Lisbon , Portugal
| | | | | | | | - N Cardim
- Nova Medical School , Lisbon , Portugal
| | - V Gil
- Hospital da Luz, SA , Lisbon , Portugal
| | - M Mendes
- Hospital Santa Cruz , Lisbon , Portugal
| | - J P Neves
- Hospital Santa Cruz , Lisbon , Portugal
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R Santos R, Abecasis J, Maltes S, Mendes GS, Oliveira L, Horta E, Guerreiro S, Freitas P, Ferreira A, Ribeiras R, Andrade MJ, Cardim N, Gil V, Mendes M, Neves JP. Cardiac magnetic resonance patterns of left ventricular hypertrophy in aortic stenosis patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Left ventricular (LV) hypertrophy is a known compensatory mechanism to pressure overload in aortic stenosis (AS) patients. However, by cardiac magnetic resonance (CMR) different patterns of LV adaptation are seen in this group of patients.
Aim
To describe the patterns of LV adaptation (by CMR) and to analyze its structure and function indexes in AS patients referred for surgical aortic valve replacement (AVR).
Methods
We prospectively studied 134 consecutive patients (age: 73y [IQR 68–77y], 49% men) with severe symptomatic AS - mean transaortic pressure gradient (AVmean): 61±1.5 mmHg; mean aortic valve area: AVA): 0.7±0.1 cm2, referred for surgical AVR with no previous history of ischemic cardiomyopathy or other. All patients underwent electrocardiogram, 2D transthoracic echocardiogram (TTE) and cardiac magnetic resonance (CMR) before surgery for LV assessment and tissue characterization. Five patterns of LV structure were considered: normal ventricular structure (normal LV mass/volume ratio [M/V], normal LVMi and normal indexed LV end-diastolic volume (LVEDVi); concentric remodeling: increased M/V, normal LVMi; concentric hypertrophy: increased M/V and LVMi; eccentric hypertrophy: increased LVMi and LVEDVi, normal M/V and ejection fraction; and adverse remodeling: dilated left ventricle, increased LVMi and normal M/V in the context of an impaired ejection fraction. Echocardiogram and CMR structural and functional indexes were compared between these groups.
Results
At baseline study, at CMR: mean LV indexed mass [LVMi]: 80.3±26.5 g/m2; mean end-diastolic LV indexed volume [LVEDVi]: 84.4±24.5 mL/m2 and median geometric remodeling ratio [M/V]: 0.95 g/mL [IQR 0. 81–1.08 g/mL]. Overall, 22% patients had normal LV structure, 30% concentric remodeling ventricular geometry, and two patients had an adverse remodeling pattern. LV hypertrophy was the most prevalent pattern and occurred in 48% of subjects (concentric 43%; eccentric 4%). In our cohort, the severity of AS (AVmean (p<0.001), LV function (LV ejection fraction [p<0.001] and Global longitudinal strain [p<0.001]), LV loading conditions (indexed left atrial volume [p<0.001] and E/e' ratio [p<0.001]) and NT-proBNP (p<0.001) were related to the pattern of LV structure (Table 1).
Conclusions
In our cohort, AS patients presented several distinct patterns of LV remodeling. Disease severity, functional repercussion and loading conditions are distinct between them.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - S Maltes
- Hospital Santa Cruz , Lisbon , Portugal
| | | | - L Oliveira
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - E Horta
- Hospital Santa Cruz , Lisbon , Portugal
| | | | - P Freitas
- Hospital Santa Cruz , Lisbon , Portugal
| | | | | | | | - N Cardim
- Nova Medical School , Lisbon , Portugal
| | - V Gil
- Hospital da Luz, SA , Lisbon , Portugal
| | - M Mendes
- Hospital Santa Cruz , Lisbon , Portugal
| | - J P Neves
- Hospital Santa Cruz , Lisbon , Portugal
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9
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R Santos R, Abecasis J, Maltes S, Mendes GS, Oliveira L, Horta E, Guerreiro S, Freitas P, Ferreira A, Ribeiras R, Andrade MJ, Cardim N, Gil V, Mendes M, Neves JP. Left ventricular reverse remodeling in post operative aortic stenosis patients: prevalence and predictor(s). Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In patients with severe aortic stenosis (AS), left ventricular (LV) remodeling is believed to be a compensatory adaptive process which should reverse after aortic valve intervention. However, this is not always the rule and remodeling persistence may negatively impact post-procedural outcomes and survival.
Aim
To assess the prevalence and predictors of morphological LV reverse remodeling in severe symptomatic AS patients after surgical aortic valve replacement (AVR).
Methods
We prospectively studied 75 patients (72y [68–77y], 45% male) with severe symptomatic AS - mean gradient (AVM): 61±17mmHg; mean indexed aortic valve area (AVAi) 0.41±0.10 cm2/m2 with no previous history of ischemic cardiomyopathy, all with high gradient, 4 with low-flow, 81% with hypertension, 27% with type 2 diabetes mellitus and 35% patients with stage 3 chronic kidney disease: median MDR creat clearance: 70.4mL/min [40–102]. All patients performed pre-operative cardiac magnetic resonance (CMR) at a mean period of 3.4 months (0–17 months) before AVR and at the 3–6th months after AVR, for LV reverse remodeling assessment. It was defined as at least the occurrence of one of the following: >15% reduction in LVEDVi; >15% reduction in LVMi by CMR; >10% reduction in geometric remodeling ratio. Clinical, AV severity data, preoperative functional LV and tissue characterization data were analyzed at multivariate regression to predict the occurrence of LV reverse remodeling.
Results
Overall, at pre-operative CMR: mean LV indexed mass (LVMi): 82±28.9 g/m2; mean end-diastolic LV indexed volume (LVEDVi): 87.4±26.6 mL/m2; mean geometric remodeling (LV mass/end-diastolic volume): 0.92±0.2 g/mL. After AVR, at echocardiographic evaluation, no patient had prosthetic obstruction or prosthetic patient mismatch: median LV-Ao gradient 12mmHg [9.1–14 mmHg]; 5 of them had mild paravalvular regurgitation. LV reverse remodeling occurred in 65 patients (88%) (Figure 1A) and these were younger, had significantly smaller preoperative AVAi and higher valvular gradients (Figure 1B). At multivariate analysis, only preoperative AVAi remained an independent predictor (odds ratio 0.85, 95% CI 0.735–0.984, p=0.029).
Conclusions
In this prospective cohort of patients LV reverse remodeling after surgical AVR was highly frequent, occurring in almost nine out of every ten patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | - S Maltes
- Hospital Santa Cruz , Lisbon , Portugal
| | | | - L Oliveira
- Hospital Divino Espirito Santo , Ponta Delgada , Portugal
| | - E Horta
- Hospital Santa Cruz , Lisbon , Portugal
| | | | - P Freitas
- Hospital Santa Cruz , Lisbon , Portugal
| | | | | | | | - N Cardim
- Nova Medical School , Lisbon , Portugal
| | - V Gil
- Hospital da Luz, SA , Lisbon , Portugal
| | - M Mendes
- Hospital Santa Cruz , Lisbon , Portugal
| | - J P Neves
- Hospital Santa Cruz , Lisbon , Portugal
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Sánchez-Marcos C, Jacob J, Llorens P, Rodríguez B, Martín-Sánchez F, Herrera S, Castillero-Díaz L, Herrero P, Gil V, Miró Ò. Análisis de la efectividad y seguridad de las unidades de estancia corta en la hospitalización de pacientes con insuficiencia cardíaca aguda. Propensity Score UCE-EAHFE. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2022.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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11
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Sánchez-Marco C, Jacob J, Llorens P, Rodríguez B, Martín-Sánchez FJ, Herrera S, Castillero-Díaz LE, Herrero P, Gil V, Miró Ò. Original articleAnalysis of the effectiveness and safety of short-stay units in the hospitalization of patients with acute heart failure. Propensity Score SSU-EAHFE. Rev Clin Esp 2022; 222:443-457. [PMID: 35842410 DOI: 10.1016/j.rceng.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/27/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES This work aims to analyze if hospitalization in short-stay units (SSU) of patients diagnosed in the emergency department with acute heart failure (AHF) is effective in terms of the length of hospital stay and if it is associated with differences in short-term progress. METHOD Patients from the EAHFE registry diagnosed with AHF who were admitted to the SSU (SSU group) were included and compared to those hospitalized in other departments (non-SSU group) from all hospitals (comparison A) and, separately, those from hospitals with an SSU (comparison B) and without an SSU (comparison C). For each comparison, patients in the SSU/non-SSU groups were matched by propensity score. The length of hospital stay (efficacy), 30-day mortality, and post-discharge adverse events at 30 days (safety) were compared. RESULTS A total of 2,003 SSU patients and 12,193 non-SSU patients were identified. Of them, 674 pairs of patients were matched for comparison A, 634 for comparison B, and 588 for comparison C. The hospital stay was significantly shorter in the SSU group in all comparisons (A: median 4 days (IQR = 2-5) versus 8 (5-12) days, p < 0.001; B: 4 (2-5) versus 8 (5-12), p < 0.001; C: 4 (2-5) versus 8 (6-12), p < 0.001). Admission to the SSU was not associated with differences in mortality (A: HR = 1.027, 95%CI = 0.681-1.549; B: 0.976, 0.647-1.472; C: 0.818, 0.662-1.010) or post-discharge adverse events (A: HR = 1.002, 95%CI = 0.816-1.232; B: 0.983, 0.796-1.215; C: 1.135, 0.905-1.424). CONCLUSION The hospitalization of patients with AHF in the SSU is associated with shorter hospital stays but there were no differences in short-term progress.
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Affiliation(s)
- C Sánchez-Marco
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - J Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Instituto de Investigación Sanitaria y Biómedica de Alicante (ISABIAL), Universidad Miguel Hernández, Alicante, Spain
| | - B Rodríguez
- Servicio de Urgencias, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - S Herrera
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - P Herrero
- Servicio de Urgencias, Hospital Central de Asturias, Oviedo, Spain
| | - V Gil
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Ò Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
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Carratalá-Perales J, Gil V, Andueza J. Puntualizaciones sobre «Características de la ventilación no invasiva prolongada en los servicios de urgencias hospitalarios y su impacto en la eficacia. Análisis del registro VNICat». Med Intensiva 2022. [DOI: 10.1016/j.medin.2022.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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13
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Sa Mendes G, Abecasis J, Maltez S, Guerreiro S, Freitas P, Horta E, Lima T, Ribeiras R, Andrade M, Cardim N, Gil V. Left ventricular myocardial work in patients with high gradient severe symptomatic aortic stenosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Left ventricular myocardial work (LVMW) is a novel method to evaluated left ventricular (LV) function using pressure-strain loops. It might correct global longitudinal strain (GLS) for afterload, being eventually useful to assess whether GLS reduction is due to reduced contractility (reflected as reduced myocardial work) or increased afterload (reflected as increased myocardial work).
Aim
To describe indices of LVMW in a group of patients with severe symptomatic aortic stenosis (AS).
Methods
We prospectively studied 104 consecutive patients (age: 71 years [IQR 66.5–75.5] years, 51% men) with severe symptomatic high gradient AS: mean transaortic pressure gradient: 56.5mmHg [IQR 46.8–67.8]; aortic valve area: 0.73cm2 [IQR 0.61–0.88]; indexed stroke volume: 47.7±1.3 mL/m2 (11 patients with low-flow AS), preserved LV ejection fraction (EV) (LVEF: 56.0% [51.0–61.3]; GLS: −14.5% [IQR −16.1 to −10.6]), with no previous coronary artery disease and no history of cardiomyopathy. Beyond complete transthoracic echocardiography, all patients underwent cardiac magnetic resonance for LV myocardium tissue characterization. As proposed for AS, LV systolic pressure was corrected adding the mean transaortic pressure gradient to non-invasive systolic blood pressure cuff measurement in the echocardiographic algorithm. Four LVMW indices were collected in 83 patients (patients excluded for atrial fibrillation, left bundle branch block or absence of non-invasive blood pressure registration) and correlated to LV function indexes, LV hypertrophy and remodeling, myocardial tissue characterization, BNP and troponin levels (Pearson or Spearman correlation). These same indexes were compared in patients with LV ejection fraction (EF) below and above 50%, normal and reduced flow and presence of replacement fibrosis.
Results
Global constructive work (GCW) (2658.6±76.4mmHg%), global myocardial work (GMW) (2218.7±74.9mmHg%) and global wasted work (GWE) (262.0mmHg% [198.8–339.5]) were high above normal with concomitant lower work efficiency (WE) (88.0% [83.2–91.8]. Weak correlations were found between LVMW indexes and parameters describing aortic valve severity, flow and LV function (table). Except for significant differences of LVMI in patients with reduced LV ejection fraction (GCW 2770.3±687.4 vs 2056.0±380.7mmHg%, p=0,014 and GMW 2362.5±657.9 vs 1621.3±319.9, p=0,021 in patients with LV EF>50% vs. LV EF<50%, respectively) work indexes were neither significantly different in low-flow patients nor in those with myocardial late gadolinium enhancement.
Conclusions
Global constructive and myocardial work are increased in these patients with severe aortic stenosis. This might reflect an increased afterload predominance rather than a LV functional impairment, particularly relevant in this group of patients with exclusive high gradient disease and preserved LVEF.
Funding Acknowledgement
Type of funding sources: None. Correlations between LVMI – LV function
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Affiliation(s)
| | - J Abecasis
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - S Maltez
- Hospital de Santa Cruz, Carnaxide, Portugal
| | | | - P Freitas
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - E Horta
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - T Lima
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - R Ribeiras
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - M Andrade
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - N Cardim
- Hospital da Luz, SA, Lisbon, Portugal
| | - V Gil
- Hospital dos Lusiadas, Lisbon, Portugal
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Maltes S, Abecasis J, Mendes GSM, Padrao C, Reis C, Guerreiro S, Freitas P, Ribeiras R, Andrade MJ, Cardim N, Gil V, Mendes M. Prevalence and determinants of right ventricular dysfunction in patients with severe symptomatic high gradient aortic stenosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Right ventricular (RV) function in aortic stenosis (AS) has been largely neglected. Recently it was demonstrated that right ventricular impairment may be influenced by left ventricular (LV) function and afterload, well before overt pulmonary hypertension development.
Aim
To describe the prevalence of RV dysfunction in a group of patients with severe symptomatic aortic stenosis (AS) and its relation to LV function parameters and afterload.
Methods
We prospectively studied 93 consecutive patients (age: 73 years [IQR 68–77] years, 55% women) with pure severe symptomatic high gradient aortic stenosis: mean transaortic pressure gradient: 57.0mmHg [IQR 46.9–71.1]; aortic valve area: 0.72cm2 [IQR 0.61–0.88]; indexed stroke volume: 48.8±1.5 mL/m2 (11 patients with low-flow AS), preserved LV ejection fraction (EV) (LVEF: 56.0% [51.0–61.3]; GLS: −14.5% [IQR −16.1 to −10.6]), with no previous coronary artery disease and no history of cardiomyopathy. Beyond complete transthoracic echocardiography, all patients underwent cardiac magnetic resonance (CMR) for LV myocardium tissue characterization (late gadolinium enhancement and extracellular volume). Normal RV function was defined according to TAPSE ≥17mm, tricuspid annular systolic velocity ≥12cm/s, mean free wall longitudinal strain ≤−20%. Patients were divided into four groups: (0) – all three RV parameters below normal (1.1%), (1) – 1 normal parameter (12.9%), (2) – 2 normal parameters (44.1%), (3) – 3 normal parameters (41.9%). Indexes of LV systolic and diastolic function, CMR derived LV geometric remodeling, hypertrophy and tissue characterization, aortic valve disease severity and afterload were compared across the 4 groups of patients. We tried to identify predictors of RV dysfunction (group 0, 1, 2 vs. group 3) at multivariate regression analysis.
Results
Left ventricular performance parameters, diastolic and myocardial work indexes were significantly different across the groups (Figure). Neither AV severity indexes nor LV tissue characterization were distinct. At multivariate analysis only global constructive work was an independent predictor of RV dysfunction.
Conclusion
RV dysfunction is common in this group of patients with severe high gradient aortic stenosis and preserved ejection fraction. RV impairment is significantly related to several LV systolic and diastolic parameters and also to LV afterload, probably accounting for RV-LV interdependence.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Maltes
- Hospital Santa Cruz, Lisbon, Portugal
| | | | | | - C Padrao
- Hospital Santa Cruz, Lisbon, Portugal
| | - C Reis
- Hospital Santa Cruz, Lisbon, Portugal
| | | | - P Freitas
- Hospital Santa Cruz, Lisbon, Portugal
| | | | | | - N Cardim
- Hospital da Luz, SA, Lisbon, Portugal
| | - V Gil
- Hospital da Luz, SA, Lisbon, Portugal
| | - M Mendes
- Hospital Santa Cruz, Lisbon, Portugal
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de Los Ángeles Fernández-Rodríguez M, Prieto-García B, Vázquez-Álvarez J, Jacob J, Gil V, Miró O, Llorens P, Martín-Sánchez FJ, Alquézar-Arbé A, Rodríguez-Adrada E, Romero-Pareja R, López-Diez P, Herrero-Puente P. Prognostic implications of Anemia in patients with acute heart failure in emergency departments. ANEM-AHF Study. Int J Clin Pract 2021; 75:e13712. [PMID: 32955782 DOI: 10.1111/ijcp.13712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/22/2020] [Accepted: 09/06/2020] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION The presence of anaemia leads to a worse prognosis in patients with heart failure (HF). There are few data on the impact of anaemia on mortality in patients with acute heart failure (AHF), and the studies available are mainly retrospective, and include hospitalised patients. OBJECTIVE Evaluate the role of anaemia on 30-day and 1-year mortality in patients with AHF attended in hospital emergency departments (HEDs). METHODS We performed a multicentre, observational study of prospective cohorts of patients with AHF. The study variables were: Anaemia (haemoglobin < 12g/dL in women and <13g/dL in men), mortality at 30 days and at 1 year, risk factors, comorbidity, functional impairment, basal functional grade for dyspnoea, chronic and acute treatment, clinical and analytical data of the episode, and patient destination. STATISTICAL ANALYSIS Bivariate analysis and survival analyses using Cox regression. RESULTS A total of 13 454 patients were included, 7662 (56.9%) of whom had anaemia. Those with anaemia were older, had more comorbidity, a worse functional status and New York Heart Association class, greater renal function impairment, and more hyponatraemia. The mortality was higher in patients with anaemia at 30 days and 1 year: 7.5% vs 10.7% (P < .001) and 21.2% vs 31.4% (P < .001), respectively. The crude and adjusted hazard ratios of anaemia for 30-day mortality were: 1.46 (confidence interval [CI] 95% 1.30-1.64); P < .001 and 1.20 (CI 95% 1.05-1.38); P = .009, respectively, and 1.57 (CI 95% 1.47-1.68) and 1.30 (CI 95% 1.20-1.40) for mortality at 1 year. The weight of anaemia on mortality was different in each follow-up period. CONCLUSIONS Anaemia is an independent predictor of mortality at 30 days and 1 year in patients with AHF attended in HEDs. It is important to study the aetiology of AHF since adequate treatment would reduce mortality.
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Affiliation(s)
- M de Los Ángeles Fernández-Rodríguez
- Servicio de Hematología y Hemoterapia, Hospital Universitario Central de Asturias, Oviedo, Spain
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - B Prieto-García
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Área de Gestión Clínica del Laboratorio de Medicina, Hospital Universitario Central de Asturias, Oviedo, Spain
- Universidad de Oviedo, Oviedo, Spain
| | - J Vázquez-Álvarez
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Unidad de Gestión Clínica de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J Jacob
- Servicio de Urgencias y Unidad de Corta Estancia, Hospital Universitario de Bellvitge, Barcelona, Spain
| | - V Gil
- Área de Urgencias. Hospital Clinic, Barcelona, Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, Spain
| | - O Miró
- Área de Urgencias. Hospital Clinic, Barcelona, Grupo de Investigación "Urgencias: procesos y patologías", IDIBAPS, Barcelona, Spain
| | - P Llorens
- Servicio de Urgencias-Corta Estancia y Hospitalización a domicilio, Hospital General Universitario de Alicante, Alicante, Spain
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - A Alquézar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu y Sant Pau, Barcelona, Spain
| | - E Rodríguez-Adrada
- Servicio de Urgencias, Hospital Rey Juan Carlos de Móstoles, Madrid, Spain
| | - R Romero-Pareja
- Servicio de Urgencias, Hospital Universitario de Getafe, Madrid, Spain
| | - P López-Diez
- Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, Spain
| | - P Herrero-Puente
- Grupo de Investigación en Urgencias y Emergencias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Universidad de Oviedo, Oviedo, Spain
- Unidad de Gestión Clínica de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
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16
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Miró Ò, López Díez MP, Llorens P, Mir M, López Grima ML, Alonso H, Gil V, Herrero-Puente P, Jacob J, Martín-Sánchez FJ. Frequency, profile and results of patients with acute heart failure transferred directly to home hospitalisation from emergency departments. Rev Clin Esp 2021; 221:1-8. [PMID: 32560917 DOI: 10.1016/j.rce.2020.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/22/2020] [Accepted: 02/11/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To describe the frequency, clinical characteristics and outcomes of patients with acute heart failure (AHF) transferred directly from emergency departments to home hospitalisation (HH) and to compare them with those hospitalised in internal medicine (IM) or short-stay units (SSU). METHOD We included patients with AHF transferred to HH by hospitals that considered this option during the Epidemiology of Acute Heart Failure in Spanish Emergency Departments (EAHFE) 4-5-6 Registries and compared them with patients admitted to IM or SSU in these centres. We compared the adjusted all-cause mortality at 1 year and adverse events 30 days after discharge. RESULTS The study included 1473 patients (HH/IM/SSU: 68/979/384). The HH rate was 4.7% (95% CI, 3.8-6.0%). The patients in HH had few differences compared with those hospitalised in IM and SSUs. The HH mortality was 1.5%, and the HH median stay was 7.5 days (IQR, 4.5-12), similar to that of IM (median stay, 8 days; IQR, 5-13; p=.106) and longer than that of SSU (median stay, 4 days; IQR, 3-7; p<.001). The all-cause mortality at 1 year for HH did not differ from that of IM (HR, 0.91; 95% CI, 0.73-1.14) or SSU (HR, 0.77; 95% CI, 0.46-1.27); however, the emergency department readmission rate during the 30 days postdischarge was lower than that of IM (HR, 0.50; 95% CI, 0.25-0.97) and SSU (HR, 0.37; 95% CI, 0.19-0.74). There were no differences in the need for new hospitalisations or in the 30-day mortality rate. CONCLUSIONS Direct transfer from the emergency department to HH is infrequent despite being a safe option for a certain patient profile with AHF.
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Affiliation(s)
- Ò Miró
- Área de Urgencias, Hospital Clínic, Barcelona; Grupo de Investigación «Urgencias: Procesos y Patologías», IDIBAPS, Universitat de Barcelona, Barcelona, España.
| | - M P López Díez
- Servicio de Urgencias, Hospital Universitario de Burgos, Burgos, España
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante; Universitat Miguel Hernández, Elx, Alicante, España
| | - M Mir
- Servicio de Urgencias, Hospital Infanta Leonor, Madrid, España
| | | | - H Alonso
- Servcio de Urgencias, Hospital Marqués de Valdecilla, Santander, España
| | - V Gil
- Área de Urgencias, Hospital Clínic, Barcelona; Grupo de Investigación «Urgencias: Procesos y Patologías», IDIBAPS, Universitat de Barcelona, Barcelona, España
| | - P Herrero-Puente
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, España
| | - J Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC); Universidad Complutense, Madrid, España
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Mirò Ò, López Díez MP, Llorens P, Mir M, López Grima ML, Alonso H, Gil V, Herrero-Puente P, Jacob J, Martín-Sánchez FJ. Frequency, profile, and outcomes of patients with acute heart failure transferred directly to home hospitalization from emergency departments. Rev Clin Esp 2020; 221:1-8. [PMID: 33998472 DOI: 10.1016/j.rceng.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 02/11/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the frequency, clinical characteristics and outcomes of patients with acute heart failure (AHF) transferred directly from emergency departments to home hospitalisation (HH) and to compare them with those hospitalised in internal medicine (IM) or short-stay units (SSU). METHOD We included patients with AHF transferred to HH by hospitals that considered this option during the Epidemiology of Acute Heart Failure in Spanish Emergency Departments (EAHFE) 4-5-6 Registries and compared them with patients admitted to IM or SSU in these centres. We compared the adjusted all-cause mortality at 1 year and adverse events 30 days after discharge. RESULTS The study included 1473 patients (HH/IM/SSU:68/979/384). The HH rate was 4.7% (95% CI 3.8-6.0%). The patients in HH had few differences compared with those hospitalised in IM and SSUs. The HH mortality was 1.5%, and the HH median stay was 7.5 days (IQR, 4.5-12), similar to that of IM (median stay, 8 days; IQR, 5-13; p = .106) and longer than that of SSU (median stay, 4 days; IQR, 3-7; p < .001). The all-cause mortality at 1 year for HH did not differ from that of IM (HR, 0.91; 95% CI 0.73-1.14) or SSU (HR, 0.77; 95% CI 0.46-1.27); however, the emergency department readmission rate during the 30 days postdischarge was lower than that of IM (HR, 0.50; 95% CI 0.25-0.97) and SSU (HR, 0.37; 95% CI 0.19-0.74). There were no differences in the need for new hospitalisations or in the 30-day mortality rate. CONCLUSIONS Direct transfer from the emergency department to HH is infrequent despite being a safe option for a certain patient profile with AHF.
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Affiliation(s)
- Ò Mirò
- Área de Urgencias, Hospital Clínic, Barcelona, Espana; Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
| | - M P López Díez
- Servicio de Urgencias, Hospital Universitario de Burgos, Spain
| | - P Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital General de Alicante, Universitat Miguel Hernández, Elx, Alicante, Spain
| | - M Mir
- Servicio de Urgencias, Hospital Infanta Leonor, Madrid, Spain
| | | | - H Alonso
- Servcio de Urgencias, Hospital Marqués de Valdecilla, Santander, Spain
| | - V Gil
- Área de Urgencias, Hospital Clínic, Barcelona, Espana; Grupo de Investigación "Urgencias: Procesos y Patologías", IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - P Herrero-Puente
- Servicio de Urgencias, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - J Jacob
- Servicio de Urgencias, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - F J Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain; Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Universidad Complutense, Madrid, Spain
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Abecasis J, Mendes G, Ferreira A, Andrade M, Ribeiras R, Ramos S, Masci P, Gil V. Relative apical sparing in patients with severe aortic stenosis: prevalence and significance. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Relative apical sparing (RAS) of LV longitudinal strain (LS) is a red flag for diagnostic suspicion of amyloid cardiomyopathy (AC). However, it may present in pts with aortic stenosis (AS), where the prevalence of transthyretin AC is being increasingly reported.
Aim
To describe the prevalence of RAS deformation pattern in patients with AS and its clinical significance.
Methods
We prospectively studied 53 pts (71±8y, 54.7% men) with severe symptomatic AS - mean gradient (AVM): 54.6 mmHg; aortic valve area 0.74cm2, referred for surgical replacement with no previous history of ischemic cardiomyopathy. Beyond ECG and transthoracic echo (TTE), all pts underwent CMR, with tissue characterization before surgery. RAS was defined as average apical LS / average basal LS + average mid LS >1 at 2D LV LS analysis. Aortic valve replacement and septal myocardial biopsy were already performed in 26 pts. AS severity indexes, LV remodelling and tissue characterization were compared in both groups, with and without RAS.
Results
RAS was present in 16 pts (30.8%). There were neither pseudoinfarct pattern or low voltage at ECG, nor infiltration suspicion from CMR study (native T1 value 1047ms [IQR 1028–1084]; ECV 22% [IQR 18–25]). Furthermore, none of the pts had suspicion of amyloid deposition at histopathology. Median CMR LVEF was 64.5% [IQR 51.3–70.8%] and 36 pts (67.9%) had non-ischemic DE, with a median fraction of 6.0% [IQR 4.9–12.7%] of LV mass. Comparing both groups, RAS cohort showed a significantly higher AVM, relative wall thickness, maximum septal thickness, peak systolic dispersion and higher LV indexed mass, DE and lower LVEF at CMR. RAS group has also higher NT pro BNP (Table).
Conclusions
RAS is common in this group of pts despite the absence of clinical and histological signs of myocardial infiltration. RAS occurs with worse indexes of LV remodeling and fibrosis consistent with a more advanced stage of the disease.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - G Mendes
- Hospital Santa Cruz, Lisbon, Portugal
| | | | | | | | - S Ramos
- Hospital Santa Cruz, Lisbon, Portugal
| | - P.G Masci
- King's College London, London, United Kingdom
| | - V Gil
- Hospital dos Lusiadas, Lisbon, Portugal
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Sa Mendes G, Abecasis J, Ferreira A, Ribeiras R, Saraiva C, Ferreira S, Gil V, Andrade M, Mendes M, Neves J, Campante Teles R, Goncalves P. LV replacement fibrosis in aortic stenosis: prevalence and relation to LV remodelling and function. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Progressive myocardial fibrosis takes part in left ventricular (LV) remodeling in aortic stenosis (AS) and drives the transition from hypertrophy to heart failure. Replacement fibrosis may be characterized by late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR).
Aim
To assess the prevalence and association between LGE and indexes of LV function in patients with severe aortic stenosis.
Methods
We prospectively studied 53 consecutive patients (age: 71±8 years [min. 51–max. 84], 54.7% men) with severe symptomatic AS, referred for surgical aortic valve replacement with no previous history of ischemic cardiomyopathy. Aortic valve mean gradient was 54.6 mmHg [IQR 46.6–63.2] and aortic valve area 0.74cm2 [IQR 0.61–0.89]; all patients with high gradient, 4 with low-flow. CMR with tissue characterization (T1 mapping, LGE and extracellular volume by ECV quantification – using 5SD from remote myocardium as signal intensity cut-off), was performed before surgery. AS severity indexes, LV mass, systolic and diastolic LV function indexes including global longitudinal strain (GLS) and torsion were compared in both groups of patients, with and without LGE.
Results
Mid-wall LGE was present in 36 patients (67.9%) with a median fraction of 6.0% [IQR 4.9–12.7%] of LV mass. Native T1 value and ECV were within normal ranges (median values: 1047ms [IQR 1028–1084]; 22% [IQR 18–25], respectively). Median CMR LV ejection fraction and mass were 64.5% [IQR 51.3–70.8%] (11 patients with reduced EF) and 76.5g/m2 [IQR 57.4–94.8g/m2], respectively. Median GLS was −13.9% [IQR −11.4 to −17.0%] and torsion was 24.2° [IQR 19.8–32.5°]. Patients with LGE had significantly higher LV mass (87.1g/m2 vs 63.3 g/m2, p=0.001), worse GLS (−14.4% vs −16.9%, p=0.041) and higher NT-proBNP values (1333.7ng/mL vs 559.9ng/mL, p=0.004) (Figure).
Conclusions
Non-ischemic LGE is common in this group of patients with severe symptomatic high gradient aortic stenosis. As it is more prevalent in patients with more pronounced LVH, lower longitudinal deformation and higher NT-proBNP values, it probably represents a more advanced stage of the disease.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - J Abecasis
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - A Ferreira
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - R Ribeiras
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - C Saraiva
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - S Ferreira
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - V Gil
- Hospital de Santa Cruz, Carnaxide, Portugal
| | | | - M Mendes
- Hospital de Santa Cruz, Carnaxide, Portugal
| | - J.P Neves
- Hospital de Santa Cruz, Carnaxide, Portugal
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Gil V, Porozhnyy M, Rybalkina O, Butylskii D, Pismenskaya N. The Development of Electroconvection at the Surface of a Heterogeneous Cation-Exchange Membrane Modified with Perfluorosulfonic Acid Polymer Film Containing Titanium Oxide. Membranes (Basel) 2020; 10:membranes10060125. [PMID: 32560542 PMCID: PMC7344879 DOI: 10.3390/membranes10060125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/14/2020] [Accepted: 06/15/2020] [Indexed: 11/24/2022]
Abstract
One way to enhance mass transfer and reduce fouling in wastewater electrodialysis is stimulation of electroconvective mixing of the solution adjoining membranes by modifying their surfaces. Several samples were prepared by casting the perfluorosulfonic acid (PFSA) polymer film doped with TiO2 nanoparticles onto the surface of the heterogeneous cation-exchange membrane MK-40. It is found that changes in surface characteristics conditioned by such modification lead to an increase in the limiting current density due to the stimulation of electroconvection, which develops according to the mechanism of electroosmosis of the first kind. The greatest increase in the current compared to the pristine membrane can be obtained by modification with the film being 20 μm thick and containing 3 wt% of TiO2. The sample containing 6 wt% of TiO2 provides higher mass transfer in overlimiting current modes due to the development of nonequilibrium electroconvection. A 1.5-fold increase in the thickness of the modifying film reduces the positive effect of introducing TiO2 nanoparticles due to (1) partial shielding of the nanoparticles on the surface of the modified membrane; (2) a decrease in the tangential component of the electric force, which affects the development of electroconvection.
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21
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Zyryanova S, Mareev S, Gil V, Korzhova E, Pismenskaya N, Sarapulova V, Rybalkina O, Boyko E, Larchet C, Dammak L, Nikonenko V. How Electrical Heterogeneity Parameters of Ion-Exchange Membrane Surface Affect the Mass Transfer and Water Splitting Rate in Electrodialysis. Int J Mol Sci 2020; 21:ijms21030973. [PMID: 32024103 PMCID: PMC7037469 DOI: 10.3390/ijms21030973] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 11/16/2022] Open
Abstract
Electrodialysis (ED) has been demonstrated as an effective membrane method for desalination, concentration, and separation. Electroconvection (EC) is a phenomenon which can essentially increase the mass transfer rate and reduce the undesirable water splitting effect. Efforts by a number of researchers are ongoing to create conditions for developing EC, in particular, through the formation of electrical heterogeneity on the membrane surface. We attempt, for the first time, to optimize the parameters of surface electrical heterogeneity for ion-exchange membranes used in a laboratory ED cell. Thirteen different patterns on the surface of two Neosepta anion-exchange membranes, AMX and AMX-Sb, were tested. Low-conductive fluoropolymer spots were formed on the membrane surface using the electrospinning technique. Spots in the form of squares, rectangles, and circles with different sizes and distances between them were applied. We found that the spots' shape did not have a visible effect. The best effect, i.e., the maximum mass transfer rate and the minimum water splitting rate, was found when the spots' size was close to that of the diffusion layer thickness, δ (about 250 μm in the experimental conditions), and the distance between the spots was slightly larger than δ, such that the fraction of the screened surface was about 20%.
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Affiliation(s)
- Svetlana Zyryanova
- Department of Physical Chemistry, Kuban State University, 149 Stavropolskaya st., 350040 Krasnodar, Russia; (S.Z.); (S.M.); (V.G.); (N.P.); (V.S.); (O.R.); (E.B.)
| | - Semyon Mareev
- Department of Physical Chemistry, Kuban State University, 149 Stavropolskaya st., 350040 Krasnodar, Russia; (S.Z.); (S.M.); (V.G.); (N.P.); (V.S.); (O.R.); (E.B.)
| | - Violetta Gil
- Department of Physical Chemistry, Kuban State University, 149 Stavropolskaya st., 350040 Krasnodar, Russia; (S.Z.); (S.M.); (V.G.); (N.P.); (V.S.); (O.R.); (E.B.)
| | - Elizaveta Korzhova
- Institut UTINAM (UMR CNRS 6213), Université de Bourgogne-Franche-Comté, 16 Route de Gray, 25030 Besançon CEDEX, France;
| | - Natalia Pismenskaya
- Department of Physical Chemistry, Kuban State University, 149 Stavropolskaya st., 350040 Krasnodar, Russia; (S.Z.); (S.M.); (V.G.); (N.P.); (V.S.); (O.R.); (E.B.)
| | - Veronika Sarapulova
- Department of Physical Chemistry, Kuban State University, 149 Stavropolskaya st., 350040 Krasnodar, Russia; (S.Z.); (S.M.); (V.G.); (N.P.); (V.S.); (O.R.); (E.B.)
| | - Olesya Rybalkina
- Department of Physical Chemistry, Kuban State University, 149 Stavropolskaya st., 350040 Krasnodar, Russia; (S.Z.); (S.M.); (V.G.); (N.P.); (V.S.); (O.R.); (E.B.)
| | - Evgeniy Boyko
- Department of Physical Chemistry, Kuban State University, 149 Stavropolskaya st., 350040 Krasnodar, Russia; (S.Z.); (S.M.); (V.G.); (N.P.); (V.S.); (O.R.); (E.B.)
| | - Christian Larchet
- Institut de Chimie et des Matériaux Paris-Est, UMR7182 CNRS–Université Paris-Est, 2 Rue Henri Dunant, 94320 Thiais, France; (C.L.); (L.D.)
| | - Lasaad Dammak
- Institut de Chimie et des Matériaux Paris-Est, UMR7182 CNRS–Université Paris-Est, 2 Rue Henri Dunant, 94320 Thiais, France; (C.L.); (L.D.)
| | - Victor Nikonenko
- Department of Physical Chemistry, Kuban State University, 149 Stavropolskaya st., 350040 Krasnodar, Russia; (S.Z.); (S.M.); (V.G.); (N.P.); (V.S.); (O.R.); (E.B.)
- Correspondence: ; Tel.: +7-918-414-5816
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García Sarasola A, Alquézar Arbé A, Gil V, Martín-Sánchez F, Jacob J, Llorens P, Rizzi M, Fuenzalida C, Calderón S, Miró Ò. NOVICA: Characteristics and outcomes of patients who have a first episode of heart failure (de novo). Rev Clin Esp 2019. [DOI: 10.1016/j.rceng.2019.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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23
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Jacob J, Llauger L, Gil V, Javaloyes P. Hiperpotasemia, también en la insuficiencia cardiaca aguda. Rev Clin Esp 2019; 219:103-104. [DOI: 10.1016/j.rce.2018.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 10/01/2018] [Indexed: 11/29/2022]
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24
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25
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Miró Ò, Gil V, Javaloyes P, Llorens P. Acerca de las guías europeas de insuficiencia cardiaca de 2016. Rev Clin Esp 2018; 218:158-159. [DOI: 10.1016/j.rce.2017.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 10/30/2017] [Indexed: 11/29/2022]
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26
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Shenoy TR, Boysen G, Wang MY, Xu QZ, Guo W, Koh FM, Wang C, Zhang LZ, Wang Y, Gil V, Aziz S, Christova R, Rodrigues DN, Crespo M, Rescigno P, Tunariu N, Riisnaes R, Zafeiriou Z, Flohr P, Yuan W, Knight E, Swain A, Ramalho-Santos M, Xu DY, de Bono J, Wu H. CHD1 loss sensitizes prostate cancer to DNA damaging therapy by promoting error-prone double-strand break repair. Ann Oncol 2018; 28:1495-1507. [PMID: 28383660 DOI: 10.1093/annonc/mdx165] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Indexed: 01/08/2023] Open
Abstract
Background Deletion of the chromatin remodeler chromodomain helicase DNA-binding protein 1 (CHD1) is a common genomic alteration found in human prostate cancers (PCas). CHD1 loss represents a distinct PCa subtype characterized by SPOP mutation and higher genomic instability. However, the role of CHD1 in PCa development in vivo and its clinical utility remain unclear. Patients and methods To study the role of CHD1 in PCa development and its loss in clinical management, we generated a genetically engineered mouse model with prostate-specific deletion of murine Chd1 as well as isogenic CHD1 wild-type and homozygous deleted human benign and PCa lines. We also developed patient-derived organoid cultures and screened patients with metastatic PCa for CHD1 loss. Results We demonstrate that CHD1 loss sensitizes cells to DNA damage and causes a synthetic lethal response to DNA damaging therapy in vitro, in vivo, ex vivo, in patient-derived organoid cultures and in a patient with metastatic PCa. Mechanistically, CHD1 regulates 53BP1 stability and CHD1 loss leads to decreased error-free homologous recombination (HR) repair, which is compensated by increased error-prone non-homologous end joining (NHEJ) repair for DNA double-strand break (DSB) repair. Conclusions Our study provides the first in vivo and in patient evidence supporting the role of CHD1 in DSB repair and in response to DNA damaging therapy. We uncover mechanistic insights that CHD1 modulates the choice between HR and NHEJ DSB repair and suggest that CHD1 loss may contribute to the genomic instability seen in this subset of PCas.
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Affiliation(s)
- T R Shenoy
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, USA
| | - G Boysen
- The Institute of Cancer Research, London, UK.,Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - M Y Wang
- The MOE Key Laboratory of Cell Proliferation and Differentiation, School of Life Sciences, Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
| | - Q Z Xu
- The MOE Key Laboratory of Cell Proliferation and Differentiation, School of Life Sciences, Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
| | - W Guo
- The MOE Key Laboratory of Cell Proliferation and Differentiation, School of Life Sciences, Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
| | - F M Koh
- Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research and Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - C Wang
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, USA
| | - L Z Zhang
- The MOE Key Laboratory of Cell Proliferation and Differentiation, School of Life Sciences, Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
| | - Y Wang
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, USA
| | - V Gil
- The Institute of Cancer Research, London, UK
| | - S Aziz
- The Institute of Cancer Research, London, UK
| | - R Christova
- The Institute of Cancer Research, London, UK
| | - D N Rodrigues
- The Institute of Cancer Research, London, UK.,Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - M Crespo
- The Institute of Cancer Research, London, UK.,Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - P Rescigno
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - N Tunariu
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - R Riisnaes
- The Institute of Cancer Research, London, UK.,Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Z Zafeiriou
- Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - P Flohr
- The Institute of Cancer Research, London, UK.,Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - W Yuan
- The Institute of Cancer Research, London, UK
| | - E Knight
- The Institute of Cancer Research, London, UK
| | - A Swain
- The Institute of Cancer Research, London, UK
| | - M Ramalho-Santos
- Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research and Center for Reproductive Sciences, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, USA
| | - D Y Xu
- The MOE Key Laboratory of Cell Proliferation and Differentiation, School of Life Sciences, Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
| | - J de Bono
- The Institute of Cancer Research, London, UK.,Prostate Cancer Targeted Therapy Group and Drug Development Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - H Wu
- Department of Molecular and Medical Pharmacology, University of California, Los Angeles, USA.,The MOE Key Laboratory of Cell Proliferation and Differentiation, School of Life Sciences, Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
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27
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Jimenez M, Gil V, Martinez‐Cutillas M, Mañé N, Gallego D. Hydrogen sulphide as a signalling molecule regulating physiopathological processes in gastrointestinal motility. Br J Pharmacol 2017; 174. [PMID: 28631296 PMCID: PMC5554320 DOI: 10.1111/bph.13918] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The biology of H2 S is a still developing area of research and several biological functions have been recently attributed to this gaseous molecule in many physiological systems, including the cardiovascular, urogenital, respiratory, digestive and central nervous system (CNS). H2 S exerts anti-inflammatory effects and can be considered an endogenous mediator with potential effects on gastrointestinal motility. During the last few years, we have investigated the role of H2 S as a regulator of gastrointestinal motility using both animal and human tissues. The aim of the present work is to review published data regarding the potential role of H2 S as a signalling molecule regulating physiopathological processes in gastrointestinal motor function. H2 S is endogenously produced by defined enzymic pathways in different cell types of the intestinal wall including neurons and smooth muscle. Inhibition of H2 S biosynthesis increases motility and H2 S donors cause smooth muscle relaxation and inhibition of propulsive motor patterns. Impaired H2 S production has been described in animal models with gastrointestinal motor dysfunction. The mechanism(s) of action underlying these effects may include several ion channels, although no specific receptor has been identified. At this time, even though there is much experimental evidence for H2 S as a modulator of gastrointestinal motility, we still do not have conclusive experimental evidence to definitively propose H2 S as an inhibitory neurotransmitter in the gastrointestinal tract, causing nerve-mediated relaxation.
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Affiliation(s)
- M Jimenez
- Department of Cell Biology, Physiology and Immunology and Neuroscience InstituteUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)Instituto de Salud Carlos IIIBarcelonaSpain
| | - V Gil
- Department of Cell Biology, Physiology and Immunology and Neuroscience InstituteUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - M Martinez‐Cutillas
- Department of Cell Biology, Physiology and Immunology and Neuroscience InstituteUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - N Mañé
- Department of Cell Biology, Physiology and Immunology and Neuroscience InstituteUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - D Gallego
- Department of Cell Biology, Physiology and Immunology and Neuroscience InstituteUniversitat Autònoma de BarcelonaBarcelonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd)Instituto de Salud Carlos IIIBarcelonaSpain
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Di Mitri D, Vasilevska J, Calcinotto A, Gil V, Boysen G, Revandkar A, Waugh D, Barry S, de Bono J, Alimonti A. Re-education of tumor-associated macrophages by CXCR2 blockade drives senescence enhancement and tumor inhibition in advanced prostate cancer. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx370.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Redon J, Sanchis J, Uso R, Trillo J, Fernandez A, Morales F, Orozco D, Gil V. [LB.01.13] THE USE OF CARDIOVASCULAR PREVENTIVE DRUGS IN SUBJECTS AFTER MYOCARDIAL INFARCTION. A POPULATION BASED STUDY. J Hypertens 2017. [DOI: 10.1097/01.hjh.0000523447.21310.b9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Escoda R, Miró Ò, Martín-Sánchez F, Jacob J, Herrero P, Gil V, Garrido J, Pérez-Durá M, Fuentes M, Llorens P. Evolution of the clinical profile of patients with acute heart failure treated in Spanish emergency departments. Rev Clin Esp 2017. [DOI: 10.1016/j.rceng.2016.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Jacob J, Miró Ò, Herrero P, Martín-Sánchez F, Gil V, Tost J, Aguirre A, Escoda R, Alquézar A, Andueza J, Llorens P. Predicción de la mortalidad a muy corto plazo de los pacientes con insuficiencia cardiaca crónica agudizada: escala EAHFE-3D. Med Intensiva 2016; 40:348-55. [DOI: 10.1016/j.medin.2015.07.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 07/24/2015] [Accepted: 07/24/2015] [Indexed: 02/01/2023]
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Tomas-Roig J, Piscitelli F, Gil V, del Río J, Moore T, Agbemenyah H, Salinas-Riester G, Pommerenke C, Lorenzen S, Beißbarth T, Hoyer-Fender S, Di Marzo V, Havemann-Reinecke U. Social defeat leads to changes in the endocannabinoid system: An overexpression of calreticulin and motor impairment in mice. Behav Brain Res 2016; 303:34-43. [DOI: 10.1016/j.bbr.2016.01.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/13/2016] [Accepted: 01/16/2016] [Indexed: 12/12/2022]
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Duncan S, McCann M, Qiang G, Gil V, Whang Kong H, Liew C. ID: 87: TRANSCRIPTION FACTOR CREB3L3 IS A NOVEL REGULATOR FOR ADIPOCYTE BIOLOGY AND METABOLISM. J Investig Med 2016. [DOI: 10.1136/jim-2016-000120.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The presence of differential metabolic risks between the metabolically-protective subcutaneous adipose tissue (SAT) and the disease-associated visceral adipose tissue (VAT) is well established, but the mechanisms that cause these differences are not well understood. Cyclic AMP responsive element binding protein 3-like 3 (CREB3L3), a previously characterized liver-specific ER-bound transcription factor, was found to be expressed in murine SAT and VAT. In obese human subjects and an obese mouse model, we found that CREB3L3 is downregulated in SAT, but not in VAT. To examine the role of CREB3L3 in adipocyte biology and metabolism, we created a fat-specific CREB3L3 knockout (KO) mouse using the AdipoQ-Cre mouse. To establish a potential role for CREB3L3 in adipocytes, we examined in vitro differentiated adipocytes from isolated WT and KO primary stromal vascular fraction. We observed that ablation of CREB3L3 in SAT adipocytes significantly upregulated expression of both lipogenic and lipolytic markers. At the same time, we also observed significantly increased expression of thermogenic markers like PGC1α and Cox8b. Taken together our data suggest potential upregulation of the fat futile cycle in SAT upon deletion of CREB3L3. Surprisingly, we found that CREB3L3 KO tends to downregulate expression of markers of both lipogenesis and lipolysis in VAT adipocytes. This observation could potentially be contributed by the tendency of CREB3l3 KO VAT to have inhibited differentiation. To investigate the in vivo function of CREB3L3, we challenged WT and KO mice with high fat diet with weekly body weight assessment. We observed that CREB3L3 ablation in adipose tissues promotes significant weight gain in mice on HFD. Unexpectedly, despite being heavier, the KO mice are not more glucose intolerant or insulin resistant. These data together suggest that ablation of CREB3L3 could potentially promote fat storage in adipose tissues to prevent metabolic diseases caused by ectopic fat deposition.
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Martinez-Cutillas M, Gil V, Mañé N, Clavé P, Gallego D, Martin MT, Jimenez M. Potential role of the gaseous mediator hydrogen sulphide (H2S) in inhibition of human colonic contractility. Pharmacol Res 2015; 93:52-63. [PMID: 25641403 DOI: 10.1016/j.phrs.2015.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 01/21/2015] [Accepted: 01/21/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Hydrogen sulphide (H2S) is an endogenous signalling molecule that might play a physiologically relevant role in gastrointestinal motility. Cystathionine β-synthase (CBS) and cystathionine γ-lyase (CSE) are two enzymes responsible for H2S production. d,l-Propargylglycine (PAG) is a CSE inhibitor whereas both aminooxyacetic acid (AOAA) and hydroxylamine (HA) are CBS inhibitors. The characterization of H2S responses and its mechanism of action are crucial to define H2S function. METHODS Human colonic strips were used to investigate the role of H2S on contractility (muscle bath) and smooth muscle electrophysiology (microelectrodes). NaHS was used as a H2S donor. RESULTS Combination of PAG and AOAA depolarized the smooth muscle (5-6mV, n=4) and elicited a transient increase in tone (260.5±92.8mg, n=12). No effect was observed on neural mediated inhibitory junction potential or relaxation. In the presence of tetrodotoxin 1μM, NaHS concentration-dependently inhibited spontaneous contractions (EC50=329.2μM, n=18). This effect was partially reduced by the guanylyl cyclase inhibitor ODQ 10μM (EC50=2.6μM, n=12) and by l-NNA 1mM (EC50=1.4mM, n=8). NaHS reversibly blocked neural mediated cholinergic (EC50=2mM) and tachykinergic (EC50=5.7mM) contractions. NaHS concentration-dependently reduced the increase in spontaneous mechanical activity (AUC) induced by carbachol (EC50=1.9mM) and NKA (EC50=1.7mM AUC). CONCLUSIONS H2S might be an endogenous gasomediator regulating human colonic contractility. Its inhibitory effect is observed at high concentrations and could be mediated by a direct effect on smooth muscle with a possible synergistic effect with NO, as well as by an interaction with the cholinergic and tachykinergic neural mediated pathways.
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Affiliation(s)
- M Martinez-Cutillas
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - V Gil
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - N Mañé
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P Clavé
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain; Fundació de Gastroenterologia Dr Vilardell and Department of Surgery, Hospital de Mataró, Mataró, Barcelona, Spain
| | - D Gallego
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
| | - M T Martin
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
| | - M Jimenez
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain.
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Mañé N, Gil V, Martínez-Cutillas M, Clavé P, Gallego D, Jiménez M. Differential functional role of purinergic and nitrergic inhibitory cotransmitters in human colonic relaxation. Acta Physiol (Oxf) 2014; 212:293-305. [PMID: 25327170 DOI: 10.1111/apha.12408] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 09/23/2014] [Accepted: 10/14/2014] [Indexed: 12/18/2022]
Abstract
AIM ATP and nitric oxide (NO) are released from enteric inhibitory motor neurones and are responsible for colonic smooth muscle relaxation. However, how frequency of neural stimulation affects this cotransmission process and the post-junctional responses has not been systematically characterized in the human colon. METHODS The dynamics of inhibitory cotransmission were studied using different protocols of electrical field stimulation (EFS) to characterize the inhibitory junction potentials (IJP) and the corresponding relaxation in colonic strips obtained from 36 patients. RESULTS Single pulses elicited a fast IJP (IJPf(MAX) = -27.6 ± 1.6 mV), sensitive to the P2Y1 antagonist MRS2500 1 μm, that ran down with frequency increase leaving a residual hyperpolarization at high frequencies (IJPf∞ = -3.7 ± 0.6 mV). Accordingly, low frequencies of EFS caused purinergic transient relaxations that cannot be maintained at high frequencies. Addition of the P2Y1 agonist MRS2365 10 μm during the purinergic rundown did not cause any hyperpolarization. Protein kinase C (PKC), a putative P2Y1 desensitizator, was able to reduce the amplitude of the IJPf when activated, but the rundown was not modified by PKC inhibitors. Frequencies higher than 0.60 ± 0.15 Hz were needed to evoke a sustained nitrergic hyperpolarization that progressively increased reaching IJPs∞ = -13 ± 0.4 mV at high frequencies and leading to a sustained inhibition of spontaneous motility. CONCLUSION Changes in frequency of stimulation possibly mimicking neuronal firing will post-junctionally determine purinergic vs. nitrergic responses underlying different functional roles. NO will be responsible for sustained relaxations needed in physiological processes such as storage, while purinergic neurotransmission evoking sharp transient relaxations will be dominant in processes such as propulsion.
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Affiliation(s)
- N. Mañé
- Department of Cell Biology, Physiology and Immunology and Neuroscience Institute; Universitat Autònoma de Barcelona; Barcelona Spain
| | - V. Gil
- Department of Cell Biology, Physiology and Immunology and Neuroscience Institute; Universitat Autònoma de Barcelona; Barcelona Spain
| | - M. Martínez-Cutillas
- Department of Cell Biology, Physiology and Immunology and Neuroscience Institute; Universitat Autònoma de Barcelona; Barcelona Spain
| | - P. Clavé
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd); Instituto de Salud Carlos III; Barcelona Spain
| | - D. Gallego
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd); Instituto de Salud Carlos III; Barcelona Spain
| | - M. Jiménez
- Department of Cell Biology, Physiology and Immunology and Neuroscience Institute; Universitat Autònoma de Barcelona; Barcelona Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd); Instituto de Salud Carlos III; Barcelona Spain
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Gil V, Parsons S, Gallego D, Huizinga J, Jimenez M. Effects of hydrogen sulphide on motility patterns in the rat colon. Br J Pharmacol 2014; 169:34-50. [PMID: 23297830 DOI: 10.1111/bph.12100] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 11/26/2012] [Accepted: 12/17/2012] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND AND PURPOSE Hydrogen sulphide (H2 S) is an endogenous gaseous signalling molecule with putative functions in gastrointestinal motility regulation. Characterization of H2 S effects on colonic motility is crucial to establish its potential use as therapeutic agent in the treatment of colonic disorders. EXPERIMENTAL APPROACH H2 S effects on colonic motility were characterized using video recordings and construction of spatio-temporal maps. Microelectrode and muscle bath studies were performed to investigate the mechanisms underlying H2 S effects. NaHS was used as the source of H2 S. KEY RESULTS Rhythmic propulsive motor complexes (RPMCs) and ripples were observed in colonic spatio-temporal maps. Serosal addition of NaHS concentration-dependently inhibited RPMCs. In contrast, NaHS increased amplitude of the ripples without changing their frequency. Therefore, ripples became the predominant motor pattern. Neuronal blockade with lidocaine inhibited RPMCs, which were restored after administration of carbachol. Subsequent addition of NaHS inhibited RPMCs. Luminal addition of NaHS did not modify motility patterns. NaHS inhibited cholinergic excitatory junction potentials, carbachol-induced contractions and hyperpolarized smooth muscle cells, but did not modify slow wave activity. CONCLUSIONS AND IMPLICATIONS H2 S modulated colonic motility inhibiting propulsive contractile activity and enhancing the amplitude of ripples, promoting mixing. Muscle hyperpolarization and inhibition of neurally mediated cholinergic responses contributed to the inhibitory effect on propulsive activity. H2 S effects were not related to changes in the frequency of slow wave activity originating in the network of interstitial cells of Cajal located near the submuscular plexus. Luminal H2 S did not modify colonic motility probably because of epithelial detoxification.
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Affiliation(s)
- V Gil
- Department of Cell Biology, Physiology and Immunology/Neuroscience Institute, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Martínez-Cutillas M, Gil V, Gallego D, Mañé N, Martín MT, Jiménez M. Mechanisms of action of otilonium bromide (OB) in human cultured smooth muscle cells and rat colonic strips. Neurogastroenterol Motil 2013; 25:e803-12. [PMID: 23941257 DOI: 10.1111/nmo.12206] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 07/19/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND The pharmacological properties of otilonium bromide (OB) have been investigated using different experimental models, techniques, and conditions, and consequently, the results are not always easy to compare. The aim of the present work was to investigate the pharmacological properties of OB in human cultured colonic smooth muscle cells (HCSMCs), which is the main target of the drug 'in vivo'. Rat colonic strips were used to confirm the pharmacological properties. METHODS Human cultured colonic smooth muscle cells were studied using the calcium imaging technique. Microelectrodes and muscle bath experiments were performed in rat colonic strips. KEY RESULTS Otilonium bromide (OB) concentration dependently inhibited nifedipine-sensitive calcium transients induced by KCl (EC50 = 3.6 μM) and BayK8644 (EC50 = 4.0 μM). All the following experiments were performed in the presence of nifedipine. In HCSMC, carbachol-induced calcium transients were inhibited by OB (EC50 = 8.4 μM). Carbachol evoked 1-a smooth muscle depolarization (10 mV) that was antagonized by 100 μM OB; and 2-a contraction that was inhibited by OB (EC50 = 13.0 μM). 'Non-nitrergic (L-NNA 1 mM) non-purinergic (MRS2500 1 μM)' conditions were used to elicit endogenous excitatory responses. Electrical field stimulation caused 1-an atropine-sensitive excitatory junction potential that was inhibited by OB (EC50 = 8.9 μM) and 2-an atropine-sensitive contraction that was inhibited by OB (EC50 = 7.3 μM). In HCSMC, neurokinin A (NKA) and CaCl2 induced calcium transients that were inhibited by OB (NKA: EC50 = 11.7 μM; CaCl2 : EC50 = 17.5 μM). CONCLUSIONS & INFERENCES Otilonium bromide causes inhibition of L-/T-type calcium channels, muscarinic, and tachykininergic responses that acting together explain the pharmacological properties of the compound.
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Affiliation(s)
- M Martínez-Cutillas
- Department of Cell Biology, Physiology and Immunology and Neurosciences Institute, Universitat Autònoma de Barcelona, Barcelona, Spain
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Cortés E, Rizo-Baeza MM, Aguilar MJ, Hidalgo MJ, Gil V. [Correspondence between the fatty acids in healthy children serum and in membrane phospholipids]. NUTR HOSP 2013; 28:1541-5. [PMID: 24160213 DOI: 10.3305/nh.2013.28.5.6528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The diet is important in the supply of fatty acids in humans, especially those of the n-3 and n-6 families by its essentiality and related physiological function. It is important to have reference values in accessible biological samples: serum and erythrocyte membranes, in order to alleviate potential shortfalls. The objective is quantifying fatty acids present in these samples from C6 to C26. MATERIAL AND METHODS the determinations of the fatty acids of 30 healthy children in serum and its corresponding membrane phospholipids from blood cells by lipid extraction, methylation, separation and quantification in gas chromatography with detection of masses have been. It is comparing the values obtained in each serum and its partner of cell membranes. RESULTS AND DISCUSSION It is have obtained normal values in healthy children. The C16, which represent a quarter of all fatty acids, it is in the same proportion in both samples, in the rest of fatty acids, there is no clear correspondence between both values. In the n-6 family, the C18:2n6 is higher in serum against the C20:4n6 which is in the phospholipids. In the same way between the n-3 family, the C20:5n3 is higher in serum and the C22:6n3 is in membrane phospholipids. These values are cause of different processes, recent nutritional contribution to serum and with long-term implications and metabolic values in the phospholipids of membranes.
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Affiliation(s)
- E Cortés
- Universidad Miguel Hernández. Departamento de Farmacología, Pediatría y Q. Orgánica y Departamento de Medicina Clínica
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Faustino M, Baptista S, Lourenco E, Leal P, Monteiro C, Cabaco R, Nedio M, Gil V. Clinic, metabolic and hemodynamic benefits of bariatric surgery. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Baptista SB, Loureiro J, Brizida L, Magno P, Leal P, Lourenco E, Monteiro C, Nedio M, Farto E Abreu P, Gil V. Contrast-induced hyperemia in the functional evaluation of coronary lesions with a pressure wire. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Baptista SB, Loureiro J, Brizida L, Magno P, Leal P, Lourenco E, Monteiro C, Nedio M, Farto E Abreu P, Gil V. Resting Pd/Pa and fractional flow reserve: do we need to obtain maximal hyperemia in all patients? Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Cortés E, Hidalgo MJ, Rizo-Baeza MM, Aguilar MJ, Gil V. [High ratio of omega 6/omega 3 ratio children with neuropathies; cause or effect]. NUTR HOSP 2013; 28:1165-1170. [PMID: 23889637 DOI: 10.3305/nh.2013.28.4.6584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION The n-3 and n-6 fatty acids compete for the same elongases and desaturases, still highly deficient synthesis of polyunsaturated fatty acids from n-3 linolenic acid. The n-3 polyunsaturated prevent disease and are important in the development and maintenance of neuronal activities, necessitating a proper relationship with their antagonists n-6. This paper studies the proportion of these fatty acids. MATERIAL AND METHODS We analyzed the fatty acids of n- 3 and n-6 in sera and membrane phospholipid with 374 children neuropathies and 34 healthy children, using gas chromatography with mass detector. It has made the relevant statistical study. RESULTS The n-3 (EPA and DHA) in serum and their corresponding membrane phospholipids correlate better than the n-6 family. The major n-6 (LA and ARA) are equally in serum, being significantly higher in phospholipids of healthy children. The n-3 (EPA and DHA) have higher values in healthy children, both in serum and phospholipids, their sum is equal to the membrane phospholipids. The n-6/n-3 ratio is higher in children with neurological disorder in both samples. CONCLUSION Not being the cause of the high rate n-6/n- 3 neuropathy, however it is advisable to increase the intake of n-3, DHA particularly across the population, especially in children with neurological disorders.
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Affiliation(s)
- E Cortés
- Departamento de Farmacología, Pediatría y Q. Orgánica, Universidad Miguel Hernández, España
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Gil V, Martínez-Cutillas M, Mañé N, Martín MT, Jiménez M, Gallego D. P2Y(1) knockout mice lack purinergic neuromuscular transmission in the antrum and cecum. Neurogastroenterol Motil 2013; 25:e170-82. [PMID: 23323764 DOI: 10.1111/nmo.12060] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Pharmacological studies using selective P2Y(1) antagonists, such as MRS2500, and studies with P2Y(1)(-/-) knockout mice have demonstrated that purinergic neuromuscular transmission is mediated by P2Y(1) receptors in the colon. The aim of the present study was to test whether P2Y(1) receptors are involved in purinergic neurotransmission in the antrum and cecum. METHODS Microelectrode recordings were performed on strips from the antrum and cecum of wild type animals (WT) and P2Y(1)(-/-) mice. KEY RESULTS In the antrum, no differences in resting membrane potential and slow wave activity were observed between groups. In WT animals, electrical field stimulation elicited a MRS2500-sensitive inhibitory junction potential (IJP). In P2Y(1)(-/-) mice, a nitrergic IJP (N(ω) -nitro-l-arginine-sensitive), but not a purinergic IJP was recorded. This IJP was equivalent to the response obtained in strips from WT animals previously incubated with MRS2500. Similar results were obtained in the cecum: 1- the purinergic IJP (MRS2500-sensitive) recorded in WT animals was absent in P2Y(1)(-/-) mice 2- nitrergic neurotransmission was preserved in both groups. Moreover, 1- spontaneous IJP (MRS2500-sensitive) could be recorded in WT, but not in P2Y(1)(-/-) mice 2- MRS2365 a P2Y(1) agonist caused smooth muscle hyperpolarization in WT, but not in P2Y(1) (-/-) animals, and 3- β-NAD caused smooth muscle hyperpolarization both in WT and P2Y(1)(-/-) animals. CONCLUSIONS & INFERENCES 1- P2Y(1) receptor is the general mechanism of purinergic inhibition in the gastrointestinal tract, 2- P2Y(1)(-/-) mouse is a useful animal model to study selective impairment of purinergic neurotransmission and 3- P2Y(1)(-/-) mouse might help in the identification of purinergic neurotransmitter(s).
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Affiliation(s)
- V Gil
- Department of Cell Biology, Physiology and Immunology and Neuroscience Institute, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Gil V, Ramírez T, Paz Y, Quesada-Canales O, Suárez-Bonnet A, Herráez P, Andrada M. Measurement of the Reid Index in Normal Pig Lungs. J Comp Pathol 2013. [DOI: 10.1016/j.jcpa.2012.11.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gil V, Gallego D, Moha Ou Maati H, Peyronnet R, Martínez-Cutillas M, Heurteaux C, Borsotto M, Jiménez M. Relative contribution of SKCa and TREK1 channels in purinergic and nitrergic neuromuscular transmission in the rat colon. Am J Physiol Gastrointest Liver Physiol 2012; 303:G412-23. [PMID: 22636169 DOI: 10.1152/ajpgi.00040.2012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Purinergic and nitrergic neurotransmission predominantly mediate inhibitory neuromuscular transmission in the rat colon. We studied the sensitivity of both purinergic and nitrergic pathways to spadin, a TWIK-related potassium channel 1 (TREK1) inhibitor, apamin, a small-conductance calcium-activated potassium channel blocker and 1H-[1,2,4]oxadiazolo[4,3-α]quinoxalin-1-one (ODQ), a specific inhibitor of soluble guanylate cyclase. TREK1 expression was detected by RT-PCR in the rat colon. Patch-clamp experiments were performed on cells expressing hTREK1 channels. Spadin (1 μM) reduced currents 1) in basal conditions 2) activated by stretch, and 3) with arachidonic acid (AA; 10 μM). l-Methionine (1 mM) or l-cysteine (1 mM) did not modify currents activated by AA. Microelectrode and muscle bath studies were performed on rat colon samples. l-Methionine (2 mM), apamin (1 μM), ODQ (10 μM), and N(ω)-nitro-l-arginine (l-NNA; 1 mM) depolarized smooth muscle cells and increased motility. These effects were not observed with spadin (1 μM). Purinergic and nitrergic inhibitory junction potentials (IJP) were studied by incubating the tissue with l-NNA (1 mM) or MRS2500 (1 μM). Both purinergic and nitrergic IJP were unaffected by spadin. Apamin reduced both IJP with a different potency and maximal effect for each. ODQ concentration dependently abolished nitrergic IJP without affecting purinergic IJP. Similar effects were observed in hyperpolarizations induced by sodium nitroprusside (1 μM) and nitrergic relaxations induced by electrical stimulation. We propose a pharmacological approach to characterize the pathways and function of purinergic and nitrergic neurotransmission. Nitrergic neurotransmission, which is mediated by cyclic guanosine monophosphate, is insensitive to spadin, an effective TREK1 channel inhibitor. Both purinergic and nitrergic neurotransmission are inhibited by apamin but with different relative sensitivity.
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Affiliation(s)
- V Gil
- Department of Cell Biology, Physiology and Immunology and Neuroscience Institute, Universitat Autònoma de Barcelona, Bellaterra, Spain
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Abstract
BACKGROUND AND PURPOSE The role of hydrogen sulphide (H₂S) as a putative endogenous signalling molecule in the gastrointestinal tract has not yet been established. We investigated the effect of D,L-propargylglycine (PAG), an inhibitor of cystathionine γ-lyase (CSE), amino-oxyacetic acid (AOAA) and hydroxylamine (HA), inhibitors of cystathionine β-synthase (CBS) on rat colonic motility. EXPERIMENTAL APPROACH Immunohistochemistry, H₂S production, microelectrode and organ bath recordings were performed on rat colonic samples without mucosa and submucosa to investigate the role of endogenous H₂S in motility. KEY RESULTS CSE and CBS were immunolocalized in the colon. H₂S was endogenously produced (15.6 ± 0.7 nmol·min⁻¹·g⁻¹ tissue) and its production was strongly inhibited by PAG (2 mM) and AOAA (2 mM). PAG (2 mM) caused smooth muscle depolarization and increased spontaneous motility. The effect was still recorded after incubation with tetrodotoxin (TTX, 1 µM) or N(ω) -nitro-L-arginine (L-NNA, 1 mM). AOAA (2 mM) caused a transient (10 min) increase in motility. In contrast, HA (10 µM) caused a 'nitric oxide-like effect', smooth muscle hyperpolarization and relaxation, which were antagonized by 1H-[1,2,4]oxadiazolo[4,3-α]quinoxalin-1-one (ODQ, 10 µM). Neither spontaneous nor induced inhibitory junction potentials were modified by AOAA or PAG. CONCLUSIONS AND IMPLICATIONS We demonstrated that H₂S is endogenously produced in the rat colon. PAG and AOAA effectively blocked H₂S production. Our data suggest that enzymatic production of H₂S regulates colonic motility and therefore H₂S ight be a third gaseous inhibitory signalling molecule in the gastrointestinal tract. However, possible non-specific effects of the inhibitors should be considered.
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Affiliation(s)
- V Gil
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
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Abstract
BACKGROUND AND PURPOSE The role of hydrogen sulphide (H₂S) as a putative endogenous signalling molecule in the gastrointestinal tract has not yet been established. We investigated the effect of D,L-propargylglycine (PAG), an inhibitor of cystathionine γ-lyase (CSE), amino-oxyacetic acid (AOAA) and hydroxylamine (HA), inhibitors of cystathionine β-synthase (CBS) on rat colonic motility. EXPERIMENTAL APPROACH Immunohistochemistry, H₂S production, microelectrode and organ bath recordings were performed on rat colonic samples without mucosa and submucosa to investigate the role of endogenous H₂S in motility. KEY RESULTS CSE and CBS were immunolocalized in the colon. H₂S was endogenously produced (15.6 ± 0.7 nmol·min⁻¹·g⁻¹ tissue) and its production was strongly inhibited by PAG (2 mM) and AOAA (2 mM). PAG (2 mM) caused smooth muscle depolarization and increased spontaneous motility. The effect was still recorded after incubation with tetrodotoxin (TTX, 1 µM) or N(ω) -nitro-L-arginine (L-NNA, 1 mM). AOAA (2 mM) caused a transient (10 min) increase in motility. In contrast, HA (10 µM) caused a 'nitric oxide-like effect', smooth muscle hyperpolarization and relaxation, which were antagonized by 1H-[1,2,4]oxadiazolo[4,3-α]quinoxalin-1-one (ODQ, 10 µM). Neither spontaneous nor induced inhibitory junction potentials were modified by AOAA or PAG. CONCLUSIONS AND IMPLICATIONS We demonstrated that H₂S is endogenously produced in the rat colon. PAG and AOAA effectively blocked H₂S production. Our data suggest that enzymatic production of H₂S regulates colonic motility and therefore H₂S ight be a third gaseous inhibitory signalling molecule in the gastrointestinal tract. However, possible non-specific effects of the inhibitors should be considered.
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Affiliation(s)
- V Gil
- Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
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Gallego D, Gil V, Aleu J, Martinez-Cutillas M, Clavé P, Jimenez M. Pharmacological characterization of purinergic inhibitory neuromuscular transmission in the human colon. Neurogastroenterol Motil 2011; 23:792-e338. [PMID: 21585621 DOI: 10.1111/j.1365-2982.2011.01725.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND In the present study, we further characterize the purinergic receptors mediating the inhibitory junction potential (IJP) and smooth muscle relaxation in the human colon using a new, potent and selective agonist (MRS2365), and antagonists (MR2279 and MRS2500) of the P2Y(1) receptor. The P2Y(12) antagonist AR-C66096 was tested as well. Using this pharmacological approach, we tested whether β-nicotinamide adenine dinucleotide (β-NAD) fulfilled the criteria to be considered an inhibitory neurotransmitter in the human colon. METHODS We carried out muscle bath and microelectrode experiments on circular strips from the human colon and calcium imaging recordings on HEK293 cells, which constitutively express the human P2Y(1) receptor. KEY RESULTS Both the fast component of IJP and non-nitrergic relaxation was concentration-dependently inhibited by MRS2279 and MRS2500. This antagonism was confirmed in HEK293 cells. However, AR-C66096 did not modify either inhibitory response. Adenosine 5'-Ο-2-thiodiphosphate and MRS2365 caused a smooth muscle hyperpolarization and transient inhibition of spontaneous motility that was antagonized by MRS2279 and MRS2500. β-Nicotinamide adenine dinucleotide inhibited the spontaneous motility (IC(50) = 3.3 mmol L(-1) ). Nevertheless, this effect was not antagonized by high concentrations of P2Y(1) antagonists. CONCLUSIONS & INFERENCES Inhibitory purinergic neuromuscular transmission in the human colon was pharmacologically assessed by the use of new P2Y(1) receptor antagonists MRS2179, MRS2279, and MRS2500. The rank order of potency of the P2Y(1) antagonists is MRS2500 > MRS2279 > MRS2179. We found that β-NAD partially fulfills the criteria to be considered an inhibitory neurotransmitter in the human colon, but the relative contribution of each purine (ATP/ADP vsβ-NAD) requires further studies.
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Affiliation(s)
- D Gallego
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, (CIBERehd), Instituto de Salud Carlos III, Barcelona, Spain
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Santos MJ, Vinagre F, Canas da Silva J, Gil V, Fonseca JE. Body composition phenotypes in systemic lupus erythematosus and rheumatoid arthritis: a comparative study of Caucasian female patients. Clin Exp Rheumatol 2011; 29:470-476. [PMID: 21640047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Accepted: 10/12/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES The amount and distribution of fat and lean mass have important implications for health and systemic inflammation may represent a risk for altered body composition. The aim of this study was to analyse whether changes in body composition are similarly associated with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), two inflammatory conditions of different pathogenesis. METHODS Body mass index (BMI), waist circumference, fat mass (FM) and fat-free mass (FFM) were measured in 92 women with SLE, 89 with RA and 107 controls. Results were compared among the 3 groups and correlations of FM percentage were explored within SLE and RA. RESULTS Abnormal body composition was more frequent in women with SLE and RA than in non-inflammatory controls, despite having a similar BMI. RA diagnosis was significantly associated with overfat (OR=2.782, 95%CI 1.470-5.264; p=0.002) and central obesity (OR=2.998, 95%CI 1.016-8.841; p=0.04), while sarcopenia was more common among SLE (OR=3.003; 95%CI 1.178-7.676; p=0.01). Sarcopenic obesity, i.e. the coexistence of overfat with sarcopenia, was present in 6.5% of SLE and 5.6% of RA women, but no controls. Independent correlations of FM percentage in women with SLE included smoking, disease activity and CRP. In RA, education, disease activity and cumulative corticosteroid dose were identified as independent predictors of FM percentage. CONCLUSIONS Women with SLE or RA diagnosis are more likely to have abnormal body composition phenotype, with some differences existing between these two conditions. Changes in body composition are partly explained by the inflammatory burden of disease and its treatment.
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Affiliation(s)
- M J Santos
- Rheumatology Research Unit, Instituto de Medicina Molecular da Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal.
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