El implante cardíaco de mioblastos y células madre autólogas de la médula ósea da una perspectiva de estímulo y posibilidad para tratar de reparar el corazón. A pesar de la experiencia en animales lograda con el fin de analizar la seguridad y la eficacia de este nuevo tratamiento, los resultados clínicos todavía se presentan inconclusos. Un tema fundamental es la plasticidad por la cual estas células pueden llegar a mejorar la función como la viabilidad del corazón. En este trabajo se efectúa una revisión de la regeneración natural que nos ofrece la naturaleza y de la experiencia clínica que la sustenta hasta el momento. Una amplia colaboración entre las ciencias básicas y las clínicas en todo el mundo es crucial para progresar en los problemas que actualmente presenta este intento de regenerar áreas fibróticas del corazón.
AntecedentesEl NT-proBNP se asocia con disfunción ventricular y mala evolución en síndromes coronarios agudos sin elevación del ST (SCA-SEST). La evidencia sobre su valor pronóstico en pacientes con SCA-SEST y función sistólica conservada es escasa. ObjetivosExplorar el valor pronóstico del NT-proBNP en pacientes con SCA-SEST sin disfunción ventricular. Material y métodosDe una cohorte de pacientes con SCA-SEST sometidos a angiografía se seleccionaron 393 con fracción de eyección del ventrículo izquierdo ≥ 40%. Laboratorios centrales independientes analizaron las angiografías y las determinaciones de NT-proBNP, troponina T, mioglobina y proteína C reactiva. Se empleó un punto de corte de NT-proBNP de 586 pg/ml. El punto final primario fue la incidencia de muerte o infarto a los 180 días. ResultadosOchenta y tres pacientes (21%) tuvieron NT-proBNP ≥ 586 pg/ml y 310 (79%) niveles < 586 pg/ml. Los pacientes con NT-proBNP elevado eran más añosos, con mayor frecuencia de sexo femenino; tuvieron una proporción mayor de marcadores séricos elevados y una proporción mayor de enfermedad coronaria extensa y de lesiones coronarias complejas. Estos pacientes, comparados con aquellos con NT-proBNP < 586 pg/ml, tuvieron una incidencia mayor de muerte (9,6% versus 2,3%; p = 0,002), infarto (9,6% versus 3,2%; p = 0,01) y muerte o infarto (16,9% versus 5,5%; p = 0,001) a los 180 días. Ajustando por variables clínicas, electrocardiográficas y angiográficas, el NT-proBNP resultó ser un predictor independiente del punto final combinado de muerte o infarto a los 6 meses y de muerte por cualquier causa. ConclusionesEl NT-proBNP es un predictor independiente de muerte e infarto y de muerte global a los 6 meses en pacientes con SCA-SEST sin disfunción ventricular.
Single-anastomosis duodenal-ileal bypass and duodeno-ileal bipartition are effective metabolic surgeries but remain technically demanding due to the complexity and risk of duodeno-ileal anastomotic leaks. Magnetic compression anastomosis using Self-Forming Magnets (SFM) offers a simplified, sutureless alternative that may reduce procedural risk. This study evaluated the feasibility, safety, and four-year outcomes of the SFM Sutureless Neodymium Anastomosis Procedure (SNAP) in patients with obesity and type 2 diabetes mellitus (T2DM). This prospective, single-center study included patients with obesity and T2DM. The SNAP technique involved endoscopic and laparoscopic deployment of SFMs to create a duodeno-ileal anastomosis without sutures or staples. Primary endpoint was change in hemoglobin A1c (HbA1c) through 48 months. Secondary endpoints included percent total weight loss (
Bilateral temporal lobe epilepsy (BTLE) represents a challenging subset of drug-resistant epilepsy, accounting for 20-35% of temporal lobe epilepsy cases. Characterized by independent seizure onset from both temporal lobes, BTLE complicates diagnosis and treatment due to the difficulty in precisely localizing seizure onset zones (SOZs) and its profound cognitive and quality-of-life impact. Memory impairment and frequent seizures significantly burden patients, necessitating advanced diagnostic and therapeutic strategies. Traditional scalp EEG often reveals bilateral ictal patterns but lacks specificity to confirm independent seizure foci. Stereoelectroencephalography remains the gold standard for accurate SOZ localization in BTLE, supported by comprehensive semiological and neuropsychological assessments. Understanding the structural and functional connectivity of the temporal lobes is essential for tailored management. Surgical resection is generally discouraged in BTLE owing to modest seizure control and high risk of cognitive decline. However, unilateral resection may benefit selected patients with pronounced seizure laterality (≥80%), though data remain inconsistent. Neuromodulation therapies, including vagus nerve stimulation, deep brain stimulation, and responsive neurostimulation (RNS), have emerged as promising alternatives, demonstrating responder rates around 70%. Notably, RNS offers unique advantages by enabling long-term monitoring to refine seizure laterality and potentially guide future surgical decisions. Despite these advances, access to neuromodulation remains limited in many settings. BTLE continues to pose diagnostic and therapeutic challenges, emphasizing the need for ongoing research to optimize individualized approaches and improve patient outcomes.
Introduction & Objectives Atopic dermatitis (AD) is a chronic inflammatory skin disease associated with comorbidities, including major adverse cardiovascular (CV) events (MACE), venous thromboembolism (VTE), and malignancy (excluding nonmelanoma skin cancer [exNMSC]). Incidence of MACE, VTE, and malignancy (exNMSC) was comparable to or lower than background rates reported in US AD population. We evaluated long-term incidence rates of MACE, VTE, and malignancy (exNMSC) by CV risk category among patients with AD with up to 6 years of UPA treatment. Materials & Methods Data were pooled from the phase 3, randomized, double-blind, multicenter, placebo-controlled Measure Up 1 & 2 (NCT03569293, NCT03607422) and AD Up (NCT03568318) trials. AD patients were randomized 1:1:1 to once-daily oral UPA 15 mg, UPA 30 mg, or placebo. After the 16-week double-blind treatment period, patients receiving UPA continued their assigned treatment, while patients treated with placebo were rerandomized 1:1 to UPA 15 mg or 30 mg. Incidence rates for MACE (CV death, nonfatal myocardial infarction, or nonfatal stroke), VTE (deep vein thrombosis or pulmonary embolism [fatal and nonfatal]), and malignancy (exNMSC) were evaluated as exposure-adjusted incidence rates per 100 patient-years (n/100 PY). MACE, VTE, and malignancy (exNMSC) background rates in the general US AD population were assessed in a retrospective observational claims-based analysis from Optum’s deidentified Clinformatics Data Mart database; this real-world reference population included patients with an AD diagnosis during the study period (March 2017–September 2024) determined by International Classification of Diseases 9th or 10th edition codes (≥ 1 inpatient or ≥ 2 outpatient claims for AD), and age restrictions from the UPA studies (12–75 years) were implemented. Background rates were weighted to mimic the age and sex distribution in the combined UPA trial population. Cohort stratification was based on the presence of CV risk factors at baseline (0 vs ≥ 1); UPA phase 3 data were further stratified by 1 vs 2 CV risk factors. CV risk factors included prior CV event, hypertension, diabetes mellitus, tobacco/nicotine use (current and former), elevated low-density lipoprotein cholesterol, or lowered high-density lipoprotein cholesterol. Results 2683 UPA-treated patients were included (UPA 15 mg, n = 1337, PY = 4435.2; UPA 30 mg, n = 1346, PY = 4752.5). MACE, VTE, and malignancy (exNMSC) background rates from the claims-based study were evaluated in 50,447 patients with AD. Long-term incidence rates in patients with up to 6 years of UPA treatment were low for MACE and VTE (all ≤ 0.2 n/100 PY) and malignancy (exNMSC; all ≤ 0.7 n/100 PY) and similar for patients who had 0 vs ≥ 1 CV risk factor. Rates from UPA phase 3 studies were similar to real-world US incidence rates in patients with AD. Rates remained low when UPA-treated patients were stratified by 1 vs 2 CV risk factors. Conclusion Incidence rates of MACE, VTE, and malignancy (exNMSC) in patients with moderate-to-severe AD who received up to 6 years of UPA treatment remained low and consistent with those observed in the overall population of patients with AD, regardless of CV risk category.
