Cardiovascular

Vasquez A. Review of JAMA Cardiology’s 2018 “Associations of Omega-3 Fatty Acid Supplement Use with Cardiovascular Disease Risks”. Video presentation (http://www.ichnfm.org/jama2018n3) and official transcript (https://www.academia.edu/35935996) 2018 February.

Jantung terletak dalam mediastinum di rongga dada, yaitu diantara kedua paru-paru, pericardium yang meliputi jantung terdiri dari 2 lapisan : pericardium viceralis dan pericardium parietalis. Kedua lapisan pericardium ini dipisahkan oleh sedikit cairan pelumas, yang mengurangi gesekan akibat gerakan pemompaan jantung. Pericardium parietalis melekat ke depan pada sternum, ke belakang pada kolumna vertebralis dank e bawah pada diafragma.

BACKGROUND: Lifestyle choices are associated with cardiovascular disease and mortality. The purpose of this study was to compare adherence to healthy lifestyle habits in adults between 1988 and 2006. METHODS: Analysis of adherence to 5 healthy lifestyle trends (Ն5 fruits and vegetables/day, regular exercise Ͼ12 times/month, maintaining healthy weight [body mass index 18.5-29.9 kg/m 2 ], moderate alcohol consumption [up to 1 drink/day for women, 2/day for men] and not smoking) in the National Health and Nutrition Examination Survey 1988-1994 were compared with results from the National Health and Nutrition Examination Survey 2001-2006 among adults aged 40-74 years. RESULTS: Over the last 18 years, the percent of adults aged 40-74 years with a body mass index Ն30 kg/m 2 has increased from 28% to 36% (P Ͻ.05); physical activity 12 times a month or more has decreased from 53% to 43% (P Ͻ.05); smoking rates have not changed (26.9% to 26.1%); eating 5 or more fruits and vegetables a day has decreased from 42% to 26% (P Ͻ.05), and moderate alcohol use has increased from 40% to 51% (P Ͻ.05). Adherence to all 5 healthy habits has gone from 15% to 8% (P Ͻ.05). Although adherence to a healthy lifestyle was lower among minorities, adherence decreased more among non-Hispanic Whites over the period. Individuals with a history of hypertension/diabetes/cardiovascular disease were no more likely to be adherent to a healthy lifestyle than people without these conditions. CONCLUSIONS: Generally, adherence to a healthy lifestyle pattern has decreased during the last 18 years, with decreases documented in 3 of 5 healthy lifestyle habits. These findings have broad implications for the future risk of cardiovascular disease in adults.

Background Frailty is associated with older age and multimorbidity (two or more long-term conditions); however, little is known about its prevalence or effects on mortality in younger populations. This paper aims to examine the association between frailty, multimorbidity, specific long-term conditions, and mortality in a middle-aged and older aged population.

Introducción y objetivos. La tercera Task Force Conjunta Europea de prevención cardiovascular recomendó el uso de la función de riesgo SCORE de predicción del riesgo de muerte cardiovascular en 10 años para la toma de decisiones en las intervenciones clínicas. El objetivo de este estudio es calibrar dicha función para España. Métodos. Se desarrolló un modelo aplicando las hazard ratio de muerte cardiovascular en 10 años de las cohortes del estudio SCORE a los valores medios específicos por la edad y el sexo de los factores de riesgo del tercer examen del estudio MONICA-Cataluña (1994-1996) y a las funciones de supervivencia cardiovascular en 10 años de la población española basadas en la mortalidad del año 2002. Resultados. El riesgo estimado mediante la función calibrada SCORE fue un 13% más alto que el estimado con la función de bajo riesgo, aunque las diferencias entre ambas oscilaron según la edad, el sexo y especialmente el tabaco. La tabla SCORE calibrada identificó 32 situaciones de alto riesgo no reconocidas en la tabla original SCORE de bajo riesgo, aunque el 50% tenía una prevalencia baja o nula. El porcentaje máximo de sujetos nuevamente identificados de alto riesgo con la tabla calibrada fue del 22%, observándose más diferencias en los varones mayores de 55 años. Conclusiones. Mientras no se disponga de estimaciones del riesgo basadas en cohortes poblacionales españolas suficientemente grandes, la utilización de las funciones originales de riesgo cardiovascular calibradas para el país permitiría adoptar decisiones clínicas y de salud pública adecuadas.

Background: The Cognitive and Emotional Health Project (CEHP) seeks to identify the demographic, social, and biological determinants of cognitive and emotional health in the older adult. As part of the CEHP, a critical evaluation study committee was formed to assess the state of epidemiological research on demographic, social, and biological determinants of cognitive and emotional health. Methods: Criteria for inclusion in the survey were large cohort studies, longitudinal in design, participants predominantly 65 years or older, with measurements of both cognition and emotion, and information on a wide variety of demographic, psychosocial, and biological factors. North American and European studies, which met these criteria, were selected for the review. Outcome measures included cognition, cognitive decline, and cognitive function. For emotion, symptoms included depression and anxiety, positive and negative affect, subjective well being, mastery, and resilience. Results: Ninety-six papers were identified that addressed cognitive and emotional outcomes. A large variety of risk factors were consistently identified with cognitive outcomes, particularly those previously associated with increased risk of cardiovascular disease. There was considerable overlap between risk factors for cognitive and emotional outcomes. Conclusion: This review identifies a large number of lifestyle and health behaviors that alter the risk for maintenance of cognitive and emotional health. Large longitudinal cohort studies are a unique source to explore factors associated with cognitive and emotional health. Secondary analyses of these studies should be encouraged as should the development of standardized questionnaires to measure cognitive and emotional health. Future research in this field should study cognitive and emotional health simultaneously.

The identification of drug therapy problems is the focus of the assessment and the last decision made in that step of the patient care process. Although drug therapy problem identification is technically part of the assessment process, it represents the truly unique contribution made by pharmaceutical care practitioners. It is also a common scenario in chronic non communicable diseases, like cardiovascular diseases. The objective of the research is to characterize the prevalence of drug therapy problems among hospitalized patients with cardiovascular diseases in Felege Hiwot Referral hospital. Hospital based general cohort study design was used. All admitted patients with cardiovascular disease/s, in Felege Hiwot Referral hospital were included. Pharmacists in collaboration with a nurse were involved in collecting the data. The data were analyzed using SPSS version 20.0. Descriptive analysis was used. The most common cardiovascular disease encountered were hypertensive heart disease (26, 32.9%), rheumatic heart disease (24, 31.6%) and, functional heart failure and cor pulmonalae (14, 18.4%). A total of 105 number of DTPs were identified with the mean number of DTP was 1.38 + 0.8. Most of the patients had drug therapy problem, of which indication related problems constituted the highest part.

MEGACODE merupakan ujian akhir untuk menentukan apakah peserta dapat lulus ACLS atau tidak. MEGACODE terdiri dari 5 peserta yang tergabung dalam 1 tim.
Memiliki peran masing-masing,
• Kapten Tim
• Ventilasi
• Compresi
• Obat-obatan
• Pencatat
Pada saat ujian setiap peran memiliki penilaian masing-masing oleh asesor walaupun bobot tertinggi berada pada peran peserta saat menjadi kapten tim.
Peserta kemungkinan besar dinyatakan lulus apabila, ketika ujian MEGACODE peserta dengan peran kapten tim berhasil mengantarkan pasien simulasinya hingga ROSC.
pada tulisan ini akan dibahas beberapa algoritma terhadap kasus-kasus gawat darurat jantung.

In the long human tradition honey has been used not only as a nutrient but also as a medicine. Its composition is rather variable and depends on the floral source and on external factors, such as seasonal, environmental conditions and processing. In this review, specific attention is focused on absorption, metabolism, and beneficial biological activities of honey compounds in human. Honey is a supersaturated solution of sugars, mainly composed of fructose (38%) and glucose (31%), containing also minerals, proteins, free amino acids, enzymes, vitamins and polyphenols. Among polyphenols, flavonoids are the most abundant and are closely related to its biological functions. Honey positively affects risk factors for cardiovascular diseases by inhibiting inflammation, improving endothelial function, as well as the plasma lipid profile, and increasing low-density lipoprotein resistance to oxidation. Honey also displays an important antitumoral capacity, where polyphenols again are considered responsible for its complementary and overlapping mechanisms of chemopreventive activity in multistage carcinogenesis, by inhibiting mutagenesis or inducing apoptosis. Moreover, honey positively modulates the glycemic response by reducing blood glucose, serum fructosamine or glycosylated hemoglobin concentrations and exerts antibacterial properties caused by its consistent amount of hydrogen peroxide and non-peroxide factors as flavonoids, methylglyoxal and defensin-1 peptide. In conclusion, the evidence of the biological actions of honey can be ascribed to its polyphenolic contents which, in turn, are usually associated to its antioxidant and anti-inflammatory actions, as well as to its cardiovascular, antiproliferative and antimicrobial benefits.

Adverse events Antipsychotic drug Autonomic Cardiovascular Side-effects Cardiovascular disease is the leading cause of death in people with severe mental disorders, and rates are proportionally greater than for other diseases such as cancer. Reports of sudden death in patients receiving antipsychotic treatment have raised concerns about the safety of antipsychotic drugs, leading to a number of recent changes in how such drugs are advertised and marketed. The majority of second generation antipsychotic drugs also have significant metabolic side-effects, such as weight gain, insulin resistance and hyperlipidemia, which may contribute indirectly to cardiovascular complications. As the use of antipsychotic drugs continues to expand into new indications and populations such as children and adolescents, a better understanding is needed of how antipsychotic drugs affect the cardiovascular system. Antipsychotic drugs interact with numerous receptors both centrally and peripherally, including monoamine receptors. The direct, non-specific pharmacological actions of antipsychotic drugs can lead to adverse cardiovascular effects, including orthostatic hypotension, tachycardia and ventricular arrhythmias. The mechanisms responsible for these antipsychotic-induced cardiovascular abnormalities have not been fully elucidated, but likely involve blockade of adrenergic or cholinergic receptors and hERG channels, in addition to impaired autonomic function. The direct and indirect effects of antipsychotic drugs on the cardiovascular system and their possible mechanisms of action are discussed in this review, where both preclinical and clinical findings are integrated.

The purpose of this study was to develop a new technological meditative tool, called the virtual reality meditative technique (VRMT) and test its feasibility for further large-scale studies. This VRMT was designed by the 7D Health research team based on principles of mind-body medicine, mental imagery, meditation, and other mystical states of consciousness to promote health-producing effects and optimal well-being. A sacred Hindu virtual reality (VR) environment was created for Hindu participants. EEG equipment was used to detect brainwave changes throughout the virtual reality experience, and self-report measures were administered to gather qualitative data. Although the sample size for this pilot study was too small for statistical data analysis, there were some observed brainwave changes, which suggest that some of the participants were experiencing shifts of consciousness. Additionally, the self-report data revealed that several participants felt calm, peaceful, and compassionate, with some experiencing improved moods. These results demonstrate the need for a further large-scale study to explore the wide range of health possibilities that this new technique could offer as a meditative aid. This VRMT intervention could have potentially therapeutic implications for complementary medicine, improving a person's well-being, as well as for enhancing one's creativity, training compassion, developing a high performance mind, and quickly experiencing higher states of mystical consciousness. Utilisation de la Réalité Virtuelle pour une Neuro-technologie Méditative (Étude Pilote) Par Ranjie Singh, Ph.D., Paula Rayo et Nirvana Singh Résumé Le but de cette étude était de développer un nouvel outil technologique, appelé la « technique méditative de réalité virtuelle » (VRMT d'après ses initiales en anglais) et de mettre à l'épreuve sa faisabilité afin de pouvoir poursuivre ultérieurement des études à grande échelle. Cette VRMT a été conçue par l'équipe de recherche de santé « 7D » et se base sur les principes de la médecine corps-esprit, l'imagerie mentale, la méditation et d'autres états mystiques de conscience, avec le but de promouvoir des effets générateurs de santé et de bien-être optimal. Un environnement de réalité virtuelle (VR) hindoue sacrée a également été créé à l'attention des participants de nationalité hindoue. Un équipement de EEG (électro-encéphalogramme) a été utilisé afin de détecter des changements dans les ondes cérébrales tout au long de l'expérience de réalité virtuelle, et des tests d'auto-évaluation ont été fournis afin de recueillir des données qualitatives. Bien que la taille d'échantillon de cette étude pilote ait été trop exiguë pour produire une analyse

Objective: The objective of this review is to evaluate the evidence for the hypothesis that cardiovascular reactivity can predict the development of preclinical (elevated blood pressure, ventricular remodeling, carotid atherosclerosis) and/or clinical cardiovascular disease states. Methods: A review of the literature was conducted examining prospective studies. Results: Three large epidemiological studies with long-term follow-up periods (20 years or more) have found blood pressure responses to the cold pressor task to be predictive of subsequent essential hypertension in initially normoten- sive samples. Studies showing less consistent results have tended to use shorter-term follow-up periods. A larger body of literature demonstrates consistent associations between stress-related cardiovascular reactivity and blood pressure elevations in youth over the course of 1 to 6 years; such relationships have not been consistently shown among adult samples. Moderately consistent evidence points to a positive relationship between reactivity and other measures of subclinical disease (increased left ventricular mass and carotid atherosclerosis) among the few prospective studies that have examined these issues to date. A number of additional factors, however, such as baseline levels of disease risk and exposure to psychosocial stress, seem to moderate these relationships. Health status at baseline also seems to moderate the association between reactivity and clinical coronary heart disease in recent reports: two of three existing studies in initially healthy samples show no evidence of a relationship between reactivity and clinical outcomes, whereas three of four studies in samples with preexisting coronary heart disease or essential hypertension show a positive relationship between reactivity and subsequent disease states. Conclusions: There is reasonable evidence to suggest that cardiovas- cular reactivity can predict the development of some preclinical states (eg, increased left ventricular mass and blood pressure) states and perhaps even new clinical events in some patients with essential hypertension or coronary heart disease. However, much more information is needed concerning moderating and potentially confounding variables before the robustness of the positive relationships can become clinically useful.

Can obesity, hypertension, diabetes, stroke, cancer and other cardiovascular diseases be prevented and reversed?
Absolutely!
How so? Very simple, just put out the oxygen that keeps the flame of these diseases burning!
Simply put, these modern ‘lifestyle’ diseases, as they are commonly called, are not so much obtained genetically or through heredity as they are obtained through a perverted eating lifestyle and habit. The genes you now have were obtained from your parents, who also obtained theirs from their parents. However, it beats the imagination that such diseases were not common in previous and earlier centuries. So, if it is hereditary, why are they surfacing now? Why did they not occur in our earlier ancestors?
The answer is simple: their lifestyles were different from ours and the problem is not with our genes, but with our diet and sedentary habits.
Many people have been able to manage and reverse their cardiovascular conditions through radical, and on some occasions, gradual, dietary changes.
You might wonder, why do medical science and the greatest physicians not know this?
Again, the answer is simple: medical science is not healthcare, it is disease care! Medicine is not supposed to heal the healthy, but the sick. It is based on three main arms: drugs/medicines (chemotherapy), surgery, and radiation. If your disease cannot be treated by any of these three arms, then medical science cannot help you!
In addition, physicians by their training cannot go outside these three arms of medicine to provide alternative healthcare. Physicians are not dietitians and they only prescribe drugs, not diet. And even dietitians and their standard dietetic recommendations, have failed to save their patients from these diseases.
In this brief diet plan for health, the author presents a background to good and sound health and suggests the simple foods that can secure a disease-free life.
That all may read and be able to apply these healthy principles for a sound and enduring health is the utmost aim of the Author.

There is enormous evidence that the initiation and growth of atherosclerosis is highly influenced by hemodynamic factors. In this study, hemodynamic factors in the following patient specific 3D carotid artery models were studied: i) normal, ii) stenosis (with plaque near to bifurcation of internal carotid artery (ICA)), and iii) surgical model (plaque with surgically fitted Palmaz–Schatz stent). The 3D model of the carotid artery was formed from CT image of a patient through a commercial software MIMICS. The geometrical measurement taken from the 3D model was used to form its CAD model using CATIA software. The CAD model was meshed in ANSYS ICEM CFD module. The inlet- and outlet- boundary conditions were defined and material properties were given in CFX-Pre module of ANSYS. Then the solver input file was given to CFX solver manager for performing computational fluid dynamics (CFD) on the model. The outputs of the CFD analysis were observed in CFD-Post. The wall shear stress and blood velocity were greater both at near the bifurcation and at bend of the carotid artery model. The abnormal model is characterized by high wall shear stress in the stenosed portion which indicates greater probability of growth of plaque. Disturbed flow patterns and oscillating velocity indicate that the vulnerability of plaque formation is high in such places. The hemodynamic values have come back near to normal values in the carotid model fitted with stent. The observed variations in hemodynamic factors in the carotid artery with plaque surgically fitted with stent were compared to its normal model. This information can be used to predict restenosis in future.

Atrial fibrillation (AF) is the most common arrhythmia worldwide, and it has a significant effect on morbidity and mortality. It is a significant risk factor for stroke and peripheral embolization, and it has an effect on cardiac function. Despite widespread interest and extensive research on this topic, our understanding of the etiology and pathogenesis of this disease process is still incomplete. As a result, there are no set primary preventive strategies in place apart from general cardiology risk factor prevention goals. It seems intuitive that a better understanding of the risk factors for AF would better prepare medical professionals to initially prevent or subsequently treat these patients. In this article, we discuss widely established risk factors for AF and explore newer risk factors currently being investigated that may have implications in the primary prevention of AF. For this review, we conducted a search of PubMed and used the following search terms (or a combination of terms): atrial fibrillation, metabolic syndrome, obesity, dyslipidemia, hypertension, type 2 diabetes mellitus, omega-3 fatty acids, vitamin D, exercise toxicity, alcohol abuse, and treatment. We also used additional articles that were identified from the bibliographies of the retrieved articles to examine the published evidence for the risk factors of AF. ª

Thyroid hormones have a significant impact on heart function, mediated by genomic and non-genomic effects. Consequently, thyroid hormone deficiencies, as well as excesses, are expected to result in profound changes in cardiac function regulation and cardiovascular hemodynamics. Thyroid hormones upregulate the expression of the sarcoplasmic reticulum calcium-activated ATPase and downregulate the expression of phospholamban. Overall, hyperthyroidism is characterized by an increase in resting heart rate, blood volume, stroke volume, myocardial contractility, and ejection fraction. The development of ''high-output heart failure'' in hyperthyroidism may be due to ''tachycardia-mediated cardiomyopathy''. On the other hand, in a hypothyroid state, thyroid hormone deficiency results in lower heart rate and weakening of myocardial contraction and relaxation, with prolonged systolic and early diastolic times. Cardiac preload is decreased due to impaired diastolic function. Cardiac afterload is increased, and chronotropic and inotropic functions are reduced. Subclinical thyroid dysfunction is relatively common in patients over 65 years of age. In general, subclinical hypothyroidism increases the risk of coronary heart disease (CHD) mortality and CHD events, but not of total mortality. The risk of CHD mortality and atrial fibrillation (but not other outcomes) in subclinical hyperthyroidism is higher among patients with very low levels of thyrotropin. Finally, medications such as amiodarone may induce hypothyroidism (mediated by the Wolff---Chaikoff), as well as hyperthyroidism (mediated by the Jod---Basedow effect). In both instances, the underlying cause is the high concentration of iodine in this medication.

In addition to their nutritive value, foods provide health benefits or have a role in disease prevention since they contain a wide range of phytochemicals which represent functional or bioactive components. These bioactive molecules present in foods are based on a variety of chemical structures, from carotenoids, through sterols and fatty acids, to different types of polyphenols. In this review, the polyphenols which are common constituents of vascular plants are explored. They are also common constituents of fruits and vegetables, teas and cocoas. The extractable polyphenols, obtainable by solvent extraction of the forest biomass, are of special interest as they are readily available form different types of forest and wood transformation residues. Flavonoids, cinnamic acid derivatives and proanthocyanidins, which share a part of their biosynthetic pathway with lignins, and therefore are associated with "woody" character of the plants, are reviewed along with some non-flavonoids important as food constituents such as stilbenes and hydrolysable tannins. The foods rich in these polyphenols are reviewed along with the forest sources of the same classes of molecules. The emphasis is put on residues of wood transformation such as bark and knotwood as these materials represent particularly rich resources for bioactive polyphenol classes. One of the most notorious bioactive properties of polyphenols is their antioxidant activity. The most important results on antioxidant capacity of forest trees extracts are presented and compared to those obtained for the extracts from healthy foods rich in polyphenols. These results are discussed also in relation to total phenol content of the studied extracts. Finally, the results on the application of selected types of polyphenols or extracts from forest biomass in prevention and/or treatment of diseases which are related to oxidative stress, cardiovascular disease, Alzheimer and cancer, are presented. It is clear from all discussed results, that the forest biomass in general and the residues of wood transformation in particular, represent the important natural resources of bioactive polyphenols. These residues have a real potential to be used as raw materials for the development of food supplements and/or functional foods which can enhance the animal and human health by disease prevention. They are also applicable for cosmetics and pharmaceutical products development, but their application in disease prevention remains more straightforward.

Resveratrol-a natural polyphenolic compound-was first discovered in the 1940s. Although initially used for cancer therapy, it has shown beneficial effects against most cardiovascular and cerebrovascular diseases. A large part of these effects are related to its antioxidant properties. Here we review: (a) the sources, the metabolism, and the bioavailability of resveratrol; (b) the ability of resveratrol to modulate redox signalling and to interact with multiple molecular targets of diverse intracellular pathways; (c) its protective effects against oxidative damage in cardio-cerebro-vascular districts and metabolic disorders such as diabetes; and (d) the evidence for its efficacy and toxicity in humans. The overall aim of this review is to discuss the frontiers in the field of resveratrol's mechanisms, bioactivity, biology, and healthrelated use.

Little research exists in humans concerning the anxiolytic, antidepressant, sedative, and adaptogenic actions the traditional Ayurvedic medicine Bacopa monnieri (BM) possesses in addition to its documented cognitive-enhancing effects. Preclinical work has identified a number of acute anxiolytic, nootropic, and adaptogenic effects of BM that may also co-occur in humans. The current double-blind, placebo-controlled cross-over study assessed the acute effects of a specific extract of BM (KeenMind W -CDRI 08) in normal healthy participants during completion of a multitasking framework (MTF). Seventeen healthy volunteers completed the MTF, at baseline, then 1 h and 2 h after consuming a placebo, 320 mg BM and 640 mg of BM. Treatments were separated by a 7-day washout with order determined by Latin Square. Outcome measures included cognitive outcomes from the MTF, with mood and salivary cortisol measured before and after each completion of the MTF. Change from baseline scores indicated positive cognitive effects, notably at both 1 h post and 2 h post BM consumption on the Letter Search and Stroop tasks, suggesting an earlier nootropic effect of BM than previously investigated. There were also some positive mood effects and reduction in cortisol levels, pointing to a physiological mechanism for stress reduction associated with BM consumption. It was concluded that acute BM supplementation produced some adaptogenic and nootropic effects that need to be replicated in a larger sample and in isolation from stressful cognitive tests in order to quantify the magnitude of these effects. The study was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12612000834853).

The interactive effect of achievement motivation and task difficulty on invested mental effort, postulated by Humphreys and Revelle . Personality, motivation, and performance: a theory of the relationship between individual differences and information processing. Psychol. Rev. 91, 153-184], was examined using behavioral, subjective, and effort-related physiological measures. Eighteen approach-driven participants and 18 avoidance-driven participants were selected based on their motive to achieve success scores and their motive to avoid failure scores. A 2 × 3 factorial design was used, with three levels of task difficulty. As expected, approach-driven participants performed better and had a stronger decrease of midfrequency band of heart rate variability than avoidance-driven participants, especially during the difficult task. These results support the interactive effect of achievement motivation and task difficulty on invested mental effort.

El objetivo de esta revisión se centra en evaluar la validez y fiabilidad del test modificado de Allen como prueba de criba-do para déficits en la circulación colateral palmar y como predictor de isquemia distal de la mano. Para ello, se realizó una revisión sistemática de la literatura a través de 6 bases de datos. Se elaboraron protocolos de búsqueda para localizar estudios que comparasen el test de Allen con la ecografía Doppler para detectar déficits de la circulación colateral de la mano; que evaluasen la incidencia de eventos isquémicos cuando la arterioclisis se realizaba ante un test de Allen anor-mal y que estudiasen la concordancia interobservador del test. En total, 14 artículos cumplieron los criterios de búsque-da. Nueve estudios evaluaron la validez del test como prueba de cribado para déficits de circulación colateral. En base a 3 estudios de metodología análoga, se calculó una sensibilidad y especificidad del test del 77% y 93%, respectivamente. Cuatro estudios que valoraban la capacidad del test para predecir isquemia no objetivaron ningún evento isquémico de la mano tras arterioclisis cuando el test de Allen era anormal. Un único estudio evaluó la fiabilidad del test, determinando una concordancia interobservador del 71,5%. Esta revisión sistemática y metanálisis permite concluir que el test de Allen no presenta una adecuada validez diagnóstica como prueba de cribado de déficits de la circulación colateral de la mano, ni resulta un buen predictor de isquemia de la mano tras una punción arterial. Además, presenta una limitada fiabilidad, por lo que no existen evidencias que sustenten su realización sistemática previa a una punción arterial. Palabras clave: Mano. Circulación colateral. Ultrasonografía. Doppler. Fiabilidad y validez. Reliability and validity of the modified Allen test: a systematic review and metanalysis The objective was to evaluate the reliability and validity of the modified Allen test in screening for collateral circulation deficits in the palm and for predicting distal hand ischemia. We performed a systematic review of the literature indexed in 6 databases. We developed a search strategy to locate studies comparing the Allen test to Doppler ultrasound to detect circulation deficits in the hand, studies assessing the incidence of ischemic events on arterial puncture after an abnormal Allen test result, and studies of Allen test interobserver agreement. Fourteen articles met the inclusion criteria. Nine assessed the validity of the test as a screening tool for detecting collateral circulation deficits. From data published in 3 studies that had followed comparable designs we calculated a sensitivity of 77% and specificity of 93% for the Allen test. Four studies that assessed the ability of the test to predict ischemia did not predict any ischemic hand events following arterial puncture in patients with abnormal Allen test results. A single study assessing the test's reliability reported an interobserver agreement rate of 71.5%. This systematic review and metanalysis allows to conclude that the Allen test does not have sufficient diagnostic validity to serve as a screening tool for collateral circulation deficits in the hand. Nor is it a good predictor of hand ischemia after arterial puncture. Moreover, its reliability is limited. There is insufficient evidence to support its systematic use before arterial puncture. Introducción La isquemia de la mano es un efecto adverso derivado de la punción de la arteria radial en el proceso de obten-ción de una muestra de sangre (gasometría arterial) o de la realización de una cateterización con finalidad diagnós-tica o terapéutica. A pesar que la oclusión arterial sinto-mática o la lesión isquémica permanente de la mano son fenómenos poco frecuentes (se ha documentado una in-cidencia de isquemia de la mano inferior al 0,2%) 1,2 , co-mo medida previa a una punción arterial, para valorar la calidad de la circulación colateral de la arteria cubital al arco palmar y predecir el riesgo de complicaciones isqué-micas, de forma rutinaria se realiza el test de Allen. Aunque existen variaciones en la bibliografía sobre el procedimiento del test de Allen, la maniobra clásica y mayoritariamente extendida es la propuesta por Bed-ford 3 en los años 70 (y modificada a partir de la prime-ra descripción de Edgar Allen), que consiste en pedir al paciente que cierre la mano en un puño y tras compri-mir la arteria radial y la cubital al mismo tiempo com-probar que la palma de la mano adquiere un color pá-lido. Posteriormente, se libera la arteria cubital, sin dejar de comprimir la arteria radial. Si en 10-15 segun-dos no se restablece la coloración normal de la palma de la mano, el test se considera anormal (positivo) y constituye una contraindicación para la punción de la arteria radial por considerar elevado el riesgo de isque-Filiación de los autores:

Objective: To (1) report the prognostic association between anxiety disorder subtypes and major adverse cardiac
events (MACE), (2) report anxiety disorder prevalence in coronary heart disease (CHD), and (3) report the efficacy
of anxiety disorder treatments in CHD.
Methods: A comprehensive electronic database search was performed in November 2013 for studies reporting
anxiety disorder prevalence according to structured interview in CHD samples or MACE, and randomized controlled
trials (RCTs) comparing anxiety disorder treatment with placebo or usual care. From4041 articles 42 samples
were selected for extraction (8 for MACE prognosis, 39 for prevalence, no RCTs were eligible).
Results: Five generalized anxiety disorder (GAD) studies reported 883MACE events (combined n= 2851). There
was a non-significant association between GAD andMACE (risk ratio= 1.20, 95% CI .86–1.68, P=.28) however
the effect size was highly significant in outpatient samples (adjusted hazard ratio = 1.94, 95% CI 1.45–2.60,
P b .001). No other anxiety disorder subtypewas associatedwithMACE. Prevalence data showed high comorbidity
with depression (49.06%; 95% CI 34.28–64.01) and substantial heterogeneity between studies. Panic disorder
prevalence was higher in psychiatrist/psychologist raters (9.92% vs. 4.74%) aswas GAD (18.45% vs. 13.01%). Panic
and GAD estimates were also heterogeneous according to DSM-III-R versus DSM-IV taxonomies.
Conclusions: The paucity of extant anxiety disorder RCTs, alongside MACE risk for GAD outpatients, should stimulate
further anxiety disorder intervention in CHD populations. Research should focus on depression and anxiety,
thereby unraveling disorder specific and more generic pathways.

Cardiovascular disease (CVD) is a major cause of morbidity and mortality
worldwide. Innovative, more stringent diagnostic and prognostic biomarkers
and effective treatment options are needed to lessen its burden. In
recent years, microRNAs have emerged as master regulators of gene
expression – they bind to complementary sequences within the mRNAs of
their target genes and inhibit their expression by either mRNA degradation
or translational repression. microRNAs have been implicated in all major
cellular processes, including cell cycle, differentiation and metabolism.
Their unique mode of action, fine-tuning gene expression rather than turning
genes on/off, and their ability to simultaneously regulate multiple elements
of relevant pathways makes them enticing potential biomarkers and
therapeutic targets. Indeed, cardiovascular patients have specific patterns
of circulating microRNA levels, often early in the disease process. This
article provides a systematic overview of the role of microRNAs in the
pathophysiology, diagnosis and treatment of CVD.

Background: Severe traumatization can evolve into dissociative identity disorder. Dissociative identity disorder patients have the unique feature of having at least two identities or dissociative parts of the personality, described as 'apparently normal part of the personality' (ANP) and 'emotional part of the personality' (EP). ANP inhibits access to traumatic memories thereby enabling daily life functioning. EP is fixated on, and has access and responses to, these memories.

Dietary fiber and whole grains contain a unique blend of bioactive components including resistant starches, vitamins, minerals, phytochemicals and antioxidants. As a result, research regarding their potential health benefits has received considerable attention in the last several decades. Epidemiological and clinical studies demonstrate that intake of dietary fiber and whole grain is inversely related to obesity, type two diabetes, cancer and cardiovascular disease (CVD). Defining dietary fiber is a divergent process and is dependent on both nutrition and analytical concepts. The most common and accepted definition is based on nutritional physiology. Generally speaking, dietary fiber is the edible parts of plants, or similar carbohydrates, that are resistant to digestion and absorption in the small intestine. Dietary fiber can be separated into many different fractions. Recent research has begun to isolate these components and determine if increasing their levels in a diet is beneficial to human health. These fractions include arabinoxylan, inulin, pectin, bran, cellulose, β-glucan and resistant starch. The study of these components may give us a better understanding of how and why dietary fiber may decrease the risk for certain diseases. The mechanisms behind the reported effects of dietary fiber on metabolic health are not well established. It is speculated to be a result of changes in intestinal viscosity, nutrient absorption, rate of passage, production of short chain fatty acids and production of gut hormones. Given the inconsistencies reported between studies this review will examine the most up to date data concerning dietary fiber and its effects on metabolic health.

A large proportion of the health woes beleaguering modern cultures are because of daily physical activity patterns that are profoundly different from those for which we are genetically adapted. The ancestral natural environment in which our current genome was forged via natural selection called for a large amount of daily energy expenditure on a variety of physical movements. Our genes that were selected for in this arduous and demanding natural milieu enabled our ancestors to survive and thrive, leading to a very vigorous lifestyle. This abrupt (by evolutionary time frames) change from a very physically demanding lifestyle in natural outdoor settings to an inactive indoor lifestyle is at the origin of many of the widespread chronic diseases that are endemic in our modern society. The logical answer is to replicate the native human activity pattern to the extent that this is achievable and practical. Recommendations for exercise mode, duration, intensity, and frequency are outlined with a focus on simulating the routine physical activities of our ancient hunter-gatherer ancestors whose genome we still largely share today. In a typical inactive person, this type of daily physical activity will optimize gene expression and help to confer the robust health that was enjoyed by hunter-gatherers in the wild. (Prog Cardiovasc Dis 2011;53:471-479)

Background: Allostatic load (AL) relates to the neural and bodily ''wear and tear'' that emerge in the context of chronic stress. This paper aims to provide clinicians with a comprehensive overview of the role of AL in patophysiology of bipolar disorder (BD) and its practical implications. Methods: PubMed searches were conducted on English-language articles published from 1970 to June 2011 using the search terms allostatic load, oxidative stress, staging, and bipolar disorder crossreferenced with cognitive impairment, comorbidity, mediators, prevention. Results: Progressive neural and physical dysfunction consequent to mood episodes in BD can be construed as a cumulative state of AL. The concept of AL can help to reconcile cognitive impairment and increased rates of clinical comorbidities that occur over the course of cumulative BD episodes. Conclusions: Data on transduction of psychosocial stress into the neurobiology of mood episodes converges to the concept of AL. Mood episodes prevention would not only alleviate emotional suffering, but also arrest the cycle of AL, cognitive decline, physical morbidities and, eventually, related mortality. These objectives can be achieved by focusing on effective prophylaxis from the first stages of the disorder, providing mood-stabilizing agents and standardized psychoeducation and, potentially, addressing cognitive deficits by the means of specific medication and neuropsychological interventions.

In addition to their nutritive value, foods provide health benefits or have a role in disease prevention since they contain a wide range of phytochemicals which represent functional or bioactive components. These bioactive molecules present in foods are based on a variety of chemical structures, from carotenoids, through sterols and fatty acids, to different types of polyphenols. In this review, the polyphenols which are common constituents of vascular plants are explored. They are also common constituents of fruits and vegetables, teas and cocoas. The extractable polyphenols, obtainable by solvent extraction of the forest biomass, are of special interest as they are readily available form different types of forest and wood transformation residues. Flavonoids, cinnamic acid derivatives and proanthocyanidins, which share a part of their biosynthetic pathway with lignins, and therefore are associated with "woody" character of the plants, are reviewed along with some non-flavonoids important as food constituents such as stilbenes and hydrolysable tannins. The foods rich in these polyphenols are reviewed along with the forest sources of the same classes of molecules. The emphasis is put on residues of wood transformation such as bark and knotwood as these materials represent particularly rich resources for bioactive polyphenol classes. One of the most notorious bioactive properties of polyphenols is their antioxidant activity. The most important results on antioxidant capacity of forest trees extracts are presented and compared to those obtained for the extracts from healthy foods rich in polyphenols. These results are discussed also in relation to total phenol content of the studied extracts. Finally, the results on the application of selected types of polyphenols or extracts from forest biomass in prevention and/or treatment of diseases which are related to oxidative stress, cardiovascular disease, Alzheimer and cancer, are presented. It is clear from all discussed results, that the forest biomass in general and the residues of wood transformation in particular, represent the important natural resources of bioactive polyphenols. These residues have a real potential to be used as raw materials for the development of food supplements and/or functional foods which can enhance the animal and human health by disease prevention. They are also applicable for cosmetics and pharmaceutical products development, but their application in disease prevention remains more straightforward.

Obesity is associated with a host of cardiovascular risk factors and its prevalence is rising rapidly. Despite strong evidence that obesity predisposes to the development and progression of coronary heart disease (CHD), numerous studies have shown an inverse relationship between various measures of obesity (most commonly body mass index) and outcomes in established CHD. In this article we review the evidence surrounding the ≪ obesity paradox ≫ in the secondary care of CHD patients and the CHD presentations where a paradox has been found. Finally we discuss the impact of cardiorespiratory fitness and a number of mechanisms which may offer potential explanations for this puzzling phenomenon.