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AIMS: To evaluate a telemonitoring strategy based on automated text messaging and telephone support after heart failure (HF) hospitalization. METHODS AND RESULTS: The MESSAGE-HF study is a prospective multicentre, randomized, nationwide trial enrolling patients from 30 clinics in all regions of Brazil. HF patients with reduced left ventricular ejection fraction (<40%) and access to mobile phones are eligible after an acute decompensated HF hospitalization. Patients meeting eligibility criteria undergo an initial feasibility text messaging assessment and are randomized to usual care or telemonitoring intervention. All patients receive a HF booklet with basic information and recommendations about self-care. Patients in the intervention group receive four daily short text messages (educational and feedback) during the first 30 days of the protocol to optimize self-care; the feedback text messages from patients could trigger diuretic adjustments or a telephone call from the healthcare team. After 30 days, the frequency of text messages can be adjusted. Patients are followed up after 30, 90, and 180 days, with final status ascertained at 365 days by telephone. Our primary endpoint is the change in N-terminal pro-brain natriuretic peptide (NT-proBNP) levels after 180 days. Secondary endpoints include changes in NT-proBNP after 30 days; health-related quality of life, HF self-care, and knowledge scales after 30 and 180 days; and a composite outcome of HF hospitalization and cardiovascular death, adjudicated by a blinded and independent committee. CONCLUSIONS: The MESSAGE-HF trial is evaluating an educational and self-care promotion strategy involving a simple, intensive, and tailored telemonitoring system. If proven effective, it could be applied to a broader population worldwide.

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Abstract Introduction: The objective of this study was to evaluate whether a surgery with the use of valved conduit is capable of leading to better immediate and late results than those obtained by the valve-sparing aortic root reconstruction technique. Methods: Between January 2002 and June 2016, 448 patients underwent aortic root reconstruction. These were divided into three groups according to the technique used: 319 (71.2%) patients received mechanical valved conduits, 49 (10.9%) received biological valved conduits, and 80 (17.9%) underwent the valve-sparing aortic root reconstruction technique. The results were examined by univariate and multivariate analyses of Cox proportional hazards models with multiple logistic regression. Results: The hospital mortality rate was 7.5%. The mortality rates were 8.2%, 12%, and 2.5% in the mechanical valved conduit, biological valved conduit, and aortic valve-sparing groups, respectively, with no significant difference between groups (P=0.1). Thromboembolic complications and reoperation-free survival were also similar (P=0.169 and P=0.688). However, valve-sparing aortic root replacement was superior in terms of long-term survival (P<0.001), hemorrhagic-free survival (P<0.001), and endocarditis-free survival (P=0.048). Multivariate analysis showed that the following aspects had an impact on mortality: age > 70 years (P<0.001; hazard ratio [HR] 1.05), preoperative acute kidney injury (P<0.0042; HR 2.9), diagnosis of dissection (P<0.01; HR 2.0), previous cardiac surgery (P<0.027; HR 2.3), associated coronary artery bypass grafting (P<0.038; HR 1.8), reoperation for postoperative tamponade (P<0.004; HR 2.2) and postoperative acute kidney injury (P<0.02; HR 3.35). Conclusion: Valve-sparing technique seems to be the operation of choice, whenever possible, for aortic root reconstruction.

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INTRODUCTION: The objective of this study was to evaluate whether a surgery with the use of valved conduit is capable of leading to better immediate and late results than those obtained by the valve-sparing aortic root reconstruction technique. METHODS: Between January 2002 and June 2016, 448 patients underwent aortic root reconstruction. These were divided into three groups according to the technique used: 319 (71.2%) patients received mechanical valved conduits, 49 (10.9%) received biological valved conduits, and 80 (17.9%) underwent the valve-sparing aortic root reconstruction technique. The results were examined by univariate and multivariate analyses of Cox proportional hazards models with multiple logistic regression. RESULTS: The hospital mortality rate was 7.5%. The mortality rates were 8.2%, 12%, and 2.5% in the mechanical valved conduit, biological valved conduit, and aortic valve-sparing groups, respectively, with no significant difference between groups (P=0.1). Thromboembolic complications and reoperationfree survival were also similar (P=0.169 and P=0.688). However, valve-sparing aortic root replacement was superior in terms of long-term survival (P<0.001), hemorrhagic-free survival (P<0.001), and endocarditis-free survival (P=0.048). Multivariate analysis showed that the following aspects had an impact on mortality: age > 70 years (P<0.001; hazard ratio [HR] 1.05), preoperative acute kidney injury (P<0.0042; HR 2.9), diagnosis of dissection (P<0.01; HR 2.0), previous cardiac surgery (P<0.027; HR 2.3), associated coronary artery bypass grafting (P<0.038; HR 1.8), reoperation for postoperative tamponade (P<0.004; HR 2.2) and postoperative acute kidney injury (P<0.02; HR 3.35). CONCLUSION: Valve-sparing technique seems to be the operation of choice, whenever possible, for aortic root reconstruction.

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RESUMEN El reemplazo valvular aórtico con prótesis sin sutura es una alternativa innovadora para el tratamiento de la estenosis aórtica en los ancianos y en los pacientes de alto riesgo. Aunque la experiencia mundial con estas prótesis lleva ya varios años, solo recientemente comenzó a comercializarse en Argentina el modelo Perceval S®. Se trata de una prótesis autoexpandible sin sutura hecha de pericardio bovino y montada en un stent de nitinol. En este estudio se presentan los primeros tres casos de reemplazo valvular aórtico con la bioprótesis Perceval realizados en Argentina. La técnica sin sutura es una alternativa prometedora para el reemplazo valvular aórtico quirúrgico con una bioprótesis, y, posiblemente, pueda competir con la terapéutica intravascular en los pacientes de alto riesgo.

ABSTRACT Aortic valve replacement with sutureless prostheses is an innovative alternative for the treatment of aortic stenosis in the el-derly and in high-risk patients. Although the world experience with these prostheses has been going on for several years, only recently, the Perceval S™ model, consisting of a self-expanding sutureless prosthesis made of bovine pericardium and mounted on a nitinol stent, has begun to be commercialized in Argentina. In this study, we present the first three cases of aortic valve replacement with Perceval bioprostheses performed in Argentina. The sutureless technique is a promising alternative for surgi-cal aortic valve replacement with a bioprosthesis, and may possibly compete with intravascular therapy in high-risk patients.

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INTRODUCCIÓN Según la Organización Mundial de la Salud, las lesiones por el tránsito ocupan los primeros lugares entre las causas de muerte y es la primera entre los jóvenes de 15 a 29 años. OBJETIVO Describir el perfil epidemiológico de las víctimas, evaluar la tendencia de la mortalidad por lesiones de tránsito (LT) y su asociación con el parque automotor y moto vehicular en Argentina entre 2002 y 2015. MÉTODOS Estudio ecológico con datos oficiales de mortalidad (codificados según CIE-10) y de parque automotor y moto vehicular para el período 2002-2015. La mortalidad por lesiones no intencionales inespecíficas fueron redistribuidas entre las no intencionales según la metodología de Global Burden of Disease. Se calcularon tasas brutas y ajustadas. Se realizaron modelos Poisson con efectos aleatorios para explorar asociaciones entre las variables en estudio. RESULTADOS Se estimó un aumento del número de muertes del 23% por el método de la redistribución. Se calculó para Argentina una tasa de mortalidad por lesiones de tránsito para el periodo de 13,78 por 100.000 habitantes. Las provincias con tasas más elevadas fueron Santiago del Estero, Santa Cruz y Jujuy con una tasa de 25,7; 25,4 y 24,9 por 100.000 habitantes respectivamente. La Ciudad Autónoma de Buenos Aires presentó la menor tasa, con media anual de 4,02 óbitos por 100.000 habitantes para el período 2002-2015. En relación al parque automotor y moto vehicular se observó un notable aumento en el período analizado. Al realizar los modelos de Poisson con efectos mixtos se observó que el riesgo fue mayor en los jóvenes varones motociclistas de Argentina, con un riesgo de 1,90% (IC 95% 1.81-1.98) para el país. DISCUSIÓN Se observaron grandes diferencias regionales, por tipo de usuario de la vía pública, por sexo y por edad, sustento para la implementación de políticas para revertir las tendencias actuales

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INTRODUCTION: Conventional techniques of surgical correction of arch and descending aortic diseases remains as high-risk procedures. Endovascular treatments of abdominal and descending thoracic aorta have lower surgical risk. Evolution of both techniques - open debranching of the arch and endovascular approach of the descending aorta - may extend a less invasive endovascular treatment for a more extensive disease with necessity of proximal landing zone in the arch. OBJECTIVE: To evaluate descending thoracic aortic remodeling by means of volumetric analysis after hybrid approach of aortic arch debranching and stenting the descending aorta. METHODS: Retrospective review of seven consecutive patients treated between September 2014 and August 2016 for diseases of proximal descending aorta (aneurysms and dissections) by hybrid approach to deliver the endograft at zone 1. Computed tomography angiography were analyzed using a specific software to calculate descending thoracic aorta volumes pre- and postoperatively. RESULTS: Follow-up was done in 100% of patients with a median time of 321 days (range, 41-625 days). No deaths or permanent neurological complications were observed. There were no endoleaks or stent migrations. Freedom from reintervention was 100% at 300 days and 66% at 600 days. Median volume reduction was of 45.5 cm3, representing a median volume shrinkage by 9.3%. CONCLUSION: Hybrid approach of arch and descending thoracic aorta diseases is feasible and leads to a favorable aortic remodeling with significant volume reduction.

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Abstract Introduction: Conventional techniques of surgical correction of arch and descending aortic diseases remains as high-risk procedures. Endovascular treatments of abdominal and descending thoracic aorta have lower surgical risk. Evolution of both techniques - open debranching of the arch and endovascular approach of the descending aorta - may extend a less invasive endovascular treatment for a more extensive disease with necessity of proximal landing zone in the arch. Objective: To evaluate descending thoracic aortic remodeling by means of volumetric analysis after hybrid approach of aortic arch debranching and stenting the descending aorta. Methods: Retrospective review of seven consecutive patients treated between September 2014 and August 2016 for diseases of proximal descending aorta (aneurysms and dissections) by hybrid approach to deliver the endograft at zone 1. Computed tomography angiography were analyzed using a specific software to calculate descending thoracic aorta volumes pre- and postoperatively. Results: Follow-up was done in 100% of patients with a median time of 321 days (range, 41-625 days). No deaths or permanent neurological complications were observed. There were no endoleaks or stent migrations. Freedom from reintervention was 100% at 300 days and 66% at 600 days. Median volume reduction was of 45.5 cm3, representing a median volume shrinkage by 9.3%. Conclusion: Hybrid approach of arch and descending thoracic aorta diseases is feasible and leads to a favorable aortic remodeling with significant volume reduction.

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INTRODUCCIÓN El Síndrome de Guillain-Barré es una polirradiculoneuropatía desmielinizante inflamatoria aguda que puede presentarse a cualquier edad y tiene un alto impacto debido a que genera invalidez transitoria, hospitalizaciones prolongadas con cuidados intensivos y procedimientos de alto costo, discapacidad secuelar y muerte. OBJETIVOS Caracterización epidemiológica del SGB en la provincia de Tucumán, previo a la introducción del virus Zika. Período 2009-2013. MÉTODOS Estudio descriptivo de corte transversal. Se utilizaron fuentes secundarias; egresos hospitalarios, mortalidad y producción de efectores públicos. Se confeccionó un instrumento de relevamiento para la información de historias clínicas. RESULTADOS La incidencia de SGB en nuestra provincia, para el período 2009 ­ 2013 fue del 0,4 por 100.000 habitantes. La edad de presentación registró una mediana de 20.5 años (rango 2-72). El 68% (26) de los pacientes se categorizaron en un nivel 2 de Brigthton. El 84% (32) de los casos presentó un 1er episodio de SGB. En lo que se refiere a la condición de egreso, el 71% (27) presentó un alta con secuelas. La trazabilidad de los pacientes solo pudo concretarse en el 53% (20) de los casos. Durante el período analizado, se registró 15% (6) de mortalidad. DISCUSIÓN El presente trabajo permite conocer las características y el comportamiento de la enfermedad previo a la introducción del virus Zika en la provincia, para así poder establecer un umbral de casos y niveles de alerta; su incidencia y prevalencia; asociaciones y complicaciones más frecuentes. Los resultados permitirán planificar estrategias de abordaje en los diferentes servicios de salud

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The transient receptor potential vanilloid 1 (TRPV1) ion channel is mainly found in primary nociceptive afferents whose activity has been linked to pathophysiological conditions including pain, itch and inflammation. Consequently, it is important to identify naturally occurring antagonists of this channel. Here we show that a naturally occurring monounsaturated fatty acid, oleic acid, inhibits TRPV1 activity, and also pain and itch responses in mice by interacting with the vanilloid (capsaicin)-binding pocket and promoting the stabilization of a closed state conformation. Moreover, we report an itch-inducing molecule, cyclic phosphatidic acid, that activates TRPV1 and whose pruritic activity, as well as that of histamine, occurs through the activation of this ion channel. These findings provide insights into the molecular basis of oleic acid inhibition of TRPV1 and also into a way of reducing the pathophysiological effects resulting from its activation.

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