This paper presents two technological developments oriented to increase the efficiency of the epidemiologic surveillance system and to improve the diagnostic and therapeutic capabilities of the rural establishments with only e-mail connectivity through wireless systems. The Telematics Department of the University of Cauca has developed a computerized epidemiologic surveillance system for the collecting, sending, processing, visualization, and feedback of epidemiologic information at national level. The use of the system in a pilot area has solved the problems of subregister, increasing the volume of data collection in 15%. The complete epidemiologic system is currently being implemented in 22 health care establishments in the Department of Cauca in Colombia. Likewise, the Technical University and Carlos III University of Madrid have developed a distance training system with a high-usability interface both for students and teachers. The system includes authoring, distribution, tracking, and visualization of courses synchronized through electronic mail messages in a clear way for the user. Both systems use a creative combination of e-mail and XML (eXtensible Markup Language)-based technologies, ready to be used through slow, intermittent, and asynchronous communication systems.

Cardiac output (CO) measurement by continuous pulmonary artery thermodilution (COCTD) has been studied in patients with pulsatile-flow LVADs (left ventricular assist devices), confirming the clinical utility. However, it has not been validated in patients with continuous-flow LVADs. Therefore, the aim of this study was to assess the validity of COCTD in continuous-flow LVADs. Continuous-flow LVADs were implanted in six miniature pigs for partial assistance of the left ventricle. Both methods of measuring CO—measurement by COCTD and intermittent pulmonary artery thermodilution, standard technique (COITD)—were used in four consecutive moments of the study: before starting the LVAD (basal moment), and with the LVAD started in normovolemia, hypervolemia (fluid overloading), and hypovolemia (shock hemorrhage). At the basal moment, COCTD and COITD were closely correlated (r2 = 0.97), with a mean bias of −0.13 ± 0.16 L/min and percentage error of 11%. After 15 min of partial support LVAD, COCTD and COITD were closely correlated (r2 = 0.91), with a mean bias of 0.31 ± 0.35 L/min and percentage error of 20%. After inducing hypervolemia, COCTD and COITD were closely correlated (r2 = 0.99), with a mean bias of 0.04 ± 0.07 L/min and percentage error of 5%. After inducing hypovolemia, COCTD and COITD were closely correlated (r2 = 0.74), with a mean bias of 0.08 ± 0.22 L/min and percentage error of 19%. This study shows that continuous pulmonary thermodilution could be an alternative method of monitoring CO in a porcine model with a continuous-flow LVAD.

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The machine provides the basis of a perfusion system with autonomous controls and the implementation of a hemofilter that enables a more efficient control of hemostasis. Moreover, the developed hardware and software are subjected to further tuning for additional purposes such as pathophysiologic studies, suboptimal grafts recovery, or recellularization of decellularized scaffolds among others.

Cardiac output (CO) measurement is mandatory in patients with left ventricular assist devices (LVADs). Thermodilution with pulmonary artery catheter (PAC) remains the clinical gold standard to measure CO in these patients, however it is associated with several complications. Therefore, the agreement between PAC and new, minimally invasive monitoring methods in LVAD needs to be further investigated. The aim of this study was to assess the accuracy and reliability of transpulmonary thermodilution with a PiCCO2 monitor compared with pulmonary artery thermodilution with PAC in a LVAD. Continuous-flow LVADs were implanted in six mini-pigs to assist the left ventricle. We studied two methods of measuring CO—intermittent transpulmonary thermodilution (COTPTD) by PiCCO2 and intermittent pulmonary artery thermodilution by CAP, standard technique (COPTD)—obtained in four consecutive moments of the study: before starting the LVAD (basal moment), and with the LVAD started in normovolemia, hypervolemia (fluid overloading) and hypovolemia (shock hemorrhage). A total of 72 paired measurements were analysed. At the basal moment, COTPTD and COPTD were closely correlated (r2 = 0.89), with a mean bias of −0.085 ± 0.245 L/min and percentage error of 16%. After 15 min of partial support LVAD, COTPTD and COPTD were closely correlated (r2 = 0.79), with a mean bias of −0.040 ± 0.417 L/min and percentage error of 26%. After inducing hypervolemia, COTPTD and COPTD were closely correlated (r2 = 0.78), with a mean bias of −0.093 ± 0.339 L/min and percentage error of 13%. After inducing hypovolemia, COTPTD and COPTD were closely correlated (r2 = 0.76), with a mean bias of −0.045 ± 0.281 L/min and percentage error of 28%. This study demonstrates a good agreement between transpulmonary thermodilution by PiCCO monitor and pulmonary thermodilution by PAC in the intermittent measurement of CO in a porcine model with a continuous-flow LVAD.

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Introduction MYBPC3 is the most frequently affected gene in Hypertrophic Cardiomyopathy (HCM). This study aimed to analyze the founder origin and clinical phenotype of the MYBPC3 c.2149–1G>A pathogenic variant, which had been previously described in only one HCM proband. Methods HCM probands who underwent genetic test at our institution were reviewed. Clinical data from carriers were collected retrospectively. In order to identify the haplotypes sharing MYBPC3 c.2149–1G>A variant, six markers covering from 46 to 62 Mb of HSA11 were genotyped in 11 carriers and 6 non-carriers. Genotype information for those markers was extracted for Iberian population (n=107) from the 1000 Genomes Browser database. Haplotypes were reconstructed with Phase 2.1 software and phylogenetic analysis with MEGA7 software. Results MYBPC3 c.2149–1G>A was identified in 7 of 523 HCM probands and 23 family members. Penetrance in carriers older than 30 years was 80% (100% men, 55% women, p=0.03). Men were significantly younger at diagnoses, with larger left atrium. One patient had an aborted sudden death. The haplotype reconstruction showed the existence of 53 haplotypes. The most probable segregation for MYBPC3 c.2149–1G>A carriers was estimated in two haplotypes, H52 and H53. The phylogeny reconstruction estimated that both H52 and H53 haplotypes may come from common ancestor H16. In fact, H52 comes from one recombination event in H53 haplotype that has recently occurred in one of our families. Characteristics of affected carriers All (n=16) Men (n=11) Women (n=5) p Age at diagnoses (years) 44 (19) 38 (22) 48 (14.5) 0.036 Maximal LVWT (mm) 19 (4) 19 (3) 17 (6) 0.209 Ejection Fraction (%) 61 (5) 61 (4) 68 (17) 0.131 Left atrium (mm) 42 (13) 44 (15) 35 (11) 0.05 Outflow Tract Obstruction 2 (12.5%) 2 (18.2%) 0 (0%) 0.524 Late Gadolinium Enhancement† 13 (92.9%) 9 (90.0%) 4 (100%) 0.714 Dyspnea (NYHA ≥2) 4 (25%) 4 (36.4%) 0 (0%) 0.242 NSVT 6 (37.5%) 4 (36.4%) 2 (40%) 0.538 Atrial Fibrillation 4 (25%) 3 (27.3%) 1 (20%) 0.635 ICD primary/secondary prevention 7 (43.8%)/1 (6.3%) 5 (45.5%)/1 (9.1%) 2 (40%)/0 (0.0%) 0.750 Data are expressed as median (interquartile range) or number (%). LVWT: left ventricular wall thickness; NSVT: non sustained ventricular tachycardia. †14 man and 4 women underwent cardiac magnetic resonance. MYBPC3 haplotype tree. Conclusions MYBPC3 c.2149–1G>A is a founder pathogenic variant that shows a high penetrance and an early onset of HCM, specially in men.

provided excellent results in occlusion rates, associated with very low rate of adverse events. The reason of our study is to demonstrate the safety and efficacy of VCS outside of a conventional operating room. Methods: A prospective, multi-investigator, randomized study was conducted in two different centers. Between May 2016 and February 2018, a total of 103 saphenous veins were treated in the 83 patients recruited. The patients were divided into two groups (group A, patients who underwent surgery in a conventional surgical room and group B patients operated on in our minor ambulatory surgical room), with the objective of identifying differences in stress level and satisfaction with the procedure performed. In both groups of patients two specialists follow the same surgical protocol, without the application of sedation, regional or general anesthesia. After the procedure, the patient rated pain during the procedure in the limb using a 10-point numerical pain rating scale (NRS), likewise he was asked to score from 0 to 3 previous stress sensation previous and after surgery. All patients revisited the clinic for evaluation 10 days, 1 month, and 3 months post procedural. Results: All treated veins (89 GSV, 9 SSV and 5 ASV) had complete closure by duplex ultrasound during the followup period. Of all the patients who underwent surgery, only 14 (17%) required coadjutant treatment with aetoxisclerol of their residual collateral varices. No phlebotomies were performed. Adverse events (phlebitis like), in the treatment area were occur in 22% of saphenous veins treated. In the Pain Rating Scale (NRS) questionnaire, group B had less pain perception 2.3 AE 1, 2 (0-8). In relation to the sensation of stress previous and after surgery, the 82% of patiens of group B had an initial score between 0-1 in comparison with 44% of group A, this score equalizes in the postoperative with 90% in both groups. Conclusion: This study shows that the use of CVCS is safe and effective in the treatment of CVI outside of a convencional operating room, maintaining the same high occlusion and low adverse events rates with the advantage of reducing the sensation of stress of the patient prior to the procedure. However, there are still many undefined variables and more studies should be done.