Prevalence and epidemiological characteristics of chronic pain in the Spanish population. Results from the pain barometer.

BACKGROUND: Chronic pain (CP) is a public health problem worldwide. AIM: To update the prevalence of CP and compare the clinical and social characteristics of people with CP with those with non-chronic continuous pain and a group without pain. METHODS: An observational cross-sectional study was carried out in a representative sample of 7058 adults from the Spanish population. Sociodemographic data, the presence of CP and non-chronic continuous pain, characteristics of pain, limitations on activities of daily living (ADL), the presence and level of anxiety and depression (HADS), quality of life (SF-12v2) and social support (DUKE) were collected. Descriptive and bivariate analyses were performed. RESULTS: The prevalence of CP was 25.9% (95% CI;24.8-26.9) and that of non-chronic continuous pain was 7.7% (95% CI;7.1-8.3). Women presented a higher prevalence of both CP (30.5% vs. 21.3%) and non-chronic continuous pain (8.8% vs. 6.6%). CP was more common in the group between 55 and 75 years old (30.6%, 95% CI = 28.6-32.6%), non-chronic continuous pain affected most the population between 18 and 34 years old (11.2%, 95% CI = 9.6-12.7%). The median duration of CP was 4 years. The lumbar was the most frequent pain site (58.1%), and 27.1% did not know the cause. A greater frequency of limitations on ADL, more anxiety and depression, and worse quality of life were shown among the subjects with CP. CONCLUSION: CP affects one in four Spanish people and impairs the mental, physical and social health. Differences exist by sex and age in its frequency. Identifying subjects with non-chronic continuous pain is fundamental to prevent their pain from becoming chronic. SIGNIFICANCE STATEMENT: Indicating the main aspects where this work adds significantly to existing knowledge in the field, and if appropriate to clinical practice. Due to its high prevalence and impact on quality of life, chronic pain has become one of the main health problems nowadays. Attention must be paid to it both from a clinical and social perspective, trying to raise awareness among the population of its possible causes and consequences. In routine clinical practice, greater consideration is given to groups of people with a higher prevalence of chronic pain, such as women and people with middle age, and with no chronic pain to prevent the appearance of chronic pain.

IBD-PODCAST Spain: A Close Look at Current Daily Clinical Practice in IBD Management.

BACKGROUND: Crohn's disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) that contributes in part to irreversible bowel damage and long-term complications, reduced quality of life, invalidity, and economic burden. Suboptimal control of IBD is associated with higher healthcare resource utilization (HCRU), impaired quality of life (QoL), and reduced work productivity. AIMS: The IBD-PODCAST study aimed to assess the proportion of IBD patients with suboptimal control and its associated impact. METHODS: IBD-PODCAST is a cross-sectional, multicenter study that aimed to characterize the CD and UC population with optimal or suboptimal control according to the STRIDE-II criteria and patient- and physician-reported measures. Here we present the results of the Spanish cohort (n = 396). RESULTS: A total of 104/196 (53.1%) CD and 83/200 (41.5%) UC patients were found to have suboptimal disease control. Long-term treatment targets according to STRIDE-II were applied in 172 (87.8%) CD and 181 (90.5%) UC patients. 125 of 172 (72.7%) CD and 74 of 181 (40.9%) UC patients were currently treated with targeted immunomodulators. Patients with CD and UC and suboptimal disease control showed impaired QoL, higher HCRU and direct costs, and also loss of work productivity compared to those with optimal control. CONCLUSION: Despite a high rate of targeted immunomodulator therapy, a substantial proportion of IBD patients show suboptimal disease control according to the STRIDE II criteria. Those patients with suboptimal disease control exhibit impaired QoL, less work productivity, and higher HCRU, suggesting that there is considerable need for better treatment approaches in IBD.

Predicting the body core temperature of recreational athletes at the end of a 10 km self-paced run under environmental heat stress.

NEW FINDINGS: What is the central question of this study? The aim was to identify the factors predicting the body core temperature of athletes at the end of a 10 km self-paced run in a hot environment. What is the main finding and its importance? Hyperthermia in athletes subjected to self-paced running depends on several factors, highlighting the integrated control of core temperature during exercise under environmental heat stress. Five of the seven variables that significantly predicted core temperature are not invasive and, therefore, practical for use outside the laboratory environment: heart rate, sweat rate, wet-bulb globe temperature, running speed and maximal oxygen consumption. ABSTRACT: Measurement of body core temperature (Tcore ) is paramount to determining the thermoregulatory strain of athletes. However, standard measurement procedures of Tcore are not practical for extended use outside the laboratory environment. Therefore, determining the factors that predict Tcore during a self-paced run is crucial for creating more effective strategies to minimize the heat-induced impairment of endurance performance and reduce the occurrence of exertional heatstroke. The aim of this study was to identify the factors predicting Tcore values attained at the end of a 10 km time trial (end-Tcore ) under environmental heat stress. Initially, we extracted data obtained from 75 recordings of recreationally trained men and women. Next, we ran hierarchical multiple linear regression analyses to understand the predictive power of the following variables: wet-bulb globe temperature, average running speed, initial Tcore , body mass, differences between Tcore and skin temperature (Tskin ), sweat rate, maximal oxygen uptake, heart rate and change in body mass. Our data indicated that Tcore increased continuously during exercise, attaining 39.6 ± 0.5°C (mean ± SD) after 53.9 ± 7.5 min of treadmill running. This end-Tcore value was primarily predicted by heart rate, sweat rate, differences between Tcore and Tskin , wet-bulb globe temperature, initial Tcore , running speed and maximal oxygen uptake, in this order of importance (ß power values corresponded to 0.462, -0.395, 0.393, 0.327, 0.277, 0.244 and 0.228, respectively). In conclusion, several factors predict Tcore in athletes subjected to self-paced running under environmental heat stress. Moreover, considering the conditions investigated, heart rate and sweat rate, two practical (non-invasive) variables, have the highest predictive power.

Analysis of conventional and nonconventional forensic specimens in drug-facilitated sexual assault by liquid chromatography and tandem mass spectrometry.

The incidence of drug-facilitated sexual assault (DFSA) has dramatically increased in the last decades. Forensic analytical scientists continuously seek new methods and specimens to prove the incidence of intoxication for the judiciary system. Factors influencing sample selection include the ease of obtaining the samples and the window of detection of the drugs, among others. Both conventional (blood, urine) and non-conventional specimens (hair, nails, fluids) have been proposed as suitable in DFSA cases. Reported sample treatments include a variety of liquid-liquid and solid-phase extraction as well as dilute-and-shoot procedures and microextraction techniques. Regarding analysis, liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) has emerged as the preferred confirmatory technique, due to its sensitivity, selectivity, and wide-scope applicability. In this review, we critically discuss the most common specimens and sample treatments/analysis procedures (related to LC-MS/MS) that have been reported during the last ten years. As a final goal, we intend to provide a critical overview and suggest analytical recommendations for the establishment of suitable analytical strategies in DFSA cases.

Monitoring endoscopic postoperative recurrence in Crohn's disease after an ileocecal resection. Does capsule endoscopy have a role in the short and long term?

Background: Small bowel capsule endoscopy (SBCE) is a noninvasive method to detect endoscopic postoperative recurrence (POR) after an ileocolonic resection in Crohn's Disease (CD). Few studies have evaluated the role of SBCE in the early POR (= 12 months). Data for detection of late POR (>12 months) and evaluation of treatment response in previous POR is scarce. We aimed to assess the SBCE performance in the three scenarios (early-POR, late-POR, and previous-POR). Methods: Retrospective 11-year cohort study of SBCE procedures performed on CD patients with ileocolonic resection. Disease activity by Rutgeerts score (RS), correlation with biomarkers, and therapeutic changes were recorded. Results: We included 113 SBCE procedures (34 early-POR, 44 late-POR, and 35 previous-POR). 105 procedures (92.9%) were complete and 97 SBCE (85.5%) were conclusive with no differences between groups. Relevant POR (RS ≥i2) was more frequent in the early-POR group compared to late-POR (58.8% vs 27.3%, p=0.02). In the previous-POR, RS improved in 43.5% of procedures, worsened in 26%, and remained unchanged in 30.5%. Fecal calprotectin (FCP) value of 100µg/g displayed the best accuracy: sensitivity 53.8%, specificity 78.8%, positive predictive value 66.7% and negative predictive value 68.4%. SBCE guided therapeutic changes in 43 patients (38%). No adverse events occurred in our cohort. Conclusion: SBCE is a safe and effective method to assess POR in the early and late setting in clinical practice, and for the evaluation of treatment response to previous POR. FCP is an accurate surrogate marker of POR and 100µg/g value had the best overall accuracy.

Heart rate variability, thyroid hormone concentration, and neuropsychological responses in Brazilian navy divers: a case report of diving in Antarctic freezing waters.

Open-water diving in a polar environment is a psychophysiological challenge to the human organism. We evaluated the effect of short-term diving (i.e., 10 min) in Antarctic waters on autonomic cardiac control, thyroid hormone concentration, body temperatures, mood, and neuropsychological responses (working memory and sleepiness). Data collection was carried out at baseline, before, and after diving in four individuals divided into the supporting (n=2) and diving (n=2) groups. In the latter group, autonomic cardiac control (by measuring heart rate variability) was also assessed during diving. Diving decreased thyroid-stimulating hormone (effect size = 1.6) and thyroxine (effect size = 2.1) concentrations; these responses were not observed for the supporting group. Diving also reduced both the parasympathetic (effect size = 2.6) and sympathetic activities to the heart (ES > 3.0). Besides, diving reduced auricular (effect size > 3.0), skin [i.e., hand (effect size = 1.2) and face (effect size = 1.5)] temperatures compared to pre-dive and reduced sleepiness state (effect size = 1.3) compared to basal, without changing performance in the working memory test. In conclusion, short-term diving in icy waters affects the hypothalamic-pituitary-thyroid axis, modulates autonomic cardiac control, and reduces body temperature, which seems to decrease sleepiness.

Double-headed amphiphile-based sponge droplets: synthesis, characterization and potential for the extraction of compounds over a wide polarity range.

Supramolecular solvents (SUPRASs) are gaining momentum in the multi-residue analysis of liquid samples thanks to the delimited hydrophilic and hydrophobic microenvironments in their nanostructures. In this work, SUPRASs with increased hydrophilicity were synthesized with the aim of enhancing the extractability of polar compounds. For this purpose, a double-headed amphiphile, 1,2-decanediol, was self-assembled in hydro-organic media in the presence and absence of sodium chloride. The SUPRASs formed, characterized by scanning electron microscopy, consisted of sponge droplets made up of a highly convoluted three-dimensional (3D) network of amphiphile. The network contained interconnected bilayers that were intersected by similarly interconnected aqueous channels with high and nearly constant water content (∼30%, w/w). Both the inherently open structure of the sponge morphology and the increased hydrophilic-hydrophobic balance of the amphiphile, provided highly hydrophilic microenvironments into the aggregates that rendered in increased recovery factors for 15 perfluorinated compounds (PFCs, C4-C18, log Pow values from 0.4 to 11.6) in natural waters. Extraction took 15 min without further clean-up or evaporation of extracts which were readily compatible with LC-MS/MS quantitation. Absolute recoveries for PFCs, at the level of a few ng L-1, were in the range 70-120%, except for perfluoropentanoic acid (40%) and perfluorobutane sulfonic acid (51%). Detection limits for PFCs in water were in the range 0.01-0.02 ng L-1, which allowed their determination in slightly polluted waters (0.07-2.33 ng L-1). This work proves that hydrophilicity in SUPRASs can be tailored through the amphiphile and the morphology of their aggregates, and that this characteristic improves compound extractability in multi-residue analysis.

Comportamiento del cáncer de tiroides en la Unidad de Cirugía Adulto del Hospital Clínico Herminda Martín de Chillán: período 2017 al 2019 / Thyroid cancer behavior in the adult surgery unit of the Herminda Martin de Chillan Clinical Hospital: period from 2017 to 2019

Resumen Objetivo: Describir las características demográficas del cáncer de tiroides en la Región de Ñuble en pacientes operados en el servicio de cirugía del Hospital Clínico Herminda Martin del 2017 al 2019. Materiales y Método: Mediante estudio descriptivo, se revisaron las historias clínicas de los pacientes operados en la Unidad de Cirugía de Adultos del hospital entre enero de 2017 y diciembre de 2019, tabulando las variables demográficas, clínicas e histopatológicas y método diagnóstico. Resultados: Se operaron 124 pacientes con afecciones tiroideas, 58 resultaron tener cáncer. Predominó el sexo femenino (50 pacientes). Se realizaron 43 tiroidectomías totales como primera cirugía y 15 disecciones cervicales. El carcinoma papilar fue el más diagnosticado (93,1%). Hubo discrepancias entre las categorías Bethesda II y IV en cuanto al diagnóstico definitivo. En mujeres el 36% de los tumores tuvo extensión extra tiroidea y el 54% tenían un diámetro mayor a 1 cm. Discusión: La prevalencia en el sexo femenino corresponde con los datos que se aportan a nivel mundial y en Chile. La discrepancia en el sistema Bethesda pudo corresponder a errores de la toma de muestra o su interpretación citológica. Los hallazgos de extensión y tamaño tumoral pueden estar en relación con el tiempo de espera para la cirugía. Conclusiones: El cáncer tiroideo es más frecuente en el sexo femenino. El carcinoma papilar fue el más diagnosticado. La asociación de tiroiditis con cáncer tiroideo fue de 98%. No se realizó ninguna cirugía conservadora.

Aim: To describe the demographic characteristics of thyroid cancer in the Ñuble Region in patients operated on by the Herminda Martín de Chillán Clinical Hospital surgery service from 2017 to 2019. Materials and Method: Through a descriptive study, the medical records of the patients operated on in the Adult Surgery Unit of the hospital between January 2017 and December 2019 were reviewed, tabulating the demographic, clinical and histopathological variables and method diagnosis. Results: 124 patients with thyroid conditions were operated on, 58 had cancer. The female sex predominated (50 patients). 43 total thyroidectomies were performed as the first surgery and 15 cervical dissections. Papillary carcinoma was the most diagnosed (93.1%). There were discrepancies between Bethesda categories II and IV regarding the definitive diagnosis. In women, 36% of the tumors had an extra-thyroid extension and 54% had a diameter greater than 1 cm. Discussion: The prevalence in the female sex corresponds to the data provided worldwide and in Chile. The discrepancy in the Bethesda system could correspond to errors in the sampling or its cytological interpretation. The findings of tumor extension and size may be related to the waiting time for surgery. Conclusions: Thyroid cancer is more frequent in females. Papillary carcinoma was the most diagnosed. The association of thyroiditis with thyroid cancer was 98%. No conservative surgery was performed.

Preseason Training Improves Perception of Fatigue and Recovery From a Futsal Training Session.

PURPOSE: To compare the posttraining recovery timeline of elite Brazilian futsal athletes before (Pre-PS) and after 10 weeks of the preseason (Post-PS) period of high-intensity technical-tactical training. METHODS: At the start (n = 13) and at the end of the preseason (n = 7), under-20 male futsal players undertook fitness testing for maximal aerobic power, the countermovement jump (CMJ), and the 10-m sprint with change of direction. Furthermore, at both Pre-PS and Post-PS, the players participated in a training session where performance and psychophysiological measures were recorded before, immediately, 3, 24, and 48 hours postsession. The measures included CMJ, 10-m sprint, creatine kinase, Total Quality Recovery Scale, and Brunel Mood Scale. Effect size (ES) analyses compared fitness and posttraining recovery values for each parameter at Pre-PS versus Post-PS. RESULTS: Only trivial ES (-0.02 to 0.11) was evident in maximal aerobic power, CMJ, and 10-m sprint at Post-PS compared with Pre-PS. For the timeline of recovery, only trivial and small ESs were evident for the 10-m sprint (-0.12 to 0.49), though CMJ recovery was improved at 3 hours (0.87) and 48 hours (1.27) at Post-PS and creatine kinase was lower at 48 hours (-1.33) at Post-PS. Perception of recovery was improved in Post-PS at 3 hours (1.50) and 24 hours postsession (0.92). Furthermore, perception of effort was lower immediately after the session (-0.29), fatigue was lower at 3 hours (-0.63), and vigor responses were improved in all postseason assessments (0.59 to 1.13). CONCLUSION: Despite minimal changes in fitness, preseason training attenuated players' perception of effort and fatigue and improved their recovery profile following a high-intensity technical-tactical training session.

Hormonal, autonomic cardiac and mood states changes during an Antarctic expedition: From ship travel to camping in Snow Island.

We evaluated the influence of an Antarctic expedition, consisting of 26-day ship travel followed by 24-day camping in the Antarctic field during the summer season, on hormonal responses, autonomic cardiac control, and mood states in individuals that live in tropical regions. Data collection was carried out in 10 individuals on the 2nd, 16th, and 26th days aboard the ship (characterized by exposure to low-luminosity and temperature-controlled environments) and on the 4th, 11th, and 23rd days of camping in the Antarctic field (prolonged exposure to natural luminosity and cold environments). Morning samples of saliva (to determine testosterone and cortisol concentrations) and blood [to determine thyroid-stimulating hormone (TSH) and thyroxine (T4) concentrations] were obtained. Next, resting heart rate variability (HRV) was recorded, and the volunteers answered a mood questionnaire. Samples of saliva for measurement of melatonin concentration were obtained at night. At the end of ship travel, blood TSH and salivary melatonin increased by 15.6% and 72.3%, respectively, whereas salivary cortisol reduced by 37.1% compared to initial values and T4 reduced by 12.2% compared to 16th day. These hormonal changes occurred alongside increased depression score and biphasic changes in HRV parameters; for example, the RMSSD, a parasympathetic-related parameter, initially decreased by 47.8% and then returned towards baseline values by the end of the ship travel. In contrast, during the camp period, blood TSH and T4 reduced by 26.5% and 34.1%, respectively, and salivary cortisol increased by 72.1%, without concomitant changes in melatonin and HRV. Also, tension score transiently reduced and then increased towards the pre-camp score by the end of the field period. Testosterone remained unaltered throughout the expedition. In conclusion, ship travel and camping in Antarctica induced distinct neuroendocrine changes, cardiac autonomic regulation, and mood states. These specific changes most likely resulted from exposure to different natural luminosity, degrees of confinement, and ambient temperature in these environments.

Bevacizumab dose adjustment to improve clinical outcomes of glioblastoma.

BACKGROUND: Glioblastoma (GBM) is one of the most aggressive and vascularized brain tumors in adults, with a median survival of 20.9 months. In newly diagnosed and recurrent GBM, bevacizumab demonstrated an increase in progression-free survival, but not in overall survival. METHODS: We conducted an in silico analysis of VEGF expression, in a cohort of 1082 glioma patients. Then, to determine whether appropriate bevacizumab dose adjustment could increase the anti-angiogenic response, we used in vitro and in vivo GBM models. Additionally, we analyzed VEGFA expression in tissue, serum, and plasma in a cohort of GBM patients before and during bevacizumab treatment. RESULTS: We identified that 20% of primary GBM did not express VEGFA suggesting that these patients would probably not respond to bevacizumab therapy as we proved in vitro and in vivo. We found that a specific dose of bevacizumab calculated based on VEGFA expression levels increases the response to treatment in cell culture and serum samples from mice bearing GBM tumors. Additionally, in a cohort of GBM patients, we observed a correlation of VEGFA levels in serum, but not in plasma, with bevacizumab treatment performance. CONCLUSIONS: Our data suggest that bevacizumab dose adjustment could improve clinical outcomes in Glioblastoma treatment.

A new sample treatment strategy based on simultaneous supramolecular solvent and dispersive solid-phase extraction for the determination of ionophore coccidiostats in all legislated foodstuffs.

A single-step sample treatment, for the simultaneous extraction and clean-up for the determination of ionophore coccidiostats in EU legislated foodstuffs, is here proposed. The treatment is based on the combination of: (i) a supramolecular solvent with restricted access properties (SUPRAS-RAM), spontaneously formed by the addition of hexanol, water and THF to the sample; and (ii) dispersive solid phase extraction (dSPE). The SUPRAS-RAM extract was directly compatible with LC-MS/MS and no further re-extraction, evaporation or cleanup procedures were necessary. SUPRAS-RAM efficiently extracted the ionophores (recoveries in milk, eggs, fat, liver, kidney, and chicken and beef muscle were in the range 71-112%) and removed proteins and carbohydrates, whereas dSPE removed fats and other lipophilic compounds. The method was validated following the European Commission Decision 2002/657/EC. Detection limits (0.004-0.07 µg kg-1) were far below the maximum residue limits (1-150 µg kg-1). Method analytical and operational characteristics were suitable for routine determination of ionophores.

The role of clean intermittent catheterization in the treatment for detrusor underactivity. / El cateterismo vesical intermitente en la insuficiencia contráctil del detrusor.

OBJECTIVE: To study the influence of clean intermittent catheterization (CIC) on the lower urinary tract function in patients with urinary retention (UR) due to detrusor underactivity (DU). MATERIAL AND METHODS: A longitudinal study was carried out on 49 patients (28 men, 21 women) of mean age 55years, who underwent CIC for UR secondary to DU. The mean CIC frequency was 3.15 times/day. Patients' clinical data were collected, and they underwent urodynamic study before and after CIC, with a mean interval of 4years. Fisher's exact test was used for the analysis of categorical variables and Student's t test for parametric variables. The level of significance was set at 0.05 for a two-tailed test. RESULTS: The second urodynamic study showed a significantly increased bladder compliance, the Bladder Outlet Obstruction Index (BOOI) and the Bladder Contractility Index (BCI) also increased but without reaching statistical significance. There was a significantly higher percentage of benign prostatic hyperplasia (BPH) and acontractile detrusor cases among the group of patients whose BCI improved after CIC, with significantly lower CIC time. CONCLUSIONS: CIC improved bladder compliance in the patients of our series. The BCI improved in BPH patients and in patients with acontractile detrusor.

Halogen bonding for increasing efficiency in liquid-liquid microextraction: Application to the extraction of hexabromocyclododecane enantiomers in river water.

Halogen bonding (XB) was here proposed, for the first time, as a solubilization mechanism for increasing efficiency in the liquid-liquid microextraction of halogenated compounds. The approach was illustrated by the extraction of hexabromocyclododecane (HBCD) enantiomers in natural waters with a supramolecular solvent (SUPRAS) made up of inverted hexagonal aggregates of decanoic acid. The XB and dispersion interactions offered by the SUPRAS were able to extract the six HBCD enantiomers (i.e. (+)-α-, (-)-α- (+)-ß-, (-)-ß-, (+)-γ- and (-)-γ-) quantitatively (e.g. recoveries in the range 89-106%) and reach concentration factors as high as 720 without the need for solvent evaporation. HBCD enantiomers in the SUPRAS extract were directly analysed by chiral liquid chromatography coupled to tandem mass spectrometry (LCMS/MS). Quantitation limits of the method (0.09-0.9 ng L-1) were below the quality standard stablished by the European Union for HBCDs in inland surface water samples (1.6 ng L-1), and the precision, expressed as relative standard deviation (n = 6), was below 9% for all the HBCD enantiomers at concentrations within the range 50-500 ng L-1. The method was successfully applied to the enantioselective determination of HBCDs in the dissolved and the particle-bound fractions of river waters containing different concentration of suspended particles (10-57.8 mg L-1) that were spiked at two concentration levels (10 and 100 ng L-1). The results here obtained prove that XB is a valuable mechanism for the solubilisation of halogenated compounds that can effectively increase their recovery from liquid and solid samples.

Polyethylene glycol improves current methods for circulating extracellular vesicle-derived DNA isolation.

BACKGROUND: Extracellular vesicles (EVs) are small membrane-bound vesicles which play an important role in cell-to-cell communication. Their molecular cargo analysis is presented as a new source for biomarker detection, and it might provide an alternative to traditional solid biopsies. However, the most effective approach for EV isolation is not yet well established. RESULTS: Here, we study the efficiency of the most common EV isolation methods-ultracentrifugation, Polyethlyene glycol and two commercial kits, Exoquick® and PureExo®. We isolated circulating EVs from the bloodstream of healthy donors, characterized the size and yield of EVs and analyzed their protein profiles and concentration. Moreover, we have used for the first time Digital-PCR to identify and detect specific gDNA sequences, which has several implications for diagnostic and monitoring many types of diseases. CONCLUSIONS: Our findings present Polyethylene glycol precipitation as the most feasible and less cost-consuming EV isolation technique.

Rescue of Discarded Grafts for Liver Transplantation by Ex Vivo Subnormothermic and Normothermic Oxygenated Machine Perfusion: First Experience in Spain.

BACKGROUND: Ex vivo machine perfusion (MP) has been reported as a possibly method to rescue discarded organs. The main aim of this study was to report an initial experience in Spain using MP for the rescue of severely marginal discarded liver grafts, and to, secondarily, define markers of viability to test the potential applicability of these devices for the real increase in the organ donor pool. METHODS: The study began in January 2016. Discarded grafts were included in a research protocol that consisted of standard retrieval followed by 10 hours of cold ischemia. Next, either normothermic (NMP) or controlled subnormothermic (subNMP) rewarming was chosen randomly. Continuous measurements of portal-arterial pressure and resistance were screened. Lactate, pH, and bicarbonate were measured every 30 minutes. The perfusion period was 6 hours, after which the graft was discarded and evaluated as potentially usable, but never implanted. Biopsies of the donor and at 2, 4, and 6 hours after ex vivo MP were obtained. RESULTS: A total of 4 grafts were included in the protocol. The first 2 grafts were perfused by NMP and grafts 3 and 4 by subNMP. The second and third grafts showed a clear trend toward optimal recovery and may have been used. Lactate dropped to levels below 2.5 mmol/L with stable arterial and portal pressure and resistance. Clear biliary output started during MP. Biopsies showed an improvement of liver architecture with reduced inflammation at the end of the perfusion. CONCLUSION: This preliminary experience has demonstrated the potential of MP devices for the rescue of severely marginal liver grafts. Lactate and biliary output were useful for viability testing of the grafts. The utility of NMP or subNMP protocols requires further research.