Similar Results in Liver Transplantation From Controlled Donation After Circulatory Death Donors With Normothermic Regional Perfusion and Donation After Brain Death Donors: A Case-Matched Single-Center Study.

Although good results have been reported with the use of normothermic regional perfusion (NRP) in controlled donation after circulatory death (cDCD) liver transplantation (LT), there is a lack of evidence to demonstrate similar results to donation after brain death (DBD). We present a single-center retrospective case-matched (1:2) study including 100 NRP cDCD LTs and 200 DBD LTs and a median follow-up of 36 months. Matching was done according to donor age, recipient Model for End-Stage Liver Disease score, and cold ischemia time. The following perioperative results were similar in both groups: alanine transaminase peaks of 909 U/L in the DBD group and 836 U/L in the cDCD group and early allograft disfunction percentages of 21% and 19.2%, respectively. The 1-year and 3-year overall graft survival for cDCD was 99% and 93%, respectively, versus 92% and 87%, respectively, for DBD (P = 0.04). Of note, no cases of primary nonfunction or ischemic-type biliary lesion were observed among the cDCD grafts. Our results confirm that NRP cDCD LT meets the same outcomes as those obtained with DBD LT and provides evidence to support the idea that cDCD donors per se should no longer be considered as "marginal donors" when recovered with NRP.

Correction to: Spanish transcultural adaptation and validation of the English version of the compliance questionnaire in rheumatology.

In the original published article, the family name was incorrectly tagged for two co-authors. The correct family names of authors José Ramón Maneiro Fernández is Maneiro Fernández and Alejandro Souto Vilas is Souto Vilas.

Spanish transcultural adaptation and validation of the English version of the compliance questionnaire in rheumatology.

To perform a transcultural adaptation and validation of a Spanish version of the compliance questionnaire in rheumatology (sCQR). In this transversal study of transcultural adaptation of the sCQR, validity was evaluated in patients with rheumatoid arthritis (RA) and a minimum 6-month follow-up by determining compliance with the electronic prescription system in consuming steroids or nonbiologic disease-modifying antirheumatic drugs. A two-week retest was proposed to all patients. All patients completed the health assessment questionnaire (HAQ), and the Morisky-Green test was also performed. Reliability was analyzed using Cronbach's alpha and the intraclass correlation coefficient (ICC). Convergent construct validity was tested in the electronic prescription system using discriminative analysis, and divergent construct validity was tested by comparing it to the HAQ. Sensitivity, specificity and ROC curves were evaluated for the sCQR and the Morisky-Green test. Of 123 recruited patients, 101 fulfilled the inclusion criteria, and 61 were on biologic therapy. 23 performed the retest. Test-retest reliability (ICC) was 0.76 (Cronbach's alpha 0.86). Multiple regression analysis showed correlation with each item of the sCQR as independent variables (r2 = 0.60). No correlation was seen between total score punctuation of the sCQR and the HAQ (r2 = 0.22). Discriminative analysis weighting each sCQR item showed a cutoff point of - 0.9991 (sensibility and 58.8%, specificity 98.3%). The likelihood ratio of the sCQR to detect ≤ 80% adherence with electronic prescriptions was 35.3. The Morisky-Green test revealed sensibility and specificity were 29.4 and 83.3%, respectively. This study validates the transcultural adaptation of sCQR in RA patients. A high reliability of sCQR for measuring adherence was found. Its predictive value suggests that it could be used as a screening instrument.

Prevalence and progression of chronic kidney disease after liver transplant: a prospective, real-life, observational, two-year multicenter study.

INTRODUCTION: chronic kidney disease is a frequent complication after liver transplantation. The use of calcineurin inhibitors is one of the causes of this complication. Current immunsuppression regimens that reduce the use of calcineurin inhibitors may be associated with an improved preservation of renal function. OBJECTIVE: the study aimed to assess the evolution of renal function after liver transplantation in the current routine clinical practice. METHODS: an observational, prospective, multicenter study in adult liver transplant recipients was performed. Two hundred and thirty patients with a good renal function before transplantation were assessed six months post-transplantation (baseline) and every six months until month 30. RESULTS: at baseline, 32% of the patients had a reduction in the glomerular filtration rate below < 60 ml/min/1.73 m2. The mean glomerular filtration rate increased from 72.3 to 75.6 ml/min/1.73 m2 at baseline and month 30 respectively (p < 0.01). The mean serum creatinine levels (mg/dl) decreased from 1.13 to 1.09 (p < 0.01). The percentage of patients with stage 3 chronic kidney disease decreased from 31.7% to 26.4%, whereas the percentage of patients with stage 4 remained unchanged (0.4% at baseline and 0.5% at month 30). No patients progressed to end-stage kidney disease that required dialysis or renal transplantation. CONCLUSION: in the routine clinical practice, a moderate deterioration of renal function is frequent after liver transplantation. However, advanced chronic kidney disease is infrequent in patients with a good pre-transplant renal function.

[AORTIC ANEURYSMS. THE SILENT ENEMIES]. / ANEURISMAS AÓRTICOS, ENEMIGOS SILENCIOSOS.

Aortic aneurysms are caused by a localized degeneration of the middle layer, which promotes the formation and progressive expansion of the aneurysm. In ascending thoracic aorta, usually have genetic cause, and intervene when they reach 5 to 5.5 cm in diameter. The downlink and abdominal aorta are associated with cardiovascular risk factors, especially age, smoking and hypertension. They are usually asymptomatic until rupture and diagnosis or is incidental or required before rupture performing an ultrasound scan in males over 65 who have been smokers. The alternative treatment to surgery in this location is with percutaneous self-expanding stent.

Copper nanowires immobilized on the boards of microfluidic chips for the rapid and simultaneous diagnosis of galactosemia diseases in newborn urine samples.

Galactosemia is a rare disease that is diagnosed through the identification of different metabolite profiles. Therefore, the specific detection of galactose 1-phosphate (Gal 1-P), galactose (Gal), and uridyl diphosphate galactose (UDP-Gal) confirms type I, II, and III galactosemia diseases. Because of the low prevalence of galactosemia, sample availability is very scarce and screening methods to diagnose the illness are not commonly employed around the world. This work describes the coupling of microfluidic chips (MCs) to copper nanowires (CuNWs) as electrochemical detectors for the fast diagnosis of galactosemia in precious newborn urine samples. Conceptually speaking, we hypothesize that the inherent selectivity and sensitivity of CuNWs, toward galactosemia metabolites detection in connection with MC selectivity could allow the fast and simultaneous detection of the three galactosemia biomarkers, which implies the fast diagnosis of any galactosemia type in just one single analysis. Electrosynthesized CuNWs show a well-defined shape, with an average length of 6 µm and a width of 300 nm. The modified electrodes exhibited an enhanced electroactive surface area twice as high as the nonmodified ones. Very good intraelectrode repeatability with relative standard deviations (RSDs) of <8% (n = 10) and interelectrode reproducibility with RSDs of <12% (n = 5) were obtained, indicating an excellent stability of the nanoscaled electrochemical detector. Under optimum chemical (3 mM NaOH, pH 11.5), electrokinetic (separation voltage +750 V, injection +1500 V for 5 s) and electrochemical (E = +0.70 V in 3 mM NaOH, pH 11.5) conditions, galactosemia diseases were unequivocally identified, differentiating between type I, II, and III, using selected precious ill diagnosed newborn urine samples. Detection proceeded within less than 350 s, required negligible urine sample consumption, and displayed impressive signal-to-noise characteristics (ranging from 14 to 80) and micromolar limits of detection (LODs) much lower than the cutoff levels (Gal 1-P > 0.4 mM and Gal > 1.4 mM). Excellent reproducible recoveries (93%-107%, RSDs <6%) were also achieved, revealing the reliability of the approach. The significance of the newborn urine samples studied confirms the analytical potency of MC-CuNWs approach, enhancing the maturity of the microchip technology and opening new avenues for future implementation of screening applications in the field.

[Alternative treatments to heart transplant]. / Tratamientos alternativos al trasplante cardiaco.

On the past 40 years it has been a significant advance in the Heart Failure treatment, both medical and electrical devices, percutaneous revascularization, surgery, and circulatory support. With them heart transplantation is no longer an essential treatment. Gradually the other techniques are limiting the role of heart transplantation in the final treatment of Heart Failure.

[The segmentary classification of complex congenital heart disease or how the embryology simplified the study of these cardiopathies. The morphology of side by syde great arteries]. / La clasificación segmentaria de las cardiopatías complejas o cómo la embriología simplificó el estudio de estas cardiopatías. Las morfologías de grandes arterias lado a lado.

In the 60-70 years of last century began the systematic study of complex congenital heart disease. The group of Dr. de la Cruz at the National Heart Institute of Mexico, based the segmental analysis of these heart in experimental study of embryological development. We could include exceptions to the complex cadiopathies, adding to the segmental classification, atrial situs, ventricular loop pedicle of the great arteries, the infundibular analysis. This presentation describes for the first time as a separate entity in the segmental analysis cadiopathies with great arteries side by side as a group with a different developmental mechanism to transposition and normally related or crossed great arteries.

Adherence to Treatment in Patients with Rheumatoid Arthritis from Spain.

OBJECTIVE: To evaluate adherence to treatment in a cohort of patients with rheumatoid arthritis in Spain and to identify potential predictors of adherence. METHODS: An observational, cross-sectional, multicenter study in outpatient clinics of Rheumatology Departments from 41 centers was conducted. A validated Spanish version of the compliance questionnaire in Rheumatology was used to measure adherence in a cohort of patients with rheumatoid arthritis, representative of the Spanish population. Univariate and multivariate analyses were performed to detect predictors of adherence. RESULTS: A total of 859 patients were recruited. An adherence rate of 79% was established. No differences were detected in adherence in patients receiving biologic disease-modifying antirheumatic drugs compared to conventional disease-modifying antirheumatic drugs, in patients receiving intravenous therapies compared to other routes of administration and in patients treated in specific day hospitals compared to polyvalent day hospitals. The number of drugs and cohabitation were independent predictors of adherence. CONCLUSION: An inexpensive and useful method was used to measure adherence in Spanish population. The adherence rate in rheumatoid arthritis is still suboptimal. Simpler, more convenient dosing regimens may improve compliance. Increased knowledge of compliance in patients with rheumatoid arthritis and the identification of possible predictors of adherence will allow to develop effective intervention strategies.

Pachydermodactyly: a systematic review.

INTRODUCTION/OBJECTIVES: Pachydermodactyly is a rare, benign fibromatosis located around the proximal interphalangeal joints. It is often misdiagnosed as juvenile idiopathic arthritis and may cause unnecessary treatments and anxiety in patients. The goal of this paper is to describe this condition through all the existing information in the scientific literature. METHOD: A systematic review and a descriptive study have been conducted. A systematic research was performed in PubMed, Embase, Cochrane Library and WOS. RESULTS: Pachydermodactyly was four times more frequent in male subjects and usually started in adolescence. Bilateral presentation was more frequent. History of microtrauma in both hands due to digital manipulation was found in almost half of the patients, many of them showed some neuropsychiatric disorder. In women, the onset happened later, unilateral involvement and family history were more frequent. Swelling of soft tissue without joint implication was found in imaging tests. The progression was usually positive and the treatment included stopping the microtrauma, administrating intralesional corticoids and/or surgery. CONCLUSIONS: Diagnosis can be established in asymptomatic young patients through a congruent physical exam, regular analytic results and imaging tests that simply show swelling of soft tissue-a biopsy is generally not required for diagnosis. As pachydermodactyly's course is asymptomatic and benign, knowledge about this condition is limited, which increases the likelihood of its underdiagnosis-it is important that clinicians know of pachydermodactyly in order to avoid misdiagnosis.

Early tacrolimus exposure does not impact long-term outcomes after liver transplantation.

BACKGROUND: Tacrolimus trough levels (TTL) during the first weeks after liver transplantation (LT) have been related with long-term renal function and hepatocellular carcinoma recurrence. Nevertheless, the significance of trough levels of tacrolimus during the early post-transplant period for the long-term outcome is under debate. AIM: To evaluate the effect of TTL during the first month on the long-term outcomes after LT. METHODS: One hundred fifty-five LT recipients treated de novo with once-daily tacrolimus were retrospectively studied. Patients with repeated LT or combined transplantation were excluded as well as those who presented renal dysfunction prior to transplantation and/or those who needed induction therapy. Patients were classified into 2 groups according to their mean TTL within the first month after transplantation: ≤ 10 (n = 98) and > 10 ng/mL (n = 57). Multivariate analyses were performed to assess risk factors for patient mortality. RESULTS: Mean levels within the first month post-transplant were 7.4 ± 1.7 and 12.6 ± 2.2 ng/mL in the ≤ 10 and > 10 groups, respectively. Donor age was higher in the high TTL group 62.9 ± 16.8 years vs 45.7 ± 17.5 years (P = 0.002) whilst mycophenolate-mofetil was more frequently used in the low TTL group 32.7% vs 15.8% (P = 0.02). Recipient features were generally similar across groups. After a median follow-up of 52.8 mo (range 2.8-81.1), no significant differences were observed in: Mean estimated glomerular filtration rate (P = 0.69), hepatocellular carcinoma recurrence (P = 0.44), de novo tumors (P = 0.77), new-onset diabetes (P = 0.13), or biopsy-proven acute rejection rate (12.2% and 8.8%, respectively; P = 0.50). Eighteen patients died during the follow-up and were evenly distributed across groups (P = 0.83). Five-year patient survival was 90.5% and 84.9%, respectively (P = 0.44), while 5-year graft survival was 88.2% and 80.8%, respectively (P = 0.42). Early TTL was not an independent factor for patient mortality in multivariate analyses. CONCLUSION: Differences in tacrolimus levels restricted to the first month after transplant did not result in significant differences in long-term outcomes of LT recipients.

[Acute coronary syndrome. Clinical and therapeuthics patterns]. / Los síndromes coronarios agudos. Diferencias clinicas y terapéuticas.

Acute Coronary Syndrome (ACS) are classified by the mechanisms of thrombosis that induce the complete of partial occlusion of coronary artery, with two tipes of ST changes in ECG. ACS with ST segment elevation (ACSSTE) is induced by a completed thrombotic occlusion by a red thrombus, it need a rapid and complete restoration of coronary artery blood flow with myocardial reperfusion in the first six hours after starting with pain. This is the mechanism by which reperfusion therapy reduces morbidity and mortality. In ACS with Non ST segment elevation (ACSNSTE) the occlusion mechanism it is a platelet trombosis with partial coronary occlusion. Treatment with antiagregant and anticoagulant drugs avoid complete coronary occlusion, and risk stratification for percutaneous treatment.

[Evaluation and perspective of 20 years of neonatal screening in Galicia. Program results.] / Evaluación y perspectiva de 20 años de cribado neonatal en Galicia. Resultados del programa.

Galician newborn screening program for early detection of endocrine and metabolic diseases began in 1978 and was a pioneer in expanded newborn screening in Spain with the incorporation of mass spectrometry in July 2000. As a primary objective, 28 diseases are screened, including those recommended SNS except sickle cell anemia which is in the inclusion phase. In its 20-year history, 404,616 newborns (nb) have been analyzed, identifying 547 cases affected by the diseases included, with a global incidence of 1: 739 newborns and 1: 1.237 of the screened inborn errors of metabolism (IEM) (1:1.580 nb if excluding benign hyperphenylalaninemia-HPA), with an average participation of 99.35%, progressively higher during the analyzed period. Among the pathologies screened, congenital hypothyroidism (1:2.211 nb), cystinuria (1:4.129 nb) and HPA (1:5.699 nb), followed by phenylketonuria and cystic fibrosis (1:10,936 nb) stand out for their incidence. Sixty-six cases of false positives were identified (seventeen of them in relation to maternal pathology) and five false negatives, being the overall PPV and NPV of the program respectively of 89.2% and 99.99%, with a sensitivity of 99.09% and a specificity of 99.98%. The mortality rate of diagnosed CME patients is 1.52%, with eleven cases presenting symptoms prior to the screening result (2%). The intelligence quotient of IEM patients at risk of neurological involvement is normal in more than 95% of cases.

El Programa Gallego para la Detección Precoz de Enfermedades Endocrinas y Metabólicas se inició en 1978 y fue pionero en España en el cribado neonatal ampliado con la incorporación de la espectrometría de masas en julio de 2000. Como objetivo primario se criban veintiocho enfermedades, incluyendo las de la cartera básica del Servicio Nacional de Salud excepto la anemia de células falciformes, que está en fase de inclusión. En sus veinte años de trayectoria se analizaron 404.616 recién nacidos (RN), identificando 547 casos afectos de las enfermedades incluidas, con una incidencia global de 1:739 RN vivos y de 1:1.237 RN de las enfermedades metabólicas congénitas (EMC) cribadas (1:1.580 RN excluyendo la hiperfenilalaninemia benigna-HPA), con una participación media del 99,35%, progresivamente creciente durante el período analizado. Entre las patologías cribadas destacan por su incidencia el hipotirodismo congénito (1:2.211 RN), la cistinuria (1:4.129 RN) y la HPA (1:5.699 RN), seguida de fenilcetonuria y fibrosis quística (1:10.936 RN). Se identificaron sesenta y seis casos de falsos positivos (diecisiete de los mismos en relación con patología materna) y cinco falsos negativos, siendo el VPP (valor predictivo positivo) y el VPN (valor predictivo negativo) global del programa del 89,2% y 99,99%, respectivamente, con una sensibilidad de 99,09% y una especificidad del 99,98%. La tasa de mortalidad de los pacientes con EMC diagnosticados fue del 1,52%, presentando once casos sintomatología previa al resultado del cribado (2%). El cociente intelectual de los pacientes con EMC y riesgo de afectación neurológica es normal en más del 95% de los casos.

[How it changed the clinical indications and surgical treatment of valvular heart diseases. The clinical challenge]. / En qué han cambiado las indicaciones MQ de las enfermedades valvulares. La visión del clínico.

In the last 30 years, it has changed the prevalence an etiology of valvular heart diseases. They have diminished the rheumatic valvular diseases and have increased the degenerative etiology in elderly people. Globally they continue to be a major pathology in the Departments of Cardiology. The diagnosis has changed and echocardiography/doppler has turned into the basic test for the diagnosis and follow-up of these patients. This best knowledge of the evolution of the different pathologies has allowed the understanding of the more precise timing for surgical treatment, without awaiting the appearance of advanced symptomatology. The percutaneous technologies for the treatment are appearing as an alternative to the cardiac surgery for the patients with high rates of comorbidity and mortality.

Investigation of the Segregation of Binary Mixtures with Iron-Based Particles in a Bubbling Fluidized Bed.

The characterization of the segregation phenomena in binary mixtures of solids with very different densities and/or particle sizes is highly relevant in many industrial processes. As a recent example, some advanced CO2 capture systems using fluidized beds include the separation by segregation of the functional materials. In this work, we have conducted mixing-segregation experiments with particles of iron ore (a typical oxygen carrier in chemical looping combustion systems) acting as jetsam, and glass beads (representing a lower density solid present in the bed) acting as flotsam, to measure solid concentration profiles at different fluidizing gas velocities and mixture compositions of different-sized particles. The experimental concentration profiles have been interpreted using a modified version of the model proposed by Gibilaro and Rowe. A relatively simple correlation is included in the model to calculate the segregation model parameters, which depend on the physical properties of the fluidized solids. The model fits reasonably well with all experimental data, especially for mixtures with a low fraction of oxygen carriers, which are the most relevant for the design of future continuous separation of solids by segregation.

Favorable Outcomes After Liver Transplantation With Normothermic Regional Perfusion From Donors After Circulatory Death: A Single-center Experience.

BACKGROUND: Controlled donation after circulatory death (cDCD) has been associated with a high incidence of ischemic cholangiopathy and other perioperative complications. In an attempt to avoid these complications, we implemented an active protocol of cDCD liver transplant (LT) with normothermic regional perfusion (NRP) preservation. METHODS: This is a descriptive analysis of data collected from a prospective date base of cDCD LT preserved with NRP from January 2015 to June 2017 with a minimum follow up of 9 months. RESULTS: Fifty-seven potential cDCD donors were connected to the NRP system. Of these, 46 livers were transplanted over a 30-month period (80% liver recovery rate). The median posttransplant peak in alanine transaminase was 1136 U/L (220-6683 U/L). Seven (15%) patients presented postreperfusion syndrome and 11 (23%) showed early allograft dysfunction. No cases of ischemic cholangiopathy were diagnosed, and no graft loss was observed over a medium follow-up period of 19 months. Of note, 13 donors were older than 65 years, achieving comparable perioperative and midterm results to younger donors. CONCLUSIONS: As far as we know, this represents the largest published series of cDCD LT with NRP preservation. Our results demonstrate that cDCD liver grafts preserved with NRP appear far superior to those obtained by the conventional rapid recovery technique.

Development and Validation of a Self-Administered Multidimensional Prognostic Index to Predict Negative Health Outcomes in Community-Dwelling Persons.

The multidimensional prognostic index (MPI) is a comprehensive geriatric assessment (CGA)-based tool that accurately predicts negative health outcomes in older subjects with different diseases and settings. To calculate the MPI several validated tools are assessed by health care professionals according to the CGA, whereas self-reported information by the patients is not available, but it could be of importance for the early identification of frailty. We aimed to develop and validate a self-administered MPI (SELFY-MPI) in community-dwelling subjects. For this reason, we enrolled 167 subjects (mean age = 67.3, range = 20-88 years, 51% = men). All subjects underwent a CGA-based assessment to calculate the MPI and the SELFY-MPI. The SELFY-MPI included the assessment of (1) basic and instrumental activities of daily living, (2) mobility, (3) memory, (4) nutrition, (5) comorbidity, (6) number of medications, and (7) socioeconomic situation. The Bland-Altman methodology was used to measure the agreement between MPI and SELFY-MPI. The mean MPI and SELFY-MPI values were 0.147 and 0.145, respectively. The mean difference was +0.002 ± standard deviation of 0.07. Lower and upper 95% limits of agreement were -0.135 and +0.139, respectively, with only 5 of 167 (3%) of observations outside the limits. Stratified analysis by age provided similar results for younger (≤65 years old, n = 45) and older subjects (>65 years, n = 122). The analysis of variances in subjects subdivided according to different year decades showed no differences of agreement according to age. In conclusion, the SELFY-MPI can be used as a prognostic tool in subjects of different ages.

EFFICHRONIC study protocol: a non-controlled, multicentre European prospective study to measure the efficiency of a chronic disease self-management programme in socioeconomically vulnerable populations.

INTRODUCTION: More than 70% of world mortality is due to chronic conditions. Furthermore, it has been proven that social determinants have an enormous impact on both health-related behaviour and on the received attention from healthcare services. These determinants cause health inequalities. The objective of this study is to reduce the burden of chronic diseases in five European regions, hereby focusing on vulnerable populations, and to increase the sustainability of health systems by implementing a chronic disease self-management programme (CDSMP). METHODS AND ANALYSIS: 2000 people with chronic conditions or informal caregivers belonging to vulnerable populations, will be enrolled in the CDSMP in Spain, Italy, the UK, France and the Netherlands. Inclusion of patients will be based on geographical, socioeconomic and clinical stratification processes. The programme will be evaluated in terms of self-efficacy, quality of life and cost-effectiveness using a combination of validated questionnaires at baseline and 6 months from baseline. ETHICS AND DISSEMINATION: This study will follow the directives of the Helsinki Declaration and will adhere to the European Union General Data Protection Regulation. The project's activities, progress and outcomes will be disseminated via promotional materials, the use of mass media, online activities, presentations at events and scientific publications. TRIAL REGISTRATION NUMBER: ISRCTN70517103; Pre-results.

[When should we start the treatment of the cardiovascular risk factors]. / Cuando debemos iniciar el tratamiento de los factores de riesgo cardiovascular?

The major Cardiovascular Risk Factors are well stablished from 50 years ago. But the limits to increase the risk at 5 or 10 years, have take a lot of time and research. They have been decreasing their limits for primary and secondary prevention. As there are many clinical trials about each of these factors, the agreement to establish their normal limits has been published and updated from time to time on the risk management guidelines currently supported by the different scientific societies. Nine modifiable factors accounted for over 90 percent of attributable risk of a first MI.