Tibial tray cementation is not necessary for knee revision with titanium metaphyseal sleeves: a mid-term prospective study in AORI 2B defects.

PURPOSE: Metaphyseal fixation with porous titanium sleeves in revision knee surgery provides mechanical support to the implant, promotes biological fixation, and has shown satisfactory short- and mid-term results. Cement is commonly used to fix the tibial tray to the epiphyseal area. The objective of this study is to determine whether cement should be used to achieve fixation of the tibial tray with the hypothesis that metaphyseal sleeves would provide enough axial and rotational stability making cementation unnecessary. MATERIAL AND METHODS: Prospective study of 60 patients undergoing knee replacement surgery with metaphyseal sleeves in type 2B defects in femur and tibia. Patients were divided into two groups according to the use of cement on the tibial component. Analysis included the American Knee Society Score (KSS) knee and functional scales, the Western Ontario and McMaster Universities (WOMAC) index, the Short Form 12 (SF-12) health survey, and radiographic assessment with a maximum follow-up of 5 years. RESULTS: No statistically significant differences were found between the two groups in any of the parameters assessed. CONCLUSION: Metaphyseal sleeves showed a 100% survivorship at five years of followup. There were no differences in clinical and radiographic outcomes at five years of follow-up depending on whether or not cement was used for tibial platform fixation. Cementation of the tibial tray would therefore not be required to achieve satisfactory mid-term results. LEVEL OF EVIDENCE: Level II: prospective cohort study. Therapeutic.

Effect of an individualized versus standard pneumoperitoneum pressure strategy on postoperative recovery: a randomized clinical trial in laparoscopic colorectal surgery.

BACKGROUND: It remains uncertain whether individualization of pneumoperitoneum pressures during laparoscopic surgery improves postoperative recovery. This study compared an individualized pneumoperitoneum pressure (IPP) strategy with a standard pneumoperitoneum pressure (SPP) strategy with respect to postoperative recovery after laparoscopic colorectal surgery. METHODS: This was a multicentre RCT. The IPP strategy comprised modified patient positioning, deep neuromuscular blockade, and abdominal wall prestretching targeting the lowest intra-abdominal pressure (IAP) that maintained acceptable workspace. The SPP strategy comprised patient positioning according to the surgeon's preference, moderate neuromuscular blockade and a fixed IAP of 12 mmHg. The primary endpoint was physiological postoperative recovery, assessed by means of the Postoperative Quality of Recovery Scale. Secondary endpoints included recovery in other domains and overall recovery, the occurrence of intraoperative and postoperative complications, duration of hospital stay, and plasma markers of inflammation up to postoperative day 3. RESULTS: Of 166 patients, 85 received an IPP strategy and 81 an SPP strategy. The IPP strategy was associated with a higher probability of physiological recovery (odds ratio (OR) 2·77, 95 per cent c.i. 1·19 to 6·40, P = 0·017; risk ratio (RR) 1·82, 1·79 to 1·87, P = 0·049). The IPP strategy was also associated with a higher probability of emotional (P = 0·013) and overall (P = 0·011) recovery. Intraoperative adverse events were less frequent with the IPP strategy (P < 0·001) and the plasma neutrophil-lymphocyte ratio was lower (P = 0·029). Other endpoints were not affected. CONCLUSION: In this cohort of patients undergoing laparoscopic colorectal surgery, an IPP strategy was associated with faster recovery, fewer intraoperative complications and less inflammation than an SPP strategy. Registration number: NCT02773173 ( http://www.clinicaltrials.gov).

ANTECEDENTES: No se sabe con certeza si individualizar las presiones del neumoperitoneo durante la cirugía laparoscópica mejora la recuperación postoperatoria. Comparamos una estrategia con individualización de la presión del neumoperitoneo (individualised pneumoperitoneum pressure, IPP) frente a una estrategia con presión estándar del neumoperitoneo (standard pneumoperitoneum pressure, SPP) respecto a la recuperación postoperatoria tras cirugía colorrectal laparoscópica. MÉTODOS: Ensayo clínico aleatorizado multicéntrico. La estrategia IPP consistió en una modificación de la posición, bloqueo neuromuscular profundo, y una distensión de la pared abdominal conseguida con la presión intraabdominal (intra-abdominal pressure, IAP) más baja en la que el espacio quirúrgico operativo siguiera siendo aceptable. La estrategia SPP consistió en una posición de acuerdo con la preferencia del cirujano, bloqueo neuromuscular moderado, e IAP fija de 12 mm Hg. El resultado primario fue la recuperación fisiológica postoperatoria, evaluada mediante la escala de calidad en la recuperación postoperatoria (Postoperative Quality of Recovery Scale, PQRS). Los resultados secundarios incluyeron la recuperación en otros dominios y la recuperación global, la aparición de complicaciones intraoperatorias y postoperatorias, duración de la estancia hospitalaria, y los valores de los marcadores inflamatorios séricos durante tres días postoperatorios. RESULTADOS: De un total de 166 pacientes, 85 recibieron una estrategia IPP y 81 una estrategia SPP. La estrategia IPP se asoció con una elevada probabilidad de recuperación fisiológica (razón de oportunidades, odds ratio OR, 2,8 (i.c. del 95% 1,2-6,4); P = 0,017, razón de riesgo, 1,8 (i.c. del 95% 1,7-1,9), P = 0,05)). La estrategia IPP también se asoció con una elevada probabilidad de recuperación emotiva (P = 0,013) y global (P = 0,011). Los eventos adversos intraoperatorios fueron menos frecuentes con la estrategia IPP (P < 0,001) y la tasa neutrófilo-linfocito fue más baja (P = 0,029). No se observaron cambios en otras variables. CONCLUSIÓN: En esta cohorte de pacientes sometidos a cirugía colorrectal laparoscópica, una estrategia IPP se asoció con una recuperación más rápida, menos complicaciones intraoperatorias y menos inflamación en comparación con una estrategia SPP.

Coupling circadian rhythms of metabolism and chromatin remodelling.

The circadian clock controls a large variety of neuronal, endocrine, behavioural and physiological responses in mammals. This control is exerted in large part at the transcriptional level on genes expressed in a cyclic manner. A highly specialized transcriptional machinery based on clock regulatory factors organized in feedback autoregulatory loops governs a significant portion of the genome. These oscillations in gene expression are paralleled by critical events of chromatin remodelling that appear to provide plasticity to circadian regulation. Specifically, the nicotinamide adenine dinucleotide (NAD)(+) -dependent deacetylases SIRT1 and SIRT6 have been linked to circadian control of gene expression. This, and additional accumulating evidence, shows that the circadian epigenome appears to share intimate links with cellular metabolic processes and has remarkable plasticity showing reprogramming in response to nutritional challenges. In addition to SIRT1 and SIRT6, a number of chromatin remodellers have been implicated in clock control, including the histone H3K4 tri-methyltransferase MLL1. Deciphering the molecular mechanisms that link metabolism, epigenetic control and circadian responses will provide valuable insights towards innovative strategies of therapeutic intervention.

Adhesin contribution to nanomechanical properties of the virulent Bordetella pertussis envelope.

Adherence to a biological surface allows bacteria to colonize and persist within the host and represents an essential first step in the pathogenesis of most bacterial diseases. Consequently, the physicochemical properties of the outer membrane in bacteria play a key role for attachment to surfaces and therefore for biofilm formation. Bordetella pertussis is a Gram-negative bacterium that colonizes the respiratory tract of humans, producing whooping cough or pertussis, a highly infectious disease. B. pertussis uses various adhesins exposed on its surface to promote cell-surface and cell-cell interactions. The most dominant adhesin function is displayed by filamentous hemagglutinin (FHA). B. pertussis Tohama I wild-type (Vir+) strain and two defective mutants, an avirulent (Vir-) and a FHA-deficient (FHA-) B. pertussis strains were studied by AFM under physiological conditions to evaluate how the presence or absence of adhesins affects the mechanical properties of the B. pertussis cell surface. Quantitative information on the nanomechanical properties of the bacterial envelope was obtained by AFM force-volume analysis. These studies suggested that the presence of virulence factors is correlated with an increase in the average membrane rigidity, which is largely influenced by the presence of FHA. Moreover, for this system we built a nanoscale stiffness map that reveals an inhomogeneous spatial distribution of Young modulus as well as the presence of rigid nanodomains on the cell surface.

Effect of antibiotics on mechanical properties of Bordetella pertussis examined by atomic force microscopy.

In recent years, the coevolution of microorganisms with current antibiotics has increased the mechanisms of bacterial resistance, generating a major health problem worldwide. Bordetella pertussis is a bacterium that causes whooping cough and is capable of adopting different states of virulence, i.e. virulent or avirulent states. In this study, we explored the nanomechanical properties of both virulent and avirulent B. pertussis as exposed to various antibiotics. The nanomechanical studies highlighted that only virulent B. pertussis cells undergo a decrease in their cell elastic modulus and height upon antimicrobial exposure, whereas their avirulent counterparts remain unaffected. This study also permitted to highlight different mechanical properties of individual cells as compared to those growing in close contact with other individuals. In addition, we analyzed the presence on the bacterial cell wall of Filamentous hemagglutinin adhesin (FHA), the major attachment factor produced by virulent Bordetella spp., under different virulence conditions by Force Spectroscopy.

[Prevalence of chronic kidney disease in patients with type 2 diabetes mellitus treated in primary care]. / Prevalencia de enfermedad renal crónica en pacientes con diabetes mellitus tipo 2 atendidos en atención primaria.

INTRODUCTION: The frequency and clinical impact of chronic kidney disease (CKD) in type 2 diabetes patients (DM2) and the benefits of early intervention highlights the need for close collaboration in detection and management between Nephrology and Primary Health Care. OBJECTIVE: Our objectives were to estimate the prevalence of CKD in DM2 patients controlled by primary care and evaluate the need to early referral of CKD DM2 patients to renal specialists. STUDY POPULATION: patients older than 18 years of age, with analysis made for any reason in the 16 Health Centers of Health Sector Alcañiz (84,340 inhabitants)during 2008. VARIABLES: age, sex, serum creatinine,urine albumin/creatinine ratio, glycated hemoglobin,potassium and hemoglobin. We calculated the estimated glomerular filtration rate (eGF) by the MDRD formula. Were viewed the Consensus Document S.E.N.-SEMFyC ERC 2008 criteria for referral to renal specialists. RESULTS: Of the 16,814 patients enrolled, 3,466 (20.6%) had DM2. In DM2 patients, the prevalence of CKD was 34.6% (IC 95%, 33-36.2). eGF <60 ml/min/m2 was recorded in 25.2% of DM2 patients. In this subgroup the prevalence of albuminuria was 31.7%. Met criteria for referral to renal specialists 104 (3%) DM2 patients and 132 (1%) non diabetic patients(p <0.0001). CONCLUSIONS: The prevalence of DM2 in the Health Centers is high, with frequent presence of CKD and albuminuria. An important percentage of patients meets the referral S.E.N.-SEMFyC criteria. The collaboration with primary care is essential in early detection and monitoring of these patients, and common primary care and nephrology protocols are need.Key words: Chronic kidney disease. Diabetes

[Adherence to treatment with erythropoiesis stimulating agents]. / Adherencia al tratamiento con agentes estimulantes de la eritropoyesis.

BACKGROUND: To establish adherence to treatment with erythropoiesis stimulating agents (ESA) in patients with anemia associated to chronic kidney disease (CKD), and analyze its relationship to response to ESA. METHODS: Retrospective study of a cohort of 198 patients with CKD who started treatment with epoetin-ß or darbepoetin-a, followed for two years. Basal characteristics, effectiveness (% of hemoglobin (Hb) target attainment, percentage increase of Hb) and adherence (medication possession rate) were registered. A non-adherent patient was one whose mean adherence was <90%. RESULTS: Average global adhesion was 89.6%, slightly higher in treatment with darbepoetin-a than with epoetin-ß; 8.6% of patients were non-adherents. Hb target was accomplished in 87% cases. Level of response to ESA treatment was independent of the degree of adherence to treatment. CONCLUSIONS: Adherence to ESA treatment was good, without differences related to degree of response.

[Conservative management in elderly patients with advanced chronic kidney disease].

The poor health outcomes of Renal Replacement Therapy (RRT) in the elderly has promoted Conservative Management (CM) as a therapeutic option in advanced chronic kidney disease. However, there is still a lack of evidence about prognosis of these patients; thus, the aim was to analyze the survival rate of elderly patients under CM and RRT and evaluate the variables related to the initiation of such treatments in clinical practice. METHODS: Prospective cohort study of RRT and CM patients >75años. Renal function parameters and geriatric assessments were carried out. This evaluation included: analysis of comorbidity, functional, cognitive, frailty, nutritional and socio-family status. RESULTS: Cohort of 37 RRT and 82 CM patients. CM patients were significantly older, with more frequency of history of vascular event, more comorbility (Charlson), worse functional situation (Barthel), higher risks of cognitive impairment (Pfeiffer) and malnutrition (MNA-SF), and higher frailty and socio-familiar impairment. Mortality rate was lower in RRT patients (8.72 vs. 3/1,000 patients/month; HR= 0.37, p=0.018), but survival advantage reduced drastically after adjustment for the different geriatric syndromes analyzed. CONCLUSIONS: Charlson's comorbidity was found to be an independent mortality predictor in elderly patients with advanced chronic kidney disease. Dialysis did not improve survival with respect to conservative treatment in patients with Charlson higher than 8 points.

Correction to: An individualised versus a conventional pneumoperitoneum pressure strategy during colorectal laparoscopic surgery: rationale and study protocol for a multicentre randomised clinical study.

After publication of our article [1] the authors have notified us that there are changes in the primary outcome and the statistical analysis plan of the study.

An individualised versus a conventional pneumoperitoneum pressure strategy during colorectal laparoscopic surgery: rationale and study protocol for a multicentre randomised clinical study.

BACKGROUND: A recent study shows that a multifaceted strategy using an individualised intra-abdominal pressure titration strategy during colorectal laparoscopic surgery results in an acceptable workspace at low intra-abdominal pressure in most patients. The multifaceted strategy, focused on lower to individualised intra-abdominal pressures, includes prestretching the abdominal wall during initial insufflation, deep neuromuscular blockade, low tidal volume ventilation settings and a modified lithotomy position. The study presented here tests the hypothesis that this strategy improves outcomes of patients scheduled for colorectal laparoscopic surgery. METHODS: The Individualized Pneumoperitoneum Pressure in Colorectal Laparoscopic Surgery versus Standard Therapy (IPPCollapse-II) study is a multicentre, two-arm, parallel-group, single-blinded randomised 1:1 clinical study that runs in four academic hospitals in Spain. Patients scheduled for colorectal laparoscopic surgery with American Society of Anesthesiologists classification I to III who are aged > 18 years and are without cognitive deficits are randomised to an individualised pneumoperitoneum pressure strategy (the intervention group) or to a conventional pneumoperitoneum pressure strategy (the control group). The primary outcome is recovery assessed with the Post-operative Quality of Recovery Scale (PQRS) at postoperative day 1. Secondary outcomes include PQRS score in the post anaesthesia care unit and at postoperative day 3, postoperative complications until postoperative day 28, hospital length of stay and process-related outcomes. DISCUSSION: The IPPCollapse-II study will be the first randomised clinical study that assesses the impact of an individualised pneumoperitoneum pressure strategy focused on working with the lowest intra-abdominal pressure during colorectal laparoscopic surgery on relevant patient-centred outcomes. The results of this large study, to be disseminated through conference presentations and publications in international peer-reviewed journals, are of ultimate importance for optimising the care and safety of laparoscopic abdominal surgery. Selection of patient-reported outcomes as the primary outcome of this study facilitates the translation into clinical practice. Access to source data will be made available through anonymised datasets upon request and after agreement of the Steering Committee of the IPPCollapse-II study. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02773173 . Registered on 16 May 2016. EudraCT, 2016-001693-15. Registered on 8 August 2016.

[Estimation of glomerular filtration rate in primary care: prevalence of chronic kidney disease and impact on referral to nephrology]. / Estimación del filtrado glomerular en atención primaria: prevalencia de enfermedad renal crónica y repercusión sobre la derivación a Nefrología.

Data were collected in 18.922 patients attending Primary Care Centers in Alcañiz (Spain), mean age 59,96 +/- 17 years, 42,9 % males and 57,1 % females. The prevalence of eGFR was: stage 3 (30-59 ml/min/1,73 m2) 15,7 %; stage 4 (15-29 ml/min/1,73 m2) 0,6 %; stage 5 no dialysis (GFR < 15 ml/min/1.73 m2) 0,1 %. This prevalence increased with age and 32 % of patients attending Primary Care services over 65 years presented a eGFR < 60 ml/min/1,73 m2. Of the total patients with eGFR < 60 ml/min/1,73 m2, 26 % had normal serum creatinine levels. Protocol implementation could implied for the Renal Unit an increase in the number of patients, specially the oldest ones. This study documents the substantial prevalence of significantly abnormal renal function among patients at Primary Care level and the importance of Primary Care collaboration in their early identification and appropriate management.

[Initial hemoglobin value as a predictor of allogeneic blood transfusion in hip fracture]. / Valor de la hemoglobina al ingreso como predictor de transfusión de sangre alogénica en fractura de cadera.

INTRODUCTION: Hip fracture is a cause of major morbidity and mortality and is often associated with high blood transfusion rate, non-complication-free therapy. The objective of the study is to evaluate the factors dependent and independent of the transfusional act, as well as to elaborate an algorithm that allows us to make a decision making based on a statistical model rationalizing the use of blood. MATERIAL AND METHODS: Prospective study on 100 patients older than 65 years intervened for hip fracture consecutively. We analyzed demographic data, drug taking, comorbidity, pre- and postoperative analytics, type of fracture and those related to surgery valuing uni- and bivariate determinants of the Transfusional Act to control the possible bias of confusion. RESULTS: Following the application of the bivariate logistic regression model only the HB at the admission (p = 0.04, or = 0.451) and the type of fracture (p = 0.003, or = 5.479) were considered associated with the transfusion act. The value of initial HB generates a ROC curve with an area under the curve of 0.848, acceptable to assess the probability of transfusion. An initial HB value lower of 12.15 g/dl will predict the transfusion with a sensitivity of 80% and a specificity of 85%. CONCLUSION: The presence of preoperative anemia and extracapsular hip fractures generate a high risk of transfusion need, while it is unlikely in intracapsular fractures without anemia at admission. In our series there is an analytical value that predicts satisfactorily 80% of blood transfusions.

INTRODUCCIÓN: La fractura de cadera es una causa de importante morbimortalidad y a menudo se asocia a una elevada tasa de transfusión sanguínea, terapia no exenta de complicaciones. El objetivo del estudio es evaluar los factores dependientes e independientes del acto transfusional, así como elaborar un algoritmo que nos permita realizar una toma de decisiones basada en un modelo estadístico racionalizando el empleo de sangre alogénica. MATERIAL Y MÉTODOS: Estudio prospectivo sobre 100 pacientes mayores de 65 años intervenidos por fractura de cadera de forma consecutiva. Se analizaron datos demográficos, toma de fármacos, comorbilidad, analítica pre- y postoperatoria, tipo de fractura y los relativos a la cirugía valorando de forma uni- y bivariada los factores determinantes del acto transfusional para controlar el posible sesgo de confusión. RESULTADOS: Tras la aplicación del modelo bivariante de regresión logística sólo la Hb al ingreso (p = 0.04, OR = 0.451) y el tipo de fractura (p = 0.003, OR = 5.479) se consideraron asociadas al acto transfusional. El valor de la Hb al ingreso genera una curva ROC con un área bajo la curva de 0.848, aceptable para valorar la probabilidad de transfusión. Un valor de Hb al ingreso inferior a 12.15 g/dl predeciría de forma correcta la transfusión con una sensibilidad de 80% y una especificidad de 85 %. CONCLUSIONES: La presencia de anemia preoperatoria y la fractura extracapsular de cadera generan un alto riesgo de necesidad transfusional, mientras que es improbable en fracturas intracapsulares sin anemia al ingreso. En nuestra serie existe un valor analítico que predice de forma satisfactoria 80% de las transfusiones sanguíneas.

Comparison of functional results of two fixation systems using single-row suturing of rotator cuff. / Comparación de resultados funcionales en 2 sistemas de fijación mediante hilera simple en sutura de manguito rotador.

INTRODUCTION: Arthroscopic repair of rotator cuff disorders is a technically demanding but successful procedure. Many anchor and suture alternatives are now available. The choice of the implant by the surgeon is less important than the configuration of the suture used to fix the tendon, however it is necessary to know if there are differences in the results, using each one of them. The aim of the study is to evaluate if there are differences between the knotted and non-knotted implant in terms of functional and satisfaction results. MATERIAL AND METHODS: A retrospective study was carried out on 83 patients operated between 2010 and 2014 in our center using 2anchoring systems with and without knotting (39 versus 44 patients respectively), with single row in complete rupture of the rotator cuff. RESULTS: At the end of the follow-up, an average score was obtained on the Constant scale of 74.6 points. 98% of the patients considered the result of the surgery satisfactory. Statistically, there were no significant differences between the 2groups in terms of functionality, satisfaction or reincorporation to activities. DISCUSSION AND CONCLUSIONS: The functional results of the single-row cuff suture are satisfactory, although biomechanical studies show advantages in favor of sutures that reproduce a transoseo system. It our series of patients the presence of knotting does not show per se a significant functional difference being both superimposable techniques in absolute values of functionality and patient satisfaction.

Localization of adhesins on the surface of a pathogenic bacterial envelope through atomic force microscopy.

Bacterial adhesion is the first and a significant step in establishing infection. This adhesion normally occurs in the presence of flow of fluids. Therefore, bacterial adhesins must be able to provide high strength interactions with their target surface in order to maintain the adhered bacteria under hydromechanical stressing conditions. In the case of B. pertussis, a Gram-negative bacterium responsible for pertussis, a highly contagious human respiratory tract infection, an important protein participating in the adhesion process is a 220 kDa adhesin named filamentous haemagglutinin (FHA), an outer membrane and also secreted protein that contains recognition domains to adhere to ciliated respiratory epithelial cells and macrophages. In this work, we obtained information on the cell-surface localization and distribution of the B. pertussis adhesin FHA using an antibody-functionalized AFM tip. Through the analysis of specific molecular recognition events we built a map of the spatial distribution of the adhesin which revealed a non-homogeneous pattern. Moreover, our experiments showed a force induced reorganization of the adhesin on the surface of the cells, which could explain a reinforced adhesive response under external forces. This single-molecule information contributes to the understanding of basic molecular mechanisms used by bacterial pathogens to cause infectious disease and to gain insights into the structural features by which adhesins can act as force sensors under mechanical shear conditions.

[Results of polyurethane implant for persistent knee pain after partial meniscectomy with a minimum of two years follow-up]. / Resultados de un implante de poliuretano para el tratamiento del dolor persistente de rodilla tras meniscectomía parcial con un mínimo de dos años de seguimiento.

PURPOSE: To present the results of a polyurethane meniscal scaffold implant in 10 patients with persistent pain after meniscectomy. METHODS: Prospective, descriptive study of ten patients who underwent arthroscopic implantation of a polyurethane meniscal scaffold. Functional, MRI, and radiography assessment was performed pre-operatively and at 6-months, 1-year, and a final follow-up at a minimum of two years. Clinical evaluation included Lysholm score, KOOS and VAS. The MRI morphology and signal intensity of the implant were evaluated according to the criteria of Genovese et al. RESULTS: Statistically significant differences were found between the mean Lysholm score before surgery (63.5 points), and that at 6 months (76.8 points) (p=.001), one year (83.3 points) (p<.001) and final follow-up (84.4 points) (p<.001). KOOS showed significant differences between before surgery (64.23 points), 6 months (73.66 points) (p=.001), one year (81.39 points) (p<.001) and final follow-up (83.34 points) (p<.001). The mean values for VAS were 5.7 points in the pre-operative evaluation, 3.6 points at 6 months-follow-up (p<.001), 1.9 points at one year (p<.001), and 1.9 points at final follow-up (p<.001). Radiology showed degenerative changes in one case. In MRI, the size of the implant and the intensity of the MRI signal gradually decreased, but it never changed to that of a normal meniscus. CONCLUSION: A significant improvement was found in all the clinical parameters 24 months after the surgery, except in one patient who underwent furher surgery. The scaffold reduced its size and but never achieved an MRI image similar to that of a normal meniscus. The procedure proved to be safe and useful for the treatment of persistent pain after meniscectomy.

Cardiac output by femoral arterial thermodilution-calibrated pulse contour analysis during liver transplantation: comparison with pulmonary artery thermodilution.

PURPOSE: The continuous monitoring of the cardiac output during liver transplantation (LT) is an essential part of the intraoperative management of the patient's hemodynamics. To verify the accuracy of a new method based on femoral artery thermodilution-calibrated pulse contour analysis (PCCO) during LT, we compared the technique with the results of an intermittent pulmonary artery thermodilution method (ICO). METHOD: A prospective study included 314 paired cardiac output measurements at 10 sampling times in 35 patients undergoing LT. After initial calibration of the pulse contour analysis, no further recalibrations were performed. Bland and Altman's statistical method, one-way ANOVA, and one sample t tests were used for the analysis of the data. A P<.05 was considered significant. RESULTS: There was a small bias 0.18 L x min(-1) (6.29% from the ICO) for the whole sample of paired measurements, associated with 95% limits of agreement of +/-4.72 (68.89%) L x min(-1). The additional analysis showed comparable biases and limits of agreement for any single time in the study period. The difference PCCO-ICO showed a negative sign for ICO >10 L x min(-1) (P<.001) and a positive sign for ICO <5 L x min(-1) (P<.001). It was greater during infusion of a vasoactive drug (P<.001). CONCLUSION: The pulse contour analysis was found to be an unsatisfactory substitute for intermittent thermodilution measurement of cardiac output during the LT.

[Rate of protein catabolism as an indicator of protein ingestion in uremic patients on hemodialysis]. / Tasa de catabolismo proteico como indicador de la ingesta proteica en pacientes urémicos en hemodiálisis.

Protein catabolic rate (PCR) has been proposed as a indirect index of dietary protein intake, but its sensitivity has been discussed. In a group of 140 chronic uremic patients undergoing maintenance hemodialysis, we evaluated the nutritional status (body mas index: BMI, triceps skinfold thickness: TST, arm muscle circumference: AMC, serum total proteins, albumin and lymphocytes) and its relation with dietary survey and PCR levels. PCR was correlated positively with Kt/V (p: 0.0001, r: 0.45) and with seric albumin (p: 0.01, r: 0.22), whereas dietary protein intake by dietary survey (g/Prot/Kg/day) was correlated strongly with anthropometric measurements like BMI, AMC (p: 0.0001) and less with Kt/V (p: 0.01), but not with serum albumin. PCR was correlated with dietary survey results: g Prot/Kg/day (p: 0.04, r: 0.18) and Kcal/Kg/day (p: 0.03, r:0.2). The results suggest that nutritional parameters with slow evolution as anthropometric measurements could be related with usual dietary intake (dietary survey), whereas serum albumin (that vary early with recent changes of dietary intake) could be related better with a biochemical index like PCR, in these way both determinations are complementary.

[Idiopathic ascites associated with hemodialysis. Case report and literature review]. / Ascitis idiopática asociada a hemodiálisis. Informe de un caso y revisión de la literatura.

BACKGROUND: Idiopathic dialysis ascites (IDA) is an uncommon disease characterized by the absence of a cause that can explain its presentation. CASE REPORT: Thirty year old female, with diabetic nephropathy under chronic hemodialysis, with massive ascites. Treatment with intensive ultrafiltration was non-successful, and we had poor clinical results with consecutive paracentesis. The study of ascitic fluid was normal. We discarded cardiovascular, hepatic, infectious, neoplastic, and metabolic etiologies and laparoscopy with hepatic and peritoneal biopsies were non-diagnostic. Finally, after renal transplantation, a rapid decrease of the ascites was observed and the diagnosis of IDA was established. DISCUSSION: IDA is a rare entity that does not seem to be related with uremia as it is usually present after the start of hemodialysis. Malnutrition and hypoproteinemia are frequently associated and could be part of the etiology of IDA, which explains the lack of response to ultrafiltration and salt restriction, usual treatment for ascites control. The pathophysiological explanation of the dramatic response of this patients to renal transplantation is unclear.

[Glycemic control related factors in type 2 diabetes mellitus patients]. / Factores relacionados con el control glucémico de pacientes con diabetes tipo 2.

OBJECTIVES: To describe metabolic, lipidic and blood pressure control and to identify blood glucose control predictive factors in patients with type 2 diabetes. MATERIAL AND METHODS: Retrospective cohort study. Ambulatory type 2 diabetic patients were selected from 2/1/00 to 14/11/01 if they had been visited yearly at least three years previously. They were classified into three groups: a) initial and final treatment with diet and/or oral glucose-lowering drugs; b) insulinized patients during follow-up; and c) initial and final therapy with insulin. BODY MASS INDEX: (BMI), blood pressure, HbA1c and lipid profile were determined at start and at the end of the study. A multiple regression model was used to predict mean HbA1c through follow-up. RESULTS: 320 patients were selected, 199 women (62.2%) and 121 men (37.8%) with mean age of 69 years (SD: 9). Mean follow-up was 5.2 years (SD: 1.1). 106 patients (33.8%) were included into A group, 70 patients (22.4%) into B group and 137 (43.8%) into C group. 63% of patients had values of HbA1c > 7.5%, 36% blood pressure > 140/85 mmHg and 8.5% LDL values > 155 mg/dl. HbA1c mean through follow-up was of 8.2% and its independent predictors were baseline HbA1c (0.37; IC 95% 0.31-0.43; p < 0.001), baseline BMI (0.023; IC 95% 0.004-0.042; p = 0.017), baseline treatment with insulin (0.67; IC 95% 0.45-0.88; p < 0.001) and insulinization during follow-up (0.46; IC 95% 0.21-0.71; p < 0.001). CONCLUSIONS: It's difficult to achieve an acceptable blood glucose control. Mean HbA1c predictive factors include baseline HbA1c and BMI and insulin therapy.