Liver Transplant From Controlled Cardiac Death Donors Using Normothermic Regional Perfusion: Comparison With Liver Transplants From Brain Dead Donors.

BACKGROUND: Liver transplantation from donors after either controlled or uncontrolled cardiac death (DCD) is associated with considerable rates of primary nonfunction (PNF) and ischemic cholangiopathy (IC). Normothermic regional perfusion (NRP) could significantly reduce such rates. METHODS: Retrospective study to analyze short-term (mortality, PNF, vascular complications) and long-term (IC, survival) complications in 11 liver transplants from controlled DCDs using NRP with extracorporeal membrane oxygenation (ECMO) (group 1). They were compared with 51 patients transplanted with grafts from donors after brain death (DBD) (group 2). Mean recipient age, sex, and Model for End-stage Liver Disease (MELD) score were not significantly different. RESULTS: In group 1, mean functional warm ischemia time was 15.8 (range, 7-40) minutes and 94.1 (range, 20-150) minutes on NRP. The ischemic damage was minimal, as shown by the slight alanine aminotransferase (ALT) and aspartate aminotransferase (AST) rises in the donor serum after 1 hour on NRP and similar rises 24 hours after transplantation in both groups. No patient had IC or acute renal failure. No significant difference was found between the groups for vascular or biliary complications. One group 1 patient had PNF (9.1%), resulting in death. Overall retransplantation and in-hospital death rates were 8.1% and 4.8%, respectively, with no significant difference between groups. Estimated mean survival was 24.6 (95% confidence interval [CI], 20.2-29.1) months in group 1 and 32.3 (95% CI, 30.4-34.2) months in group 2 (not a statistically significant difference). CONCLUSION: In our experience, liver transplants from controlled DCDs using NRP with ECMO is associated with a low risk of PNF and IC, with short- and long-term results comparable to those in DBD transplants.

Livestock hauliers' attitudes, knowledge and current practices towards animal welfare, occupational wellbeing and transport risk factors: A Mexican survey.

Mexico is the 7th largest producer of beef in the world. The livestock transport is a vital component of today's world agrifood economy that directly impacts on the development of animal production, animal welfare, public policies, labor regulations, food safety, markets and consumers. In this study two aims were established; the first aim was to identify the attitudes and perceptions of commercial hauliers towards animal welfare and their influence on the accident risks. The second aim was to characterize the current practices of the commercial cattle transport in Mexico and to detect the risk factors for animal welfare and hauliers' wellbeing. The interviews were conducted individually at the hauliers' rest points, sanitary inspection points localized along the Federal Highway 57 or at the companies' offices of cattle transportation. We used univariate, bivariate and multivariate statistics based on a hierarchical cluster analysis. The results showed that cattle transport in Mexico is characterized for long travel distances because the cattle departed from farms in the southern states of Mexico to the feedlots located in central and northern regions of the country. The journeys of short and middle distances departed from the feedlots to the slaughterhouses. The hauliers' characteristics were: age from 29 to 48 years-old, elementary or secondary studies completed, 65% of hauliers mentioned six years of experience in cattle transport, they learned about cattle transportation by means of a family member who was already engaged in this activity. The cluster analysis identified four hauliers' groups: groups 1 and 3 were related to animal welfare and groups 2 and 4 less related to animal welfare. This study showed that empathy towards cattle was a key element in identifying hauliers at risk of road accidents during cattle transportation. Years of experience in cattle transport played an important role in emphasizing closer perceptions towards welfare. Considering current trends towards increased transport times and logistics stops, there is a need to develop systems of welfare assessment and decision-making that provide tools and protocols that can minimize the biological cost to animals and hauliers, which may have been underestimated in the past.

Prp31p promotes the association of the U4/U6 x U5 tri-snRNP with prespliceosomes to form spliceosomes in Saccharomyces cerevisiae.

The PRP31 gene encodes a factor essential for the splicing of pre-mRNA in Saccharomyces cerevisiae. Cell extracts derived from a prp31-1 strain fail to form mature spliceosomes upon heat inactivation, although commitment complexes and prespliceosome complexes are detected under these conditions. Coimmunoprecipitation experiments indicate that Prp31p is associated both with the U4/U6 x U5 tri-snRNP and, independently, with the prespliceosome prior to assembly of the tri-snRNP into the splicing complex. Nondenaturing gel electrophoresis and glycerol gradient analyses demonstrate that while Prp31p may play a role in maintaining the assembly or stability of tri-snRNPs, functional protein is not essential for the formation of U4/U6 or U4/U6 x U5 snRNPs. These results suggest that Prp31p is involved in recruiting the U4/U6 x U5 tri-snRNP to prespliceosome complexes or in stabilizing these interactions.

Extreme lateral lumbar interbody fusion. Surgical technique, outcomes and complications after a minimum of one year follow-up. / Artrodesis intersomática lumbar extralateral. Técnica quirúrgica, resultados y complicaciones con un seguimiento mínimo de un año.

«Minimally invasive¼ techniques have been recently been developed in order to achieve good clinical results with a low incidence of complications. The extralateral interbody fusion or direct transpsoas is a minimally invasive anterior arthrodesis. A total of 97 patients with 138 segments received surgery between May 2012 and May 2015. The follow-up was from 12-44 months. The mean age was 68 years (41-86). The most common cause of intervention was the adjacent segment (30%), deformity (22%), and lumbar disc disease (21%). The interbody cage was implanted as: Single (stand-alone) in 33%, and additional fixation was used in the others: Screws, percutaneous unilateral (11%), bilateral (27%), or with a lateral plate (62%). The mean stay was 3.2 days (2-6). The score on a lumbar visual analogue scale decreased from 9 to 4.1, and dropped to 3 after one year. The improvement in disc height was from 8.4mm to 13.8mm, and a larger increase in the foramen diameter from 10.5 to 13.1mm, which were statistically significant. The early major complications recorded were, three motor femoral nerve injuries and retroperitoneal haematoma (4%), and the early minor were: two fractures (2%). As major late complications there was an abdominal hernia, a mobilization of 10mm and three radiculopathy (5%), and as minor late, three fracture, two mobilisations greater than 10mm, four mobilisations of less than 10mm, and one mobilisation of a screw plate (10%). The extralateral interbody fusion technique is a safe and reliable when performing a lumbar fusion by an alternative minimally invasive route.

Adult spinal deformity treated with minimally invasive surgery. Description of surgical technique, radiological results and literature review. / Deformidad del adulto tratada mediante cirugía mínimamente invasiva. Técnica quirúrgica, resultados radiológicos y revisión de la literatura.

The prevalence of adult spinal deformity has been increasing exponentially over time. Surgery has been credited with good radiological and clinical results. The incidence of complications is high. MIS techniques provide good results with fewer complications. This is a retrospective study of 25 patients with an adult spinal deformity treated by MIS surgery, with a minimum follow-up of 6 months. Radiological improvement was SVA from 5 to 2cm, coronal Cobb angle from 31° to 6°, and lumbar lordosis from 18° to 38°. All of these parameters remained stable over time. We also present the complications that appeared in 4 patients (16%). Only one patient needed reoperation. We describe the technique used and review the references on the subject. We conclude that the MIS technique for treating adult spinal deformity has comparable results to those of the conventional techniques but with fewer complications.

Impact of reduction mammoplasty on the quality of life of obese patients suffering from symptomatic macromastia: A descriptive cohort study.

BACKGROUND: Although reduction mammoplasty (RM) is an effective and efficient treatment for symptomatic macromastia, overweight and obese patients who request this treatment are frequently rejected because of selection criteria based on the body mass index. Scientific evidence is inconclusive regarding the increased postoperative complications in obese patients undergoing RM, and there is a lack of adequately designed studies examining the impact of RM on the quality of life of this group of patients. PATIENTS AND METHODS: A descriptive cohort study was performed on 37 consecutive obese patients (body mass index > 30 kg/m(2)) undergoing bilateral RM for symptomatic macromastia. Short Form SF-36 quality-of-life questionnaires were completed at interviews a week before surgery and 6 and 18 months after surgery. In addition, 37 women of matching ages, who were companions of patients hospitalized at our short-stay surgery unit, were used as a control group for comparison. Significant differences between repeated measurements on a single sample were assessed using the Wilcoxon signed-rank test. To evaluate these changes, we used effect size by computing Hedges' g corrected. RESULTS: The preoperative SF-36 physical component score was significantly lower than the control group's score (40 vs. 53, p < 0.001). There was no significant difference in the mental component score (45 vs. 49, p = 0.210). Postoperative SF-36 scores were increased with a normalizing effect, as 18 months after surgery only the body pain domain scored lower than the control group scores. CONCLUSIONS: According to our results, obese women with symptomatic macromastia undergoing RM exhibited increased quality of life, and this improvement was maintained over time. THERAPY: Level III Evidence.

Respiratory rate estimation from multilead directions, based on ECG delineation.

Estimating the instantaneous respiratory rate (Rr) from the electrocardiogram (ECG) is of interest as respiration direct measurement in clinical situations is often cumbersome. In this study, the Rr was estimated from the same Final Directions of maximum projection (FD) used for multi lead ECG automatic delineation. Power spectral analysis over the directions based on QRS complex main peak and T wave onset, peak and end spatial loops was used for Rr estimation. On a subset of the Physionet MGH/MF dataset, the proposed method yielded more accurate Rr estimates (minimum mean absolute error (MAE), 2.82 bpm) than the frequency tracking algorithm (minimum MAE, 4.53 bpm) and Fourier-based frequency estimation (minimum MAE, 4.94 bpm) using each lead alone, outperforming also the weighted multi-signal oscillator-based algorithm estimates for two or three lead (minimum MAE, 3.04 bpm). It was also shown that the FD of the three orthogonalized leads from Principal Component algorithm, improve the performance of Rr estimation.

The REG1 gene product is required for repression of INO1 and other inositol-sensitive upstream activating sequence-containing genes of yeast.

A search was conducted for suppressors of the inositol auxotrophic phenotype of the ino4-8 mutant of yeast. The ino4-8 mutation is a single base pair change that results in substitution of lysine for glutamic acid at position 79 in the bHLH domain of the yeast regulatory protein, Ino4p. Ino4p dimerizes with a second bHLH protein, Ino2p, to form a complex that binds to the promoter of the INO1 gene, activating transcription. Of 31 recessive suppressors of ino4-8 isolated, 29 proved to be alleles of a single locus, identified as REG1, which encodes a regulatory subunit of a protein phosphatase involved in the glucose response pathway. The suppressor mutation, sia1-1, identified as an allele of REG1, caused constitutive INO1 expression and was capable of suppressing the inositol auxotrophy of a second ino4 missense mutant, ino4-26, as well as ino2-419, a missense mutation of INO2. The suppressors analyzed were unable to suppress ino2 and ino4 null mutations, but the reg1 deletion mutation could suppress ino4-8. A deletion mutation in the OPI1 negative regulator was incapable of suppressing ino4-8. The relative roles of the OPI1 and REG1 gene products in control of INO1 expression are discussed.

Increased stimulation of alkaline phosphatase by small doses of colchicine entrapped in liposomes. A biochemical test to detect effective liposome-hepatocyte interaction.

The subcutaneous administration of colchicine encapsulated in small unilamellar vesicles reduced the initial toxicity peak and maintained for several days an adequate level of the drug in the liver. Colchicine is an excellent marker for effective liposome-hepatocyte interaction since it fulfills the following criteria: (a) When taken up by the hepatocytes within liposomes, it is active and induces the synthesis of alkaline-phosphatase two to three times over control values. The injection of at least ten times more free colchicine is necessary to attain a similar induction. (b) If released from extracellular liposomes, colchicine is cleared rapidly from the circulation. The results show that liposomes, in spite of their reduced aqueous compartment (approximately 1.0 microliter/mumole of lipid), can achieve clinical utility when administered subcutaneously because of their efficient interaction with parenchymal cells and their continual arrival from the injection site.

Participatory research on workers' health.

The concern for workers' health has increased in Latin America during the last decade both on the part of research institutions and trade unions. A special emphasis has been given to active participation of workers not just in the transformation of working conditions to improve health but also in generation of knowledge. This paper presents an action oriented participatory research methodology based on a collective questionnaire that permits the recollection of data on characteristics of the labour process, risks and health damage. A comparison between the information on risks, health damage and the relationship risks-damage obtained with this methodology and those of an individual questionnaire applied at the same steel factory shows that the results produced are very similar. In view of these findings it is concluded that the participatory methodology has some important advantages over traditional methodologies since it provides qualitative information on the labour process, a precise picture of the main risks and how they are produced and semi-quantitative data on health damage, and at the same time, generates a process of consciousness and organization among workers that enables them to promote health oriented action.

[Improvement in diurnal oral ingestion in the malnourished newborn infant induced by the administration of nocturnal enteral nutrition]. / Mejoría de la ingestión oral diurna en el lactante desnutrido inducida por la administración de nutrición enteral nocturna.

The purpose of this study was evaluate the impact of nocturnal nasogastric tube feeding on diurnal caloric intake in children with severe energy protein-calorie malnutrition. Sixteen infants admitted to the Pediatric Nutrition Department with severe malnutrition were randomly assigned into groups: eight children in group A and eight in group B. Infants in both groups received 100% of their caloric requirements by oral feeding ad libitum. An additional 30% caloric charge was given to patients in group A by nocturnal nasogastric tube feeding. At admission and at their 7th day, weight, height, arm circumference, triceps and subscapular skinfold thickness were recorded. Weight for age, weight for height, height for age and upper arm muscle circumference were estimated. Every meal was weighted and measured before and after being eaten in order to calculate the child caloric intake using food composition tables. There were no statistically differences in all parameters between groups at admission. At discharge significant differences on caloric intake were found (179.7 +/- 75.34 kcal vs. 98.38 +/- 37.73 kcal; p 0.02). This findings suggest that nocturnal support with an extra caloric supply over the normal requirements for age improve the diurnal caloric intake of children with severe protein energy malnutrition.

[Interaction of work demands in the genesis of mental suffering]. / Interacción de las exigencias de trabajo en la generación de sufrimiento mental.

Current working conditions and new forms of work organization are affecting workers' health in numerous ways which can only be explained by more complex theories and methodologies than those used traditionally. The authors analyze some important elements of the work process and the interaction among work demands as determinants of mental and psychosomatic disorders and fatigue (MPDF) among workers in a Mexican industrial plant. The workers studied (n = 830) were male, with a mean age of 32. MPDF represent one-third of the disease burden among these workers. An association was observed with the number of years worked, type of activity, and job area. Job-related demands and work organization, including excessive work, strict supervision, dangerous work, unnatural positions, and intense and hard physical labor were also closely related to these conditions. The most relevant problem is the combination of many different demands. Interaction among the combinations was found to be additive or synergistic. In the latter condition the risk of morbid effects increases beyond merely an additive effect.

Supporting development of rural settlements as a means for controlling the growth of large cities: three case studies in Colombia.

PIP: A hypothesis is advanced that forceful support to small rural settlements can fundamentally redefine regional development and alleviate acute problems facing cities. Colombia is divided into 32 territorial units (departments), 1056 municipalities, which are agglomerations of four or five villages. The three projects were carried out under one contract during early 1993 for the department of Valle de Cauca, a prosperous area located in the Pacific southwest. A master plan for urban development was designed for each of the three villages. The population of the village of Villagorgona was 13,399, which was to exceed 18,000 in less than 5 years. Community development priorities were centered on converting an irrigation canal into the axis of a linear park, building a civic center, and creating a road system. The village of El Placer had a population of 8349 and its priorities included the construction of an upgraded aqueduct and a civic center, the improvement of roadways, the rehabilitation of the river and integrating it into the fabric of the settlement, and the creation of an urban code for local authorities to control growth and development. The village of Amaime had a population of 3730 in 1992. The development plan called for integration with the aqueduct being planned in El Placer, creation of a civic center, construction of a sewage treatment plant, rehabilitation of existing river banks, development of a recreational center, and creation of an urban code. These case studies demonstrated that the villages had higher population growth than the capital city of Cali, the inhabitants preferred to remain in the villages because of their satisfaction with the quality of life, the communities were interested in creating neighborhood organizations for improving the environment, the villages served as service centers for outlying farm inhabitants, and manifest interest was identified in changing from the village status to municipal status.^ieng

Isogeneic MSC application in a rat model of acute renal allograft rejection modulates immune response but does not prolong allograft survival.

Application of mesenchymal stromal cells (MSCs) has been proposed for solid organ transplantation based on their potent immuno-modulatory effects in vitro and in vivo. We investigated the potential of MSCs to improve acceptance of kidney transplants in an MHC-incompatible rat model including isogeneic kidney transplantation (RTx) as control. MSCs were administered i.v. or i.a. at time of transplantation. No immunosuppression was applied. Renal function was monitored by serum-creatinine, histopathology, immunochemistry for graft infiltrating cells and expressions of inflammatory genes. We demonstrated the short-term beneficial effects of MSC injection. In the long term, however, MSC-related life-threatening/shortening events (thrombotic microangiopathy, infarctions, infections) were evident despite decreased T- and B-cell infiltration, lower interstitial inflammation and downregulated inflammatory genes particularly after i.a. MSC injection. We conclude that i.a. MSC administration provides efficient immunomodulation after allogeneic RTx, although timing and co-treatment strategies need further fine-tuning to develop the full potential of powerful cell therapy in solid organ transplantation.

Respiration effect on single and multi lead ECG delineation strategies.

The main purpose of this work is to study the influence of the mechanical effect of the respiration over T wave end delineation. The performance of automatic delineation systems based in Wavelet Transform (WT) was compared, considering single lead (SL), post processing selection rules (SLR) and multi lead (ML) approaches. The T wave locations obtained over real and simulated ECG signals were analyzed together with the respective respiratory signal (ECG-derived or simulated). The linear relation between the variations on obtained marks and the mechanical effect of the respiration was measured using spectral coherence. With respect to the ML strategy we also explored the evolution of the vectorcardiographic spatial loop using the direction of maximum projection of the WT in the region close to the T wave end (T(e)). The relation between this direction and the respiration is also explored. The marks obtained from the SLR and ML delineation strategies show advantage over the SL strategy based marks. The coherence around the respiratory frequency between the respiratory signal and the error in T end marks was found to be higher using SLR (a minimum of 0.92) than using ML (a maximum of 0.80). According to obtained results, the multi lead delineation presents a lower sensibility to the mechanical effect of the respiration for the T wave end delineation, particularly the obtained with ML.

[Work and health in the Mexican "maquiladora" industry: a dominant trend in dominated neoliberalism] / Trabajo y salud en la industria maquiladora mexicana: una tendencia dominante en el neoliberalismo dominado.

This paper discusses health and working conditions of workers in the export-oriented "maquiladora" industry in Mexico. The work is intensive and performed mostly by women. It is the country's second largest source of foreign exchange. The "maquiladora" industry illustrates the effect of neoliberalism on working and health conditions, unveiling the impact of overall flexibilization of labor and growing technological changes. The situation for risks and demands is complex. Taylorist demands persist in work organization, with multiple chemical risks and probable effects beyond the workplace. There are also demands from repetition strain and uncomfortable positions. Effects on workers' health include high morbidity rates as reflected by demands on the social health/welfare services, some two to four times greater than for other industrial workers. There is a high percentage of stress-related illnesses as the reason for medical consultation. There are also effects on workers' families. Low birthweight is 2.8 times higher in women who work in the "maquila" than in other labor groups. Work-related accidents are common, the second most frequent cause for medical consultation in some cases. The analysis identifies some of the tendencies in which workers' health could be important in coming years for large contingents of workers.

[Natural history of human immunodeficiency virus infection in a cohort of Chilean patients]. / Historia natural de la infección por virus de inmunodeficiencia humano en una cohorte de pacientes chilenos.

We characterized clinical manifestations and the risk to develop AIDS in a cohort of 32 patients infected with human immunodeficiency virus without AIDS A multivariate analysis was performed to determine association between the progression of infection and control variables (socioeconomic level, age, sex and sexual preferences) and causal variables (psycho-social changes, significant clinical events, stress scoring and sexual activity). The cumulative AIDS incidence, defined as a CD4 lymphocyte count below 200 cells/cm3 was 50% at 6.5 years and 82% at 8 years. Using clinical criteria to define AIDS, 50% developed the disease at 8 years of follow up. Among studied factors, only age (faster progression at higher age) and time of evolution were associated with progression in stages before AIDS, the most frequent diseases were acute diarrhea, sexual transmission diseases, oral candidiasis, sinusitis and varicella zoster infections. The reduction; of CD4 lymphocytes-below 200 cells/cm3 always preceded the symptoms of the disease. Two patients have remained more than eight years without clinical or immunological deterioration.

PIP: Clinical manifestations and the risk of developing AIDS were studied in a cohort of 32 HIV-seropositive patients referred by their treating physicians to the Center for Medical Investigation of the Catholic University of Chile. The only exclusion criteria were a CD4 lymphocyte count below 400 or marked symptoms of AIDS. The study design included an examination at entry and every 6 months thereafter for a maximum follow up of 3 years. A multivariate analysis was conducted to determine the relation between disease progression and control and causal variables. The subjects were 8 women averaging 38 years old and 24 men averaging 33 years. Most were middle class and had higher education. 46% of the men became sexually active before age 15 and 42% were homosexual. HIV transmission was sexual in 28 subjects, through intravenous drug use in 2, and by unknown route in 2. The subjects had been infected for an average of 4.3 years at entry into the study. Of the 30 whose date of infection was known, 16 developed AIDS during the study according to the criterion of CD4 lymphocyte count below 200, and 8 of these developed markers of AIDS. 50% of patients developed AIDS 6.5 years after infection and 82% 8 years after. Using clinical criteria, 50% of patients had developed AIDS 8 years after infection. Multivariate analysis showed only subject's age at infection (faster progression at higher ages) and length of time since infection to be related to the risk of developing AIDS. No association was observed between development of the disease and sex, sexual orientation, use of alcohol or drugs, smoking, history of sexually transmitted diseases, number of sexual partners, or frequency of sexual relations. The most frequently observed pathologies before the stage of AIDS were acute diarrhea, sexually transmitted diseases, oral candidiasis, sinusitis, and varicela zoster infections. In the patients who progressed to AIDS, the decline of the CD4 lymphocyte count below 200 always preceded other symptoms. Two patients showed no significant decline in CD4 lymphocyte count or clinical manifestations of AIDS more than 8 years after infection.

[Resistance of human immunodeficiency virus (HIV) to zidovudine. Genotypic analysis in strains isolated from Chilean patients]. / Resistencia del virus de inmunodeficiencia humano (VIH) a zidovudina (AZT): análisis genotípico en cepas aisladas de pacientes chilenos.

BACKGROUND: Resistance of HIV to AZT is the result of mutations in the pol gene that codifies the enzyme reverse transcriptase. AIM: To assess the resistance to antiretroviral drugs in Chilean patients infected with HIV. MATERIAL AND METHODS: The presence of mutations was searched in 22 patients infected with HIV. The emergence or persistence of these mutations was studied in sequential samples of 19 patients. The presence of the mutation that confers resistance to didanosine (DDI) was studied in those subjects exposed to the drug. Polymerase chain reaction techniques were used to analyze mutations in codons 41, 70 and 215 of the pol gene (resistance to AZT) and the mutation in codon 71 (resistance to DDI). RESULTS: On admission, none of the patients without previous exposure to AZT had drug resistance mutations. Seven of 12 patients (58.3%) that had received AZT had mutations in codon 215. In two, they were associated to a mutation in codon 41 and in two, a mutation in codon 70. After a mean follow up of 14 months, 13 of 15 patients (86%) that received AZT had viral strains genotypically resistant to the drug. In nine of these, the resistance was associated with disease progression. None of the 10 patients that received DDI had the mutation in codon 74 that confers resistance to the drug. However, in one of these patients, that never received AZT, a virus with a mutation in codon 215 was detected. CONCLUSIONS: A high percentage of patients that have received monotherapy with AZT have genotypic resistance to the drug. This resistance is associated with clinical and immunological derangement in 70% of these subjects.