Distribution of Hg and Se in Muscle and Liver of the Thornback Guitarfish Platyrhinoidis triseriata from the Eastern Pacific Ocean.

Human consumption of the thornback guitarfish (Platyrhinoidis triseriata) is concentrated in coastal populations of the Pacific coast of Mexico as its meat is prized for its high quality. This study analyzes the distribution of mercury and selenium in the muscle and liver of Platyrhinoidis triseriata and the risk to human health associated with its consumption. In order to conduct these estimates, specimens were collected from the Eastern Pacific Ocean in 2015 and 2016 and found mean concentrations (µg g-1 wet weight) of mercury ranging from 0.02 to 0.58 in muscle and 0.10 to 0.31 in liver. Selenium ranged from 0.14 to 1.31 in muscle and from 0.93 to 4.52 in liver. Mercury levels in the muscle of P. triseriata were significantly correlated (positive correlation) with the total length of the specimens. The predominant prey of P. triseriata was the shrimp Pleuroncodes planipes and according to the biomagnification factor, only mercury was biomagnified. The risk to consumers associated with the simultaneous presence of mercury and selenium in the muscle and liver of rays under the selenium health benefit value approach indicated that consumption of P. triseriata from this area is beneficial to human health.

Severe Cutaneous Adverse Reactions to Drugs in Latin America: The RACGRAD Study.

BACKGROUND AND OBJECTIVE: Severe cutaneous adverse reactions to drugs (SCARs) are associated with high morbidity and mortality and with sequelae. Objective: To characterize patients with SCARs in 8 health care institutions in Latin America. METHODS: We performed a cross-sectional, descriptive, multicenter study of patients diagnosed with SCARs in Latin America between January 2009 and December 2018. The analysis was carried out using a database in BD Clinic. RESULTS: We collected 70 patients, of whom 42 (60%) were women. Mean age was 38.7 years. Forty-two patients (60%) had DRESS-DIHS, 12 (17.1%) TEN, 5 (7.1%) SJS, 6 (8.5%) AGEP, 4 (5.7%) other reactions not classified as SCARs, and 1 (1.4%) overlapping SJS-TEN. The main causative drugs were aromatic anticonvulsants in 31 cases (44.3%), ß-lactam antibiotics in 11 cases (15.7%), and non-ß-lactam antibiotics in 6 cases (8.6%). In all of the cases, the suspected drug was withdrawn at the first sign of a SCAR. Sixty-six patients (94.2%) received anti-inflammatory treatment, mostly systemic corticosteroids. Complications occurred in 53 cases (75.7%), and 3 patients died (4.3%). Thirteen patients (18.6%) had sequelae. CONCLUSIONS: This is the first multicenter report on SCARs in Latin America. DRESS-DIHS was the most frequently reported clinical entity, and anticonvulsants were the main triggers. Most of the patients received systemic corticosteroids. Complications were frequent, and 3 patients died.

Presence of Newcastle disease viruses of sub-genotypes Vc and VIn in backyard chickens and in apparently healthy wild birds from Mexico in 2017.

Virulent Newcastle disease viruses (NDV) have been present in Mexico since 1946, and recently, multiple outbreaks have been reported in the country. Here, we characterized eleven NDV isolated from apparently healthy wild birds and backyard chickens in three different locations of Jalisco, Mexico in 2017. Total RNA from NDV was reverse-transcribed, and 1285 nucleotides, which includes 3/4 of the fusion gene, was amplified and sequenced using a long-read MinION sequencing method. The sequences were 99.99-100% identical to the corresponding region obtained using the Illumina MiSeq. Phylogenetic analysis using MinION sequences demonstrated that nine virulent NDV from wild birds belonged to sub-genotypes Vc and VIn, and two backyard chicken isolates were of sub-genotype Vc. The sub-genotype Vc viruses had nucleotide sequence identity that ranged from 97.7 to 98% to a virus of the same sub-genotype isolated from a chicken in Mexico in 2010. Three viruses from pigeons had 96.3-98.7% nucleotide identity to sub-genotype VIn pigeon viruses, commonly referred to as pigeon paramyxovirus, isolated in the USA during 2000-2016. This study demonstrates that viruses of sub-genotype Vc are still present in Mexico, and the detection of this sub-genotype in both chickens and wild birds suggests that transmission among these species may represent a biosecurity risk. This is the first detection and complete genome sequencing of genotype VI NDV from Mexico. In addition, the utilization of an optimized long-read sequencing method for rapid virulence and genotype identification using the Oxford nanopore MinION system is demonstrated.

Large scale, prospective screening of EGFR mutations in the blood of advanced NSCLC patients to guide treatment decisions.

BACKGROUND: In a significant percentage of advanced non-small-cell lung cancer (NSCLC) patients, tumor tissue is unavailable or insufficient for genetic analyses. We prospectively analyzed if circulating-free DNA (cfDNA) purified from blood can be used as a surrogate in this setting to select patients for treatment with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). PATIENTS AND METHODS: Blood samples were collected in 119 hospitals from 1138 advanced NSCLC patients at presentation (n = 1033) or at progression to EGFR-TKIs (n = 105) with no biopsy or insufficient tumor tissue. Serum and plasma were sent to a central laboratory, cfDNA purified and EGFR mutations analyzed and quantified using a real-time PCR assay. Response data from a subset of patients (n = 18) were retrospectively collected. RESULTS: Of 1033 NSCLC patients at presentation, 1026 were assessable; with a prevalence of males and former or current smokers. Sensitizing mutations were found in the cfDNA of 113 patients (11%); with a majority of females, never smokers and exon 19 deletions. Thirty-one patients were positive only in plasma and 11 in serum alone and mutation load was higher in plasma and in cases with exon 19 deletions. More than 50% of samples had <10 pg mutated genomes/µl with allelic fractions below 0.25%. Patients treated first line with TKIs based exclusively on EGFR positivity in blood had an ORR of 72% and a median PFS of 11 months. Of 105 patients screened after progression to EGFR-TKIs, sensitizing mutations were found in 56.2% and the p.T790M resistance mutation in 35.2%. CONCLUSIONS: Large-scale EGFR testing in the blood of unselected advanced NSCLC patients is feasible and can be used to select patients for targeted therapy when testing cannot be done in tissue. The characteristics and clinical outcomes to TKI treatment of the EGFR-mutated patients identified are undistinguishable from those positive in tumor.

In vitro Validation of Quantitative Light-Induced Fluorescence for the Diagnosis of Enamel Fluorosis in Permanent Teeth.

This study aimed to validate quantitative light-induced fluorescence (QLF) as a diagnostic tool for mild and moderate enamel fluorosis in permanent teeth, comparing it to visual diagnosis and histological assessment completed using polarized light microscopy (PLM). The buccal surfaces of 139 teeth were visually classified using the Thylstrup and Fejerskov Index (TFI) into sound (TFI 0; n = 17), mild (TFI 1-2; n = 69), and moderate (TFI 3-4; n = 43) fluorosis. Fluorosis was then assessed with QLF (variables ΔF, A, and ΔQ at 5-, 15-, and 30-radiance thresholds) using as reference areas the entire surface and a region of interest (ROI), identified as the most representative region of a fluorosis lesion. PLM images of longitudinal thin sections including the ROI were assessed for histological changes. Correlations among TFI, PLM, and QLF were determined. A receiver-operating characteristic curve was conducted to determine QLF's diagnostic accuracy when compared to the TFI and PLM assessments. This was used to assess the probability that the images were correctly ranked according to severity as determined by PLM and TFI. A positive correlation was found between QLF and PLM, and between QLF and TFI. QLF showed the highest sensitivity and specificity for the diagnosis of mild fluorosis. There was also a strong agreement between TFI and PLM. The selection of a ROI resulted in a stronger correlation with TFI and PLM than when the entire surface was used. The study results indicate that defining an ROI for QLF assessments is a valid method for the diagnosis of mild and moderate enamel fluorosis.

Potential of Entomopathogenic Fungi as Biological Control Agents of Diamondback Moth (Lepidoptera: Plutellidae) and Compatibility With Chemical Insecticides.

The objectives were to evaluate the efficiency of entomopathogenic fungi against Plutella xylostella (L.) and the compatibility of the most virulent isolates with some of the insecticides registered for use on cabbage crops. Pathogenicity tests used isolates of Beauveria bassiana, Metarhizium rileyi, Isaria fumosorosea, Isaria sinclairii, and Lecanicillium muscarium standardized at a concentration of 10(7) conidia/ml. Cabbage leaf discs were immersed in these suspensions, and after evaporation of the excess water, were placed 10 second-instar larvae of P. xylostella, totaling 10 leaf discs per treatment. Mortality was assessed 7 d after treatment, and the isolates that caused mortality>80% were used to estimate LC50 and LT50. The compatibilities of the most virulent isolates and the insecticides were tested from the mixture of these into the culture medium, and after solidifying, the medium was inoculated with an aliquot of the isolated suspension. The following parameters were evaluated: growth of the colony, number and viability of conidia after 7 d. The isolated IBCB01, IBCB18, IBCB66, and IBCB87 of B. bassiana, LCMAP101 of M. rileyi, and ARSEF7973 of I. sinclairii caused mortality between 80 and 100%, with LC50 and LT50 between 2.504 to 6.775×10(4) conidia/ml and 52.22 to 112.13 h, respectively. The active ingredients thiamethoxam and azadirachtin were compatible with the entomopathogenic fungi. The results suggest that the use of these isolates is an important alternative in the pesticidal management of P. xylostella, with the possible exception of the associated use of chemical controls using the active ingredients thiamethoxam or azadirachtin.

Current status of prenatal diagnosis in Cuba: causes of low prevalence of Down syndrome.

OBJECTIVES: To analyze trends in cytogenetic prenatal diagnosis in Cuba and to analyze possible causes leading to a low Down syndrome prevalence in a country where the triple test is not available. METHODS: An analysis of the Cuban program in prenatal cytogenetic diagnosis from 1984 to 2012 was conducted. Results are described, with particular emphasis on indications, abnormal results, types of invasive procedures, and terminations of pregnancy. RESULTS: Cytogenetic prenatal diagnostic analyses (n = 75,095) were conducted; maternal age was the indication for 77.9% of the amniocenteses and chorionic villus samplings. The detection rate of chromosomally abnormal pregnancies was 2.3% for maternal age and increased to 8-9% for other indications. When a chromosomal abnormality was identified, 88.5% terminated the pregnancy. In 2002, the live birth prevalence of Down syndrome was 8.4 per 10,000 live births, and in 2012, 7 per 10,000. CONCLUSION: Prenatal diagnosis in Cuba has contributed to a significant reduction in chromosomal aberrations. The impact increased because of the demographic trends of the population, the high index of terminations of pregnancy, and the establishment of a network of cytogenetic laboratories throughout Cuba.

Mercury levels in myliobatid stingrays (Batoidea) from the Gulf of California: tissue distribution and health risk assessment.

With the aim of knowing Hg distribution in selected tissues of myliobatid stingrays and assessing health risk to Mexican population, Hg concentration was determined in the muscle and liver of four ray species. Total Hg levels were determined by cold vapor atomic absorption spectrophotometry. With respect to the muscle, devil rays (Mobula spp.) showed lower Hg levels (<0.22 µg g(-1)) than Rhinoptera steindachneri (0.37 ± 0.25 µg g(-1) wet weight). In the case of the liver, the highest Hg concentration was found in Mobula japanica (0.22 ± 0.01 µg g(-1)). Hg levels in the muscle and liver varied according to the species; in some case, the liver accumulated more Hg than the muscle and the opposite pattern in other cases. R. steindachneri showed a significant difference between both tissues. No significant differences of Hg levels between males and females and between juveniles and adult specimens of R. steindachneri were found. Positive correlation between Hg concentrations and disc width and total weight was not significant for R. steindachneri (Rs < 0.36, p > 0.05). Batoids showed Hg values below the Mexican (NOM-027-SSA1-1993) limits (1.0 µg g(-1)) in fishes for human consumption. The species with the highest potential of Hg transfer to human population is R. steindachneri; however, an adult (70 kg) could consume approximately 943 g per week without representing a health risk. Nevertheless, further and continuous monitoring is needed since batoids support an important fishery in Mexican waters, being a food resource and income to coastal communities.

Immunotherapeutic effects of recombinant adenovirus encoding granulocyte-macrophage colony-stimulating factor in experimental pulmonary tuberculosis.

BALB/c mice with pulmonary tuberculosis (TB) develop a T helper cell type 1 that temporarily controls bacterial growth. Bacterial proliferation increases, accompanied by decreasing expression of interferon (IFN)-γ, tumour necrosis factor (TNF)-α and inducible nitric oxide synthase (iNOS). Activation of dendritic cells (DCs) is delayed. Intratracheal administration of only one dose of recombinant adenoviruses encoding granulocyte-macrophage colony-stimulating factor (AdGM-CSF) 1 day before Mycobacterium tuberculosis (Mtb) infection produced a significant decrease of pulmonary bacterial loads, higher activated DCs and increased expression of TNF-α, IFN-γ and iNOS. When AdGM-CSF was given in female mice B6D2F1 (C57BL/6J X DBA/2J) infected with a low Mtb dose to induce chronic infection similar to latent infection and corticosterone was used to induce reactivation, a very low bacilli burden in lungs was detected, and the same effect was observed in healthy mice co-housed with mice infected with mild and highly virulent bacteria in a model of transmissibility. Thus, GM-CSF is a significant cytokine in the immune protection against Mtb and gene therapy with AdGM-CSF increased protective immunity when administered in a single dose 1 day before Mtb infection in a model of progressive disease, and when used to prevent reactivation of latent infection or transmission.

CH bond activation in aromatic ketones mediated by iridium-tris(pyrazolyl)borate complexes.

Reaction of complex [TpMe2Ir(η4-CH2C(Me)C(Me)C2)] (1) with a series of aromatic ketones at 130 °C renders, by means of a selective ortho-CH activation, Ir(III)-metallacycles 2-5, which display an Ir-H bond. When [TpMe2Ir(C6H5)2N2] (6) is treated with 2-(trifluoromethyl)acetophenone and 2-fluoroacetophenone at 80 °C, the formation of dimeric (7) and trimeric architectures (8) is achieved through the meta- and para-CH activation of the aromatic ketone, respectively. The generation of complexes 2-5 is proposed to occur by the initial formation of Ir(III) η1-ketone adducts as key intermediates, followed by aromatic CH activations and the release of a butadiene ligand. The formation of complexes 7 and 8 involves an assisted process in which a metal center activation of the less sterically hindered C-H bond of the aromatic ketone takes place (releasing a benzene molecule), followed by the coordination of the carbonyl group, which generates the respective dimeric and trimeric structures. Complexes 7 and 8 are efficient catalysts for the transfer hydrogenation of ketones and aldehydes using isopropanol as the hydrogen source. All complexes have been fully characterized by NMR spectroscopy, FT-IR, elemental analysis and, in the cases of 7 and 8, X-ray crystallography. Details of the reaction conditions, isolation of the products, and proposals for the pathways of formation of complexes 2-5 and 7-8 are discussed.

Hematological and biochemical blood values in wild populations of black howler monkeys (Alouatta pigra) of Campeche, México.

BACKGROUND: The clinical analyses of free-ranging New World primates are extremely limited. The aim of this study was to obtain baseline data of blood chemistry and hematological values of free-ranging Alouatta pigra. METHOD: 17 males and 17 females were captured. We collected blood from the caudal tail vein; conventional techniques were used to analyze the samples RESULTS: Hemoglobin, hematocrit, and erythrocytes were significantly higher in males than in females. In relation to biochemical blood values, albumin/globulin ratio, cholesterol, triglycerides, calcium, phosphorus, magnesium, and iron were significantly higher in males than in females, while creatinine was significantly higher in females than in males. CONCLUSIONS: In general, measured parameters are similar to those of other primates and will be used as reference values for futures studies.

Blood parameters are little affected by time of sampling after the application of ketamine in black howler monkeys (Alouatta pigra).

BACKGROUND: Ketamine hydrochloride is an anesthetic commonly utilized to obtain biological samples in various non-human primates. Its application alters individual hematologic and biochemical values. The aim of this study was to analyze its effect on blood parameters of Alouatta pigra. METHOD: We collected blood samples at 10 and 40 minutes after the application of ketamine in 12 adult female A. pigra living in free-ranging conditions. RESULTS: The analysis showed that 40 minutes after application of ketamine, the number of platelets, lymphocytes and concentration of phosphorus decreased; however, creatinine, cholesterol, triglycerides, and potassium values increased. CONCLUSIONS: Our results suggest that ketamine appears to have little effect on the hematology and blood biochemistry of Alouatta pigra females with respect to those reported for other non-human primates. It is also important to consider the elapsed time after their application when taking blood samples for proper interpretation of the hemogram of Alouatta pigra females.

Recycling of polymeric composites from industrial waste by pyrolysis: Deep evaluation for carbon fibers reuse.

The use of polymeric composite on transport applications as reinforcement material has been increased due to the low fuel consumption when replacing heavier materials. It is estimated that 170,000 tons of polymeric composites will be discarded by 2025, and recycling processing for carbon fibers recovery is required to save primary energy and reduce waste. Among the current techniques, pyrolysis processing has been most effective. On the other hand, innovation must maintain the structure for reuse since physical and mechanical properties are important for recycled materials. For this reason, the goal of the present study was the recycling of polymeric composite by pyrolysis. The recovered carbon fibers were analyzed in SEM and EDS to verify surface defects compared with virgin carbon fibers. The effect of temperature, time, and atmosphere were investigated. Results showed that at 550 °C for 1 h, it was possible to obtain free carbon fibers from the polymeric matrix. After the pyrolysis process in this condition, the fibers had no pores, material fracture, and carbonization. This paper contributes to the widening and systematizing knowledge on effectiveness and understanding polymeric composites recycling for carbon fiber recovery, maintaining its structure for reuse.

Expression of AT1 and AT2 angiotensin receptors in astrocytomas is associated with poor prognosis.

Astrocytomas develop intense vascular proliferation, essential for tumour growth and invasiveness. Angiotensin II (ANGII) was initially described as a vasoconstrictor; recent studies have shown its participation in cellular proliferation, vascularisation, and apoptosis. We conducted a prospective study to evaluate the expression of ANGII receptors - AT1 and AT2 - and their relationship with prognosis. We studied 133 tumours from patients with diagnosis of astrocytoma who underwent surgery from 1997 to 2002. AT1 and AT2 were expressed in 52 and 44% of the tumours, respectively, when determined by both reverse transcriptase-polymerase chain reaction and immunohistochemistry. Ten per cent of low-grade astrocytomas were positive for AT1, whereas grade III and IV astrocytomas were positive in 67% (P<0.001). AT2 receptors were positive in 17% of low-grade astrocytomas and in 53% of high-grade astrocytomas (P=0.01). AT1-positive tumours showed higher cellular proliferation and vascular density. Patients with AT1-positive tumours had a lower survival rate than those with AT1-negative (P<0.001). No association to survival was found for AT2 in the multivariate analysis. Expression of AT1 and AT2 is associated with high grade of malignancy, increased cellular proliferation, and angiogenesis, and is thus related to poor prognosis. These findings suggest that ANGII receptors might be potential therapeutic targets for high-grade astrocytomas.

The karyotype of Alouattapigra (Primates: Platyrrhini): mitotic and meiotic analyses.

We describe for the first time the karyotype of the black howler monkey, Alouatta pigra. Conventional staining, G- and C-banding, and fluorescence in situ hybridization (FISH) with a peptide nucleic acid (PNA) pantelomeric probe were performed. Eight free ranging adult individuals, four males and four females, within the natural distribution of the species presented a diploid karyotype with 2n = 58. Mitotic analyses showed an autosomal complement composed of 6 submetacentric, 3 metacentric, and 19 acrocentric chromosome pairs for females, and 6 submetacentric, 3 metacentric, and 18 acrocentric pairs for males. Meiotic analyses in males revealed 27 autosomal bivalents and a quadrivalent composed of a submetacentric X(1) and acrocentric X(2), Y(1), and Y(2). The G-banded karyotype allowed us to identify pair #17 as the autosomal pair involved in the rearrangement and the morphology of the quadrivalent components. C-banding technique in metaphase I corroborated the structure of the quadrivalent showing four C+ centromeres. FISH analysis showed telomeric signals at the terminal regions of all chromosomes. No interstitial signals were detected. DNA sequence data were in accordance with those previously published for this species.

Prognostic factors influencing survival rates in children following lung transplantation.

OBJECTIVES: To assess the results of lung transplantation (LT) in children under 17 years of age and identify factors affecting long-term survival. METHODS: A retrospective review was performed of 37 patients (<17 years) who had received a lung transplant between 1996 and 2007. Morbidity, mortality, and survival were analyzed by the Kaplan-Meier method and the log-rank test. RESULTS: There were 37 LTs: 30 bilateral, four lobar, two liver-lung, one unilateral. Indications for transplantation were: cystic fibrosis (n = 30), pulmonary fibrosis (n = 1), bronchiectasis (n = 1), Kartagener's syndrome (n = 1), bronchiolitis obliterans (n = 3), and pulmonary fibrosis due to radiotherapy-chemotherapy (n = 1). The intubation time and oxygenation index of donors were 49 +/- 36 hours and 455 +/- 83.5 mm Hg, respectively. Seventeen patients needed extracorporeal circulation (ECC) and 13 were coded as priorities. High blood pressure and renal failure were the most frequent complications. Overall survival rates were 65.7%, 59.4%, 56.1%, 44.5%, and 39.6% at 1, 2, 3, 5, and 10 years, respectively. Need for ECC (P = .001), surgical complications (P = .037), oxygenation index <450 mm Hg (P = .005), OLT in priority code (P = .04), and age of donor >16 years (P = .005) were associated with poor survival. CONCLUSIONS: LT is an appropriate procedure for certain types of end-stage pediatric pulmonary pathologies, achieving acceptable long-term survival rates. When the procedure is carried out under a surgical priority code, it is associated with a high rate of perioperative morbidity and mortality and poorer long-term survival. Other factors that have a negative influence on survival include the need for ECC, surgical complications, an oxygenation index <450 mm Hg, and donor age >16 years.

Experience of the Reina Sofia Hospital in lung transplantation from donors older than forty years.

INTRODUCTION: The shortage of suitable donors for lung transplantation (LT) has led to liberalization of criteria for donor selection. This study evaluated the outcomes of LT among a subset of patients receiving organs from standard donors older than 40 years of age. METHODS: We distributed patients who underwent LTs performed between 1993 and 2007 into 2 groups: Group A, donors younger than 40 years; and Group B, donors 40 years of age or older. We compared donor and recipient preoperative, operative, and recipient postoperative factors by univariate analyses. RESULTS: We reviewed 255 consecutive LT patients: Group A, 198 patients (78%); and Group B, 57 patients (22%). Donors from Group A showed longer intubation times (43 hours vs 34 hours; P = .026) and a better PaO2/FiO2 ratio (477 vs 454 mm Hg; P = .020), with no differences in other donor variables. Among patients dying of primary graft failure, 20% were from Group B versus 5.6% from Group A (P = .04). There were no differences in mortality or other postoperative variables. Survival rates did not differ between groups (70%, 62%, 52%, and 45% in Group A vs 60%, 45%, 45%, and 20% in Group B at 1, 3, 5, and 10 years, respectively; P = .13). CONCLUSION: The use of ideal donors older than 40 years of age might be related to a higher incidence of primary graft failure. However, long-term survival is similar to that of recipients from younger donors.

Results of lung transplantation in patients with chronic obstructive pulmonary disease.

OBJECTIVE: The objective of this study was to evaluate the results and survival rates of patients who underwent lung transplantation (LT) to treat chronic obstructive pulmonary disease (COPD). METHODOLOGY: We performed a retrospective analysis of 63 patients with COPD who underwent LT between 1996 and 2007. Our statistical analysis was based on descriptive statistics and survival analysis (Kaplan-Meier and log-rank test). RESULTS: Sixty-three LTs were performed in 53 male and 10 female patients with COPD. Twenty-eight LTs were unipulmonary and 35 were bipulmonary. Four cases required extracorporeal circulation. Surgical complications arose in 18 cases. There were 3 cases of intraoperative death as a result of cardiac failure. The most frequent long-term complications were hypertension (39.7%), renal failure (42.9%), and neoplasms (20.6%). Overall survival times (mean, 2553 days) were 75.9%, 74.15%, 65.67%, 55.87%, and 42.05% at 1, 2, 3, 5, and 10 years, respectively. No differences were observed in survival according to the following: donor age >30 years (P = 8), type of transplantation (unilateral vs bilateral; P = .57), donor intubation time >48 hours (P = .2), or donor oxygenation index <450 mm Hg (P = .3). CONCLUSIONS: No differences were observed in survival according to the type of transplantation (unilateral vs bilateral), which suggests that unipulmonary transplantation is a reasonable option, given that this procedure reduces both the ischemia time compared with bilateral transplantation and the surgery time, as well as offering more efficient use of donor organs.

Results of lung transplantation in patients with cystic fibrosis.

Lung transplantation (LT) is the only available option for patients with cystic fibrosis (CF) with end-stage lung disease. We reviewed our experience with LT in patients with end-stage CF (CFLT) to identify variables associated with survival and to compare the results with other indications for LT (OILT). Between October 1993 and October 2007, we performed 259 consecutive LTs in 250 patients for treatment of various end-stage pulmonary conditions. The indications for LT were CF in 78 patients idiopathic pulmonary fibrosis in 76, COPD in 64, bronchiectasis in 11, alfa-1-antitrypsin deficit in 5, primary pulmonary hypertension in 4, bronchiolitis obliterans syndrome in 4, and other indications in 11. Our study group comprised 78 patients with CF (30.11%) (CFLT). We observed significant differences in the actuarial survival between the CFLT and OILT groups. Perioperative mortality and the incidence of bronchiolitis obliterans syndrome were comparable in both groups. We found that in patients with CF, LT performed under urgency code (mechanical ventilation) showed no significant difference from LT performed electively insofar as long-term survival, early death, or perioperative death. The functional results in the CFLT group were excellent. We observed significant improvement in PaO(2), PaCO(2), forced vital capacity, and forced expiratory volume in the first second of expiration at 6, 12, and 36 months compared with the pretransplantation baseline values.

Urgency-code lung transplantation for cystic fibrosis: experience and results.

Lung transplantation (LT) under urgency-code mechanical ventilation (UCMV) has been identified in the International Society for Heart and Lung Transplantation (ISHLT) Registry as a negative prognostic factor increasing the likelihood of mortality. The objective of this study was to review our experience of UCLT for with cystic fibrosis (CF) patients compared with elective LT (ELT). From October 1993 to October 2007, we performed 259 consecutive LTs in 250 patients, of whom 78 (31.20%) had CF. Our study group comprised CF patients who received UCLT (n = 23). The type of LT in the UCLT group was as follows: bipulmonary (18), left unipulmonary (2), and bilobar transplantation from cadavers (3). The UCLT group more often required cardiopulmonary bypass (CB) (P = .025), pulmonary tailoring (P = .030), and longer periods of pulmonary ischemia (P = .066) than the ELT group. We noticed a greater number of cases of pneumonia during the first postoperative month in the UCLT group. However, incidence of surgical complications, early and perioperative mortality, and episodes of acute and chronic rejection (bronchiolitis obliterans syndrome) did not differ between the groups. Survival rates at 1, 3, 5, and 10 years were 73.66%, 63.74%, 42.49%, and 42.49%, respectively, in the UCLT group (mean, 1927 [SE = 366] days) and 75.95%, 71.32%, 63.37%, and 63.37% in the ELT group (mean, 2946 [SE = 281] days; P = .3417). In our experience, UCLT in patients with CF is fully justified. Careful selection of such cases permits acceptable long-term survival rates to be achieved with no increase in early or perioperative mortality.