Necroptosis blockade prevents lung injury in severe influenza.

Severe influenza A virus (IAV) infections can result in hyper-inflammation, lung injury and acute respiratory distress syndrome1-5 (ARDS), for which there are no effective pharmacological therapies. Necroptosis is an attractive entry point for therapeutic intervention in ARDS and related inflammatory conditions because it drives pathogenic lung inflammation and lethality during severe IAV infection6-8 and can potentially be targeted by receptor interacting protein kinase 3 (RIPK3) inhibitors. Here we show that a newly developed RIPK3 inhibitor, UH15-38, potently and selectively blocked IAV-triggered necroptosis in alveolar epithelial cells in vivo. UH15-38 ameliorated lung inflammation and prevented mortality following infection with laboratory-adapted and pandemic strains of IAV, without compromising antiviral adaptive immune responses or impeding viral clearance. UH15-38 displayed robust therapeutic efficacy even when administered late in the course of infection, suggesting that RIPK3 blockade may provide clinical benefit in patients with IAV-driven ARDS and other hyper-inflammatory pathologies.

Pelleting and particle size reduction of corn increase net energy and digestibility of fiber, protein, and fat in corn-soybean meal diets fed to group-housed pigs.

BACKGROUND: Reduction of the particle size of corn increases energy digestibility and concentrations of digestible and metabolizable energy. Pelleting may also reduce particle size of grain, but it is not known if there are interactions between particle size reduction and pelleting. The objective of this experiment was to test the hypothesis that particle size reduction and pelleting, separately or in combination, increase N balance, apparent total tract digestibility (ATTD) of fiber and fat, and net energy (NE) in corn-soybean meal diets fed to group-housed pigs. METHODS: Six corn-soybean meal-based diets were used in a 3 × 2 factorial design with 3 particle sizes of corn (i.e., 700, 500, or 300 µm) and 2 diet forms (i.e., meal or pelleted). Pigs were allowed ad libitum access to feed and water. Twenty-four castrated male pigs (initial weight: 29.52 kg; standard diviation: 1.40) were allotted to the 6 diets using a 6 × 6 Latin square design with 6 calorimeter chambers (i.e., 4 pigs/chamber) and 6 periods. Oxygen consumption and CO2 and CH4 productions were measured during fed and fasting states and fecal and urine samples were collected. RESULTS: Regardless of particle size of corn, the ATTD of gross energy (GE), N, and acid-hydrolyzed ether extract (AEE), and the concentration of NE were greater (P < 0.05) in pelleted diets than in meal diets. Regardless of diet form, the ATTD of GE, N, and AEE, and the concentration of NE were increased (linear; P < 0.05) by reducing the particle size of corn, but the increase was greater in meal diets than in pelleted diets (interaction; P < 0.05). CONCLUSIONS: Both pelleting and reduction of corn particle size increased nutrient digestibility and NE, but increases were greater in meal diets than in pelleted diets.

Reduction of particle size of field peas (Pisum sativum L.) increases net energy and digestibility of starch when fed to growing pigs, but there is no difference in nutritional value between peas from the U.S. and peas from Canada.

Two experiments were conducted to test the hypothesis that particle size of field peas and location where peas are grown do not affect apparent total tract digestibility (ATTD) of nutrients and gross energy (GE), digestible energy (DE), metabolizable energy (ME), and net energy (NE), apparent ileal digestibility (AID) of starch, or standardized ileal digestibility (SID) of crude protein (CP) and amino acids (AA). In both experiments, three sources of field peas were used. One source was obtained from the U.S., and two sources were obtained from Canada (i.e., Canada 1, Canada 2). The U.S. field peas were ground to 678, 457, or 265 µm, whereas the two sources of Canadian peas were ground to 411 and 415 µm. Therefore, five batches of field peas were used in both experiments. A basal diet contained corn and soybean meal as the only source of energy, starch, and AA, and five diets containing corn and soybean meal and 50% of each source of field peas were also formulated. The ratio between corn and soybean meal was 1.92:1 in all diets. In Exp. 1, an N-free diet was also used to calculate basal endogenous losses of AA and CP, but in Exp. 2, no N-free diet was used. In Exp. 1, seven barrows (initial body weight = 60.6 ± 2.1 kg) that had a T-cannula installed in the distal ileum were allotted to a 7 × 7 Latin square design with seven diets and seven periods. In Exp. 2, twenty-four pigs (initial body weight = 30.8 ± 1.0 kg) were housed in six calorimeter chambers with four pigs per chamber. The six chambers were allotted to one of the six diets using a 6 × 6 Latin square design with six consecutive periods of 15 d. Results of Exp. 1 demonstrated that the SID of CP and AA was not influenced by the origin of the peas or by the particle size, but the AID of starch increased (linear, P < 0.001) as particle size was reduced from 678 µm to 457 or 265 µm. Results of Exp. 2 indicated that growing location did not affect concentrations of DE, ME, or NE of field peas, but concentrations of DE, ME, and NE increased (linear, P < 0.05) when the particle size was reduced from 678 µm to 457 or 265 µm. In conclusion, field peas grown in Canada or the U.S. have the same nutritional value, but starch digestibility and NE increase if the particle size of field peas is reduced.

The interaction between RIPK1 and FADD controls perinatal lethality and inflammation.

Perturbation of the apoptosis and necroptosis pathways critically influences embryogenesis. Receptor-associated protein kinase-1 (RIPK1) interacts with Fas-associated via death domain (FADD)-caspase-8-cellular Flice-like inhibitory protein long (cFLIPL) to regulate both extrinsic apoptosis and necroptosis. Here, we describe Ripk1-mutant animals (Ripk1R588E [RE]) in which the interaction between FADD and RIPK1 is disrupted, leading to embryonic lethality. This lethality is not prevented by further removal of the kinase activity of Ripk1 (Ripk1R588E K45A [REKA]). Both Ripk1RE and Ripk1REKA animals survive to adulthood upon ablation of Ripk3. While embryonic lethality of Ripk1RE mice is prevented by ablation of the necroptosis effector mixed lineage kinase-like (MLKL), animals succumb to inflammation after birth. In contrast, Mlkl ablation does not prevent the death of Ripk1REKA embryos, but animals reach adulthood when both MLKL and caspase-8 are removed. Ablation of the nucleic acid sensor Zbp1 largely prevents lethality in both Ripk1RE and Ripk1REKA embryos. Thus, the RIPK1-FADD interaction prevents Z-DNA binding protein-1 (ZBP1)-induced, RIPK3-caspase-8-mediated embryonic lethality, affected by the kinase activity of RIPK1.

Cost-Effectiveness Analysis of Implantable Cardioverter Defibrillator Therapy for Primary Prevention Patients with Additional Risk Factors in Brazil

Abstract Background: Implantable cardiac defibrillators (ICDs) therapy for primary prevention (PP) of sudden cardiac arrest (SCA) is well-established but underutilized globally. The Improve SCA study has identified a cohort of patients called 1.5 primary prevention (1.5PP), based on PP patients with the presence of documented risk factors: non-sustained ventricular tachycardia, frequent premature ventricular contractions, left ventricular ejection fraction < 25%, and pre-syncope or syncope. Objective: This study evaluated the cost-effectiveness of ICD therapy compared to no ICD among 1.5PP patients in the Brazilian public healthcare system. Methods: Modified inputs to a published Markov model were applied to compare costs and outcomes of ICD therapy to no ICD therapy from the Brazilian payer's perspective. Mortality and utility estimates were obtained from the IMPROVE SCA trial. Additional effectiveness inputs were sourced from the literature. Cost inputs were obtained from the Brazilian Unified Health System and the Ministry of Health. Costs were discounted at 4.7%; quality-adjusted life years (QALYs) were discounted at 1.45%. This study applied a willingness-to-pay (WTP) value of three times Brazil's gross domestic product (GDP) in 2017, R$105,723 (Brazilian Real). Results: The total discounted lifetime costs for ICD therapy were R$100,920 compared to R$43,866 for no ICD therapy. Total discounted QALYs for ICD therapy and no ICD therapy were 9.85 and 7.15, respectively. The incremental cost effectiveness ratio was R$21,156 per QALY and less than the R$105,723 WTP threshold. Results from sensitivity analyses were consistent with base case results. Conclusions: ICD therapy compared to no ICD therapy is cost-effective in the 1.5PP population in Brazil. (Int J Cardiovasc Sci. 2021; [online].ahead print, PP.0-0)

Evaluación del impacto de la terapia de resincronización cardiaca en pacientes de Latinoamérica / Evaluation of the impact of cardiac resynchronisation on patients Latin America

Resumen Objetivo: medir el impacto de la terapia de resincronización cardiaca en términos de variables ecocardiográficas en pacientes de países latinoamericanos. Método: se realizó un estudio prospectivo, multicéntrico, intervencionista, en el que los pacientes elegibles fueron llevados, por primera vez, a implante de un dispositivo de resincronización cardiaca. El objetivo primario fue valorar los cambios del tamaño y la función del ventrículo izquierdo por medio de un ecocardiograma previo al implante del dispositivo y en el sexto mes. Los objetivos secundarios evaluados fueron hospitalizaciones, cambios en la clase funcional, mortalidad, calidad de vida y un score compuesto clínico basado en estos factores de evaluación global del paciente. Resultados: para cumplir el objetivo primario se analizaron datos de 75 sujetos. La edad promedio fue de 63,7 años; 21.3% fueron mujeres y 30.7% tuvieron cardiopatía isquémica. Al sexto mes de seguimiento las mediciones de volumen de fin de diástole y sístole del ventrículo izquierdo disminuyeron en promedio 37.6 ml y 37.8 ml, respectivamente. La fracción de eyección del ventrículo izquierdo en promedio se incrementó un 11%. El puntaje compuesto clínico mostró mejoría en el 86.4% de los pacientes en el sexto mes postimplante del resincronizador. Conclusiones: se observó remodelado inverso del ventrículo izquierdo y mejoría en el estado clínico de los pacientes con insuficiencia cardiaca y disfunción sistólica del ventrículo izquierdo que recibieron terapia de resincronización cardiaca en el ámbito de la práctica clínica de rutina.

Abstract Objective: To measure the impact of cardiac resynchronisation therapy in terms of cardiac ultrasound variables in patients from Latin-American countries. Method: A prospective, multicentre, interventionist study was conducted, in which the eligible patients were those that had a cardiac resynchronisation device implanted for the first time. The primary objective was to assess the changes in size and left ventricular function by means of a cardiac ultrasound carried out prior to implanting the device and in the sixth month. The secondary objectives evaluated were hospital admissions, change in functional class, mortality, quality of life, and an overall assessment of the patient using a combined clinical score based on these factors. Results: A total of 75 subjects were analysed in order to complete the primary objective. The mean age was 63.7 years; 21.3% were female, and 30.7% had ischaemic heart disease. At the sixth month, the left ventricular end-diastolic and systolic volume decreased by a mean of 37.6 ml and 37.8 ml, respectively. The left ventricular ejection fraction increased by a mean of 11%. The combined clinical score showed an improvement in 86.4% of the patients in the sixth month after the implantation of the synchronisation device. Conclusions: A reverse remodelling of the left ventricle was observed, as well as an improvement in the clinical stage of patients with heart failure and left ventricular systolic dysfunction that received cardiac resynchronisation treatment in the setting of routine clinical practice.

Aproximación Neurodinámica a la Cognición Social / Neurodimanic Approach to Social Cognition

En las últimas décadas ha crecido el estudio los mecanismos involucrados en el comportamiento social, gran parte de estas indagaciones se han realizado desde una aproximación de la neurociencia social cognitiva, la cual se basa en un modelo representacional del procesamiento de información. No obstante, esta aproximación ha sido ampliamente criticada por desconocer la participación del cuerpo, la dinámica afectiva, el contexto social, el cambio durante el desarrollo y suponer un procesamiento modular endógeno. En este sentido, este artículo presenta un modelo neurodinámico de la cognición social (CS), comprendiéndola desde una aproximación enactiva, situada, relacional y sistémica. Desde este modelo se describen los principales cambios en esperados la actividad cerebral durante las interacciones sociales en tiempo real y durante la ontogenia. Se concluye resaltando los desafíos y oportunidades que este tipo de aproximaciones puede proporcionar a la neurociencia y psicología social del futuro.

In recent decades it has seen a growing interest to study the mechanisms involved in social behavior, much of these inquiries fall within social cognitive neuroscience approach, which is based on a representational model of information processing. However, this approach has been widely criticized for ignoring the body participation, emotional dynamics, social context, developmental changes and assuming an endogenous modular processing. In this regard, this article presents a neurodynamic model of social cognition, which understand social process from an enactive, embodied, situated, relational and systemic perspective. This model let us described the main expected changes in brain activity during ongoing social interactions and ontogeny. The conclusion highlights the challenges and opportunities that this kind of approach can provide for a coming neuroscience and social psychology.

Viabilidad de la evaluación domiciliaria del estado funcional de pacientes con enfermedad pulmonar obstructiva crónica en fase de recuperación de una exacerbación / Feasibility of Home-Based Functional Status Assessment of Chronic Obstructive Pulmonary Disease Patients Recovering From an Exacerbation

Introducción: La prueba de actividades de la vida diaria de Glittre (prueba ADL) es, en un entorno de laboratorio, una medida fiable del estado funcional de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) estable. Nos propusimos adaptar la prueba para poder llevarla a cabo en el entorno domiciliario (test ADLm) y supervisar la recuperación del estado funcional de pacientes con EPOC después de una exacerbación atendida en un programa de hospitalización domiciliaria (HD). Método: Evaluamos a 17 pacientes con EPOC moderada a muy grave después de una exacerbación en 3 visitas domiciliarias: el día del alta de HD (V0), al cabo de 10días (V10post) y un mes después del alta (V30post). Los pacientes realizaron la prueba ADLm (vueltas VO2 y VE), impacto de la EPOC (CAT), el Cuestionario de disnea para las ADV London Chest (LCADL), la escala de disnea Medical Research Council modificada (MRCm) y una dinamometría de las extremidades superiores (fuerza de prensión). Resultados: el número de vueltas al circuito en la prueba ADLm (4, 5 y 5, p < 0,05), el CAT (19, 12 y 12, p < 0,01), la MRCm (2, 1,5 y 1, p < 0,01) y el dominio de cuidado personal del LCADL (6, 5 y 5, p < 0,01) mejoraron durante el seguimiento (V0, V10post y V30post, respectivamente). No se constataron cambios significativos en el VO2, el VE o la fuerza de prensión. Conclusión: Nuestros resultados indican que, tras una exacerbación de la EPOC, es factible realizar la prueba ADLm en el entorno domiciliario, y que el estado funcional continúa mejorando 10 días después del alta de HD

Introduction: The Glittre Activities of Daily Living Test (ADL-Test) is a reliable functional status measurement for stable chronic obstructive pulmonary disease (COPD) patients in a laboratory setting. We aimed to adapt the test to the home setting (mADL-Test) and to follow-up the functional status recovery of post-exacerbation COPD patients included in a home hospitalization (HH) program. Method: We assessed 17 exacerbated moderate-to-very-severe COPD patients in 3 home visits: at discharge to HH (V0), 10days (V10post) and 1month after discharge (V30post). Patients completed the mADL-Test (laps, VO2 and VE), COPD assessment test (CAT), London Chest ADL Test (LCADL), modified Medical Research Council (mMRC) and upper limb strength (handgrip). Results: The number of laps of the mADL-Test (4, 5 and 5, P < .05), CAT (19, 12 and 12, P < .01), mMRC (2, 1.5 and 1, P < .01) and the self-care domain of the LCADL (6, 5 and 5, P < .01) improved during follow-up (V0, V10post and V30post, respectively). No significant changes were evidenced in VO2, VE or handgrip. Conclusion: Our results suggest that the mADL-test can be performed in the home setting after a COPD exacerbation, and that functional status continues to improve 10 days after discharge to HH

Grado de actividad física diaria de los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) y su relación con la clasificación Global Initiative for Chronic Obstructive Lung Disease (GOLD) / Level of daily physical activity in chronic obstructive pulmonary disease (COPD) patients according to GOLD classification

Introducción y objetivo: La guía Global Initiative for Chronic Obstructive Lung Disease (GOLD) para la clasificación de pacientes con enfermedad pulmonar obstructiva crónica (EPOC) no refleja adecuadamente el impacto de la enfermedad al no considerar la actividad física diaria (AFD). Pacientes y métodos: Se seleccionaron prospectivamente 48 pacientes (12 por cada grupo GOLD). Se midió la AFD mediante acelerometría clasificando a los pacientes en 3 niveles de actividad (muy inactivo, sedentario, activo). Resultados: No se observaron diferencias significativas en los niveles de actividad física entre los grupos GOLD (p = 0,361). Los porcentajes de pacientes muy inactivos fueron 33% para el grupo A, 42% para el B, 42% para el C y 59% para el D. Además, los pacientes sedentarios alcanzaron el 50% en el grupo A, el 42% en los B y C, y el 41% para el grupo D. Discusión: Los pacientes EPOC con muy bajos niveles de actividad física están presentes en todos los estadios de la clasificación GOLD, incluso en aquellos definidos como de bajo impacto (por ejemplo, el GOLD A). Es necesario detectar precozmente a los pacientes en riesgo que podrían beneficiarse de intervenciones específicas (AU)

Introduction and objective: The Global Initiative for Chronic Obstructive Lung Disease (GOLD guideline) for patients with chronic obstructive pulmonary disease does not adequately reflect the impact of the disease because does not take into account daily physical activity (DPA). Patients and methods: Forty eight patients (12 in each GOLD group) were prospectively recruited. DPA was evaluated by accelerometer. Patients were classified into 3 levels of activity (very inactive, sedentary, active). Results: No significant differences in levels of physical activity among GOLD groups (P = .361) were observed. The percentages of very inactive patients were 33% in group A, 42% in group B, 42% in group C and 59% in group D. In addition, high percentage of sedentary patients were observed through 4 groups, in group A (50%), B and C (42%, each), and group D (41%). Discussion: COPD patients has very low levels of physical activity at all stages of GOLD classification even those defined as low impact (such as GOLD A). Is necessary to detect patients at risk who might benefit from specific interventions (AU)

Desarrollo de la comprensión de las consecuencias de las emociones / Development of understanding of emotional consequences

La investigación en comprensión emocional ha privilegiado el estudio de los antecedentes y ha desatendido el que atañe al conocimiento sobre las consecuencias de las emociones. Se diseñó una tarea para niños de dos rangos de edad (4 a 5 y 5 a 6 años) con dos historias (valencias positivay negativa). Se midió la concordancia entre valencias (consecuencia-historias), y la calidad de las justificaciones sobre la elección de la consecuencia. Se encontró que la concordancia cambia en función de la edad, la valencia de las historias y las justificaciones a la elección de la consecuencia; las justificaciones dependen de la edad; existe una relación estrecha entre el desarrollo de la comprensión de las consecuencias y la regulación emocional.

Research about emotional understanding has privileged the study of antecedents, but has missed the study of knowledge of the consequences of emotions. We created a task for children of two ages (4 to 5 and 5 to 6 years) with two stories (positive and negative valences). We assessed the valences concordance (consequence-stories), and the justification quality on the consequence election. We found that concordance changes in function of age, story valence and justifications; justifications depend on age; there is a close relation between the developmentof understanding of emotional consequences and emotional regulation.

Cuál es el mejor FEV1 para detectar insuficiencia respiratoria crónica en la EPOC estable / Below what FEV1 Should Arterial Blood be Routinely Taken to Detect Chronic Respiratory Failure in COPD?

Introducción: La gasometría arterial es la medición de elección para el diagnóstico de insuficiencia respiratoria crónica en la enfermedad pulmonar obstructiva crónica (EPOC). Se ha sugerido que el FEV1 se sitúe entre el 30 y el 50% del valor teórico para su indicación, pero estas cifras nunca han sido validadas. Objetivo: Identificar los valores de FEV1 post-broncodilatador (BD) y saturación arterial de oxígeno (SaO2) que proporcionen la mejor sensibilidad, especificidad y coeficientes de probabilidad (CP) para el diagnóstico de insuficiencia respiratoria crónica hipoxémica y/o hipercápnica en la EPOC estable. Métodos: Se incluyeron 150 pacientes (39 con PaO2 < 60mmHg [8 kPa] y 14 de ellos con una PaCO2¡Ý50mmHg[6,7 kPa]). Se seleccionaron los mejores puntos de corte de FEV1 post-BD y SaO2 para predecirla insuficiencia respiratoria crónica empleando los CP y las curvas Receiver Operating Characteristic. Resultados: Un FEV1 post-BD igual al 36% y una SaO2 del 90% fueron los mejores valores predictivos de insuficiencia respiratoria hipoxémica y un FEV1 post-BD igual al 33% para la variante hipercápnica. Un FEV1 ¡Ý45% descartó la insuficiencia respiratoria hipoxémica. Conclusión: Un FEV1 post-BD igual al 36% se erige en el mejor punto de corte para predecir adecuadamentetanto la insuficiencia respiratoria hipoxémica como la hipercápnica en el paciente con EPOC estable. Por su parte, una SaO2 del 90% ofrece el mejor valor para la insuficiencia hipoxémica aislada. Estos valores podrían ser considerados para futuras recomendaciones/guías clínicas de la EPOC(AU)

Introduction: To diagnose and assess chronic respiratory failure in stable chronic obstructive pulmonarydisease (COPD) the measurement of arterial blood gases (ABG) is required. It has been suggested that ABGbe determined for this purpose when FEV1 ranges between 50% and 30% predicted, but these thresholdsare not evidence-based.Objective: To identify the post-bronchodilator (BD) FEV1 and arterial oxygen saturation (SaO2) valuesthat provide the best sensitivity, specificity, and likelihood ratio (LR) for the diagnosis of hypoxaemicand/or hypercapnic chronic respiratory failure in stable COPD.Methods: A total of 150 patients were included (39 with PaO2 < 60mmHg[8 kPa], 14 of them with a PaCO2¡Ý50mmHg[6.7 kPa]). The best post-BD FEV1 and SaO2 cut-off points to predict chronic respiratory failurewere selected using the PC and the Receiver Operating Characteristics (ROC) curves.Results: A post-BD FEV1 equal to 36% and an SaO2 of 90% were the best predictive values for hypoxaemicrespiratory failure and a post-BD FEV1 equal to 33% for the hypercapnic variant. An FEV1 ¡Ý45% ruled outhypoxaemic respiratory failure. Conclusion: A post-BD FEV1 of 36% is the best cut-off point to adequately predict both hypoxaemic andhypercapnic respiratory failure in the patient with stable COPD. For its part, an SaO2 of 90% is the bestvalue for isolated hypoxaemic failure. These values could be considered for future clinical recommendations/guidelines for COPD(AU)

Trasplante de pulmón con donantes no controlados a corazón parado. Factores pronósticos dependientes del donante y evolución inmediata postrasplante / Lung Transplantation with Uncontrolled Non-Heart-Beating Donors. Transplantation. Donor Prognostic Factor and Immediate Evolution Post Transplant

Introducción: La donación en asistolia no controlada (DANC) constituye una alternativa al trasplantepulmonar con donantes en muerte encefálica. El objetivo principal del estudio es describir la incidenciade eventos al mes tras el trasplante con pulmones de DANC, y la influencia de los factores dependientesdel donante y del proceso de donación.Pacientes y métodos: Estudio de una cohorte histórica de 33 receptores de trasplante pulmonar realizadosen los hospitales Puerta de Hierro y Marqués de Valdecilla con 32 DANC procedentes del Hospital ClínicoSan Carlos durante el periodo 2002-2008. Se estudiaron los siguientes eventos: complicaciones quirúrgicasy médicas, disfunción primaria del injerto, rechazo agudo, neumonía y mortalidad. Se evaluaron lascaracterísticas del donante y los tiempos del proceso de donación (minutos).Resultados: La mediana de edad de los receptores fue 50,5 años (rango intercuartílico, 38,5-58); 28 hombresy 5 mujeres. La incidencia acumulada de los eventos al mes fue: neumonía, 10 (31,3%); disfunciónprimaria del injerto, 15 (46,9%); rechazo, 12 (37,5%); mortalidad, 4 (12,1%); complicaciones médicas,25 (78,1%), y quirúrgicas, 18 (56,3%). La mediana del tiempo de asistolia fue mayor en los sujetos conneumonía (15 vs. 7,5; p = 0,027), la mediana del tiempo de isquemia fría fue superior en los sujetos quepresentaron complicaciones quirúrgicas y mortalidad (436 vs. 343,5; p = 0,04; 505 vs. 410; p = 0,033, respectivamente),y las medianas de los tiempos de isquemia total fueron superiores en los receptores quefallecieron (828 vs. 695; p = 0,036).Conclusiones: Los DANC constituyen una alternativa válida para expandir el pool de donantes pulmonaresante la carencia actual de pulmones válidos para el trasplante. La incidencia de complicaciones escomparable con los datos publicados en la literatura(AU)

Introduction: Uncontrolled donation after cardiac death (DACD) has become an alternative to lung transplantationwith encephalic-death donation. The main objective of this study is to describe the incidenceof clinically relevant events in the period of thirty days after lung transplant with uncontrolled DACD andthe influence of factors depending on the donor and donation process as well.Patients and methods: Historical cohort study of 33 lung transplant receivers at Hospital Puerta de Hierro and Hospital Marqués de Valdecilla with 32 DACD from Hospital Clínico San Carlos from 2002 to 2008.We studied surgical and medical complications, primary graft dysfunction, acute rejection, pneumonia and mortality. We made an evaluation of the donor characteristics and donation procedure times (minutes). Results: Median age of recipients was 50.5 years (interquartile range, 38.5-58). There were 28 malesand 5 females. Cumulative incidence of events in the first month was: pneumonia 10 (31.3%); primarygraft dysfunction 15 (46.9%); rejection 12 (37.5%); mortality 4 (12.1%); medical complications 25 (78.1%);and surgical complications 18(56.3%). Median time of cardiac arrest was higher in those who presentedpneumonia (15 vs. 7.5; p = 0.027). Median time of cold ischemia was higher in those who presentedsurgical complications and mortality (436 vs. 343.5; p = 0.04; 505 vs. 410; p = 0.033, respectively), andmedian of total ischemia times were longer in the recipients who died (828 vs. 695; p = 0.036).Conclusions: Uncontrolled DACD are a valid alternative for expanding the donor pool in order to mitigatethe current shortage of lungs that are valid for transplantation. The incidence of complications iscomparable with published data in the literature(AU)

Movimientos períodicos del sueño ¿Relación con el síndrome de Guillain-Barre?

El presente informe describe los hallazgos clínicos y polisomnográficos en una mujer con antecedentes de síndrome de Guillain-Barré que refería hipersomnia diurna relacionada con moviminetos periódicos del sueño.