Kidney transplant from uncontrolled donation after circulatory death donors maintained by nECMO has long-term outcomes comparable to standard criteria donation after brain death.

Uncontrolled donation after circulatory death (uDCD) increases organ availability for kidney transplant (KT) with short-term outcomes similar to those obtained from donation after brain death (DBD) donors. However, heterogeneous results in the long term have been reported. We compared 10-year outcomes between 237 KT recipients from uDCD donors maintained by normothermic extracorporeal membrane oxygenation (nECMO) and 237 patients undergoing KT from standard criteria DBD donors during the same period at our institution. We further analyzed risk factors for death-censored graft survival in the uDCD group. Delayed graft function (DGF) was more common in the uDCD group (73.4% vs 46.4%; P < .01), although glomerular filtration rates at the end of follow-up were similar in the 2 groups. uDCD and DBD groups had similar rates for 10-year death-censored graft (82.1% vs 80.4%; P = .623) and recipient survival (86.2% vs 87.6%; P = .454). Donor age >50 years was associated with graft loss in the uDCD group (hazard ratio: 1.91; P = .058), whereas the occurrence of DGF showed no significant effect. uDCD KT under nECMO support resulted in similar graft function and long-term outcomes compared with KT from standard criteria DBD donors. Increased donor age could negatively affect graft survival after uDCD donation.

Spatiotemporal distribution of δ(13)CCO2 in a shallow cave and its potential use as indicator of anthropic pressure.

This study deals with the spatiotemporal dynamics of CO2 and its isotopic composition (δ(13)CCO2) in the atmosphere of Altamira Cave (northern Spain) over two annual cycles. In general terms, the cavity shows two distinct ventilation modes, acting as a CO2 reservoir from October to May (recharge stage), while actively exchanging gases with the outside atmosphere between July and September (discharge stage). In recharge mode, the in-cave air shows higher and relatively homogeneous CO2 values (3332 ± 521 ppm) with lower δ(13)CCO2 (-23.2 ± 0.4‰). In contrast, during the discharge stage, the CO2 concentrations are lower and relatively more variable (1383 ± 435 ppm) and accompanied by higher δ(13)CCO2 (up to -12‰). This seasonal pattern is controlled by the distinct rates of exchange of air masses with the external atmosphere through the annual cycle, as well as by changes in the production of CO2 in the soil and natural fluctuations in the concentration of dissolved inorganic carbon transported by drip water into the cave. In contrast to the interpretations of previous studies in Altamira Cave, no local air intakes into the deepest cave sections were flagged by our δ(13)C measurements. This finding is also supported by analyses of CO2 and (222)Rn in air, density of airborne particles and air temperature. In addition, preliminary experiments examining the visitor-produced disturbances on δ(13)CCO2 were conducted during the various cave ventilation stages to explore the potential use of this parameter as an indicator of anthropic pressure in caves. Our data show that visits (overall stay of 60-85 min; i.e., 4 people for 20 min) significantly affected δ(13)CCO2 (up to Δδ(13)C âˆ¼ -2‰) in the Polychrome Hall of Altamira Cave under conditions of low natural CO2 (discharge stage), whereas it remained almost unaltered under circumstances of high CO2 concentration (recharge stage). This demonstrates that δ(13)CCO2 is sensitive to perturbations produced by visitors during certain periods.

[Surveillance cultures after high-level disinfection of flexible endoscopes in a general hospital]. / Evaluación microbiológica de la desinfección de alto nivel de los endoscopios flexibles en un hospital general.

INTRODUCTION: Flexible endoscopes are instruments with a complex structure which are used in invasive gastroenterological procedures, therefore high-level disinfection (HLD) is recommended as an appropriate reprocessing method. However, most hospitals do not perform a quality control to assess the compliance and results of the disinfection process. OBJECTIVES: To evaluate the effectiveness of the flexible endoscopes’ decontamination after high-level disinfection by surveillance cultures and to assess the compliance with the reprocessing guidelines. MATERIAL AND METHODS: Descriptive study conducted in January 2013 in the Gastroenterological Unit of a tertiary hospital. 30 endoscopic procedures were randomly selected. Compliance with guidelines was evaluated and surveillance cultures for common bacteria were performed after the disinfection process. RESULTS: On the observational assessment, compliance with the guidelines was as follows: pre-cleaning 9 (30%), cleaning 5 (16.7%), rinse 3 (10%), first drying 30 (100%), disinfection 30 (100%), final rinse 0 (0%) and final drying 30 (100%), demonstrating that only 3 of 7 stages of the disinfection process were optimally performed. In the microbiological evaluation, 2 (6.7%) of the 30 procedures had a positive culture obtained from the surface of the endoscope. Furthermore, 1 (4.2%) of the 24 biopsy forcepsgave a positive culture. The organisms isolated were different Pseudomonas species. CONCLUSION: High-level disinfection procedures were not optimally performed, finding in 6.7% positive cultures of Pseudomonas species.

Evaluación microbiológica de la desinfección de alto nivel de los endoscopios flexibles en un hospital general / Surveillance cultures after high-level disinfection of flexible endoscopes in a general hospital

Introducción: Los endoscopios flexibles son instrumentos de estructura compleja utilizados en procedimientos invasivos de la vía digestiva por lo que se recomienda la desinfección de alto nivel como un método de reprocesamiento apropiado. Sin embargo, en la mayoría de hospitales no se ha realizado un control de calidad que evalúe el cumplimiento y resultado del proceso de desinfección. Objetivos: Comprobar la eficacia del proceso de descontaminación de los endoscopios a nivel microbiológico y evaluar el cumplimiento de las directrices de desinfección de alto nivel. Material y método: Estudio descriptivo realizado en enero del 2013 en el servicio de gastroenterología de un hospital de tercer nivel. Se seleccionaron 30 procedimientos endoscópicos aleatoriamente. Se observó el cumplimiento de las directrices y se realizaron cultivos para gérmenes comunes luego del proceso de desinfección. Resultados: En la evaluación observacional se determinó que el cumplimiento de las directrices fue: pre-limpieza 9 (30%), limpieza 5 (16,7%), enjuague 3 (10%), primer secado 30 (100%), desinfección 30 (100%), enjuague final 0 (0%) y secado final 30 (100%); cumpliéndose de manera óptima sólo 3 de las 7 etapas correspondientes al proceso de desinfección. En la evaluación microbiológica, 2 (6,7%) de los 30 procedimientos analizados tuvieron un cultivo positivo en la superficie del endoscopio. Además, 1 (4,2%) de las 24 pinzas evaluadas dio un cultivo positivo. Los microorganismos aislados fueron diferentes especies de Pseudomonas. Conclusión: Se determinó que los procedimientos de desinfección de alto nivel no se realizaron de manera óptima, hallando en un 6,7% cultivos positivos a Pseudomonas de diferentes especies.

Introduction: Flexible endoscopes are instruments with a complex structure which are used in invasive gastroenterological procedures, therefore high-level disinfection (HLD) is recommended as an appropriate reprocessing method. However, most hospitals do not perform a quality control to assess the compliance and results of the disinfection process. Objectives: To evaluate the effectiveness of the flexible endoscopes’ decontamination after high-level disinfection by surveillance cultures and to assess the compliance with the reprocessing guidelines. Material and methods: Descriptive study conducted in January 2013 in the Gastroenterological Unit of a tertiary hospital. 30 endoscopic procedures were randomly selected. Compliance with guidelines was evaluated and surveillance cultures for common bacteria were performed after the disinfection process. Results: On the observational assessment, compliance with the guidelines was as follows: pre-cleaning 9 (30%), cleaning 5 (16.7%), rinse 3 (10%), first drying 30 (100%), disinfection 30 (100%), final rinse 0 (0%) and final drying 30 (100%), demonstrating that only 3 of 7 stages of the disinfection process were optimally performed. In the microbiological evaluation, 2 (6.7%) of the 30 procedures had a positive culture obtained from the surface of the endoscope. Furthermore, 1 (4.2%) of the 24 biopsy forceps gave a positive culture. The organisms isolated were different Pseudomonas species. Conclusion: High-level disinfection procedures were not optimally performed, finding in 6.7% positive cultures of Pseudomonas species.