Structural relaxation, dynamical arrest, and aging in soft-sphere liquids.

We investigate the structural relaxation of a soft-sphere liquid quenched isochorically (ϕ = 0.7) and instantaneously to different temperatures Tf above and below the glass transition. For this, we combine extensive Brownian dynamics simulations and theoretical calculations based on the non-equilibrium self-consistent generalized Langevin equation (NE-SCGLE) theory. The response of the liquid to a quench generally consists of a sub-linear increase of the α-relaxation time with system's age. Approaching the ideal glass-transition temperature from above (Tf > Ta), sub-aging appears as a transient process describing a broad equilibration crossover for quenches to nearly arrested states. This allows us to empirically determine an equilibration timescale teq(Tf) that becomes increasingly longer as Tf approaches Ta. For quenches inside the glass (Tf ≤ Ta), the growth rate of the structural relaxation time becomes progressively larger as Tf decreases and, unlike the equilibration scenario, τα remains evolving within the whole observation time-window. These features are consistently found in theory and simulations with remarkable semi-quantitative agreement and coincide with those revealed in a previous and complementary study [P. Mendoza-Méndez et al., Phys. Rev. 96, 022608 (2017)] that considered a sequence of quenches with fixed final temperature Tf = 0 but increasing ϕ toward the hard-sphere dynamical arrest volume fraction ϕHS a=0.582. The NE-SCGLE analysis, however, unveils various fundamental aspects of the glass transition, involving the abrupt passage from the ordinary equilibration scenario to the persistent aging effects that are characteristic of glass-forming liquids. The theory also explains that, within the time window of any experimental observation, this can only be observed as a continuous crossover.

Epidemiology of Non-Tuberculous Mycobacteria isolated from clinical specimens in Madrid, Spain, from 2013 to 2017.

The epidemiology of non-tuberculous mycobacteria (NTM) in Spain is largely unknown because systematic reporting is not compulsory. The aim of our study was to describe the frequency and diversity of NTM species in our region and their distribution according to the source sample, gender, and age of the patients. We performed a multicenter study of all NTM isolated in 24 public hospitals in Madrid from 2013 to 2017. A total of 6.923 mycobacteria were isolated: 4535 (65.5%) NTM, and 2.388 (34.5%) Mycobacterium tuberculosis complex (MTB). Overall, 61 different NTM species were identified. The most frequently isolated species were Mycobacterium avium complex (47.7%), M. lentiflavum (12.2%), M. gordonae (9.2%), M. fortuitum (8.9%), and M. abscessus (3.9%). Whereas MTB cases were stable during the study period, the number of NTM isolates increased considerably from 930 isolates in 2013 to 1012 in 2017; a sharp increase occurred in the last year. The rise in NTM isolates was mostly due to M. lentiflavum, M. kansasii, and M. abscessus mainly isolated from respiratory specimens in patients older than 60. The increase in isolation rate of NTM in our region is consistent with the increasing rates reported worldwide in the last decades. The rise in NTM isolates was mainly attributed to M. lentiflavum but it also should be noted the increasing of species with high pathogenic potential such as M. kansasii and M. abscessus.

Multigenerational effects of triclosan on the demography of Plationus patulus and Brachionus havanaensis (ROTIFERA).

Triclosan is a personal care product widely used in North America, Europe and Asia as antimicrobial ingredient in many consumer chemical products. In Mexico concentrations of triclosan have been reported in aquatic systems. However, there is no law regulating the presence of chemicals such as triclosan, in aquatic systems. The scarce data about this chemical has increased concern among ecotoxicologists regarding possible effects on aquatic organisms. Moreover, multigenerational studies are rarely studied and the results vary depending on the contaminant. Rotifers, are a dominant group of zooplankton, and have been used in aquatic risk assessments of personal care products due to their sensitivity and high reproductive rates. Plationus patulus and Brachionus havanaensis are common rotifers distributed in aquatic ecosystems of Mexico and have been used in ecotoxicological bioassays. In this study, the median lethal concentration (LC50, 24h) of P. patulus and B. havanaensis exposed to triclosan was determined. Based on the LC50, we tested three sublethal concentrations of triclosan to quantify the demographic responses of both rotifers for two successive generations (F0, and F1). The 24h LC50 of triclosan for P. patulus and B. havanaensis were 300 and 500µgL-1 respectively. Despite the concentration, triclosan had an adverse effect on both Plationus patulus and Brachionus havanaensis in both generations exposed. Experiments show that P. patulus was more sensitive than B. havanaensis when exposed to triclosan. When exposed to triclosan the parental generation (F0) of P. patulus was far more affected than F1.

Long-term spatio-temporal dynamics of the mosquito Aedes aegypti in temperate Argentina.

Buenos Aires city is located near the southern limit of the distribution of Aedes aegypti (Diptera: Culicidae). This study aimed to assess long-term variations in the abundance of Ae. aegypti in Buenos Aires in relation to changes in climatic conditions. Ae. aegypti weekly oviposition activity was analyzed and compared through nine warm seasons from 1998 to 2014, with 200 ovitraps placed across the whole extension of the city. The temporal and spatial dynamics of abundances were compared among seasons, and their relation with climatic variables were analyzed. Results showed a trend to higher peak abundances, a higher number of infested sites, and longer duration of the oviposition season through subsequent years, consistent with a long-term colonization process. In contrast, thermal favorability and rainfall pattern did not show a consistent trend of changes. The long-term increase in abundance, and the recently documented expansion of Ae. aegypti to colder areas of Buenos Aires province suggest that local populations might be adapting to lower temperature conditions. The steadily increasing abundances may have implications on the risk of dengue transmission.

Brainstem and Autonomic Nervous System Dysfunction: A Neurosurgical Point of View.

Central autonomic control nuclei and pathways are mainly integrated within the brainstem, especially in the medulla oblongata. Lesions within these structures can lead to central dysautonomia.Central autonomic control structures can be damaged by tumors, during surgery, or by other neurosurgical pathologies. These may elicit clinical or subclinical autonomic complications that can constitute a serious clinical problem.The authors present a broad review of the central autonomic nervous system, its possible dysfunctions, and the relation between neurosurgery and this "not-well-known system". Preliminary results of an autonomic study of brainstem lesions that is currently being carried out by the authors are also shown.

Work instability in rheumatoid arthritis patients from Argentina: prevalence and associated factors.

To determine the prevalence of and associated factors to work instability (WI) in rheumatoid arthritis (RA) Argentinean patients. Observational cross-sectional study that assessing employment status in currently working RA patients. They answered the validated version of RA work instability scale (RA-WIS). High-risk WI was considered when RA-WIS was ≥17. Factors associated with high-risk WI were examined by univariable and multivariable analysis. Four-hundred and fifty RA patients were enrolled; of these, 205 patients were currently employed, but only 172 have completed questionnaires required [RA-WIS and health assessment questionnaire (HAQ-A)]. Their mean age was 49.3 ± 10.8 years; 81.3 % were female; and their mean disease duration was 8.1 ± 7.2 years. Fifty-two percent of patients were doing manual work. The mean RA-WIS score was 11.4 ± 6.8, and 41 % of patients had a high-risk WI. High-risk WI was associated with radiographic erosions (p < 0.001) and HAQ-A >0.87 (p < 0.001) in the univariable analysis, whereas in the multivariable logistic regression analysis the variables associated with a high-risk WI were as follows: HAQ-A >0.87 [odds ratio (OR) 12.31; 95 % CI 5.38-28.18] and the presence of radiographic erosions (OR 4.848; 95 % CI 2.22-10.5). In this model, having a higher monthly income (OR 0.301; 95 % CI 0.096-0.943) and a better functional class (OR 0.151; 95 % CI 0.036-0.632) were protective. Forty-one percent of RA working patients had high-risk WI. The predictors of high RA-WIS were HAQ-A ≥0.87 and radiographic erosions, whereas having a better functional class and have higher incomes were protective.

Antibacterial and non-cytotoxic effect of nanocomposites based in polyethylene and copper nanoparticles.

In this study, an antibacterial, but not cytotoxic nanomaterial based on polyethylene and copper nanoparticles was prepared by in situ polymerization. PE-CuNps nanocomposites against Escherichia coli, completely suppressed the number of live bacteria after 12 h incubation compared to neat PE. TEM images showed that nanocomposites damage the plasma membrane of the bacteria, revealing a bacteriolytic effect. Toxic effects of copper nanoparticles on viability of neuroblastoma line cell also was evaluated, revealing a non cytotoxic effect for the doses used, showing that this nanocomposite is a ideal material for medical devices.

Distribution of human papillomavirus genotypes in Paraguayan women according to the severity of the cervical lesion.

The incidence of cervical cancer in Paraguay is among the highest in the world. This study aimed to determine the distribution of human papillomavirus (HPV) genotypes in Paraguayan women, according to the severity of the cervical lesion. This cross-sectional study included 207 women without a squamous intraepithelial lesion, 164 with low-grade squamous intraepithelial lesions, 74 with high-grade squamous intraepithelial lesions, and 41 with cervical cancer. Type-specific HPV was determined by the polymerase chain reaction with MY9/11 L1 and GP5+/GP6+ L1 primers, followed by restriction fragment length polymorphism and reverse line blotting hybridization, respectively. In total, 12 high-risk and 24 low-risk HPVs types were detected. HPV 16 was the most prevalent, followed by HPV 18 in cervical cancer (14.6%), HPV 31 in high-grade squamous intraepithelial lesions (14.9%), HPVs 58/42 in low-grade squamous intraepithelial lesions (9.1% each), and HPVs 31/58 (2.4% each) in women without squamous intraepithelial lesions. Among 285 positive samples, 24.2% harbored multiple HPV types, being this more prevalent in women with squamous intraepithelial lesions (30.8% in low-grade squamous intraepithelial lesions, 22.5% in high-grade squamous intraepithelial lesions, and 22.0% in cervical cancer) than in women without lesions (9.3%). The higher prevalence of HPV 16 and other high-risk HPVs in women both with and without cervical lesions may explain the high incidence of cervical cancer in Paraguay. This information may be of importance for local decision makers to improve prevention strategies. In addition, these results may be useful as baseline pre-vaccination data for a future virological surveillance in Paraguay.

[Ganglioneuroma coinciding with a lumbar disk herniation]. / Ganglioneuroma coincidente con una extrusión discal lumbar.

INTRODUCTION. Ganglioneuromas or gangliomas are tumours of the sympathetic ganglia that contain cells of the neural crest, so they can appear in all body localizations. They are generally benign, more frequent between 10 and 40 years, may secrete hormones and, sometimes, Neurofibromatosis type I and other genetic disorders can be associated. OBJECTIVE. To review the scientific literature related to the topic and to present a case treated in our service. DISCUSSION. The symptoms depend on location and vasoactive secreted hormones. In spite of that, they are generally benign tumours, although sometimes they can spread out. Since laboratory and image test are of limited usefulness, the conclusive diagnosis is anatomopathologic. In symptomatic patients the best procedure is surgical removing. CONCLUSION. Ganglioneuroma and disk herniation association constitute an exceptional disorder. Its treatment implies surgery resection.

[Neuroendoscopic biopsy. Experience in 31 patients and literature review]. / Biopsia neuroendoscópica. Revisión de la literatura y experiencia en 31 pacientes.

OBJECTIVE. To describe our experience with the endoscopic management of intraventricular tumors, analyzing biopsy effectiveness, and to compare our results with those obtained from an extensive literature review. MATERIALS AND METHODS. Between 2003 and 2010, 31 patients aged between 7 months and 77 years, diagnosed of solid and/or cystic intra and/or periventricular tumors, underwent neuroendoscopic biopsy. We analyze operative technique, pathological result, management of associated hydrocephalus, rate of complications and postoperative technique. RESULTS. 32 endoscopic procedures were done and biopsy was successfully performed in 28 cases, with positive histological result in 25 of them (78% success rate per procedure and 89% success rate per biopsy). Most frequent pathological diagnosis was grade II astrocytoma. 30 patients had associated hydrocephalus that required endoscopic third ventriculostomy (19 cases, with 73.7% success rate) and/or septostomy (12 patients, 3 associated with ventriculostomy and 9 with ventriculo-peritoneal shunt). Frameless neuronavigation was used in three selected cases. During the surgery and the postoperative period the following complications appeared: intraventricular hemorrhage in four cases (two of them died), seizures in two patients, new neurological findings in three cases (Parinaud's sign, transient palsy of third cranial nerve and hemiparesis associated with palsy of third cranial nerve), and cerebrospinal fluid leak and infection in one case. 19 patients received subsequent treatment (microsurgical resection in 1, radiosurgery in 2, radiotherapy in 8, chemotherapy in 5 and chemo-radiotherapy in 3). CONCLUSIONS. Endoscopic management of intraventricular and/or periventricular brain tumors is effective, and allow diagnostic biopsy and simultaneous treatment of the associated hydrocephalus in many cases. So, it could be the treatment of choice in those tumors that are not suitable for microsurgical resection. Although this technique is not exempt of serious complications, morbimortality could be lower than conventional microsurgical approach.

Development, equivalence study, and normative data of version B of the Spanish-language Free and Cued Selective Reminding Test.

INTRODUCTION: The Free and Cued Selective Reminding Test (FCSRT) is widely used for the assessment of verbal episodic memory, mainly in patients with Alzheimer disease. A Spanish-language version of the FCSRT and normative data were developed within the NEURONORMA project. Availability of alternative, equivalent versions is useful for following patients up in clinical settings. This study aimed to develop an alternative version of the original FCSRT (version B) and to study its equivalence to the original Spanish-language test (version A), and its performance in a sample of healthy individuals, in order to develop reference data. METHODS: We evaluated 232 healthy participants of the NEURONORMA-Plus project, aged between 18 and 90. Thirty-three participants were assessed with both test versions using a counterbalanced design. RESULTS: High intra-class correlation coefficients (between 0.8 and 0.9) were observed in the equivalence study. While no significant differences in performance were observed in total recall scores, free recall scores were significantly lower for version B. CONCLUSIONS: These preliminary results suggest that the newly developed FCSRT version B is equivalent to version A in the main variables tested. Further studies are necessary to ensure interchangeability between versions. We provide normative data for the new version.

[Pilomyxoid astrocytoma. Three cases and review]. / Astrocitomas pilomixoides. Presentación de tres casos y revisión de la literatura.

INTRODUCTION: Pilomyxoid astrocytoma (PMA) is a central nervous system (CNS) tumour with peculiar clinicopathological features, that turn it into an entity different from pilocytic astrocytoma (PA). It appears in 2007 WHO classification of tumours of the CNS as an PA subtype belonging to the group of astrocytic tumours. Nowadays little is still known about this tumour entity; the histological origin and clinical behavior remain controversial, and there is no consensus about its management. OBJECTIVE: To review the scientific literature related to the topic and to present three cases treated at our service. CONCLUSIONS: PMA is an histological entity related to PA with a greater trend to regrowth and cerebrospinal fluid dissemination, therefore strict follow-up and oncological treatment is recommended.

[Ventricular haemorrhage in preterm neonates and posthemorrhagic hydrocephalus. Proposal of a management protocol based on early ventriculo-peritoneal shunt]. / Hemorragia intraventricular del prematuro e hidrocefalia post-hemorrágica.Propuesta de un protocolo de manejo basado en la derivación ventrículo-peritonealprecoz.

INTRODUCTION: About 50% of the preterm neonates with a ventricular haemorrhage will develop posthaemorrhagic hydrocephalus. Medical treatment is not effective neither safe, does not reduce shunt's dependence and therefore can not be recommended; early and repetitive ventricular or lumbar punctures and the use of intraventricular fibrynolitic treatment have showed no effect on reducing patient's disability, shunt's necessity or mortality of these patients and furthermore, they can have several and important side effects. The ventriculo-peritoneal shunt can be in many cases the only option for definitive treatment, despite well-known infective and obstructive complications and there is an ongoing debate about the ideal moment for the intervention. OBJECTIVE: To present a diagnostic and treatment protocol for post-haemorrhagic hydrocephalus of the preterm and describe our initial experience with its application on the Paediatric Neurosurgical Department at the Hospital Materno-Infantil Carlos Haya of Málaga. MATERIALS AND METHODS: A total of 21 patients with diagnosis of preterm post-haemorrhagic hydrocephalus were surgically treated at our hospital with ventriculoperitoneal shunt between January 2003 and September 2006 following the designed protocol. All the cases were Papile's grade III or IV with severe ventricular dilation (Thalamus-Caudate index over 1.5 cm) and subacute or chronic presentation. We used medium pressure valves and antibiotic impregnated catheters. We considered 1500 g as the minimum weight permitted for the intervention. We report the early and late postoperative complications and the patients functional state at the ambulatory follow up classifying them in 4 grades (Excellent or Grade 1; Good or Grade 2; Regular or Grade 3; Poor or Grade 4) according to the presence of neurological focal signs, relation with the surrounding environment, response to stimuli and presence of seizures. RESULTS: The most frequent complications were escaphocephalic cranium in 5 patients, persistent subgaleal collections in 2 patients, symptomatic slit ventricles in 2 patients and surgical wound dehiscence with shunt infection in 1 patient. One patient presented a systemic fungical infection with non-diagnosed meningeal compromise previous to the shunt. 7 patients required shunt replacement (14 procedures); in 2 cases of tabicated hydrocephalus an endoscopical septostomy (associated with an ETV that did not function) was done, and in a third case ETV and shunt removal was performed after shunt malfunction, with delayed failure of ETV. For the functional results 9 patients were classified as Grade 1, 5 patients as Grade 2, 3 patients as Grade 3 and 4 patients as Grade 4. This means a 67% of good or excellent results. CONCLUSIONS: We propose a diagnostic and treatment protocol for preterm neonates with haemorrhagic hydrocephalus that we have been using since 2003 at our department. In our experience it is possible to shunt patients starting at 1500 g with low morbidity. The use of protocols can help in reducing complications and improving functional results in these patients.

[Development of a risk map in an oral and maxillofacial surgical unit]. / Desarrollo de un mapa de riesgos en una unidad de cirugía oral y maxilofacial.

INTRODUCTION: the main aim of this study was to develop and implement a risk map in the Oral and Maxillofacial Surgery Service of the University Hospital «Virgen de las Nieves¼ of Granada to minimize the incidence of adverse effects (AE). MATERIALS AND METHODS: Longitudinal, prospective study carried out in the Oral and Maxillofacial Surgery Service of the Hospital Universitario Virgen de las Nieves of Granada, from June 2017 to May 2018, through the methodology of «Analysis and Failure Mode Effect¼. Management of the different AE was addressed. The following phases were considered as it follows: identification of the problem, identification of AE for within the practice of the oral and maxillofacial surgery that represents a problem in the assistive safety, creation of an interdisciplinary working group, analysis of the current situation in patient safety and risk management using 2analysis tools, SWOT and PITELO, preparation of the patient care process, development of a catalog of AE and preparation of a risk map. RESULTS: A total of 33 AE were identified. The risk map showed a higher incidence of AE in the Surgical Area (22) compared to the areas of Outpatient Clinic and Hospital Discharge (6). A total of 10 critical AE were identified. CONCLUSIONS: The elaboration of a risk map allowed to determine the process of the oral and maxillofacial surgical patient, and to elaborate a catalog of AE.

[Management of adverse events in an Oral and Maxillofacial Surgery Unit]. / Gestión de eventos adversos en un Servicio de Cirugía oral y Maxilofacial.

INTRODUCTION: Patient safety in oral and maxillofacial surgery is oriented towards providing patient care by means of adequate risk management that minimises adverse events and fosters a culture of safe clinical practices as the fundamental basis of quality health care. To implement preventive actions are implemented in order to improve patient safety and to reduce the incidence of adverse events, as well as to improve the quality of care. The aim of this report is to implement preventive measures in order to improve the health care of the patient in an Oral and Maxillofacial Surgery Unit by reducing the Adverse Events and proving good quality healthcare. MATERIALS AND METHODS: A longitudinal, prospective, single centre study was conducted using a methodology of analysis of modes of failure and effects of the management of potentially serious adverse events in the Oral and Maxillofacial surgical unit of the University Hospital of Granada (June-November 2017), as well as the preparation and implementation of a series of corrective measures. RESULTS: A total of 33 adverse events were recorded, with 10 of them considered as critical, distributed in different areas of care, and referred from Primary Health Care and from other hospitals. Seven preventive actions were implemented: information to the patient, training actions, improvements in the protocols and procedures, in the care process and clinical practice, as well as the need to set up an adequate checklist, and other miscellaneous. DISCUSSION: The implementation of preventive measures represent a notable advance in the prevention of harm to the patient and the organisation, involving healthcare staff in a safety culture oriented towards quality care.

Porous Nanogold/Polyurethane Scaffolds with Improved Antibiofilm, Mechanical, and Thermal Properties and with Reduced Effects on Cell Viability: A Suitable Material for Soft Tissue Applications.

The use of implants carries on a series of problems, among them infections, poor biocompatibility, high levels of cytotoxicity, and significant mechanical differences between implants and host organs that promote stress shielding effects. These problems indicate that the materials used to make implants must meet essential requirements and high standards for implantations to be successful. In this work, we present the synthesis, characterization and evaluation of the antibiofilm, mechanical, and thermal properties, and cytotoxic effect of a nanocomposite-based scaffold on polyurethane (PU) and gold nanoparticles (AuNPs) for soft tissue applications. The effect of the quantity of AuNPs on the antibacterial activity of nanocomposite scaffolds was evaluated against Staphylococcus epidermidis and Klebsiella spp., with a resulting 99.99% inhibition of both bacteria using a small quantity of nanoparticles. Cytotoxicity was evaluated with the T10 1/2 test against fibroblast cells. The results demonstrated that porous nanogold/PU scaffolds have no toxic effects on fibroblast cells to the 5 day exposition. With respect to mechanical properties, stress-strain curves showed that the compressive modulus and yield strength of PU scaffolds were significantly enhanced by AuNPs (by at least 10 times). This is due to changes in the arrangement of hard segments of PU, which increase the stiffness of the polymer. Thermogravimetric analysis showed that the degradation onset temperature rises with an increase in the quantity of AuNPs. These properties and characteristics demonstrate that porous nanogold/PU scaffolds are suitable material for use in soft tissue implants.

State diagram for the electrostatic adsorption of charged colloids on confining walls: simulation and theory.

We study the structure of charged colloidal suspensions under confinement and determine a state diagram for the occurrence of electrostatic adsorption onto the confining walls, an effect that results in the accumulation of particles on the bounding surfaces and that could be relevant in experiments. We use Monte Carlo simulations to quantify this structural transition and perform theoretical calculations based on integral equations. Overall, our results provide a guide for experimentalists dealing with charged colloidal systems to determine the relevance of this purely electrostatic effect.

Dynamic arrest within the self-consistent generalized Langevin equation of colloid dynamics.

This paper presents a recently developed theory of colloid dynamics as an alternative approach to the description of phenomena of dynamic arrest in monodisperse colloidal systems. Such theory, referred to as the self-consistent generalized Langevin equation (SCGLE) theory, was devised to describe the tracer and collective diffusion properties of colloidal dispersions in the short- and intermediate-time regimes. Its self-consistent character, however, introduces a nonlinear dynamic feedback, leading to the prediction of dynamic arrest in these systems, similar to that exhibited by the well-established mode coupling theory of the ideal glass transition. The full numerical solution of this self-consistent theory provides in principle a route to the location of the fluid-glass transition in the space of macroscopic parameters of the system, given the interparticle forces (i.e., a nonequilibrium analog of the statistical-thermodynamic prediction of an equilibrium phase diagram). In this paper we focus on the derivation from the same self-consistent theory of the more straightforward route to the location of the fluid-glass transition boundary, consisting of the equation for the nonergodic parameters, whose nonzero values are the signature of the glass state. This allows us to decide if a system, at given macroscopic conditions, is in an ergodic or in a dynamically arrested state, given the microscopic interactions, which enter only through the static structure factor. We present a selection of results that illustrate the concrete application of our theory to model colloidal systems. This involves the comparison of the predictions of our theory with available experimental data for the nonergodic parameters of model dispersions with hard-sphere and with screened Coulomb interactions.

Prevalence and management of potential candidates for simultaneous pancreas-kidney transplantation in a provincial setting.

INTRODUCTION: Simultaneous pancreas-kidney (SPK) transplantation is the best therapeutic option for correctly selected diabetic patients with advanced chronic kidney disease (CKD). OBJECTIVES: The objectives of this study were to quantify in a Spanish province the prevalence and incidence of type 1 and 2 diabetics with stage IV-V CKD who are potential candidates for SPK, and to analyze the selection for SPK in clinical practice. MATERIALS AND METHODS: All patients with diabetic neuropathy (DN) in predialysis, hemodialysis, or peritoneal dialysis (PD) in our transplantation referral area (population, 1.8 million; data collection ended December 7, 2005) were examined for basic SPK criteria (NTO 2005 Consensus). A new assessment was performed 9 months later, including new possible recipients, and patients were classified as: follows in study, excluded after study, added to SPK waiting list, or SPK-transplanted. RESULTS: In 2005, there were 1371 patients in dialysis or predialysis, including 179 (13%) with DN (41 type 1 and 138 type 2 DM); only 16 of these patients (8.9% of DN patients), 8.9 per million population (PMP), met the basic criteria for SPK transplantation. There were 68 with DN in predialysis, including 8 (11.7%) possible SPK candidates; 7 with DN in PD, no candidates for SPK; and 104 patients with DN in hemodialysis, including 8 (7.2%) SPK candidates. After 9 months, 7 new potential candidates were identified (incidence of 5.1 PMP/y). Of 23 possible candidates, 3 refused SPK, 7 awaited completion of study, 8 were excluded after study, 1 was on the SPK waiting list, and 7 underwent SPK transplantation. CONCLUSIONS: In our setting, approximately 9% of DN patients with stage IV-V CKD were potential SPK candidates in 2005 and 2006. After completion of studies, less than half were eventually included on the waiting list, generating an effective demand for SPK of 2-4 new patients PMP/y.

Long-Term Outcomes of Intestinal and Multivisceral Transplantation at a Single Center in Argentina.

BACKGROUND: Intestinal failure (IF) patients received parenteral nutrition (PN) as the only available therapy until intestinal transplantation (ITx) evolved as an accepted treatment. The aim of this article is to report the long-term outcomes of a series of ITx performed in pediatric and adult patients at a single center 9 years after its creation. PATIENTS AND METHODS: This is a retrospective analysis of the ITx performed between May 2006 and January 2015. Diagnoses, pre-ITx mean time on PN, indications for ITx, time on the waiting list for types of ITx, mean total ischemia time, and warm ischemia time, time until PN discontinuation, incidence of acute and chronic rejection, and 5-year actuarial patient survival are reported. RESULTS: A total of 42 patients received ITx; 80% had short gut syndrome (SG); the mean time on PN was 1620 days. The main indication for ITx was lack of central venous access followed by intestinal failure-associated liver disease (IFALD) and catheter-related infectious complications. The mean time on the waiting list was 188 days (standard deviation, ±183 days). ITx were performed in 26 children and 14 adults. In all, 32 procedures were isolated ITx (IITX); 10 were multiorgan Tx (MOT; 3 combined, 7 multivisceral Tx (MVTx), 1 modified MVTx and 2 with kidney); 2 (4.7 %) were retransplantations: 1 IITx, 1 MVTx, and 5 including the right colon. Thirteen patients (31%) received abdominal rectus fascia. All procedures were performed by the same surgical team. Total ischemia time was 7:53 ± 2:04 hours, and warm ischemia time was 40.2 ± 10.5 minutes. The mean length of implanted intestine was 325 ± 63 cm. Bishop-Koop ileostomy was performed in 67% of cases. In all, 16 of 42 Tx required early reoperations. The overall mean follow-up time was 41 ± 35.6 months. The mean time to PN discontinuation after Tx was 68 days (P = .001). The total number of acute cellular rejection (ACR) episodes until the last follow-up was 83; the total number of grafts lost due to ACR was 4; and the total graft lost due to chronic rejection was 3. At the time of writing, the overall 5-year patient survival is 55% (65% for IITx vs 22% for MOT; P = .0001); 60% for pediatric recipients vs 47% for adults (P = NS); 64% when the indication for ITx was SG vs 25% for non-SG (P = .002). CONCLUSIONS: At this center, candidates with SG, in the absence of IFALD requiring IITx, showed the best long-term outcomes, independent of recipient age. A multidisciplinary approach is mandatory for the care of intestinal failure patients, to sustain a rehabilitation and transplantation program over time.