Use of noninvasive measurement of the indocyanine green plasma disappearance rate in patients with septic shock.

OBJECTIVE: Our aim was to analyse the relation between serial values of the indocyanine green plasma disappearance rate (ICG-PDR) with hospital mortality in the first 48 hours of ICU admission in patients with septic shock. METHODS: A prospective observational study was carried out over 12 months of patients admitted to the ICU with septic shock. Each patient underwent noninvasive determination of ICG-PDR at 24 and 48 hours with the LiMON® module. Follow-up was performed until hospital discharge or exitus. RESULTS: 63 patients. Age 61.1±12.3 years. 60.3% men. SOFA score on admission 8.7±3.3, APACHE II score was 27.9±10.7 points. A total of 44.4% of patients died. The ICG-PDR values in the first 24 hours of ICU admission were lower in nonsurvivors: 10.5 (5.7-13.0)%/min vs. 15.9 (11.4-28.0)%/min, p <0.001. Furthermore, in nonsurvivors, there was no improvement in ICG-PDR between 24 h and 48 h, while in survivors, there was an increase of 25%: 15.9 (11.4-28.0)%/min and 20.9 (18.0-27.0)%/min, p=0.020. The silhouette measure of ICG-PDR cohesion and separation for the clusters analysed (nonsurvivors and survivors) was satisfactory (0.6). ICG-PDR<11.7%/min was related to in-hospital mortality, ICG-PDR> 18%/min to survival, and the interval between 11.7% and 18%/min covered a range of uncertainty. In the two-stage cluster, ICG-PDR, SOFA and APACHE II present satisfactory predictive scores 24 hours after patient admission. CONCLUSIONS: ICG-PDR in our setting is a useful clinical prognostic tool and could optimise the decision tree in patients with septic shock.

Developing an interpretable machine learning model for predicting COVID-19 patients deteriorating prior to intensive care unit admission using laboratory markers.

Coronavirus disease (COVID-19) remains a significant global health challenge, prompting a transition from emergency response to comprehensive management strategies. Furthermore, the emergence of new variants of concern, such as BA.2.286, underscores the need for early detection and response to new variants, which continues to be a crucial strategy for mitigating the impact of COVID-19, especially among the vulnerable population. This study aims to anticipate patients requiring intensive care or facing elevated mortality risk throughout their COVID-19 infection while also identifying laboratory predictive markers for early diagnosis of patients. Therefore, haematological, biochemical, and demographic variables were retrospectively evaluated in 8,844 blood samples obtained from 2,935 patients before intensive care unit admission using an interpretable machine learning model. Feature selection techniques were applied using precision-recall measures to address data imbalance and evaluate the suitability of the different variables. The model was trained using stratified cross-validation with k=5 and internally validated, achieving an accuracy of 77.27%, sensitivity of 78.55%, and area under the receiver operating characteristic (AUC) of 0.85; successfully identifying patients at increased risk of severe progression. From a medical perspective, the most important features of the progression or severity of patients with COVID-19 were lactate dehydrogenase, age, red blood cell distribution standard deviation, neutrophils, and platelets, which align with findings from several prior investigations. In light of these insights, diagnostic processes can be significantly expedited through the use of laboratory tests, with a greater focus on key indicators. This strategic approach not only improves diagnostic efficiency but also extends its reach to a broader spectrum of patients. In addition, it allows healthcare professionals to take early preventive measures for those most at risk of adverse outcomes, thereby optimising patient care and prognosis.

Short-term outcomes of chemoradiotherapy and local excision versus total mesorectal excision in T2-T3ab,N0,M0 rectal cancer: a multicentre randomised, controlled, phase III trial (the TAU-TEM study).

BACKGROUND: The standard treatment of T2-T3ab,N0,M0 rectal cancers is total mesorectal excision (TME) due to the high recurrence rates recorded with local excision. Initial reports of the combination of pre-operative chemoradiotherapy (CRT) and transanal endoscopic microsurgery (TEM) have shown reductions in local recurrence. The TAU-TEM study aims to demonstrate the non-inferiority of local recurrence and the improvement in morbidity achieved with CRT-TEM compared with TME. Here we describe morbidity rates and pathological outcomes. PATIENTS AND METHODS: This was a prospective, multicentre, randomised controlled non-inferiority trial including patients with rectal adenocarcinoma staged as T2-T3ab,N0,M0. Patients were randomised to the CRT-TEM or the TME group. Patients included, tolerance of CRT and its adverse effects, surgical complications (Clavien-Dindo and Comprehensive Complication Index classifications) and pathological results (complete response in the CRT-TEM group) were recorded in both groups. Patients attended follow-up controls for local and systemic relapse. TRIAL REGISTRATION: NCT01308190. RESULTS: From July 2010 to October 2021, 173 patients from 17 Spanish hospitals were included (CRT-TEM: 86, TME: 87). Eleven were excluded after randomisation (CRT-TEM: 5, TME: 6). Modified intention-to-treat analysis thus included 81 patients in each group. There was no mortality after CRT. In the CRT-TEM group, one patient abandoned CRT, 1/81 (1.2%). The CRT-related morbidity rate was 29.6% (24/81). Post-operative morbidity was 17/82 (20.7%) in the CRT-TEM group and 41/81 (50.6%) in the TME group (P < 0.001, 95% confidence interval 42.9% to 16.7%). One patient died in each group (1.2%). Of the 81 patients in the CRT-TEM group who received the allocated treatment, 67 (82.7%) underwent organ preservation. Pathological complete response in the CRT-TEM group was 44.3% (35/79). In the TME group, pN1 were found in 17/81 (21%). CONCLUSION: CRT-TEM treatment obtains high pathological complete response rates (44.3%) and a high CRT compliance rate (98.8%). Post-operative complications and hospitalisation rates were significantly lower than those in the TME group. We await the results of the follow-up regarding cancer outcomes and quality of life.

Removal of microcontaminants by zero-valent iron solar processes at natural pH: Water matrix and oxidant agents effect.

This work deals with microcontaminants (MCs) removal by natural solar zero-valent iron (ZVI) process at natural pH in actual matrices. Commercial ZVI microspheres were selected as ZVI source and hydrogen peroxide and persulfate were used as oxidant agents. The experimental plan comprised the evaluation of sulphates and carbonates/bicarbonates effect on process performance, the possibility of adding an iron chelate (EDDS) to take advantage of leached iron and the treatment of MCs in actual MWWTP secondary effluent. The presence of sulphates and EDDS addition did not lead to significant changes in the process efficiency, while the carbonates naturally present in natural water (458 mg/L) diminished the treatment time need to reach the decontamination goal. Finally, the treatment of a MCs mixture consisting of Atrazine, Carbendazim, Imidacloprid, and Thiamethoxam in the range of µg/L in actual MWWTP secondary effluent by solar/msZVI/H2O2 and solar/msZVI/S2O82- obtained 7 and 22% of total removal after 180 min, respectively, which indicated a moderate competitiveness of these processes with respect to other advanced oxidation processes.

Evaluation of commercial zerovalent iron sources in combination with solar energy to remove microcontaminants from natural water at circumneutral pH.

Solar zerovalent iron (ZVI) was studied at circumneutral pH in combination with hydrogen peroxide and persulfate for removal of imidacloprid as a model contaminant in natural water. Three commercial ZVI sources, steel wool (ZVI-SW) and two iron micro-powders (ZVI-MS and ZVI-S) were independently evaluated. First, different ZVI corrosion conditions were tested in contact with air, exposed to natural solar radiation and with addition of oxidants, such as H2O2 and S2O82-, demonstrating the importance of released iron. Then, the technical feasibilities of solar/H2O2/ZVI and solar/S2O82-/ZVI were assessed for the elimination of 1 mg/L of imidacloprid. In general, H2O2 concentrations and treatment times were high. Only ZVI-MS (1 mM) reached 80% imidacloprid degradation after 157 min and 3 mM (102 mg/L) of H2O2. Solar/S2O82-/ZVI performance was better, reaching >80% imidacloprid degradation in <60 min with 1 mM (192 mg/L) S2O82- for all ZVI sources. Efficiency was highest with ZVI-MS, which was therefore selected for feasibility testing of a microcontaminant (MC) mixture containing 100 µg/L each of atrazine, carbendazim, imidacloprid and thiamethoxam with both solar/oxidizing agents/ZVI. H2O2 took 180 min to achieve 76% degradation of the sum of MCs, while 80% total degradation was reached after 69 min by adding S2O82-, confirming its higher efficiency. Finally, this study showed that ZVI in combination with solar radiation does not enhance significantly the photocatalytic cycle.

Application of solar photo-Fenton in raceway pond reactors: A review.

This work critically reviews the present knowledge about the use of Raceway Pond Reactors (RPR) to treat municipal wastewater treatment plant (MWWTP) secondary effluents by solar photo-Fenton process. The possibility of using RPR to treat industrial wastewater, which has been barely explored, is also reviewed. Initially, the general concepts and operation principles of RPR are described as well as their origin for photo-Fenton applications. Then, the main results and advances related to contaminants of emerging concern (CECs) removal, inactivation of microorganisms, industrial wastewater treatment and kinetic modelling are presented. Key aspects such as the impact of liquid depth, the continuous flow operation feasibility, the increase in treatment capacity, and the kinetic modelling are addressed along the review. At the end, main challenges and research gaps are identified, which should be the focuses of future research.

Long-Term Results of ACL Reconstruction Using a Nonanatomic Double-Bundle Technique with Extra-Articular Reinforcement.

Extra-articular procedures for the improvement in rotational stability after anterior cruciate ligament (ACL) reconstruction have gained popularity in the last decade. This surgical gesture hoped to improve resistance to the high tensional forces affecting the ACL graft during cutting and pivoting movements of the lower extremity and eventually prevent ACL reconstruction failure. We performed this study to analyze the long-term results of patients undergoing ACL reconstruction using a nonanatomic double-bundle technique with an additional extra-articular augmentation. All the cases that underwent an ACL reconstruction using a nonanatomic double-bundle technique with an extra-articular reinforcement during the period between 1992 and 1997 were reviewed. The inclusion criteria for this study included a minimum follow-up of 10 years and age between 14 and 45 years at the time of the surgery. Forty patients were included in this series (34 males and 6 females). The mean Lysholm score after a minimum follow-up period of 10 years was 92.3 (standard deviation [SD], 9.4). The average preoperative Tegner score of the participants was 7.0 (SD, 1.1). This score decreased to 5.7 (SD, 1.2) at the end of follow-up. Follow-up X-rays were reviewed to assess the degenerative changes in the three knee compartments. Degenerative changes ≥ Kellgren-Lawrence grade 2 were observed in our six (15%) patients, all of them in the medial knee compartment. With these results, we conclude that double-bundle nonanatomic ACL reconstruction combined with an extra-articular reinforcement resembling the anterolateral ligament offers good overall long-term results, with relatively low rates of osteoarthritis.

EDDS as complexing agent for enhancing solar advanced oxidation processes in natural water: Effect of iron species and different oxidants.

The main purpose of this pilot plant study was to compare degradation of five microcontaminants (MCs) (antipyrine, carbamazepine, caffeine, ciprofloxacin and sulfamethoxazole at 100 µg/L) by solar photo-Fenton mediated by EDDS and solar/Fe:EDDS/S2O82-. The effects of the Fe:EDDS ratio (1:1 and 1:2), initial iron species (Fe(II) or Fe(III) at 0.1 mM) and oxidizing agent (S2O82- or H2O2 at 0.25-1.5 mM) were evaluated. The higher the S2O82- concentration, the faster MC degradation was, with S2O82- consumption always below 0.6 mM and similar degradation rates with Fe(II) and Fe(III). Under the best conditions (Fe 0.1 mM, Fe:EDDS 1:1, S2O82- 1 mM) antipyrine, carbamazepine, caffeine, ciprofloxacin and sulfamethoxazole at 100 µg/L where 90% eliminated applying a solar energy of 2 kJ/L (13 min at 30 W/m2 solar radiation <400 nm). Therefore, S2O82- promotes lower consumption of EDDS as Fe:EDDS 1:1 was better than Fe:EDDS 1:2. In photo-Fenton-like processes at circumneutral pH, EDDS with S2O82- is an alternative to H2O2 as an oxidizing agent.

Comparison of different detoxification pilot plants for the treatment of industrial wastewater by solar photo-Fenton: Are raceway pond reactors a feasible option?

This paper represents a first approach in the study of photoreactor selection to treat industrial wastewater using solar photo-Fenton. In this context, simulated textile industry effluent containing a mixture of four dyes at different initial dissolved organic carbon (DOC) concentrations (45, 90, 180 and 270 mg/L) was treated by using three different solar reactor geometries: (i) tubular (5 cm diameter) provided with compound parabolic collector (ii) tubular (5 cm diameter) provided with flat collector and (iii) open channels forming raceway ponds with two liquid depths (5 and 15 cm). For comparison purposes, mineralisation percentages over 75% and chronic toxicity reduction were set as treatment goals. Regardless of the initial DOC concentration, negligible differences in terms of treatment time and hydrogen peroxide consumptions were found between the flat collector and compound parabolic collector photoreactors. Conversely, the treatment in the raceway pond reactors always resulted in higher values. In spite of this, when the photoreactors were compared in terms of treatment capacity (mg of DOC removed/m2 min) the raceway pond reactor at 15 cm of liquid depth presented the best results, with values as much as two or three times higher than those of the tubular reactors, except for the wastewater with 270 mg of DOC/L for which the raceway pond reactor at 5 cm liquid depth became the best option. When the treatment capacity is modified to include the photoreactor investment (mg of DOC removed/€ m2) the differences between the raceway pond reactor at both liquid depths and the photoreactors with solar collectors increased by as much as two orders of magnitude, which demonstrates the potential application of the former for the treatment of industrial wastewater by solar photo-Fenton.

Membrana de oxigenación extracorpórea (ECMO) y ventilación mecánica ultraprotectora en el estatus asmático casi fatal / Extracorporeal membrane oxygenation (ECMO) and ultraprotective mechanical ventilation for near-fatal status asthmaticus

No disponible

Soporte con membrana de oxigenación extracorpórea en paciente con miocardiopatía de estrés secundaria a feocromocitoma / Extracorporeal membrane oxygenation support in a patient with pheochromocytoma stress myocardyopathy

No disponible

Intervalos de referencia de la tirotropina durante la gestación en la provincia de Huelva / Thyrotropin reference ranges during pregnancy in the province of Huelva, Spain

Objetivo: El diagnóstico correcto de hipotiroidismo gestacional requiere determinar los intervalos de referencia trimestrales locales de la TSH. En su ausencia las guías recomiendan utilizar como límites superiores 2,5-3,0-3,0μU/ml para el 1.°-2.°-3.° trimestre. Nuestro objetivo es calcular el rango de referencia para nuestra población. Material y métodos: Estudio observacional de base poblacional realizado en gestantes sanas de 11 centros de salud de la provincia de Huelva incluidas consecutivamente durante el año 2016 en el proceso de embarazo. Excluimos las gestantes con antecedentes de enfermedad tiroidea o médica, malos antecedentes obstétricos, embarazo gemelar, autoinmunidad tiroidea y TSH en valores extremos (<0,4μU/ml o>10μU/ml), así como las que durante el estudio iniciaron tratamiento con levotiroxina por disfunción tiroidea. Resultados: Seleccionamos 186 gestantes de 30,7 años (IC 95%: 29,8-31,6) e IMC de 23,6 (IC 95%: 23,2-24,0) que mayoritariamente se hicieron la 1.ª analítica con anterioridad a la 11.ª semana de gestación. Fueron válidas para el análisis 145-105-67 gestantes en el 1.°-2.°-3.° trimestre, respectivamente, tras excluir sucesivamente abortos (18,9%), autoinmunidad (6,5%), hipo/hipertiroidismos (2,2%) y tratamientos con levotiroxina durante el 2.°/3.° trimestre (18,6%). El percentil 97,5 de la TSH para el 1.°-2.°-3.° trimestre, respectivamente, fue de 4,68-4,83-4,57μU/ml. Durante el estudio se detectaron 80 gestantes con disfunción tiroidea (55,2%), recibiendo 33 de ellas tratamiento con levotiroxina (22,7%); con los nuevos criterios la prevalencia de disfunción tiroidea se reduciría al 6,2% y la necesidad de tratamiento al 4,1%. Conclusión: El rango de normalidad de TSH de nuestra población difiere del propuesto en las guías. Un 18,6% de las gestantes fueron tratadas innecesariamente

Objective: The correct diagnosis of hypothyroidism during pregnancy requires knowledge of the local trimester-specific thyrotropin (TSH) reference ranges. When these are not available, the guidelines recommend upper limits of 2.5, 3.0, and 3.0μU/ml for the 1st, 2nd, and 3rd trimesters, respectively. The aim is to establish the reference range for our local population. Material and methods: A population-based observational study was performed on healthy pregnant women from 11 healthcare centres in the province of Huelva. Women were recruited consecutively during 2016 through the pregnancy process. Women were excluded who had a history of thyroid or medical disease, a poor obstetric history, multiple pregnancy, thyroid autoimmunity, and extreme TSH values (<0.4μU/ml or>10μU/ml), as well as women treated with levothyroxine for thyroid dysfunction. Results: The study included a total of 186 pregnant women, with a mean age of 30.7 years (95% CI: 29.8-31.6) and a body mass index (BMI) of 23.6 (95% CI: 23.2-24.0). Most of them had the first laboratory tests performed before week 11 of pregnancy. Valid subjects for analysis were 145, 105, and 67 pregnant women in the 1st, 2nd, and 3rd trimesters, respectively, after excluding those due to abortion (18.9%), autoimmunity (6.5%), hypo/hyperthyroidism (2.2%), and levothyroxine treatment during the 2nd/3rd trimester (18.6%). The 97.5% TSH percentile for the 1st, 2nd, and 3rd trimester was 4.68, 4.83, and 4.57μU/ml, respectively. Thyroid dysfunction was identified in 80 women (55.2%), 33 of whom received treatment with Levothyroxine (22.7%). With the new criteria, thyroid dysfunction prevalence would be reduced to 6.2%, and the need for treatment to 4.1%. Conclusion: The reference range for TSH in our population differs from that proposed by the guidelines. Unnecessary treatment was being given to 18.6% of pregnant women

Techno-economic assessment of a multi-effect distillation plant installed for the production of irrigation water in Arica (Chile).

In the context of a regional Chilean project (FIC Taltape project, BIP code 30158422-0), a multi-effect distillation (MED) pilot plant has been built and installed in a small community in the north of Chile (Taltape, Arica) in order to supply treated water for agricultural and domestic purposes. The aim of this paper is to assess the techno-economic feasibility of this system for supplying water with the required quality to the population. The characterization of the feed water and the effluents from the MED pilot plant (distillate and brine), obtained during five months of operation, has been firstly performed. Then, the prediction of the operation of the water treatment system with solar energy has been carried out using a typical meteorological year and the design of a static solar field that cover the thermal energy needs of the water treatment plant. The annual simulations of the MED pilot plant operating with solar energy showed that the water needs can be mostly covered using a static solar thermal field with a total area of 113.2 m2, which would generate roughly 46% of the total heat required by the water treatment plant. The technical analysis has been completed with an exhaustive economic assessment. The specific water costs have been determined for the MED pilot plant and the scale factor when the productivity is increased up to 5000 m3/day has been evaluated. The cost of distillated water produced by the MED plant varied from 15.0 USD$/m3 for the 10 m3/day production capacity to 1.25 USD$/m3 when this variable is increased to 5000 m3/day.

Postoperative Care in Kidney Transplantation: A Comparison Between Controlled and Uncontrolled Donation After Circulatory Death.

Recent research in kidney transplantation has revealed differences in the evolution of renal function among patients transplanted from 2 alternative programs for donation after circulatory death (DCD). A retrospective, observational, single-center study was carried out from 2013 to 2016 at a level III hospital intensive care unit (ICU) to assess the progression of kidney recipients after transplants from uncontrolled DCD (uDCD) or controlled DCD (cDCD). The following variables were collected for data analysis: demographics, comorbidities, type of donation, lactate, hemoglobin and glucose levels at ICU admission, creatinine concentration at ICU admission, at-hospital ward transfer, at-hospital discharge, radioisotope imaging results, ICU and in-hospital length of stay, and mortality. There were 87 patients eligible for analysis, 42.5% of which were uDCD recipients. Improvement in kidney function was significantly delayed after uDCD compared with cDCD. A multivariate analysis showed that both uDCD and lactate levels at ICU admission increase the risk of poor outcome after renal transplantation. No deaths were registered in either patient group. Our results suggest that kidney transplantation recipients from uDCD recover renal function at a slower rate than patients transplanted from cDCD, a factor that does not affect mortality.

Results of Controlled Donation After Circulatory Death in a Third-Level Hospital.

OBJECTIVE: To investigate the characteristics and evolution of controlled donation after circulatory death (DCD) type III. MATERIALS AND METHODS: Observational and retrospective study of controlled DCD type III of donors conducted from 2014 to 2016. Clinical data, intensive care unit (ICU) stay, cause of death, warm ischemia time, and total time were collected. Delayed graft function (DGF) and survival of renal transplant were also registered. Qualitative variables are described as frequencies and absolute values and quantitative variables as medians and interquartile ranges. RESULTS: A total of 21 donors were collected; 71% (15) were males, median age was 55 years (interquartile range [IR] 48-72), and median ICU stay was 7 days (IR 4-12). The main cause of death was anoxic encephalopathy (57%, 12), followed by intracerebral hemorrhage (28%, 6). In 48%, withdrawal of life support occurred in the operating room, and 98% of donors were preserved by abdominal super-rapid cannulation technique. Average warm ischemia time was 20 minutes (IR 16-24), and total ischemia time was 26 minutes (IR 23-34). Of the donations, 57% were livers and 90% were kidneys. Out of 42 kidneys donated, 54% (23) of them were valid. Median renal transplant hospital stay was 18 days (IR 6-24), and 46% develop DGF. Survival at discharge was 100%. CONCLUSION: DCD type III ensures a source of organs. The main cause of death was anoxic encephalopathy. Most donors were able to donate some solid organ.

Living Donor in Renal Transplantation: Minimizing Risks.

In recent years, the broadening of indications for renal transplantation, together with the progressive reduction of donations following brain stem death, has led to living donation being considered in increasing numbers of cases for renal transplantation. To investigate this further, it is necessary to assess the impact it has on the postoperative outcomes in the intensive care unit (ICU). Our group conducted a retrospective, observational, single-center study from 2013 to 2016 to evaluate differences in outcomes between living and cadaveric kidney donation both during ICU admission and total hospitalization. We compared differences in characteristics between living and deceased graft recipients including demographics, comorbidities, analytical data, radioisotope imaging test results, complications, ICU and hospital ward length of stay, and mortality. In all, 387 patients were eligible for analysis, and 13% received living donor grafts. Our results demonstrate that this group had significantly fewer complications, shorter length of hospital stay, and reduced mortality in comparison with recipients of cadaveric donor grafts. The better postoperative outcomes from living donor grafts could result from careful selection of the donor and less inflammatory injury, minimizing risk in the postoperative period.