Lung Transplantation in Controlled Donation after Circulatory-Determination-of-Death Using Normothermic Abdominal Perfusion.

The main limitation to increased rates of lung transplantation (LT) continues to be the availability of suitable donors. At present, the largest source of lung allografts is still donation after the neurologic determination of death (brain-death donors, DBD). However, only 20% of these donors provide acceptable lung allografts for transplantation. One of the proposed strategies to increase the lung donor pool is the use of donors after circulatory-determination-of-death (DCD), which has the potential to significantly alleviate the shortage of transplantable lungs. According to the Maastricht classification, there are five types of DCD donors. The first two categories are uncontrolled DCD donors (uDCD); the other three are controlled DCD donors (cDCD). Clinical experience with uncontrolled DCD donors is scarce and remains limited to small case series. Controlled DCD donation, meanwhile, is the most accepted type of DCD donation for lungs. Although the DCD donor pool has significantly increased, it is still underutilized worldwide. To achieve a high retrieval rate, experience with DCD donation, adequate management of the potential DCD donor at the intensive care unit (ICU), and expertise in combined organ procurement are critical. This review presents a concise update of lung donation after circulatory-determination-of-death and includes a step-by-step protocol of lung procurement using abdominal normothermic regional perfusion.

The efficacy of pulmonary rehabilitation training program for patients after lung transplantation.

Background: Pulmonary rehabilitation is recognized widely as one of the most effective measures to promote postoperative recovery of lung transplant recipients (LTRs), and it has positive effects on both short- and long-term quality of life (QoL) and survival outcomes. However, no standardized pulmonary rehabilitation training programs exist specifically for LTRs. The pulmonary rehabilitation programs widely used in clinical practice focus mainly on exercise or respiratory training, to some extent neglecting other therapeutic methods that could promote patient health, such as nutrition support, pain control, spiritual comfort, and so on. This study aimed to develop a postoperative pulmonary rehabilitation training program for LTRs and evaluate its effectiveness. Methods: Using convenience sampling, all patients who underwent lung transplantation (LTx) at Shanghai Pulmonary Hospital from January 2021 to December 2022 were screened for inclusion and exclusion criteria, and a total of 68 patients were finally included in this study. A non-synchronous quasi-experimental design was used, with patients who underwent LTx in 2021 as the control group and patients who underwent LTx in 2022 as the experimental group. The control group received routine treatment, health education, and rehabilitation guidance when patients determined the date of surgery. In addition to this, the experimental group received pulmonary rehabilitation training. The incidence of postoperative pulmonary complications (pulmonary infections), duration of chest tube drainage, intensive care unit (ICU) length of stay, postoperative pain scores, postoperative QoL, pulmonary function, oxygenation index, and the distance in the 6-minute walking test (6MWD) were compared between the two groups. Results: The length of ICU stay and duration of chest tube drainage in the experimental group were lower than those in the control group, and the results of oxygenation index, 6MWD, and St. George's Respiratory Questionnaire (reflecting the QoL) were better than those of the control group (P<0.05). There was no significant difference in the pain of the two groups 1 week after surgery and 3 months after surgery, and the pain score of the experimental group was lower than that of the control group at 1 month after surgery (P<0.05). There was no significant difference in the incidence of complications between the two groups (P>0.05). Conclusions: The postoperative pulmonary rehabilitation training program for LTRs is safe and effective. It can shorten both the duration of chest tube drainage and ICU stay, it can also improve patients' exercise capacity and pulmonary function while also promote safety outcomes of LTRs, and improve QoL scores.

Association between ABO and Rh blood groups and Toxoplasma gondii infection: A cross sectional study.

We aimed to determine the association between the seropositivity to Toxoplasma gondii and the ABO and Rh blood groups in 2,053 people. ABO and Rhesus blood groups and anti-T. gondii IgG and IgM antibodies were determined using commercially available assays. Of the 2,053 people studied, 171 (8.3%) were positive for anti-T. gondii IgG antibodies. Sixty-five (38.0%) and 36 (21.1%) of these 171 individuals had high anti-T. gondii IgG antibody levels (≥150 IU mL-1) and anti-T. gondii IgM antibodies, respectively. We found the following prevalences of T. gondii infection among the ABO groups: 8.5% in group A, 4.3% in group B, 4.7% in group AB, and 8.9% in group O (P = 0.19). The prevalences of T. gondii infection among Rh groups were: 8.4% in the Rh-positive group and 7.1% in the Rh-negative group (P = 0.58). Logistic regression analysis showed that the frequencies of ABO and Rh blood groups were similar (P > 0.05) among people with positive and negative serology for anti-T. gondii IgG antibodies, with high (≥150 IU mL-1) and lower (<150 IU mL-1) levels of anti-T. gondii IgG antibodies, and with positive and negative serology for anti-T. gondii IgM antibodies. Results does not support an association between T. gondii infection and ABO and Rh blood groups.

Seroprevalence of Toxoplasma gondii in Women of Reproductive Age and Associated Risk Factors in Chiapas, Mexico.

Background: We analyzed the seroepidemiology of Toxoplasma gondii infection in women of reproductive age in Chiapas, Mexico. Materials and Methods: One hundred seven women (mean age 25.3 years; range: 13-42 years) were enrolled in a public hospital. The presence of immunoglobulin G (IgG) antibodies to T. gondii in serum samples of participants was determined by an enzyme immunoassay. Bivariate and logistic regression analyses were used to determine the association between characteristics of women and seropositivity to T. gondii. Results: Of the 107 women surveyed, 49 (45.8%) were positive for anti-T. gondii IgG antibodies. T. gondii infection was positively associated with cats at home (odds ratio [OR] = 3.85; 95% confidence interval [CI]: 1.21-12.20; p = 0.02), and negatively associated with eating out of home (OR = 0.29; 95% CI: 0.11-0.80; p = 0.01). Conclusions: This is the highest T. gondii exposure rate in women of reproductive age reported in Mexico.

Pelvic actinomycosis secondary to intrauterine device.

Actinomycosis is a rare bacterial infection causing lesions and abscesses, often mimicking tumors. It commonly affects the cervicofacial, abdominal, and thoracic regions. We present a case of a woman with an intrauterine device (IUD) who developed an abscess and abdominal symptoms. Initial studies suggested a tumor, but biopsy revealed inflammation. Subsequently, she was diagnosed with Actinomyces Israelii infection, her IUDwas removed, and she was treated with penicillin, resulting in improvement. Pelvic actinomycosis is uncommon and often diagnosed late, often post-surgery, requiring combined surgical and medical treatment.

Toxoplasma gondii infection of the central nervous system and suicide: A case-control study of decedents.

We sought to determine the association between Toxoplasma gondii (T. gondii) infection of the central nervous system and suicide in a sample of decedents in Mexico City. One hundred and forty-seven decedents (87 who committed suicide and 60 who did not commit suicide) were studied. Brain tissues (amygdala and prefrontal cortex) of decedents were examined for the detection of T. gondii using immunohistochemistry. Detection of T. gondii was positive in 7 (8.0%) of the 87 cases (6 found in prefrontal cortex and one in amygdala), and in one (1.7%) of the 60 controls (found in prefrontal cortex) (OR: 5.16; 95% CI: 0.61-43.10; P = 0.14). Results suggest that T. gondii infection in brain is not associated with suicide. Further studies to confirm this finding are needed.

Influence of Donor Type-Donation After Brain Death Versus Donation After Circulatory Death-on Lung Transplant Outcomes.

BACKGROUND: We sought to analyze the influence of lung donor type (brain death [BD] vs controlled donation after cardiac death [DCD]) on lung graft viability and to compare short-term outcomes of lung transplantation using grafts from BD and DCD donors. METHODS: This was a retrospective study of the lung donor population and lung transplants performed at our Institution between January 2020 and December 2022. Demographic characteristics of the donors and donation type (BD vs DCD) were assessed. Lung graft viability rate and post-transplant outcomes were analyzed and compared between donor types. RESULTS: There were 203 donors; among them, 149 (73%) were viable. There were 176 BD donors (87%) and 27 DCD donors (13%), with viability rates of 75% and 59%, respectively, performing 81 single (40%) and 122 double-lung transplants (60%). Recipient PaO2/fraction of inspired oxygen and primary graft dysfunction at 24 and 72 hours did not differ between donor types. Thirty-day mortality did not differ between recipients from BD donors and recipients from DCD donors: n = 28 (21%) vs n = 3 (18%), respectively (P = .81). CONCLUSIONS: Donation after cardiac death donors is a safe source to increase the donor pool for lung transplantation, allowing similar short-term outcomes as lung transplants from BD donors regarding graft function and early survival.

Drilling of Cross-Ply UHMWPE Laminates: A Study on the Effects of the Tool Geometry and Cutting Parameters on the Integrity of Components.

Ultrahigh-molecular-weight polyethylene (UHMWPE) is used in the defence industry mainly owing to its properties, such as excellent dimensional stability, excellent ballistic performance, and light weight. Although UHMWPE laminates are generally studied under impact loads, it is crucial to understand better the optimal machining conditions for assembling auxiliary structures in combat helmets or armour. This work analyses the machinability of UHMWPE laminates by drilling. The workpiece material has been manufactured through hot-pressing technology and subjected to drilling tests. High-speed steel (HSS) twist drills with two different point angles and a brad and spur drill that is 6 mm in diameter have been used for this study. Cutting forces, failure, and main damage modes are analysed, making it possible to extract relevant information for the industry. The main conclusion is that the drill with a smaller point angle has a better cutting force performance and less delamination at the exit zone (5.4 mm at a 60 m/min cutting speed and a 0.05 mm/rev feed) in the samples. This value represents a 46% improvement over the best result obtained in terms of delamination at the exit when using the tool with the larger point angle. However, the brad and spur drill revealed a post-drilling appearance with high fuzzing and delamination.

Surgical Complications After Lung Transplantation: The Reina Sofía Hospital Experience.

OBJECTIVE: To assess the incidence of surgical complications after lung transplantation and its influence on early mortality and long-term survival. METHODS: Retrospective review of 792 lung transplants (LTs) performed from 1994 to 2022. Among them, 769 with complete data were selected. Patients with and without surgical complications were compared by univariable and multivariable analyses. RESULTS: There were 385 single LTs (50%), 371 double LTs (48%), 8 bilobar LTs (1%), and 5 combined liver LTs (1%). Two hundred forty-nine patients presented surgical complications (32%) as follows: bronchial (n = 61), vascular (n = 55), pneumothorax (n = 33), and phrenic nerve palsy (n = 22). Thirty-day mortality (noncomplicated vs complicated) was 57 (41%) vs 80 (59%), P < .001. Transplants for bronchiectasis (58%), pulmonary hypertension (50%), and re-transplants (78%) presented more surgical complications (P < .001). Double LT (40%), bilobar LT (88%), and combined liver LT (100%) presented more surgical complications (P < .001). Complicated recipients were younger (49 ± 15 vs 45 ± 17 years; P = .001), with longer ischemic times (429 ± 67 vs 450 ± 76 min [2nd graft]; P = .007), and required extracorporeal support (ECLS) more often (43% vs 57%; P < .001). Survival at 1, 5, 10, 15, and 20 years (noncomplicated vs complicated): 78%, 63%, 52%, 41%, 31% vs 52%, 42%, 35%, 26%, 22%; P < .001). Predictors of mortality were the need for ECLS (odds ratio [OR] 4.14; P < .001), postoperative ventilation (hours) (OR 1.01; P < .001), and vascular complications (OR 4.78; P < .001). CONCLUSION: Surgical complications remain an important source of morbidity and mortality after lung transplantation. Complex surgical procedures requiring ECLS develop frequent surgical complications needing long postoperative ventilation that are associated with early mortality and poorer long-term survival.

Case Report of Complex Chest Wall Repair for Sternal Dehiscence After Bilateral Lung Transplantation.

BACKGROUND: We report a case of a complex chest wall reconstruction because of sternal dehiscence, requiring different surgical procedures for its complete resolution. CASE REPORT: A 54-year-old man patient with Langerhans cell histiocytosis and chronic obstructive pulmonary disease underwent bilateral sequential lung transplantation through a clamshell incision, using nitinol thermo-reactive clips for sternal closure. One year later, he consulted because of chest pain, fever, and purulent secretions. Physical examination and chest X-ray revealed a right pulmonary hernia due to post-clamshell wound dehiscence. Chest wall repair was performed, placing an expanded-polytetrafluoroethylene synthetic mesh, and the sternum was realigned and fixated with titanium plates and screws. However, in the immediate postoperative period, there was a large amount of serous drainage through the surgical wound, needing negative pressure therapy. Unfortunately, the wound became necrotic with exposure to the osteosynthesis material. In addition, a chest computed tomography scan showed fluid accumulation in the anterior chest wall. Therefore, two-stage revision surgery was indicated: first, the removal of the previous prosthesis and, the definite one, the use of a pedicled latissimus dorsi myocutaneous flap to provide effective coverage of the wound. CONCLUSION: Sternal dehiscence is not an uncommon complication after clamshell incision in patients undergoing bilateral sequential lung transplantation, and it is associated with significant morbidity. In the presence of chest wall instability, surgical repair is mandatory.

Enhancing Image Quality via Robust Noise Filtering Using Redescending M-Estimators.

In the field of image processing, noise represents an unwanted component that can occur during signal acquisition, transmission, and storage. In this paper, we introduce an efficient method that incorporates redescending M-estimators within the framework of Wiener estimation. The proposed approach effectively suppresses impulsive, additive, and multiplicative noise across varied densities. Our proposed filter operates on both grayscale and color images; it uses local information obtained from the Wiener filter and robust outlier rejection based on Insha and Hampel's tripartite redescending influence functions. The effectiveness of the proposed method is verified through qualitative and quantitative results, using metrics such as PSNR, MAE, and SSIM.

Serial lung ultrasound in monitoring viral pneumonia: the lesson learned from COVID-19.

Background: Lung ultrasound (LUS) has proven to be useful in the evaluation of lung involvement in COVID-19. However, its effectiveness for predicting the risk of severe disease is still up for debate. The aim of the study was to establish the prognostic accuracy of serial LUS examinations in the prediction of clinical deterioration in hospitalised patients with COVID-19. Methods: Prospective single-centre cohort study of patients hospitalised for COVID-19. The study protocol consisted of a LUS examination within 24 h from admission and a follow-up examination on day 3 of hospitalisation. Lung involvement was evaluated by a 14-area LUS score. The primary end-point was the ability of LUS to predict clinical deterioration defined as need for intensive respiratory support with high-flow oxygen or invasive mechanical ventilation. Results: 200 patients were included and 35 (17.5%) of them reached the primary end-point and were transferred to the intensive care unit (ICU). The LUS score at admission had been significantly higher in the ICU group than in the non-ICU group (22 (interquartile range (IQR) 20-26) versus 12 (IQR 8-15)). A LUS score at admission ≥17 was shown to be the best cut-off point to discriminate patients at risk of deterioration (area under the curve (AUC) 0.95). The absence of progression in LUS score on day 3 significantly increased the prediction accuracy by ruling out deterioration with a negative predictive value of 99.29%. Conclusion: Serial LUS is a reliable tool in predicting the risk of respiratory deterioration in patients hospitalised due to COVID-19 pneumonia. LUS could be further implemented in the future for risk stratification of viral pneumonia.

Influence of De Novo Malignancies on Long-Term Survival after Lung Transplantation.

(1) Background: Malignancies are an important cause of mortality after solid organ transplantation. The purpose of this study was to analyze the incidence of malignancies in patients receiving lung transplants (LT) and their influence on patients' survival. (2) Methods: Review of consecutive LT from 1994 to 2021. Patients with and without malignancies were compared by univariable and multivariable analyses. Survival was compared with Kaplan-Meier and Cox regression analysis. (3) Results: There were 731 LT malignancies developed in 91 patients (12.4%) with related mortality of 47% (n = 43). Native lung cancer, digestive and hematological malignancies were associated with higher lethality. Malignancies were more frequent in males (81%; p = 0.005), transplanted for emphysema (55%; p = 0.003), with cyclosporine-based immunosuppression (58%; p < 0.001), and receiving single LT (65%; p = 0.011). Survival was worse in patients with malignancies (overall) and with native lung cancer. Risk factors for mortality were cyclosporine-based immunosuppression (OR 1.8; 95%CI: 1.3-2.4; p < 0.001) and de novo lung cancer (OR 2.6; 95%CI: 1.5-4.4; p < 0.001). (4) Conclusions: Malignancies are an important source of morbidity and mortality following lung transplantation that should not be neglected. Patients undergoing single LT for emphysema are especially at higher risk of mortality due to lung cancer in the native lung.

Natural Infection of Nyssorhynchus darlingi and Nyssorhynchus benarrochi B with Plasmodium during the Dry Season in the Understudied Low-Transmission Setting of Datem del Marañon Province, Amazonian Peru.

The persistence of malaria hotspots in Datem del Marañon Province, Peru, prompted vector control units at the Ministry of Health, Loreto Department, to collaborate with the Amazonian International Center of Excellence for Malaria Research to identify the main vectors in several riverine villages that had annual parasite indices > 15 in 2018-2019. Anophelinae were collected indoors and outdoors for two 12-hour nights/community during the dry season in 2019 using human landing catch. We identified four species: Nyssorhynchus benarrochi B, Nyssorhynchus darlingi, Nyssorhynchus triannulatus, and Anopheles mattogrossensis. The most abundant, Ny. benarrochi B, accounted for 96.3% of the total (7,550/7,844), of which 61.5% were captured outdoors (4,641/7,550). Six mosquitoes, one Ny. benarrochi B and five Ny. darlingi, were infected by Plasmodium falciparum or Plasmodium vivax. Human biting rates ranged from 0.5 to 592.8 bites per person per hour for Ny. benarrochi B and from 0.5 to 32.0 for Ny. darlingi, with entomological inoculation rates as high as 0.50 infective bites per night for Ny. darlingi and 0.25 for Ny. benarrochi B. These data demonstrate the risk of malaria transmission by both species even during the dry season in villages in multiple watersheds in Datem del Marañon province.

Airway Complications after Lung Transplantation-A Contemporary Series of 400 Bronchial Anastomoses from a Single Center.

(1) Objective: To determine whether recent advances in lung transplantation (LT) have reduced the incidence and changed the risk factors for airway complications (AC). (2) Methods: Retrospective analysis of patients receiving a lung transplant between January 2007 and January 2019. An AC was defined as a bronchoscopic abnormality in the airway, either requiring or not requiring an endoscopic or surgical intervention. Both univariable and multivariable analyses were performed to identify risk factors for AC. (3) Results: 285 lung transplants (170 single and 115 bilateral lung transplants) were analysed, comprising 400 anastomoses at risk. A total of 50 anastomoses resulted in AC (12%). There were 14 anastomotic and 11 non-anastomotic stenoses, 4 dehiscences, and 3 malacias. Independent predictors for AC were: gender male (OR: 4.18; p = 0.002), cardiac comorbidities (OR: 2.74; p = 0.009), prolonged postoperative mechanical ventilation (OR: 2.5; p = 0.02), PaO2/FiO2 < 300 mmHg at 24 h post-LT (OR: 2.48; p = 0.01), graft infection (OR: 2.16; p = 0.05), and post-LT isolation of Aspergillus spp. (OR: 2.63; p = 0.03). (4) Conclusions: In spite of advances in lung transplantation practice, the risk factors, incidence, and lethality of AC after LT remains unchanged. Graft dysfunction, an infected environment, and the need of prolonged mechanical ventilation remain an Achilles heel for AC.

Correction of Lacrimal Gland Ptosis in Blepharoplasty: A Systematic Review.

PURPOSE: Lacrimal gland ptosis has a prevalence of 10% to 15% in Caucasian patients, reaching up to 60% in older age. Its involuntary resection during blepharoplasty carries the potential risk of compromising corneal lubrication. The purpose of this systematic review is to check whether there is a consensus in the literature regarding the surgical procedure of choice and which outcomes and complications have been observed. METHODS: A systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A search was carried out in the Medline, Scopus, and Cochrane databases in March 2022. RESULTS: A total of 16 studies involving 483 patients with lacrimal gland ptosis have been included. In 90.06% of patients, resuspension or direct refixation of the gland to the lacrimal fossa with suture to the orbital periosteum was performed. Follow up has been inconsistent, with an average of 18 months. Regarding complications, 5 recurrences and only 2 patients with persistent dry eye were observed. CONCLUSIONS: In general, the evidence is sparse. Nevertheless, repair of lacrimal gland ptosis is a relatively simple, reproducible, and safe surgical technique, with a low likelihood of recurrence, severe, or persistent complications. A classification is proposed for both the grading of ptosis and its treatment.

Granulomatous tattoo reaction treated with topical allopurinol.

Granulomatous reactions to tattoo ink have been frequently associated with exogenous pigment, although sometimes they are the manifestation of a cutaneous or an underlying systemic sarcoidosis. We report a case of a patient with a granulomatous reaction to a black tattoo pigment treated with 3% topical allopurinol for 3 months. We observed complete resolution without any side-effects. Examination and follow-up ruled out sarcoidosis. Oral allopurinol has been proven to be effective for the management of granulomatous reactions to tattoos. Based on the significant improvement we have described in our patient, we recommend new studies to reveal all the potential benefits of the topical use of allopurinol for the treatment of granulomatous reactions to tattoo ink.

Dengue and COVID-19 Co-Circulation in the Peruvian Amazon: A Population-Based Study.

The COVID-19 pandemic affected the main Amazon cities dramatically, with Iquitos City reporting the highest seroprevalence of anti-SARS-CoV-2 antibodies during the first COVID-19 wave worldwide. This phenomenon raised many questions about the possibility of a co-circulation of dengue and COVID-19 and its consequences. We carried out a population-based cohort study in Iquitos, Peru. We obtained a venous blood sample from a subset of 326 adults from the Iquitos COVID-19 cohort (August 13-18, 2020) to estimate the seroprevalence of anti-dengue virus (DENV) and anti-SARS-CoV-2 antibodies. We tested each serum sample for anti-DENV IgG (serotypes 1, 2, 3, and 4) and SARS-CoV-2 antibodies anti-spike IgG and IgM by ELISA. We estimated an anti-SARS-CoV-2 seroprevalence of 78.0% (95% CI, 73.0-82.0) and an anti-DENV seroprevalence of 88.0% (95% CI, 84.0-91.6), signifying a high seroprevalence of both diseases during the first wave of COVID-19 transmission in the city. The San Juan District had a lower anti-DENV antibody seroprevalence than the Belen District (prevalence ratio, 0.90; 95% CI, 0.82-0.98). However, we did not observe these differences in anti-SARS-CoV-2 antibody seroprevalence. Iquitos City presented one of the highest seroprevalence rates of anti-DENV and anti-SARS-CoV-2 antibodies worldwide, but with no correlation between their antibody levels.

Survey on the association between Toxoplasma gondii infection and violent behavior in inmates.

We evaluated the association between T. gondii seropositivity and violent behavior in a sample of inmates in Durango, Mexico. Through a cross-sectional study design, we studied 128 inmates (mean age: 35.89 ± 10.51; range: 19-65 years). Sera of participants were analyzed for anti-T. gondii IgG antibodies using a commercially available enzyme-linked immunosorbent assay. Violence was assessed by 1) the Historical, Clinical and Risk Management-20 (HCR-20) tool; 2) the type of the crime for which inmates were convicted; and 3) the Buss-Perry Aggression Questionnaire (AGQ). Of the 128 inmates, 17 (13.3%) had high risk of violence by the HCR-20 criteria, 72 (56.3%) were considered violent by the type of the crime committed, and 59 (46.1%) were considered violent by the AGQ. Depending on the evaluation method of violence, the seroprevalence of T. gondii infection in violent inmates varied from 0% to 6.9%. No statistically significant difference in anti-T. gondii IgG seroprevalence between violent and non-violent inmates was found (for instance by AGQ, OR: 1.17; 95% CI: 0.22-6.07; P = 1.00). Mean scores of the AGQ in T. gondii seropositive inmates (73.67 ± 29.09; 95% CI: 50.00-99.31) were similar to those (79.84 ± 25.00; 95% CI: 75.46-84.27) found in T. gondii seronegative inmates (P = 0.55). Mean scores of anger, psychical aggression, verbal aggression, and hostility in T. gondii seropositive inmates were similar to those found in T. gondii seronegative inmates. Results of this study suggest that infection with T. gondii is not associated with violence in inmates in Durango, Mexico. Further studies with larger sample sizes and in several correctional facilities to determine the association between T. gondii infection and violence in inmates are needed.